The homeless are people without a regular abode. They are either unwilling or unable to obtain a suitable, safe, and permanent residence. People who reside in warming centers and domestic violence shelters are also described as homeless. In addition, people who sleep in private or public places that are not fit to be used by human beings are also put under the same criteria. There are various causes of homelessness. These include poverty, inadequate employment opportunities and lack of proper healthcare. Other causes include wars and clashes, lack of affordable housing facilities, disability and natural disasters like floods or earthquakes that destroy residences. In addition, homelessness can be caused by mental disorders, drug abuse and discrimination by the society due to certain reasons like sexual orientation. Some other people find themselves homeless owing to domestic violence, mortgage foreclosures, eviction by tenants and forced expulsion by government in order to set the land aside for other developments.
History of Homelessness
The problem of homelessness was not existent in pre-historic times. Initially, human beings lived in traditional shelters such as caves, huts, and tents. Building these structures was easy and everyone could afford a dwelling because natural building materials were readily available and almost everyone knew how to build. However, during the modern times, the art of building became professional and expensive. Many individuals migrated to urban areas during the industrial revolution. Increased homelessness occurred because of higher land and house prices and strict housing codes. People who were unable to pay the exorbitant rental fees were evicted and, therefore, became homeless. Around 1500s, the homeless in England were punished because they were seen as unauthorized beggars. However, in the 16th, 17th and 18th centuries, they provided them with housing and training for jobs, instead of punishment in order to prevent them from over-relying on the state. The homeless people on the streets in the United States increased after the American civil war (Bloom, 2005).
More people were left homeless in the 1930s because of the Great Depression, which also resulted in increased poverty. In the 1970s, the homeless population increased due to de-institutionalization of people with mental illnesses. The psychiatric, outpatient, and social services that were promised to these people were not provided and, consequently, most of them ended up being homeless. In the 1980s, the number of homeless people increased further owing to an increase in social service and housing cuts. One of the reasons for this was the huge budget deficits caused by the transfer of federal funds to military initiatives. United States also introduced homelessness legislation in the 1980s, such as the McKinney-Vento Homeless Assistance Act of 1987. In the 21st century, homelessness continues to be a growing problem in the United States. In 2009, the American Recovery and Reinvestment Act and Helping Families Save Their Homes Acts were passed to deal with the problem of homelessness (Bloom, 2005).
Nature of Problems Faced By the Homeless
The homeless people face a number of problems. These people lack a secure shelter. Consequently, they lack privacy and security. They also suffer from the ever-increasing violent crimes. The homeless also have to carry their belongings all the time because there is no secure place to keep them. They often face hostility because there are laws that forbid loitering. These people also lack sanitation and hygiene facilities. Moreover, they do not have a permanent abode and, therefore, they cannot keep contacts or addresses. Getting employment for the homeless is hard as they are seen as unfitting employees. They also have limited access to services like education, banking, and healthcare. Moreover, their access to communication technology is limited. They are also discriminated and rejected by other people (Calsyn and Morse, 1990).
Clinical Issues and Intervention Strategies
The major clinical issues concerning the homeless include physical health, mental illness, and substance abuse. They experience ill health at higher rates than the rest of the population due to several reasons including lack of proper hygiene, poor nutrition, exposure to communicable diseases, violence, rain and cold weather. Poor health exacerbates the problem of homelessness, as the sick will be unable to go to work or school. Mortality rates are also higher among the homeless. These people also lack preventive care (Gelberg, Linn, and Leake, 1988).
The homeless suffer from physical illnesses such as hypertension, respiratory problems, skin diseases, trauma, tuberculosis, HIV/AIDS, ear, dental and eye problems, among others. They suffer from acute illnesses like respiratory diseases such as pneumonia and influenza. They also suffer from skin problems such as corns and sunburn. Moreover, they suffer from trauma resulting from wounds, fractures, and burns. These illnesses come about as a result of exposure to cold, sun and rain, poor nutrition, lack of shoes and poor hygiene. They also suffer from chronic conditions such as diabetes, hypertension, arthritis and neurological problems. Communicable diseases are also more prevalent among the homeless due to poor sanitation and overcrowding in one shelter. These include skin infections, lice infestation, respiratory infections, tuberculosis, hepatitis, and sexually transmitted diseases such as HIV/AIDS. Many homeless people also suffer from poor dental health (Gelberg, Linn, and Leake, 1988).
Another clinical concern among the homeless is substance abuse disorders. They abuse alcohol, heroin, cocaine and other drugs at higher rates than the rest of the population. Alcohol abuse leads to exposure to accidents, reduced economic productivity, and other serious health problems in the heart, nervous system and the liver. Heroin and cocaine abuse leads to addiction to the drug. Since it is injected into the bloodstream, it exposes the users to health risks such as HIV/AIDS, hepatitis, and other illnesses. It also affects the social and mental ability of the users (Gelberg, Linn, and Leake, 1988).
The homeless also suffer from mental disorders. Most of them suffer from illnesses such as schizophrenia, depression, anxiety, mood disorders, and other illnesses in varying degrees. The mentally ill homeless population increased after de-institutionalization (Gelberg, Linn, and Leake, 1988).
The homeless have many health problems and in order to deal with them, they need access to healthcare services. Intervention strategies should include services such as assessment, preventive services, diagnosis, and follow-up. The homeless should first be assessed in order to determine the best healthcare to provide to them. Issues like source of food, reason for homelessness, history of illness, and use of drugs should be looked into. Preventive services should be offered to the homeless. These include immunization, screening, family planning, and health education. The homeless should be examined to come up with the correct diagnosis. After treatment, follow-up should be done to ensure that the homeless complete it. They may be unable to follow through with their medication because of problems such as constant movement, lack of a safe place to keep their medication, and the need to meet other basic necessities like food and shelter. Treatment for the homeless with physical illnesses is not very different from that of other people. However, it requires intervention strategies that take into consideration the problems of the homeless. Effective practices include giving them larger doses for a short period such as injections. The homeless also risk losing their medication as they keep moving around, therefore, they should not be given all their drugs at once (Gelberg, Linn, and Leake, 1988).
For mental illnesses, various intervention strategies can be adopted. The mentally ill require treatment, rehabilitation, and support. These include diagnosis, management of medication, treatment planning, therapy and counseling, social skills training in patient care, housing, crisis management and income support. Minor mental problems such as depression and anxiety can be treated easily. However, serious mental disorders such as dementia, major depression, schizophrenia, bipolar disorder, and severe personality disorders need to be dealt with by a team of healthcare professionals. Such illnesses need the expertise of a psychiatrist. Intervention strategies should aim at curing the mental disorder and solving the problem of homelessness. The mentally ill should be provided with rehabilitation, housing, healthcare, substance abuse treatment, and legal protection. The psychiatric treatment for the homeless with mental disorders includes four steps namely: engagement, basic service provision, transition, integration, and housing stabilization. Engagement involves persuading the mentally ill to accept treatment. In order for the treatment to run smoothly, the mentally ill should be given basic needs like clothing, food, and shelter. After treatment, they can be placed into community mental health programs. Successful treatment of mental illness can only occur when the homeless have stable housing (Gelberg, Linn, and Leake, 1988).
Substance abuse disorders interventions should focus on the addiction and other needs that the homeless people have. They should try to help more in areas like, motivation, detoxification, and rehabilitation. Motivating the person to stop using the drugs is difficult and requires serious outreach and convincing. Detoxification involves giving the individual medication that will minimize withdrawal symptoms. During detoxification, the individual also needs mutual support. After detoxification, an individual needs to go through a period of rehabilitation. In this phase, he/she should be protected and given support to prevent relapsing. The person also needs to be provided with learning and employment opportunities. He/she also needs recovery housing that is free from any drugs (Gelberg, Linn, and Leake, 1988).
Future Considerations and General Solutions
In order to curb the problem of homelessness, several strategies should be adopted. The already existing programs to assist the homeless should be supported and funded continuously in order to ensure their success and expansion to provide more services and to cater for more homeless people. The government should also fund programs aimed at curbing substance abuse among these people since the available resources are not sufficient to cater for their needs. There is a scarcity of healthcare professionals willing to deal with the homeless. More professionals should be encouraged to help the homeless by giving them internships in community-based health programs. In addition, healthcare professionals dealing with the homeless should be trained continually in order to be aware of the current practices and be able to give the most suitable care to the homeless (Rosenthal, 2000).
Bloom, A. (2005). Toward A History of Homelessness. Journal of Urban History. Vol. 31, No. 6.
Calsyn, R. and Morse, G. (1990). Homeless Men and Women: Commonalities and a Service Gender Gap. American Journal of Community Psychology. Vol. 18.
Gelberg, L., Linn, L. S., and Leake, B. D. (1988). Mental Health, Alcohol and Drug Use, and Criminal History among Homeless Adults. American Journal of Psychiatry. Vol. 145, no. 2.
Rosenthal, R. (2000). Imaging Homelessness and Homeless People: Visions and Strategies within the Movement(s). Journal of social distress and the homeless. Vol.9, no. 2.