Remember the Homeless for the Holidays

With Christmas coming and Chanukah in full swing, I thought I'd share a portion of a paper I wrote in grad school regarding homelessness, mental disorder, suicidality, and masculinity...

Ok, ok, I'm sharing this because of a fellow garden blogger posting about volunteering to help the homeless and mentioning the potential for an angry outburst.

This is in NO WAY intended to dissuade people from helping the homeless.  Instead it should encourage you to help those less fortunate because of underlying issues leading to their misfortune.  I strongly encourage everyone to consider donating to a local nonprofit which aids in helping homeless individuals.  Doing something or buying something or donating something is all fine and good and very much appreciated, but nonprofits really need cash for the multitude of unseen emergencies and crises.  Individual monetary donations really, really help nonprofits because they can use this money as they see fit unlike with grants which stipulate certain, predetermined uses for the monies.  Having worked at a nonprofit, I cannot tell you how much monetary donations matter when it comes to purchasing gas, paying for medical care, and the many other things that cannot be obtained through items and volunteer hours although both are very much appreciated.  I would kiss all the donors who helped pay for my clients' light bills and bus tickets.

If you are considering donating to a food bank, strongly consider donating money.  A food bank can pool your money and the monies of others for a greater purchasing power and get a lot more bang for your buck by buying in bulk rather than a local grocery store.  If you already have food items in your cupboard, go ahead and donate those, but buying a new product and donating to a food bank wastes money that could be used for a greater purchasing power.  It's not nearly as gratifying to sign a check as it is to plunk down a fresh can of green beans, but the check does a whole lot more good for those you're trying to help.  So please give a monetary donation to a nonprofit you appreciate.


Without further adieu:

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A Brief Review of Homelessness, Suicidality, Imprisonment, and Masculinity

Of all US states and territories, 0.30% of the population experienced homelessness in 2005, and Oregon had an estimated 16,221 homeless people and one of the largest homeless rates per capita with a 0.45% of total population affected by homelessness (Homelessness Research Institute et al., 2007). Approximately half of this homeless population is unsheltered, and many who cannot find shelter are men, especially men of color (Passaro, 1996). Homelessness is strongly correlated with mental illness, masculinity, and suicide, and these issues are compounded by the effects of incarceration and youth.

While the causes of homelessness are based upon correlations, there are strong risk factors for becoming homeless, and these risk factors mirror disturbing trends within the prison system. Individuals who experience homelessness for extended periods of time are more likely than those who are transiently homeless to be male, a person of color, and undereducated with a history of mental illness, incarceration, and drug addiction (Phelan & Link, 1999). Folsom et al. (2005) found similar results in a survey of those in the San Diego County Adult Mental Health Services. They found strong correlations of homelessness to maleness, African American ethnicity, substance abuse, lack of health assistance, schizophrenia, bipolar disorder, and poorer functioning. As Hwang (2001) illustrates, schizophrenia is present in 10-13% of homeless individuals at any one time. While schizophrenia is not related to violent behavior (Rice & Harris, 1995), it is overrepresented within the penal system in addition to major depression and mania (Teplin, 1990). This overrepresentation is particularly troubling due to the fact that some individuals with severe mental illness are sent to a psychiatric hospital and are not recorded or represented in arrest and detainment rates (Teplin, 1990). Those who are imprisoned have a high risk of reincarceration and/or homelessness (Metraux & Culhane, 2004). The prison system and homelessness circulate around mental illness and feed into each other leaving those suffering from illness largely without treatment. Those with mental illness are overrepresented within the prison system and within the homeless population which compounds the effects of mental illness, homelessness, and incarceration.

The lives of homeless individuals, in many ways, lack the social dignity afforded to individuals who have the means to find a home (Jacobson, 2007). Street homelessness in particular leaves a person vulnerable to hate crimes, disease, and mistreatment from authorities including accusations of prostitution (National Coalition for the Homeless, 2006). In one study that surveyed 2,401 homeless individuals, 54% of them had been victimized in some way during their time on the streets (Lee & Schreck, 2005).  Theft was a prevalent form of victimization with 15.7% of those surveyed having had a possession stolen, and 11.0% had a possession stolen and were beaten (Lee & Schreck, 2005). Rates of victimization were strongly correlated with longer periods of homelessness and begging/panhandling so that the longer an individual remained on the streets and were increasingly exposed to the public, the more likely the individual was to be victimized (Lee & Schreck, 2005).

According to their 2006 account of violent crimes against the homeless, the National Coalition for the Homeless discovered 142 violent crimes against homeless individuals. This undoubtedly underrepresents the total number of violent crimes that the homeless experience due to under-reporting and also due to police reports not recording homelessness status (National Coalition for the Homeless, 2006). However, from their findings, the National Coalition for the Homeless (2006) uncovered crimes that would doubtfully happen if the victim’s situation had been different. In one instance, a man was taunted and beaten to death by a group of teenage males for being “a bum” (National Coalition for the Homeless, 2006). Nationally, this was one homeless individual in 20 that the National Coalition for the Homeless reported as being killed in 2006.

According to Hawke, Davis, and Erienbusch’s (2007) study of homeless deaths in Los Angeles, the most common causes of death was cardiovascular disease, substance use, and trauma (e.g., homicide and suicide). The average age of death was 48 years old, substantially below the average life expectancy within the US. In one study of homeless individuals in Toronto, researchers found that, of their sample, 61% reported suicidal ideation and 34% had attempted suicide at some point (Eynan, Langley, Tolomiczenko, Rhodes, Links, Wasylenki, & Goering, 2002). Of those with a psychotic disorder (e.g., schizophrenia), all had reported suicidal ideation, and 72.2% had attempted to commit suicide (Eyan et al., 2002). Of those with a mood disorder (e.g., major depression), 76.4% had reported suicidal ideation, and 42.5% had attempted to commit suicide (Eyan et al., 2002). Within a hospital setting, Iribarren, Sidney, Jacobs, and Weisner (2000) found that the strongest link to a successful suicide was a prior hospitalization for a suicide attempt.

In 2005, the most commonly successful methods of suicide in the US were firearms (accounting for 52.1% of suicides), hanging, cutting, poisoning, and drowning (American Association of Suicidology, 2008). These methods are often crude, painful, and undesirable as form of dying, and they are traumatizing to the person who discovers the body first. Armour (2006) states:

Self-death is incomprehensible. The horror it embodies creates lasting trauma as survivors struggle to grasp how the person could have done it and are consumed with guilt for having failed to save their loved one’s life. Indeed, the lasting legacy for suicide survivors is that the death of their loved one was preventable. This socially held belief implicitly makes those closest to the victim responsible for the death and for the conditions that generated their loved one’s wish to take life as a way out. At the same time, suicide is a fundamental betrayal and a profound form of desertion. Regardless of the victim’s state of mind, the act is an affront that leaves relationships forever unfinished and survivors to pick up the fragments of a shattered existence. (p.64)

While this is a selfish view of suicide, it speaks to the traumatic nature of suicide, but this trauma should be extended to the individual who died. For those who are homeless, the suicide of a fellow homeless family member or friend leaves the individual even more vulnerable with the loss an ally.

Street homelessness and suicide are gendered issues that disproportionately affect men for a number of reasons. Masculinity is a socially imagined expectation for men, and as such, men experience health expectations differently than women and seek to separate themselves from the feminized imagining of health care (Courtenay, 2000). Because of the feminization of help-seeking, men are less likely to seek treatment for depression and suicidal ideation and more likely to successfully commit suicide despite gender-equal rates of depression (Courtenay, 2000). Additionally, men are required to be the “stronger sex” (Courtenay, 2000), and homeless men in particular are “failures” (Passaro, 1996). When strength fails, suicide can become an alternate solution to retain masculinity without the feminization of health and help.

Compounding the issue of homelessness is age. There are a large number of youths who are homeless and represent approximately 3% of the urban homeless population (1.7 million; National Coalition for the Homeless, 2007). Of these, 6% are gay, lesbian, transsexual, or bisexual; 46% have a history of physical abuse, and 17% have been raped or sexually assaulted (National Coalition for the Homeless, 2007). Homeless youths who have a history of abuse are 1.9 to 4.3 times more likely to attempt suicide than youths without a history of abuse (Molnar, Shade, Kral, Booth, & Watters, 1999), and suicidality for homeless adolescents is strongly correlated with self-esteem, depression, physical abuse, sexual abuse, and the loss of a friend to suicide (Yoder, 1999). Many homeless youths come from a foster care or institutional setting (National Coalition for the Homeless, 2007).

Bibliography

Armour, M. (2006). Violent death: Understanding the context of traumatic and stigmatized grief. Journal of Human Behavior in the Social Environment, 14, 53-90.

Courtenay, W. H. (2000). Constructions of masculinity and their influence on men's well-being: A theory of gender and health. Social Science & Medicine, 50, 1385-1401.

Eynan, R., Langley, J., Tolomiczenko, G., Rhodes, A. E., Links, P., Wasylenki, D., & Goering, P. (2002). The association between homelessness and suicidal ideation and behaviors: Results of a cross-sectional survey. Suicide and Life-Threatening Behavior, 32, 418-427.

Folsom, D. P., Hawthorne, W., Lindamer, L., Gilmer, T., Bailey, A., Golshan, S., Garcia, P., Unutzer, J., Hough, R., & Jeste, D. V. (2005). Prevalence and risk factors for homelessness and utilization of mental health services among 10,340 patients with serious mental illness in a large public mental health system. American Journal of Psychiatry, 162, 370-376.

Homelessness Research Institute of the National Alliance to End Homelessness. (2007). Homelessness counts. Retrieved May 2, 2008, from http://www.endhomelessness.org/files/1440_file_30099_NAEH_FINAL_lo.pdf

Hwang, A. (2001). Mental illness and mortality among homeless people. Acta Psychiatrica Scandinavica, 103, 81-82.

Iribarren, C., Sidney, S., Jacobs, D. R., & Weisner, C. (2000). Hospitalization for suicide attempt and completed suicide: Epidemiological features in a managed care population. Social Psychiatry and Psychiatric Epidemiology, 35, 288-296.

Jacobson, N. (2007). Dignity and health: A review. Social Science and Medicine, 64, 292-302.

Lee, B. A. & Schreck, C. J. (2005). Danger on the streets: Marginality and victimization among homeless people. American Behavioral Scientist, 48, 1055-1081.

Metraux, S. & Culhane, D. P. (2004) Homeless shelter use and reincarceration following prison release. Criminology & Public Policy, 3, 139–160.

Molnar, B. E., Shade, S. B., Kral, A. H., Booth, R. E., & Booth, J. K. (1998). Suicidal behavior and sexual/physical abuse among street youth. Child Abuse and Neglect, 22, 213-222.

National Coalition for the Homeless. (2006). Hate, violence, and death on Main Street USA. Retrieved February 18, 2008, from http://www.nationalhomeless.org/getinvolved/projects/hatecrimes/hatecrimes2007.pdf

National Coalition for the Homeless. (2007). Homeless youth. Retrieved May 3, 2008, from http://www.nationalhomeless.org/publications/facts/youth.pdf

Passaro, J. (1996). The Unequal Homeless: Men on the Streets, Women in Their Place. New York: Routledge.

Phelan, J. C. & Link, B. G. (1999). Who are "the homeless"?: Reconsidering the stability and composition of the homeless population. American Journal of Public Health, 89, 1334-1338.

Rice, M. E. & Harris, G. T. (1995). Psychopathy, schizophrenia, alcohol abuse, and violent recidivism. International Journal of Law and Psychiatry, 18, 333-342.

Teplin, L. A. (1990). The prevalence of severe mental disorder among male urban jail detainees: comparison with the Epidemiologic Catchment Area Program. American Journal of Public Health, 80, 663-669.

Yoder, K. A. (1999). Comparing suicide attempters, suicide ideators, and nonsuicidal homeless and runaway adolescents. Suicide and Life-Threatening Behavior, 29, 25-36.

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Don't forget to donate throughout the rest of the year as well!!!

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Note:  I could not find a couple of the sources because when I write papers, for some reason, I make the poor assumption I can find the citation later...  I could find the information now, but it wouldn't be the exact same citation as it would have been were I more careful with my citations.  If you really need the citation for Hawke, Davis, and Erienbusch (2007) or American Association of Suicidology, (2008), I can probably find it for you.