Homelessness: Mental Illness And Substance Abuse
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633,782 people experience homelessness on any given night in the United States. More than one-fifth of the 610,000 homeless people in the United States suffer from a severe mental illness, according to the US Department of Housing and Urban Development. The majority of them have schizophrenia, bipolar disorder or depression, which are all manageable with the right medication and counseling, but will only get worse if left untreated. Without proper care, this burden costs the federal government millions of dollars a year in housing and services all while prolonging the treatment of their disorders. 38 percent of homeless people abuse alcohol while 26 percent consistently use drugs. The Substance Abuse and Mental Health Services Administration, SAMHSA, provides direct services within supportive housing settings for people experiencing chronic homelessness. A chronically homeless person has experienced homelessness for a year or longer and has a disability. The biggest feat to tackle while progressing towards an end of homelessness is funding for services. Continual financial support for SAMHSA will continue to be critical to ending homelessness.

Substance Abuse and Mental Health Association

SAMHSA is partnered with The National Alliance to End Homelessness, in their 2014 Policy Guide, the Alliance recommends that for the 2015 Fiscal Year, Congress should provide at least $100 million for SAMHSA Homeless Services to fund essential treatment services and permanent supportive housing for homeless suffering from substance abuse and mental health issues. If congress provides this money, while only part of their $3.6 million budget for FY 2015, SAMHSA will not only be able to provide essential treatment services but they will help to ultimately eradicate the current societal views on homelessness in the United States.

The Substance Abuse and Mental Health Services Administration's Homelessness Resource Center (HRC) is a learning environment devoted to spreading knowledge and sustainable methods to prevent and ultimately end homelessness. Their team of providers, consumers, policy-makers, researchers and public agencies at Federal, State, and local levels work in part with SAMHSA's Recovery Support Strategic Initiative. SAMHSA's homeless and housing programs work together in order to end homelessness by supporting individuals through a positive process of change while improving their personal health, living a self-directed life and working each day to reach their full potential.

“The National Alliance to End Homelessness evaluates policy and develops practical, cost-effective policy solutions. The Alliance works with the public, private and nonprofit sectors to build state and local capacity, leading to stronger programs and policies that help communities achieve their goal of ending homelessness.”

SAMHSA, along with the National Alliance to End Homelessness will work toward increasing awareness and understanding of mental health issues and substance use disorders. Promoting emotional health and wellness, addressing the prevention of substance abuse and mental illness. All while increasing access to effective treatment and supportive recovery. These common goals and initiatives will help SAMHSA support mental health fields with data collection from nationwide surveys, build public awareness on the importance of human behavioral health and its correlation with homelessness in the United States. SAMHSA will support innovation, improvement in mental health practices, engage in activities that support behavioral health system transformation. SAMHSA will bring these practices together with critical knowledge towards prevention in order to treat people with mental illness and addictions.

SAMHSA’s mission statement reads: “SAMHSA’s mission is to reduce the impact of substance abuse and mental illness on America’s communities…serves as a national voice on mental health and mental illness, substance abuse, and behavioral health systems of care…helps to ensure dollars are invested in evidence-based and data-driven programs and initiatives that result in improved health and resilience.”

These programs are highly effective and cost-efficient, filling important structural gaps and helping people experiencing chronic homelessness begin to access critical medical assistance. Research has shown that the most successful endeavors for the homeless population bring housing assistance together with mental support services. The Administration requested $74 million for SAMHSA Homeless Services programs in FY 2015, the same amount the program received in FY 2014.

With sufficient funding, SAMHSA will not only be able to provide effective resources for those suffering mental illness and substance abuse issues, they will ultimately change the current status quo on homelessness in the United States, ultimately ending current societal views on the homeless as portrayed in the media.

Homelessness in the Media

Charles M. Blow, a writer for the New York Times, wrote an article about societal views on homelessness in the United States. He states that we have placed negative stereotypes on poor people, especially those on the streets. We see the homeless as incompetent—people with poor intentions and even untrustworthy. Our urges have us looking the other way instead of offering to help those in need. He believes this is why we as a society are not adamant on Congress making a change, instead we focus on ourselves. We lack empathy, we do not look at the problem and try to find solutions, we turn the other way hoping it will disappear.

Paul Boden, the organizing director for the Western Regional Advocacy project, who was once homeless himself, speaks on his firsthand experience; he states that homeless people go unseen everyday, pedestrians simply ignore their existence. The majority of people that walk by ignore them or say something rude, looking and treating them like they are dirt. If they are lucky some people may have the decency to acknowledge their presence or apologize for not having any spare change or food on them. Everyone has their own perceptions on homeless people, and this has a direct effect on how we react to people we see living on the streets. Paul Toro, a Psychology professor at Wayne State University, argues that some think homeless people are lazy, don’t work hard for what they want, or even deserve what they get. “The closer that poverty is to the face of people that aren’t in poverty, the uglier it is. And the unfortunate part is that often gets manifested as the person is ugly—not the poverty is ugly. And poverty is ugly. It doesn’t smell good.”

SAMHSA’s work will create enough of a media buzz once they receive their large amount of funding. Once they have our attention we will see the work being done, we will no longer categorize all homeless people as lazy or ugly, as stated in the article. We will see them as sick people who need help. Addiction and mental illness are nobody’s fault; they just need the proper care that can be provided to them through SAMHSA’s work. We have seen similar success stories through other organizations in the United States, further supporting the confidence that SAMHSA will succeed with proper funding.

Other Successful Organizations

MHA, the Mental Health Association, was the first organization in Western Massachusetts to bring specialized permanent housing resources to homeless individuals using the Shelter Plus Care model. The Shelter Plus Care Program provides rental assistance and supportive services to homeless persons with disabilities and their families. The program provides assistance through four components: Tenant-based Rental Assistance, Sponsor-based Rental Assistance, Project-based Rental Assistance and Single Room Occupancy for Homeless Individuals.

MHA also introduced the highly successful Safe Havens model to the area. A Safe Haven is a 24/7 community-based early recovery model of supportive housing that serves homeless with mental illness and substance use disorders. Many of these people have not had access to traditional programs or health care, resulting in high use of emergency room and acute care services With around 25 beds the Safe Haven places no treatment participation demands on residents but expects them to transition from unsafe and unstable street life to permanent housing and to re-engage with treatment services. MHA has become an essential part of state and local plans to end homelessness by creating a variety of care services—from street outreach to preventive interventions and permanent housing. (Safe Havens, 2014)

MHA’s Housing First program successfully kept 95 percent of participants housed for one year or longer, which is higher than the national average of 85 percent. They recently held a golf tournament that helped to raise $27,000, just this small amount of funding allowed for MHA to expand their community and program resources, making them available to their patients. The MHA shows us the positive effects proper funding has on a statewide scale; they are a model for what is possible on a nation-wide scale on generating long-term solutions. (Ingersoll, 2013).

The U.S. Interagency Council on Homelessness (USICH) recognized the Tenancy Preservation Program (TPP) as a promising solution. The USICH is charged with coordinating federal agencies to identify and fund programs to end homelessness. The TPP, piloted by MHA in 1998 and now a statewide program, works with individuals and families at high risk of becoming homeless due to lease violations related to their disability. Housing is retained in 90 percent of the cases through court approved reasonable accommodations, skilled assessments, short-term interventions and well-coordinated linkages to services and supports that ensure housing stability. These organizations show how proper funding can have a positive impact on services in the United States and how similar results will happen with SAMHSA with proper funding.

The SAMHSA 2016 Fiscal Year Budget Request includes three new programs that draw on funds across the Mental Health, Substance Abuse Prevention and Substance Abuse Treatment appropriations. Any amounts spent or awarded will be tracked as distinct funding streams and will only be used for purposes constant with legislative direction and intent.

Once congress supplies SAMHSA with sufficient funding SAMHSA will be able to take their methods and make them accessible for those in need. Their most important aspect of their services is Motivational Interviewing their patients, this provides a foundation for assisting individuals with developing the rationale for beginning change in their lives. These resources provide basic information about the process of eliciting change talk and providing advice of motivational interviewing. Eliciting change talk is the consciously directive strategy on the part of the counselor for resolving indecision. Instead of the counselor advocating for change, which often puts the clients in the position of defending against it, motivational interviewing takes a different approach. The idea is to have the counselor enable the client’s communication of change talk, that is, for the client to present the arguments for change. There are four categories of change talk, they are; recognition of disadvantages in the status quo, recognition of the advantages of change, expression of optimism about change and ultimately the expression of intention to change.

Shared decision making allows an individual along with their healthcare provider to determine the best treatment and care. It is a fundamental process in primary care and behavioral health care incorporation; to make it imperative that those individuals with behavioral health conditions learn skills to participate in decisions with their healthcare providers. Emphasize change statements; provide affirmations and statements of hope SAMHSA’s work is more than a “band aid” for homelessness in the United States, but a large-scale change agent for the future.

More attention must be directed at how to better deliver appropriate mental health and substance abuse services to the homeless in America. While $100 million is not a large part of the $3.6 billion of SAMHSA’s budget for the coming year, it will be more than enough to get SAMHSA’s work progressing to where it needs to be in order to create long term systemic changes for homelessness in the United States, ultimately changing the status quo while providing long term housing for the chronically homeless. Sufficient funding is imperative if any change is to happen.

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