"The system for care is so fragmented that even a homless person with full mental capacity might have difficulty negotiating it."
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Statistics about the mentally ill generally state that about one third of the homeless population is seriously mentally ill. However, those who work directly with homeless people believe the number is much higher. Abby Lehrman, outreach coordinator for the Brinton Psychiatric Homeless Project, which is associated with Healthcare for the Homeless in San Francisco, estimates that 90 percent to 95 percent of homeless people suffer from mental illness. She disagrees with how statistics have been collected: the transient nature of homeless people poses a significant barrier to the accurate collection of epidemiological data. In addition, stigmatization dissuades people from seeking out mental health treatment. As a result, says Lehrman, “The majority of people with mental illness on the streets have never been diagnosed because they have never received comprehensive health care.”
Lehrman works with a team including case managers, therapists, and a psychiatrist, who go from shelter to shelter, food project to food project, to offer their services. Some agencies offer space for her group to set up a base; otherwise, the group travels around in a van, distributing healthcare services directly to the homeless. By traveling to the places where homeless people congregate, Lehrman and her team hope to reach those people who normally would fall through the cracks of the community-based mental health service system.
Mental illness, she believes, often underlies other health problems, such as substance abuse and lack of good hygiene. These problems, inherent to life on the streets, can also cause depression and other psychological disorders. One of Lehrman’s homeless patients in San Francisco, a drug addicted, mentally-ill alcoholic, went from clinic to clinic looking for help. While he was treated for alcoholism and drug addiction, no one would address his mental illness, which he was told was not severe enough to merit treatment. In addition, mental health clinics required sobriety before they would treat him at all. After sobering up, and as a result of extensive advocacy by Lehrman on his behalf, this man finally secured housing, but in the absence of services to treat his mental illness, as soon as he moved in, he started drinking again and soon died. In this way, mental health and the other myriad problems of homelessness form an aggravating cycle.
Combined substance abuse and mental illness is highly prevalent among the homeless population; more than half of homeless drug addicts also suffer from a mental illness. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), an agency in the US Department of Health and Human Services, those who suffer from both mental illness and substance abuse tend to have particularly severe symptoms, deny their mental health and substance abuse problems, abuse several different drugs, and refuse treatment. In addition, many anti-psychotic drugs adversely react to abused recreational drugs, resulting in highly potent, potentially fatal effects. Being dual-diagnosed with addiction and mental illness means that people who want to get help often can’t; at traditional clinics, their substance abuse problem disqualifies them from receiving mental health treatment. According to Lehrman, there simply are not enough dual-diagnosis programs to help homeless people in need of treatment.
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