User:Abains1721/Homelessness and mental health/Bibliography

Drafting

Legend: My changes to the article will be in bold. Sentences pulled straight from original article will be in regular text, and new headings/formatting will be in underlined (subheadings will be underlined and italicized). See talk section for reformatting information. Original citations in paragraphs. Majority of work will be reorganizing.

Responses

Responses to mental health and homelessness include measures focused on housing and mental health services. Providers face challenges in the form of community adversity.

Housing

Modern efforts to reduce homelessness include "housing-first models", where individuals and families are placed in permanent homes with optional wrap-around services.(citation 16) This effort is less expensive than the cost of institutions that serve the complex needs of people experiencing homeless, such as emergency shelters, mental hospitals and jails. The alternative approach of housing first has shown positive outcomes. One study reports an 88 percent housing retention rate for those in Housing First, compared to 47 percent using traditional programs. (citation 23) Additionally, a review of permanent supportive housing and case management on health found that interventions using “housing-first models” can improve health outcomes among chronically homeless individuals, many of whom suffer from substance use disorders and severe mental illness. Improvements include positive changes in self-reported mental health status, substance use, and overall well-being. These models can also help reduce hospital admissions, length of stay in inpatient psychiatric units, and emergency room visits. (citation 25).

One study evaluating the efficacy of the Housing First model followed mentally ill homeless individuals with criminal records over a 2-year period, and after being placed in the Housing First program only 30% re-offended. Overall results of the study showed a large reduction in re-conviction, increased public safety, and a reduction in crime rates. (citation 27). A significant decline in drug use was also seen with the implementation of the Housing First model. The study showed a 50% increase in housing retention and a 30% increase in methadone treatment retention in program participants.

Mental health services

Uninterrupted assistance greatly increases the chances of living independently and greatly reduces the chances of homelessness and incarceration. (citation 26). Through longitudinal comparisons of sheltered homeless families and impoverished domiciled families, there are a collection of social buffers that slow one's trajectory toward homelessness. A number of these factors include "entitlement income, a housing subsidy, and contact with a social worker." (citation 16). These social buffers can also be effective in supporting individuals exiting homelessness. One study utilizing Maslow's hierarchy of needs in assessing housing experiences of adults with mental illnesses found a complex relationship between basic needs, self-actualization, goal setting, and mental health . Meeting self-actualization needs are vital to mental health and treatment of mental illness. Housing, stable income, and social connectedness are basic needs, and when met can lead to fulfillment of higher needs and improved mental health.

Research calls for evidence based remediation practices that transform mental health care into a recovery oriented system. (citation 24) . The following list includes practices currently being utilized to address the mental health needs of homeless individuals.

• Integrated service system, between and within agencies in policy making, funding, governance and service delivery.
• Low barrier housing with support services.
• Building Assertive Community Teams (ACT) and Forensic Assertive Community Teams (FACT).
• Assisted Community Treatment (ACT).
• Outreach services that identify and connect homeless to the social service system and help navigate the complex, fragmented web of services.

(citation 24).

Challenges

Fear surrounds the introduction of mentally ill homeless housing and treatment centers into neighborhoods, due to existing stereotypes that homeless individuals are often associated with increased drug use and criminal activity. The Housing First Model study, along with other studies, show that this is not necessarily the case. Proponents of the NIMBY (not-in-my-backyard) movement have played an active role in the challenges faced by housing and mental health service interventions for the homeless.

Talk Section

Proposed Revision

Hello. I am a student at UC Berkeley and I am working on this page. I propose to merge 2 sections, evidence based remediation practices and modern responses, and retitle them as Response. Within this section, I propose to create three subsections: Housing, Access to care (which will include evidence based remediation practices along with updated practices for mental health care), and Challenges. I will organize the existing information, editing for clarity, and including sources tied to the United States as a whole.

Bibliography

“A focus on self-actualization seems to occur when more basic needs were not met, which supports Maslow’s later hypothesis that being needs may emerge from the frustration, not fulfillment, of basic needs”

“Transforming mental health care into a recovery-oriented system will require further consideration of person-centered care planning as well as the impact of limited resources especially for those who have experienced cumulative adversity and disadvantage”]