Homelessness and Mental Health - Foundations of Health

Preferred phrase for addict/former addict

Person with substance use / person in recovering

Preferred phrase for lapse/ relapse / slip

Experienced a recurrence or resumed

Preferred phrase for at risk populations / vulnerable populations

Key populations / priority populations

High priority populations

Poverty + homelessness

Abusive relationships

Chronic Conditions & Disabilities

High risk behaviors

-Those with barriers or exclusion

Social determinants of health

poverty, literacy, social inclusion

Other words for homeless person + terms (4)

Person experiencing homelessness / unhoused

At risk- usually affordability related

Provisionally accommodated- living with others, short-term rental, institutional care

Emergency sheltered- ex. gospel mission and Kelowna Women's Shelter

Unsheltered- public space, vehicle

Absolute vs sheltered vs hidden homelessness

Absolute homelessness- AKA chronic homeless, may lack financial support or experience mental, physical or substance challenges

Sheltered homelessness- Regular or occasional use of shelters for sleeping

Hidden homelessness- Sleeping in vehicles, couch surfing- often episodic, due to job oss, domestic violence, lack of employment opportunities

Contributing factors leading to homelessness

-Lack of affordable housing

-Low income/ poverty

-Substance use

-unemployment/underemployment

-immigration

-violence and criminal history

-Family conflict

Absolute vs relative vs subjective poverty

Absolute- deprivation of resources that is life threatening

Relative- deprivation in relation to others that have more

Subjective- Perception that there is insufficient funds to meet needs

SDOH

Socioeconomic status

Literacy

Social inclusion

Poverty

Insufficient financial resources to meet basic living expenses: food, shelter, clothing, transportation, medical expenses

People experiencing homelessness are more likely to…

-Be impacted by SDOH- live/work in high-risk environments, less safe/secure food access, experience inequities from healthcare

-Have limited access to transportation and childcare

-Have increased stress and incidents of mental health and addiction challenges

(These impact access to disease prevention and worsen health challenges)

Health challenges of populations experiencing homelessness

Higher levels of: Morbidity, mortality, alcohol/drug use, mental illness, infectious disease.

Mental health stats (3)

1 in 5 people in Canada with personally experience a mental health problem or illness

By age 40, 50% of the population will have had a mental health issue

Major depression affects 5.4% of the Canadian population, and anxiety disorders affect 4.6%

Mental health impact on youth (6 points)

-Most people with mental illness see symptoms before age 18

-20% of Canadian youth are affected by a mental illness or disorder

-11% of 15-24 year olds reported experiencing depression

-Between 2008-2018, there was a 61% increase in emergency room visits from youth and -60% increase in hospitalizations for mental health disorder

-Only 1 out of 5 children receive appropriate mental health services

2 leading causes of death among youth and young adults (15-34)

Accidents, suicide

Fastest growing population of homelessness

Ages 16-24

Barriers to finding shelter for youth

-Many landlords do not rent to youth on welfare

-Alternative and affordable housing such as single room occupancy hotels are viewed as unsafe by youth

-Youth with substance may not be able to access shelters as many require you to not use them

Mortality rate of unhoused youth compared to housed

11-40 times higher mortality rate

Maslow’s Heirarchy of needs

Mental health related to sexual health

Depressive symptoms- risk factor for sex trading among homeless youth

Conduct disorder- associated with high-risk behaviours (sex trading, multiple partners, drug use)

Substance abuse- increase the odds of engaging in survival sex

Most common reports of male and female youth homelessness

Female: sexual abuse/sexual victimization, low in relationship power

Male: Identify as gay or bisexual

Stages of street exiting (6)

1. A precipitating factor

2. Courage to change

3. Seeking support

4. Transitioning

5. Restructuring

6. Successful exiting

-Average of 6 attempts before success

Mental health relating to oral care

-Chaotic lifestyle

-Low priority for oral health care

-Cravings for sugar and tobacco

-Dry mouth is a side effect of many mental health medications

-Homeless individuals are at greater risks of trauma

Challenges accessing oral care

-Dental anxiety

-Chaotic lifestyle

-Distrust

-Perception that dentists will not accept them as patients

-Critical of dentists

-Prefer community dental clinics instead of private practices

Mental Health Continuum

5 components of positive mental health

-Ability to enjoy life

-Dealing with life’s events

-Emotional well-being

-Spiritual well-being

-Social connections and respect for culture, equity, social justice, personal dignity

Stigma + enacted vs perceived/felt stigma

Mark of disgrace associated with a particular circumstance, quality of person

Enacted: Actively discriminated against

Felt: Stigmatized individuals internalize negative beliefs about themselves

Harm reduction

Aimed to reduce negative consequences from high risk behaviours

-focused on increasing safety and minimizing injury, disease and death

Trauma definition

Experiences that overwhelm an individuals capacity to cope

Trauma influencers

Magnitude, complexity, frequency, duration, where its coming from

-Can be caused from daily occurrences (bullying, harrassment)

ACE (Adverse Childhood Experiences)

Other word for unmotivated/ non compliant

Person experiencing barriers to accessing services

Nurses Role in Health care for priority populations

-Advocacy

-Awareness

-Knowledge

-Creating a safe space

Outreach resources, street level nursing

-Policy development

-Research

Canadian homeless strategy- 3 main concepts

Outcomes-based: Community specific needs, current and comprehensive access

Knowledge: Immediate access for health care providers, resources, public knowledge

Safe & Affordable housing: Immediate access, consumer choice, recovery oriented, individualized, social/community integration