The Trauma of Homelessness

It's the age-old question, the chicken or the egg, and how do you serve it best? In this case what came first, being homeless or Post-Traumatic Stress disorder, and how do you end it? Post-Traumatic Stress Disorder and homelessness can create a cycle that feeds on itself. The act of becoming homeless in itself can act as a catalyst for Post-Traumatic Stress Disorder, while also being caused by it. Permanent sustainable housing has proven to be effective in addressing both of these issues.

I will be addressing the mental/physical health issues of homelessness, and a possible solution through research, and my own experience as a homeless Veteran in 2013-2014.

In order to address homelessness, you have to define it. Section 330 of the Public Health Services Act defines homelessness as an individual without permanent housing who may live on the streets, stay in a shelter, mission, single room occupancy facilities, abandoned building or vehicle; or in any other unstable or non-permanent situation(42 U.S.C., 254b Page 276). The Bureau of Primary Health Care further adds that an individual may be considered to be homeless if that person is doubled up, a term that refers to a situation where individuals are unable to maintain their housing situation and are forced to stay with a series of friends and/or extended family members(bphc.gov). The Department of Housing and Urban Development defines chronic homelessness as either (1) an unaccompanied homeless individual with a disabling condition who has been continuously homeless for a year or more, OR (2) an unaccompanied individual with a disabling condition who has had at least four episodes of homelessness in the past three years Department of Housing and Urban Development). On any given night in America, there are 553,742 million homeless (Evans, 6), and of that 95,419 are chronically homeless (Evans, 16) .

Now that homelessness has been defined, let's take a closer look at the underlying causes of homelessness and chronic homelessness. For simplicity sake, I will only address the physical and mental health causes of homelessness, because these two are the main factors leading to lower income, lack of available housing, domestic violence, substance abuse, and the social stigma they bring.
First, a look at physical health issues and why they can lead to homelessness. According to the Department of Housing and Urban Development, people living in shelters are more than twice as likely to have a disability compared to the general population (endhomelessness.org). Employers are less likely to hire someone who will require accommodations due to a physical or mental health issue. This in turn means that those with mental and physical health issues on average earn significantly lower than the average American, and the unemployment rate is nearly double that of a non-disabled person. Earning far less means that what housing they can find is typically in higher crime rate areas Add into this mess an accident that greatly impairs and individual's ability to work, and this could start a cycle that can quickly spiral out of control.

Next up is mental health. I will not attempt to cover the whole range of mental health disorders here, there are volumes of published work for that. Instead I will focus solely on Post-Traumatic Stress Disorder and how it relates to homelessness, both leading up to and hindering recovering from homelessness. The National Institute of Mental Health, a federal agency that is a part of the Department of Health and Human Services, defines Post-Traumatic Stress Disorder as a disorder that develops in some people who have experienced a shocking, scary, or dangerous event (nimh.nih.gov). Some of the symptoms include, but are not limited to, flashbacks, nightmares, avoiding people, places or things that act as reminders of the traumatic event, easily startled or angered, feelings of guilt or shame related to the triggering event, and difficulty remembering key factors related to the traumatic event. The social stigmas around Post Traumatic Stress Disorder mean that many prefer to go untreated.

According to a study performed by the National Institutes of Health, many individuals fear being labeled as "dangerous/violent" or "crazy and avoid treatment early on to circumvent a label of mental illness (Mittal). This leads to a worsening of symptoms, and potentially loss of employment and income. Poor mental health can also cause poor physical health. According to the National Institutes of Health, individuals with poor mental health are more likely than the general population to have lifestyle risk factors such as smoking, lack of exercise, obesity, and poor diet(Osborn). These in turn make the individual less employable, and therefore more at risk of becoming homeless. According to the National Alliance to End Homelessness, the experience of not having a home leads to PTSD (endhomelessness.org). There's the initial loss of a home, and the social stigma of being homeless. Next is the constant stress of uncertainty about the basic necessities of life, food, shelter, water, and security. This constant struggle for the basics can over time erode an individual's ability to cope on a day to day basis. Every day becomes an endless fight or flight response.

In my own experience of being homeless, I found that most shelters only offered a short term, less than 60 days, solution to housing the homeless. They also do not address any mental health issues. Hospitals and mental health facilities address mental and physical illness, but do nothing to address the homelessness condition. The traditional means of dealing with homelessness does not work, and is in desperate need of an overhaul. This is slowly happening, and the fight is being led by non-profit veterans' organizations. For years, Veterans have relied on the Veterans Administration to help service members and Veterans when they came home, and just like community hospitals, they addressed mental/physical health separate from the issue of homelessness. Only since the wars in Iraq and Afghanistan, has the Veterans Administration started to take a comprehensive look at mental illness and homelessness together. A lot of the changes in addressing homelessness is due to the many non-profit, Veterans-helping-Veterans organizations that have started up since 2001, that most Veterans in need are getting the help to combat mental and physical health issues, and homelessness.

In order to combat, and ultimately break the cycle of homelessness, the push for permanent supportive housing has grown. In recent years, there has been a growing trend for tiny home communities. Tiny homes are generally under 500 square feet, and most being between 80 and 400 square feet. The smallest generally have a bed, toilet, desk and a very minimal kitchen with one to two stovetop burners and a kitchen sink. An article in the digital magazine CURBED, featured ten tiny home communities established for the homeless. Of the ten communities in the article, none had rent more than $400, or 30% of an individual's income. The true beauty comes from the community centers these homes are generally designed around.

These community centers offer a kitchen where individuals can cook and share meals, shower facilities (if the homes are to small to have one), and communal gathering areas for recreation, entertainment, and education. The biggest thing that the community centers have to offer is access to case management, mental health specialists, and the occasional doctors. One of the more successful tiny home communities is the Veterans Community Project in Kansas City, Missouri. Opened in January of 2018, this community currently houses thirteen chronically homeless veterans. Eventually they will have enough homes for forty-nine chronically homeless veterans. Veterans Community Project provides mentoring, case management, counseling, and linkage to other programs and services (veteranscommunityproject.org). Because of their success, over 600 cities have reached out to the Veterans Service Project to come set up there or teach them how to replicate what its founders have created in Kansas City (Wall 2018). If we can prove the long-term viability of permanent sustainable housing, in tiny home communities, we can go beyond helping just Veterans in this manner. Imagine a gated tiny home community for domestic violence survivors, where a survivor and their children can be safe, have a sense of stability, and community support. visualize a tiny home community here runaway teens, or teens in foster care can learn the essential skills necessary to living in an adult world, and still attend school.

In short, mental and physical illness leads to homelessness, and homelessness leads to physical and mental trauma. Building communities that address a long-term approach to combating homelessness works, and breaks that cycle. The number of permanent supportive housing communities is growing, and slowly the number of homeless in America is shrinking.

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