Psychosocial Factors & Homelessness

Homelessness exists when people lack safe, stable, and appropriate places to live. Sheltered and unsheltered people are homeless. People living doubled up or in overcrowded living situations or motels because of inadequate economic resources are included in this definition, as are those living in tents or other temporary enclosures.

Introduction

Each year between 2–3 million people in the United States experience an episode of homelessness (Caton et al., 2005). The psychological and physical impact of homelessness is a matter of public health concern (Schnazer, Dominguez, Shrout, & Caton, 2007). Psychologists as clinicians, researchers, educators, and advocates must expand and redouble their efforts to end homelessness.

The APA Presidential Task Force on Psychology’s Contribution to End Homelessness, commissioned by James Bray, PhD during his tenure as APA's president, developed a mission to identify and address the psychosocial factors and conditions associated with homelessness and define the role of psychologists in ending homelessness.

In the United States, the overall population of people living without homes can be divided into several subgroups including individual adults, families with children, and unaccompanied youth. Diversity also exists in the behavioral characteristics of people living without homes. Structural and psychosocial factors combine to heighten the risk of homelessness (D. G. Anderson & Rayens, 2004; Buckner, 2008; Webb, Culhane, Metraux, Robbins, & Culhane, 2003; Wilson, 2005).

Poverty

  • Until 2008, when widespread economic instability resulted in a significant increase in the loss of housing among blue-collar workers and the middle class (Aratani, 2009), the great majority of people who experienced homelessness were extremely poor (Burt et al., 1999).

  • Among people seeking emergency shelter for the first time, most fell well below nationally established indicators of poverty (U.S. Conference of Mayors, 2008).

  • According to recent estimates, African Americans constitute 42% of the population of people living without homes, Caucasians 39%, Latinos 13%, Native Americans 4%, and Asians 2% (U.S. Conference of Mayors, 2008).

  • The most obvious structural deficiency is the well-documented imbalance between the demand for low-income, affordable housing and its limited availability (Bassuk et al., 1997). This disparity between demand and supply –linked to the failure of multiple factors—disproportionately burdens poor people (Aratani, 2009; Lehmann et. al, 2007).

  • Inadequate education and high dropout rates quash opportunities to earn incomes sufficient to meet rising costs of food, transportation, and child care. Against a backdrop of increasing costs and limited assets, poor people compete for affordable housing (Rafferty & Shinn, 1991).

  • People with pervasive mental illness are less able to obtain lucrative or steady employment and, in the absence of supportive housing, are more likely to be without homes (Caton et. al, 2005; Herman et. al, 1997; Koegel et. al, 1995; Stein & Gelberg, 1995).

Substance Use

  • Lehman and Cordray’s (1993) meta-analysis of 16 epidemiological studies of populations of people experiencing homelessness in the United States was performed to provide more precise estimates for the prevalence of alcohol, drug, and mental health disorders. Weighted estimates were 28% for current alcohol disorder and 10% for current drug use disorder.

  • Farrell and colleagues (1998) reported that substance-related disorders were some of the most common mental disorders among populations experiencing homelessness, with 5% of the household sample (out of 100,000 households), 7% of the institutional sample (out of 755 people), and over 21% of the sample of those without homes recorded as alcohol dependent.

  • Youths who are homeless have also been found to exhibit high rates of substance-use disorders, including alcohol abuse or dependence, and drug abuse or dependence (Rotheram-Borus, 1993).