Running head: MENTAL HEALTH ISSUES Chepkosgei 1

Mental Health Issues: A Review of Literature

Carolyne Chepkosgei

The University of Texas at El Paso

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Abstract

Mental health issue’ affects people worldwide. A high percentage of the homeless population

suffer from serious untreated mental health problems and in most cases the mental problems

make them homeless. This paper uses the primary research survey and several different

secondary sources. It reports on their views of the services homeless people receive and what the

service provider’s offer. Mismatch between expectations and provision, disputes with healthcare

providers, dissatisfaction with the degree to which they have choice in their care. The suspicions

on the intentions of health professionals demonstrate the extent to which powerlessness and

social exclusion are replicated in healthcare economies. The inadequacy of hostels and care is

also emphasized, with some recommendations for services. There are few data on homeless

people’s perceptions of services for mental health problems. Homeless people have strong views

about the adequacy of services to meet their needs. They were particularly concerned about

stigma, and the inadequacy of services that they have to use. This paper reports their

recommendations for change on the mental health care system.

Keywords; Mental health issues, Homeless persons.

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Mental Health Issues and Homelessness

The purpose of this paper is to review the literature regarding the impact of mental health

care on the homeless population in the US. This will involve a complete review of the qualitative

and quantitative data provided by the mental health providers and the homeless service receivers.

Mental illness is a “disease that causes mild to severe disturbances in thinking, perception and

behavior” that can impair daily functioning (National Institute of Mental Health [NIMH], n.d.).

Mental health issues are common where mental disorders are the leading cause of disability in

the United States. Homelessness has been a national issue in the mid-20th century due to the

consequences of closing state mental hospitals without providing replacement treatment for

people with the most serious mental illness (Heather pg.1).

Homelessness and mental health issue do not only occur in the United States, but also in

other countries. In the U.K., the Conservative government introduced a programme of “Care in

the Community” that provided neither adequate care for the mentally ill, nor community support.

The Journal article Homeless Mentally ill Persons by Nieto et al. states that between the year

1988 and 1995, the average daily number of long-stay beds available in hospitals for the

mentally ill were extremely reduced (Nieto et al.pg.1). During the same period, the proportion of

the average hospital budget spent on mental health fell from 14.4 percent to 12 percent (Nieto et

al.pg 2).

In the early years of 1980s, the United States also experienced the trend of

deinstitutionalizing mental-health hospitals. A large percentage of the released patients ended up

in the homeless system and the movement in state mental health systems shifted towards

community-based treatment as opposed to long-term confinement in institutions. Unfortunately,

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because of the lack of local community programs, many of the patients ended up in the streets.

(Nieto et al.2008)

The country’s investments on improving the mental health of ill people have been

reduced in the recent decades. Because of the decrease of money, many are unable to get the

necessary help to improve mental conditions. The view of the society has changed as well and

now mentally ill people are often perceived as violent people who are often unemployed,

homeless and unwilling to contribute to the society. It is necessary to promote better point of

views on the citizens with mental illnesses to change their image in the society.

For the first time now, government officials are calling for an end to homelessness. The

mental health care system should be improved by finding more investments. The following

research questions are aimed to of understand homelessness and mental health issue;

 What are the common mental health issues, and how do they affect the homeless

population in the United States?

 What is the current state and the need of improving the mental health in the United

States?

 How does the mental health of other countries compare with the mental health in the US?

 What should the government do to improve on the mental health care system and reduce

the crimes caused by the homeless people with mental health issues?

The conclusions made on the basis of primary research in this literature review will

discuss the main issues of the topic. It analyzes what the homeless individuals and the mental

health providers think should be done for the mental health care system to be improved. The

secondary sources used in this paper include online, and multimedia references: a journal

articles, a statistical data from the NAMI and the Advocacy center, book and magazine articles.
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These sources will discuss the psychological, social, and behavioral aspects of an individual

mental issues, common mental health issues, current state of the issue and what the government

can do to improve the situation. It also discusses the comparison of mental health issues in the

United States to countries.

The primary research chosen for the topic was the “Mental Health Issues survey” done on

five of homeless individuals with mental health issues, mental health providers and 10 random

UTEP students. The survey consisted of the following questions;1. Is mental issue a big

problem? 2.Should people work out their own mental health problems?3. Is it true that if you

have mental illness, you have it for life?4. Do you agree that females are more likely to have

mental health illness than men?5. Is medication the best treatment for mental illness?6. Are

people with mental health illnesses generally violent and dangerous?7. Are adults more likely to

have a mental illness?8. Can you tell by looking at someone whether they have a mental illness?

9. Is it true that people with mental illness are generally shy and quiet?10. Can mental illness

happen to anybody?11. Would you be willing to work or go to school with a person with mental

illness?12. Would you be happy to befriend a person with a mental illness?

The survey was better to use for the primary research rather than interview since mental

health is an issue that not everybody is comfortable talking about. Most people would prefer

writing down what they think on paper. The secondary sources include the information gathered

by psychologists and experts through news articles, books, journals, and videos. So, instead of

interviewing another psychologist, it was more effective to get answers from actual people by

taking a survey that directly linked to mental issues.

The primary research mismatched with the secondary research as it proved that mental

health issue is growing and is a bigger problem. The statistics differ at large on what is written in
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the secondary sources which is actually less compared to the real data. Many people are affected

by the mental health issue than it was thought to be. The inaccurate data may be because most of

the affected choose to be silent about what they are going through which at the end causes

negative effects that affect their mind, behavior, and also their social interactions.

Common mental health issues and how they affect the homeless population in the

United States.

Mood disorders, including major depression, dysthymic disorder, and bipolar disorder,

are the most prevalent in the United States out of all kinds of psychological disorders. Nine

percent of all adults suffer over the course of a year, and 21.4 percent will be affected over the

course of a lifetime. Women are 50 percent more likely to suffer from mood disorders than men.

Pressures created by their multiple roles, gender discrimination and associated factors of poverty,

hunger, malnutrition, overwork, combine to account for women's poor mental health especially

the mood disorder. Approximately 19 percent of all adults will suffer from an anxiety disorder

each year, but this number becomes 31 percent over their lifetimes. Over a twelve-month period,

three percent of Americans will suffer from substance abuse, and over one’s lifetime, the number

rises to around 15 percent (NAMI 2015).

Mental health issues disrupt people’s ability to carry out essential aspects of daily life,

such as self-care and household management. It may also prevent people from forming and

maintaining stable relationships or cause people to misinterpret others’ guidance and react

irrationally. This often results in pushing away caregivers, family, and friends who may be the

reason that is keeping that person from becoming homeless. As a result of these factors and the

stresses of living with a mental disorder, people with mental illnesses are much more likely to

become homeless than the general population (Library Index, 2009).

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Poor mental health may also affect physical health, especially for people who are

homeless. Mental illness may cause people to neglect taking the necessary precautions against

disease. When combined with inadequate hygiene due to homelessness, this may lead to physical

problems such as respiratory infections, skin diseases, or exposure to tuberculosis or HIV. In

addition, half of the mentally ill homeless population in the United States also suffers from

substance abuse and dependence (Substance Abuse and Mental Health Services Administration

2009). Minorities, especially African Americans, are over-represented in this group. Some

mentally ill people self-medicate using street drugs, which can lead not only to addictions, but

also to disease transmission from injection drug use. This combination of mental illness,

substance abuse, and poor physical health makes it very difficult for people to obtain

employment and residential stability.

The current state of mental care system in the United States and the need for

improvement.

Currently in the United States, there is an organization that has been formed to help imp-

rove the mental health care system. The organization is ‘Mental health America (MHA)’ which is

an organization that is committed to promote mental health as a critical part of overall wellness. It

advocates for prevention services for all, early identification and intervention for those at risk,

integrated services, care and treatment for those who need it, and recovery as the goal. The

organization believes that gathering and providing up-to-date data and information about

disparities faced by individuals with mental health problems is a tool for change in the mental

health care system (MHA 2015).

In the United States, approximately 44 million American adults have a mental health

condition. Since the release of the first State of Mental Health in America report (2015), there
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has only been a slight decrease in the number of adults who have a mental health condition. The

rate of youth experiencing a mental health condition continues to rise in the society today.

According to the report, the rate of youth with Major Depressive Episode(MDE) was seen to

increase from 11.93% to 12.63%. There was only a 1.5% decrease in the rate of youth with MDE

who did receive treatment. Data shows that 62% of youth with MDE received no treatment.

More Americans are insured and accessing care. We can continue to see the effects of healthcare

reform on the rate of adults who are uninsured. (SAMHSA 2017).

This year there is a 2.5% reduction in the number of adults with a mental health condition

who were uninsured. Despite having insurance many Americans are experiencing a mental health

condition and still report having needs that are not catered for. Around 9 million adults reported

having an unmet mental care need. Mental health workforce shortage is still experienced. Many

states have some improvement in their individual to mental health provider ratio. But in states

with the lowest workforce there was almost 4 times the number individuals to only 1 mental

health provider. (SAMHSA 2017).

The broken mental care of the United States should be improved for the betterment of the

country. Current treatments and the dominant model of mental healthcare do not adequately

address the complex challenges of mental illness, which accounts for roughly one-third of adult

disability globally. These circumstances call for radical change in the system and practices of

mental healthcare, including improving standards of clinician training, developing new research

methods, and re-envisioning current models of mental health care delivery. Because of its

dominant position in the United States healthcare marketplace and its commitment to research

and innovation, is strategically positioned to make important contributions that will shape the

future of mental health care nationally and globally.

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Comparison of the Mental health care in the United States and other countries

Mental health is a worldwide issue. Depending on where one is diagnosed, hospitalized

and treated one may have an entirely different experience than someone living in another

country. According to the World Health Organization, countries with the highest amount of

mental health disorders where US, Ukraine, Colombia, New Zealand, Lebanon and France

averaging at about 20% of the population. Countries with the lowest rates where Japan, China,

Nigeria and Israel averaging at around seven percent of the population. Data shows that many

disorders increase as a population grows older (WHO 2018).

When looking at treatment in psychiatric hospitals developed countries like France has

little in the way of programs for patients inside the hospital. Depending on what part of country,

many US hospitals use activities and support groups to keep patients occupied and active during

their time. Countries like Canada offer some wellness programs, typically more than France, but

less than the United States (Community Mental Health empowerment 2018).

Fig.1 below shows the mental health budget in the United States as a percent of overall

spending in other countries in comparison to the United States. The United States has usually

had a higher than average spending. In the 1980s the growth in health expenditures accelerated

per capita in the United States. The 10.1% average annual growth rate in the United States.

during the 1980s was the highest among comparable countries. The comparably wealthy

countries saw an average of 7.0% annual growth during this period. Since 1990, health spending

has grown similarly in the U.S. and comparable countries. Health spending growth in both the

U.S and comparable countries has slowed in recent years. In the 2005-2010 period, the U.S. had

a 4.2% average annual growth rate compared to 7.2% the previous five-year period. Comparable

countries also saw a drop to a 4.2% average annual growth rate during the 2010-2016 period,
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down from 5.2% on average in the 2005-2010 period. (Kaiser Family Foundation analysis of

data from OECD (2017).

What to be done by the United States to Improve mental care system and end

homelessness.

The government should channel funds into direct services that seemingly sustain

homeless lifestyles, these result-oriented plans are designed to focus efforts and funds on the

creation of permanent supportive housing for the most troubled and difficult, “chronic” homeless

population. Considering that it is actually cheaper to house someone than it is to fund the

otherwise needed myriad services, this approach is touted as being a cost-effective

solution. (Bhui et al.pg 2)

Many service providers applaud the government’s focus on ending homelessness, as

opposed to managing it, and realize the necessity of incorporating all sectors of society in order
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to accomplish such a goal. These concerns are exacerbated by a failure to receive sufficient

additional allocations while already struggling with budgets spread extremely. The government

should also empower state and community partners to improve their response to individuals and

families experiencing homelessness and mental health issues, examine the operation of mental

health programs, particularly mainstream programs that serve both homeless and non-homeless

persons, to improve the provision of services to persons experiencing homelessness and to

develop, test, disseminate, and promote the use of evidence-based homelessness prevention and

early intervention programs and strategies.

The government should also improve the effectiveness of leadership and governance for

mental health, the provision of comprehensive, integrated mental health and social care services

in community based settings, implementation of strategies for promotion and prevention and to

strengthened the information systems, evidence, and research (Lake et al.2017).

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References

Bhui, K., Shanahan, L., & Harding, G. (2006). Homelessness and Mental Illness: A Literature

Review and a Qualitative Study of Perceptions of the Adequacy of Care. International

Carroll, Heather. "Serious Mental Illness and Homelessness." Treatment Advocacy Center.

September 2016. Accessed December 14, 2016.

http://www.treatmentadvocacycenter.org/storage/documents/backgrounders/smi-

andhomelessness.pdf

Kaiser Family Foundation analysis of data from OECD (2017), "OECD Health Data: Health

expenditure and financing: Health expenditure indicators", OECD Health Statistics

(database) (Accessed on March 19, 2017). Get the data PNG

Lake, J., & Turner, M. S. (2017). Urgent Need for Improved Mental Health Care and a More

Collaborative Model of Care. The Permanente journal, 21, 17-024.

Library Index. “The Health of the Homeless – The Mental Health of Homeless People.” 2009.

Available from http://www.libraryindex.com

Journal of Social Psychiatry, 52(2), 152–165. https://doi.org/10.1177/0020764006062096

National Institute of Mental Health. (n.d). The Numbers Count: Mental Disorders in America.

Retrieved from http://www.nimh.nih.gov/health/publications/the-numbers-count-mental-

disorders-in-america/index.shtml

Nieto G., Gittelman M., Abad A. (2008). Homeless Mentally Ill Persons: A bibliography

review. International Journal of Psychosocial Rehabilitation. 12 (2),

Substance Abuse and Mental Health Services Administration, Center for Mental Health Services.

“Homelessness.” http://mentalhealth.samhsa.gov/cmhs/Homelessness/ (Accessed: June

11, 2009)
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World Health Organization. (2018).

SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use

and Health,https://www.samhsa.gov/data/nsduh/reports-detailed-tables-2017-NSDUH

Mental Health America. (2015).

National Alliance on Mental Illness. (2015).

ilacc.org/wpcontent/uploads/2015/02/mentalillness_factsheet-1-1.pdf