Homelessness: A need for better care

Should homelessness alone be a criterion for mental health treatment?

Despite the enormous challenges facing the homeless population, many are seen in our clinics hopeful and endorsing a fair mood. Many are polite and answer questions in an attempt to diminish the burden they feel they impose on others, including the medical system. Many display strong resiliency and find ways to cope, relate, and find meaning despite their challenging circumstances. Yet, many also come to us suffering and seeking assistance.

We empathize with the frustration psychiatrists feel when using terms such as “homelessidal” to refer to patients who are homeless and suicidal. The term is meant to evoke the perceived helplessness in trying to care for a homeless patient in the emergency department. Although 2 days of housing in an inpatient psychiatric unit and prescribing an antidepressant can give homeless patients a brief respite, it does little to address the root cause of that person’s suffering. We also find that the use of diagnostic labels can be insufficient, and often inappropriate, in the context of the expected reactions to the significant stressors of being homeless.

We routinely see the distress and hopelessness in our patients suffering from homelessness. We think that psychiatry is capable of softening those daily traumas using supportive therapy. We think that psychiatry is capable of positively challenging the despondency by activating meaning and purpose, as suggested by Dr. Frankl. While those are not typical interventions in modern psychiatry, they are established and validated. By considering homelessness in and of itself a criterion for mental health treatment, we can begin to address those challenges, and engage in alternative, longer lasting treatment considerations.
 

How to proceed?

Though the answer for caring for the homeless may not be in psychopharmacology, we think that psychiatry could enhance the care of the homeless by pursuit of two main goals.