User:EEmenike/Homelessness in the United States

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Homelessness in the United States refers to the issue of homelessness in the United States, a condition wherein people lack a fixed, regular, and adequate residence. The number of homeless people across the United States varies from different federal government accounts. In 2014, approximately 1.5 million sheltered homeless people were counted. The federal government statistics are prepared by the United States Department of Housing and Urban Development's Annual Homeless Assessment Report; as of 2018, HUD reported there were roughly 553,000 homeless people in the United States on a given night, 0.17% of the population. Annual federal HUD reports contradict private state and local reports where homelessness is shown to have increased each year since 2014 across several major American cities, with 40 percent increases noted in 2017 and in 2019. In January 2018 the federal government gave comprehensive nationwide statistics, with a total number of 552,830 individuals, of which 358,363 (65%) were sheltered in provided housing, while some 194,467 (35%) were unsheltered.

Historically, homelessness emerged as a national issue in the 1870s. Early homeless people lived in emerging urban cities, such as New York City. Into the 20th century, the Great Depression of the 1930s caused a substantial rise in unemployment and related social issues, distress, and homelessness. In 1990, the U.S. Census Bureau estimated the homeless population of the country to be 228,621 (or 0.09% of the 248,709,873 enumerated in the 1990 U.S. census) which homelessness advocates criticized as an undercount. In the 21st century, the Great Recession of the late 2000s and the resulting economic stagnation and downturn have been major driving factors and contributors to rising homelessness rates.

The causes of homelessness are a combination or variation of interpersonal, individual, and socioeconomic factors. Research shows that mental illness and addiction as the common causes associated with homelessness. Interpersonal relationships with family, friends, and romantic partners, increased housing prices (high rent, high mortgages, lack of affordable housing), as well as eviction rates also contribute to the state of homeless people. A 2022 study found that differences in per capita homelessness rates across the country are not due to mental illness, drug addiction, or poverty, but to differences in the cost of housing. West Coast cities including Seattle, Portland, San Francisco, and Los Angeles have homelessness rates five times that of areas with much lower housing costs like Arkansas, West Virginia, and Detroit, even though the latter locations have high burdens of opioid addiction and poverty.

In 2009 it was estimated that one out of 50 children or 1.5 million children in the United States of America would experience some form of homelessness each year. There were an estimated 37,878 homeless veterans in the United States during January 2017 (of which over 90% were male), or 8.6 percent of all homeless adults (as compared with approximately 7 percent of the U.S. population in 2018 that were military veterans). Texas, California and Florida have the highest numbers of unaccompanied homeless youth under the age of 18, comprising 58% of the total homeless under 18 youth population. New York City reported it had approximately 114,000 temporarily homeless school children.

The presence of unsheltered homeless people living on city streets, particularly in front of businesses and shops has been reported by their owners to affect customers, clients, and workers. Audio deterrents are often used to drive homeless people from these areas.

Health complications are a significant cause for concern for homeless individuals. With a lack of fixed, regular, or adequate residence, hygiene and access to healthy food are unavoidable problems. Due to their particular situation, there is greater exposure to atmospheric conditions, resulting in both cold and heat stress and increased mortality rates. Environmental conditions have become specific causes of raspatory and circulatory diseases among the homeless population.

There have been many efforts on the part of the federal government as well as non-profits and charitable organizations to solve and end homelessness. George Bush in his 2001 campaign made ending chronic homelessness by 2012 part of his Compassion Agenda. Approaches such as Housing First (a model based on the philosophy that housing is a right and asserts that homeless people should be given immediate access to permanent housing) and Rapid Rehousing (a program that involves finding homeless families or individuals houses in the private rental market, covering the first few months of rent for them as a means to eventual permanent housing) is used in catalyzing the journey towards no homelessness.

Employment

Many homeless people in the United States work, both part-time and full time. Employment opportunities can be useful in providing financial stability to homeless individuals, however estimates of unemployment within the homeless population range from 57% to 90%. Programs seeking to help homeless people find and maintain jobs usually focus on individual characteristics of homeless people as barriers (such as addiction and mental illness). However, research done shows that there is also a systemic factors that exclude homeless people from the work force, such as expectations, as well as the overall structure of the labor market. The rise of temporary employment in the modern labor market has made homeless people unable to secure stable employment and income to ensure their ability to afford and maintain a house.

Housing First

The Housing First approach is an evidence based approach that recognizes that housing as one of the most impactful social determinants of health that affect those experiencing homelessness. Housing First has been met with success since its initial implementations in 2009 by providing relatively no strings-attached housing to homeless people with substance use disorder problems or mental health issues. Housing First allows homeless men and women to be taken directly off the street into private community-based apartments, without requiring treatment first. This allows homeless people to return to some sense of normalcy, from which it is believed that they are better-poised to tackle their addictions or sicknesses. The relapse rate through these types of programs is lower than that of conventional homeless programs. The BHH Collective is a program that has implemented the Housing First approach. It began in 2015 as an initiative in Chicago, Illinois, between BHH and University of Illinois Hospital to provide frequent homeless emergency department patients. The housing was paid for by the hospital and federal housing subsidies. The program also provides the individuals with case managers, specialized health services based on the individual's needs, and other services they need. BHH Collective aims to address the connection between housing and health by providing supportive housing to homeless individuals in order to improve the health of homeless people and address homelessness at the same time.

Other Transitional Housing Programs

Studies have been conducted to demonstrate the ability of homeless people to receive and maintain houses and jobs when provided with adequate support. In LA's Homeless Opportunity Providing Employment (HOPE), for homeless adults with mental illness, individual characteristics in regards to specific mental illness or substance abuse struggles played little role in the systemic difference to the employment outcomes, however these factors including race and ethnicity did affect individual housing outcomes.

The provision of housing for homeless people reduces healthcare costs, inpatient hospitalizations, and emergency room costs. When provided with supportive housing, many homeless people are eligible for healthcare coverage. People with housing are less likely to need health services as a stable home provides protection from the elements, prevention from sicknesses, wounds and infections, and a generally safer environment than city streets. This is what Rapid Rehousing programs (RRHP) support. Designed to aid families experiencing homelessness, RRHP provides access to private affordable housing markets for better transition back into stable housing. The three major parts necessary for such a programs success is: finding landlords and appropriate housing' providing move in assistance; providing case management and other support services to ensure the prolonged and eventual permanent rehousing success of each family.

In the early 2000s, the provision of housing for homeless persons was contingent on their treatment and abstinence from addictive substances. However, emerging Permanent supportive housing approaches reversed the requirements and provided homeless people housing without evidence of treatment for mental illness or substance abuse. These interventions are usually paired with case managers and with the inclusion of income assistance programs, there is a significant increase in number of days spent stably housed for participating individuals.

Other permanent housing

Federal and Presidential Efforts

In 2001, President Bush made ending chronic homelessness by 2012 as part of his Compassion Agenda as his campaign promised to fully fund the McKinney Act. The bi-partisan, congressionally mandated, Millennial Housing Commission included ending chronic homelessness in 10 years among its principal recommendations in its Report to Congress in 2002. By 2003, the Interagency Council on Homelessness had been re-engaged and charged with pursuing the President's 10-year plan. On October 1, 2003, the Administration announced the award of over $48 million in grants aimed at serving the needs of the chronically homeless through two initiatives. The "Ending Chronic Homelessness through Employment and Housing" initiative was a collaborative grant offered jointly by HUD and the Department of Labor (DOL). With the focus on providing housing and employment for the homeless population (as it has been chosen as the main problem), there has not been much attention placed on their comprehensive health. Addressing homeless health is difficult in a traditional healthcare setting due to the complex nature of the needs of homeless people and the multitude of health consequences they face. In 2003–04, during the 108th United States Congress meeting, the proposed Bringing America Home Act was intended to provide comprehensive treatment for many homeless mental and substance use disorder patients - it has not been passed or funded.

Under President Obama's administration, a federal strategic plan to end homelessness was released in 2010. This plan created four key goals: Prevent and end homelessness among Veterans in 5 years; Finish the job of ending chronic homelessness in 7 years; Prevent and end homelessness for families, youth, and children in 10 years; Set a path to ending all types of homelessness. Capitalizing on these insights, the Plan built on previous reforms and the intent by the Obama Administration to directly address homelessness through intergovernmental cooperation for not only rehabilitating the homeless population but preventing homelessness to those at high-risk. First Lady Michelle Obama called for the collaboration of mayors, governors, and county officials to commit to ending Veteran homelessness in their communities in 2015 and reached out to additional mayors and local leaders to also participate.

Health

Homelessness is a public welfare and health epidemic within the United States. Any period of homelessness is associated with adverse health consequences. These adverse health consequences are associated with poor living conditions and a lack of access to treatment facilities. Due to living in extreme poverty it is unlikely for an individual or a family to have a healthcare plan. These healthcare plans are important in obtaining treatment for illnesses or injury from treatment facilities. Without it, individuals and families are left to deal with their ailments themselves or endure further financial burden by receiving treatments without a health insurance plan. Respiratory infections and outbreaks of tuberculosis and other aerosol transmitted infections have been reported. Homeless intravenous drug users are at an increased risk of contracting HIV, and hepatitis B and C infections.

The close living spaces of areas such as Skid Row in California provide an environment in which infectious diseases can spread easily. These areas with a high concentration of homeless individuals are dirty environments with little resources for personal hygiene. It was estimated in a report to congress that 35% of homeless were in unsheltered locations not suitable for human habitation.

There is a bidirectional relationship between homelessness and poor health. Homelessness exacts a heavy toll on individuals and the longer individuals experience homelessness, the more likely they are to experience poor health and be at higher risk for premature death. Health conditions, such as substance use and mental illness, can increase people's susceptibility to homelessness. Conversely, homelessness can further cause health issues as they come with constant exposure to environmental threat such as hazards of violence and communicable diseases. Homeless people have disproportionately high rates of poly substance use, mental illness, physical health problems and legal issues/barriers in attaining employment.

Large number of homeless people work but few homeless people are able to generate significant earnings from employment alone. Physical health problems also limit work or daily activities which are barriers to employment. Substance use is positively associated with lower work level but is negatively related to higher work level. Those with physical health problems are substantially more likely than those with mental health problems to be in the more generous disability programs. Substance use disorders are also a barrier to participation in disability programs. Rates of participation in government programs are low, and people with major mental disorders have low participation rate in disability programs.

Mental Illness

Homeless individuals report mental illness as being the third most common reason for becoming or remaining homeless. Such illnesses are often closely linked with the fourth reason—substance use—and therefore it is generally accepted that both of these issues should be treated simultaneously. Although many medical, psychiatric, and counseling services exist to address these needs, it is commonly believed that without the support of reliable and stable housing such treatments remain ineffective. Furthermore, in the absence of a universal healthcare plan, many of those in need cannot afford such services.

A representative sample of homeless youth across multiple US cities found that, in each city, more than 80% of the sampled individuals met criteria for at least one psychiatric diagnosis. Epidemiological studies have found that only about 25–30% of homeless persons have a severe mental illness such as schizophrenia. Early studies, comparing homeless persons found that depression and suicidal thoughts were very prevalent, along with symptoms of trauma and substance abuse.

Comprehensive health care

Comprehensive healthcare usually refers to a form of medical care that meets a patients whole needs through the provision of a wide range of health services. This form of holistic care in relation to homeless people is often difficult for them to access (due to issues of location, stigma, etc.) and difficult for care givers to perform and manage (as a result of the unpredictability of homeless people day to day).

Tailored care approach

As high-risk and socially disadvantaged persons, homeless patients tend require a lot of acute care (short term but active treatment) with poor results. Due to the conditions homelessness creates, acute care and health is difficult to manage and maintain. The Tailored Care approach recognizes the situation of homeless people and seeks to provide specialized care to the homeless community. Studies have found that the tailored approach is good at engaging homeless persons seeking health care for the first time. These health care facilities position themselves in homeless shelters or in areas easily accessible to the homeless population. Some of these health care providers not only provide health services, but also meal kits, on-site showers, transportation, and hygiene kits. This form of holistic and tailored care leads to the reduction in emergency service use and hospitalizations amongst the homeless community.

This approach has been used in the government-sponsored Health Care for the Homeless Model (HCH Model) as well as other . Each HCH project is federally funded and works as federally qualified health centers that work at the intersection of multiple disciplines. These health centers usually provide their patients access to health services such as primary care, mental health services, and addiction services as well as social services such as after-jail services and case management. However, there is no set structure that each health center needs to follow—each health center has the agency to provide a variety of services based on their networks and connections with the local neighborhood, government, or community but are not mandated to do so except for providing primary care.