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Isolation, Homelessness and Schizophrenia

 Arpita Ghosh

 

Bethany Yeiser, an individual who suffers from schizophrenia, and was homeless for several years said:

“My homelessness was a direct result of untreated schizophrenia…I found comfort in the isolation…But because of untreated schizophrenia, my mind was broken.” (Psych Central, 2021).

Reflecting upon what schizophrenia is will help get an insight into Yeiser’s statement. Schizophrenia is a mental health disorder associated with impairment in daily functioning. Individuals with this disorder may have disorganized speech and behavior, and experience delusions and hallucinations (APA, 2022). Another sign of this disorder is psychosis wherein there is a loss of contact with reality, and an inability to connect with others (Hooley et al., 2021). This inability to form connections with others may lead to feelings of isolation. Feelings of detachment and experience of delusions and hallucinations, among patients with chronic schizophrenia, often lead to homelessness (Eglit et al., 2018). To investigate this, the blog first establishes the relation between chronic schizophrenia and homelessness. Second, it elucidates why individuals with chronic schizophrenia have a greater risk of becoming homeless and why it is especially challenging to treat them. It then focuses on the possible measures to help such patients from becoming homeless.

Building on this, homelessness can be said to be a manifestation of social isolation associated with chronic schizophrenia. Although individuals with other mental health disorders may experience feelings of social isolation, those with chronic schizophrenia are especially prone to it because of the severity of their symptoms (Eglit et al., 2018). Further, there is the clinical concern of social isolation among these patients because they are subject to intense societal discrimination. Additionally, since these patients lack social interaction skills and goal-directed behavior, they are often inefficient at their workplace- which can lead to situations of unemployment and poverty, further worsening the quality of their lives (Hooley et al., 2021; Wible, 2012). Thus, these socio-environmental factors make them more susceptible to homelessness—making them financially incapable of obtaining proper healthcare or housing facilities (Eglit et al., 2018).

Moreover, their experience of social isolation is related to cognitive biases which often make them believe that people around them–friends and family, are motivated to harm them (Cagliostro, 2022). Their psychotic symptoms make them perceive the world differently, which often makes them suspicious of people, making them more likely to avoid people and isolate themselves. Furthermore, such behaviors are often not understood by their family members who are at times unsupportive of them and are likely to abandon them from their homes (Chen et al., 2015). Thus, lack of support from family members serves as a risk factor for homelessness among individuals with chronic schizophrenia.

The absence of familial support and a lack of patients' adherence to treatment conditions are perhaps the two most important reasons that make treatment of these patients extremely difficult (Burra et al., 2009). Additionally, their intense psychotic symptoms contribute to making them unable to benefit from available treatment programs. Since they cannot advocate for themselves or convey their needs because of their disorganized behavior they refuse to seek help from others. Moreover, finding suitable housing facilities for these patients can be challenging as they are often reluctant to go to the housing centers or receive treatment because of their previous unpleasant experiences in such places. Furthermore, individuals with schizophrenia, released from prison are at a greater risk of becoming homeless which in turn makes them more prone to substance abuse, further exacerbating the severity of their symptoms (Hooley et al., 2021; Kushel et al., 2005). These reasons thus explicate why schizophrenia is difficult to treat among these patients and is often linked to poor prognosis, and improper symptom management.

            Understanding the challenges in treating patients with chronic schizophrenia who become homeless, may help in generating policies that can perhaps prevent them from reaching this state of homelessness, and help in their recovery. Although healthcare and financial policies have been made to help these patients, several loopholes exist in them which make homelessness among patients with chronic schizophrenia a persisting problem. As discussed above, the housing centers may not be the best places for several patients, because of the prevalence of their discriminatory treatment. Thus, a stepping stone toward making these programs more effective would be to generate awareness among the public and caregivers about the high risk of homelessness among patients with schizophrenia. Healthcare and housing centers must destigmatize themselves about this disorder and be sufficiently equipped to treat them in a way that does not infantilize them or make them feel incapable of performing daily tasks. Further, the financial policies in place for these patients often cannot be used by them because applying for such schemes is difficult (Bailey et al., 2016). Policymakers must amend their policies to make such financial schemes more accessible to these patients. This can perhaps be done if the government establishes a body of trained volunteers who can assist these patients who become homeless, with chores like making their identity cards, and bank accounts, and helping them withdraw money. This can help these patients regain their lost self-esteem and realize that they too have the right to be integrated into society and can function like any other human being. Lastly, awareness campaigns for patients’ family members are imperative to help them understand the condition of their loved ones which can perhaps prevent them from being unsupportive of them and abandoning them.

            In conclusion, this blog aimed to unpack the association between chronic schizophrenia, which often leads to homelessness. This state of becoming homeless stems from their feelings of social isolation, not just because of their delusional thoughts, but also because of the discriminatory treatment they receive from their family and health caregivers. This coupled with other reasons makes their treatment even more difficult. Hence, spreading awareness about these patients among their family members, healthcare providers, and policymakers through educational campaigns can change the way in which they are treated, bring forth structural reformation in policies, and develop effective treatment plans to help them efficiently.

 

References

American Psychological Association. (2022). Schizophrenia. American Psychological Association. https://www.apa.org/topics/schizophrenia

Bailey, M. S., Engler, D. G., & Hemmeter, J. (2016). Homeless with Schizophrenia Presumptive Disability Pilot Evaluation. Social Security. Retrieved March 29, 2022, from https://www.ssa.gov/policy/docs/ssb/v76n1/v76n1p1.html

Burra, T. A., Stergiopoulos, V., & Rourke, S. B. (2009). A Systematic Review Of Cognitive Deficits In Homeless Adults: Implications For Service Delivery. The Canadian Journal of Psychiatry, 54(2), 123–133. https://doi.org/10.1177/070674370905400210

Cagliostro, D. (2022). Paranoid Schizophrenia: Overview of Causes, Symptoms, & Treatments. Psycom.net. https://www.psycom.net/paranoid-schizophrenia

Chen, I.M., Wu, K. C.C., Chien, Y.L., Chen, Y.H., & Lee, S.T. (2015). Missing Link In Community Psychiatry: When A Patient With Schizophrenia Was Expelled From Her Home. Journal of the Formosan Medical Association, 114(6), 553–557. https://doi.org/10.1016/j.jfma.2012.05.001 

Eglit, G., Palmer, B. W., Martin, A. S., Tu, X., & Jeste, D. V. (2018). Loneliness In Schizophrenia: Construct Clarification, Measurement, And Clinical Relevance. PloS One, 13(3), e0194021. https://doi.org/10.1371/journal.pone.0194021

Hooley, J. M., Nock, M. K., & Butcher, J. N. (2021). Abnormal Psychology (18th ed.). Pearson.

Kushel, M. B., Hahn, J. A., Evans, J. L., Bangsberg, D. R., & Moss, A. R. (2005). Revolving doors: imprisonment among the homeless and marginally housed population. American Journal Of Public Health, 95(10), 1747–1752. https://doi.org/10.2105/AJPH.2005.065094

The Gazette Of India. (2017). The Mental Healthcare Act, 2017 No. 10 Of 2017. An Act To Provide For Mental Healthcare And Services For Persons With Mental Illness. e-Gazette. https://egazette.nic.in/WriteReadData/2017/175248.pdf

Price, M. (2009). More Than Shelter. American Psychological Association. https://www.apa.org/monitor/2009/12/shelter

Psych Central. (2021). Inside Schizophrenia Podcast: Homelessness - A Symptom of Schizophrenia. Psych Central. https://psychcentral.com/blog/is/podcast-homelessness-a-symptom-of-schizophrenia#Episode-Transcript

Tracy, N. (2021). Why Schizophrenia Patients Are Difficult to Treat. HealthyPlace. https://www.healthyplace.com/thought-disorders/schizophrenia-treatment/why-schizophrenia-patients-are-difficult-to-treat

Wible C. G. (2012). Schizophrenia As A Disorder Of Social Communication. Schizophrenia Research And Treatment. https://doi.org/10.1155/2012/920485

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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