The callous nature and the lack of empathy social media displayed circulating images of Heather walking around naked was disturbing. After some soul searching, I decided to drill down on Mental Health and Homelessness. What cannot be disputed is that the pandemic has placed a tremendous stress on the psyche of the youth and young adults in our society. The lack of class time, coupled with being cut off from afterschool socializing activities along with the ‘hard guava crop’ (economic downturn) we are experiencing has led to an increase in the number of incidents of anxiety and depression in the population. Evidence has shown that if left untreated mental health problems interfere with learning, self-esteem, education and socialization. This silent epidemic can have lifelong repercussions and at times lead to homelessness and death.
There are many false assumptions about mental health issues that coincidently frame it in a bad light and create stigma. According to CMHA “Mental illness is a disturbance in thoughts and emotions that decreases a person’s capacity to cope with the challenges of everyday life”. Therefore, when someone is perplexed and unable to cope, we need to stand up and help. One of the tenets of community development is UJIMA: “to build and maintain our community together and make our brothers and sisters problems our problems and to solve them together”. If we coalesced around Heather during her disturbance and became her ‘keeper’ by humanizing her challenges instead of parading her as a caricature to poke fun at, we would become part of the solution addressing our community psychological and emotional well-being.
It is well known that the general population is wary of individuals suffering with mental health issues and views them as non contributors to society. A majority of the population believe the following about mental health patients: they are dangerous and violent, they lack intelligence or are developmentally handicapped, they cannot hold a job, they lack will power or are lazy and weak, they are unpredictable and cannot be trusted, and finally, mental health patients are to blame for their circumstances and they need to shape up. Notwithstanding all of the above, they are still someone’s son, or daughter, or father, or mother.
Gunn explained “We are all aware that the very existence of mental illness has been challenged and that definitions are extremely difficult to formulate…yet most of us believe that somewhere in the confusion there is a biological reality of mental disorder, and that this reality is a complex mixture of diverse conditions, some organic, some functional, some inherited, some learned, and some acquired, some curable, others unremitting. It would be surprising if such a combination had a clear-cut relationship with any social parameter, especially one which is arbitrarily determined by legislation”.
Historically, individuals with mental illness were institutionalized in prisons, psychiatric or other long-term health facilities. With the realization that the mentally ill fundamentally suffer from “clinically significant patterns of behavioral or emotional functioning that are associated with some level of distress, suffering … or impairment in one or more areas of functioning e.g., work school, social and family interactions”, a progressive policy of deinstitutionalization began in the early 1960s, which resulted in a steep decline in hospitalized (locked in) populations. It is often erroneously reported that the policy of deinstitutionalization has led to a rise in homelessness.
The debate over whether homelessness is a “pathway” to mental illness and substance abuse, or mental illness and substance abuse are “pathways” to homelessness is still raging. From my lens mental health and homelessness are correlated and together are part of a social epidemic that leads to perpetual poverty. Research has shown that 66% of homeless persons have a lifetime diagnosis of mental illness. Their plight, enveloped in inappropriate labelling, stigma and marginalization have overwhelm them without any semblance of compassion or empathy. Such derision should trigger concern. Approximately half of all people who suffer from mental illness are probably suffering from concurrent mental disorders according to the experts. In the UK, Canada, the USA and much of the developed world, mental disorders are the leading cause of disability among people aged 15 to 44. I presume the demographic range in similar in the Caribbean.
I interviewed a number of social work practitioners to ascertain why the increase in mental health occurrences during the pandemic. The following statement by Afiya Hypolite encapsulated the reason for the upward trend. She stated that “a common thread in her debriefs is the internalization and suppression of childhood trauma and since mental health is fused with cognitive behaviour and emotional well-being when individuals are less active and their routines are disrupted, anxiety and depression overwhelm them, resulting in disturbance in thoughts and actions”. With such reasoning as a backdrop, we must strive to have structured programs and offer a hand to the afflicted.
The problematic videos of Heather highlighted how the media helps to reinforce the stereotypes of mental illness in society. The media portrays mental health patients in a plethora of ways, as homicidal maniacs to be feared, childlike to be protected by parental figures, rebellious, free spirited; violent seductress, narcissistic parasite, mad scientist, sly manipulator; helpless/depressed female, and comedic relief. Research of a seventeen-year sample of television content revealed that more than 70% of mentally ill characters in primetime drama were depicted as violent and over 20% of them killed someone.
In addition to problematic portrayals in the broadcast media, the majority of newspaper stories of mental illness in North America associate psychiatric illness with violence, crime, danger and unpredictability. “In children’s television programs they are described as crazy, mad, nuts, wacky, loony unacceptable and funny”. However, in actuality, someone with mental illness is much more likely to be a victim rather than a perpetrator of violence. Calling the actions of violent offenders’ “crazy” spreads a dangerous stereotype and belies the complex relationship between criminality and mental illness.
Yet, the spawned narrative that mental health, homelessness, drug abuse and violence co-habit dark corners of society as an underbelly of an interdependent ecological subsystem is farfetched. Public Health Agency of Canada states “In order for mental illness to cause violence, it must precede it. In order to infer causality from empirical evidence, therefore, a clear temporal ordering of events must be established” I think they are saying that mental health violence is an outward projection by the individual of a learnt behavior of abuse perpetuated by the community. Therefore, their actions are a reflection of the population. There are times when people with mental illnesses commit acts of violence. More often that not the following risk factors: substance abuse or dependence; a history of violence, juvenile detention, or physical abuse; and recent stressors such as being a crime victim, getting divorced, or losing a job can all precipitate violence in all humans.
The homeless population is difficult to research because of its transient nature. However, homelessness has grown in size and complexity in current years. Historically known as a crisis only of urban centers the increasing occurrence of homelessness extends to suburban and rural areas. The demographic profile of homeless population is also changing. While in the past men used to encompass the vast majority of homeless persons, now women and children represent the fastest growing subgroup of the homeless population, followed by youth. In recent years homelessness has become a major political issue. Homelessness and change are now an evolving constant along a social continuum. In developed countries as the safety net is reduced, individuals fall through the crack and homelessness becomes the norm. In developing countries where safety nets are marginal or none existent squatting communities become prevalent.
In Canada, The Housing First model was a move towards ending the huge social issue of homelessness and helping people get back into community life. Basically, the project tried to decipher whether or not a person with mental illness can better concentrate on personal issues if they have a place to live. The overall goal was to provide evidence about what services and systems could best help people who are living with a mental illness and are homeless. At the same time, the project provided meaningful and practical support for hundreds of vulnerable people. This type of re-entry program is paramount in creating second chance opportunities for the displaced. The notion that mental health patients and homeless people are without scruples and are not yearning for a better life is debunked. The following testimonial from a re-entry participant speaks volume. “Just the small things I have found have been the biggest reward to come out of changing my life, not having to worry where my next meal is coming from and having clean clothes every day without any of the hassles involved of my old life, doing things like taking the dog for a walk to get the morning paper and some fresh bread for breakfast are the highlights of my week now”.
Social policies, institutional records, societal views and ideologies tend to conceal what is going on in society and consequently contribute to the demonization of mental illness and homelessness. Framing mental illness in a negative light subjugates the affected and classified them objectively as subalterns. Current policies, practices, and the stigma and pressures attached to mental health all contribute to homelessness. The National Association of State Mental Health Program Directors states “Persons with severe mental illness have a life expectancy 25 years shorter than the general population, their lives cut short more often by cardiovascular diseases and other health problems than by suicide and injuries”. Kessler further states that “multiple co-morbidities stemming from poor access to medical care, and the side effects of powerful antipsychotic medications” are also factors in reducing life expectancy. “People with severe mental illness are also at a greater risk for substance abuse due to the societal pressures than those without a mental illness. About ½ of all individuals who have a severe mental illness will develop a substance abuse disorder in their life time”. This hand and glove analogy of mental health, homelessness and addiction forces society at large to realize the dependency that inundates this community.
A policy shift to focusing on skills development within a community’s mental health disabilities context will impart skills that persons like Heather need to participate and succeed in the job market and to maximize their potential and independence. If giving a fighting chance the afflicted can persevere. A concerted approach to tracking people who live at the margins is required to assure that fiscal macro governmental responsibilities do not endanger the less fortunate and continually place a face on these illnesses and displacement.
In order to build and maintain our community together, we must take a path towards an outcome of changing minds and shifting lenses to visualize mental illness and homelessness as functional disabilities. We must reframe and address this social issue on a micro level through insular communities. From a practical perspective, the adoption of a Community Resource Base model that incorporates the following basic principles: consumer participation in mental health policy development, system planning, and evaluation; a focus on community involvement and integration; a balancing of resources between formal services and other kinds of supports; the need for strategies to address stigma and other factors that keep people with mental illnesses from being full members of their communities; and outcome measurement and research that reflect the needs and contributions of all stakeholders that helps to ensure services are delivered according to a “best practice” approach .