Schizophrenia and homelessness: What's the link?

Why is schizophrenia so prevalent in the homeless community?

There are many contributing factors to the increased rate of schizophrenia within the homeless population. Symptoms like hallucinations and delusions can make it difficult to live with family or maintain normal jobs. Additionally, there are some societal factors at play.

One key to the link between schizophrenia and homelessness is inadequate access to mental health services. A lack of resources, coupled with the stigma surrounding mental illness, prevents individuals with schizophrenia from receiving the support they need, which increases their risk of homelessness. ^[2]

This is exacerbated by the withdrawal and social isolation that is common with schizophrenia. Without a close network of supportive family and friends, individuals may never get treatment or even the proper diagnosis. ^[1] Furthermore, losing their support network means they don’t have the same access to financial and housing support.

Schizophrenia can significantly decrease an individual's ability to maintain employment due to cognitive impairment, difficulty with concentration, and erratic behavior. ^[5] Loss of employment and financial hardship may lead to housing instability, eviction, and eventual homelessness.

Substance abuse frequently co-occurs with schizophrenia, which further increases the risk of homelessness in this population. ^[1] Together, schizophrenia and addiction can make it even harder to hold down a job or a stable place of housing.

The consequences of homelessness in individuals with schizophrenia

Homelessness among individuals with schizophrenia is problematic as this population has an increased risk of negative outcomes. They are likely to have a very low quality of life and to contribute to problems within the community. ^[1] They also have an increased risk of crime victimization, drug abuse, and even mortality.

Individuals with schizophrenia are more likely to become victims of crime than other unhoused individuals. One study found that homeless men with psychosis had an increased risk of being threatened, robbed, assaulted, and injured. ^[5] Unhoused women with schizophrenia were more likely to be raped or sexually assaulted than those without the disorder. ^[5]

Additionally, this population has an increased risk of death, from various causes. Homeless individuals with schizophrenia are more likely to be victims of homicide. ^[5] They also have an increased risk of suicide, fatal accidents, and even freezing to death while living on the streets. ^[5]

Heart disease is also more common among individuals with schizophrenia and is more likely to go untreated among the homeless, which is another cause of this increased risk of death. ^[2]

What's the solution?

Clearly, action is needed to help this community. While there is no perfect solution to decreasing the number of people with schizophrenia living without homes, there are several proposed strategies that have seen promising results in the existing body of research.

One proposed solution that has seen promising results in initial studies is a program called Recovery After an Initial Schizophrenic Episode (RAISE). This early intervention treats individuals during or immediately after their first psychotic episode, using holistic methods with less of an emphasis on medication than traditional treatments. ^[3]

An early evaluation of RAISE found that individuals who went through this program were more likely to retain housing, employment, and overall outcomes, compared to the general schizophrenic population. ^[3]

Supportive housing programs offer another promising solution. These programs are designed to provide stable homes, case management services, and access to mental health treatment. Research has found that these programs can significantly improve outcomes for individuals with schizophrenia and increase housing stability. ^[4]

Overall, these solutions present proven paths to decrease homelessness in the schizophrenic population, while also significantly improving quality of life. While these interventions can be costly, they are expected to decrease expenses in the long term by reducing hospital stays, emergency room visits, and justice system costs. ^[3]