June 1st, 2010

Study on homelessness offers many insights

As complex and overwhelming an issue as homelessness is, there’s plenty psychologists can do to tackle its separate components and help alleviate the problem. Such were the findings of a report released in February by an APA presidential task force on psychology’s contribution in ending homelessness.

The report, commissioned by James Bray, Ph.D., during his tenure as APA president last year, concludes that psychologists can help on both a one-on-one level – helping to treat substance abuse and other mental health disorders – and by serving as liaisons to community services, whether related to housing, employment or other areas.

In years of working with the homeless, Bray says he found that “many times, they had emotional, psychological and substance abuse issues, and with help, they could become productive citizens again.” This observation inspired him to assemble the task force.

The report’s many recommendations include providing strength-based services to the homeless or people who are at risk of becoming homeless; incorporating a better understanding of homelessness into graduate school programs; and advocating for funding for safe low-income housing and substance abuse treatment programs.

Identifying populations who traditionally face a higher risk of homelessness – including people who have been in jail, those who have had alcohol or substance abuse problems, 18-year-olds aging out of foster care – can be preventative measures, the report says. So can appreciating the broad range of circumstances of the people who may find themselves without homes.

“You really have a wide variety of people who end up on the street and they need different types of interventions,” Bray says. “There are people who may have severe mental illness, veterans who haven’t received proper care, and women and children in poverty. A mother might have to choose between taking her child to a doctor’s appointment and getting fired or keeping her job.”

Job losses and foreclosures in the economic downturn have led to an increase in homelessness. Other more indirect factors noted in the report include foster care placement, which research has shown is a strong predictor of homelessness in adulthood. Though the relationship between the two is complex, intermediating factors may include children in foster care not receiving the mental health treatment they need and continuing to have emotional or behavioral problems as adults. Separation from parents, siblings, and other caregivers can have long-term destabilizing effects as well.

Successful intervention requires a collaborative and comprehensive approach. Policies supporting housing and wraparound services are needed to help keep people from falling back into homelessness, Bray says. Meanwhile, psychologists can help facilitate access to support services in the community. In order to be eligible for welfare benefits, for example, people must provide documentation of a disability that interferes with their ability to work. This documentation must be completed by a health or mental health professional.

“In addition to providing clinical services, psychologists can help people get other services they need, whether employment supports or services rather than unemployment,” says Allison Ponce, Ph.D., assistant professor of psychiatry at the Yale School of Medicine and a task force member.

Psychologists working in conjunction with community organizations may also encourage those who are homeless to receive clinical services. Many poor people do not trust mental health professionals, the report notes, and many with mental health or substance abuse disorders are reluctant to meet in a provider’s office. For these reasons, meeting in a place familiar to the homeless might be vital, especially in the beginning.

“It’s important that services can happen at a coffee shop or a shelter or in other ways that meet people’s needs,” Ponce says.

An important piece of clinical services, the report notes, is building resilience. Fostering positive relationships – with psychologists and among family members – can help boost self-confidence and in turn, boost resilience. Boosting coping mechanisms is another piece.

“Some people have better coping mechanisms than others,” Bray says. Given job loss and even home loss in this economy, solid coping mechanisms and resilience are especially valuable.

A survey of more than 400 psychologists that was included in the report found that while more than 70 percent had done activities related to homelessness such as providing therapy or assessments, or conducting research or fundraising, only 18.7 percent spent at least a few hours a week working with the homeless. Of those who did work with the homeless, 80.5 percent did at least some of the work as a volunteer. While nearly half of those surveyed said that lack of time was an obstacle to getting involved with the homeless, 37 percent said they might do more if they were simply asked.

“We know psychologists are compassionate as a group,” says Beryl Ann Cowan, J.D., Ph.D., a psychologist with Children’s Hospital Boston. “I think they can learn more [about homelessness] and continue to make contributions through volunteer efforts. They can use skills they already have.” A psychologist who is skilled in working with a particular population, for instance, may devote a small amount of time to running a support group, she suggests.

Though on the whole, she adds, “they, like everyone else, need to be paid for their services. But they can advocate, they can provide counseling … there are so many different ways in which they can help.”

By Ami Albernaz

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