Saturday, May 19, 2007

The Homeless, Dispelling the Myths

I attended Psychiatry Grand Rounds a few weeks ago for a talk by Dr. Carole North, a psychiatrist who is probably most famous as an epidemiologist. She has done several studies looking at the homeless population.
I won't go through every aspect of her talk, but will provide a few fun facts here:

Substance abuse accounts for most of the mental illness in the homeless population. It is also hypothesized that increased rates, since 1980, of bipolar disorder and schizophrenia may be related to the effects of continued use of crack cocaine.

The rate of non-substance abuse mental illness in the homeless population is not nearly as high ("50% of the homeless are schizophrenics!") as is commonly thought. The rate of schizophrenia is around 6% - schizophrenia affects around 1% of the general population. In 1990 in St. Louis, depression was highest, but even this was related to what Dr. North termed 'misery' - higher in men, and most likely associated with having to be out in the elements on days of harsh weather.

African-American men who are homeless are more likely to be younger, have jobs, and still make less income than Caucasian men who are homeless.

Women are most likely (around 20%) to be homeless because of family conflicts.

Of those who are substance abusers, most use cocaine (including crack), and they typically do not use money from government assistance or income from jobs to buy drugs. No, by a large percentage, they use the money they get from panhandling, and in some cases make up a disproportionate number of panhandlers. So know that when you give money to panhandlers, there's a good chance it will be used to buy drugs. As Dr. North stated at the end of her talk, she gives money to shelters and other services for the homeless, but not to panhandlers.

Only two people, out of nearly 900 in one of her studies, said that they chose to be homeless.


Pseudo-Iamblichus said...

That last statistic was a bit of a shock: 2 out of 900.

There but for the grace of God go I...

Fr. Greg said...

While I have no reason to doubt this information as far as it goes, my experience with the homeless, and with substance abusers as a separate category, indicates that the relationship between mental illness and substance abuse/addiction is not as straightforward as implied. It seems that many folks who end up abusing alcohol, crack, and/or other substances, are already experiencing mental health issues when they begin to experiment with drugs, thus leading to a vicious circle. Also, because of the "misery" of homelessness, it, in and of itself, can provide a strong inducement to begin or exascerbate substance abuse, especially in someone whose mental and emotional resources are already over-taxed.

AG said...

Fr. Greg,

You have pointed out a problem with Dr. North's studies that she will also admit to: because she is using self-report surveys, she has no way of teasing out apparent non-substance abuse mental illness from that caused by substance abuse, and vice versa. Her studies, while showing correlations, do not allow for analysis of causation.

In future science posts, I hope to address issues of proclivity to substance abuse and dependence, co-morbidity between substance dependence and other mental illnesses, and so forth. A stat I left out was that a plurality of the men from her study in the early 90s DID give substance abuse as the primary reason for their homelessness.

Fr. Greg said...


I look forward to reading the future posts you propose. In my experience, substance abuse/addiction never takes place in a vacuum. A treatment center chaplain I used to know, himself in recovery from alcoholism, stated, "One is always codependent before one becomes an addict." While I do not necessarily agree with THAT particular "diagnosis" of all pre-addicts, there does always seem to be SOMETHING that predisposes to substance abuse problems, even if, at some point, SA becomes the primary identified problem, by self or others, becoming the issue which needs to be addressed before it is possible to address the other problems present.