homelessness and mental health homelessness and mental health in a study in western societies, homeless people have a higher prevalence of mental illness when compared to the general population. they also are more likely to suffer from alcoholism and drug dependency. it is estimated that 20–25% of homeless people, compared with 6% of the non-homeless, have severe mental illness. others estimate that up to one-third of the homeless have a mental illness. in january 2015, the most extensive survey ever undertaken found 564,708 people were homeless on a given night in the united states. depending on the age group in question and how homelessness is defined, the consensus estimate as of 2014 was that, at minimum, 25% of the american homeless—140,000 individuals—were seriously mentally ill at any given point in time. 45% percent of the homeless—250,000 individuals—had any mental illness. more would be labeled homeless if these were annual counts rather than point-in-time counts. being chronically homeless also means that people with mental illnesses are more likely to experience catastrophic health crises requiring medical intervention or resulting in institutionalization within the criminal justice system. majority of the homeless population do not have a mental illness. although there is no correlation between homelessness and mental health, those who are dealing with homelessness are struggling with psychological and emotional distress. the substance abuse and mental health services administration conducted a study and found that in 2010, 26.2 percent of sheltered homeless people had a severe mental illness. nikes and homeless studies have found that there is a correlation between homelessness and incarceration. those with mental illness or substance abuse problems were found to be incarcerated at a higher frequency than the general population. fischer and breakey have identified the chronically mentally ill as one of the four main subtypes of homeless persons; the others being the street people, chronic alcoholics, and the situationally distressed. the first documented case of a psychiatrist addressing the issue of homelessness and mental health was in 1906 by karl wilmanns. historical context united states in the united states, there are broad patterns of reform within the history of psychiatric care for persons with mental illness.: 11 these patterns are currently categorized into three major cycles of reform. the first recognized cycle was the emergence of moral treatment and asylums, the second consists of the mental hygiene movement and the psychopathic (state) hospital, and most recent cycle includes deinstitutionalization and community mental health.: 727 in an article addressing the historical developments and reforms of treatment for the mentally ill, joseph morrissey and howard goldman acknowledge the current regression of public social welfare for mentally ill populations. they specifically state that the "historical forces that led to the transinstitutionalization of the mentally ill from almshouses to the state mental hospitals in the nineteenth and twentieth centuries have now been reversed in the aftermath of recent deinstitutionalization policies".: 12 asylums further information: greyhound therapy within the context of transforming schemas of moral treatment during the early nineteenth century, the humanitarian focus of public intervention was linked with the establishment of asylums or snake pits for treatment of the mentally ill.: 727 the ideology that emerged in europe disseminated to america, in the form of a social reformation based on the belief that new cases of insanity could be treated by isolating the ill into "small, pastoral asylums" for humane treatment. these asylums were meant to combine medical attention, occupational therapy, socialization activities and religious support, all in a warm environment. in america, friends asylum (1817) and the hartford retreat (1824) were among the first asylums within the private sector, yet public asylums were soon encouraged, with dorothea dix as one of its key lobbyists. the effectiveness of asylums was dependent on a collection of structural and external conditions, conditions that proponents began to recognize were unfeasible to maintain around the mid-nineteenth century. for example, with the proliferation of immigrants throughout industrialization, the original purpose of asylums as small facilities transformed into their actualized use as "large, custodial institutions" throughout the late 1840s.: 15 overcrowding severely inhibited the therapeutic capacity, inciting a political reassessment period about alternatives to asylums around the 1870s. the legislative purpose of state asylums soon met the role society had funneled them toward; they primarily became institutions for community protection, with treatment secondary. deinstitutionalization toward the end of world war ii, the influx of soldiers diagnosed with "war neurosis" incited a new public interest in community care. in addition to this, the view that asylums and state hospitals exacerbated symptoms of mental illness by being "inherently dehumanizing and antitherapeutic" spread through the public consciousness. when psychiatric drugs like neuroleptics stabilized behavior and milieu therapy proved effective, state hospitals began discharging patients, with hope that federal programs and community support would counterbalance the effects of institutionalization. furthermore, economic responsibility for disabled people began to shift, as religious and non-profit organization assumed the role of supplying basic needs.: 10 the modern results of deinstitutionalization show the dissonance between policy expectations and the actualized reality.: 60–61 community mental health centers in response to the flaws of deinstitutionalization, a reform movement reframed the context of the chronically mentally ill within the lens of public health and social welfare problems. policy makers intentionally circumvented state mental hospitals by allocating federal funds directly to local agencies. for example, the community mental health centers (cmhc) act of 1963 became law, "which funded the construction and staffing of hundreds of federal centers to provide a range of services including partial hospitalization, emergency care, consultation, and treatment." despite efforts, newly founded community centers "failed to meet the needs of acute and chronic patients discharged in increasing numbers from public hospitals". with decreased state collaboration and federal funding for social welfare, community centers essentially proved unable "to provide many essential programs and benefits", resulting in a growth of homelessness and indigency, or lack of access to basic necessities. it is argued that an over reliance on community health has "left thousands of former patients homeless or living in substandard housing, often without treatment, supervision or social support.": 727–728 state mental hospitals as debates regarding the deteriorating role of american asylums and psychiatry amplified around the turn of the century, new reformation arose. with the founding of the national committee for mental hygiene, acute treatment centers like psychopathic hospitals, psychiatric dispensaries and child guidance clinics were created. beginning with the state care act in new york, states began assuming full financial control for the mentally ill, in an effort to compensate for the deprivations of asylums. between 1903 and 1950, the number of patients in state mental hospitals went from 150,000 to 512,000. morrissey recognizes that despite persistent problem of chronic mental illness, these state mental hospitals were able to provide a minimal level of care.: 20 united states president john f. kennedy signed the community mental health act that was put in place to give funding for community-based facilities rather than having patients going to state hospitals. decades later, once the community mental health act was implemented a lot of state hospitals suffered and were on the verge of forced to close which pushed patients to the community-based facilities. the closures of the state hospitals lead to an overcrowding in the community facilities and there was a lack of support, which lead to patients not having access to the medical help they needed. personal factors neurobiological determinants the mental health of homeless populations is significantly worse than the general population, with the prevalence of mental disorders up to four times higher in the former.: 465 it is also found that psychopathology and substance abuse often exist before the onset of homelessness, supporting the finding that mental disorders are a strong risk factor for homelessness.: 470 ongoing issues with mental disorders such as affective and anxiety disorders, substance abuse and schizophrenia are elevated for the homeless.: 465 : 82 one explanation for homelessness states that "mental illness or alcohol and drug abuse render individuals unable to maintain permanent housing.": 114 one study further states that 10–20 percent of homeless populations have a dual diagnoses, or the co-existence of substance abuse and of another severe mental disorder. for example, in germany there is a link between alcohol dependence and schizophrenia with homeless populations.: 85 trauma there are patterns of biographical experience that are linked with subsequent mental health problems and pathways into homelessness.: 465 martens states that reported childhood experiences, described as "feeling unloved in childhood, adverse childhood experiences, and general unhappiness in childhood" seem to become "powerful risk factors" for adult homelessness. for example, martens emphasizes the salient dimension of familial and residential instability, as he describes the prevalence of foster-care or group home placement for homeless adolescents. he notes that "58 percent of homeless adolescents had experienced some kind of out-of-home placement, running away, or early departure from home.": 82 moreover, up to 50 percent of homeless adolescents report experience with physical abuse, and almost one-third report sexual abuse.: 465 in addition to family conflict and abuse, early exposure to factors like poverty, housing instability, and alcohol and drug use all increase one's vulnerability to homelessness. once impoverished, the social dimension of homelessness manifests from "long exposure to demoralizing relationships and unequal opportunities.": 81 trauma and homeless youth youth experiencing homelessness are more susceptible to developing post-traumatic stress disorder (ptsd). common psychological traumas experienced by homeless youth include, sexual victimization, neglect, experiences of violence, and abuse. in an article published by homeless policy research institute it notes that homeless youth are subjected to many different forms of trauma. a study was done and found that 80% of youth that experienced homelessness in los angeles suffered at least one traumatic experience. another study was conducted in canada that showed a more severe statistic that canadian homeless youth have been through 11 to 12 traumatic experiences. while trauma is prevalent in homeless youth, it is not uncommon for an adolescent to experience an increase of trauma after they experience homelessness. the lgbtq community represents 20% of the homeless youth population. the reason for this high percentage is due to the issues and/or rejection from their family due to the sexual orientation. societal factors draine et al. emphasize the role of social disadvantage with manifestations of mental illness. he states that "research on mental illness in relation to social problems such as crime, unemployment, and homelessness often ignores the broader social context in which mental illness is embedded.": 566 stigma lee argues that societal conceptualizations of homelessness and poverty can be juxtaposed, leading to different manifestations of public stigma. in his work through national and local surveys, respondents tended to deemphasize individual deficits over "structural forces and bad luck" for homeless individuals. in contrast, the respondents tended to associate personal failures more to the impoverished than homeless individuals.: 511 nonetheless, homeless individuals are "well aware of the negative traits imputed to them – lazy, filthy, irresponsible dangerous – based on the homeless label." in an effort to cope with the emotional threat of stigma, homeless individuals may rely on one another for "non-judgmental socializing". however, his work continues to emphasize that the mentally ill homeless are often deprived of social networks like this.: 508 social isolation people who are homeless tend to be socially isolated, which contributes negatively to their mental health. studies have correlated that those who are homeless and have a strong support group tend to be more physically and mentally healthy. aside from the stigma received by the homeless population, another aspect that contributes to social isolation is the purposeful avoidance of social opportunity practiced by the homeless community out of shame of revealing their current homeless state. social isolation ties directly to social stigma in that homeless socialization outside of the homeless community will affect how the homeless are perceived. this is why homeless individuals talking with those who are not homeless is encouraged since it can combat the stigma that is often associated with homelessness. racial inequality one dimension of the american homeless is the skewed proportion of minorities. in a sample taken from los angeles, 68 percent of the homeless men were african american. in contrast, the netherlands sample had 42 percent dutch, with 58 percent of the homeless population from other nationalities.: 89 furthermore, lee notes that minorities have a heightened