Affordable Housing, Homelessness, and Mental Health: What Heath Care Policy Needs to Address

By Martin, Edward J. | Journal of Health and Human Services Administration, Summer 2015 | Go to article overview

Affordable Housing, Homelessness, and Mental Health: What Heath Care Policy Needs to Address


Martin, Edward J., Journal of Health and Human Services Administration


INTRODUCTION

The United States economic crisis has deeply affected the lives of millions of Americans. This has resulted in pay reductions, job layoffs, bankruptcies, and skyrocketing foreclosures, which have plunged many families and individuals into severe economic hardship, particularly those living in low-income communities. As such, deepening poverty is inextricably linked with rising levels of homelessness for many Americans. In contrast to the popular "skid row" stereotype that the word "homeless" tends to trigger, many are in fact families and young single people. Still, the vast majority of homeless persons in the United States are those who suffer from mental health issues. Yet within this context the new health care legislation - Patient Protection Affordable Care Act of 2010 (ACA) - lacks any significant policy remedy with regard to mental health and homelessness.

One of the leading causes of homelessness in the United States is the result of chronic mental health disorders suffered by the severely mentally ill (SMI). People with untreated psychiatric illnesses comprise one-third, or 250,000, of the estimated 744,000 homeless population in the United States (USDHHS, 2012; USDHUD, 2010; National Alliance to End Homelessness, 2009). Among these, approximately two-thirds were single persons and one-third families. One-quarter of the homeless were chronically homeless while one-third have a serious mental illness, mostly schizophrenia or a bi-polar disorder. The quality of life for these individuals is clearly in question and many are victimized on a regular basis. At the present, the ACA has failed to address this concern, that is, mental illness and its relationship to homelessness. Missing from the ACA are public health services for the homeless that should provide a range of services such as, diagnosis, medication, alcohol and drug treatment, and hospitalization. All of this is compounded by the political-economic problem of inadequate and unaffordable housing.

HEALTHCARE POLICY

The annual expenditures from public and private sources for health care amount to one in every seven dollars of the gross domestic product (GDP). Americans each year spend more on health care than on national defense, more per capita for health care than for automobiles and gasoline combined (USDHHS, 2012). Suffice it to say, health and medicine are basic concerns of American citizens. Thus health care policy is fundamental to human well-being and economic stability because the resources and attention given to health care, the institutions that deliver it, and the way it is received affect the shape of social relations by providing affordable health care or incurring costs to the public which could otherwise be avoided. This is why the same perplexing logic that characterizes the policies of poverty and homelessness also plagues health care policy. Indeed, the interrelated issues and outcomes that exist between poverty, homelessness and mental health make it essential that they be considered together when discussed in terms of public policy. Consequently, health care policy and homelessness are closely linked for two reasons: first, the high cost of health care serves as one of the primary contributors to poverty or low income for many Americans, and second, the poor and the aged are more likely than the rest of the population to be afflicted with illness and high medical expenses. However, the goals and priorities of affordable and accessible health care, and affordable and accessible housing are in conflict with each other, precisely because one goal arguably, precludes the pursuit of others.

Prior to the passage of the ACA, the traditional American health care system was a mix of public and private institutions with little central planning or coordination. At the highest level of the health care profession--among physicians, dentists, psychiatrists, and psychologists - fee for service (FFS) practice has been the general rule for purchasing health care either out-of-pocket or through private insurance. …

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