On the Periphery: Homelessness, Health, and Hope

Homeless
/ˈhōmləs/

1. having no home or permanent place of residence; condition of lacking stable, safe, and adequate housing.

Homelessness in the United States of America

According to Maslow’s Hierarchy of Needs, shelter falls into the category of physiological needs – the most basic and fundamental things required for humans to survive. Shelter is of vital importance and a significant piece of the puzzle when considering the well-being of the mind, body, and spirit. Due to the essentiality of housing, of concern is the increasing unaffordability of shelter, interfaced with the reality touted by the Department of Housing and Urban Development (HUD) which is that as of 2022, at least 582,000 Americans were unhoused, an increase of 2,000 people since 2020. Being without a home is a problem that is increasingly on the rise, especially with the costs to be housed at an all-time high.

Homelessness and Health

Just above physiological needs in Maslow’s Hierarchy are safety needs, inclusive of health. Health challenges among the unhoused are prevalent due to:

• Daily Activities—Some individuals who are unhoused live under circumstances that pose particular problems for developing a treatment plan. For many, it may be difficult to keep a supply of medication while living on the street. For an alcoholic trying to stay sober, a homeless existence may present too many opportunities for drinking. Some former patients complain that neuroleptic medications, prescribed for a schizophrenic illness, may make them too drowsy and interfere with their alertness against the dangers on the streets.
• Multiplicity of Needs—In addition to physical and mental health problems and difficulties with such things as housing and income maintenance, those who are unhoused also suffer from drug or alcohol abuse. Any health care program for homeless adults should expect that 25 to 40 percent of patients will suffer from serious alcohol or drug abuse problems (Fischer and Breakey, 1986).
• Disaffiliation—Although many without homes establish individual support networks outside a family structure, some lack those networks that enable most people to sustain themselves in society. Such isolation often causes (and sometimes is caused by) a limited capacity to establish supportive relationships with other people. Difficulties in establishing and maintaining relationships can work against the development of cooperation with health care providers and may be an important factor in explaining what is often inaccurately described as a "lack of motivation."
• Distrust—In addition to distrust of authority, some who are unhoused are disenchanted with health and mental health care providers. Some have had bad experiences with medications, hospitals, doctors, and other human service professionals and are leery of further involvement.

Homelessness and the Periphery

While being unhoused is an issue with respect to accessibility, covering, and health, in addition to lack of physical location, those without homes exist on or outside of the periphery of society as well. Homelessness does not just encompass the absence of a set place of residence, but also carries and falls into a category often labeled as, “less than,” by a society which does not just include the unhoused, but the impoverished, incarcerated, etc. Bridget Deschenes states, “People experiencing homelessness are often marginalized. This stems from a power differential between those that have housing, and those who do not.” This power differential shows up in a way that enforces democracy working against the unhoused, instead of for. The invisible line drawn in the sand between those with shelter and those without shows up in housing, health, career, community, accessibility, decision-making, family, equity, and much more.

In order to decrease the divide, we must consider implementing interventions that have the ability to help rather than harm. Those interventions are inclusive of, but not limited to: housing, income/rental assistance, harm reduction, sensitivity training, access to clinics, mental health support, support networks, etc. Also, it is important that as a society, we move from a system-centered approach to a person-centered approach. A system-centered approach reinforces the unhoused on the periphery which is marginalization, particularly if mistakes are punitive in nature and cause continued homelessness and/or marginalization. A person-centered approach assists people in moving beyond being unhoused in a way that ideally lessens disenfranchisement and perhaps even creates space and intentional opportunity for recovery.

As we close in on the 2023 holiday season where people often think more about those who are unhoused, provide blessing bags, help out in soup kitchens, offer meals, etc., may we continue to actively seek ways in which we can support, shift mindset, petition government, and not just invite but intentionally create and develop space for the those whom society has placed on the periphery to come in closer.