Clinical: Explaining the key question (homelessness)

In February 2016, the homelessness charity St Mungo’s produced a report called “Stop the Scandal: an investigation into mental health and rough sleeping” which showed that 4/10 rough sleepers have a mental health problem and that this is a growing problem.

Prevalence in general population

1 in 6 (17%) in the England have a common mental health disorder and this figure will be lower for those who do not sleep rough demonstrating how high the figure is for rough sleepers.

Evaluation point: On the other hand, it is possible that it just seems like there are more people with mental health problems on the streets than there actually are; it could be a diagnostic bias as living on the street may mean you are more likely to interact with outreach professionals and the police which means we know more about levels of mental health in this population. However, this is unlikely to be the case, as this population are far less likely to seek help and the St Mungo’s report indicates that GPs are known to have turned homeless people away due to their lack of fixed abode meaning they are less likely to be referred than people who who have an address.

Cause and Effect

Disentangling cause and effect is tricky; does homelessness trigger mental health problems or does having mental health problems make you are more likely to become homeless due to eviction or family breakdown?

Homelessness causes mental health issues

Biological causes

  • Sleep deprivation has been linked to psychosis sleep and in particular deep sleep characterized by REM is essential for replenishing neurotransmitter levels (reference needed here)

Evaluation point: This is supported by the case study of Peter Tripp, a radio DJ who stayed awake for 8 days (201 hours) for a charity ‘wakeathon’ began to experience hallucinations (e.g. seeing spiders in his shoes and mice and kittens scampering around the studio, thought his desk draw was on fire) and delusions (e.g. believing one of the doctors was an undertaker come to take him away, he was so scared he ran out into the street), suggesting that chronic sleep deprivation could be a cause of mental ill health. However, as this was a case study the results are not generalisable and it is possible that Peter Tripp only experienced this because he was genetically predisposed to respond more negatively to sleep deprivation; it has also been suggested that he may have been taking amphetamines in order to keep himself awake and therefore these may have been the cause of the hallucinations.

  • Poor diet; a balanced diet is essential for mental health
    • lack of amino acids such as tryptophan can cause mood related problems due as the brain will not be able to create enough serotonin
    • a lack of essential fatty oils such as omega 3 and 6 is essential for brain functioning

Evaluation: Studies on tryptophan and depression for and against

  • Chronic Stress: Heightened cortisol levels due to being exposed to constant sources of physical and social stress (cold, sleep deprivation, hunger, fear of crime, discrimination) lead to inhibition of serotonin and consequent depressive symptoms.

Environmental factors (Learning Theory)

  • People who are homeless may have experienced some trauma which was outside of their control which caused them to become homeless e.g. they were a victim of sexual abuse or domestic violence; this may have led to learnt helplessness where they have over-generalised what the had learnt and failed to initiate coping strategies, e.g. not engaging with outreach workers as they believe they are not able to get out of their situation

Evaluation point: Link to Seligman’s dog experiments but also argue that this is an animal experiment and therefore has issues with extrapolation of results to such as complex situation as this

Social factors

  • People who are homeless are a marginalised out-group in society facing high levels of stigma, prejudice and discrimination. This makes them vulnerable and a target for sexual and physical violence which will lead to further traumatisation and potential PTSD
  • Isolation from friends and family will lead to belonging needs being unmet and low self esteem which can lead to mental health issues.
  • Discrimination can lead to chronic stress which becomes a precipitating factor for an underlying mental health issue.

Evaluation: Link to Veling

Diathesis stress model

Not everyone who faces the stress of being homeless has mental health problems (6/10) and therefore some sort of predisposing factors must be necessary, e.g. genetic predisposition which is then exacerbated by stress, link to epigentic factors.

Evaluation: Adoption studies such as Tienari

Social drift

Underlying mental health problems (prodromal symptoms) such as delusional beliefs (paranoia, persecution etc) lead people to have problems with family leading them to become homeless or to find it hard to manage themselves and then become evicted.This means that the mental health issues actually preceded begin homeless and this explains why so many people who are homeless have mental health problems.

Evaluation: Goldberg and Morrison