3 discussion post

AN EXPLORATION OF FAMILY VIOLENCE AMONG HOMELESS MEN WITH MENTAL ILLNESS:

IMPLICATIONS FOR PRACTICE

John T. Pardeck

ABSTRACT

This study found a high incidence (55%) of famuy violence among homeless men with mental ulness. The most common form of violence was physical; the least common was sexual abuse. Practice imphcations for these findings are discussed.

Mental illness is often foiind among the chronically homeless (Shlay & Rossi, 1992; Snow et al., 1994). Another common problem among the homeless is the dually diagnosed: those who are chemically dependent and also mentally ül. The problem that these individuals face is that most often, alcohol and drug treatment providers do not admit persons with co-occurring psychiatric disorders because they are not prepared to deal with mental health problems; most mental health program^s refuse admission to those who are also drinking or using drugs on the same grounds. This is the population that is most likely to fall through treatment facility cracks (Baum & Bumes, 1993). Wright et al. (1998) cite a number of studies that report national esti- mates of mental illness among the homeless population to be about 33% (Bachrach, 1984; Institute of Medicine, 1988; Tessler & Dennis, 1989; Wright & Weber, 1987; Koegel & Bumham, 1987; McCarty et al., 1991). The data from the 1996 National Survey of Homeless Assistance Providers and Clients support these findings on mental illness al- though some argue that because the literal and often chronic homeless are overrepresented in many studies, the prevalence of mental ulness has been overestimated (Snow, Anderson, & Koegel, 1994; Wright & Weber, 1987). Even though the exact percentage of homeless people •with mental illness is not known, most researchers agree that mental illness is a significant problem among them.

The psychiatric literature also suggests that it would be reasonable to assume that violent experiences are often associated with mental

Reprint requests to John T. Pardeck, PhD., LCSW, Professor of Social Work, School of Social Work, Southwest Missouri State University, Springfield, MO 65804.

illness. For example. Beck and Van der Kolk (1987) found a high rate of childhood abuse among patients with various psychiatric disabilities most particularly depression and substance abuse. Muenzenmaier and others (1993) found a high incidence of childhood abuse among cUents receiving mental health services. Craine, Henson, Colliver, and MacLean (1988) reported that over 60% of clients receiving mental health services in a state hospital met the diagnostic criteria for post- traumatic stress disorder. Clearly the psychiatric literature suggests a relationship between mental illness and violence; the purpose of this study is to explore this relationship among homeless men, specifically examining the kinds of violence and the point at which they experi- enced violence in their hves.

METHOD

The data for this study were drawn from the case records of clients who received services from a large homeless shelter in a mid-western state in the United States. Included were both quantitative and quedi- tative data.

The research instrument employed was the chent intake instrument used by the homeless shelter. This instrument gathered extensive data on clients entering the shelter including basic demographic informa- tion, reasons for being homeless, medical histories that included infor- mation on chemical abuse and emotional disabilities, and a general social history that covered life experiences, including whether clients experienced some form of violence during the hfe cycle.

Using a table of random numbers, 296 client files, 20% of the sample population were drawn from a 1999 roster of 1,480 homeless people entering the shelter studied. Of the 296 subjects, 150 were males.

FINDINGS

Table 1 reports data on gender and history of family violence in the research sample. Even though there is a statistically significant greater number of homeless women with a history of family violence versus men, an extremely large number of men (33%) experienced fam- ily violence.

Table 2 indicates that 55% of homeless men who had a history of mental illness also experienced family violence—a statistically signifi- cant finding. The researcher also explored the kinds of violence experi-

TABLE 1 History of Violence by Gender N=296

History Of Violence

No

Yes

Gender

Male N=150*

66.7%

33.3%

Female N=144*

31.9%

68.1%

*N may vary due to missing data

TABLE 2 History of Violence by Mental Illness N=150

History Of Violence

No

Yes

x2=4.64 p<.05

Mental Illness

No N = 49*

69%

31%

Present

Yes N = 31*

45%

55%

*N may vary due to missing data

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enced by the men; these included physical and emotional ahuse, and sexual abuse.

Physical violence was the most common form of family violence found among the homeless men with mental illness (Table 3); 86% experi- enced such violence during childhood, 9% during adulthood, £ind 5% during both childhood and adulthood.

The next most common form of family violence was emotional abuse. As can be observed in Table 4, the majority of the men (94%) experi- enced abuse during childhood, 6% during adulthood, and 0% during childhood and adulthood. The least common form of family violence was sexual abuse (Table 5). As would be suspected, 100% of those who experienced sexual abuse noted that it had occurred during childhood.

The researcher also explored themes of family violence recorded in the case records of the sample. The following provides examples of relevant narrative information indicating the kinds of violence experi- enced: emotional abuse; physical, sexual, and mental ahuse; extreme abuse in all forms; physical ahuse hy stepfather and mom; mothers abusive to kids when drinking; abuse by oldest daughter; physical and

TABLE 3 History of Physical Abuse and Mental Illness

N=17

History of Physical Abuse

Yes No

When Physical Abuse Occurred

During Childhood During Adulthood During Both Childhood and Adulthood

Percent

17 83

Percent 86 9 5

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TABLE 4 History of Emotional Abuse and Mental Illness

History of Emotional Abuse

Yes No

When Emotional Abuse Occurred

During Childhood During Adulthood During Both Childhood and Adulthood

N=17

Percent

11 89

Percent

94 6 0

mental abuse by foster parents; father, £in alcoholic, broke client's nose twice; mother physically and mentally abusive; father abusive both physically and sexually; physical beatings by stepfather; when growing up there would be fist fights with brothers to the point of hospitaliza- tion; 4 concussions; mother and her husbands were abusive; physical abuse by father; aH types of abuse; verbed abuse; violence in family of origin; physical, sexual, verbal, emotional abuse—family very dysfunc- tional.

What is clear from these case narratives is that all kinds of violence were experienced by the homeless men in this research. Most of the violence was family based and occurred during childhood. It can be concluded from these narratives that many of the homeless men came from extremely dysfunctional family systems which may explain why these clients were mentally ill.

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TABLE 5 History of Sexual Abuse and Mental Illness

N=17

History of Sexual Abuse

Yes No

When Sexual Abused Occurred

During Childhood During Adulthood During Both Childhood and Adulthood

Percent

7 93

Percent 90 5 5

IMPLICATIONS FOR PRACTICE

This study reports that homeless men who are confronted with men- tal illness often have a history of family violence. The most common form of violence is physical; the least common is sexual abuse. Given that v£irious forms of violence are part of the lifecycle of homeless men with mental illness, it is critical that they receive appropriate services and treatment intervention. However, Craig and Timms (2000) argue, that it is very difficult to provide these services and treatment inter- ventions to this population. The following note the unique problems faced by homeless people vsdth psychiatric problems.

1. Homeless people with mental illness are less likely than other homeless people to use medical and mental health services.

2. Many of these people with mental illness are homeless because of this disability. They have a particularly hard time coping with

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daily hfe tasks including working. They are also reluctant to apply for economic assistance; e.g.. Supplemental Security In- come (SSI). Since they also often lack supportive kinships and other social networks, they are often isolated and poor. This com- bination makes treatment intervention even more difficult.

3. When homeless people with mental illness do successfully access services, the fact that medical and psychiatric services are often offered by different agencies makes effective intervention diffi- cult. Furthermore, many of these services are short-term.

The above issues indicate that intervention strategies aimed at homeless men with mental illness must be innovative. Since many of these men have experienced violence in their lives, services should be offered in a safe environment—ideally in the shelter where they are housed. The services should offer long-term medical and mental health treatment, which should continue after the men leave the shelter. Practitioners must be particularly skilled at engaging clients who not only are mentally ill, but also have experienced various kinds of vio- lence. Craig and Timms (2000) suggest that one of the most effective strategies for treating men with mental iUness is to use outreach teams skilled in offering physical and mental interventions. One goal of these teams is to ensure that these men apply for the various welfare sup- ports available, particularly Supplemental Security Income (SSI).

CONCLUSION

The data report that 55% of the homeless men with mental Illness in this study experienced violence, most often during childhood. Craig and Timms (2000) suggest that homeless people with special needs, such as those described in this study, do not access treatment and supportive services. Strategies are offered to practitioners for serving this population. It is suggested that these services be offered in the homeless shelter and that they should be long term. Practitioners who work with this population must be sensitive to the fact that not only are they mentally ill, but they have experienced violence in their lives, particularly in their famihes of origin.

REFERENCES

Bacbracb, L. L. (1984). Tbe homeless mentally ill and mental bealtb services: An analytical review of the literature. Washington, DC: American Psy- chiatric Association.

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Baum, A. S., & Bûmes, D. W. (19&3). A nation in denial: The truth about homelessness. Boulder, CO: Westview Press.

Beck, J. C, & Van der Kolk, B. A. (1987). Reports of childhood incest and current behavior of chronically hospitalized psychotic women. American Journal of Psychiatry, 144, 1474-1476.

Craig, T., & Timms, P. (2000). Facing up to social exclusion: Services for home- less mentally ill people. International Review of Psychiatry, 12, 206-212.

Craine, L. S., Henson, C. E., Colliver, J. A., & MacLean, D. G. (1988). Preva- lence of a history of sexual abuse among female psychiatric patients in a state hospital system. Hospital and Community Psychiatry, 39, 300-304.

Institute of Medicine. (1988). Homelessness, health, and human needs. Wash- ington, DC: National Academy Press.

Koegel, P., & Bumam, M. A. (1987). Traditionell and non-traditional homeless alcohohcs. Alcohol Health and Research World, 11(3), 28-34.

McCarty, D., Argeriou, M., Huebner, R. B., & Lubran, B. (1991). Alcoholism, drug abuse, and the homeless. American Psychologist, 46(11,1139-1148.

Muenzenmaier, K., Meyer, L., Struening, E., & Ferber, J. (1993). Childhood abuse and neglect among women outpatients with chronic mental illness. Hospital and Community Psychiatry, 44, 666-670.

Shlay, A., & Rossi, P. (1992). Social science research and contemporary studies of homeiessness. Annual Review of Sociology, 18, 129-160.

Snow, D., Anderson, L., & Koegel, P. (1994). Distorting tendencies in research on the homeless. American Behavioral Scientist, 37(4), 461—477.

Tessler., R., & Dennis, D. (1989). The socio-spatial stigmatization of home- lessness and HIV/AIDS: Toward an explanation of the NIMBY syn- drome. American Journal of Psychiatry, 148, 903-914.

Wright, J., & Weber, E. (1987). Homelessness and health. New York: McGraw HiU.

Wright, J., Rubin, B., & Devine, J. (1998). Beside the golden door: Policy, politics and the homeless. New York: Aldine de Gruyter.

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