Recommendable!
It was a huge mistake to close or reduce the capacity of mental institutions in the 1960s/1970s. This was a misguided reform! Quite possibly, homeless individuals with serious mental or substance use disorders could benefit from better medical care in sheltered environments.
"... A recent rise in homelessness, coupled with the COVID-19 pandemic and epidemic of deaths from opioids and other substances, has added new urgency to efforts to understand the health disparities faced by this population. The Department of Housing and Urban Development (HUD) estimates that the number of people experiencing homelessness in the US rose by about one-fifth between 2017 and 2023. West Coast cities have witnessed an especially sharp and concentrated increase in unsheltered homelessness ...
Yet, despite extensive qualitative and small-scale research suggesting that poor health is both a cause and consequence of homelessness, data limitations have left significant gaps in our understanding of the relationship between health and homelessness, including fundamental questions about the magnitude of health disparities faced by this population. ...
one small San Francisco-based study found that a surge in homeless deaths during the [Covid-19] pandemic was due to increased deaths from acute drug toxicity and traumatic injury, not COVID-19 ...
We find, for example, that after controlling for gender and age, people recorded in the Census as sheltered and unsheltered homeless faced similar mortality risk, ... This finding highlights the health risks faced even by people residing in shelters ...
We also find that white homeless individuals face about 40% higher mortality risk than Black homeless individuals. This pattern is striking because in the housed population, and even among the housed poor, Black individuals face higher mortality risk than white individuals. This reversal in mortality rates by race might hold clues about how the predominant pathways to homelessness differ across groups. For example, it may be the case that white individuals tend to become homeless due to personal difficulties – such as substance abuse and behavioural health issues – while Black individuals are more likely to become homeless due to economic hardship and a lack of resources in friend and family networks to buffer against loss of housing. ...
In other words, elevated mortality risk appears to persist well after people exit literal homelessness, suggesting that the immediate hazards of homelessness are not the primary drivers of premature death in this population. Rather, it may be the case that poor health precedes – or causes – homelessness, or that the health hazards caused by homelessness produce long-term mortality risks. Indeed, both homelessness and elevated mortality risk are likely rooted in a complex interplay between socioeconomic disadvantage and health over the life course. ..."
Yet, despite extensive qualitative and small-scale research suggesting that poor health is both a cause and consequence of homelessness, data limitations have left significant gaps in our understanding of the relationship between health and homelessness, including fundamental questions about the magnitude of health disparities faced by this population. ...
Key findings
We find that people who have experienced homelessness face 3.5 times the mortality risk of people who are housed, accounting for differences in demographic characteristics and geography ... This disparity far exceeds the mortality gap between Black and white housed individuals (relative hazard of 1.4) and between poor housed and all housed individuals (2.2). Looking at mortality risk over the life cycle reveals another striking finding: a 40-year-old homeless person faces similar mortality risk to a housed person nearly twenty years older ... By 2022, about 16% of those who were homeless in 2010 had passed away, compared to just 6% of the housed poor sample and 4% of the overall housed sample. ...one small San Francisco-based study found that a surge in homeless deaths during the [Covid-19] pandemic was due to increased deaths from acute drug toxicity and traumatic injury, not COVID-19 ...
We find, for example, that after controlling for gender and age, people recorded in the Census as sheltered and unsheltered homeless faced similar mortality risk, ... This finding highlights the health risks faced even by people residing in shelters ...
We also find that white homeless individuals face about 40% higher mortality risk than Black homeless individuals. This pattern is striking because in the housed population, and even among the housed poor, Black individuals face higher mortality risk than white individuals. This reversal in mortality rates by race might hold clues about how the predominant pathways to homelessness differ across groups. For example, it may be the case that white individuals tend to become homeless due to personal difficulties – such as substance abuse and behavioural health issues – while Black individuals are more likely to become homeless due to economic hardship and a lack of resources in friend and family networks to buffer against loss of housing. ...
In other words, elevated mortality risk appears to persist well after people exit literal homelessness, suggesting that the immediate hazards of homelessness are not the primary drivers of premature death in this population. Rather, it may be the case that poor health precedes – or causes – homelessness, or that the health hazards caused by homelessness produce long-term mortality risks. Indeed, both homelessness and elevated mortality risk are likely rooted in a complex interplay between socioeconomic disadvantage and health over the life course. ..."
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