Cover Story

Mental Health Awareness

BY Anna-elisa jakob and Amanda Haggard

A study on mental illness from the University Medical Center Hospital at Hamburg-Eppendorf shows the majority of homeless people struggle with mental illness. Franziska Bertram, the chief researcher involved in the study, explains what this means for associations and providers offering assistance to the homeless.

When Bertram and a team of forensic specialists began examining the mental health of homeless people, it seemed at first that they were significantly better off than the general population: Researchers at the University Medical Center Hospital Hamburg-Eppendorf (UKE) surveyed about 650 homeless people throughout Germany as to whether they had suffered from a mental health disorder at any point in their lives, and only 23 percent or participants responded affirmatively. However, they found indications of an undiagnosed illness in more than twothirds of those surveyed.

In Tennessee, a report from NAMI Tennessee says one in six people are diagnosed with a mental illness, and many others go undiagnosed. NAMI Tennessee is a subchapter of the National Alliance on Mental Illness.

Amongst unsheltered and homeless people, a tendency to go “underdiagnosed”, as doctor and chief researcher Franziska Bertram puts it, seems to be a major problem. Homeless people are much more prone to suffering from mental illnesses, yet less likely to obtain a diagnosis by a medical professional.

The team only examined illnesses which are also notably common amongst the general population, such as depression, addiction struggles, and anxiety disorders. Other studies suggest that schizophrenic disorders are also prevalent amongst homeless people, suggesting the percentage of people suffering from mental illnesses could be even higher.

According to the study, one decisive factor in assessing one’s own mental health might be one’s background. Bertram remarks that: “When we asked them what the most important cause for their homelessness was, people of German origin often cited their mental health. Homeless people of a different origin seemed to place less emphasis on this factor — even if they were highly likely to struggle with mental illnesses.”

Several factors may contribute to the crucial role that one’s background and origin play in respect to mental health: “A valid residence permit, the possibility of obtaining health insurance, language skills, social networks — all those are factors influencing the mutual interdependence of health and origin”, Bertram says.

The report in Tennessee also says folks here struggle to get help when they need it most. Of the 231,000 adults in Tennessee who did not receive needed mental health care when they needed it, 38.5 percent did not because of cost; 3,224,296 people in Tennessee live in a community that does not have enough mental health professionals to begin with. Tennesseans more than six times as likely to be forced out of their insurance networks for mental health care than for primary health care, compounding the problem and “making it more difficult to find care and less affordable due to higher out-of-pocket costs,” the report says.

Many homeless people suffering from mental illnesses have difficulties benefiting from the services currently offered to them: “Say that you are suffering from a substance addiction and then have to navigate the pressure that comes with addiction within a crowded space amongst many other homeless people — it is easy to imagine how this could lead to added stress," says Bertram. Depression, anxiety disorders, and schizophrenia make those affected notably sensitive to stressful situations. A room of one’s own acting as a place of retreat can be particularly important in these cases.

Bertram argues that the services provided to the homeless lack systematic infrastructures and fail to bring together social work, medical and psychotherapeutic support, as well as different forms of housing. This would be important to be able to correctly diagnose illnesses and subsequently treat them in a targeted way.

Translated from German by Elena Löhndorf via Translators without Borders

Courtesy of Hinz&Kunzt / International Network of Street Papers