For decades, homelessness has been a major health problem that defies easy solutions.  

Defined by U.S. federal legislation as people who "lack a fixed, regular, and adequate nighttime residence,"  determining how many homeless people there really are remains a perennial problem.  Part of the difficulty in understanding how common homelessness really is deals with the relative invisibility of homeless people who, for their own safety, often prefer to stay hidden to avoid criminal victimization or possible arrest. Since many jurisdictions make vagrancy a criminal offense, homeless people are often driven even further underground and the living conditions they endure are typically appalling.   

And there are any number of reasons why someone could end up on the street.   Along with the enormous number of people who were forced into homelessness when mental hospitals were closed across the United States during the 1970s, whole families have been reduced to homelessness following the recent economic reversals of the past ten years. According to some estimates, approximately one out of every thirty children (2.5 million in all) are living in substandard housing or no housing at all with California and Florida having the greatest proportion of homeless people under the age of 18.   

Returning veterans who become homeless due to mental health problems or economic hardship are also becoming more common in homeless populations.   Despite numerous media stories about homeless veterans and the problems they face, actual studies exploring the incidence and causes of veteran homelessness remain scarce. According to one estimate, the number of veterans without stable accommodation was placed at nearly 58,000 (twelve percent of the known homeless across the U.S.) as of 2013.  

cohort study collecting data on 310,685 who served in the military from 2005 to 2006 reported a five-year homeless incidence at 3.7 percent after leaving the military.  That same study identified the strongest predictors of homelessness as military pay grade, substance abuse, and being diagnosed with a psychotic disorder.  Another cohort study looking at formerly homeless veterans found that 44 percent experienced at least one day of homelessness within five years after being successfully placed in housing and that drug use and posttraumatic stress were the strongest predictors of later homelessness.   

While the U.S. Department of Veterans' Affairs (VA) has spent decades attempting to address veteran homelessness,  it remains unclear how effective their programs have been to date given the number of veterans living on the street.  A new study published in the journal Psychological Services provides an in-depth look at veterans seen in VA mental health clinics who are deemed to be at high risk for homelessness.   A team of researchers led by Jack Tsai of the U.S. Department of Veterans Affairs (VA) New England Mental Illness Research, Education, and Clinical Center used national VA administrative data on 306,351 veterans referred to specialty mental health care.  All veterans were referred to one of 130 VA clinics between October 1, 2008, to September 31, 2012 and were followed up afterward to determine who was most likely to end up homeless.

Overall results showed that 5.6 percent of all veterans referred for mental health services experienced homelessness within the following twelve months.  Women showed a slightly higher risk than men (7.6% vs. 5.4%) and risk of homelessness also seemed strongly linked to age. Veterans aged 46-55 years were most likely to become homeless though veterans in other age groups were also represented.  

In looking at specific risk factors, not being married and having a substance abuse problem appeared to be the strongest predictors of later homelessness.   Other factors that were identified included:  being Black, having a low income, and falling into the 46-55 age group.  

The results of this study helps demonstrate how vulnerable many veterans can be following their return from deployment. Along with veterans who have mental health or substance abuse problems, veterans with few financial assets or who don't have family members they can turn to for support may find themselves on the street.  

Even though veteran homelessness may be on the decline, at least according to recent statistics, the failure of recent legislative initiatives to improve veteran benefits may well see a reversal of this trend as more veterans find themselves facing financial hardship.  Whether or not the current administration is willing  to address this remains to be seen. 

References

Tsai, Jack; Hoff, Rani A.; Harpaz-Rotem, Ilan, One-year incidence and predictors of homelessness among 300,000 U.S. Veterans seen in specialty mental health care. Psychological Services, Vol 14(2), May 2017, 203-207.

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