NCLIP

Mental Health in the Homeless and Displaced Population

3 min read

Mental Health in the Homeless and Displaced Population

Key Points

  • Housing instability is both a cause and consequence of mental illness and substance-use disorders.
  • Barriers include poverty, discrimination, legal entanglement, limited services, and psychosocial trauma burden.
  • Recovery-oriented approaches require coordinated housing, health, behavioral health, and social support systems.
  • Nurses are critical connectors for assessment, referral, advocacy, and cross-sector collaboration.

Pathophysiology

Homelessness and displacement expose individuals to chronic stress, trauma, victimization risk, and interrupted care, all of which worsen psychiatric symptoms and physical health outcomes. Co-occurring serious mental illness and substance-use disorders are common and can create cyclical instability.

Repeated housing loss erodes social support and treatment continuity, increasing emergency utilization and reducing long-term recovery probability without integrated interventions.

Classification

  • Housing instability factors: Economic shocks, legal displacement, discrimination, and inadequate affordable housing.
  • Clinical vulnerability factors: Serious mental illness, SUD, trauma exposure, and untreated comorbidity.
  • Service access barriers: Transportation gaps, insurance limitations, fragmented systems, and rural scarcity.

Nursing Assessment

NCLEX Focus

Assess immediate safety, housing status, and co-occurring SMI/SUD together to guide realistic care planning.

  • Assess current housing status, shelter safety, and immediate survival risks.
  • Assess psychiatric symptom burden, suicidality, and substance-use severity.
  • Assess access barriers: transportation, insurance, identification documents, and service eligibility.
  • Assess social supports, legal stressors, and prior engagement with community resources.
  • Assess readiness for motivational therapies and recovery-housing options.

Nursing Interventions

  • Coordinate rapid linkage to housing, case management, and integrated behavioral health services.
  • Use motivational interviewing and recovery-oriented planning for SUD/SMI stabilization.
  • Advocate for trauma-informed, low-barrier care pathways across agencies.
  • Collaborate with social work, legal aid, and public programs for benefits and transport access.
  • Support continuity through follow-up touchpoints and community partner communication.

Fragmentation Risk

Isolated referrals without coordinated follow-up often fail for clients facing multiple structural barriers.

Pharmacology

Medication effectiveness depends on stable access, storage feasibility, and follow-up continuity. Nursing care should prioritize practical adherence supports, regimen simplification where possible, and integrated monitoring with outreach-based services.

Clinical Judgment Application

Clinical Scenario

An unhoused client with bipolar disorder and alcohol use reports repeated shelter loss, missed medication doses, and recurrent emergency visits.

Recognize Cues: Clinical instability is linked to housing and access disruption. Analyze Cues: SMI/SUD and structural barriers are reinforcing each other. Prioritize Hypotheses: Immediate priorities are safety, housing linkage, and treatment continuity. Generate Solutions: Build integrated plan with outreach psychiatry, case management, and recovery housing referral. Take Action: Activate interdisciplinary coordination and short-interval follow-up. Evaluate Outcomes: Reduced crisis visits and improved medication continuity.

그래프 뷰