Interview with Monica Boyer, MH/MR/EI Consultant

When most people hear the term "homeless," they more than likely initially think of the physical hardships of being without a home. If you're homeless, where do you sleep? What do you do without a bathroom, or a shower? How do you live without all of the everyday possessions most people take for granted, like a toothbrush or a comb or a child's beloved stuffed animal?

Most people, however, do not consider the effects being homeless can have on a person's mental health. The stress that they endure and the depression that can overwhelm become secondary to their physical and material trials and tribulations. However, the mental effects are just as important, affecting the mind that is ultimately the powerhouse and control center for the body.

Monica Boyer has first-hand experience with this connection between the homeless and mental health. Boyer is a consultation and education coordinator for Lebanon County MH/MR/EI (Mental Health/Mental Retardation/Early Intervention). As a representative for her office, she also serves on various boards, such as the Suicide Prevention Task Force and the Lebanon County Coalition to End Homelessness, and helps people learn about her office through seminars and expos such as the Under 20 Festival, the 50+ Festival, Healthy Kids Day and the Human Services Expo.

As the vice president of the Lebanon County Coalition to End Homelessness, Boyer is on the steering committee and executive committee. Coalition members exchange a lot of information with each other on different services available to homeless people. The coalition currently has a number of ongoing projects. Right now, their goal is to have a family shelter built. Also, the homeless street count was just completed for HUD (Housing and Urban Development). This count, called the Point-In-Time Survey for the Unsheltered Homeless, is documented every other year.

In a recent interview, Boyer helps bring to light how mental health and homelessness are linked. She touches upon such issues as how and why mental illness occurs, what the homeless/mentally ill demographic looks like, what organizations exist to help them, and society's effect upon those suffering from this dual affliction.

How are the homeless affected by mental illness?

This boils down to the question about whether mental illness is really the effect or the cause of homelessness. It's not really that the homeless are "affected" by mental illness. They don't just become homeless and become affected by a mental disease.

Being mentally ill does not occur as a result of being homeless. Mental illness may just be more prominent among the homeless. Most people are mentally ill before they become homeless and are affected by their respective symptoms before they're out on the streets. Oftentimes as a result of their mental illness they are unable to keep up with their bills or take care of themselves. This is what leads to their being homeless. If someone was living in a home and seeing a doctor, then their symptoms could be under control. After becoming homeless, since they can't afford to see a doctor, their mental illness could surface more readily.

You say that there's a distinction between mental illness being the cause or the effect of homelessness. How exactly are they connected?

Mental illness can surely be exacerbated by homelessness and the stress that comes from it. Homelessness can, in turn, also be exacerbated by mental illness. There's a fine line between what exactly is the cause and what is the effect.

What other factors are linked to homelessness and being mentally ill?

There's something called comorbidity. Comorbidity is two things happening at the same time. In the case of the homeless, we typically are seeing mental illness and substance abuse happening simultaneously. We see a higher percentage of this occurring in the homeless population because they tend to self-medicate. They don't have access to a psychiatrist, so they use "street drugs" (alcohol, etc.).

What types and forms of mental illness occur among the homeless?

Depression is one mental disorder that greatly affects the homeless. Someone who is not clinically depressed, but then becomes homeless, can be more prone to becoming so. Anxiety disorders are also a big one. The nature of other mental illnesses cause those affected to not handle their affairs the proper way, like with schizophrenia.

In what way?

If they don't know how to handle their life the proper way, they find themselves homeless and can't afford their medication. A big part of the connection between mental illness and homelessness has to do with medication. That's what it comes down to ... having medication in order to control the disease and control yourself.

Are these forms and degrees of mental illness the same across the homeless population, occurring in all ages and genders the same? Or do they occur in uneven distributions?

One mental illness that generally does affect a certain age group is schizophrenia. It often hits individuals in their early 20s. While schizophrenia often has its onset in a younger individual, it does not mean that it goes away when someone reaches a certain age. It is an illness that often begins in the early 20s but needs to be managed for the lifetime. Someone just graduated from high school, just getting their life started, is hit with hearing strange and scary voices. It's tough trying to convince people to come in to get help. They usually turn to alcohol, drugs, etc.

The three major categories of mental illness in which we usually find the most people are schizophrenia, mood disorders and personality disorders. Among these groups, schizophrenia and bipolar disorders are the largest groups that we see. Schizophrenia generally affects younger generations, but bipolar disorders can affect a wide range of ages.

Does society itself help or hinder people in these categories suffering form mental illness?

Society generally hinders the homeless and their recovery from mental illness. There still exists today a stigma about mental illness. Society wouldn't hesitate or draw back if someone has something like diabetes. But being mentally ill means in our society that you're crazy, wacko, dangerous. What mental illness really means is that there is a chemical imbalance in the brain. Like with heart disease or cancer or other illnesses, if the right medication is received it can be treated. However, because of the stigma, people don't come in to get help.

What types of organizations are there to help the homeless suffering from mental illness?

For those who do desire aid, obviously we, MH/MR/EI, help them. The Mental Health Association of Lebanon County is involved in mental health advocacy and runs support groups. Lebanon County Crisis Intervention is there for emergency cases.

However, there are no places in Lebanon County that serve as houses or shelters for the homeless. The Rescue Mission and the Agape House are wonderful programs, but not emergency shelters. In both of these shelters, families can't stay together and are separated. The Rescue Mission is for men, and the Agape house is for women and children and boys under 14 years old. Often when families are offered shelter that would separate them, they choose to remain together and hence remain homeless. That's why we're trying to get this family shelter started.

What's holding you back from getting this shelter built?

The main thing standing in our way is funding for building and operational costs.

What can the general public do to help homeless people who suffer from mental illness?

One of the biggest things they can do is recognize that homelessness exists. We're not a big city where you can plainly see it. But whether people see it or not, there are homeless on the street. People are doubled up, tripled up, in houses. Those that aren't doubled up are actually, literally, on the street or living in places that are not suitable for human habitation, like vehicles and abandoned buildings. People need to realize that homelessness exists in our community.

After that, it all comes down to funding. Agencies and organizations need money to do what they do. Volunteering is also good. We had about 70 volunteers come out to do the last street count.

Realizing how people use the term "homeless" is also important for the public to understand. People have this image of the homeless as being lowdown with no ambition. However, any time of the day, people become homeless through situational occurrences. Through no fault of their own they lose their insurance, lose their jobs and means of living, and become homeless. There are people who "choose" to be homeless. There are people who are homeless because they are mentally ill and are fearful of "the system." And there are people who are homeless because of the choices they made.