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Athabasca University University of Calgary ATHABASCA UNIVERSITY UNIVERSITY OF CALGARY UNIVERSITY OF LETHBRIDGE A Literature Review of the Psychological Impact of Homelessness Mandana Diba A Final Project submitted to the Campus Alberta Applied Psychology: Counselling Initiative in partial fulfillment of the requirements for the degree of MASTER OF COUNSELLING Alberta April 2007 DEDICATION I dedicate this work to the memory of my father, for his continuous love, support, words of encouragement, and for being the first one teaching me the meaning and effects of power and privilege. Also, to my son Reza, for his endless help and support throughout this program. i ii iii ABSTRACT There is a reported lack of literature on the psychological impact of homelessness. The present paper aims to fill this void. The definition of homelessness, prevalence, developmental factors associated with homelessness, and psychological impact of homelessness will be reviewed. Interventions aimed at reducing harm and facilitating “exits” for homeless people will be presented, followed by a summary of the implications and key findings of this review. iv ACKNOWLEDGEMENTS I would like to acknowledge Dr. Simon Nuttgens for supervising my final project. I would also like to thank Dr. Sandra Collins for acting as second reader for this project. I extend my appreciation to Dr. Shelly Russell-Mayhew for her feedback on the first draft of this project and Pam Hirakata for her thoughtful questions. I would like to thank my family especially my daughter for their patience throughout my re-schooling. Much of family time was lost, but due to their patience and thoughtfulness our relationship remained strong. My appreciation also goes to many homeless individuals whom I came to contact with, for giving me the privilege of having a glimpse into their lives and see their pains as well as their survival strengths. Above all, my thank goes to God who gave me the strength to learn from my experiences and to follow my dreams. v Table of Contents Chapter I. Introduction ..........................................................................................................2 Chapter II. Procedure ............................................................................................................3 Chapter III. The Literature Review........................................................................................4 Defining Homelessness .....................................................................................................5 Prevalence of Homelessness ..............................................................................................7 Developmental Factors Associated with Homelessness......................................................7 The Psychological Impact of Homelessness.......................................................................9 Addiction and other mental health concern ..................................................................10 Trauma ........................................................................................................................18 Physical Illness............................................................................................................26 Human contact and relationship ...................................................................................28 Stressful life event .......................................................................................................29 Women and Homelessness ..............................................................................................32 Interventions....................................................................................................................34 Housing .......................................................................................................................35 Supportive relationship ................................................................................................36 Mental illness and addictio ..........................................................................................36 Case Management Strategies .......................................................................................41 Counselling and Therapy .............................................................................................43 Summary.........................................................................................................................51 Chapter IV. Synthesis and Implications ...............................................................................54 References...........................................................................................................................60 1 A Literature Review of the Psychological Impact of Homelessness CHAPTER I INTRODUCTION Homelessness is a debilitating condition affecting many individuals in the world and in our society. In Canada, as many as 150,000 to 300,000 individuals are thought to be homelessness (McLaughlan, 1987), and considering the lack of a current statistic, one would imagine that this number is significantly higher. My first experience with homelessness came from delivering food baskets to individuals whose homes had been destroyed due to Iraq’s sudden military attack on Iran. I observed the food line-ups, the separation of families, and the tears in some people’s eyes. These were people who were in enormous pain due to their losses. Many expressed their embarrassment at having to receive food donations. Owning a blanket or having money was considered wealth. These people had lost everything—their jobs and belongings, including their notes, pictures, and many items that could connect them to their past. Similarly, in my current experience with homeless individuals in Vancouver’s Downtown Eastside, many people carry, if anything, just a bag of items. They have also lost everything they may have once had, perhaps not to a bomb or missile, but to some force just as powerful as those weapons, powerful enough to cause them to leave everything behind, and become homeless. The current literature lacks an in-depth review of the factors contributing to an individual becoming and remaining homeless and the psychological impact of such experiences. According to my investigation, a comprehensive review of interventions, such as counselling, is also lacking. There is a reported lack of an in-depth understanding of factors contributing to individuals’ homelessness and the psychological factors of living in 2 such a debilitating condition (Bentley, 1997; Evans & Forsyth, 2004). There is also a lack of reports on factors that may lead some individuals to remain in such a condition, or those that can empower homeless individuals to exit from it. The present paper examines the psychological impact of homelessness and factors that may reduce harm or help individuals to exit from it. Such an understanding is necessary for the development of counselling interventions (Bentley 1997; Hertlein & Kilmer, 2004; Washignton, 2002), as well as social policies, programs, and interventions that can reduce the harm to this population. Here, I will present a definition of homelessness and review the literature on factors associated with homelessness, prevalence, and the psychological impact of homelessness. The current literature on suggested interventions will be discussed, and a summary and discussion of the reviewed literature will be presented. CHAPTER II PROCEDURE In the present literature review, I have adapted Mertens’ (1998) recommendations for reviewing secondary sources and evaluating research reports, as well as drawing from my experience working in this field. I have been working with homeless individuals for the last five years, supporting them in various transitional housings in Vancouver’s Downtown- Eastside. There are no facts or stories gathered from individuals or agencies other than what has been reported or written elsewhere. Electronic databases that have been used for this literature review include: PsycARTICLES, PsycINFo, Medline, SocINDEX, PsychLIT, Psychology and Behavioral Sciences Collection, Dissertation Abstracts International, and two different search engines, OVID, and EBSCOhost. The key search terms included homeless, homelessness, poverty, housing and instability, housing, and violence. The search 3 also included all the terms covered in the title of this project. In addition, books, government studies, reports, other organizations’ research projects and relevant information available on the Internet have been utilized. Parameters in this literature review include using English language publications and articles published from 1980 to 2006. Both qualitative studies, quantitative studies, and studies that combine these methods have been included. In addition, I have adopted the definition of homelessness offered by the Kappel Ramji Consulting Group (2002) that includes individuals affected by either visible or hidden homelessness. Visible homelessness includes individuals who stay in emergency hostels and shelters and those who sleep in rough places considered unfit for human habitation such as parks and ravines, doorways, vehicles, and abandoned buildings. Hidden homelessness includes those who are temporarily staying with friends or relatives, women staying with a man only to obtain shelter, individuals living in illegal or physically unsafe buildings, or those who are living in a household and are subject to violence just because they have no place to go to. CHAPTER III THE LITERATURE REVIEW The present literature
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