The head of Nashville, Tennessee's Metropolitan Homelessness Commission discusses the behavioral health and trauma concerns of men experiencing homelessness.
“The pressures placed on men in our society to be tough, strong, and macho make it hard for some men to admit that they have mental health problems, maybe even to themselves,” said Steven Samra, Commissioner, Nashville (Tennessee) Metropolitan Homelessness Commission. “Men have been taught to be tight-lipped about emotional matters. The reluctance to speak openly about these issues can be even more pronounced for men experiencing homelessness, because any sign of vulnerability can make a man a target on the street,” Samra added. Though men may feel this attitude is self-protective, it can keep them from seeking help with the very issues that may prolong their homelessness.
Samra, who also serves as an advocate on Tennessee’s Statewide Task Force to End Homelessness, believes that, because men are socialized to steer clear of expressing emotions other than anger, it is often hard for men experiencing homelessness to seriously consider the need for change in their lives. “We need to recognize that men can get complacent with the dysfunctional but familiar life of homelessness,” Samra said. Transition is hard—it requires changing the mindset that says a man should be totally self-sufficient, that he doesn’t need help. It is hard to identify a path out of homelessness when men are in denial about addiction or mental health issues.”
Trauma is widespread among men who experience homelessness, but this topic may also be taboo for many men. Research shows that the vast majority of men experiencing homelessness are survivors of violence and victimization. A 2000 study on the lifetime prevalence of trauma among homeless people in Sydney, Australia, found that trauma affected 90% of the men studied. While another study from 2005 on the need for abuse and trauma services among people experiencing homelessness reported that 69% of men who had co-occurring disorders had experienced a life-altering traumatic event.
Data also show that trauma is even more common among this population than are mental health issues or substance use disorders. According to data from SAMHSA’s Ending Chronic Homelessness for Persons with Serious Mental Illnesses and Co-Occurring Substance Use Disorders: Blueprint for Change – 2003, fewer than 4 in 10 people experiencing homelessness are dependent on alcohol, and fewer than 3 in 10 abuse other drugs. Data from SAMHSA’s TIP 55: Behavioral Health Services for People Who Are Homeless – 2013 reports between 20% and 50% of people experiencing homelessness have a diagnosable serious mental illness.
The pervasiveness of trauma among men experiencing homelessness underscores the importance of advancing trauma-informed care. While awareness of the impact of trauma has increased among homeless service providers in recent years, much remains to be done to ensure that there is greater uniformity and consistency of trauma-informed services for people experiencing homelessness, according to one study on trauma-informed care.
Among the key considerations in implementing trauma-informed service approaches is recognizing that trauma survivors feel safe when they have maximum control over their circumstances and what happens to them. Because men who are experiencing homelessness have control over so few areas of their life, it is important for service providers to use a client-centered approach to avoid “helping” in a top-down manner. The person being served needs to have the final say about decisions that affect his life in order to feel safe and avoid re-traumatization.
“Housing First models make so much sense for men experiencing homelessness who are trauma survivors and/or have behavioral health issues,” said Samra. “People can’t deal with their complex personal struggles while they are just trying to survive. Once a man has a place to live, he is much more likely to be able to feel safe enough to begin a process of examining his life and choosing to make some changes toward his recovery.” Learn more about Housing First at the Alliance to End Homelessness.
This article was originally published as a Voices from the Field Blog post to highlight the theme of Men’s Behavioral Health Conditions. Find the latest SAMHSA Blog posts about behavioral health and homelessness.
Access more behavioral health and homelessness resources.