Makeshift beds under the highway in the north end of Hartford. (photo by Jose Vega)
Makeshift beds under the highway in the north end of Hartford. Jose Vega

The recent introduction of CT HB 6532 in February 2021: An Act Appropriating State Funds for Mental Health Services and Housing  is greatly appreciated by nurses advocating for better mental services for patients. The bill will allot funds to address the expansion of residential services for young adults, hire additional housing coordinators, and expand respite services, along with other short-term stabilization of patients with mental health issues.

Paulette Atse

I am currently a registered nurse who will be graduating from a master’s program to become a Psychiatric Mental Health Nurse Practitioner this month. In my years of experience as a psychiatric nurse, I have noticed the toll of mental illness on lack of stable housing and homelessness. The impact of homelessness also significantly affects one’s mental health. The move towards passing this bill is encouraging news which will positively affect these individuals.

Homelessness, broadly defined, refers to individuals without a stable place to call home. As a nurse, I have worked with many patients who have become regulars to hospitals’ emergency rooms and consequently to inpatient units due to homelessness. A significant increase is usually seen during the winter months as individuals seek warmth from the freezing Connecticut temperatures. While these patients have genuine psychiatric and other comorbid diagnoses, the lack of stable housing contributes to increased ER visits and mental health exacerbation.

As I transition through my clinical rotations, a new awareness of the impact of homelessness on the psyche has been identified in the outpatient population that I am privileged to care for. Issues such as substance abuse, legal issues, and other traumatic incidents have led to housing instability and/or comorbid mental health diagnoses. Many homeless individuals with mental health diagnosis have become involved with the legal system and many have been incarcerated due to the precarity of their lives. The healthcare system is also negatively impacted as the visits to healthcare facilities are not included in allocated budgets. The implementation of programs to enhance mental health and stable housing will also be favorable for society as those that benefit will be able to manage their lives better and be productive. Homelessness and mental health issues combined lead to other compromising health and psychological issues such as physical and sexual abuse due to the situational vulnerability. Legislators and related advocates need to aspire to incorporate substantial collaborative programs to alleviate this scourge.

I am aware of the significant shortage of housing and programs that facilitate a comprehensive approach to this dilemma. Short term shelters that provide nightly beds and a shower provide only an immediate bandage to a wound that is more than surface deep. Patients often refuse this option, choosing instead to be discharged back to the streets or to their vehicles if they are fortunate enough to own one. During these short inpatient visits some patients often create new alliances with like-minded individuals. Several may end up lodging with a peer who has access to some form of public housing. While this is usually a good gesture on behalf of their fellow peers; the plan often ends in another dilemma. The relationship between these individuals is usually compromised by comorbid substance abuse issues resulting in decompensation which often requires further inpatient interventions. The need to address these closely combined issues is long overdue.

Along with the plan and funds to be distributed for this important matter, more comprehensive programs are needed to combat the revolving door that is too often seen in this population. I am grateful for the proposed bill, but I want to recommend additions that would increase the chances for successful functioning of this group. More systematic programs that provide all-inclusive boarding along with life-skills training would complement the use of these funds. Some inclusions may be educational classes, resume building, job placement, financial planning and budgeting, diagnoses and medication management, and individual and group psychotherapy. These curricula would be a part of discharge planning and could integrate and work along with housing plans such as HUD, Habitat for Humanity, Hope and Healing Homes and other similar programs towards successful completion and discharge to stable housing, being equipped with the correct tools for success.

The implementation and inclusion of such programs could be a part of the solution for those experiencing these problems.  Bill 6532 will be a step in the right direction and would be an advantage and relief to the currently burdened healthcare facilities that are the primary providers for this population. However, more intense, structured interventions are needed to guarantee success and eradicate the frequent visits to emergency rooms that are often associated with those who have mental health diagnoses and are further challenged by the lack of stable housing.

Paulette Atse lives in Naugatuck.

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