Mention post-traumatic stress disorder (PTSD) as it relates to homelessness, and most people will probably think of military veterans, but other homeless populations struggle with PTSD. Indeed, the experience of homelessness itself is a trauma that can lead to PTSD.
PTSD is an anxiety disorder that can occur after an individual has experienced a traumatic event, particularly one that involves the threat of injury or death. It is still unclear why a particular trauma may lead to PTSD for some individuals but not for others, or why some individuals are traumatized by a particular event when others are not.
We do know that:
- PTSD changes the body’s response to stress;
- An individual with a history of trauma may be more susceptible to experiencing PTSD from a future traumatic event; and
- Symptoms of PTSD may not appear for weeks or even months after the triggering traumatic event.
There are a number of ways in which the traumatic experience of homelessness can lead to PTSD:
- The actual event of becoming homeless can lead to trauma through the loss of stable shelter, family connections, and accustomed social roles and routines;
- The ongoing condition of homelessness creates stressors that include the uncertainty of where to find food and safe shelter and the potential for experiencing violence and victimization, which can erode a person’s coping mechanisms; and
- Homelessness might serve as a breaking point for those who have preexisting behavioral health conditions or a history of traumatization.
According to the U.S. National Library of Medicine, symptoms of PTSD fall into three main categories:
- “Reliving” the event, which disturbs day-to-day activity, including, for example, flashbacks and nightmares;
- Avoidance, which includes emotional numbing and feeling detached; and
- Arousal, which might include difficulty concentrating, sleep disturbances, and outbursts of anger, amongst other symptoms.
One of the greatest challenges for homeless service providers is that the PTSD is post-traumatic, not co-occurring-traumatic. Its symptoms may not manifest until after a person is stably housed. Another challenge for providers comes from the fact that delaying the housing component can create more psychological barriers to housing stability.
Fortunately, research shows that post-trauma resiliency can be learned through effective training programs for both consumers and providers.
At a minimum, homeless assistance providers should ensure that programs and policies reflect the needs of people suffering from PTSD:
- Housing should be provided as quickly as possible to provide safety and stability while minimizing the potential for associated traumatic experiences;
- Since symptoms may be delayed, people receiving homeless assistance should be counseled about psychological changes they may experience in the future, and offered referrals for psychiatric help; and
People suffering from PTSD need ongoing support to reach a successful recovery and reintegration into social routines.
Image “Homeless and Cold” courtesy of Ed Yourdon’s photostream.