Homelessness and Mental Illness: A Lethal Combination

This week, Fargo-Moorhead recognizes National Hunger and Homelessness Week, a time to raise awareness about the on-going problem of homelessness—not just in the big cities of New York, LA, and Chicago—but here in the frozen land of MN and ND, in our very own backyards. Whether or not it is acknowledged, homelessness is a problem in virtually every community. The National Coalition for the Homeless estimates that across the US on a given night, between 500,000 to 1 million Americans experience homelessness.
What people in our community may not know, however, is that an estimated 1,000 to 1,500 individuals in the Fargo-Moorhead area are homeless. The 2009 Wilder Research report, which gathered information from homelessness people in the Fargo-Moorhead area on one night in October by combing shelters, transitional housing, soup kitchens, and unsheltered areas like parking lots and alleys, found a total of 443 homeless people. Considering the total number of homeless individuals in our region, this figure is undoubtedly higher. Every year, local shelters like the YWCA and Churches United for the Homeless report maximum capacity and utilization.

While homelessness itself is a devastating experience, there’s evidence that mental illness is more prevalent among homeless individuals, compounding the problems they already face. The same Wilder report of the F-M area found that over 40% of the individuals surveyed had been recently diagnosed with schizophrenia, bipolar disorder, major depression, anti-social personality disorder, or PTSD. This finding reflects a host of social research that has found a nation-wide association between homelessness and mental illness, particularly bipolar disorder and schizophrenia. Based on this research, it is likely that mental illness is a factor that contributes toward homelessness. Being able to effectively diagnose mental illness and make treatment available to at-risk populations could potentially reduce the problem of homelessness.

What is bipolar disorder?
This week, the Concordia neurochemistry class discussed the issues with diagnosing and treating bipolar disorder, a condition that seems to be over-represented in homeless individuals. Bipolar disorder is characterized by uncontrollable and debilitating extremes of mood, which cycle between two states: mania (extremely high mood and energy levels) and depression. People with bipolar disorder are on a “roller coaster” of emotion, cycling between moods every few days, weeks, or months (depending on severity). Understandably, this can be very difficult to deal with personally, and can impair relationships and social functioning.
Diagnosing bipolar disorder is difficult. Like all mental illnesses, it cannot be detected with a quick-and-easy blood test or x-ray. Instead, a psychiatrist or psychologist needs to spend enough time with the individual in order to determine if the rapid cycling of moods is occurring and interfering with normal functioning. This can be tricky because the depression, mania, and sometimes psychotic behavior can look very much like other mental illnesses—like schizophrenia or certain types of personality disorders.
Treating bipolar disorder
The use of medication in treating bipolar disorder has been met with some success. Treating the disorder often involves a combination of medications in order to target both depression and elevated mood (mania). This is usually done through using anti-depressants and anti-psychotics. Another option that has shown relatively high success rates is the use of lithium carbonate, a natural element. Lithium is widely used now as an mood stabilizer in bipolar disorder, balancing the extremes of low and high mood. Exactly how lithium is effective in bipolar disorder, however, is still relatively unknown. What happens in the brain when a person takes lithium?

Researchers have a couple of ideas. One suggestion is that lithium prevents too much of a substance in the brain called myo-inositol from being produced. Too much myo-inositol may contribute to the rapid cycling in bipolar disorder. Another hypothesis is that lithium decreases signaling in a biochemical pathway called GSK-3. This pathway is also believed to possibly contribute to the symptoms of bipolar disorder. Finally, lithium may also decrease the levels of arachidonic acid in the brain, an omega-6 polyunsaturated fatty acid found in cell membranes. This substance is important for a variety of biological functions, including chemical signaling and cell growth in the brain. Arachidonic acid causes inflammation and may damage cells of the nervous system if too much is released. Lithium may protect nerve cells by decreasing arachidonic acid.
So should doctors be prescribing lithium if they don’t even know how it works in the brain? Lithium has been in use for years and shown to be an effective mood stabilizer in many cases of bipolar disorder. While too much lithium can be toxic, doctors are aware of what they are dealing with and do their best to balance the potential benefits of the drug with the associated risk of harm. Most of all, it is important that people who take lithium are aware of both the benefits and possible risks, and make a choice they feel comfortable about.
Making treatment available
Medications like lithium or other treatment options like therapy have been shown to be helpful in treating bipolar disorder. Unfortunately, sometimes the people who need these resources the most do not have access to it. Many people, not just homeless people, can’t afford medical insurance to get the treatment they need. Additionally, not all insurance companies recognize mental illnesses equally as a legitimate condition. While drugs may be covered by insurance companies, other options like therapy and counseling may not be, limiting the options people have. This inaccessibility of treatment has made it very difficult for people with mental illness to get the help they need. Increasing awareness of mental disorders like bipolar disorder and their social implications may help increase the availability of treatment and services to people who need them the most.
Events this week in Fargo-Moorhead

 
 
 
 
 
 
 
This month, the Fargo-Moorhead community is doing the Fill the Dome project for a fourth year in a row. Students around the area are collecting enough donations to fill the 80,000-square-foot Fargodome with food for local pantries and shelters. Each year, the project collects hundreds of tons of food. The project is wrapping up next week!
Students in Concordia College’s Echo Band are teaming up with the F-M Coalition for the Homeless to create awareness of homelessness as well as raise funds for local organizations. Their concert will be held Tuesday evening in the Centrum, Knutson Campus Center.
The Lake Agassiz Regional Library in Moorhead is holding Holiday Season Amnesty for patrons with overdue materials and fines! $2 will be forgiven per donated non-perishable food item. Donations will go to local food pantries serving the homeless and needy.
 
For the full 2009 Wilder Research report of the Fargo-Moorhead area, visit:
http://www.wilder.org/download.0.html?report=2354