Doughty: Historical Background

Rebecca Doughty, NURS 7455

Introduction

Homelessness is stressful, dangerous, and harmful for the people who experience it. The toll it takes on men and women can be measured in overall poor health outcomes. Homeless women are particularly vulnerable, especially when mental illness and substance abuse are present. Most have experienced trauma and victimization, both prior to becoming homeless and during their lives on the street. A brief literature review will illustrate the complexity of female homelessness.

Colorado Coalition for the Homeless (2012). The characteristics of homeless women. Policy Brief.

More than 25% of all homeless individuals are female, and it is estimated that 100% of these women have experienced domestic or sexual violence during their lifetimes. Once on the streets, a majority experience assault and rape. Government subsidized housing units often have one-strike rules governing violence, so even though they are being assaulted, the women are evicted from their housing. Homeless women experience higher rates of mortality, poor health, mental illness, substance abuse, and adverse birth outcomes. As with their male counterparts, homeless women lack the resources for and access to health care. The statistical information provided in this article is useful for informing further research with homeless women.

Lewis, J.H., Andersen, R.M., & Gelberg, L. (2003). Health care for homeless women: Unmet needs and barriers to care. Journal of General Internal Medicine, 18:921-928.

People who are homeless often have difficulties securing health care. Not only do they feel unwelcome in hospitals and at doctor’s offices, they do not have the resources to pay for care. This study of 1,668 homeless women found that real and perceived barriers to care impact the overall health of this population. Nearly 40% of the sample felt they had needed to be seen by a health care practitioner in the past 60 days, yet did not. The authors determined that being uninsured did not constitute a barrier to care. Rather, the homeless women cited non-financial reasons for not having their health checked. For example, not knowing where to seek care, long waits, and being too sick were all reasons women in the sample provided. This article provides useful information about why homeless women do not access health care.

Hill, R.P. (1991). Homeless women, special possessions, and the meaning of “home”: An ethnographic case study. Journal of Consumer Research, 18(3), 298-310.

The author of this article set out to investigate the predicament of shelter-based homeless women and identify the meaning of “home” and “possessions.” The women who were interviewed as part of this study were much less attached to typical consumer goods. This was linked to the lifetime of poverty associated with this population. They valued sacred items such as religious beliefs and memories. The author also found that the homeless women had a child-like dependence on shelter staff that was related to insufficient bonding with friends or family. The common conception of “home” was an environment that provided the typical provisions of a home, such as safety, food, clothing, and shelter. The information in this article is pertinent and necessary for holistically understanding the female homeless population.

Padgett, D.K., Leibson, H., Abrams, C., & Davis, A. (2006). In their own words: Trauma and substance abuse in the lives of formerly homeless women with serious mental illness. American Journal of Orthopsychiatry, 76(4), 461-467.

The role of mental illness in homelessness is documented in this article by Padgett, et al. Mentally ill persons, especially women, are far more likely to become involved in the use of illegal drugs. Mentally ill women are twice as likely to be victims of trauma, and this is compounded by homelessness. This article gives a good description of living on the streets with co-occurring disorders. An understanding of this phenomenon is necessary to provide intervention.

Wenzel, S.L., Leake, B.D., & Gelberg, L. (2000). Health of homeless women with recent experience of rape. Journal of General Internal Medicine, 15:265-268.

This study identifies the connection between rape and substance abuse among women who are homeless. Looking at a sample of 974 homeless women, the researchers found that 13% had been raped in the past year, and half of those had been raped twice. These women were far more likely to abuse illicit drugs. A weakness of this study was that rape was narrowly defined as penile penetration of an orifice. Clearly, a broader definition that considers the full spectrum of sexual assault should be used. The information in this article can be used to develop rape screening and counseling for women who are homeless.

Conclusion

 Homelessness among women is not a problem that will be easily resolved. Mental illness, substance abuse, and histories of trauma and victimization conspire to create a complex social and medical issue. Women experience homelessness in very different ways than men. The question that I will explore this semester is: What are the defining characteristics of women who are homeless, and how can we use this knowledge to create respectful, sensitive interventions?