30% of people experiencing chronic homelessness have a serious mental illness
(Office of National Drug Control Policy, 2014), while those experiencing
serious mental illness only make up about 4% of the general population (National
Survey on Drug Use and Health,
2015). Mental illness is not only more prevalent in the homeless population, but
is also a risk factor for becoming homeless (United States Conference of
Mayors, 2008). Those experiencing both homelessness and mental illness are more
likely to have decreased quality of life, decreased physical health, difficulty
getting their basic needs met, and spend more time homeless than those without
mental illness (Sullivan, Burnam, Koegel, & Hollenberg, 2000). Thus,
homeless adults with mental illness are in need of interventions that stress
housing stability, provision of food and clothing, and decreasing depressive
symptoms (Sullivan et al., 2000).
with mental illness and substance addictions are the least likely subgroup of
the homeless population to receive and maintain housing (Tsemberis &
Eisenberg, 2000). Cairns (2001) found that the primary reasons why people with
mental illness lose housing are inadequate preparation, difficultly managing on
a low budget, isolation, and lack of meaningful occupation. Occupational
therapists are in a unique position to help address all of these difficulties.
Occupational therapy interventions can also improve functional cognition and
cognitive deficits, such as impaired attention, memory, organization, and
problem solving (Allen et al., 2007; Medalia, Herlands, & Baginsky, 2003).
This is especially important for individuals experiencing homelessness, as
cognitive skills are particularly needed during difficult tasks, environmental
changes, and hazardous situations (Helfrich, Chan, & Sabol, 2011). To
improve cognitive functioning and ability to retain housing, people with mental
illness may benefit from practical assistance with daily activities and skills
training (Caplan, Schutt, Turner, Goldfinger, & Seidman, 2006).
therapy has a long history in mental health, and the purpose of occupational
therapy in community mental health is to “increase an individual’s ability to
live as independently as possible in the community while engaging in meaningful
and productive life roles” (American Occupational Therapy Association AOTA,
2013). According to the AOTA, occupational therapy interventions for community
mental health may include education, work, skills training, health and
wellness, and cognitive remediation and adaptation. Brown & Stoffel (2011)
found that occupational therapists can address lack of long-term housing by
analyzing performance skills and various needs for living in the community. One
way to do this would be to help individuals develop routines and habits around
maintaining their living space.
have found that homeless adults with mental illness were able to significantly
improve their knowledge of life skills and retain the information long-term
after participating in a life skills group intervention with an occupational
therapist (Helfrich & Fogg, 2007; Helfrich et al., 2011). Similarly,
practical skills interventions conducted by consistent staff in small groups
were correlated with higher client satisfaction, improved mental health status,
and greater success in maintaining housing (Calsyn, Morse, Klinkenberg, Yonker,
& Trusty, 2002). Overall, the literature supports improved housing
retention and knowledge of life skills for individuals with mental illness who
participate in a life skills group intervention.