British Columbia's homeless suffered from severe mental health challenges long before they lost their homes, a new study has found.
And more than half of Vancouver's homeless and mentally ill suffer from schizophrenia, according to preliminary data from another study.
These findings were among the research presented Monday at a "Health of the Homeless" summit in Vancouver.
Mental illness came first
"Health challenges, and especially trauma experience among homeless individuals, start much earlier then actual living in substandard housing, very often in childhood or critical developmental periods," said Dr. Michael Krausz, who holds the LEEF Chair for Addiction Research at UBC.
Krausz presented results of a recent study of 500 homeless British Columbians found in Vancouver, Victoria and Prince George.
Among other objectives, the study was designed to address the chicken-or-egg question that has plagued homeless policymakers for decades: Do people lose their housing due to their mental challenges? Or do they become ill as a result of losing their home?
The results were unequivocal: More than half of the men and women in the large study group were found to have suffered from both physical and emotional abuse, often at an early age. More than seven out of every 10 women were also victims of sexual abuse, along with three in 10 men.
In addition to being frequent victims of childhood abuse, the majority of homeless British Columbian are also parents: 71 per cent had one or more children, and 25 per cent had two or more.
Schizophrenia common in Vancouver
Another study found that more than half of the homeless and mentally ill Canadians enrolled in the Vancouver portion of the landmark At Home/Chez Soi study suffer from schizophrenia.
Among that Vancouver study's "higher needs" subgroup -- who include many long-term homeless -- fully 72 per cent are affected by the mental disorder, which commonly manifests as auditory hallucinations, paranoid delusions, or disorganized speech and thinking.
The At Home/Chez Soi research demonstration project is investigating mental health and homelessness in five Canadian cities. Vancouver researchers have already enrolled 255 of a planned 500 participants.
"We're trying to recruit in a way that give us a representative sample of the Vancouver homeless population," said Dr. Julian Somers, who leads the Vancouver portion of the project.
The Vancouver homeless reported heavy use of emergency services: 58 per cent had been to emergency rooms within the last six months, and 32 per cent were arrested by police within the past six months.
There were also found to be remarkably upbeat. Fully 73 per cent agreed with the statement, "I am hopeful about my future."
"They believe in themselves," Somers told the conference. "We have to do likewise."
Homeless treatment paradox
Dr. Christian G. Schutz, who serves as medical manager for the Burnaby Centre for Mental Health and Addiction, described a "homeless treatment paradox" in which those most in need tend to get the least care.
As an example, Schutz described the fate facing individuals with fetal alcohol syndrome. Though they tend to be intellectually capable as adults, 80 per cent are unable to live independently.
But because British Columbia requires that an individual have an IQ of less than 70 in order to qualify for long-term support services, Schutz said those with fetal alcohol syndrome are systematically excluded from care and consigned to homelessness by the province.
Outreach workers report an extremely high prevalence of fetal alcohol syndrome among the homeless.
"Concurrent disorders are more central than had been recognized before," Schutz told the conference. "Those with concurrent disorders... are more likely to be Aboriginal, more likely to live on the street... And two to three times more likely to not receive the help they need."