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Article written by Sturm Collage of Law “Too High a Price: What Criminalizing Homelessness Costs Colorado”

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Article written by Sturm Collage of Law “Too High a Price: What Criminalizing Homelessness Costs Colorado”

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60 Pages Posted: 27 Apr 2018

Date Written: April 27, 2018

Abstract

Like most of America, Colorado faces a homeless epidemic. Amidst a stark rise in housing costs and equally sharp drop in available affordable housing, Colorado's cities struggle to address the overwhelming needs of its homeless residents. While professing a dedication to eliminating homelessness through homeless and poverty services, state actors continue to write, pass, and enforce local ordinances that criminalize life-sustaining behaviors. Laws that criminalize panhandling, begging, camping, sitting or lying in public, and vagrancy target and disproportionately impact residents that are homeless for activities they must perform in the course of daily living.

This Report examines how laws criminalizing homeless people for being homeless have become widespread in Colorado. Through a comprehensive analysis of the enforcement of anti-homeless laws, this Report also examines the cost-economic and social-anti-homeless laws impose upon all Colorado citizens.

In the process of examining trends across branches of government and across the state, we found similarities between the constitutional challenges to anti-homeless laws and other discriminatory legal frameworks that criminalized people for their identities or statuses. Ordinances punishing people without homes for behaviors necessary to their daily lived existence will soon become another chapter in a shameful history of invalidated laws, such as Anti-Okie Laws, Jim Crow Laws, "Ugly Laws," and Sundown Laws. Federal courts have begun to recognize the dubious constitutionality of anti-homeless laws, and, in turn, municipalities like Denver and Boulder have begun re-examining how they enforce anti-homeless ordinances. But the data still reveal a trend: a startling high number of ordinances enforced at an alarming rate which comes with a high price tag for Colorado.

To analyze statewide trends, we identified 76 cities in Colorado based on population and geographic diversity, which represent roughly 70% of the state's population. We surveyed these 76 municipal codes and identified numerous anti-homeless ordinances that target those without homes, such as: sitting, sleeping, lying, or storing belongings in public prohibitions; restrictions on begging or panhandling; camping bans; loitering and vagrancy prohibitions; and trespass, park closure, and sanitation laws. Based on this research, we have come to following conclusions:

* Colorado's 76 largest cities have 351 anti-homeless ordinances; * Cities criminalize homelessness in a variety of ways; * Adopted ordinances inspire similar ordinances in other municipalities; and * Ordinances lack clarity and obstruct government transparency and accountability

From the 76 surveyed cities, we selected 23 cities for more in-depth research using Open Records Requests to examine how anti-homeless ordinances are enforced. We found: * Cities issue citations to homeless residents at a staggering rate. For example, 30% of all citations that Grand Junction issued are pursuant to an anti-homeless ordinance. Fort Collins issues citations to homeless individuals at the rate of two citations per homeless resident per year. Colorado Springs has doubled the rate at which they enforce anti-homeless ordinances between 2010 and 2014.

* Many cities aggressively target homeless residents for panhandling and for trespassing. Fewer than half of the cities surveyed have restrictions on begging or panhandling, yet Denver arrested nearly 300 homeless individuals in 2014 for panhandling. Between 2013 and 2014, Denver issued over 2,000 trespass citations to homeless individuals. This represents more than half of all trespass citations in the city even though homeless residents are only 0.05% of the population.

* Some cities use camping bans to target homeless residents. Boulder stands out in issuing camping ban citations by issuing 1,767 between 2010 and 2014-as compared with Denver, which issued fifteen in the same time frame, or Durango, which issued zero. Boulder issued camping ban citations at a rate of two citations per homeless resident. Eighty-seven percent of Boulder's camping citations were issued to homeless residents.

* Several cities fail to track how anti-homeless citations are enforced against individuals who are homeless-this includes Durango, Pueblo, Colorado Springs, and Aurora. Because most cities also do not track "move on" orders, the data provided by the cities do not address how these widely used policing tactics impact homeless residents' lives.

* Cities do not provide sufficient services for their homeless populations. For example, Fort Collins provides 118 shelter beds for over 400 homeless residents. On its best night, Boulder provides 280 beds for 440 homeless residents. Some cities, like Grand Junction, have limited services and publicize their attempts to deter people who are homeless from coming to their city.

A major contribution of Too High A Price is that it comprehensively analyzes the cost of anti-homeless ordinances by calculating the cost of policing, adjudication, and incarceration. By studying the enforcement of five anti-homeless ordinances in Denver, we found that in 2014 alone, Denver spent nearly three-quarters of a million dollars ($750,000.00) enforcing these ordinances. We estimate that just six Colorado cities spent a minimum of five million dollars ($5,000,000.00) enforcing fourteen anti-homeless ordinances over a five-year period. For reasons discussed in the report, this number is significantly under-inclusive. Reducing or eliminating anti-homeless ordinances would achieve governmental goals of reducing ineffective spending; expanding efficient homelessness services and prevention; and reducing collateral consequences and implicit social costs associated with criminalizing homelessness.

Too High A Price also includes seven separate City Spotlight Reports that takes a deeper dive into the criminalization of homelessness in the cities of Denver, Boulder, Colorado Springs, Durango, Fort Collins, Grand Junction, and Pueblo. With these case studies, this Report also shows that judicial action alone is not enough to stop the unconstitutional criminalization of homeless people. Despite recent court decisions invalidating panhandling ordinances as unconstitutional, Colorado cities enforce other more facially-neutral ordinances in a way that disparately impacts homeless people. Because so many cities have such ordinances, the Colorado state legislature must step in and enact legislation that establishes affirmative rights for homeless individuals at the state level. The Right to Rest Act, Colorado House Bill HB-16-1191, introduced by Representatives Salazar and Melton in February 2016, will help combat the disparate impact of these ordinances in Colorado's communities.

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too high a price:  what criminalizing homelessness costs colorado

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Too High a Price: What Criminalizing Homelessness Costs Colorado

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Like most of America, Colorado faces a homeless epidemic. Amidst a stark rise in housing costs and equally sharp drop in available affordable housing, Colorado'

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News Article produced by FoxNews states “Denver mayor touts 'ambitious' plan to get homeless off streets, take back downtown for frustrated residents”

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News Article produced by FoxNews states “Denver mayor touts 'ambitious' plan to get homeless off streets, take back downtown for frustrated residents”

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EXCLUSIVE - Denver's homeless problem is so bad that one resident resorted to dumping human excrement left by his office on the steps of City Hall to convey his frustration.

Mike Johnston, the Democratic mayor of Denver, may be on the other side of the aisle, but he understood where libertarian think tank owner Jon Caldara was coming from with his viral stunt.

"I've known Jon Caldara for a long time, so we've had more than our handful of discussions, but I think he and I share the same goal, which is what we want is be able to get people housed and be able to get back clean, safe public spaces that everyone can access," Johnston told Fox News Digital. "We know one of the reasons that happens is when folks are living out in tents and encampments, they don't have access to public bathrooms. They don't have access to trash pick-up. And so often they have no place else to drop trash and no place else to go to the bathroom, and so that's one of the reasons why we know it's not the right solution. It's inhumane, it's not good for the city."

While a Democrat, Johnston calls himself a nonpartisan mayor for Denver. The deep-blue city - President Biden took nearly 80% of the vote there in 2020 - is one of many throughout the country struggling with skyrocketing living costs and accompanying homelessness.
DENVER BUSINESSMAN DUMPS POOP FOUND OUTSIDE HIS BUSINESS ON CITY HALL STEPS, DEMANDS ACTION ON HOMELESS CRISIS

"One of the things I love about this job as a nonpartisan mayor and about this task is people from all ends of the spectrum care deeply about this and getting it done," he said, calling his plan "so ambitious." "We were able to bring together really diverse coalitions to work on this."

According to the Annual Homelessness Assessment Report released late last year, Denver had the 10th-largest homeless population among American cities in 2022 at nearly 7,000, and was fourth-worst among cities outside California. Johnston said he hears constantly from city businesses that have lost foot traffic and revenues, and even had to close down, because their downtown locations were beset by the various consequences of homeless people. To illustrate, Caldara shared photos of used needles, human waste and broken glass around his think tank office.

Johnston, who took office in July, immediately declared homelessness a public emergency and released a $50 million plan to get 1,000 people into transitional or semi-permanent housing by year's end, according to CBS Denver. He then hopes to keep homeless encampments that have marred city streets closed for good.

"We now have one of the highest commercial vacancy rates of any city in America," Johnston said. "We're tied with San Francisco, which also has a very significant homeless population. So we know this is one of the major drivers that changes how people feel about their downtown. It affects visitors, affects tourists, affects who wants to work downtown, affects who wants to keep their businesses downtown."

Johnston said the city has seen a 300% increase in homelessness in just the past five years, accompanied by more deaths of residents on the streets, and called it the top issue for voters and for his administration.

"We view that as a crisis on all fronts," he said. "That also means more encampments. It means more businesses who have people living or sleeping in front of their business, or in front of their home, or in their public parks."
COLORADO FENTANYL SEIZURES THIS YEAR ALREADY SURPASS ALL OF LAST YEAR, AUTHORITIES SAY

Johnston acknowledged drug use, particularly from the fentanyl epidemic gripping the country, and mental health issues were contributing factors to homelessness, but said primarily the issue was the high cost of living in Denver.

"We believe you stabilize people in the same way that they got destabilized," he said. "We first got them back into housing. We provide wraparound services on mental health, addiction treatment, workforce training and these are meant to be transitional units. So what we're doing is bringing on hotels we've converted into micro units. We have open half-acre, acre vacant lots where we put up tiny home villages... The goal is these are transitional spots where people will come three, six months, get their lives back together, get a job, get some savings, be able to move into their own place, so they can pay rent and get back up on their feet.

"If we can get all those folks that are currently unsheltered into housing and can close those encampments and keep them closed and reactivate the city, we will have done what most other cities have struggled to do, which is actually to get people into housing and to get back vibrant, joyful, safe downtowns and no longer have encampments in them," Johnston added.

He hopes Denver can be a model for the rest of the country in that regard.
THIS MAJOR US CITY RETHINKS ITS LIBERAL HOMELESS POLICY

Reached for comment on Johnston's approach, Caldara scoffed.

"Another 'housing first' plan throwing $ at the homeless," he wrote in a text message, suggesting instead, "Enforce the camping ban. Arrest people. Clean up streets."

Caldara shared a column he wrote about how Denver should look to Colorado Springs, the second-largest city in the state after the capital, as a model on how to deal with the issue. He derided Johnston's approach as "adorable" and said the housing units were effectively a safe place for the homeless "to lay down their heads at the end of a responsibility-free day of criminal activity."

Colorado Springs, Caldara said, enforces its laws against drug use, theft, assault and public defecation in a way Denver fails to do.

"People should be able to walk around and go to work without stepping over bottles, puddles of urine and vomit. And human feces," he told Fox News Digital last month.

Asked to respond to claims Denver doesn't enforce the law, Johnston spokeswoman Jordan Fuja said he was committed to enforcing the law for everyone.

"But we know that law enforcement doesn't have the capacity to respond to the city's volume of 911 calls. That's why his 2024 budget includes funding for the largest police recruit class since 2005, which will put us on the path to meet the full authorized strength of the police department," she said in a statement.

Democratic San Francisco Mayor London Breed raised eyebrows among some progressives with a plan requiring anyone receiving welfare to submit to mandatory drug testing and treatment programs, but Johnston's office said there would be no such requirements to live in one of the "micro-communities."

"There will not be sobriety requirements to enter one of the micro-communities. Each community will be operated by service providers who create and maintain community rules that must be followed by those living in the community," Fuja said.
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Denver mayor touts 'ambitious' plan to get homeless off streets, take back downtown for frustrated residents

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Denver Mayor Mike Johnston speaks about his administration's ambitious bid to combat the city's homelessness problem in an interview with Fox News Digital.

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“New Mexico confronts 48% spike in homelessness with housing programs and rental assistance” Article by Cronkitenews

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“New Mexico confronts 48% spike in homelessness with housing programs and rental assistance” Article by Cronkitenews

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ALBUQUERQUE, N.M. - After declining for almost a decade, New Mexico's homeless population has increased by 48% from the previous year. According to a report released by the New Mexico Legislative Finance Committee, this spike is primarily due to housing shortages and rising rents.

The report said rents in New Mexico increased by 70% from 2017 to 2021 while wages increased by 15%. Zillow reports the average price for a home in New Mexico in January 2017, was $173,063; in the current market, the average New Mexico home has increased to $293,040. For the U.S. as a whole in the same period, the average price for a home went from $206,839 in January 2017 to $346,653 in 2023.

To combat housing costs, the Albuquerque Housing Authority, AHA, has implemented a voucher program for low-income individuals. Households assisted through the Housing Choice Voucher Program pay 30% of their income toward rent. AHA pays private landlords the difference between what participating households pay and the rent for the units. Through this program, the AHA says, over 4,000 Albuquerque households receive rental assistance.

"If you look at the minimum wage, someone would have to work two or three jobs just to get an apartment," said Tony Watkins, the continuum of care coordinator with the New Mexico Coalition to End Homelessness, a nonprofit organization founded in 2000 by a group of nonprofit agencies and the New Mexico Mortgage Finance Authority

Watkins said that in addition to race and gender identity, "landlords cannot officially discriminate against someone based solely on social class," under the human rights ordinance. One of the things the coalition will be working on for the next legislative session is eviction prevention.

Watkins said that there is institutional racism built into the system that disproportionately affects certain groups of homeless individuals who should be receiving support. "We have way too many Native and Indigenous people that have been undocumented as experiencing homelessness."

According to Watkins, this racism can be traced to the program begun in 1934 by the Federal Housing Administration to insure home mortgage loans. "Ninety percent of those loans for the first 20 to 30 years went to white families," he said. "Insurance companies backed by the federal government deliberately would get a map and draw red lines around neighborhoods that weren't considered worthy. And most of those people were inner city and people of color."

These affected communities were denied credit to either buy or fix up their houses, Watkins said. The racial makeup of Albuquerque reflects this. Most of the white population lives on the eastern side of the city, where housing costs are higher, while the majority of the Hispanic population lives on the inner and southwest side of the city.

Discrimination was prohibited by Title VII of the Civil Rights Act of 1968 "concerning the sale, rental, and financing of housing based on race, religion, national origin, sex, (and as amended) handicap and family status," according to the Department of Housing and Urban Development.

Despite the Civil Rights Act, the legacy of decades of discrimination is still seen, including in this study from the Massachusetts Budget & Policy Center that showed in 2019 "only 44.6% of Black households, 48.1% of Latinx, and 57.1% Indigenous, Asian, or Pacific Islander households owned their homes compared to 73.7% of White households."

"I think the system is not designed in a way that people really know exactly where to go to get the help that they need," said Monet Silva, executive director of the New Mexico Coalition to End Homelessness. According to Silva, many of the coalition's programs provide support to individuals and families where they most need help, such as with mental illness.

"We need that intensive support for families on their own terms in their own home, focusing on their strengths to help them problem-solve because families are the best solutions to their problems," Watkins said.

The coalition administers housing programs both in Albuquerque and throughout the state for people who are homeless. It maintains a local, centralized database of information on clients and their needs that enables the organization to coordinate services with partner providers throughout the state. People are evaluated to determine individual vulnerabilities, disabilities and factors such as whether someone is a survivor of domestic violence.

Alexandra Paisano is the coordinator for the coalition's Coordinated Entry System, a process whereby people experiencing homelessness can access quick and streamlined services. She said that Albuquerque consistently gets about 200 new household applicants per month, and the number of people per household can vary from two to nine. The coalition recently received funding from Albuquerque to put people in a transitional phase into hotels.

Nearly half of all renters in Albuquerque spend more than 30% of their income on housing, according to city data. To classify as low income, an individual must have an income at or below 80% of the area median income, AMI. Very low income is classified at 50% of the AMI and extremely low income is at 30% of AMI. The AMI is classified each year by HUD.

The coalition keeps an accurate count of the homeless population, tracks the patterns of services used in the state and tracks patterns of homeless causes and needs.

"It's a way of rebuilding the system to have a binding list of everyone that is experiencing homelessness so we know exactly who they are and what their needs are so we can address those head-on and be able to get them into housing or the support that they need," Silva said.

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Homelessness in New Mexico has increased by 48% in the past year

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Homelessness in New Mexico increased 48% this year due to housing shortages and rent increases. Government agencies and nonprofit organizations are responding with housing programs and rental assistance to promote stable, more permanent housing.

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FoxNews21’s article and video “CSPD’s Homeless Outreach Team continues to help the unhoused”

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FoxNews21’s article and video “CSPD’s Homeless Outreach Team continues to help the unhoused”

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(COLORADO SPRINGS) - A day in the life of a Homeless Outreach Team (HOT) officer from the Colorado Springs Police Department is not easy as they continue to help offer resources and solutions for the unhoused population, as well as enforce the law.

The team of six, plus their Seargent Olav Chaney, who heads up operations, respond to dozens of calls daily.

"I get complaints, dozens of complaints, a day," SGT. Chaney said. "A lot of them are the same areas that we hit regularly."

This unit disbands homeless encampments on private property which, at times, can include sorting through heaps of trash that may be littered with dirty needles, biohazard materials, or drugs.

The HOT patrols over 200 miles of Colorado Springs enforcing the law and responding to calls when needed; whereas other smaller municipalities like Manitou Springs only have a small stretch of downtown property to enforce due to a new ordinance that banned loitering.

According to SGT. Chaney, two years ago 396 people in Colorado Springs identified as chronically homeless compared to last year when that number rose by over 100 to 470.

Now, law enforcement says arrests are on the rise too.

"That's that's a big part of the issue, is... of the crime, unfortunately," SGT. Chaney explained. "And a lot of violent crime is definitely in the Dorchester Park areas that have had several homicides over the last several months and we're still looking for some of those folks."

SGT. Chaney said in the past three years, his team has cleared more than 300 felony warrants and can clear more than 2,000 misdemeanor warrants in one year.

"A lot of the felony warrants there involving serious assaults, homicides, second-degree assault, domestic violence stuff," he said. "And then there's all the petty crime."

Outreach crews will also team up with officers to offer help for those homeless, working with organizations, such as Homeward Pikes Peak, who ride along on calls and offer resources to the unhoused to help provide resources to get them back on their feet.

But officials say oftentimes people in these camps do not want any help making this problem a difficult one to solve.

"We have rules in society. We have laws and society, and so we keep responding to those same people over and over again, hopefully, hopefully getting to them at some point where they're going to say, all right, I'm done, I'm ready for some help," SGT. Chaney said.

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CSPD's Homeless Outreach Team continues to help the unhoused

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(COLORADO SPRINGS) - A day in the life of a Homeless Outreach Team (HOT) officer from the Colorado Springs Police Department is not easy as they continue to help offer resources and solutions for the unhoused population, as well as enforce the law. The team of six, plus their Seargent Olav Chaney, who heads up [...]

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“Prevalence of Mental Disorders and Addictions among Homeless People in the Greater Paris Area, France” Article By MDPI

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“Prevalence of Mental Disorders and Addictions among Homeless People in the Greater Paris Area, France” Article By MDPI

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Open Access Feature Paper Article

by 1,2,*, 3 and

Observatoire du Samusocial de Paris, 75012 Paris, France

Santé publique France, French National Public Health Agency, 94410 Saint-Maurice, France

INSERM, Sorbonne Université, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP), Department of Social Epidemiology, 75012 Paris, France

Author to whom correspondence should be addressed.

The Samenta Research Group: François Beck, Christine Chan-Chee, Jean-Marie Firdion, Marie-Jeanne Guedj, Marie Jauffret-Roustide, Stéphane Legleye, Valérie Le Masson, Alain Mercuel, Sylvie Zucca, 75012 Paris, France.

1. Introduction

The homelessness phenomenon is more important than ever in Western Europe and North America in this period of economic constraints on welfare budgets and increased social inequalities. Homelessness is the result of complex interactions among structural factors such as the decreased availability of low-cost housing, unemployment, lack of social welfare policies, or immigration, and individual factors of social vulnerability such as physical and mental illness, addiction, loneliness, loss of social support, or some accumulation of other adverse life events [ 1, 2, 3]. Surveys showed that homelessness cannot be considered as a distinct social category, but as the extremity of a social gradient which shares a social proximity with other people living in conditions of poverty and economic insecurity [ 1]. Nevertheless, stigmatized and excluded groups are more likely to become homeless, in particular those with minority racial or ethnic status or those with previous experience of mental illness [ 4, 5, 6]; these groups are currently overrepresented among homeless people in Europe and the US [ 2, 7, 8, 9, 10]. The relationship between homelessness and mental illness has already been discussed. More often, mental illness occurs before the onset of homelessness, and more rarely during homelessness [ 11]. These observations raise the question between the social causation or social selection hypotheses to explain this relation [ 12]. The social causation hypothesis, which argues that a less favourable socio-economic position leads to an increased risk of psychopathology [ 13], is well-demonstrated in the general population for depression and anxiety disorders, whereas the social selection hypothesis, which argues that deterioration in mental health leads to less favourable social and economic conditions [ 14], is retained by many authors for psychotic disorders. Given these observations and some empirical results of research in homelessness, the observed temporal relationships between mental illness and the onset of homelessness are more in favour of the social selection hypothesis [ 2]; for mentally ill people already at the bottom of the social gradient previously mentioned, any social exclusion of income, wealth, or housing, or any adverse life event (such as a divorce, a separation, or an imprisonment) may lead them to homelessness.

Statistical research on homelessness started in France in the 1990s, addressing methodological issues and providing insights into the living conditions and trajectories of the homeless people [ 1]. In 1996, a study conducted in Paris city shelters showed a high prevalence of severe psychiatric disorders and addictions [ 8]. Thirteen years later, the current study has been conducted in a larger, more representative sample, including the whole Greater Paris area, and a greater variety of types of structures and services dedicated to homeless people. It originated from the observation of an increasing number of people living on the streets in the Greater Paris area who refused any kind of aid, which was then interpreted by social workers and local authorities as a consequence of their mental and behavioural disorders. Our main objectives were to estimate the prevalence of severe psychiatric disorders and addictions among the homeless population in the Greater Paris area, to compare their prevalence between men and women, and to explore some biographic factors associated with severe psychiatric disorders.

2. Materials and Methods

2.1. Population and Sampling

The study's population includes French-speaking adults who had slept at least once in a place not intended for human habitation (street, squat, train station, etc.) or who had been taken in by an organization providing free or low-cost housing services within the five days preceding the survey, as well as those encountered in day-centres and those frequenting hot meal distribution points in the Greater Paris area in 2009.

First, we constituted an exhaustive sampling frame of all the homeless aid services in the Parisian region using different sources provided by public and private bodies. This frame contained 797 different housing services (short-stay centres, long-stay centres, hotels, and parent-child centres), 89 day-centres, and 20 hot meal distribution points.

Then, we employed a three-stage random sampling following the Time Location Sampling method [ 15]. In the first stage, we carried out a randomized, unequal probabilities sampling in each of 15 strata that took into account the type of service, a binary geographic variable (Paris inner-city/suburbs), and, when warranted, the sex of the people sheltered. The probability that services would be included was proportional to the capacities of each service. Parisian services, those services dedicated to women, and those dedicated to people less than 25 years of age were overrepresented to improve the strength of the analyses. In the second stage, we randomly selected half-days from the operating hours of each selected service. In the third stage, for every selected half-day, a researcher selected homeless individuals by simple random sampling.

The number of subjects needed to estimate a prevalence of severe psychiatric disorders or addictions of 30% [ 8, 10], was estimated at 800 for an expected precision of 3%. With a response rate of 71%, 859 people were interviewed between February and April 2009, and of those, 840 with complete data were retained in the analysis.

2.2. Data Collection

A pair of specifically trained investigators (a professional lay interviewer and a clinical psychologist) interviewed each person for an average time of one hour. First, a detailed questionnaire about personal and family history, past and present social situation, housing and living conditions, and health and use of healthcare services at the time of the survey was administered.

A section on addictions (alcohol, drugs, medications abuse) used the Alcohol Use Disorders Identification Test (AUDIT) [ 19] and the Assessment and Screening of Assistance Needs (ASAN) drugs questionnaire [ 20], followed by questions on intake methods in the absence of housing.

Psychiatric disorders were investigated through a structured clinical interview (MINI plus v 5.0 [ 21]) integrated into the questionnaire, which generated diagnoses according to the Diagnostic and Statistical Manual of Mental Disorders (DSM, 4th revision). The design of the study, tested on 45 people during a preliminary survey, took into account the risk of under- or over-diagnosis with this type of tool in the absence of a clinician [ 22, 23, 24]. Therefore, once the lay interviewer had completed the questionnaire, the psychologist who had observed the subject/interviewer interaction conducted an open clinical interview to support an eventual diagnosis. Finally, all the questionnaires and clinical reports had been systematically reviewed by a psychiatrist, out of the subject's presence, in order to get a final "diagnosis" based on the 10th International Classification of Diseases (ICD-10) [ 25]. In order to make a differential diagnosis of dementia or neurological damage for people 50 and older, the Mini Mental Status Examination [ 26] was also integrated into the questionnaire.

This study has been approved by 2 ethics committees the Comité pour la protection des personnes of the Necker University Hospital in Paris (No. 08.553), and the national Comité consultatif sur le traitement de l'information en matière de recherche (No. 909007) and by the Commission Nationale de l'Informatique et des Libertés, in charge of the citizens' data protection.

2.3. Statistical Analysis

For each person surveyed, we calculated a sampling weight using the inverse of the product of the inclusion probabilities calculated at each stage of the sampling design. This weight was modified to take into account the heterogeneous use of services by means of the Generalized Weight Share Method [ 27]. All the statistical analyses and the estimates presented here took into account the complex sampling design, using Stata 10 ® (StataCorp, College Station, TX, USA).

In our analysis, severe psychiatric disorders included non-mood psychotic disorders (ICD-10: F20-29), severe mood disorders (ICD-10: F30-39 except F32.0 and F32.1, mild or moderate mood disorders), and anxiety disorders (ICD-10: F40-48).

To analyse the factors associated with severe psychiatric disorders, we compared the people who presented these disorders to those who did not (excluding people presenting a personality disorder: F60-F69) to some characteristics associated with psychiatric disorders found in the literature: demographics (age, sex, family status, country of birth), adverse life events in childhood and adolescence (running away, sexual violence), and variables associated with homelessness: level of education, social origin (parents' employment at 12 years), parents' difficulties (fights and/or addictions), as well as age, housing conditions, and problematic use of alcohol and/or marijuana before the first experience of homelessness. These factors were identified using an age- and sex-adjusted multivariate Poisson model with robust variance, which was more suited to the cross-sectional design of the survey than logistic regression [ 28].

3. Results

3.1. Prevalence of Psychiatric Disorders and Addictions

The estimated size of the French-speaking adult population using housing services or frequenting day-centres or hot meal distribution points for an average week during the study period was 21,176 people (95% CI: 17,582-24,770). We estimated the proportion of homeless people with at least one severe psychiatric disorder at 31.5% ( Table 1). These disorders consisted of psychotic disorders (13.2%, mostly schizophrenia: 8.4%), anxiety disorders (12.3%, including post-traumatic syndromes: 4.2%), and severe mood disorders (6.7%, including depression: 4.5%). Non-severe mood disorders (mainly mild to moderate depressions) were found in 15.8% of people. With regard to addictions, more than a quarter of the population presented a regular consummation of psychoactive substances (28.6%). Alcohol dependence was found in 21.0% of people and a daily or almost daily consumption of marijuana in 16.1%.

Almost half of the homeless people with psychotic disorders presented an addiction to at least one psychoactive substance (49.3%); they were alcohol-dependent in 30.1% of cases and regular users of marijuana in 30.9%. Accordingly, when compared to people not suffering from psychotic disorders, their risk of having at least one addiction was significantly higher: Odds Ratio (OR) = 2.9; p < 0.05). On the contrary, people with severe mood disorders and those with anxiety disorders had lower risks of addiction than people not suffering from these disorders (respectively OR = 0.5; p < 0.05 and OR = 0.3; p < 0.05). The global prevalence estimates masked significant disparities according to gender and origin, while 52.1% of the population were female (of which, 77.2% were born abroad) and 47.9% were male (of which 62.1% were born in France, p < 0.05).

3.2. Prevalence of Psychiatric Disorders by Gender

Comparatively with homeless men ( Table 1), homeless women had significantly higher prevalence of anxiety disorders (21.0%, i.e., more than double the prevalence in men) and depression (6.2%). Conversely, homeless men had higher prevalence of delusional disorders (5.0%, i.e., more than 5 times greater than female prevalence) and addictions. Prevalence of addictions in men generally exceeded that in women by about three times, whether considering a global prevalence (37.5% versus 11.9%, p < 0.0001) or, specifically, alcohol dependence (24.8% versus 4.1%, p < 0.0001), the regular consumption of illegal drug(s) and/or the misuse of prescription drug(s) (22.6% versus 8.0%, p < 0.01), and the regular consumption of marijuana (21.4% versus 6.1%, p < 0.0001).

3.3. Biographic Factors Associated with Severe Psychiatric Disorders

The analysis of factors associated with severe psychiatric disorders (SPD) among the homeless population in the Ile-de-France ( Table 2) shows that homeless people of French origin, people who experienced some adverse life events before the age of 18 (running away, sexual violence, parents fights and/or addictions), and those who experienced homelessness for the first time before the age of 26 were at a higher risk of SPD. Compared to people who lived with their parents when they first experienced homelessness, those who had lost their own home were twice as likely to have SPD. Neither the level of education nor the parental employment status was associated with SPD. A problematic use of alcohol and/or marijuana before homelessness was significantly more often reported by homeless with SPD (40.8%) than by homeless without SPD (19.9%). This association was no more significant in the final model (p = 0.127), but it was solely due to the introduction of the country of birth (being or not born in France) with a PR reduced by less than 20% (from 1.58 to 1.28). Indeed, it remained significant in a final model that did not take into account the country of birth (PR = 1.35, 95% CI: 1.03-1.77, p = 0.028).

4. Discussion

The observed prevalence of psychiatric disorders and addictions in our survey reveals the great differences between men and women in the homeless population, as well as the importance of their origin and of some biographical factors.

The comparison of the prevalence of psychiatric disorders between the homeless and the French general population [ 31] indicated psychotic disorders at a rate 10 times higher, mild mood disorders four times higher, and addictions three to five times higher than in the general population. These results are comparable with other French studies on homelessness, especially that of Kovess et al. [ 8], which found psychotic disorders in 16% of participants, and that of Fazel [ 10], which found psychotic disorders in 12.7%.

The nature of the psychiatric disorder differs according to people's gender. Anxiety disorders and depression were most frequent in women, as it is generally observed in the general population, particularly in France [ 31]. Conversely, addictions were more frequent in men, as it is observed in the general population in France with similar sex ratios for alcohol dependence and the regular consumption of marijuana [ 32]. Women were predominantly found in "social hotels", and a majority of them were immigrant single mothers (which led to the realization of a specific survey, some years later as mentioned above). The population living in hotels reflects the rise of homeless families in the Ile-de-France that we have observed over the last several years [ 33]. The preponderance of anxiety and depressive disorders that we found within the study population is the same as those found in an American study [ 34], in which psychotic disorders were also rare, while depressive syndromes were predominant (2.5 times more depressive syndromes than in the general population). However, it is worth noting that this prevalence differs only slightly from other poor, but housed, families with the same profiles [ 35, 36, 37]. Also, people who live with their families, but have no home, more often turn to addictions than those with family and home, but less often than people without home and family [ 35]. The disorders observed among homeless people in families are closer to those found among immigrants in the general population, for which we find a preponderance of depressive disorders and anxiety disorders (including post-traumatic stress disorders) in the literature [ 38, 39]. When the 'healthy migrant effect' explains why immigrants may have a better mental health [ 40] (at least at their arrival in the host country), the psychopathology of immigrants is generally attributed to an original aetiology, traumatic migration conditions, or harsh living conditions in the host country [ 41].

In our study, the mentally ill homeless did not seem different from other homeless in terms of level of education or parental social situation (unlike other results found in the literature [ 11, 42, 43]), but this population had been homeless at a younger age. Since we did not know participants' mental health status previous to homelessness, we cannot exclude that psychotic young adults might have lost or been thrown out of their homes due to early behavioural problems. However, our results argue, with others [ 44, 45, 46], for the fastest possible access to homes and/or for better care of the mental disorders of the youngest homeless populations before their mental states deteriorate.

Sullivan showed that mentally ill homeless people appear to have more in common with other homeless people than with the mentally ill-housed population [ 11]. However, in our study, the mentally ill were distinct in terms of severe life events in childhood. Not only have these events been more often observed in homeless than in the general population [ 1, 47, 48], but they can also be interpreted within homeless populations as supplementary biographic disadvantages or risk factors of severe psychiatric disorders [ 4, 11, 49]. Thus, mentally ill homeless suffer a triple disadvantage: poverty, childhood adverse events, and mental illness.

5. Conclusions

To conclude, those results advocate for an improvement in detection, housing, and care of psychiatric homeless people, not only for the most visible part of the population but also for homeless families. They also advocate for addressing more pervasive causes of homelessness; that is to say, changes are required in some policies that directly or indirectly affect the health, stability, and well-being of poor households (in terms of income distribution, housing, employment, education, etc.) for the effective prevention of homelessness, starting with child development in healthy and stable environments and leading to full-functioning and healthy adulthood. The general picture on homelessness keeps changing in the Greater Paris area. It has actually worsened recently with an endless rise in the number of homeless women, an increasing diversity of homeless peoples' origins, and the recent observation of homeless, foreign, unaccompanied minors in the context of the refugees crisis in Europe. All this is to say that such a representative survey on the mental health of homeless people deserves to be replicated almost 10 years after, and special attention should be paid to minors and non-French speaking people.

AMA Style

Chicago/Turabian Style

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Prevalence of Mental Disorders and Addictions among Homeless People in the Greater Paris Area, France

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The Samenta study was conducted in 2009 in the Greater Paris area to estimate the prevalence of psychiatric disorders in homeless people. A cross-sectional survey was performed with a three-stage random sample of homeless people (n = 859), including users of day services, emergency shelters, hot meal distribution, long-term rehabilitation centres, and social hotels.

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News scholarly article by Taylor and Francis “Understanding Homelessness”

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News scholarly article by Taylor and Francis “Understanding Homelessness”

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ABSTRACT

This paper reviews the literature on understanding homelessness. It criticizes approaches that ignore, distort or diminish the humanity of homeless people, or else, add little to our understanding of that humanity. In particular, it rejects what it calls "epidemiological" approaches, which deny the possibility of agency for homeless people, insofar as those approaches view the situation of those people largely as a "social fact", to be explained in terms of causal variables or "risk factors" of different kinds. It evaluates the concept of homelessness pathways as a way of making sense of research findings on homelessness. It takes issue with realist approaches, insofar as these approaches purport to identify "underlying" mechanisms that "cause" homelessness, and discusses ethnographic approaches focused on "homeless culture". Throughout, the paper emphasizes the need to understand homelessness as multidimensional and storied, and concludes with a plea for more research that looks at the whole life of a homeless person, rather than just at selected episodes of rooflessness.

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ABSTRACT This paper reviews the literature on understanding homelessness. It criticizes approaches that ignore, distort or diminish the humanity of homeless people, or else, add little to our understanding of that humanity.

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Channel 9 News entitled “Denver Sweeps Homeless Encampment; first time in months city not offering other housing options”

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Channel 9 News entitled “Denver Sweeps Homeless Encampment; first time in months city not offering other housing options”

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Denver sweeps homeless encampment; first time in months city not offering other housing options

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KRQE News entitled “New Mexico's rise in homelessness highest in the nation”

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KRQE News entitled “New Mexico's rise in homelessness highest in the nation”

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New Mexico's rise in homelessness highest in the nation

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“New Mexico's rise in homelessness highest in the nation” By KOB4

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“New Mexico's rise in homelessness highest in the nation” By KOB4

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New Mexico to receive $16M in federal funding to combat homelessness