Suicide and the Homeless
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An Observational Study of Suicide Death in Homeless and Precariously Housed People in Toronto
Hunger and Homelessness
The daily lives of people experiencing homelessness are stressful, dangerous, traumatic, and often take a toll on their mental health. Access to adequate housing that meets a certain standard of living is a social determinant of mental health status. People can go without many things but going without a safe and comfortable space to live can be catastrophic for ones general well-being. Homelessness itself can trigger a mental illness or worsen an existing condition, without even considering other factors such as poverty, personal conflicts, death of a loved one, serious medical condition, social isolation and other personal issues.
Studies confirm that people experiencing homelessness tend to have poorer mental health and have higher prevalence of mental illnesses than the general population. However, its important to note that not all people experiencing homelessness have or will ever develop a mental health condition. Yet, for those who do, contrary to the stereotype of the person experiencing homelessness suffering with psychosis, depression and suicidal behaviours are more commonly reported.
Mental Health Commission of Canada estimates that up to 50% of people experiencing homelessness have a mental illness. A Toronto study found that 66% of people experiencing homelessness experienced serious depression sometime in their lifetime, and 56% did so in the past year. Because mood disorders such as depression usually first appear in adolescence or young adulthood, youth tend to have the highest prevalence of depression than any other group.
Rates of depression are alarmingly high among youth experiencing homelessness. Considering the social factors that impact mental health, this population is clearly a population at higher risk. Negative impact on mental health often begins well before a young person experiences homelessness. Unhealthy family relationships, family breakdown, poverty, physical, emotional and sexual abuse, histories of domestic violence and neglect are known factors that impact this population. Given the extent of adversity that youth face even before experiencing homelessness, it is no surprise that nearly one in three youth experiencing homelessness suffers from depression.
Homelessness is often described as a process of repeated exposures of stressful circumstances and being immersed in unsafe or dangerous environments. These reoccurring and ongoing negative experiences can have devastating outcomes for those with depression thinking of suicide.
Not all individuals with depression will commit suicide, however 60% of those who died from suicide suffered from depression. While depression may not be 100% preventable, suicidal behaviour including completed suicide, suicide attempts and suicidal ideation are a preventable public health challenge in Canada. Suicide is the 9th leading cause of death in the country, with men three times more at risk than women.
A number of studies have reported higher rates of suicidal behaviour among youth experiencing homelessness in comparison to other youth. In Ottawa, 43% of youth experiencing homelessness reported suicidal thoughts, and 46% in Toronto and Vancouver reported a past suicide attempt. Of those at greater risk of suicide include youth with co-occurring substance use and mental health conditions.
Recently, suicide among First Nations and Inuit Peoples has been described as national epidemic and public health crisis, with Inuit having suicide rates 25 times higher than the national average. This issue has been linked to the legacy of residential schools including the social and economic inequities Indigenous Peoples face such as inadequate housing and poverty. As part of the solution, The National Inuit Suicide Prevention Strategy calls for addressing the inequalities experienced by Inuit in the areas of housing, education and healthcare while validating Inuit culture, language and identity. Health Canada has also developed the National Aboriginal Youth Suicide Prevention Strategy Program Framework in 2010, however further financial resources are required to prevent and reduced the risk factors associated with suicide.
There is no single-handed solution to reduce the rates of suicide and depression among those experiencing homelessness. Yet, it is essential to strengthen systems that support youth, families and communities including clinical, outreach and community programs, along with coordinating policies targeting mental health, housing, income, and employment. In addition, addressing the historical determinants such as the legacy of residential schools that are believed to have shaped the mental health of Indigenous Peoples is critical in fostering and promoting healthy communities while paving Canadas way towards reconciliation.
The Need for Early Mental Health Intervention to Strengthen Resilience in Street-involved Youth - Homeless Hub Research Summary Series
Are 3 Times More Likely To Attempt Suicide, Be Hurt By
The report, More Than a Place to Sleep, examined the effects of homelessness on teenagers ? and found that homeless high schoolers are more likely than their housed peers to attempt suicide, experience intimate partner violence and suffer from preventable but serious health issues.
The nonprofit Institute for Children Poverty & Homelessness released the research, which relied on a small data sample of high schoolers in New York City collected by the Centers for Disease Control in its 2015 Youth Risky Behavior survey.
While homelessness among teenagers is nothing new, few studies have attempted to understand the nuances of how being homeless affects them. 2015 was the first year the CDC included survey questions that distinguished homeless students from housed students.
Of the 5,762 New York City students surveyed who answered questions about housing, 712 reported experiencing a degree of homelessness. That could mean living in a shelter, crashing somewhere temporarily or residing in someone elses home.
The streets, its always there for you, said a homeless student who graduated in 2013. Someone on my block might say Hey, you all right? You can come stay with me, and theyre a drug dealer, and its not like necessarily were doing anything bad, but its just the environment Im around. So what happens after that? You know what I mean? Its not good.
Homeless high school students also arent getting adequate nutrition and sleep which are the basic building blocks for their development.
Over a period of a week, 33 percent of students said they went without breakfast. Homeless teens are more than twice as likely as housed students to go to school hungry.
I remember going to M&M World, stealing the candy and putting it in my pocket, being chased by the security guard, said one of the teenagers surveyed, who was formerly homeless. But I was doing it because I was hungry Imagine going the whole day not eating.
Students who eat breakfast are more likely to have better attendance and participate in class, according to a 2015 survey of teachers conducted by the nonprofit No Kid Hungry.
But even when breakfast is available at school, underserved kids are often reluctant to partake. For one, they might be too ashamed to admit that they dont have enough food at home. Logistical issues also often come into play. If breakfast is served before school officially starts, their parents may not be able to get their kids to school then, according to the No Kid Hungry report.
Imagine going the whole day not eating." Homeless student
Homeless students are also more likely to get fewer than four hours of sleep. That puts them at risk for obesity, diabetes, developing mental health issues and substance abuse problems, among other things.
Leveraging existing problems could better protect and support homeless students, the authors of the report say. The Institute for Children Poverty & Homelessness recommended expanding school-based health programs to target homeless students and to expand services for them at shelters. It also emphasized the need to collect more accurate data. The current CDC survey focused only on homeless students in high school, not homeless students who are younger.
The long-term health and
well-being of students experiencing homelessness are in
danger, yet until now the unique needs and risks these
students face have gone unrecognized, the authors of
the report noted. The disparity in health outcomes for
homeless students, like the disparity in educational
success, appear to surpass the impacts of poverty or race;
ameliorating these disproportionate burdens is imperative to
breaking the cycle of homelessness.
Teens Are At Higher Risk For Suicide Than Their
Yet, data on these students was never separated from their housed peers until the CDC's 2015 report on risky behavior in youth. Now, new research using this survey finds that homeless youth are at a much greater risk of suicide compared to their peers.
The Institute for Children, Poverty, and Homelessness used the data to see how homeless students compared to students who have stable homes. They looked at the sample of 5,762 students in New York City who answered questions about housing. 712 of those students had experienced some form of homelessness, which could include living in a home that was not theirs or living in a shelter, The Huffington Post reports.
Homeless students were three times more likely to attempt suicide than students who lived at home with a parent or guardian, the study found. While only 6% of housed students contemplated suicide, 20% of homeless students did.
Other findings from the study may contribute to this risk, like that 40% of homeless teens have depression and that nearly one in four have been forced into unwanted sexual activity.
Teen homelessness is an epidemic at an all-time high, according to The Huffington Post. There are so many homeless youths that New York shelters turned away about 5,000 kids in 2012 due to a lack of beds.
The long-term health and well-being of students experiencing homelessness are in danger, yet until now the unique needs and risks these students face have gone unrecognized, the researchers wrote.
We're a long way off from solving youth homelessness, but even knowing the data on homelessness and health is a step toward making the lives of these kids better.
And the researchers are calling for
even more steps. We need more data on this group of teens
and kids even younger than them, they wrote, and for schools
and shelters to expand resources for students' mental and
Youth 5-10% LGBT
Homeless Youth 20-40% LGBT
There are approximately 1.6 million to 2.8 million homeless young people in the United States, and estimates suggest that disproportionate numbers of those youth are gay, lesbian, bisexual, or transgender. These vulnerable gay and transgender youth often run away from home because of family conflict and then face overt discrimination when seeking alternative housing, which is compounded by institutionalized discrimination in federally funded programs.
We do not have to accept this reality. The federal government has the power to reduce and eventually eliminate rates of gay and transgender youth homelessness while addressing youth homelessness overall. Congress can and should make a financial commitment to services directed at these young people. They should join with federal agencies and couple it with an expansion of equal rights and protections to all gay, lesbian, bisexual, and transgender people. As the numbers below show, its time we provide these young people with the help they need.
An alarming number of gay and transgender young people are homeless
1.6 million to 2.8 million: The estimated number of homeless youth in the United States.
20 to 40 percent: The portion of the homeless youth population who are gay or transgender, compared to only 5 to 10 percent of the overall youth population.
320,000 to 400,000: A conservative estimate of the number of gay and transgender youth facing homelessness each year.
14.4: The average age that lesbian and gay youth in New York become homeless.
13.5: The average age that transgender youth in New York become homeless.
Homeless gay and transgender youth see higher rates of abuse and victimization
58 percent: The portion of homeless gay and transgender youth who have been sexually assaulted, compared to 33 percent of homeless heterosexual youth.
44 percent: The portion of homeless gay and transgender youth who reported being asked by someone on the street to exchange sex for money, food, drugs, shelter, or clothes, compared to 26 percent of straight homeless youth.
Rejection and discrimination at home lead to severe personal and social problemsHomeless youths who abuse alcohol
13: The average age gay and lesbian youth now come out after self-identifying as gay or lesbian as young as ages 5 to 7.
62 percent: The portion of homeless gay and transgender youth who experience discrimination from their families, compared to 30 percent of their heterosexual peers.
42 percent: The portion of homeless gay and transgender youth who abuse alcohol, compared to 27 percent of heterosexual youth.
62 percent: The portion of homeless gay and transgender youth who attempt suicide, compared to 29 percent of their heterosexual homeless peers.
8.4 times: How much more likely gay and transgender youth are to attempt suicide if they are rejected by their families in adolescence compared to if they are not rejected by their family. They are also 5.9 times as likely to have experienced depression, 3.4 times as likely to have used illicit drugs, and 3.4 times as likely to have had unprotected sex.
Harassment at school leads to high dropout rates
86 percent: The portion of gay and lesbian students who reported being verbally harassed at school due to their sexual orientation in 2007.
Verbally harassed 86%
Physically harassed 44%
Physicaaaally attacked 22%
44 percent: The portion of gay and lesbian students who reported being physically harassed at school because of their sexual orientation in 2007.
22 percent: The portion of gay and transgender students who reported having been physically attacked in school in 2007. Sixty percent say they did not report the incidents because they believed no one would care.
31 percent: The portion of gay and transgender students who report incidents of harassment and violence a school to staff only to receive no response.
Two times: How much less likely gay and transgender students are to finish high school or pursue a college education compared to the national average.
Child welfare systems often fail to protect gay and transgender youth
78 percent: The portion of gay and transgender youth who were either removed from or ran away from their New York foster care placements due to conflict and discrimination related to their sexual orientation or gender identity.
88 percent: The portion of professional staff in out-of-home placements who say that gay and transgender youth were not safe in group-home environments.
$53,665: The estimated cost to maintain a youth in the criminal justice system for one year, while it only costs $5,887 to permanently move a homeless youth off the streets and prevent them from reentering the criminal justice system.
Federal programs overlook homeless gay and transgender youth
$195 million: The portion of the federal governments $4.2 billion budget for homeless-assistance programs that is targeted toward homeless youth.
$195 million targeted toward homeless youth
Less than 1 percent: The portion of the $44 billion federal budget for homeless assistance, public housing, and affordable housing programs allocated for homeless youth housing assistance.
44,483: The number of youth who were given a bed in a shelter through Runaway and Homeless Youth Act programs in 2008, compared to 766,800 homeless youth identified through these programs.
For more information, see: On the Streets: The Federal Response to Gay and Transgender Homeless Youth
Behind the face of every homeless young person is another heartbreaking story a teenage boy abused by his alcoholic parent, a pregnant girl rejected by her guardian, or a teenager trying to escape gang membership or a life of forced prostitution.
In case after case, the main cause of youth homelessness is physical, sexual, and/or emotional abuse from parents or guardians.
The facts about homelessness are staggering ... but acknowledging the depth of the problem is the first step in fixing it.
That's why Covenant
House works day and night to
provide shelter and support for kids who have endured lives
of abuse, neglect, and homelessness. In 2015, Covenant House
provided services to more than 51,000 of these kids. Our
Residential and Community Service Center programs cared for
29,987 homeless kids, and Covenant House Street Outreach
teams served an additional 21,186 homeless and at-risk youth
on the streets in the 21 cities where Covenant House
'We need to get on top of intergenerational poverty, teen
suicide, homelessness and addiction'
While Herbert praised the successes and innovation in a number of those arenas, he also spoke somberly of societal problems affecting the state's most vulnerable populations that must be overcome.
"But before we talk about the peaks, let me say a few words about two of the very deep and shadowy valleys in our state's current landscape: drug addiction and homelessness," his speech noted.
Herbert later said the state must get on "top" of the problems of intergenerational poverty, teen suicide, homelessness and addiction.
The governor praised the local efforts taken by cities and law enforcement, but stressed state leaders stand willing to listen to recommendations.
"And let us, as a state, be emphatically clear that we will no longer tolerate the unconscionable drug trade that victimizes the most vulnerable in our community. Let us all agree tonight that this must absolutely stop," Herbert stressed, receiving a standing ovation.
Herbert pointed out that even as "daunting" as those challenges may be, there is much to celebrate in Utah, such as the state's robust economy and a drive to achieve educational excellence.
"If we will unite and focus, Utah can be at the top of the nation in student achievement," he said.
A cornerstone of his speech was the unveiling of a collaborative initiative to pair education with industry.
Herbert said Talent Ready Utah will help fill 40,000 high-skill, high-paying jobs over the next four years. The effort will be led by the Governor's Office of Economic Development, his education adviser, Tami Pyfer, and in partnership with the State Board of Education.
That collaboration, he added, will build on the state investment in education of $1.8 billion over the last five years.
The governor acknowledged the need to put more money in education to meet the needs of the fastest growing student population in the nation, but he noted his "concern" over altering tax policies that would impair the state's economy.
Herbert said the state would be best served by undertaking a robust examination of sales tax exemptions which have blossomed from 48 to 89 since 1996 and by taking a hard look at income tax credits.
In a press conference after Herbert's address, Utah's top Democrats said the governor's push for possible tax reforms fall far short of being able to deliver on the degree of funding needed by the education system.
"It's time the rubber hit the road," Senate Minority Leader Gene Davis, D-Salt Lake City, said. Herbert's praise of the state's 85 percent high school graduation rate still ignores those students left behind, Davis added.
The governor also touched on the economic challenges in rural Utah, urging state leaders to get behind the goal of creating 25,000 new jobs in the 25 counties off the Wasatch Front over the next four years.
"Reaching that goal will require unprecedented partnerships to grow and diversify the economy in rural Utah. To that end, I will work with Lt. Gov. Cox and the Rural Partnership Board, the private sector and you, the Legislature, to ensure that all Utahns have the same economic opportunities," he said.
In the arena of air quality, the governor conceded that the area's pollution woes are a concern given Utah's role as the fastest growing state in the nation.
"We will continue to fast track the arrival of cleaner fuels, cleaner cars and to get people to drive less and to conserve more," he said.
Herbert, pointing to Utah's rapid expansion of its transit system and the state's requirement of refinery and other industry investments in "best available" emission control technology, said he plans to tour the state to point out its successes.
"And along the way, I will also visit those organizations that need a little extra encouragement to help us make measurable improvements to our air quality," he said.
Afterward, House Minority Whip Joel Briscoe, D-Salt Lake City, said it is true that the state has made "incremental" progress in improving air quality.
"But incremental progress is not enough," he said, pointing to the huge crowd that attended a clean air rally earlier this month at the state Capitol. Those crowds, he added, underscore the public's desire for more action.
"We can do more, we have to do more," added House Minority Leader Brian King, D-Salt Lake City.
As for liquor law reform, Herbert said Utah needs to continue on its path of curtailing underage drinking, prevention of alcohol abuse and tackling impaired driving.
He said those efforts can continue without "stigmatizing" responsible adults' purchase and consumption of alcoholic drinks in dining establishments.
During the legislative session, he said, leaders will work to "keep and enhance what works for Utah and repeal what does not," indicating the state's notorious liquor barriers in restaurants might need to be peeled away.
Herbert also touched on the optimism that exists for a Washington, D.C., administration that appears willing to return power to the states.
"There is a renewed appreciation for the 10th Amendment and a realization that the states are truly the laboratories of democracy, the place where real solutions are developed to improve people's lives," he said.
Herbert ended on an uplifting note stressing his belief that Utah can conquer the challenges that lie ahead.
"Personally, I am committed to this
trek, no matter how difficult the way," he said. "I am
exhilarated by the challenge because I have never been more
optimistic about Utah's prospect for
Homelessness has been identified as an important risk factor for suicide death, but there is limited research characterising homeless people who die by suicide. The goal of this study is to identify personal, clinical, and suicide method-related factors that distinguish homeless and precariously housed people who die from suicide from those who are not homeless at the time of suicide.
Coroner records were reviewed for all suicide deaths in Toronto from 1998 to 2012. Data abstracted included housing status as well as other demographics, clinical variables such as the presence of mental illness, and suicide method.
Of 3319 suicide deaths, 60 (1.8%) were homeless and 230 (6.9%) were precariously housed. Homeless and precariously housed people were each younger than nonhomeless people (P < 0.0001). Compared with nonhomeless, homeless people were more likely to be male and less likely to be married, to have interpersonal conflict, or to leave a suicide note. Homeless people and precariously housed were more likely to have died by fall/jump than nonhomeless people (62%, 57%, and 29%, respectively).
Homeless and precariously housed
people are overrepresented among suicide deaths in a large
urban center and differ demographically, clinically, and in
their suicide method from nonhomeless people who die by
suicide. Targeted suicide prevention strategies should aim
to address factors specific to homeless people.
Suicide behaviour rates vary
significantly between countries due to a range of cultural,
behavioural and health-related factors. Gender and
age-related factors also appear to be impor tant key
determinants of vulnerability to suicide ideation and
suicide completion. The homeless population is par ticularly
at risk, due to multiple complex issues that relate to
social exclusion, alcohol, drug, mental health and
nutritional issues. Studying homeless people is problematic
due to access, the transitory nature of their contact with
statutary services, problems of self-repor t and recall in
people - some of whom have mental health and cognitive
issues. There is an increasing interest from practitioners
and academic researchers in spiritual factors that appear to
modulate the responses of an individual to the internal and
external threats that underlie the motivation to end his or
her life. Effective approaches to suicide prevention and
crisis management require a good understanding of the
interplay between this complex set of biological,
psychological and social domains. These will be explored in
the final section of this review. This paper, therefore,
aims to provide a non-systematic review of the existing
literature published in academic journals and relvant
grey literature and focuses on themes in the
literature that will hopefully inform both policy and
Among the homeless there are high rates of mortality and a significant number of attempted and completed suicides. In Tel-Aviv, Israel, there is an ongoing municipal outreach program for the homeless.
The aim of the present study was to describe the subgroup of homeless persons who had died by suicide.
Over a 9-year period the records of each homeless person who had died were assessed by two psychiatrists and a clinical criminologist. The project was undertaken in a large city and was feasible due to close cooperation between the municipal welfare department and mental health consultants.
Of the 1,192 homeless persons located and contacted, 156 persons had died (13.1%). Nine of the deaths were by completed suicide (5.8%). All were male. Mean age for the suicide subgroup was 34 +/- 8.7 years, significantly younger than those who died of other causes (p < .01). The majority had completed high school education. While the majority of deaths were drug or alcohol related, in only 1 of 9 deaths by suicide was there a history of drug abuse. Psychiatric comorbidity was recorded in 4 of the 9 persons. The majority of persons (6/9) had died of suicide by hanging.
Suicide is not a negligible cause of
death among the homeless population.
This study was carried out with three
goals: (1) to determine the prevalence of suicidal ideation
and suicide attempts among the homeless; (2) to determine
what aspects of homelessness predict suicidality, and (3) to
determine which aspects remain predictive after controlling
for key covariates, such as mental illness. A sample of 330
homeless adults were interviewed. Sixty-one percent of the
study sample reported suicidal ideation and 34% had
attempted suicide. Fifty-six percent of the men and 78% of
the women reported prior suicidal ideation, while 28 percent
of the men and 57% of the women had attempted suicide.
Childhood homelessness of at least 1 week without family
members and periods of homelessness longer than 6 months
were found to be associated with suicidal ideation.
Psychiatric diagnoses were also associated with suicidality
in this sample.