Homelessness is lacking stable and appropriate housing. People can be categorized as homeless if they are: living on the streets (primary homelessness); moving between temporary shelters, including houses of friends, family and emergency accommodation (secondary homelessness); living in private boarding houses without a private bathroom or security of tenure (tertiary homelessness). The legal definition of homeless varies from country to country, or among different jurisdictions in the same country or region. United States government homeless enumeration studies also include people who sleep in a public or private place not designed for use as a regular sleeping accommodation for human beings. People who are homeless are most often unable to acquire and maintain regular, safe, secure and adequate housing due to income that is inconsistent or lacking altogether. Homelessness and poverty are interrelated. There is no methodological consensus on counting the homeless and identifying their needs; therefore in most cities only estimated homeless populations are known.
In 2005, an estimated 100 million people worldwide were homeless and as many as one billion people (one in 6.5 at the time) live as squatters, refugees or in temporary shelter, all lacking adequate housing. Historically in the Western countries, the majority of homeless have been men (50-80%), with single males particularly over represented.
When compared to the general population, people who are homeless experience higher rates of adverse physical and mental health outcomes. Chronic disease severity, respiratory conditions, rates of mental health illnesses and substance use are all often greater in homeless populations than the general population. Homelessness is also associated with a high risk of suicide attempts. People experiencing homelessness have limited access to resources and are often disengaged from health services, making them that much more susceptible to extreme weather events (e.g., extreme cold or heat) and ozone levels. These disparities often result in increased morbidity and mortality in the homeless population.
There are a number of organizations that provide help for homeless people. Most countries provide a variety of services to assist homeless people. These services often provide food, shelter (beds), and clothing and may be organized and run by community organizations (often with the help of volunteers) or by government departments or agencies. These programs may be supported by the government, charities, churches, and individual donors. Many cities also have street newspapers, which are publications designed to provide employment opportunities to homeless people. While some homeless people have jobs, some must seek other methods to make a living. Begging or panhandling is one option, but is becoming increasingly illegal in many cities. People who are homeless may have additional conditions, such as physical or mental health issues or substance addiction; these issues make resolving homelessness a challenging policy issue.
In 2004, the United Nations sector of Economic and Social Affairs defined a homeless household as those households without a shelter that would fall within the scope of living quarters due to a lack of or a steady income. They carry their few possessions with them, sleeping in the streets, in doorways or on piers, or in another space, on a more or less random basis.
In 2009, at the United Nations Economic Commission for Europe Conference of European Statisticians (CES), held in Geneva, Switzerland, the Group of Experts on Population and Housing Censuses defined homelessness as:
In its Recommendations for the Censuses of Population and Housing, the CES identifies homeless people under two broad groups:
(a) Primary homelessness (or rooflessness). This category includes persons living in the streets without a shelter that would fall within the scope of living quarters;
(b) Secondary homelessness. This category may include persons with no place of usual residence who move frequently between various types of accommodations (including dwellings, shelters, and institutions for the homeless or other living quarters). This category includes persons living in private dwellings but reporting 'no usual address on their census form.
The CES acknowledges that the above approach does not provide a full definition of the 'homeless'.
Article 25 of the Universal Declaration of Human Rights, adopted 10 December 1948 by the UN General Assembly, contains this text regarding housing and quality of living:
Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing, and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.
The ETHOS Typology of Homelessness and Housing Exclusion was developed as a means of improving understanding and measurement of homelessness in Europe, and to provide a common "language" for transnational exchanges on homelessness. The ETHOS approach confirms that homelessness is a process (rather than a static phenomenon) that affects many vulnerable households at different points in their lives.
The typology was launched in 2005 and is used for different purposes: as a framework for debate, for data collection purposes, for policy purposes, monitoring purposes, and in the media. This typology is an open exercise that makes abstraction of existing legal definitions in the EU member states. It exists in 25 language versions, the translations being provided mainly by volunteer translators.
Recent homeless enumeration survey documentation utilizes the term unsheltered homeless. The common colloquial term street people does not fully encompass all unsheltered people, in that many such persons do not spend their time in urban street environments. Many shun such locales, because homeless people in urban environments may face the risk of being robbed or assaulted. Some people convert unoccupied or abandoned buildings ("squatting"), or inhabit mountainous areas or, more often, lowland meadows, creek banks, and beaches. Many jurisdictions have developed programs to provide short-term emergency shelter during particularly cold spells, often in churches or other institutional properties. These are referred to as warming centers, and are credited by their advocates as lifesaving.
This section possibly contains original research. (February 2011)
Following the Peasants' Revolt, English constables were authorized under 1383 English Poor Laws statute to collar vagabonds and force them to show support; if they could not, the penalty was gaol. Vagabonds could be sentenced to the stocks for three days and nights; in 1530, whipping was added. The presumption was that vagabonds were unlicensed beggars. In 1547, a bill was passed that subjected vagrants to some of the more extreme provisions of the criminal law, namely two years servitude and branding with a "V" as the penalty for the first offense and death for the second. Large numbers of vagabonds were among the convicts transported to the American colonies in the 18th century. During the 16th century in England, the state first tried to give housing to vagrants instead of punishing them, by introducing bridewells to take vagrants and train them for a profession. In the 17th and 18th centuries, these were replaced by workhouses but these were intended to discourage too much reliance on state help.
The growing movement toward social concern sparked the development of rescue missions, such as the U.S. first rescue mission, the New York City Rescue Mission, founded in 1872 by Jerry and Maria McAuley. In smaller towns, there were hobos, who temporarily lived near train tracks and hopped onto trains to various destinations. Especially following the American Civil War, a large number of homeless men formed part of a counterculture known as "hobohemia" all over the United States. This phenomenon re-surged in the 1930s during and after the Great Depression.
How the Other Half Lives and Jack London's The People of the Abyss (1903) discussed homelessness and raised public awareness, which caused some changes in building codes and some social conditions. In England, dormitory housing called "spikes" was provided by local boroughs. By the 1930s in England, there were 30,000 people living in these facilities. In 1933, George Orwell wrote about poverty in London and Paris, in his book Down and Out in Paris and London. In general, in most countries, many towns and cities had an area that contained the poor, transients, and afflicted, such as a "skid row". In New York City, for example, there was an area known as "the Bowery", traditionally, where people with an alcohol use disorder were to be found sleeping on the streets, bottle in hand.
The Great Depression of the 1930s caused a devastating epidemic of poverty, hunger, and homelessness. There were two million homeless people migrating across the United States. Many lived in shantytowns they called "Hoovervilles". In the 1960s, nature and growing problem of homelessness changed in England as public concern grew. The number of people living "rough" in the streets had increased dramatically. However, beginning with the Conservative administration's Rough Sleeper Initiative, the number of people sleeping rough in London fell dramatically. This initiative was supported further by the incoming Labour administration from 2009 onwards with the publication of the 'Coming in from the Cold' strategy published by the Rough Sleepers Unit, which proposed and delivered a massive increase in the number of hostel bed spaces in the capital and an increase in funding for street outreach teams, who work with rough sleepers to enable them to access services.
Modern homelessness started as a result of economic stresses in society and reductions in the availability of affordable housing such as single room occupancies (SROs) for poorer people. In the United States, in the 1970s, the deinstitutionalisation of patients from state psychiatric hospitals was a precipitating factor that seeded the homeless population, especially in large cities like New York City. This theory is vigorously disputed by clinical psychologist Seth Farber who points out that "the emptying of the state mental hospitals took place almost entirely in the 1960s and 1970s," a decade or more before the steep rise in homelessness which began in the late 1980s.
The Community Mental Health Act of 1963 was a predisposing factor in setting the stage for homelessness in the United States. Long-term psychiatric patients were released from state hospitals into SROs and were supposed to be sent to community mental health centers for treatment and follow-up, but the plan was not properly executed. The community mental health centers mostly did not materialize, and this population largely was found living in the streets soon thereafter with no sustainable support system.
Also, as real estate prices and neighborhood pressure increased to move these people out of their areas, the SROs diminished in number, putting most of their residents in the streets. The Bay Area is booming with economically successful people who end up driving up the price of housing and increases the divide between the people who need the housing and the new houses being built. Other populations were mixed in later, such as people losing their homes for economic reasons, those with addictions, the elderly, and others. Trends in homelessness are closely tied to neighborhood conditions, according to a report by the Edna McConnell Clark Foundation in 1990.
In 2002, research showed that children and families were the largest growing segment of the homeless population in the United States, and this has presented new challenges, especially in services, to agencies. Some trends involving the plight of homeless people have provoked some thought, reflection and debate. One such phenomenon is paid physical advertising, colloquially known as "sandwich board men".
In the US, the government asked many major cities to come up with a ten-year plan to end homelessness. One of the results of this was a "Housing first" solution. The Housing First program offers homeless people access to housing without having to undergo tests for sobriety and drug usage. Weekly staff visits as well as a normal lease agreement are also a part of the program. Consumers have to pay 30 percent of their income every month as rent. Rather than to have a homeless person remain in an emergency homeless shelter it was thought to be better to quickly get the person permanent housing of some sort and the necessary support services to sustain a new home. But there are many complications of this kind of program which must be dealt with to make such an initiative work successfully in the middle to long term. The Housing First program seems to benefit the homeless in every aspect except for substance abuse, for which the program offers little accountability. An emerging consensus is that the Housing First program still gives clients a higher chance at retaining their housing once they get it. A few critical voices argue that it misuses resources and does more harm than good; they suggest that it encourages rent seeking and that there is not yet enough evidence-based research on the effects of this program on the homeless population. Some formerly homeless people, who were finally able to obtain housing and other assets which helped to return to a normal lifestyle, have donated money and volunteer services to the organizations that provided aid to them during their homelessness. Alternatively, some social service entities that help homeless people now employ formerly homeless individuals to assist in the care process.
Homelessness has migrated toward rural and suburban areas. The number of homeless people has not changed dramatically but the number of homeless families has increased according to a report of HUD. The United States Congress appropriated $25 million in the McKinney-Vento Homeless Assistance Grants for 2008 to show the effectiveness of Rapid Re-housing programs in reducing family homelessness. In February 2009, President Obama signed the American Recovery and Reinvestment Act of 2009, part of which addressed homelessness prevention, allocating $1.5 billion for a Homeless Prevention Fund. The Emergency Shelter Grant (ESG) program's name was changed to Emergency Solution Grant (ESG) program, and funds were re-allocated to assist with homeless prevention and rapid re-housing for families and individuals.
On 20 May 2009, President Obama signed the Homeless Emergency Assistance and Rapid Transition to Housing (HEARTH) Act into Public Law (Public Law 111-22 or "PL 111-22"), reauthorizing HUD's Homeless Assistance programs. It was part of the Helping Families Save Their Homes Act of 2009. The HEARTH act allowed for the prevention of homelessness, rapid re-housing, consolidation of housing programs, and new homeless categories. In the eighteen months after the bill's signing, HUD was to make regulations implementing this new McKinney program.
The HEARTH Act also codified in law the Continuum of Care planning process, long a part of HUD's application process to assist homeless persons by providing greater coordination in responding to their needs. This final rule integrated the regulation of the definition of homeless and the corresponding recordkeeping requirements, for the Shelter Plus Care program and the Supportive Housing Program. This final rule also established the regulation for the definition developmental disability and the definition and recordkeeping requirements for homeless individual with a disability for the Shelter Plus Care program and the Supportive Housing Program.
A substantial percentage of the US homeless population are individuals who are chronically unemployed or have difficulty managing their lives effectively due to prolonged and severe substance or alcohol use. Substance abuse can cause homelessness from behavioral patterns associated with addiction that alienate an addicted individual's family and friends who could otherwise provide support during difficult economic times. Increased wealth disparity and income inequality causes distortions in the housing market that push rent burdens higher, making housing unaffordable. Paul Koegel of RAND Corporation, a seminal researcher in first-generation homelessness studies and beyond, divided the causes of homelessness into structural aspects and then individual vulnerabilities.
The basic problem of homelessness is the need for personal shelter, warmth, and safety. Other difficulties include:
Homeless people face many problems beyond the lack of a safe and suitable home. They are often faced with reduced access to private and public services and vital necessities:
There is sometimes corruption and theft by the employees of a shelter, as evidenced by a 2011 investigative report by FOX 25 TV in Boston wherein a number of Boston public shelter employees were found stealing large amounts of food over a period of time from the shelter's kitchen for their private use and catering. Homeless people are often obliged to adopt various strategies of self-presentation in order to maintain a sense of dignity, which constrains their interaction with passers-by and leads to suspicion and stigmatization by the mainstream public.
Homelessness is also a risk factor for depression caused by prejudice (i.e. "deprejudice"). When someone is prejudiced against people who are homeless and then becomes homeless themselves, their anti-homelessness prejudice turns inward, causing depression. "Mental disorders, physical disability, homelessness, and having a sexually transmitted infection are all stigmatized statuses someone can gain despite having negative stereotypes about those groups." Difficulties can compound exponentially. For example, a homeless man in New Jersey found that he could not get food from some volunteer organizations if he did not have a legally-recognized address; after being mugged, he lost valuable identification documents and contact information so he could not contact his daughter; since his hips and knee had been broken because of the attack, it was harder for him after recovering in the hospital to walk to those places which did offer free food; in numerous instances, problems seemed to exacerbate other problems in a downward cycle. A study found that in the city of Hong Kong over half of the homeless people in the city (56%) suffered from some degree of mental illness. Only 13% of the 56% were receiving treatment for their condition leaving a huge portion of homeless untreated for their mental illness.
The issue of anti-homeless architecture has recently come to light in 2014 after a photo displayed hostile features (spikes on the floor) in London and took social media by storm. The photo of an anti-homeless structure was a classic example of hostile architecture in an attempt to discourage people from attempting to access or use public space in irregular ways. However, although this has only recent came to light, hostile architecture has been around for a long time in many places. An example of this is a low overpass that was put in place between New York City and Long Island. Robert Moses was the artist that designed it this way in an attempt to ban public buses from being able to access through it.
Homeless people are often the victims of violent crime. A 2007 study found that the rate of violent crimes against homeless people in the United States is increasing. A study of women veterans found that homelessness is associated with domestic violence, both directly as the result of leaving an abusive partner and indirectly due to trauma, mental health conditions, and substance abuse.
Rent regulation has a small effect on shelter and street populations. This is largely due to rent control reducing the quality and quantity of housing. For example, a 2019 study found that San Francisco's rent control laws reduced tenant displacement from rent controlled units in the short-term, but resulted in landlords removing 30% of the rent controlled units from the rental market, (by conversion to condos or TICs) which led to a 15% citywide decrease in total rental units, and a 7% increase in citywide rents.
Conditions such as alcohol use disorder and mental illness are often associated with homelessness. Many people fear the homeless due to the stigma surrounding the homeless community. Surveys have revealed that before spending time with the homeless, most people fear them, but after spending time with the homeless, that fear is lessened or is no longer there. Another effect of this stigma is isolation.
Most countries provide a variety of services to assist homeless people. Provisions of food, shelter, and clothing and may be organized and run by community organizations, often with the help of volunteers, or by government departments. Assistance programs may be supported by government, charities, churches, and individual donors. In 1998, a study by Koegel and Schoeni of a homeless population in Los Angeles, California, found that a significant minority of homeless did not participate in government assistance programs, with high transaction costs being a likely contributing factor.
The United States Department of Housing and Urban Development and Veterans Administration have a special Section 8 housing voucher program called VASH (Veterans Administration Supported Housing), or HUD-VASH, which gives out a certain number of Section 8 subsidized housing vouchers to eligible homeless and otherwise vulnerable US armed forces veterans. The HUD-VASH program has shown success in housing many homeless veterans. The support available to homeless veterans varies internationally, however. For example, in England, where there is a national right to housing, veterans are only prioritized by local authority homelessness teams if they are found to be vulnerable due to having served in the Armed Forces.
Non-governmental organizations also house or redirect homeless veterans to care facilities. Social Security Income/Social Security Disability Income, Access, Outreach, Recovery Program (SOAR) is a national project funded by the Substance Abuse and Mental Health Services Administration. It is designed to increase access to SSI/SSDI for eligible adults who are homeless or at risk of becoming homeless and have a mental illness or a co-occurring substance use disorder. Using a three-pronged approach of Strategic Planning, Training, and Technical Assistance (TA), the SOAR TA Center coordinates this effort at the state and community level.
While some homeless people are known to have a community with one another, providing each other various types of support, people who are not homeless also may provide them friendship, food, relational care, and other forms of assistance. Such social supports may occur through a formal process, such as under the auspices of a non-governmental organization, religious organization, or homeless ministry, or may be done on an individual basis. In Los Angeles, a collaboration between the Ostrow School of Dentistry of the University of Southern California and the Union Rescue Mission shelter offer homeless people in the Skid Row area free dental services.
Homeless people can also provide waste management services to earn money. Some homeless people find returnable bottles and cans and bring them to recycling centers to earn money. For example, they can sort out organic trash from other trash or separate out trash made of the same material (for example, different types of plastics, and different types of metal). Especially in Brazil, many people are already engaged in such activities. In addition, rather than sorting waste at landfills, ... they can also collect litter found on/beside the road to earn an income. Invented in 2005, in Seattle, Bumvertising, an informal system of hiring homeless people to advertise, has provided food, money, and bottles of water to sign-holding homeless in the Northwest. Homeless advocates have accused its founder, Ben Rogovy, and the process, of exploiting the poor and take particular offense to the use of the word "bum" which is generally considered pejorative. In October 2009, The Boston Globe carried a story on so-called cyberbegging, or Internet begging, which was reported to be a new trend worldwide.
The United States Department of Labor has sought to address one of the main causes of homelessness, a lack of meaningful and sustainable employment, through targeted training programs and increased access to employment opportunities that can help homeless people develop sustainable lifestyles. This has included the development of the United States Interagency Council on Homelessness, which addresses homelessness on the federal level in addition to connecting homeless individuals to resources at the state level. All individuals who are in need of assistance are able, in theory, to access employment and training services under the Workforce Investment Act (WIA), although this is contingent upon funding and program support by the government, with veterans also being able to use the Veterans Workforce Investment Program.
Under the Department of Labor, the Veterans' Employment and Training Service (VETS) offers a variety of programs targeted at ending homelessness among veterans. The Homeless Veterans' Reintegration Program (HVRP) is the only national program that is exclusively focused on assisting veterans as they reenter the workforce. The VETS program also has an Incarcerated Veterans' Transition Program, as well as services that are unique to female Veterans. Mainstream programs initiated by the Department of Labor have included the Workforce Investment Act, One-Stop Career Centers, and a Community Voice Mail system that helps to connect homeless individuals around the United States with local resources. Targeted labor programs have included the Homeless Veterans' Reintegration Project, the Disability Program Navigator Initiative, efforts to end chronic homelessness through providing employment and housing projects, Job Corps, and the Veterans Workforce Investment Program (VWIP).
Street newspapers are newspapers or magazines sold by homeless or poor individuals and produced mainly to support these populations. Most such newspapers primarily provide coverage about homelessness and poverty-related issues and seek to strengthen social networks within homeless communities, making them a tool for allowing homeless individuals to work. In New York City in 1989, a street newspaper was created called Street News which put some homeless to work assisting with writing, producing, and mostly selling the paper on streets and trains. Street News was written pro bono by a combination of homeless, celebrities, and established writers. In 1991, in England, a street newspaper following the New York model was established, called The Big Issue which is published weekly.
Many housing initiatives involve homeless people in the process of building and maintaining affordable shared housing. This process works as a double impact by not only providing housing but also giving homeless people employment income and work experience.
Homeless shelters can become grounds for community organization and the recruitment of homeless individuals into social movements for their own cause. Cooperation between the shelter and an elected representative from the homeless community at each shelter can serve as the backbone of this type of initiative. The representative presents and forwards problems raises concerns and provides new ideas to the director and staff of the shelters. Examples of possible problems are ways to deal with substance use disorders by certain shelter users, and resolution of interpersonal conflicts. SAND, the Danish National Organization for Homeless People, is one example of an organization that uses this empowerment approach. Issues reported at the homeless shelters are then addressed by SAND at the regional or national level. To open further dialogue, SAND organizes regional discussion forums where staff and leaders from the shelters, homeless representatives, and local authorities meet to discuss issues and good practices at the shelters.
Los Angeles conducted a competition promoted by Mayor Eric Garcetti soliciting ideas from developers to use bond money more efficiently in building housing for the city's homeless population. The top five winners were announced on 1 February 2019 and the concepts included using assembly-ready molded polymer panels that can be put together with basic tools, prefabricated 5-story stack-able houses, erecting privately financed modular buildings on properties that do not require City Council approval, using bond money to convert residential garages into small apartments which are then dedicated to homeless rentals, and the redeveloping of Bungalow-court units, the small low-income iconic buildings that housed 7% of the city's population in the 1920s.
In the neighborhood of Westlake, Los Angeles, the city is funding the first transitionally homeless housing building using "Cargotecture", or "architecture built from repurposed shipping containers." The Hope on Alvarado micro-apartment building will consist of 4-stories of 84 containers stacked together like Lego bricks on top of a traditionally constructed ground floor. Completion is anticipated by the end of 2019.
Voting for elected officials is important for the homeless population to have a voice in the democratic process.
In 1979 a New York City lawyer, Robert Hayes, brought a class-action suit, Callahan v. Carey, against the City and State, arguing for a person's constitutional "right to shelter". It was settled as a consent decree in August 1981. The City and State agreed to provide board and shelter to all homeless men who met the need standard for welfare or who were homeless by certain other standards. By 1983 this right was extended to homeless women.
There are many community organizations and social movements around the world which are taking action to reduce homelessness. They have sought to counteract the causes and reduce the consequences by starting initiatives that help homeless people transition to self-sufficiency. Social movements and initiatives tend to follow a grassroots, community-based model of organization - generally characterized by a loose, informal and decentralized structure, with an emphasis on radical protest politics. By contrast, an interest group aims to influence government policies by relying on more of a formal organizational structure. These groups share a common element: they are both made up of and run by a mix of allies of the homeless population and former or current members of the homeless population. Both grassroots groups and interest groups aim to break stereotyped images of homeless people as being weak and hapless, or defiant criminals and drug addicts, and to ensure that the voice of homeless people and their representatives is clearly heard by policymakers.
Homeless shelters are most often night shelters, where people leave in the morning to do whatever they can manage and return in the evening when the beds in the shelter open up again for sleeping. An example of a homeless shelter is Pine Street Inn in Boston's South End neighborhood. There are some daytime shelters where people might go instead of being stranded on the street, and to receive meals, counseling, avail themselves of resources, and otherwise spend their day until returning to their overnight sleeping arrangements. An example of such a day center shelter model is Saint Francis House in Boston, founded in the early 1980s, which is open to the homeless all year long during daytime hours and was originally based on the settlement house model.
Many homeless people keep all their possessions with them because they have no access to storage. There have been "bag" people, shopping cart people, and soda can collectors (known as binners or dumpster divers) who sort through garbage to find items to sell, trade, or eat. Such people have typically carried all their possessions with them all the time. If they had no access to or ability to get to a shelter and possible bathing, or access to toilets and laundry facilities, their hygiene was lacking. This has created social tensions in public places.
These conditions have created an upsurge in tuberculosis and other diseases in urban areas. In 1974, Kip Tiernan founded Rosie's Place in Boston, the first drop-in and emergency shelter for women in the United States, in response to the increasing numbers of needy women throughout the country.
There are various places where a homeless person might seek refuge:
The inhabitants of such refuges are called in some places, like New York City, "Mole People". Natural caves beneath urban centers allow for places where people can congregate. Leaking water pipes, electric wires, and steam pipes allow for some of the essentials of living.
Transitional housing provides temporary housing for certain segments of the homeless population, including the working homeless, and is meant to transition residents into permanent, affordable housing. This is usually a room or apartment in a residence with support services. The transitional time can be relatively short, for example, one or two years, and in that time the person must file for and obtain permanent housing along with gainful employment or income, even if Social Security or assistance. Sometimes transitional housing programs charge a room and board fee, maybe 30% of an individual's income, which is sometimes partially or fully refunded after the person procures a permanent residence. In the U.S., federal funding for transitional housing programs was originally allocated in the McKinney-Vento Homeless Assistance Act of 1986.
Foyers are a specific type of Transitional Housing designed for homeless or at-risk teens. Foyers are generally institutions that provide affordable accommodation as well as support and training services for residents. They were pioneered in the 1990s in the United Kingdom, but have been adopted in areas in Australia and the United States as well.
Supportive housing is a combination of housing and services intended as a cost-effective way to help people live more stable, productive lives. Supportive housing works well for those who face the most complex challenges - individuals and families confronted with homelessness who also have very low incomes or serious, persistent issues such as substance use disorder, addictions, alcohol use disorder, mental illness, HIV/AIDS, or other serious challenges.
In South Australia, the state government of Premier Mike Rann (2002-2011) committed substantial funding to a series of initiatives designed to combat homelessness. Advised by Social Inclusion Commissioner David Cappo and the founder of New York's Common Ground program, Rosanne Haggerty, the Rann government established Common Ground Adelaide, building high-quality inner city apartments (combined with intensive support) for "rough sleeping" homeless people. The government also funded the Street to Home program and a hospital liaison service designed to assist homeless people admitted to the emergency departments of Adelaide's major public hospitals. Rather than being released back into homelessness, patients identified as rough sleepers were found accommodation backed by professional support. Common Ground and Street to Home now operate across Australia in other States.
In 2013, a Central Florida Commission on Homelessness study indicated that the region spends $31,000 a year per homeless person to cover "salaries of law enforcement officers to arrest and transport homeless individuals - largely for nonviolent offenses such as trespassing, public intoxication or sleeping in parks - as well as the cost of jail stays, emergency room visits and hospitalization for medical and psychiatric issues. This did not include "money spent by nonprofit agencies to feed, clothe and sometimes shelter these individuals". In contrast, the report estimated the cost of permanent supportive housing at "$10,051 per person per year" and concluded that "[h]ousing even half of the region's chronically homeless population would save taxpayers $149 million over the next decade - even allowing for 10 percent to end up back on the streets again." This particular study followed 107 long-term-homeless residents living in Orange, Osceola or Seminole Counties. There are similar studies showing large financial savings in Charlotte and Southeastern Colorado from focusing on simply housing the homeless."
Health care for homeless people is a major public health challenge. Homeless people are more likely to suffer injuries and medical problems from their lifestyle on the street, which includes poor nutrition, exposure to the severe elements of weather, and a higher exposure to violence. Yet at the same time, they have reduced access to public medical services or clinics, in part because they often lack identification or registration for public healthcare services. There are significant challenges in treating homeless people who have psychiatric disorders because clinical appointments may not be kept, their continuing whereabouts are unknown, their medicines may not be taken as prescribed, medical and psychiatric histories are not accurate, and other reasons. Because many homeless people have mental illnesses, this has presented a crisis in care.
Homeless people may find it difficult to document their date of birth or their address. Because homeless people usually have no place to store possessions, they often lose their belongings, including identification and other documents, or find them destroyed by police or others. Without a photo ID, homeless persons cannot get a job or access many social services, including healthcare. They can be denied access to even the most basic assistance: clothing closets, food pantries, certain public benefits, and in some cases, emergency shelters. Obtaining replacement identification is difficult. Without an address, birth certificates cannot be mailed. Fees may be cost-prohibitive for impoverished persons. And some states will not issue birth certificates unless the person has photo identification, creating a Catch-22. This problem is far less acute in countries that provide free-at-use health care, such as the UK, where hospitals are open-access day and night and make no charges for treatment. In the U.S., free-care clinics for the homeless and other people, do exist in major cities, but often attract more demand than they can meet.
The conditions affecting homeless people are somewhat specialized and have opened a new area of medicine tailored to this population. Skin conditions, including scabies, are common because homeless people are exposed to extreme cold in the winter and have little access to bathing facilities. They have problems caring for their feet and have more severe dental problems than the general population. Diabetes, especially untreated, is widespread in the homeless population. Specialized medical textbooks have been written to address this for providers.
There are many organizations providing free care to homeless people in countries which do not offer free state-run medical treatment, but the services are in great demand given the limited number of medical practitioners. For example, it might take months to get a minimal dental appointment in a free-care clinic. Communicable diseases are of great concern, especially tuberculosis, which spreads more easily in crowded homeless shelters in high-density urban settings. There has been ongoing concern and studies about the health and wellness of the older homeless population, typically ages 50 to 64, and older, as to whether they are significantly more sickly than their younger counterparts and if they are under-served.
In 1985, the Boston Health Care for the Homeless Program was founded to assist the growing numbers of homeless living on the streets and in shelters in Boston and who were suffering from a lack of effective medical services. In 2004, Boston Health Care for the Homeless in conjunction with the National Health Care for the Homeless Council published a medical manual called "The Health Care of Homeless Persons", edited by James J. O'Connell, M.D., specifically for the treatment of the homeless population. In June 2008 in Boston, the Jean Yawkey Place, a four-story, 7,214.2-square-metre (77,653 sq ft) building, was opened by the Boston Health Care for the Homeless Program. It is an entire full-service building on the Boston Medical Center campus dedicated to providing healthcare for homeless people. It also contains a long-term care facility, the Barbara McInnis House, which expanded to 104 beds and is the first and largest medical respite program for homeless people in the United States.
A 2011 study led by Dr. RebeccaT. Brown in Boston, conducted by the Institute for Aging Research (an affiliate of Harvard Medical School), Beth Israel Deaconess Medical Center, and the Boston Health Care for the Homeless Program found the elderly homeless population had "higher rates of geriatric syndromes, including functional decline, falls, frailty and depression than seniors in the general population and that many of these conditions may be easily treated if detected". The report was published in the Journal of Geriatric Internal Medicine. There are government avenues which provide resources for the development of healthcare for the homeless. In the United States, the Bureau of Primary Health Care has a program that provides grants to fund the delivery of healthcare to the homeless. According to 2011 UDS data community health centers were able to provide service to 1,087,431 homeless individuals. There are also many nonprofit and religious organizations which provide healthcare services to the homeless. These organizations help meet the large need which exists for expanding healthcare for the homeless.
The 2010 passage of the Patient Protection and Affordable Care Act could provide new healthcare options for the homeless in the United States, particularly through the optional expansion of Medicaid. A 2013 Yale study indicated that a substantial proportion of the chronically homeless population in America would be able to obtain Medicaid coverage if states expanded Medicaid under the Affordable Care Act.
There have been significant numbers of unsheltered persons dying of hypothermia, adding impetus to the trend of establishing warming centers as well as extending enumeration surveys with vulnerability indexes.
In 1999, Dr. Susan Barrow of the Columbia University Center for Homelessness Prevention Studies reported in a study that the "age-adjusted death rates of homeless men and women were four times those of the general U.S. population and two to three times those of the general population of New York City". A report commissioned by homeless charity Crisis in 2011 found that on average, homeless people in the UK have a life expectancy of 47 years, 30 years younger than the rest of the population.
People experiencing homelessness are at a significant increased risk to the effects of extreme weather events. Such weather events include extreme heat and cold, floods, storm surges, heavy rain and droughts. While there are many contributing factors to these events, climate change is driving an increasing frequency and intensity of these events. The homeless population is considerably more vulnerable to these weather events due to their higher rates of chronic disease and lower socioeconomic status. Despite having a minimal carbon footprint, homeless people unfortunately experience a disproportionate burden of the effects of climate change.
Homeless persons have increased vulnerability to extreme weather events for many reasons. They are disadvantaged in most social determinants of health, including lack of housing and access to adequate food and water, reduced access to health care, and difficulty in maintaining health care. They have significantly higher rates of chronic disease including respiratory disease and infections, gastrointestinal disease, musculoskeletal problems and mental health disease. In fact, self-reported rates of respiratory diseases (including asthma, chronic bronchitis and emphysema) are double that of the general population.
The homeless population often live in higher risk urban areas with increased exposure and little protection from the elements. They also have limited access to clean drinking water and other methods of cooling down. The built environment in urban areas also contributes to the "heat island effect", the phenomenon whereby cities experience higher temperatures due to the predominance of dark, paved surfaces and lack of vegetation. Homeless populations are often excluded from disaster planning efforts, further increasing their vulnerability when these events occur. Without the means to escape extreme temperatures and seek proper shelter and cooling or warming resources, homeless people are often left to suffer the brunt of the extreme weather.
The health effects that result from extreme weather include exacerbation of chronic diseases and acute illnesses. Pre-existing conditions can be greatly exacerbated by extreme heat and cold, including cardiovascular, respiratory, skin and renal disease, often resulting in higher morbidity and mortality during extreme weather. Acute conditions such as sunburn, dehydration, heat stroke and allergic reactions are also common. In addition, a rise in insect bites can lead to vector-borne infections. Mental health conditions can also be impacted by extreme weather events as a result of lack of sleep, increased alcohol consumption, reduced access to resources and reduced ability to adjust to the environmental changes. In fact, pre-existing psychiatric illness has been shown to triple the risk of death from extreme heat. Overall, extreme weather events appear to have a "magnifying effect" in exacerbating the underlying prevalent mental and physical health conditions of homeless populations.
In 2005, Hurricane Katrina, a category 5 hurricane, made landfall on Florida and Louisiana. It particularly affected the city of New Orleans and the surrounding areas. Hurricane Katrina was the deadliest hurricane in the US in seven decades with more than 1,600 confirmed deaths and more than 1,000 people missing. The hurricane disproportionately affected marginalized individuals and individuals with lower socioeconomic status (i.e., 93% of shelter residents were African-American, 32% had household incomes below $10,000/year and 54% were uninsured). The storm nearly doubled the number of homeless people in New Orleans. While in most cities the homeless people account for 1% of the population, in New Orleans' the homeless account for 4% of the population. In addition to its devastating effects on infrastructure and the economy, the estimated prevalence of mental illness and the incidence of West Nile Virus more than doubled after Hurricane Katrina in the hurricane-affected regions.
In western countries such as the United States, the typical homeless person is male and single, with the Netherlands reporting 80% of homeless people aged 18-65 to be men. Some cities have particularly high percentages of males in homeless populations, with men comprising eighty-five percent of the homeless in Dublin. Non-white people are also overrepresented in homeless populations, with such groups two and one-half times more likely to be homeless in the U.S. The median age of homeless people is approximately 35.
In 2005, an estimated 100 million people worldwide were homeless. The following statistics indicate the approximate average number of homeless people at any one time. Each country has a different approach to counting homeless people, and estimates of homelessness made by different organizations vary wildly, so comparisons should be made with caution.
The number of homeless people worldwide has grown steadily in recent years. In some developing countries such as Nigeria and South Africa, homelessness is rampant, with millions of children living and working on the streets. Homelessness has become a problem in the countries of China, India, Thailand, Indonesia, and the Philippines despite their growing prosperity, mainly due to migrant workers who have trouble finding permanent homes.
Determining the true number of homeless people worldwide varies between 100 million and 1 billion people based on the exact definition used. Refugees, asylum-seekers, and internally displaced persons (ITDs) can also be considered homeless in that they too experience "marginalization, minority status, socio-economic disadvantage, poor physical health, collapse of social supports, psychological distress, and difficulty adapting to host cultures" like the domestic homeless.
In the past twenty years, scholars like Tipple and Speak have begun to refer to homelessness as the "antithesis or absence of home" rather than rooflessness or the "lack of physical shelter." This complication in the homelessness debate further delineates the idea that home actually consists of an adequate shelter, an experienced and dynamic place that serves as a "base" for nurturing human relationships and the "free development of individuals" and their identity. Thus, the home is perceived to be an extension of one's self and identity. In contrast, the homeless experience, according to Moore, constitutes more as a "lack of belonging" and a loss of identity that leads to individuals or communities feeling "out of place" once they can no longer call a place of their own home
This new perspective on homelessness sheds light on the plight of refugees, a population of stateless people who are not normally included in the mainstream definition of homelessness. It has also created problems for researchers because the nature of "counting" homeless people across the globe relies heavily on who is considered a homeless person. Homeless individuals, and by extension refugees, can be seen as lacking lack the "crucible of our modern society" and lacking a way of actively belonging to and engaging with their respective communities or cultures As Casavant demonstrates, a spectrum of definitions for homelessness, called the "continuum of homelessness," should refer to refugees as homeless individuals because they not only lose their home, but they are also afflicted with a myriad of problems that parallel those affecting the domestic homeless, such as "[a lack of] stable, safe and healthy housing, an extremely low income, adverse discrimination in access to services, with problems of mental health, alcohol, and drug abuse or social disorganization" Refugees, like the domestic homeless, lose their source of identity and way of connecting with their culture for an indefinite period of time.
Thus, the current definition of homelessness unfortunately allows people to simplistically assume that homeless people, including refugees, are merely "without a place to live" when that is not the case. As numerous studies show, forced migration and displacement brings with it another host of problems including socioeconomic instability, "increased stress, isolation, and new responsibilities" in a completely new environment
For people in Russia, especially the youth, alcohol and substance use is a major cause and reason for becoming and continuing to be homeless. The United Nations, United Nations Centre for Human Settlements (UN-Habitat) wrote in its Global Report on Human Settlements in 1995: "Homelessness is a problem in developed as well as in developing countries. In London, for example, life expectancy among homeless people is more than 25 years lower than the national average."
Poor urban housing conditions are a global problem, but conditions are worst in developing countries. Habitat says that today 600 million people live in life- and health-threatening homes in Africa, Asia, and Latin America. For example, more than three in four young people had insufficient means of shelter and sanitation in some African countries like Malawi. "The threat of mass homelessness is greatest in those regions because that is where population is growing fastest. By 2015, the 10 largest cities in the world will be in Asia, Latin America, and Africa. Nine of them will be in developing countries: Mumbai, India - 27.4 million; Lagos, Nigeria - 24.4; Shanghai, China - 23.4; Jakarta, Indonesia - 21.2; São Paulo, Brazil - 20.8; Karachi, Pakistan - 20.6; Beijing, China - 19.4; Dhaka, Bangladesh - 19; Mexico City, Mexico - 18.8. The only city in a developed country that will be in the top ten is Tokyo, Japan - 28.7 million."
In 2008, Dr. Anna Tibaijuka, Executive Director of UN-HABITAT, referring to the recent report "State of the World's Cities Report 2008/2009", said that the world economic crisis we are in should be viewed as a "housing finance crisis" in which the poorest of poor were left to fend for themselves.
In Australia the Supported Accommodation Assistance Program (SAAP) is a joint Commonwealth and state government program which provides funding for more than 1,200 organizations which are aimed to assist homeless people or those in danger of becoming homeless, as well as women and children escaping domestic violence. They provide accommodation such as refuges, shelters, and half-way houses, and offer a range of supported services. The Commonwealth has assigned over $800 million between 2000 and 2005 for the continuation of SAAP. The current program, governed by the Supported Assistance Act 1994, specifies that "the overall aim of SAAP is to provide transitional supported accommodation and related support services, in order to help people who are homeless to achieve the maximum possible degree of self-reliance and independence. This legislation has been established to help the homeless people of the nation and help rebuild the lives of those in need. The cooperation of the states also helps enhance the meaning of the legislation and demonstrates their desire to improve the nation as best they can." In 2011, the Specialist Homelessness Services (SHS) program replaced the SAAP program.
Homelessness in Canada has grown in size and complexity since 1997. While historically known as a crisis only of urban centres such as Montreal, Laval, Vancouver, Edmonton, Calgary, and Toronto, increasing homelessness in suburban communities requires new services and resources.In recent years homelessness has become a major social issue in Canada. In Action Plan 2011, the Federal Government of Canada proposed $120 million annually from April 2014 until April 2019--with $70 million in new funding--to renew its Homelessness Partnering Strategy (HPS). In dealing with homelessness in Canada, the government focus is on the Housing First model. Thus, private or public organizations across Canada are eligible to receive HPS subsidies to implement Housing First programs. Canada spends more than 30 billion annually on social service programs for the homeless.
In Finland the municipalities are required by law to offer apartments or shelters to every Finnish citizen who does not have a residence. In 2007 the center-right government of Matti Vanhanen began a special program of four wise men modeled after a US-originated Housing First policy to eliminate homelessness in Finland by 2015.
There are estimated to be 15,000 homeless persons in Hungary of which about 6,500 live in Budapest (2016). There have been repeated attempts at criminalizing homelessness in Hungary by the Fidesz government and homeless people face severe restrictions in many cities. 131 homeless people died of cold exposure in Budapest between 2006 and 2010.
After the abolition of serfdom in Russia in 1861, major cities experienced a large influx of former peasants who sought jobs as industrial workers in rapidly developing Russian industry. These people often lived in harsh conditions, sometimes renting a room shared between several families. There also was a large number of shelterless homeless. Immediately after the October Revolution a special program of "compression" ("?") was enabled: people who had no shelter were settled in flats of those who had large (4, 5 or 6-room) flats with only one room left to previous owners. The flat was declared state property. This led to a large number of shared flats where several families lived simultaneously. Nevertheless, the problem of complete homelessness was mostly solved as anybody could apply for a room or a place in dormitory (the number of shared flats steadily decreased after large-scale residential building program was implemented starting in the 1960s).
By 1922 there were at least 7 million homeless children in Russia as a result of nearly a decade of devastation from World War I and the Russian Civil War. This led to the creation of a large number of orphanages. By the 1930s the USSR declared the abolition of homelessness and any citizen was obliged to have a propiska - a place of permanent residency. Nobody could be stripped of propiska without substitution or refuse it without a confirmed permission (called "order") to register in another place. If someone wanted to move to another city or expand their living area, he had to find a partner who wanted to mutually exchange the flats. The right for shelter was secured in the Soviet constitution. Not having permanent residency was legally considered a crime.
After the breakup of the USSR, the problem of homelessness sharpened dramatically, partially because of the legal vacuum of the early 1990s with some laws contradicting each other and partially because of a high rate of frauds in the realty market. In 1991 articles 198 and 209 of Russian criminal code which instituted a criminal penalty for not having permanent residence were abolished. In Moscow, the first overnight shelter for homeless was opened in 1992. In the late 1990s, certain amendments in law were implemented to reduce the rise in homelessness, such as the prohibition of selling last flat with registered children.
Nevertheless, the state is still obliged to give permanent shelter for free to anybody who needs better living conditions or has no permanent registration, because the right to shelter is still included in the constitution. Several projects of special cheap 'social' flats for those who failed to repay mortgages were proposed to facilitate mortgage market.
In South Africa, there are an estimated 200,000 homeless people from a diverse range of backgrounds. Most South African municipalities primarily view homelessness as a social dependency issue, responding with social interventions.
In Sweden, municipalities are required to provide a home to any citizen who does not have one. However, landlords and lessors have the right to select guests among applicants. Owners, including municipalities themselves, avoid homeless people, unemployed people or people with a bad credit score. People who cannot pay their rent will be evicted, including families with small children. In 2009, 618 children were evicted.
Since the late 1990s, housing policy has been a devolved matter, and state support for the homeless, together with legal rights in housing, have therefore diverged to a certain degree. A national service, called Streetlink, was established in 2012 to help members of the public obtain near-immediate assistance for specific rough sleepers, with the support of the Government (as housing is a devolved matter, the service currently only extends to England).
A member of the public who is concerned that someone is sleeping on the streets can report the individual's details via the Street Link website or by calling the referral line number on 0300 500 0914. Someone who finds themselves sleeping on the streets can also report their situation using the same methods. It is important to note that the Streetlink service is for those who are genuinely sleeping on the streets, and not those who may merely be begging, or ostensibly living their life on the streets despite a place to sleep elsewhere (such as a hostel or supported accommodation).
The annual number of homeless households in England peaked in 2003-04 at 135,420 before falling to a low of 40,020 in 2009-10. In 2017-18, there were 56,600 homeless households, which was 60 per cent below the 2003-04 peak ,and 40 per cent higher than the 2009-10 low. The UK has more than 120,000 children in temporary accommodation, a number which has increased from 69,050 children in 2010.
In 2007 the official figures for England were that an average of 498 people slept rough each night, with 248 of those in London. It is important to note that many individuals may spend only a few days or weeks sleeping rough, and so any number for rough sleepers on a given night hides the total number of people actually affected in any one year.
Homelessness in England since 2010 has been rising. By 2016 it is estimated the numbers sleeping rough had more than doubled since 2010. The National Audit Office say in relation to homelessness in England 2010-17 there has been a 60% rise in households living in temporary accommodation and a rise of 134% in rough sleepers. It is estimated 4,751 people bedded down outside overnight in England in 2017, up 15% on previous year. The housing charity Shelter used data from four sets of official 2016 statistics and calculated 254,514 people in England were homeless.
The Homelessness Reduction Act 2017 places a new duty on local authorities in England to assist people threatened with homelessness within 56 days and to assess, prevent and relieve homelessness for all eligible applicants including single homeless people from April 2018. Before the 2017 HRA, homeless households were defined and measured as those who were owed a 'main homelessness duty' by local authorities. But since 2018, the definition of homeless households has broadened as households are owed a new relief duty and a prevention duty. The main homelessness duty definition has not been changed by the 2017 HRA. However, these households are now only owed a main duty if their homelessness has not been successfully prevented or relieved. In 2019-20, 288,470 households were owed the new prevention or relief duties, which is four times the number of households owed the 'main duty' in 2017-18 prior to implementation of the Homelessness Reduction Act.
In the United States, the number of homeless people grew in the 1980s, as welfare cuts increased. By the mid-1980s, there was a dramatic increase in family homelessness. Tied into this was an increasing number of impoverished and runaway children, teenagers, and young adults, which created a new substratum of the homeless population (street children or street youth).
In 2015, the United States reported that there were 564,708 homeless people within its borders, one of the higher reported figures worldwide.
Housing First is an initiative to help homeless people reintegrate into society, and out of homeless shelters. It was initiated by the federal government's Interagency Council on Homelessness. It asks cities to come up with a plan to end chronic homelessness. In this direction, there is the belief that if homeless people are given independent housing to start, with some proper social supports, then there would be no need for emergency homeless shelters, which it considers a good outcome. However this is a controversial position.
There is evidence that the Housing First program works more efficiently than Treatment First programs. Studies show that having the stability of housing through the Housing First program will encourage the homeless to focus on other struggles they are facing, such as substance abuse. Meanwhile, Treatment First programs promote an "all or nothing" approach which require clients to participate in programs applicable to their struggles as a condition for housing assistance. Treatment First utilizes a less individualistic approach than Housing First and solutions are created under one standard rather than fit to each client's specific needs.
In October 2009, as part of the city's Leading the Way initiative, Mayor Thomas M. Menino of Boston dedicated and opened the Weintraub Day Center which is the first city-operated day center for chronically homeless persons. It is a multi-service center, providing shelter, counseling, healthcare, housing assistance, and other support services. It is a 320-square-metre (3,400 sq ft) facility located in the Woods Mullen Shelter. It is also meant to reduce the strain on the city's hospital emergency rooms by providing services and identifying health problems before they escalate into emergencies. It was funded by $3 million in grants from the American Recovery and Reinvestment Act of 2009, Massachusetts Department of Housing and Community Development (DHCD), the Massachusetts Medical Society and Alliance Charitable Foundation, and the United States Department of Health and Human Services Substance Abuse and Mental Health Services Administration (SAMHSA).
In 2010 in New York City, where there were over 36,000 homeless people in 2009, there was a mobile video exhibit in the streets showing a homeless person on a screen and asking onlookers and passersby to text with their cellphones a message for him, and they also could donate money by cellphones to the organization Pathways to Housing. In September 2010, it was reported that the Housing First Initiative had significantly reduced the chronic homeless single person population in Boston, Massachusetts, although homeless families were still increasing in number. Some shelters were reducing the number of beds due to lowered numbers of homeless, and some emergency shelter facilities were closing, especially the emergency Boston Night Center. In 2011, the Department of Veterans Affairs Supportive Services for Veterans Families Initiative, SSVF,
In 2019, in an interview with CBS News, scholar Sara Goldrick-Rab said that her study on college student homelessness found that "[n]early one in ten college students said they were homeless in the last year, meaning they had at least one night where they didn't know where they were going to sleep."
According to the most recent count by the Puerto Rico Department of Family, in January 2017 there were 3,501 homeless persons in the territory. The study shows that 26.2% of this population live in the capital, San Juan. Other municipalities percentage of this population was Ponce with 6.3%, Arecibo with 6%, Caguas with 5.3%, and Mayagüez with 4.7%. Results from the study determined that 76% of the homeless population were men and 24% were women and that both men and women populations, were on average age, 40 years old. This steadily increasing population, might have increased more drastically as a result of Hurricane María which caused over 90 billion dollars in damage to the island of Puerto Rico.
Data provided by the Department of Community Social Development of San Juan, indicates that in 1988 the number of homeless in the municipality was of 368, while in 2017 there are about 877 persons without a home. While the average age for the overall homeless population is 40 years old for both women and men, in San Juan the median is 48 years for men and 43 years for women. Other data obtained showed that more than 50% have university level education. Also it revealed that 35% of men and 25% of women have relapsed more than four times after unsuccessful attempts to reinsert themselves socially. Reasons given to wander are varied with the most common causes being drug abuse (30.6%), family problems (22.4%), financial or economic problems (15.0%), and others such as unemployment, mental health problems, domestic violence, evictions, or lack of support when released from prison.
Homelessness in popular culture is depicted in various works. The issue is frequently described as an invisible problem, despite its prevalence. Writers and other artists play a role in bringing the issue to public attention. Homelessness is the central theme of many works; in other works homelessness is secondary, added to create interesting characters or contribute authenticity to the setting (e.g., for a story set in the impoverished inner city). Some stories and films depict homeless people in a stereotypical or pejorative manner (e.g., the exploitation film Hobo With a Shotgun, which depicts homeless people fighting).
With regard to Axis II, Cluster A personality disorders (paranoid, schizoid, schizotypal) were found in almost all participants (92% had at least one diagnosis), and Cluster B (83% had at least one of antisocial, borderline, histrionic, or narcissistic) and C (68% had at least one of avoidant, dependent, obsessive-compulsive) disorders also were highly prevalent.
Pensioners David and Jean Davidson found living in a Travelodge hotel was a cheaper option than an old people's home and have never looked back.
Many of the homeless suffer from "street feet", which, Bell explains, are really sore feet, blistered and damaged from walking around all day with no means to change socks and shoes or care for their feet.