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Homeless Vets

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Homeless Veterans and Mental Health
Shana Holt
August 24, 2015
Ann Reagan

Homeless Veterans and Mental Health According to the "National Alliance on Mental Illness" (2015), "Veterans make up as much as one third of the nation's population of homeless people." (Homeless Veterans). The National Coalition for Homeless Veterans estimate that 45% of these veterans are also living with a mental illness and half suffer with substance abuse problems like drug addiction or alcoholism. This population is predisposed to a number of medical, psychiatric, and social problems such as tuberculosis, HIV infection, hepatitis, alcoholism and substance use, skin and foot disease, schizophrenia and related psychoses, malnutrition, and trauma. Many of these veterans have lost their families, homes or even both as a result of the inability to adapt to civilian life. America's homeless veterans have served in all wars including some of our most recent like Operation Enduring Freedom, Operation Iraqi Freedom and Operation New Dawn. The Veterans Administration (VA) currently provides specialized homelessness programs to almost 150,000 homeless veterans. “Since 1987, VA's programs for homeless veterans have emphasized collaboration with such community service providers to help expand services to more veterans in crisis." ("National Coalition for Homeless Veterans", n.d.).

Epidemiology Paper Roles This paper will explain the role epidemiology plays in the surveillance of mental illness and substance abuse among America’s Homeless Veteran population. It will also discuss the definition and description of epidemiology, epidemiological methods, the epidemiological triangle and levels of prevention that is related to homelessness, mental illness, and substance abuse associated with our veterans.

What is Epidemiology?
To better comprehend the role epidemiology plays in the surveillance of health and disease associated with the homeless veteran population, it is important to have a good understanding of what epidemiology is and how it is implemented. “Epidemiology is the study of the distribution and determinants of health-related States or events, and the application of this study to the control of diseases and other health problems. Various methods can be used to carry out epidemiological investigations: surveillance and descriptive studies can be used to study distribution; analytical studies are used to study determinants.” (World Health Organization, 2015) Some areas of epidemiological study are etiology of disease, outbreak investigation, surveillance and screening, bio monitoring, and clinical trials when comparing treatment effects. Epidemiologist work together with other scientific professionals like biologists to help understand disease process, statisticians work to translate data and make appropriate conclusions, social scientists to explain proximate and distal causes more clearly, and engineers for exposure assessment. A much more simple description of epidemiology is the study of the incidence and spread of disease within populations, with a goal of determining the causality. The purpose of epidemiology is to find the causes of diseases that affect a population so that science can develop a plan for disease prevention, protection, and control. (Sweeney, Gebbie, & Tilson, 2015, p. 407).
Steps and Methods of Epidemiology.
When performing an epidemiological study, it is important to quickly establish the way in which data will be obtained. There are three major categories of data sources that are commonly used in epidemiological investigations. The three basic methods of epidemiology are routinely collected data, data collected for other purposes, and original data. Routinely collected data include various vital records such as birth certificates, death certificates, or marriage certificates. This type of data collection also encompasses census data and surveillance data. Census data is done here in the United States every ten years and provides population data, including demographic distribution (i.e., age, sex, and race), geographic distribution, economic status and education. Surveillance data is carried out by the Centers for Disease Control and Prevention, it is a systematic collection regarding disease occurrence. Data collected for other purposes is data that is collected from hospitals, physicians, health departments, and insurance records about morbidity. Surveillance systems often fall in this category for things like registries or health department reporting systems. Original data collected for specific epidemiological studies are often performed by agencies such as the National Center for Health Statistics or the Centers for Disease Control and Prevention. They perform surveys that provide information on the health status and actions of the population. (Stanhope & Lancaster, 2015, Chapter 9).
Epidemiologic Triangle
The Epidemiologic Triangle, also known as the Epidemiologic Triad, was developed by scientists in order to better understand infectious diseases and how they are spread. Like all triangles, the Epidemiologic Triangle has three corners. Each corner represents a different Vertex. Vertex 1 is considered the "What" or better known to epidemiologists as the etiologic agent. It is the organism that is causing the disease or illness. “The pathogenicity of an agent is its ability to cause disease”. (Brackman, 1996, Chapter 9, Epidemiology, Chain of Infection). It can also be characterized by the organism’s virulence or invasiveness. Virulence is the severity of the infection and is represented by describing the morbidity or incidence of the disease. It also shows the mortality or death rate of the infection. The invasiveness of an organism is its ability to invade tissue. Vertex 2 is the "Who" or host of the triangle. This is the person or organism that is being affect by Vertex 1. Last, is Vertex 3 also referred to as the "Where", environment or method of transmission. This is a compilation of external elements that cause or permit disease transmission. Transmission refers to the way in which an agent travels from the source to the host. There are four major methods of transmission. Contact transmission occurs when the agent is sprayed directly, indirectly or by airborne droplets. This form of transmission is referred to as person to person transmission. Common vehicle transmission refers to agents that are transmitted by a common inanimate vehicle or object. An example of this type of transmission would be a foodborne illness. Airborne transmission of an agent is spread by means of droplet nuclei or dust particles in the air. Tuberculosis is a good example of this form of transmission. The last method of transmission is vector borne transmission. Vector-borne transmission can be classified as external or internal. External transmission occurs when the organism is carried physically on a vector that infects the host. When organisms are carried within a vector it is known as internal transmission. (Brackman, 1996, Chapter 9, Epidemiology, Chain of Infection). The goal of epidemiologists is to break at least one of these Vertex, thereby stopping the continuation of the disease or illness. Homelessness remains a social disease of epidemic proportions. The surveillance and screening method was used in the assessment of homeless veterans who also have mental illness. This assessment was done at local emergency departments that see a number of homeless veterans suffering from alcoholism and post-traumatic stress disorder (PTSD). The local Veteran’s Administration Health Clinic also served as a valuable location for information collection and observation along with the local homeless shelters. Many homeless veterans stay near hospitals, clinics, and shelters in order to avoid the harsh elements that the Northeast Texas weather can bestow upon a person. Nation-wide, veterans make up one third of the homeless population, 33% of the homeless population are male veterans. According to the U.S. Department of Veterans Affairs (2011),”Veteran status is associated with a higher risk of homelessness; and that a greater proportion of Veterans were in the homeless population than in either the general population or the population living in poverty.” (Prevalence and Risk of Homelessness among U.S. Veterans: A Multisite Investigation). However, only some 25% of the homeless Veteran population have utilized the homeless services provided by the Veteran’s Administration. Shreveport, LA houses a large acute care veteran’s hospital and long term nursing facility for veterans, however often the acute hospital has a census that will not allow new admissions and the long term facility has a two year waiting list. Currently in the Ark-La-Tex, there are no homeless shelters or centers for veterans and they must utilize public homeless shelters.
The vulnerability of this population is immense. The “United States Interagency Council on Homelessness” (2013) describes the vulnerability of Veterans as having “high rates of Post-Traumatic Stress Disorder, traumatic brain injury, and sexual assault, all of which increase the risk of homelessness. About half of Veterans experiencing homelessness have serious mental illness, half have a history with the criminal justice system, and nearly 70 percent have substance abuse disorders.” (Veterans) Veterans many times are unemployed or living on a fixed income. Many Veterans find it difficult to adjust or adhere to civilian life and are unable to adapt due to lack of income because of limited education or transferable skills from military to civilian life. Many of these Veterans have combat-related physical health issues and disabilities as a result of their service to this country. Culturally, approximately 40% of all homeless veterans are African American or Hispanic. White, Black, and Hispanic rates of Veterans among the homeless population were similar to corresponding rates in the general population. Asian, American Indian, and Pacific Islander rates were slightly higher among the general population however, these three groups comprised only 4% of the homeless Veteran population. (U.S. Department of Veterans Affairs, 2011) Traditionally African Americans have close family ties and pull together in times of need but also don’t want to burden families with their problems thus the rate of homelessness. The Hispanic community also has strong family ties and religious beliefs. This statistic for this culture is surprising. White families often do not have these strong family ties especially white males over the age of eighteen.
Veterans have the same constitutional rights as any other American citizen regardless of economic status, religion, race, or disability including mental disability. Every veteran is entitled to a representative to assist them with legal issues. This representative in located at the local county court house. Veterans also have access to health services both physical and mental. The Veterans Administration Health Clinic employees someone that specializes in managing the incidence of homeless veterans in their area. As mentioned earlier many do not utilize these services, maybe because they do not know they are available. The world we live in today has many biases about homeless people. It is difficult to distinguish between homeless veteran population and general homeless population. Many people do not take into consideration that the homeless person on the corner may be a veteran they just assume that all homeless people are lazy with no ambition or value. This is a sad thought. All lives are valuable and every life matters. These homeless veterans, however are the very people who have fought for the freedom we have to do things like going back to school and getting a better education. Isn’t it time to rightly thank them for their service and put an end to homelessness among the veteran population?

Brackman, P.S. (1996). Medical Microbiology (4th ed.). Retrieved from
Centers for Disease Control and Prevention. (n.d.). Retrieved from
National Alliance on Mental Illness. (2015). Retrieved from
National Coalition for Homeless Veterans. (n.d.). Retrieved from
Stanhope, M., & Lancaster, J. (2015). Foundations of Nursing in the Community (4th ed.). Retrieved from Elsevier.
Sweeney, P., Gebbie, K., & Tilson, H. (2015). Principles of Public Health Practice (3rd ed.). Retrieved from The University of Phoenix eBook Collection.
United States Interagency Council on Homelessness. (2013). Retrieved from
U.S. Department of Veterans Affairs. (2011). National Center on Homelessness among Veterans. Retrieved from
World Health Organization. (2015). Retrieved from of Form
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