Stigma, Homelessness and Mental Illness

Lauren Gonzales, Ph.D., a clinical psychologist and assistant professor in Adelphi’s Gordon F. Derner School of Psychology

A homeless man visits an emergency room six times in a few months, reporting hallucinations and suicidal thoughts. Despite having been previously diagnosed with schizophrenia, the man is consistently refused care. One doctor notes, “He is only in the ER for food and shelter.”

The man’s experience, which was described in a 2018 case study published in The New England Journal of Medicine, highlights the stigma that surrounds mental illness, especially among the homeless. It’s this stigma that Lauren Gonzales, Ph.D., a clinical psychologist and assistant professor in Adelphi’s Gordon F. Derner School of Psychology, has been devoted to researching.

Dr. Gonzales takes a holistic approach to clinical psychology, seeking to understand how societal factors impact marginalized communities.

In a set of 2018 papers published by Psychiatry Research and Psychiatric Services, Dr. Gonzales studied the effects of different housing treatment facilities and their locations on mental health stigma and community participation. The papers were part of a joint research project led by Philip T. Yanos, Ph.D., Dr. Gonzales’ graduate adviser at the City University of New York’s John Jay College of Criminal Justice.

The team surveyed people with psychiatric diagnoses in two different types of housing facilities, those which contained only residents who were diagnosed with a mental illness, and integrated housing, where people with mental illnesses were scattered throughout a community apartment building or facility. The team also surveyed community members in each neighborhood.

They found that housing type can affect stigma and participation, but others factors such as location are also in play.

“People in congregate housing might do better in a more urban environment like East Harlem, for example, versus a more spread-out environment like Westchester,” Dr. Gonzales says.

This is because congregate housing might be more noticeable in a suburban environment.

“Stigma is also influenced by whether or not you have a choice to disclose your diagnosis to others, whether or not you feel safe actually integrating into your community,” she explains. “These are all considerations that I think have implications for treatment and recovery for people with psychiatric diagnoses,” as people with mental illnesses can face difficulties recovering if they’re feeling stigmatized by their communities.

Dr. Gonzales is currently working with her doctoral students to launch an online study about the stigma healthcare providers attach to people with mental illnesses.

“We’re interested to see if patient characteristics, specifically race, criminal history and housing status are associated with the provider’s likelihood to give a better or worse prognosis,” Dr. Gonzales says. “Is there [a stigma] that leads one group to be more marginalized and have poorer mental health outcomes compared to another group that might have more privilege?”

In addition to studying the way stigma exacerbates problems of people with mental health diagnoses, Dr. Gonzales has conducted research into homelessness and its effect on those with mental illness.

In her paper “Can reduced homelessness help explain public safety benefits of mental health court?” published by the American Psychological Association in May 2018, Dr. Gonzales examines the role mental health courts, which can connect individuals with mental illnesses and criminal justice involvement with supervised treatments and community services rather than sentencing them to jail or prison time. These courts, which were first established in the early 1990s, have been associated with reductions in recidivism and violent behavior. But Dr. Gonzales wanted to understand exactly why they have been so effective and what resources may be contributing to decreased violence.

“I was interested, again, in that social piece of it,” Dr. Gonzales says.

Dr. Gonzales studied 88 participants who came before the court and received referrals to mental health programs including housing treatment, as well as 81 participants who went through standard jail processing procedures. She wanted to see if increases in housing resources were connected with that decrease in violence.

“We found that our hypothesis was correct,” Dr. Gonzales says. “The reduction in homelessness was associated with some of these positive outcomes of the mental health court.”

She will continue to bridge clinical psychology with sociological and epidemiological research to better understand the environmental factors that prevent persons with mental illnesses from receiving proper treatment.