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To describe and compare the prevalence of psychosocial and psychiatric disorders among veterans with multiple sclerosis (MS) and a propensity-score-matched group of veterans without MS, and to identify sociodemographic and clinical characteristics associated with comorbid psychosocial and psychiatric problems among veterans with MS.
Methods
Data were linked and extracted from the Veterans Affairs (VA) Homeless Operations Management and Evaluation System and the Corporate Data Warehouse. The total sample comprised 27,342 veterans in the VA healthcare system between January 1, 2022, and June 30, 2023, who met eligibility criteria for an MS diagnosis (n=13,671) and 1:1 propensity-score-matched sample of veterans who did not have MS (n=13,671). MS diagnosis, substance use disorder (SUD), mental illness, and homelessness were defined using standard ICD-10 codes. Covariates included sex, age, Charlson Comorbidity Index (CCI), and VA service-connected disability rating.
Results
A higher prevalence of mental illness among veterans with MS (33%) was found compared with those without MS (31%). Multivariable logistic regression models indicated MS was negatively associated with diagnoses of alcohol use disorder, stimulant use disorders, posttraumatic stress disorder, and schizophrenia/schizoaffective disorder but positively associated with diagnoses of cannabis use disorder and major depressive disorder. MS was not significantly related to homelessness. Disparities in psychosocial and psychiatric disorders among veterans with MS are described.
Conclusion
This study provides novel insights regarding rates of homelessness, SUD, and mental illnesses among veterans with MS. Interdisciplinary approaches to identification and management of mental illness, SUD, and homelessness among veterans with MS are critically needed.
This chapter explores the principal constitutional challenges to laws that regulate unhoused persons and public property. Municipal ordinances have been challenged on the grounds that they are unconstitutionally vague or overbroad, impose cruel and unusual punishments, violate the right to travel, or infringe the right to equality. This chapter discusses the successes and shortfalls of these challenges. Its concluding parts discuss how U.S. and Canadian courts have rejected a positive right to housing.
This chapter provides an overview of homelessness in the United States and Canada. It discusses the risk factors associated with homelessness. It explains how vagrancy laws historically regulated unhoused persons. These laws were struck down following the rise of the void for vagueness doctrine. This chapter discusses how local governments enacted narrowly tailored municipal ordinances that governed unhoused persons and public property, which withstood void for vagueness challenges.
This chapter explains why the State has greater power to regulate and police unhoused persons compared to people with access to housing. It shows how and why the State has more power to regulate need-alleviating conduct that occurs on public property than on private property. It demonstrates how laws that govern public property operate like legal rules that impose affirmative duties to act on unhoused persons. Yet others control whether unhoused persons can fulfil this affirmative duty, and unhoused persons must make non-egalitarian trade-offs to fulful their positive obligations.
This chapter explores the relationship between homelessness and two prominent conceptions of liberty: positive liberty as self-actualization and negative liberty as non-interference. It sets out how scholars have approached the relationship between homelessness, property, and both forms of liberty. It demonstrates how unhoused persons tend to lack positive and negative liberty.
This final chapter demonstrates how the State can fulfil its three fiduciary duties to end homelessness, maintain public property’s shared value, and legitimize laws that govern public space. This chapter unpacks each of these duties and explains their substantive content. Drawing on existing research, this chapter provides concrete proposals for how the State can respect each of its three fiduciary obligations related to homelessness and public property.
This chapter discusses the State’s three fiduciary duties related to homelessness and public property. Its opening parts describe why the State and individuals are in a fiduciary relationship and why the State has an overarching fiduciary duty to counteract domination. It then discusses other fiduciary relationships that arise in public law contexts. It then explains how the State has three fiduciary duties, all of which seek to minimize domination. More specifically, the State has fiduciary duties to: (1) end homelessness and secure access to housing, (2) maintain public property’s shared value, and (3) legitimize laws that regulate public space. It elucidates the relationship between these three duties.
This chapter introduces the republican conception of liberty as non-domination. It explains how unhoused persons experience two forms of domination because they lack private property rights. First, others exert control over unhoused persons’ opportunities to obey laws that govern public property. Second, unhoused persons must make non-egalitarian sacrifices (or trade-offs) to obey laws that regulate public space.
This chapter defends the State’s fiduciary duties discussed in the previous chapter. It demonstrates why various other ameliorative or coercive governmental measures either fail to mitigate domination or exacerbate it. These governmental measures include increased shelter spaces, zoning, concentration strategies, and dispersal tactics. The final parts of this chapter demonstrate why encampments are a partially justifiable response to homelessness. Yet the State must provide access to housing because individuals cannot justifiably establish encampments as a form of self-help .
This chapter demonstrates how the punishments associated with laws that govern public property entrench individuals in homelessness, such that they will continue to experience non-egalitarian coercion and domination. It explores how these laws result in fines, fees, and surcharges that can result in significant criminal justice debt. It shows how punishments can result in collateral consequences that limit employment prospects and access to housing.
In Homelessness, Liberty and Property, Terry Skolnik establishes a novel theory about the government's duties to end homelessness, maintain public property's value, and legitimize laws that regulate public space. In doing so, Skolnik provides new insight into how the property law system and the regulation of public space limit unhoused persons' freedom and political equality. The book deepens our understanding of how various areas of law, such as constitutional law, legal philosophy, criminal law, and property law, approach the reality of homelessness and advances original arguments to provide new justifications for the right to housing. Skolnik concludes by offering a set of concrete proposals for how the government can reduce the incidence of homelessness and treat unhoused persons with greater concern and respect. This title is part of the Flip it Open Programme and may also be available open access. Check our website Cambridge Core for details.
This chapter begins the last section, a section that explores how the police power can be used to address modern social problems. We look at a number of these wicked problems, including housing, transportation, environmental degradation, and other predicaments, and connect our conception of the police power as described earlier in this book to the use of this power proactively to confront these especially difficult problems.
Despite high childbearing rates among homeless women in India, the antenatal health and healthcare behaviours among such population remain poorly understood. To address this research gap, a mixed-methods approach was employed in the present study, involving interviews with a sample of 400 women aged 15–49 years, utilising time and location sampling techniques. Additionally, a purposeful sample of 52 women from the same age group participated in in-depth interviews. The respondents exhibited rampant socio-economic backwardness, including chronic homelessness (36%), no formal education (54%), engagement in rag picking (31%), and low income levels. About 56% of the women reported poor self-rated health (SRH), notably higher among those aged 35 and above and those living alone (68%). Poor SRH was also prevalent among the ever married (61%), ragpickers (61%), beggars (62%), chronic homeless individuals (62%), tobacco (60%) and alcohol consumers (61%), and those with chronic diseases (61%). Common health issues included depression or anxiety (56%) and iron deficiency anaemia (35%). The level of unmet healthcare needs was 41%, with significant variation across diseases. Lack of reproductive health rights and awareness, socio-cultural beliefs, stigma, socio-economic poverty, poor quality of public healthcare services, irregularity in charity-run healthcare, and time constraints hindered antenatal care visits. The study underscores the urgent need for population-centric programmes and policies aimed at promoting reproductive health to achieve Sustainable Development Goal 3 of ‘Good health and wellbeing’ by 2030.
Whereas most of the cases analyzed in this book pertain to concept formation in relatively well-bounded constellations of activity systems, the case of Housing First 2.0 discussed in this chapter represents concept formation in a broad field of activities aimed at the eradication of homelessness, located at multiple levels from national policy and government strategy down to counties, cities, and housing units working with individual clients. As such, the concept formation process is also lengthy and far from linear. The chapter traces a process of practical experimentation and supportive research that led to the emerging germ cell concept of Housing First 2.0. It is still too early to say to what extent and in what timeframe the new concept may stabilize, generalize, and actually transform homelessness work nationwide. In other words, ascending to the new expanded concrete has only begun. The ascending to the concrete needs to be followed and supported over the long haul.
Despite significant evidence that age is an important factor in homelessness, life course considerations have not been systematically incorporated into the most influential theories of the factors that heighten the risk of becoming homeless. To address this oversight, this article examines variations in the risk of transitioning into homelessness among single adults in Dublin, Ireland. Consideration is given to how these transitions are shaped by the interaction between life course stage and changing personal circumstances, experiences, and relationships. It reveals that while some triggers of homeless, such as leaving institutional or private rented accommodation, are common experiences among all age groups, younger and older adults both experience distinct patterns of transition into homelessness. This understanding can help to strengthen the traditionally weak evidence base for homelessness prevention strategies, and in particular inform the design of targeted measures, that address the specific homelessness risks faced by some age groups.
The law treats older adolescents in a confusing and inconsistent manner. The age at which teenagers acquire legal capacity to make decisions for themselves is governed by a hotchpotch of rules that appear to have little coherent policy underlying them. There has been a noticeable shift towards protecting older children from the risks and responsibilities of adult life. The age at which an adolescent might marry, purchase cigarettes or leave education and training, has increased to delay such decisions until adulthood. Despite the tendency to extend the restrictions of childhood for such decisions, there is also a case for lowering the age at which older young people can participate in other areas of adult life, such as participation in elections. The inconsistent legal treatment of 16- and 17-year-olds causes particular difficulties for those who are unable to remain safely at home. In many ways, the law treats this group as children, expecting them to remain dependent on their parents and limiting their ability to forge an independent life, yet those who leave home are not given the protection and care afforded to younger children.
Homeless persons with dogs are often the subject of stigma, with the public criticising them for not having a proper lifestyle to care for a pet. There is solid documentation of how dogs enhance a homeless person’s life, but there are few publications that address the welfare of the dog. This descriptive study assesses the physical and behavioural health of dogs belonging to homeless persons through a One Welfare lens by observing animal/human well-being, environment, and “a life worth living”. A survey was carried out along with a visual assessment of the condition of the dog for 100 human-dog dyads in the Western United States. Results showed that dogs of homeless persons were well cared for and physically healthy (which was consistent with other studies), and had few behavioural problems, but did display evidence of separation distress while the owner was away. Results from this study can provide information that may lead to policy and practice changes, including, for example, changes to policies and practices prohibiting dogs from being kept with their owner while staying at a homeless shelter. Typically, shelters report that they do not have the resources to care for a person with a dog.
Despite increasing attention to the importance of gender as an analytic to understanding neoliberal welfare reform, little attention has been paid to how motherhood operates to structure experiences. We propose the term ‘maternal activation’ to describe how homeless mothers as a group are subject to, and yet repurpose and resist, specific forms of social control characterising neoliberal paternalistic welfare structures. Drawing on a Critical Discourse Analysis of semi-structured interviews with fifty-four frontline homelessness workers, and eighteen homeless mothers, within the newly conditionalised Welsh homelessness system, we argue that homeless mothers have distinct experiences of neoliberal welfare governance. They navigate contradictory demands of attentive caregiving and economically engaged citizenship, amid devaluation of care created by a neoliberal emphasis on entrepreneurialism. However, performing intense motherhood offers strategic advantage for homeless mothers by enabling them to be read as ‘legible’. This highlights the utility of motherhood as a framework to understand welfare citizenship.
Service providers have a unique understanding of older homeless adults’ challenges and service needs. However, research on the experiences of health care providers (HCPs) who work with this population is limited. We aimed to gain a better understanding of the experiences (roles, challenges, and rewards) of HCPs who work with older homeless adults (age 50 and over) in outreach settings. We conducted individual semi-structured interviews with 10 HCPs who worked in these roles. Four themes emerged: (a) the client–provider relationship as an essential building block to HCPs’ work; (b) progression of care that acknowledges the “whole person”; (c) collaboration as integral to providers’ work; and (d) the importance of system navigation. Providers found their work personally and professionally fulfilling but were frustrated by system-level challenges. Findings can be used to identify strategies on how to further support providers in their roles and enhance service provision for older homeless individuals.