Introduction
Homelessness and vulnerability are connected components that can predispose an individual to mental illness. Individuals experiencing vagrancy are susceptible to symptoms of anxiety, depression, and post-traumatic stress disorder. According to Manning and Greenwood (2019), the stressors that vagrant individuals experience, such as limited access to food, support, and shelter, can result in mental health illnesses. Vulnerable individuals are at an increased risk of experiencing exploitation as a result of several factors.
For instance, societal solitude, impoverishment, and vagrancy might enhance a person’s sensitivity to psychiatric disorders (Tsai et al., 2023). Due to homelessness, a history of psychiatric illness, and recent bereavement, Beth has an increased risk of harming herself. However, through a collaborative approach with the psychiatric nurse, the client can develop a safety plan that promotes her safety and mitigates risks. Therefore, risk assessment, formulation, and management strategies can aid patients with suicidal ideation to live better lives.
Contextual Information
Homelessness and Mental Health
Housing is a basic need that entails the provision of shelter to individuals. According to Fleury et al. (2021), a family lacking regular and fixed nighttime accommodation, such as those residing in emergency shelters, can be regarded as homeless. According to Lanham, White, and Gaffney’s (2022) research, more than 580,000 Americans were likely to be homeless in 2022. Limited wages, high home and healthcare costs, and unemployment result in poverty, a significant cause of vagrancy among individuals. Since most individuals might be unemployed, they are likely to have low incomes. This limits their access to health services since they might be expensive for uninsured individuals.
Homelessness can negatively affect an individual’s mental health. According to Sleet and Francescutti (2021), 580,466 people in America will likely be homeless in one night. Gutwinski et al. (2021) reported that 1 in every eight vagabonds is likely to have a serious mental illness such as major depressive disorder. According to Gutwinski et al.’ ‘s (2021) research, mental health disorders such as schizophrenia are prevalent among homeless people. The connection between homelessness and mental illness is intricate and two-way in nature. An individual’s psychological problems can make it hard for them to find employment and perform activities in ways that encourage stable housing.
Poor mental health is exacerbated by destitution since the stress of being homeless can aggravate pre-existing psychological conditions and promote substance abuse, anxiety, fear, and insomnia. Vagabonds with mental illnesses have the exact needs of those who are not homeless: affordable housing through the House First project, low-cost medical and dental treatment, education, transit, and safety (Loubière et al., 2022). As a result, they should have a warm and comforting environment, with the availability of essentials such as food, accessible caregivers, and shelter. Social isolation is another significant stressor associated with homelessness. Due to lack of finances, shame, or humiliation, vagrants may withdraw from social activities and the greater community. This social isolation can lead to emotions of pessimism, melancholy, and loneliness, which can worsen mental fitness issues.
Discrimination is another stressor faced by homeless individuals. Bigotry from mainstream society, such as exclusion, discrimination, and unfavorable stereotypes, occurs daily among vagrants (Gilmer and Buccieri, 2020). Discriminatory treatment has the potential to worsen unfavorable mental health outcomes since they are capable of instilling alienation and inadequacy feelings. According to Padgett (2020), vagrancy can be a traumatic experience that alters a person’s indicators of mental illness.
According to Gutwinski et al. (2021), those who have ever been homeless are more likely to have problems with their mental health. Being a vagabond exposes one to a range of risks and a constant fear of victimization, which can make it a stressful experience. People with mental health issues are frequently discharged from hospitals and jails without sufficient home-based support, resulting in an overrepresentation among the homeless population (Laliberté et al., 2020). Therefore, community-based mental health care can aid in the provision of support.
Vulnerability in Mental Health
The presence of psychological illness is a significant factor that influences mental stability vulnerability. People who suffer from mental diseases frequently have poor judgment, which makes it difficult for them to navigate situations and adequately communicate their desires. Moreover, the indications and aftermath of mental illness can severely hinder an individual’s comprehension of their legal rights and ability to safeguard oneself against mistreatment or injury.
One crucial factor that contributes to vulnerability in mental health is destitution. It is more difficult for impoverished individuals to break the cycle and improve since they frequently have fewer possibilities for work and education (Baugh, Vanderbilt, and Baugh, 2019). Their vulnerability is increased by their inability to pay for necessary medications, permanent housing, mental health treatment, or other necessities.
One essential aspect determining psychiatric health susceptibility is social isolation. Individuals who are disconnected from society do not have a support system to whom they may turn for guidance, safety, or assistance (Czaja, Moxley, and Rogers, 2021). They could find it harder to withstand pressure or compulsion from someone looking to take advantage of or damage them if they have no social ties. Another crucial factor in mental health vulnerability is substance use disorders.
According to Ramey and Regier (2019), substance misuse inhibits cognitive function and decision-making abilities, eroding judgment and increasing vulnerability to abuse. Persons with substance use disorders may associate with individuals who prey on their weaknesses or engage in riskier behaviors in their frantic search for drugs or money. The other factor is age, where young and older adults who are mentally unstable might be especially susceptible to abuse. According to Fang and Yan (2021), older people’s cognitive and physical decline may make it more difficult for them to protect themselves against exploitation or abuse. However, young individuals might not have as much life experience or understanding, which leaves them more open to being tricked or forced by others.
Since women often confront precise risks and barriers, gender-based vulnerability is an essential subject matter of discussion in terms of mental fitness. Hossain et al. (2020)suggest that women and girls may be particularly vulnerable to injury or exploitation in mental fitness settings because of gender-based violence and prejudice. The relationship between gender and intellectual fitness can exacerbate vulnerability, sustaining destructive power relationships and wielding excessive influence.
According to Babik and Gardner (2021), physical or intellectual limitations might make it difficult for someone to recommend and defend himself. Their limited access to support services exacerbates their vulnerability to exploitation. One of the most significant barriers to receiving treatment for mental problems is the stigma associated with it in society (Subu et al., 2021). People cannot completely acknowledge their vulnerability and seek the necessary help because of this internalized shame.
Risk Assessment
Risk to Self
Beth’s recent self-harming activity indicates that she is in danger of committing suicide. Self-harming behavior may suggest suicidal thoughts in addition to being a standard coping method for persons under distress (Predescu and Sipos, 2023). Beth’s stated desire to die adds credence to this worry. Her social disengagement and emotional outbursts are signs of deteriorating intellectual health. According to Motillon-Toudic et al. (2022), people who are unhappy or dejected prefer to isolate and withdraw from others, which increases the risk of suicide. A history of mental disorders, which include melancholy, anxiety, substance abuse, lack of social assistance, latest loss or trauma, and availability of devices for self-damage, are other variables that could increase Beth’s risk of suicide.
Risk from Others
Given that Beth is homeless, she is more vulnerable to victimization. Individuals who do not live in their own houses are more likely to become victims of crime than those who do (Rossa-Roccor, Schmid, and Steinert, 2020). Due to multiple reasons, they become easy prey. For instance, not having a secure and safe place to live poses people such as Beth with difficult living conditions that include sleeping in packed and unsafe centers. Such environments make them more susceptible to criminal acts as they lack the protection and security afforded by stable housing.
According to Bertram et al. (2021), the social isolation that typically comes with homelessness exacerbates the danger from others. Beth’s lack of a stable support network and social connections diminishes her safety net and increases her vulnerability to exploitation and victimization. Without friends, family, or neighbors nearby who can assist or notice potential dangers, Beth may become an easy target for perpetrators.
Moreover, the limited resources available to vagrant individuals can make them potential criminal targets. According to Regalado, Timmer, and Jawaid’s (2022) research, a person’s vulnerability to robbery, theft, and fraud might be increased by a lack of financial resources, personal items, and basic requirements. Beth is homeless, implying that she lacks secure storage for her belongings, thus leaving them exposed. Moreover, she lacks financial resources to safeguard her property due to unemployment. This predisposes her to threats beyond the usual crimes of sexual assault, robbery, theft, fraud, and exploitation. People who take advantage of the helplessness of people experiencing homelessness may use their terrible position for their benefit or put them in harmful situations.
Risk Formulation
Presenting Problems
It is evident from Beth’s recent self-harm that she is in a great deal of misery. According to Macneil et al. (2012), the presenting problem extends beyond diagnosis to incorporate the clinician and the client to identify the difficulties the individual is facing. Anger, grief, and emptiness serve as a means of expressing emotions that are too difficult to articulate. Beth’s expression of dying desire is a critical challenge since it indicates that she feels hopeless.
According to Holliday et al. (2021), individuals who express a desire to kill themselves are more likely to commit suicide. She used to enjoy the company of others but has since withdrawn from her friends. This coping strategy might be dangerous as it could make her feel alone and isolated. Her tearfulness is a sign that she is experiencing emotional misery. These tears may be a manner of releasing pent-up emotions, including disappointment, grief, or anger.
Beth used to appreciate art, mainly painting, because it alleviated her mind of many worries. She has, however, lost interest in the hobbies she used to like. This might indicate sadness, anhedonia, or the inability to enjoy pleasure (Ma et al., 2023). Her lack of interest in artwork indicates she is losing enjoyment in activities she used to experience delight.
Predisposing Factors
Predisposing factors are the circumstances that make an individual more susceptible to developing a specific condition or experiencing a particular outcome. According to Macneil et al. (2012), predisposing factors involve the identification of potential biological contributors such as birth difficulties and organic brain injuries. Beth’s parents dying is a significant loss that could contribute to mental health issues. According to Gomez (2021), grief can trigger feelings of sadness, loneliness, and despair. This traumatic event likely caused profound emotional distress, grief, and destabilization in Beth’s life.
Macneil et al. (2012) suggest that personality factors and changes are likely to predispose an individual to psychiatric illnesses. Beth was unable to concentrate on her studies since she had lost emotionally and financially supportive parents in one go. Furthermore, leaving college early can cause feelings of failure, sadness, and uncertainty about the future, making it a significant source of stress.
Precipitating Factors
The precipitating factor in Beth’s situation is her experience of homelessness. Macneil et al. (2012) argue that precipitating factors comprise significant events preceding the onset of the disorder. These might include physical, legal, occupational, and interpersonal stressors. Without stable housing and access to necessities, Beth is faced with numerous stressors that can significantly impact her mental health.
Being without a permanent home can intensify feelings of isolation, hopelessness, and despair, which can erode one’s self-esteem and ability to engage in daily activities. Additionally, the struggle to secure employment and necessities like food and hygiene compound her challenges. These lived experiences of homelessness have likely played a significant role in the deterioration of Beth’s mental health, as they have heightened her vulnerability and contributed to her withdrawal and tearfulness.
Perpetuating Factors
Perpetuating factors are the ongoing circumstances that maintain a person’s predicament. Macneil et al. (2012) suggest that perpetuating factors can include ongoing substance use and repeating behavioral patterns. In Beth’s case, cutting off contact with her aunt Martha is a perpetuating factor. Considering that she had a good relationship with her aunt before her parents’ death, it is evident that the loss of her guardians had a profound impact on her ability to maintain connections with loved ones.
Beth is likely to have restricted her access to practical and emotional assistance by isolating herself from sources of support. According to Prizeman, Weinstein, and McCabe (2023), withholding assistance promotes emotions of hopelessness and loneliness. Moreover, Beth’s behavior of crying and being withdrawn is an indicator of a worsening mental state. Her manifestations are an indication that limited support systems perpetuate the condition.
Protecting Factors
Protective factors are elements that serve as buffers, mitigating the effects of risk on an individual’s well-being. Macneil et al. (2012) advise that protective factors involve the identification of strengths that can impact the disorder. Protective factors can involve providing social support, skills, and interest in performing fun activities.
Macneil et al. (2012) suggest that positive factors have been lacking in mental health interventions, and their inclusion can result in a reduced likelihood of increased resilience. Painting and art may also act as a protective factor for Beth. Vaartio-Rajalin et al. (2021) suggest that painting, gallery visits, and other art activities are means of self-expression that can help relieve stress. These were previous efforts used by Beth to get some rest from stressful matters she had in her life.
Even if she now claims that art is “pointless,” she ought to acknowledge the possibility that rekindling her enthusiasm for the medium might serve as a buffer for her mental health. Macneil et al. (2012) propose that protective factors can create a high enthusiasm between the client and the therapist, resulting in a therapeutic relationship. By encouraging her artistic expression, Beth can reclaim her resilience, sense of achievement, and sense of purpose, all of which might improve her general well-being and spark her healing process.
Safety Planning
Personal Factors
Mental health nursing incorporates safety planning as a vital consideration. According to Moscardini et al. (2020), safety planning is the most commonly used suicide prevention tool. Higgins et al. (2015) suggest that a nurse must identify the personal issues surrounding their patient, the environment the client is living in, and the level of support from family members while creating an appropriate plan to ensure their safety.
As for Beth, she can collaborate with a mental health nurse to identify clinical manifestations that she should observe, such as suicidal thoughts. Beth needs to understand that changes in mood, behavior, or ways of thinking can characterize suicidal ideation. In addition, she should understand that withdrawal into seclusion, being extremely irritable, and losing hope in life might indicate suicidal thoughts. This can also be manifested in other ways, such as starting to talk about death or death or giving out her property.
The nurse should work with Beth to help her plan to deal with difficult emotions healthily. Elliott et al. (2021) suggest that exercise, writing, and relaxation hobbies are all beneficial strategies to cope with issues. The nurse should teach her additional coping strategies, such as listening to music and having fun with her favorite sports. The physician should help Beth identify individuals she can confide in when she feels overburdened with stress. The client can increase her social interaction with people by visiting her relatives and friends more frequently. She should participate in healthy practices like eating a balanced diet, exercising regularly, sleeping enough, and listening to music. Such exercises and other activities can be used as a way of improving one’s physical and mental health.
Environmental Factors
Beth can work with the nurse to remove access to means of self-harm by getting rid of any objects that she could use to harm herself. This may include things like razors, knives, or medications. The client may surround herself with positive people and things to help establish a secure and supportive atmosphere. This might entail hanging out in settings such as a friend’s house or a community center, where she feels secure and at ease. By recognizing and avoiding circumstances that make her uncomfortable, she can lessen the stressors she is exposed to. This entails limiting time spent in noisy environments and avoiding conflicts with others.
Support Networks
Support networks have immense value in mental health since they provide room for personal growth and patient encouragement. Opening up to a caring person can make patients feel better since they might feel that they are being heard. According to Samari et al. (2022), individuals with mental illnesses may sense shame, causing them to avoid confiding in others. In Beth’s case, she should work with the nurse to identify individuals she can count on for support and help.
The nurse can suggest caseworkers, the client’s friends, therapists, and family members, especially her aunt. The nurse should help the client create a plan for contacting the identified support system. This can be done by writing a list of numbers of the support system, which the patient can contact at any time she feels low. The health professional needs to deal with clients to identify community resources and link them to Beth. Community resources for mental health might include support groups, crisis shelters, and helplines. By implementing safety planning strategies, the patient can have a reduced risk of suicide and can have a positive outcome.
Crises Management Plan
Crisis planning involves outlining crucial information that should be considered whenever there is a mental health emergency. Beth might not like planning for something she hopes will not happen. However, predicament management planning could help her understand what she can do in an emergency. Rozek and Bryan (2020) suggest that crisis response planning (CRP) is an effective tool for preventing suicidal attempts and should be incorporated into trauma-focused remedies for patients.
CRP involves the identification of warning signs, internal coping strategies, social support, and professional services. The nurse should communicate to Beth the signs of suicide and teach her de-stressing strategies such as mindfulness. The client’s support network would be instrumental since talking to people close to her would aid in the identification of suicidal signs. Nurses should offer clients emergency hotlines such as 911, which they can contact when suicidal feelings emerge.
Conclusion
Homelessness and vulnerability are two concepts that are closely related and can exacerbate mental illnesses. Vagabonds and susceptible groups might face heightened levels of stress coupled with isolation, which increases their vulnerability to psychological disorders. Beth experiences vulnerability due to her homeless situation and has been feeling withdrawn from her friends, lacks interest in activities she used to enjoy, and thinks of death. These signs are indicative of psychological distress, and a risk assessment conducted revealed that she is at risk of self-harm and from others. These risks are increased by predisposing, precipitating, and predisposing factors.
However, protective factors such as the love for art could be a significant source of strength for the client. The client and the mental health nurse can collaborate closely to create a safety plan entailing the identification of suicidal signs and managing them. Beth can improve her symptoms by utilizing the available social support network, practicing healthy coping mechanisms, and ensuring her environment is free from self-harm material such as razors. If her symptoms worsen, she should contact emergency services for further management.
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