Working with Individuals Experiencing Homelessness: A Holistic Approach for Psychiatric Nurse Practitioners
Homelessness[1] is more than the absence of a physical shelter—it reflects a complex web of social, emotional, medical, and psychological challenges. Psychiatric Nurse Practitioners (PNPs) are integral in addressing these multifaceted needs through a holistic, person-centered approach.[2] This article explores strategies and interventions for PNPs using case studies to illustrate the impact of comprehensive care.
Case Study 1: Addressing Co-Occurring Mental Health and Substance Use Disorders
Patient Profile:
Maria, a 42-year-old woman, has been homeless for five years. She presents to the clinic with severe anxiety, depression, and alcohol dependence. She reports using alcohol to manage the trauma of domestic violence and the stress of living on the streets.
Challenges:
Maria’s co-occurring disorders[3] and history of trauma create barriers to recovery. Additionally, her lack of housing stability complicates consistent treatment.
Intervention:
The PNP conducts a trauma-informed assessment, providing a safe space for Maria to share her experiences. She introduces Maria to medication-assisted treatment (MAT) for alcohol dependence[4] and prescribes an antidepressant to stabilize her mood. The PNP also connects Maria with a case manager to help her access housing and domestic violence resources.
Outcome:
Maria begins to reduce her alcohol intake and reports feeling hopeful for the first time in years. Securing transitional housing allows her to attend therapy sessions consistently and engage in a recovery program.
Takeaway:
A holistic approach that integrates mental health, substance use treatment, and social support is essential for individuals like Maria.
Case Study 2: Chronic Medical Conditions and Mental Health
Patient Profile:
James, a 58-year-old man, has been experiencing homelessness for over a decade. He has unmanaged diabetes, hypertension, and symptoms of psychosis. He frequently visits emergency rooms but lacks continuity of care.
Challenges:
James’s chronic medical conditions exacerbate his psychiatric symptoms, and his transient lifestyle makes follow-up care difficult.
Intervention:
The PNP partners with a mobile health team to deliver care at a local shelter.[5] She addresses James’s immediate medical needs, stabilizing his blood sugar and blood pressure. The PNP prescribes an antipsychotic medication and coordinates with a peer support specialist to help James navigate the healthcare system.
Outcome:
James begins attending regular appointments and demonstrates improved adherence to his treatment plan. With the help of the peer specialist, he enrolls in a supportive housing program.
Takeaway:
Integrating medical and psychiatric care with mobile outreach and peer support can significantly improve outcomes for individuals with complex needs.
Case Study 3: Overcoming Barriers to Care
Patient Profile:
Aisha, a 29-year-old woman, has been homeless since aging out of the foster care system. She struggles with PTSD[6] and has avoided seeking mental health care due to negative past experiences with providers.
Challenges:
Aisha’s distrust of the healthcare system and her untreated PTSD create significant barriers to engagement.
Intervention:
The PNP uses a motivational interviewing (MI)[7] approach to build trust and rapport with Aisha. By validating her experiences and emphasizing a partnership in care, the PNP encourages Aisha to share her goals. Together, they develop a treatment plan that includes trauma-focused therapy and a low-dose SSRI for anxiety.
Outcome:
Aisha begins attending therapy sessions and reports feeling empowered in her care decisions. She expresses hope about her future and starts exploring job training programs.
Takeaway:
Building trust and tailoring care to the individual’s goals are vital in overcoming barriers to engagement.
Key Challenges in Working with Individuals Experiencing Homelessness
Mental Health and Trauma: Individuals experiencing homelessness have higher rates of PTSD, depression, and psychosis, often stemming from adverse life events.
Substance Use Disorders: Substance use often serves as a coping mechanism, complicating mental health treatment and recovery.
Health Disparities: Chronic medical conditions are common and often untreated, contributing to a lower life expectancy.
Systemic Barriers: Lack of access to healthcare, stigma, and fragmented services create obstacles to comprehensive care.
Holistic Strategies for Psychiatric Nurse Practitioners
Trauma-Informed Care: Recognize the impact of trauma and create a safe, nonjudgmental environment.
Integrated Care: Address physical health, mental health, and substance use disorders simultaneously.
Collaboration: Partner with social workers, peer support specialists, and housing agencies to provide wraparound services.
Flexible Delivery: Use mobile clinics, telehealth, and outreach programs to meet patients where they are.
Advocacy: Advocate for systemic changes to improve access to care and reduce stigma.
Conclusion
Caring for individuals experiencing homelessness requires more than clinical expertise—it demands empathy, creativity, and a commitment to addressing the root causes of their challenges. Through holistic, integrated care, PNPs can help patients move toward stability, recovery, and hope.
By embracing the principles of trauma-informed care, building trust, and fostering collaboration, PNPs can play a transformative role in the lives of individuals who often feel unseen and unsupported. Together, we can create pathways to health, dignity, and a better quality of life for all.
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References:
[1] Somerville, Peter. "Understanding homelessness." Housing, theory and society 30.4 (2013): 384-415.
[2] Walker, Jessica N., et al. "The impact of an educational intervention on nursing staff attitudes toward patients experiencing homelessness and mental illness." Journal of the American Psychiatric Nurses Association 28.6 (2022): 474-479.
[3] Karadzhov, Dimitar. "Reckoning with complexity: The intersection of homelessness and serious mental illness, and its implications for nursing practice." Journal of Psychiatric and Mental Health Nursing 27.1 (2020): 1-3.
[4] Rieckmann, Traci, et al. "Medication-assisted treatment for substance use disorders within a national community health center research network." Substance abuse 37.4 (2016): 625-634.
[5] Fraino, Joan Alviar. "The Role of a Psychiatric Mental Health Nurse Practitioner as Part of a Mobile Health Unit for the Homeless Population." (2015).
[6] Wiewel, Brenda, and Laura Hernandez. "Traumatic stress and homelessness: A review of the literature for practitioners." Clinical Social Work Journal 50.2 (2022): 218-230.
[7] Milbrun, Mindy Anne. The Development and Evaluation of a Nurse Practitioner-Directed Motivational Interviewing Program: Assessing Its Impact on Readiness for Change Among Inpatient Drug Rehabilitation Patients. Diss. Wilmington University (Delaware), 2024.