With the increase of drug and alcohol abuse tagged with the large homeless population that we have in society today, the dynamic of a nurse’s assignment.  Some people do not understand or know the progression or living options for these individuals.  It can be a continuation of the same unless the patient chooses to change and has resources to take the necessary steps to get better.

Where do these people go?

Let’s examine the options:

1. Home – The most ideal.  Usually at the beginning of the illness, prior to and the beginning of the addiction or the progression of the mental illness.  This patient still has a job and functional.
2. Move in with friends – The addiction is growing to the substance of their choice to the point they need to downsize due to the cost of the lifestyle.  The reason is that the mental illness untreated or treated they had lost their job or need to work part-time due to decompensating.  If the patient is treated, will they continue their meds or self-medicate?  More times than not, they self-medicate.
3. Homeless shelters/Tent cities – The issues (addiction & mental illness) are becoming great.  The patient may have exhausted their resources to the point that their friends and family cannot take them in any longer due to stealing, the mental illness progression, or other reasons relating to abuse and illness.
4. The streets – Life has completely changed for this patient where they could be committing crimes to support their habit or they aren’t able to work due to the decompensation from their illness.
5. Hospitals – In Florida, we have the Baker Act.  If you feel that you are a danger to yourself or others you or someone else can Baker Act you for a mandatory 72-hour psychiatric hold.  The psychiatric doctor can hold the patient or not and also depends on if the patient takes their medications, and cooperates with meetings or rules of the unit.  Often, the patients can refuse the medication so this delays treatment.  The other scenario is that the patient forgot to make their appointment due to their illness and ran out of medication.
6. Jail – The patient is arrested in the community and they stay there for their sentence and released back into the community.  Some with lengthy records, including felonies.  When you have a lengthy record or receive a felony, it is difficult to find housing and a job.
7. The cycle starts back at #3 unless they get housed in an Assistant Living Facility (ALF), group home, or Skilled Nursing Facility (SNF) as a Traumatic Brain Injury (TBI) staying across the hall from a fragile individual.  The patient may sign themselves out of the facility and go back to the streets due to having more freedom and options for continuing the same circle.