69 MARTINDALE CENTER FOR THE STUDY OF PRIVATE ENTERPRISE Four pathways to homelessness Denmark supports low-income people by providing substantial unemployment benefits and free health care, so most of the homeless population follows four main non–income-related pathways to homelessness: substance abuse, mental health, early social exclusion, and migration. Together, substance abuse and mental illness create about 85% of Denmark’s homeless population (Benjaminsen & Dyb, 2008). Currently, 18% of Denmark’s homeless population comes from the Middle East, Africa, the EU, and other Nordic countries. This figure representing the migrant population continues to grow, further complicating the situation (Thiesen & Tanderup, n.d.). Despite Denmark’s social welfare system, the country’s youth remain a contributing factor in the homeless population. People are slipping through the safety net, falling to the street through these four pathways. Substance abuse One study on mutually exclusive main diagnoses found that 33% of the homeless population suffered alcohol abuse, 31% drug abuse, and 20% mental illness, but these problems tend to overlap (Benjaminsen & Dyb, 2008). Substance abusers are often stuck in a vicious cycle of needing stability to qualify for established rehab programs yet needing rehab to build stability. In general, Denmark’s public alcohol treatment is limited, with only 11.9% of all alcoholics receiving treatment. The two main forms of treatment are 1) inpatient, involving intensive, round-the-clock residential rehabilitation centers designed to treat serious substance abuse issues, and 2) outpatient, a more flexible form of rehab that allows people to continue with work or school and typically offers more group counseling to teach recovery skills and prevent relapse. Only 4% of Denmark’s general substance abuse population receive inpatient treatment because facilities require that a patient be cognitively well functioning, possess at most “light” mental health issues, and be able to secure housing with a stable network. These requirements prevent nearly all of Denmark’s homeless population from securing spots. While meant to be flexible, outpatient treatment is not fully immersive and often allows too much room for relapse and little recovery among Denmark’s homeless. Taken together, the treatment options limit access to the homeless and often actually reinforce their homelessness. Mental health The second most common pathway to homelessness is mental health. The 2020 Financial Act allocated 600Mkr annually to strengthen regional psychiatry together with a 10-year plan to improve psychiatric care. This new plan will focus on promoting prevention and the cohesion between general practices, psychiatric hospital services, and social psychiatry. Early prevention programs like Mind My Mind target young adults and children. Mind My Mind reports 75% of participating children showed reduced symptoms. However, most other psychiatric initiatives in the 10-year plan involve increased access to technology, which will not help those on the streets or in shelters whose technology access is limited at best. For example, there are online psychotherapy programs, such as the Center for Telepsychiatry, a 10- to 12-week, web-based treatment with automated clinical therapy resource. Denmark also has psychiatric emergency outreach that serves as a suicide prevention hotline where operators can help callers get more assistance (Rist, 2021). These programs are effective but only reach those who can access the internet or telephones, often leaving the homeless removed from these resources. Estimates suggest 20% to 30% of Denmark’s homeless population suffers from mental illness. Despite common beliefs that the mentally ill get help in treatment centers, it is extremely hard for the mentally ill, once homeless, to get consistent care. Although public health-care system GPs provide initial basic conversational therapy, a psychotherapist working in Denmark since 2018 described therapy practices and long wait times as follows: “It’s crowded. You cannot have an easy appointment for free” (Roney & Anziano, n.d.). Adding to the personal time costs of waiting, the public system does not provide completely free services except for those 18 to 24 years of age. Anyone else receiving psychotherapy pays a discounted price of 400kr per session, which is not feasible for the homeless (Christensen, n.d.). Limits on how many patients public psychologists can take annually create wait times of up to 52 weeks. Moreover, public appointments come only with permanent Danish residency or Danish citizenship. Homeless migrants have no access unless they get access to a citizen service number. A study comparing psychiatric care between people with places of residence and homeless patients found that although the frequency of admission to psychiatric emergency units or referral to outpatient clinics did not differ, 35% of the homeless patients were not offered further treatment after initial consultation, as compared to only 18% of other patients. The study further determined that those homeless admitted to treatment centers were more likely to be placed into locked wards and given compulsory medication and injec-
RkJQdWJsaXNoZXIy MTA0OTQ5OA==