From a humanistic perspective, a person is headed down an unhealthy path when their needs as a human being are not met. Environment is indispensable. Environment is a term that encompasses not only the physical needs, but also the emotional, mental, and spiritual aspects of human wholeness.

There are more specific components of environment that directly impact physical and mental wellbeing, especially regarding specific groups of people who have a shared collective life experience. Our life experiences, combined with social and environmental aspects shape our physical and mental wellbeing. Just like our rooted relatives require specific nutrients from the soil and other environmental factors to grow and thrive, human life is also dependent on the connection to the life around us.

Disconnection causes disruptions to wellbeing. According to Kirkbride et al. (2024) and a recent government report (Whitman et al., 2022) people of color, those who are displaced, veterans, those at an economic disadvantage, rural residents, those with disabilities, and the lesbian, gay, bisexual, transgender and queer (LGBTQ+) communities have experienced disconnections more-so than the general population in the United States. These disconnections come in the form of systemic racism, discrimination, bias, miscommunication, lack of cultural awareness, historical trauma, generational trauma, post-traumatic stress, physical and emotional abuse, disruption to family connection, disruption in cultural life, increased rate of incarceration, and substance use. According to the report by Whitman et al. (2022), all of these elements further contribute to disproportionate opportunities for housing, food security, safe environment, education, occupation, income, and adequate health care. Kirkbride et al. (2024) conclude that with increased exposure to conditions that do not support life there is also a direct correlation to increased risk of poorer mental and physical health. 

 How do Veterans, Homeless and Incarcerated populations intersect?

The intersection between Veterans, the unhoused, and incarcerated populations is multidimensional. Kelton et al. (2025) report that incarceration and homelessness are reciprocal among United States (U.S.) veterans, and the risk for both incarceration and homelessness is even greater for people of color who have served in the military. Some veterans get caught up in a vicious cycle stemming from lack of mental health support. A recent study by Taylor et al. (2020) indicate that 40 percent of veterans have invisible wounds of the mind because of their service, and that lack of awareness of resources and access to mental health services facilitated the stigma involved in not seeking help. The same study (Tayler et al., 2020) indicates that co-occurring mental health disorders, substance use, and disruptions in family life further contribute to involvement with law enforcement and homelessness. 

Karissa the Dragon Slayer 

I watched the Soft White Underbelly video (2025) detailing the courageous life story of Karissa. Her life is full of dragons she has slayed along the way. Her parents’ substance use introduced her and her brother to trauma, the foster care system, homelessness, substance use of their own, and eventually led to the heartache of death. Karissa tried to heal her residual mental anguish through the numbness of alcohol. She found her way out, eventually, through the support of an AA group. Her parents and her little brother died of fentanyl poisoning from opioid pill use.  She gave birth to her sons, twins, shortly after the death of her immediate family. Her sons reminded her of the importance of family, and the importance of her life. Although her heart was crushed, she saw through the hurt to see the importance of giving a different life to her sons than what she had growing up. She gives credit to her aunts, and her AA group. She conquered generational trauma, substance use, homelessness, overwhelming heartache, and despair. The details of her journey serve as a reminder of the importance of healthcare’s focus on humanity. Healthcare providers should always listen with an open mind to be able to offer the weapons required to slay dragons. Dragons that patients do not simply invite along the way on their life’s journey. Interdisciplinary teams are called to look at the big picture of a person’s walk in life to see how best to equip them on their journeys. We do this with an openness of heart and mind, and with only the best intentions. We do this by empowering the dragon slayers by helping them find the strength in their resilience. This is a common human thread, so this principle is applicable to all.

Actionable Responsibilities

My grandfather, a substance use counselor by trade and a minister to the brokenhearted by calling, always said, “If it’s gonna be, it’s up to me.” It’s up to every healthcare provider to hold themselves accountable to the role they play in patient outcomes.
The Department of Health and Human Services (Whitman et al., 2022) lay out a strategy to address the disconnections from life that threaten the physical and mental health of the most vulnerable people by using a health ecosystem to illustrate how to impact a people’s overall wellbeing at the different levels of impact. This ecosystem (Whitman et al., 2022) begins upstream by pulling in resources from the community to address systemic racism and increase preventative health efforts, then moves midstream to access to care efforts through coordination of care, and finally downstream to address the needs of the individual through networks that provide equitable care. Cultivating this ecosystem requires collaboration at every level. An example of upstream cultivation efforts made through policy change is how CBC Radio (2019) reported on Portugal’s decriminalization of drug use through a healthcare approach has reduced opioid overdose deaths. Community-driven responses rely on those with lived experience to break ground. These community-driven responses like the supervised injection facilities that Gordon (2018) reports to be a living testament to lives saved through harm reduction efforts. Specific populations that have their own health systems can improve access to care through coordination outside of those systems. Kelton et al. (2025) that Veterans Health Administration is working to improve access to care and decrease homelessness by having staff connect with the court system to coordinate health and housing resources for veterans. An example of impacting health outcomes at both the midstream and downstream levels is through professional nurse associations. Crowder et al. (2022) indicate that professional nurse associations yield the potential to build coalitions that impact policy change and strengthen recruitment efforts within respective communities to improve communication and cultural awareness that leads to improved health outcomes for the communities served.

Local Intervention

In Oklahoma, there are 39 tribes each relying on the strength and resilience of culture to overpower the insurmountable disease and death brought on by the opioid crisis. Many tribes have organized tribal opioid response programs to bring harm reduction, education, medication- assisted treatment (MAT), and reliance on cultural identity to communities on the reservations most impacted. Native News Online (2024) reports successful efforts made by the Choctaw Nation of Oklahoma, through the funding of the Community Opioid Intervention Prevention Grant available through the Indian Health Service, the tribe has been able to distribute naloxone, increase medication-assisted treatment services, and expand culturally based recovery programs. The results are indicative of the efforts. The number of Choctaw citizens who are getting MAT has exceeded four times more than the expected number (Native News Online, 2024), and the number of naloxone kits has exceeded 5000 to reach the communities most in need. 

References

CBC Radio. (2019, June 18). How Portugal tackled its addiction epidemic to become a world model. https://www.cbc.ca/radio/ideas/how-portugal-tackled-its-addiction-epidemic-to-become-a-world-model-1.5178848

Crowder, S. J., Tanner, A. L., Dawson, M. A., Felsman, I. C., Hassmiller, S. B., Miller, L. C., Reinhard, S. C., & Toney, D. A. (2022). Better together: Coalitions committed to advancing health equity. Nursing Outlook, 70(6), S48–S58. https://doi.org/10.1016/j.outlook.2022.02.013

Gordon, E. (2018, July 6). Lessons from Vancouver: U.S. cities consider supervised injection facilities. WHYY. https://whyy.org/segments/lessons-from-vancouver-u-s-cities-consider-supervised-injection-facilities/

Kelton, K., Yu, M., Singh, K., Harris, A. H. S., Blue-Howells, J., Stimmel, M., Gabrielian, S., & Finlay, A. K. (2025). Risk of homelessness among veterans with and without criminal legal system involvement. Psychological Services. https://doi.org/10.1037/ser0000993

Kirkbride, J. B., Anglin, D. M., Colman, I., Dykxhoorn, J., Jones, P. B., Patalay, P., Pitman, A., Soneson, E., Steare, T., Wright, T., & Griffiths, S. L. (2024). The social determinants of mental health and disorder: Evidence, prevention and recommendations. World Psychiatry, 23(1), 58–90. https://doi.org/10.1002/wps.21160

Native News Online. (2024, December 23). Choctaw Nation found a better way to deliver harm reduction. It’s working. https://pulitzercenter.org/stories/choctaw-nation-found-better-way-deliver-harm-reduction-its-working

Soft White Underbelly. (2025, June 1). Breaking the cycle-Karissa. YouTube. https://www.youtube.com/watch?v=mSEcTIPtmSY

Taylor, S., Miller, B. L., Tallapragada, M., & Vogel, M. (2020). Veterans’ transition out of the military and knowledge of mental health disorders. Journal of Veterans Studies, 6(1), 85. https://doi.org/10.21061/jvs.v6i1.131

Whitman, A., De Lew, N., Chappel, A., Aysola, V., Zuckerman, R., & Sommers, B. (2022, April 1). Addressing social determinants of health: Examples of successful evidence-based strategies and current federal efforts. Department of Health and Human Services Assistant Secretary for Planning and Evaluation: Office of Health Policy. https://aspe.hhs.gov/sites/default/files/documents/e2b650cd64cf84aae8ff0fae7474af82/SDOH-Evidence-Review.pdf