Eight Minutes to a Happier You: The Call That Can Change Your Day”

In a world where technology often leads us to feel more isolated than connected, a simple, eight-minute phone call to a friend or loved one can be a powerful antidote to loneliness and the stressors of daily life. This seemingly small act of reaching out can have profound effects on our mental well-being, offering a quick yet meaningful way to enhance our mood and strengthen our connections with others.

A study published in JAMA Psychiatry (Kahlon et al., 2021) sheds light on the impact of these brief, empathy-driven conversations. Individuals who received empathetic calls for just four weeks reported significant reductions in feelings of loneliness, depression, and anxiety. These findings highlight the remarkable power of human connection and the potential of a simple phone call to offer comfort and understanding on our busiest days.

The concept of an eight-minute catch-up call is not just about checking a box on our social to-do list; it’s about creating a space for genuine connection and support. Here’s how you can make the most of an eight-minute phone call:

1. Clear Boundaries: Setting a specific timeframe provides a clear beginning and end, making it easier to fit into busy schedules.

2. Focused Connection: Knowing there’s a limited time encourages both parties to focus on meaningful conversation, enhancing the quality of interaction.

3. Reduces Overwhelm: The brevity avoids the potential for the call to feel like a burden, making it more likely for future connections.

4. Avoids Missing Wrap-up Cues: With a predetermined limit, both individuals are on the same page about when the conversation will end, avoiding any awkwardness.

5. Encourages Regularity: The ease of committing to eight minutes can lead to more frequent check-ins, strengthening relationships over time.

Initiating the Eight-Minute Catch-Up:

Simply ask, “Do you have eight minutes for a quick catch-up?” This question sets the stage for a focused, meaningful conversation that respects each other’s time and commitments. In times of uncertainty or when the weight of the world feels too heavy to bear, knowing that someone is just a phone call away can make all the difference.

As we navigate the complexities of modern life, let’s remember the value of picking up the phone and reaching out. Just eight minutes can brighten someone’s day, deepen our relationships, and remind us of the joy found in simple human connection.

Laura Moore, MPsy., is an integrative therapist at the Centre For Interpersonal Relationships (CFIR) in Toronto under the supervision of Dr. Lila Z. Hakim, C. Psych. Laura provides psychological services to adults and couples experiencing a wide range of concerns. Laura has a particular interest and expertise in relationship distress, with an emphasis on interpersonal and couple relationship functioning. Laura has helped countless individuals navigate issues related to intimacy, fertility, sex, infidelity, separation and divorce. Additionally, her past research focuses on cultivating spousal attunement following traumatic experiences. 

Kahlon, M. K., Aksan, N., Aubrey, R., Clark, N., Cowley-Morillo, M., Jacobs, E. A., … & Tomlinson, S. (2021). Effect of Layperson-Delivered, Empathy-Focused Program of Telephone Calls on Loneliness, Depression, and Anxiety Among Adults During the COVID-19 Pandemic: A Randomized Clinical Trial. JAMA Psychiatry, 78(6), 616-622. https://doi.org/10.1001/jamapsychiatry.2021.0113

Establishing and maintaining your boundaries

Dr. Karine Côté, C.Psych.

The importance of asserting boundaries to promote healthy and sustainable relationships with others is more and more talked about in the media. Whether it is with your significant other, parent, sibling, friend or co-worker, being able to identify and assert your boundaries can be a significant skill to build. 

Boundaries are defined as limits and rules we set for ourselves within our relationships. They can be psychological, emotional or physical in nature, and require being mindful of your needs and limits within various situations (DBT.com, 2024). Boundaries can help you meet your interpersonal needs, promote closeness, limit over enmeshment, and increase your sense of self-efficacy. 

Here are a few key ingredients to keep in mind to help you establish and maintain your boundaries with others.

Identify: Your thoughts, emotions and physical sensations represent a guide to your internal needs and limits. Being attuned to them and building your ability to understand their underlying meaning and function can help you identify your needs and limits. 

Assert: Your boundaries will have a much better chance to be respected if they are clearly expressed to others. Speaking in I statements and communicating when you and the other are emotionally regulated will also give you the best chance to be heard.

Clarify: Sometimes, the intention or the meaning behind our boundaries can be misunderstood by others. Taking the space to clarify them as needed will also increase your chance of being heard and respected in your boundaries.

Reinforce: When the other has modified their behaviors or reactions to respect your boundaries, giving them acknowledgment and showing your appreciation can help confirm they are on the right track in meeting your needs – and therefore reinforce these positive changes.

Repeat: In some cases, asserting a boundary once may not be enough for it to be consistently respected by the other. After all, we are all creatures of habit! Repeating the boundary can also help sustain the needed changes in your interpersonal relationships.

Asserting boundaries and engaging in satisfying, respectful and sustainable relationships can present with challenges at times. Clinicians at CFIR-CPRI are here to support should you need help in navigating complex interpersonal dynamics.

Reference

DBT.com (2024). Interpersonal Boundaries. https://dialecticalbehaviortherapy.com/interpersonal-effectiveness/interpersonal-boundaries/

Dr. Karine Côté, D.Psy., C.Psych. is a psychologist at the Centre for Interpersonal Relationships (CFIR). Dr. Côté provides psychological services to individual adults and couples experiencing a wide range of psychological and relationship difficulties related to mood and anxiety disorders, trauma, eating disorders, sleep disruptions, and interpersonal betrayal. She works from a humanistic approach and integrates therapeutic techniques from gestalt and object relations psychotherapies, emotion-focused therapy (EFT), and cognitive-behavioral therapy (CBT).

Finding the Magic in Modern Dating: Navigating Disenchantment and Rediscovering Joy

In the era of swiping right and instant connections, the quest for love can sometimes feel more like a relentless grind than a romantic journey. With an array of dating apps and ever-changing social norms, it’s not uncommon to feel disenchanted by the modern dating world. Whether you identify as heterosexual, LGBTQ+, or are exploring your identity, the challenges of forming meaningful connections in this fast-paced era are universal.

Understanding the Root of Disenchantment

The first step in overcoming dating disenchantment is understanding its source. Are you overwhelmed by the paradox of choice, finding it hard to connect deeply when there are so many options? Or perhaps, you’re fatigued by the ‘game’ – the endless cycle of matching, chatting, and often, ghosting. Recognize that these feelings are normal, and many others share your experience.

Embracing Authenticity

One of the keys to revitalizing your dating experience is embracing authenticity. Be true to yourself in your dating profile and interactions. Honesty about who you are and what you’re looking for not only attracts the right people but also sets the stage for genuine connections.

Quality Over Quantity

Instead of swiping endlessly, focus on quality interactions. Take the time to read profiles thoroughly and engage in meaningful conversations. This approach may mean fewer dates, but it increases the likelihood of those dates being more satisfying and compatible.

Balancing Hope with Realism

Maintain a balance between hope and realism. It’s essential to stay optimistic but equally important to have realistic expectations. Not every date will lead to a love story, and that’s okay. Each experience is a step in your journey of self-discovery and understanding what you truly desire in a partner.

Taking Breaks is Healthy

If you’re feeling overwhelmed, it’s okay to take a break. Use this time to engage in activities you love, reconnect with yourself, and nurture other relationships in your life. A break can provide a fresh perspective and re-energize you for when you’re ready to dive back in.

Remember, the path to finding a partner is as much about self-exploration as it is about finding another. In the modern dating world, it’s the journey of understanding yourself and what you need in a relationship that eventually leads to the magic you’re seeking. Stay true, stay patient, and let the journey unfold.

Laura Moore, MPsy., is a psychodynamic therapist at the Centre For Interpersonal Relationships (CFIR) in Toronto under the supervision of Dr. Lila Z. Hakim, C. Psych. Laura provides psychological services to adults and couples experiencing a wide range of concerns. Laura has a particular interest and expertise in relationship distress, with an emphasis on interpersonal and couple relationship functioning. Laura has helped countless individuals navigate issues related to intimacy, fertility, sex, infidelity, separation and divorce. Additionally, her past research focuses on cultivating spousal attunement following traumatic experiences. 

Weaving the Fabric of Female Friendship (Part 2)

Strengthening Threads: Fostering and Sustaining Friendships in The Seasons of Life

In our quest for friendship, qualities like loyalty and kindness shine brightly. However, deep-rooted relationships require traits that aren’t always in the spotlight. Research points to the importance of confidence, rooted in a clear self-identity, as we navigate life’s changing scenes. Indeed, friendships serve various purposes: some for a reason, others for a season, and a few for a lifetime.

Essential Traits for Enduring Friendships:

  1. Adaptability: A friend’s capacity to adjust to life’s flux is invaluable. Their flexibility in the face of change is a testament to genuine support.
  2. Confident Self-awareness: Friends who know themselves well offer authenticity and stability, fostering real connection and collective growth.
  3. Attentive Listening and Boundaries: A trusted friend knows when to offer advice, when to listen, and when to simply be present.
  4. Encouraging Personal Growth: Celebrating each other’s growth is crucial. A true friend supports you not only in stillness but also applauds your successes.

Cultivating New Bonds Later in Life:

As the casual social settings of youth evolve into the busier crossroads of adulthood, finding new friends requires intentionality. Friendships formed later in life often possess an unparalleled richness.

  • Common Interests: Shared activities or clubs can be fertile grounds for new friendships.
  • Volunteering: Offering time to causes can connect you with like-minded individuals.
  • Rekindling Old Friendships: Revisiting past relationships with maturity can rejuvenate bonds.
  • Embracing Vulnerability: Authenticity and openness pave the way for meaningful connections, transcending the barriers of time and age.

The Dynamics of Friendship:

Friendships are as fluid as life itself. Some acquaintances teach us lessons, others are companions for particular phases, and some become lifelong partners. By embracing the transience of some friendships, we can fully engage with them. Recognizing the role each friend plays, allows us to appreciate their unique impact.

Friendships enrich our lives with their varied textures and depths. Identifying key attributes of a solid friend and mastering the art of building connections as adults is incredibly rewarding. Through life’s intricate ballet, friends—whether they’re with us for a reason, a season, or a lifetime—harmonize our dance.Laura Moore, MPsy., is a psychodynamic therapist at the Centre For Interpersonal Relationships (CFIR) in Toronto under the supervision of Dr. Lila Z. Hakim, C. Psych. Laura provides psychological services to adults and couples experiencing a wide range of concerns. Laura has a particular interest and expertise in relationship distress, with an emphasis on interpersonal and couple relationship functioning. Laura has helped countless individuals navigate issues related to intimacy, fertility, sex, infidelity, separation and divorce. Additionally, her past research focuses on cultivating spousal attunement following traumatic experiences.

Weaving the Fabric of Female Friendship (Part 1)

The Depth and Diversity of Women’s Bonds

In the realm of human connections, female friendships are uniquely profound, acting as emotional lifelines through life’s highs and lows. Woven with shared experiences and empathetic exchanges, these relationships are pillars of support.

Women, as research suggests, often communicate with a richness of emotion, creating a tapestry of understanding and intimacy in their friendships. Dr. Deborah Tannen notes that conversation is more than mere words to many women; it’s a channel for affirmation and connection. Yet, this expressiveness can also lead to conflicts due to misunderstandings (Tannen, 2011).

Societal roles have historically placed women as the emotional backbone in relationships, fulfilling yet at times leading to uneven emotional labour or competition among peers (Li et al., 2022).

Psychologically, the merits of female friendships are substantial. They act as shields against mental health struggles, with studies highlighting their role in reducing depression and anxiety (Choi et al., 2020). The ‘love hormone’ oxytocin also plays a crucial role in these bonds, aiding in stress management and being released during meaningful interactions (Taylor et al., 2000).

However, these deep bonds are not without their challenges. Disagreements within female friendships can be as emotionally taxing as romantic breakups, often due to misaligned expectations or life changes.

Recognizing and navigating these complexities is key to maintaining these bonds. Relational psychology underscores the importance of vulnerability and communication in strengthening friendships.

The essence of female friendships lies in their deep dialogues and shared growth. Their influence on mental health and resilience in the face of adversity is profound. While they require care and understanding, the emotional depth they add to life is invaluable. Cherish these bonds, for like all treasured things, they flourish with nurturing and love.

Laura Moore, MPsy., is a psychodynamic therapist at the Centre For Interpersonal Relationships (CFIR) in Toronto under the supervision of Dr. Lila Z. Hakim, C. Psych. Laura provides psychological services to adults and couples experiencing a wide range of concerns. Laura has a particular interest and expertise in relationship distress, with an emphasis on interpersonal and couple relationship functioning. Laura has helped countless individuals navigate issues related to intimacy, fertility, sex, infidelity, separation and divorce. Additionally, her past research focuses on cultivating spousal attunement following traumatic experiences. 

Choi, K. W., et al. (2020). The impact of social relationships on the mental health of women in the United States. The American Journal of Psychiatry, 177(10), 42.

Li, L., Lee, Y., & Lai, D. W. L. (2022). Mental health of employed family caregivers in Canada: A gender-based analysis on the role of workplace support. The International Journal of Aging and Human Development, 95(4), 470-492.

Tannen, D. (2011). Genderlect Styles. In E. Griffin, A. Ledbetter, & G. Sparks (Eds.), A First Look at Communication Theory (10th ed.). McGraw-Hill Education.

Taylor, S. E., Klein, L. C., Lewis, B. P., Gruenewald, T. L., Gurung, R. A. R., & Updegraff, J. A. (2000). Biobehavioral responses to stress in females: Tend-and-befriend, not fight-or-flight. Psychological Review, 107(3), 411–429.

TAKE A BREAK

When we get angry or are in heightened conflict, we lose the ability to think complexly. This process is commonly referred to as the fight-flight-freeze response, which is the body’s automatic, built-in system designed to protect us from threat or danger. The fight-flight-freeze response developed early in human evolution and continues to impact our psychology today. While this response was helpful when we were running away from predators as early human beings, it’s less helpful when we are having complex interactions with our partner. It’s important for all couples to recognize when they are angry, as this can trigger their flight-fight-freeze response. Taking a break is one-way couples can reduce this response and be better able to navigate complex discussions.

When:

Any partner at any time can ask for a break. Remember, it’s important to tell your partner a) you need a break, and b) when you will return. Unless your safety is at risk, never leave a partner without telling them when you will return. You may need to take multiple breaks throughout an argument – that’s OK, just ensure you follow the same process each time.

Process:

Using the 20-minute break wisely…

Starting a Break:

Begin by letting your partner know you need a break by saying “I need a break; I’ll be back in 20 minutes”. It’s important to always let your partner know how long your break will be and when you will return.

0-15 minutes:

Spend the first 10-15 minutes on a task that’s unrelated to your conflict. Read a book, listen to an uplifting song, or read a magazine. Focus on an activity that is either relaxing or pleasurable.

15-20 minutes:

Spend the last few minutes reflecting on what primary “hurt” emotions you want your partner to better understand (avoid simply using Anger). Think about how you might communicate these emotions using an “I-statement”. Also spend some time being curious about how your partner may have understood the conflict. To gain greater insight into your partners experience, try to imagine their life “as a movie”, in which you are only a “secondary character”. Now imagine how their movies “narrator” might describe the conflict from your partners perspective.

Tips:

  • Try your best not to use breaks as a “rebuttal” or as a punishment.
  • Avoid spending your break thinking about rebuttals or “who’s right”. Instead, focus on relaxing your mind and body.
  • If you find yourself returning to the same problem repeatedly, this is a good sign that you might benefit from couples therapy to deal with the issue.

Remember: Breaks will not solve every problem, but they should help you think more clearly about the ones that do occur.

Try your best!

Joshua Peters is a Clinical Psychology Doctoral Resident and Registered Psychotherapist (RP) with the Centre for Interpersonal Relationships, Ottawa. Over the past decade, he has presented at several notable conferences, including the Guelph Sexuality Conference, the National 2SLGBTQ+ Service Providers Summit, and the Community-Based Research Centre’s Atlantic Regional Forum. Joshua also regularly contributes to online, radio, and television news stories for the CBC, Global News, the Toronto Star, and other organizations. In his clinical practice, he is particularly interested in providing psychotherapy, mental health research, and advocacy for the 2SLGBTQ+ community — especially for those from rural and other marginalized backgrounds. Joshua has obtained a specialization in Psychology at the University of Ottawa, a Master of Arts in Counselling at Saint Paul University, and is currently completing his final year in the Doctorate in Clinical Psychology at the University of Prince Edward Island under the supervision of Dr. Aleks Milosevic and Dr. Lila Hakim. 

COULD MY SYMPTOMS BE DUE TO COMPLEX TRAUMA (C-PTSD)? 

Complex post-traumatic stress disorder (C-PTSD) is a relatively new diagnosis for understanding how past events can impact our mental health in the present. If you’re struggling with difficult symptoms, you might have wondered if they could be due to complex trauma. 

Complex trauma involves experiencing a series of events of a threatening or horrific nature, where escape is difficult or impossible. These events overwhelm an individual’s capacity to control or cope with the stressor. They can occur in childhood or adulthood, and could include (but aren’t limited to):

  • Domestic violence
  • Physical abuse
  • Sexual abuse, harassment, or assault
  • Neglect or abandonment
  • Racial, cultural, religious, gender, or sexual identity-based oppression and violence
  • Bullying
  • Kidnapping
  • Torture
  • Human trafficking
  • Genocide and other forms of organized violence

Those with complex trauma develop post-traumatic symptoms such as flashbacks, avoiding reminders of the events, and feeling constantly “on edge” or hypervigilant. But due to the prolonged and pervasive nature of the trauma, those with complex trauma develop additional symptoms that are important to recognize.

The first is trouble with affect regulation. This means they might have trouble calming down after a stressor or have strong emotional reactions. On the other end of the scale, they may often feel emotionally numb, or not able to experience positive emotions such as joy. 

Secondly, individuals with complex trauma struggle with negative self-concept. This means they often have strong beliefs that they are worthless, or a failure. They might feel intense guilt or shame in relation to these beliefs.

Finally, individuals with complex trauma often have issues in relationships with others. They might have trouble sustaining relationships and feeling closeness to other people. They might have short, intense relationships, or avoid relationships altogether.

Complex trauma often occurs across generations (sometimes referred to as intergenerational trauma), due to a lack of resolution of previous traumas and prejudice and discrimination that results in the oppression of entire families and groups.

Always consult with an experienced mental health professional if you believe that you may have complex trauma or another condition. Regardless of the cause of your symptoms, there are many treatment options available that can help you achieve your goals and feel better. 

Camille Labelle, BSci, is a therapist working at the Centre for Interpersonal Relationships (CFIR) under the supervision of Dr. Lila Hakim, C.Psych. They provide individual therapy to adults who have experienced single-incident or complex trauma or are seeking support for other mental health conditions such as anxiety or depression. They use an integrated approach including emotion-focused therapy (EFT) and cognitive behavioural therapy (CBT) to empower people to process their experiences, understand their reactions, and change their lives. 

References

Ford, J. D. & Courtois, C. A. (2020). Treating Complex Post-Traumatic Stress Disorders in Adults, 2nd ed: Scientific Foundations and Therapeutic Models. New York, NY: The Guilford Press. 

World Health Organization. (2019). International Statistical Classification of Diseases and Related Health Problems (11th ed). https://www.icd.who.int/  

    Long-distance relationships: Four pillars to boost the possibility of success

    By: Anya Rameshwar, B.A., R.P. (Qualifying)

    Please note that the worry and sadness associated with a long-distance relationship can vary significantly from person to person — and no two experiences are exactly alike. For more, we recommend consulting with a mental health professional. You can find resources at the bottom of this post. 

    A long-distance relationship is a romantic relationship between people who live far apart and cannot meet frequently. Most couples have been confronted with this dilemma at some point, whether it be ongoing, temporary, unexpected, or anticipated. The experience brings heartache, sadness, and even anxiety in any scenario, with doubts, fears and “what will become of us” questions. 

    But don’t let those lingering worries and late-night ruminations overwhelm you. Having to separate from your romantic partner(s) means learning to navigate long-distance relationships. 

    Focus determines direction. Focus on maintaining your relationship(s) while apart, and you’ll be successful. 

    To help you navigate these changing dynamics, here are relationship cornerstones you can focus on when building up and strengthening your partnership(s).

    The 4 pillars of a long-distance relationship. 

    1. Passion – Nourish the passion in your relationship(s). This contributes to greater fulfilment – both in and out of the bedroom – as well as happiness and well-being. 
    2. Romance – Enhance the romance in your relationship(s). Preserve some of the elements that were present from the early stages of your attraction. 
    3. Communication – Share what you need, what you want, and what you don’t want with your partner(s)— actively discussing the relationship(s) and assuring ongoing commitment. 
    4. Trust – Be honest and forthcoming. Be transparent and allow space to explore topics that might trigger your mistrust. Keep and follow through on commitments you make. 

    How Not To Communicate In Relationships

    By: Dr. Ashwin Mehra, C.Psych

    It is a well-known adage that good communication is a central component of healthy relationships. Whether we communicate as a partner, parent, family member, or employee, the quality of the communication drives the outcome of that interpersonal interaction. We know this to be true through scientific research, as well as from our personal experiences. However,  it should be emphasized that negative communication can be just as detrimental to interpersonal outcomes as positive communication can be beneficial to them. We can understand negative communication using the framework of Polyvagal Theory, which is based on the activation status of the autonomic nervous system mediated by the action of the vagus nerve. This theory posits that our mind and body can be in a positive  (social engagement) state or in a distressed negative (fight/flight/freeze) state. The resultant communication from each state invariably influences the quality of the communication made from the respective positive or negative state. An interesting observation is that the neural pathways linking to empathy, mentalization and long-term thinking are disengaged during the fight/flight/freeze mind-body states. Engaging in communication with a partner, child or co-worker from this state is obviously counter-productive. Most people, in hindsight, usually wish to take back the things that they have communicated from this negative mind-body state.

    In therapy, we can learn to better manage these negative mind-body states so that we can effectively navigate towards the positive mind-body states before communicating, rather than after. This helps us to be in the best possible position to communicate our emotional and other needs and to stay open to other viewpoints during the discussion. This allows us to stay engaged with empathy, mentalization and long-term thinking and the quality of our communication reflects this increased mental capacity. We can use our communication to emotionally self-regulate and strive to co-regulate with others, leading to desired interpersonal outcomes. Therapy becomes an exploratory process to help understand the pathways towards negative communication as well as a structured process to help remove blocks and build capacities towards positive communication. In summary, good communication is built on the foundation of also learning how not to communicate, and therapy can help with achieving that capability.

    The Logistics of ‘Fighting’

    Conflict, arguments, discussions, fights — whatever you’d like to call them –are entirely normal in all relationships. No matter how hard you might try to avoid them, chances are you are going to encounter conflict at some point within your personal relationships. What if, instead of trying to avoid conflict, we became better at it?

    ‘Good’ communication is said to be the secret to all conflict resolution. Although ‘good’ communication is essential, you should also consider some logistics when resolving conflict. Here are five tips to improve the logistics of your arguments:

    1. Schedule your conflict. It sounds odd at first, but take a moment to think about it: Have you ever said something you did not mean during an argument? Most of us have. Emotional flare-ups at times stop us from engaging the “rational” part of our brains. Taking some time apart and preparing to “argue” at a specific time will allow both of you to settle your emotions and give you some time to reflect on what is important to you.
    2. Take care of your body first. You would not go into an important business meeting or school presentation hungry, sleep-deprived, or in an unpleasant physical state, would you? Of course not. Doing so would alter your ability to think and perform in those situations effectively. The same applies here. If possible, make sure all your physical needs are met before engaging in a potentially conflictual discussion. Not only will this improve your mood, but it also allows you to think more clearly.
    3. Neutral environment. Our environment makes a huge difference! Try to find a neutral place where you both feel comfortable discussing the issue(s) (and try to keep conflict out of your bedroom!) Ideally, bedrooms are for sleeping or sex; do not bring your arguments into that space.
    4. Limit distractions. Put your mobile devices away, turn off the television, and give each other full and undivided attention. No one likes to feel like they are being ignored or not listened to; inattentiveness may make the argument much harder than it already is. The fewer distractions, the quicker you can focus on the discussion and (hopefully) come to a resolution.
    5. No interruptions. If you have children in the house, make a conscious effort to watch your voice’s volume and tone. Finding healthy ways to resolve conflicts is vital because children and adolescents can absorb discord energy between parents. You also want to make sure you are in an environment where you will not be interrupted or cut-off. It is vital to mutually dedicate this time to focus on each other and the issue at-hand without fearing interruptions.

    Rebeca Fernandez Bosanac, B.A. is a counsellor at CFIR working under the supervision of Dr. Reesa Packard, M.A., Ph.D., R.P. Rebeca is currently studying to complete her Master of Arts in Counselling Psychology at Yorkville University. Her professional experience includes working with at-risk youth struggling with extensive trauma, dual-diagnoses, and behavioural issues and working in harm-reduction programs with individuals who struggle with substance abuse, trauma, homelessness, and mental health disorders.