December 12, 2007

Homelessness And Mental Illness

The fine folks at the Treatment Advocacy Center had a post yesterday about how homeless shelters and the streets have come to replace many of the former state hospitals and became de facto psych units along with jails and prisons. TAC estimates that "roughly 150,000 to 200,000 individuals with schizophrenia or bipolar disorder are homeless." (People with depression and PTSD don't count? Oh my.)

I share TAC's concern. Homeless shelters are not a place where more than a few people will ever get stable, regardless of whether they are being treated or not (keep in mind, homeless shelters have zero involuntary commitment powers over people staying at their facilities as far as meds are concerned, at least as far as I know). Many shelters are wildly underfunded, dirty and cramped. Very difficult places to sleep, according to clients I've interviewed at these places in the past. That's not a criticism of these places or the people running them--they simply don't have the resources to make things otherwise.

But implicit in TAC's concern and explicit elsewhere in its advocacy is a call for these folks to simply be redirected to a series of new state hospitals. Silly TAC: the state hospital system has not ever been nor will it ever be humane (they are far better than they once were, however). While TAC tries to play the community resources card, as if that's also an answer, whomever it is at TAC who writes these posts misses two very crucial points that continually undercut various attempts to end homelessness and end the game of cycling the mentally ill to the streets:

First, we have a treatment paradigm of anti-psychotics that is simply not working well at all, no matter how hard various advocates such as Fuller Torrey argue that black is actually white. Sorry, Torrey, but I've read the CATIE studies and I have to wonder about how deep you and your group's humanity toward the homeless really is if you insist that the answer lies in meds such as Risperdal, which the Attorney General of Arkansas alleges were defective and just as bad as bad old Haldol and Thorazine. Second, we have utterly decimated public housing in this country and that's why so many people are ending up homeless in the first place, regardless of their mental status. There is simply no safety net in our culture anymore. We simply need to build more housing for these folks. The various 10-Year Plans to End Homelessness that have been rolled out around the country in recent years simply aren't getting the job done.

For example, in Seattle we have a fairly decent network of homeless shelters. In recent weeks as the weather has turned colder, they've been turning away dozens of people each night. One shelter tells me that they've recently had families showing up looking for a place for the night (generally, families get absorbed by the system well before things reach the emergency shelter stage). It's pretty harsh out there. Two nights ago, a man in his 50s or 60s froze to death in a park a stone's throw from the Seattle Art Museum's schmancy sculpture garden and a block or so from the pricey condos of flashy Belltown.

Lovely.

I'll have more to say about homeless and mental illness in coming weeks. I am soon to start picking up part-time work as a social worker at one of the largest shelters in the country, a stop-gap thing to make some money before the writing thing picks up again after the New Year (I can assure you it's low paid work). Speaking of which, I will soon be beginning a new freelance relationship with a really good publication. More on that when things begin to jell into reality.

Posted by Philip Dawdy at December 12, 2007 12:03 AM
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Comments

Here's the solution to homelessness, housing, as you point out. If they weren't a hate group, it would be shocking that TAC doesn't mention that a large percentage of the homeless are veterans. I'm not sure how taking psych meds will give one a home. Seems like taking a major tranquilizer would make one less able to defend oneself on the streets. I'm also not sure psych hospitals today are much better than they used to be.

Posted by: Sally at December 12, 2007 03:10 AM

Glad to hear you will be helping up close and personal and also getting some more paid work writing.

Posted by: Sorrowful at December 12, 2007 06:32 AM

Women are being discharged to homeless shelters with vouchers for somewhere to sleep. One woman told me when she got there it was full[discharged from inpatient psych ward], another one cried to me she couldn't handle living on the streets any longer. The [staff]told that woman "just because you don't have a home doesn't mean we can't discharge you." I witnessed these events myself, and had a discussion with someone within the mental health system in Wash.State re: discharge to shelters. The "system" is aware of it, knows the places are full to capacity, and "they" are stuck within an infrastructure that offers no where else to send ppl., unless it's the state hospital. Housing is rare to find, and as a parent of a nearly 20 year old in the housing system, I can tell you that I am pressured to take her home to reside with me; complete contrast to what staff tell me, is she needs independence. They need her bed open. That simple. I won't soon forget the 2 women that begged not to be sent back to the streets, and I doubt they were able to keep any medication treatement plan in place. TAC has no clue, none at all, either to MOST ALL CITIZENS that homelessness and mental wellness go hand in hand--start with asking WHY the mental health system and the homeless system entities are not working together on this problem. There is a large gap when separate entities don't pay attention to what the other does. Therefore, it baffles me that the homeless funding[shelters, etc] are not basically pissed at the mental health system for over-crowding their shelters by using them as discharge plans for their patients.

I also would like to know where the ppl. being discharged social workers and advocates are? they are also non existent, due to lack of funding. I was told that by a social worker.

I was so shocked when I heard staff telling one 20something woman that the shelter was going to be "a neat place to stay". Give me a fucking break.

Sorry this is long, but this is reality and the 10 year plan will NEVER work until this country takes on mental illess with prevention,therapy,and housing with support. Wonder why some patients are called revolving door patients? because sometimes, being inpatient in a psych unit in Seattle gets you off of the streets at night, a shower, and food. No one listens to patients! [I did].

Posted by: Stephany at December 12, 2007 09:01 AM

The best job I ever had as a social worker was for a inter-organizational program which combined housing, social services and supports for people "formerly homeless, mentally ill adults."

We housed people with drug abuse problems, and mental health issues. All were homeless before they entered our program. All were free to use our services or NOT. They stayed housed. The incident of hospitalization went WAY down regardless of whether they were on meds or not. No one was mandated to say a word to us, the social services staff. If they chose to work with us it was purely voluntary.

I worked in two neighboring residences with a total of 80 people in them. Rarely did people get hospitalized. Occasionally people would have a rough time with an "episode" of some sort. We kept a watchful eye and they virtually always came through it without major incident.

It was a beautiful program and I wish there was one where I live now. I wish they existed everywhere.

Give people homes and they do a hell of a lot better. And most of them can live independently. Our people did and they are the very people TAC is talking about. I was in a major city with a ton of homelessness. It works.

TAC is a sick and fucked up organization. They don't know what humane treatment is.

Posted by: Gianna at December 12, 2007 09:02 AM

The continuing paradox - State mental health directors, agencies, and programs talk ad nauseum about transformation to a system predicated on the Principles of Wellness and Recovery yet too many mental health consumers find themselves discharged to the streets or the shelters. How many of us could achieve recovery, wellness or even perpetuate our own existence under such circumstances? Would society accept similar discharges of persons not coming off psychiatric units? And why more than eight years after the Olmstead decision is so little being done to develop housing in the community?

Just once I'd like to see a required discharge plan include the following: Patient is to be discharged to the streets where he/she will be sheltered in the Potemkin Village of Recovery & Wellness. [An address where words and deeds never intersect.] It wouldn't be right but at least it would be honest.

Posted by: Joe at December 12, 2007 09:16 AM


Our own dear Sarasota (population 54,000) Florida has been named the #1 meanest city for the homeless. Bravo, Sarasota, Bravo. I think we have some kind of ordinance that fines or imprisons you for outdoor sleeping without "permission", then imprisons you again when you can't pay the fine. Sickening.


http://www.usatoday.com/news/nation/2006-01-13-homeless-cities_x.htm

Posted by: NAP at December 12, 2007 11:38 PM

I just scanned TAC's artilce about the homeless mentally ill in jail. I'm wondering what are they in jail for since neither homelessness nor mentall illness is a crime. Maybe the reason these people are in such distress in jail is because they are being held without reason in which case their persistent pleas to be let out according to the law might be unfortunately labeled as mental illness, or they are people who, while not mentally ill, experience severe emotional stress from being locked in jail, a normal response to being locked in jail regardless of any psychiatric label or lack thereof.

Posted by: Sally at December 13, 2007 08:17 AM
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