Although I did not intend for this to be a series, this is the third article I have written about homelessness. I also wanted to say a few words about mental illness, as I am close to several people so diagnosed. This came up during commenting (on Blogcritics)on one of the previous articles, and I felt that it needed to be discussed in more detail than the comment structure allows. The previously two articles about homelessness were, “Where Do Americans Live?” and “Ask Not What the Homeless Can Do for You, Ask What TheyCan Do for Themselves.”
This is a much to brief article to allow for more than a
thumbnail sketch of mental illness and why homeless people are at a greater
risk if they have certain disorders. Nor is it an expose on drugs and street
living, but rather a look at how the three come together. Please use the links provided, and your own
searches on the topics, to better educate yourself.
Mental Illness
Most, if not all, people suffer from the effects of
mental disorders to some extent. Perhaps
suffer is too strong a word for what many people consider to be personality
traits or quirks. Consider someone you
believe to be “anal retentive”; everything has to be just so, or they may be
disturbed when their routine is out-of-kilter.
Mostly we adjust to them and their ways, and manage to get along. But, this could be more than just quirkiness;
it might be a manifestation of Obsessive-Compulsive Disorder (OCD).
Another example would be people who seem grumpy or
grouchy much of the time, which might be symptomatic of Dysthymia (a mild form
of depression) or one of several other mood disorders. Not liking to speak in public is a fairly
common “quirk” but could be seen in people with a mild specific phobia, or
other anxiety disorders.
In myself I can see what I call the “edges” of several
disorders. I am slightly OCD; I
sometimes feel the need to check to make sure I’ve locked a door, or turned off
the water or the stove. Mostly, I don’t
check, but occasionally it nags at me.
Now, imagine that you can’t control the urge to check the stove, or you
feel compelled to wash your hands, multiple times, for hours, until they chap
and bleed.
I am also slightly autistic, which was much more of a
problem when I was younger. Then, I felt
the need to count things; people, tiles or bricks, passing cars. I seem to have mostly outgrown that but
another trait seems to have stayed with me.
When reading, and sometimes during other solitary activities, I rock
back and forth, just slightly, or tap my foot, fingers, or shake my leg. Mostly I don’t even realize that I am doing
it, but frequently my wife notices. This
is not something that generally disrupts my life, but I see it as another
“edge” of a disorder. Picture not being
able to stop the compulsions, rocking and counting; this is one aspect of
full-blown Autism.
This chart lists the most common, of more than 400,
mental disorders and their frequency.
Most people with a disorder don’t hear voices or see hallucinations;
those types of extreme cases are very rare, occurring in less 1% of the
population. Major depressive disorder,
specific phobias, and alcohol abuse top the list, all over 10%. Other common disorders ranging in frequency
from 2% to <10% are: ADHD, PTSD, drug abuse, bipolar disorder, and panic
disorder. Many of these are rare enough
that most people never encounter them.
I know of several people, diagnosed with a variety of
mental illnesses, some of which I am very close to. One of them is bipolar, and has had extreme
mood swings for over 20 years. The
biggest problem with bipolar disorder is that during the manic phase they are
higher than anyone on any recreational drug ever has been. Although I have never read this in medical
publications, I suspect that this feeling is just as addictive, and perhaps
more so, than any street drug. Why would
we expect that this addicted person would willingly give up their high?
But herein lies the rub – the depression that
follows these highs are so very low.
Most people have experienced mild depression, from losing a job to a
loved one passing, and most people rebound back to a normal emotional level
fairly quickly, but imagine being ten or a hundred times that depressed. The bipolar sufferers MUST be on the
medication at all times to prevent going into a, perhaps fatal,
depression. If left to their own devices
the manic personality will demand that high with no thoughts to the resultant
consequences. Many of them then self-medicate
to try and alleviate the depression – usually with street drugs or
alcohol. Either of these will add their
own set of problems that do not mesh well with their ailment. This article, “Self-medicating: Whenthe Cure IS the Disease”, has some more information about
co-morbidity and dual-diagnoses.
Having two or more disorders is known as co-morbidity and
occurs very frequently with some disorders.
Perhaps the greatest co-morbid disorders are substance abuse, and either
anxiety or mood disorders, being twice as likely as in those not using
drugs. There are four risk factors
associated with this co-morbidity: genetic vulnerabilities; environmental
triggers; developmental effects; and the fact that similar areas of the brain
are involved. A recently recognized
co-morbid connection was found between substance disorders, perhaps not surprisingly, and Post-Traumatic
Stress Disorder (PTSD). In one recent
study 23% of over 9,200 patients were found to have three, co-morbid diagnoses.
Another person that I know has a panoply of diagnoses:
Antisocial personality disorder, which causes them to completely disregard the
feelings of others; Borderline personality disorder, similar to bipolar in that
they have mood swings but more importantly is the unstable sense of identity
and difficulty with interpersonal relationships; Narcissistic personality
disorder, prompting unrealistic fantasies, requiring constant attention,
lacking empathy; Panic disorder; and in my opinion Schizophrenia because of the
observed paranoia, social withdrawal, and drug use (as many as 50% of Schizophrenics abuse drugs). These are some very troubling diagnoses and
also very hard to live with, but mostly manageable with the proper use of
medications and therapy.
At this time, neither of them is homeless, but the
situation for them, and for others suffering from many types of mental
disorders, could change at any time.
Substance Abuse
Although substance abuse is considered to be a mental
disorder, I think it deserves a few words.
This is an epidemic
in almost every sense of the word:
- Increased virulence – the purity and availability of many drugs have increased dramatically
- Introduction into novel settings – meth has moved into small towns throughout the U.S.
- Changes in host exposure and susceptibility – younger children are being exposed to drugs every year.
Don’t you think that more than 20 million user’s, or over
6% of the U.S. population constitutes an epidemic?
I’m not sure if I understand why one of the only areas in
which the U.S continues to lead the world is in illegal drug use.
But, enough on drugs for now; I have a future article in
the works on that.
Homelessness
There are two commonly used definitions for homelessness:
“Not having customary access to a conventional dwelling” and “living in public
or private emergency shelters; or in the streets, parks, subways, bus
terminals, rail stations, airports, under bridges or aqueducts, abandoned
buildings, cars, or in any public or private space not designated for
shelters.” Neither of these definitions
addresses every possible situation, nor can they be expected to encompass every
one, in just a few words. But regardless
of the official definition, we know homelessness when we see it.
The total number of homeless is nearly impossible to
estimate, since there is no place where they are known to be, at any given
time. Several different counts have
arrived at around 1, 500,000 people as of 2011.
The map on this
blog shows the national distribution, with most populous states and cities
having the most homeless.
I mentioned in my previous article that a major concern
that had come to the attention of the United Nations was a lack of clean, safe
water. This, and the lack of proper
sanitation facilities are adding a third factor to the overall problem;
traditional diseases.
The single greatest cause for homelessness is lack of
affordable housing, whether it is from foreclosure, loss of public assistance,
or because some other need is more pressing than the rent. The most common composition of homeless
families is a mother with one to two children.
It shouldn’t be surprising that in this situation, food or medical care
for the children is more important than housing. One in fifty children in the U.S. will
experience homelessness in their lifetime; and they will be twice as likely to
go hungry, or have health problems as adults, and have less than a 25% chance
of finishing high school.
In most cities there are shelters which can provide, at
least temporary, accommodations, but these are neither permanent nor do they
provide any sort of medical or therapeutic treatment. There are programs, such as the Homeless
Outreach Project, in New York and other cities, which have helped a significant
number of the homeless living in city parks into treatment, entitlement
programs, and temporary housing. The
greatest limiting factor is still permanent housing, but below are links to the
outreach project websites for San Diego, Los Angeles, Denver, Kansas City,
Chicago, Philadelphia, New York, and Miami.
There isn’t room here for an exhaustive list, but if you want to help
there are places that need it.
Mixing the Three
One question to consider is whether a homeless person is
more likely to have a mental disorder, or substance abuse problem, before or
after becoming homeless. Not surprising,
to me at any rate, is that there is no clear understanding of this question; it
is almost classically, a chicken-and-egg problem. Unquestionably though, if people like these
are living on the street, without even basic medical treatment, especially
those with a high probability of co-morbid diagnoses, without the specialized
drugs and counseling usually needed, how can they be expected to even cope,
much less improve.
Another disturbing aspect in this whole situation is the
appalling number of veterans that are among the homeless. One estimate shows that more than 10% of the
total number was in the military, down from as much as 30% in 2004. Back to the chicken/egg, are they homeless
because of PTSD, or does the homelessness exacerbate the PTSD? Use these links for more on veterans and PTSD.
One of the most significant issues with getting help for
the homeless that are also mentally ill and/or substance abusers is facilities
that that can handle the complex interconnected problems. A run-of-the-mill shelter is not set up to
give treatment or therapy for either case.
Drug rehabilitation clinics usually don’t have psychiatrists or
psychologists trained in mental health issues.
What is needed is a facility that does
have all necessary people and equipment in one place.
Problem or
Solution
I had said in my second article on this topic that one
solution to the homeless problem would be to house them in their own “village”
with necessities supplied, such as: housing, food, education, training, and
most importantly, medical care. The long
term goal of this program would be helping to reestablish them into normal
society. Furthermore, I suggested that
if deemed appropriate, this newly trained group could, repay if you will, by
working on state or federal-level infrastructure projects, ala President Roosevelt’s
CCC or WPA programs. Those were
effective not only in allowing millions of unemployed to work and earn pay, but
also provided dams, highways, national parks, and other large-scale projects.
One of the reasons that I thought my plan had merit was
because it allows maximum resource utilization.
We do this all of the time; a team is dispatched to tackle a fire, not a
lone fireman. Likewise, we collocate
certain facilities as in hospitals; doctors, pharmacy, radiology, and
surgery. I propose the same sort of
thing: for housing it’s like a hotel
with all needed services in one place; for food, it’s like a restaurant with
storage, refrigerators, stoves, cooks all in one place; with training, as in a
school, with instructors and training materials all together; and exactly like
in a hospital, for medical needs. How
can it not make sense to do these things all in one location, instead of spread
out in several locations, with volunteers trying to get back and forth, without
all of the things you need to make it work, not at hand?
There were, and of course will be, detractors to this
plan, saying that this would be just another ghetto, or that it sounded like a
Dickensian work-house. Certainly, if
care is not taken and a multi-year or even multi-decade plan is not
established, including funding, then it could turn out that way. Any program is only as good as the people
working on it, intentions notwithstanding; we know where good intentions lead.
I just don’t think this is possible on a small scale,
which is what is happening now. Volunteer
organizations, church groups, scout troops, compassionate individuals are all
trying to help, but in many cases it is just too little. As I said above, this needs to have
resources, which are too expensive and too spread out, which are organized in
the most efficient way possible.
I don’t see how we can consider these people crazy; we
are the one that have the means to fix this – and we don’t.
No comments:
Post a Comment