Transformation and Healing After Trauma, Loss and Grief

My Mythic Garden

A blog by author and trauma expert Gary W. Reece, Ph.D.

The Invisibles

By

Gary Reece, Ph.D.

Imagine walking out the front door of your home and not going back. Look at all you’d be leaving behind; the comfort and convenience of your bathroom, the coziness and bounty of your kitchen, the privacy of your own bedroom, the warmth and safety of your living room, your big screen and all your electronic toys, the mobility of your car: just leaving with the clothes on your back. Oh yes, and all the medications you take for a variety of health problems. Then you walk down the block, out of your neighborhood, leaving family, friends and job behind. The biggest step and final loss no credit cards, ATM card and your smart phone. You are now disconnected from your world. This is the context, the connective tissue which binds you to your community, the nexus, context of connection, hope, meaning and purpose the bedrock of your identity.

What would you do? What would be your first move? As I wrote this paragraph, I began to feel the anticipatory anxiety of vulnerability and loss of control. I realize that I would not survive one night on the street; I am so dependent on all the things mentioned above. I can’t imagine having to figure out how to survive without all the things I consider basic necessities. This is the plight of the homeless person!

Every day I encounter the homeless, some with shopping carts piled high with their meager possessions, some with just layers of clothes they wear every day. I wonder, what’s this person’s story? How can this be happening in such a wealthy country? Sometimes when I sit with a friend at a Starbuck’s near a major intersection, I hear one particular homeless person yelling obscenities at the passing drivers: another shirtless man throws projectiles at the passing cars. When I exit the freeway I often see families at the intersection with a cardboard sign—“an Instagram” trying to capture their story and ask for help all at the same time.

There are an estimated 744,000 homeless people in the U.S. and of that number it is estimated that 250,000 have severe forms of mental illness. A summary of a Mental Illness Policy Org.,
put it this way:
People with untreated psychiatric illnesses comprise one-third, or 250,000 of the estimated homeless population. The quality of life for these individuals is abysmal. Many are victimized regularly. One study found that 28% of homeless people with previous psychiatric hospitalizations obtained some food from garbage cans and 8% used garbage cans as a primary food source. The homeless population, especially homeless persons with serious mental illness, has increased steadily since the 1970’s.

How did this come about? Like most social problems it is a result of the simultaneous failure of several critical systems, each with unforeseen consequences compounding the problems they had hoped to solve. The homeless population, especially homeless persons with serious mental illness, has increased steadily since the 1970’s. This is seen in all major cities but also in smaller cities and towns. Recent studies reveal that 27-to 36% of the discharges from state mental hospitals had become homeless within six months. From the NY Times in 1984 came this analysis:

The policy that led to the release of most of the nation’s mentally ill patients from the hospital to the community is now widely regarded as a major failure. Sweeping critiques of the policy, notably the recent report of the American Psychiatric association, have spread the blame everywhere, faulting politicians, civil libertarian lawyers and psychiatrists.

Like most dramatic stories there are plenty of villains to blame. First to blame are the psychiatrists who fell in love with their “psycho-tropic” medications seeing them as a “panacea for mental illness.”

Again the NY Times enlightens us:

The records show that Many of the psychiatrists involved as practitioners and policy makers in the 1950’s and 1960’s said in interviews that heavy responsibility lay on a sometimes neglected aspect of the problem: the overreliance on drugs to do the work of
society.

And then there were the politicians who were dogged by the images and financial problems of the state hospitals which were viewed as “snake pits” and a financial burden on the “taxpaying” public. Typical of politicians they were eager to try anything to provide tax relief, so they were ripe for the hard sell by the scientific and medical establishment who sold Congress and the state legislatures on a quick fix for a complicated problem that was bought sight unseen.
This quick fix was two pronged, 1) medicate the patients and 2) deinstitutionalize and send them to their home communities for treatment at local community mental health centers. This solution had a cascading effect which I saw personally as a young intern at a mental health center. I interviewed a family with a son who had just been released from Camarillo State Hospital. (California) They were having trouble caring for him at home and wanted to know what their options were. I consulted with my supervisor who informed me that there were “none.” This was due to the political situation in California at the time. As I have learned since, in California for example, the patients in state mental hospitals reached a peak of 37, 500 in 1959. This number fell to 22,000 when Ronald Reagan became governor in 1967. His successor Edmund G. Brown Jr. noted that the decline continued under his administration and expressed regret about the way the policy started and ultimately evolved. “They’ve gone too far, too far in letting people out,” he said when interviewed.

Dr. Robert Felix director of the National Institute of Mental Health and an advocate of community centers reflected on the situation and notes:

“Many of those patients who left the state hospitals should never have done so. We psychiatrists saw too much of the old snake pit, saw too many people who shouldn’t have been there and we overreacted. The result is not what we had intended.”

In retrospect, we see the problem had many sources, the psychiatrists thought drugs were the cure all. Politicians wanted to save money: they saw the state hospitals as a huge burden and looked for easy solutions. The advocates of small community mental health clinics were impressed with several studies of how effective they could be with good staff, an adequate budget, and community support, they oversold their effectiveness because they were looking at ideal circumstances. One psychiatrist stated: “Extravagant claims were made for the benefits of shifting from state hospitals to community clinics, the professional community made mistakes and was overly optimistic, but the political community wanted to save money, and tranquilizers became the panacea, the state programs were buying them by the carload, resulting in sending drugged patients back to the community. Local mental health centers were going to be the greatest thing going, and then they gradually defunded them, and the patients went off their medications.” It is easy to see, now in hindsight how this whole problem developed. But the question now is what can to be done about it?
The Risks of Being Homeless
If you are homeless and mentally ill it means that you are more likely to have major health problems which go untreated. You are more likely to be a victim of a crime: women are more likely to be sexually abused, sexually transmitted diseases are more common in the homeless, and drug abuse and addiction have a higher frequency amongst this population. Murder and freezing to death are also major threats to the homeless. The homeless in general have a three times higher risk of death than the general population. Finally the homeless are more likely to suffer from mental illness, even if they were not ill to begin with. One study found that people with substance abuse issues and other mental disorders experience even greater barriers to affordable low-income housing. The American Psychological Association offered this definition of homelessness: “Homelessness exists when people lack a safe, stable and appropriate place to live. Sheltered and unsheltered people are homeless. People living in doubled up or overcrowded living situations or motels because of inadequate economic resources are included in this definition: as are those living in tents or other forms of temporary housing.”

The Cost of Homelessness
In 2001, a University of Pennsylvania study that examined 5,000 homeless people with mental illness in New York City found they cost taxpayers an average of $40,500 a year for their use of emergency rooms, psychiatric hospitals, shelter and prisons. This means that the actual cost of doing nothing about homelessness is costing us more than a well thought out coordinated program of attack aimed at solving this problem. One researcher stated that adequate shelter, and a community based support system would be far cheaper that what we have now. But there is also another cost included in the equation: the cost of self-esteem and helplessness and degradation that goes with being a person who no longer feels connected or valued as a human being, but rather is seen as a derelict.

Since these individuals do not vote, do not have expensive advocates in congress, and are invisible unless depicted on the 6 o’clock news being shot by the police, it is difficult to create a coalition of individuals who can formulate a comprehensive program which would provide affordable housing, structured treatment programs, job training, child care, medical care and addiction treatment. Rather than dumping them on the street or allowing them to fall through the gaping hole in the social safety net, it is both more humane as well as financially more cost effective to address this huge social problem that seems to be getting worse all the time. All of these individuals are suffering: they need our help, not an occasional hand out. It must be recognized that the mentally ill homeless person is often the last person to seek help or even recognize how badly they need treatment, this does not mean that they don’t need our help, it means that we must help them in spite of their state of being. Living on the street is no way to live for any of us. We created this problem, now after 75 years of neglect and indifference it is a problem that needs urgent attention. Homelessness is a cancer, a treatable illness that will salvage thousands of lives, reduce urban blight; reduce crime and overuse of our emergency rooms and burden on law enforcement and pay for itself in costs saved. But they need to be seen as part of our community and viewed with compassion. In short, seen! Look at them before you cross to the other side of the street!

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