The Unhoused — Part 3
Pandemic Diary Entry #62
October 19, 2020
In Part 1 of this series I discussed the subject of the unhoused portion of housing, Part 2 was a discussion on the way that drugs play into the homeless picture, here I would like to discuss, what I consider the third leg of our unhoused situation, mental illness.
Mental illness is also often cited as a major cause of homelessness.
When discussing mental illness and its relationship to homelessness it is complicated. There are many factors overlapping and exacerbating each other. These include, but are certainly not limited to:
- biological risk factors
- triggers such as significant loss, trauma, abuse, greatly reducing someone’s ability to function and increasing the risk of homelessness.
- effects of child abuse (physical, emotional, sexual as well as neglect) that carry into adulthood substance use
- psychiatric hospitalizations
- clashes with the law enforcement and time spent in jail
- little or no access to support systems such as mental health care, social support, and family.
- isolation due to prejudices, misunderstandings, and mistreatment
- government policies and insurance policies that make accessing mental health care difficult for many and impossible for some; without help and treatment, mental illness symptoms worsen and the risk of homelessness further increases.
A study by the National Institute of Mental Health found that approximately 18% of Americans have some sort of mental illness with 5% severely mentally ill. Studies show that 45% of the homeless population suffers some form of mental illness while 20–25% suffer from severe mental illness, which can include schizophrenia, bipolar disorder or major depression.
In the Journal of Legal Studies, one study showed that 17.3% of prison inmates with severe mental illness were homeless prior to being arrested and 40% were homeless at one point in their lives, compared to 6% of undiagnosed inmates.
In San Francisco of the 10,856 individuals who experienced homelessness in 2016/2017 and accessed care at the Department of Public Health, 58% had been treated for serious mental health disorders.
San Francisco has a sever shortage of psychiatric beds with roughly 400 public beds available for the homeless population. 150 of those are in the city, and another 250 in other counties that contract with San Francisco. San Francisco has actually lost 155 psychiatric beds, mainly in skilled nursing homes that have closed due to the cost of housing in the City. Depending on the level of care, each bed costs from $85,000 in a nursing home to $800,000 a year in psychiatric intensive care units.
So how did we get here?
It began in California in 1967, when the California legislature passed, and Governor Reagan signed, the Lanterman-Petris-Short Act (LPS). This essentially allowed local, private facilites to accept more patients, in particular those with milder forms of mental illness. Prior to the act, many individuals with mental health disabilities lived in state hospitals and large facilities, often for long periods of their life, and some in abusive environments.
The act created three specific criteria for when a court can order an individual to be confined to a mental health facility without his or her consent: when people are a danger to themselves, a danger to others or “gravely disabled.”
A recent audit of LPS showed what is patently obvious, the system is not working.
At the federal level the same intention of stopping the practice of institutionalizing the mentally ill began with the Community Mental Health Act of 1963, signed by JFK. The idea was to successfully and quickly treat patients in their own communities and then return them to “a useful place in society.” The program was never adequately funded and the monies never made it into the communities.
The Mental Health Systems Act of 1980 which passed by Jimmy Carter was to provide federal funded grants to community health centers. It was repealed by Ronald Reagan with OBRA, the Omnibus Budget Reconciliation Act.
The appearance of OBRA was to give mental ill patients a choice to seek treatment outside of a mental institution, an option to seek treatment at clinics at the state level, and the freedom to administer their own medication. Under the quise of establishing block grants for the states to provide mental health care, it was actually a budget cut. OBRA cut federal spending by 30 percent, making the mental health situation worse.
The 2008 recession, exacerbated the situation in more modern times. States were forced to cut over $4 billion from their mental health budgets. The result being that the streets, jails, prisons and nursing homes have become the places we dump those with serious mental illnesses.
Programs that provide long-term (a year or longer) stable housing for people with mental illnesses can help to improve mental health outcomes, including reducing the number of visits to inpatient psychiatric hospitals. A 2015 study concluded that services that deliver cognitive and social skill training, particularly in developing and maintaining relationships, would be useful in helping people with mental illnesses and homelessness regain housing. — Peter Tarr, Ph.D. Brain and Behavior Foundation
There is no quick fix, without long term treatment and support, people with mental illness won’t be able to remain in housing once they receive it.
COVID has devastated our economy, and wiped out the tax bases of many cities and states, I do not see the mental health budgets getting back on a healthy footing for a long time to come. Leaving many of our mentally ill to continue to ply the streets waiting for help.
San Francisco weather: 72 degrees and sunny
NYSE DOW compared to one year ago: +1781
COVID cases in the US: 8,392,254
Deaths from COVID in the US: 224,816
OED word of the day: blue law In colonial New England: a strict law motivated by religious belief, particularly one preventing entertainment or leisure activities on a Sunday.
Days since Shelter In Place was initiated: 218
Reading: Standing Soldiers, Kneeling Slaves by Kirk Savage.
I have finished The Plague by Albert Camus, I highly recommend it for those interested in understanding the emotional side of living with, not only constant death from plague, but also the emotional difficulties of isolation.
My Black and White Picture of the Day
Something Silly From the Internet: