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The Mentally Ill Homeless: Cause and Effect

ProfessionalIn Looking Up at the Bottom Line, Richard R. Troxell suggests that the arrangements made decades ago for the care of America’s mentally ill have resulted in another case of good intentions gone wrong. It was a reform movement, concerned with disability rights and independent living. Some institutions were terrible places.

Richard says,

Disgruntled, underpaid workers were physically and mentally abusing our mentally ill citizens. Legal Aid in Chicago filed a lawsuit that called for deinstitutionalization. Similar lawsuits swept the country. This coincided with the advent of psychotropic drugs such as Lithium. Mental health providers faced heavy social service dollar reductions. There was the hope that these things could be balanced by treating people on an outpatient basis. They would treat people while they were on a kind of invisible tether.

We have talked about why the consequences didn’t match the theory. When Richard was drafting the Homeless Protected Class Resolution, about one-fourth of the adult homeless in America suffered from some type of mental illness. When he was writing Looking Up at the Bottom Line, the low-side estimate was more like one-third. When House the Homeless in Austin conducted its 2010 health survey, 175 of the 501 respondents had been diagnosed with mental illness.

This was an issue in the struggle over Austin’s No Sit/No Lie Ordinance earlier this year. The ordinance was bad enough already, but it discriminated against people with disabilities of all kinds, and especially against those with mental disabilities. With the help of several other agencies, House the Homeless was able to file some of the roughest edges off the ordinance.

Unintended consequences are the dark side of any social experiment. When plans are being made, the person who says, “But, wait…,” and describes a possible bad outcome, is often labeled as a naysayer and a negative thinker. But sometimes optimism, especially optimism based on the availability of funding, turns out to have been unjustified.

Our country in the 1980s was not prepared for a massive influx of troubled and dysfunctional people into the mainstream. Maybe it all happened too fast, maybe nobody was thinking ahead. Whatever programs and protections were organized for the support of so many confused individuals turned out to be inadequate, and the situation has only gotten worse.

A fascinating brand-new report from Dr. Guy Johnson and Prof. Chris Chamberlain of the Royal Melbourne Institute of Technology in Australia reveals a surprise:

They found only 15 per cent had mental health issues before becoming homeless, while 16 per cent of the sample developed mental health problems after becoming homeless.

Are you getting that? Half of the mentally ill homeless became that way after becoming homeless. Australia is a lot like the United States, and has about the same proportion of the mentally ill people experiencing homelessness. It wouldn’t be at all surprising to learn that half of America’s mentally ill homeless, too, got that way after becoming homeless. It’s enough to tip anybody over the edge, especially in a life already filled with stressors.

Worse, the Australian research shows that the young are most vulnerable to mental health challenges that are caused by or exacerbated by the homeless condition. And, even worse than that, the young are apt to develop substance abuse issues along with mental health problems.

Dr. Johnson, who is a researcher for the Australian Housing and Urban Research Institute, seems to be saying that treating mental illness is too little, too late. It may lop off some of the problem’s branches, but it does not attack the root. Homelessness is the root of a large share of mental illness, not the other way around.

Concentrating on mental health, he says, deflects attention from the lack of housing, the inability of people to pay for what housing there is, and the inevitable family breakdown that results. The belief that mental illness is the primary cause of homelessness sends the wrong message to policy-makers about exactly what services are needed to end homelessness.

Dr. Johnson goes for the Housing First approach, saying:

Homelessness does cause mental health issues, particularly anxiety and depression, and is a serious problem for a significant minority of homeless people… For homeless people directly affected by these structural factors, the solution lies outside the medical arena – and research indicates that providing housing to homeless people before treating their mental health issues is actually a more effective approach.

Reactions?

Source: “Looking Up at the Bottom Line,” Amazon.com
Source: “Research sheds light on homelessness and mental illness,” RMIT.edu, 06/06/11
Image by AR McLin, used under its Creative Commons license.

  1. Michael Dare says:

    As someone totally homeless but only partially mentally ill, I gotta belabor the obvious and state that the depression of having no home does indeed go away when you’ve got one. Then you find all sorts of new things to be depressed about. You want to save people’s lives, make life worth living.

  2. Pat Hartman says:

    Thanks for responding, Michael.

  3. Houston Resident says:

    I have personally known highly successful individuals that, as a result of substance abuse, lost their jobs and relationshiops and ended-up homeless. After less than one year of being homeless, their intellectual capacity was drastically reduced, their behavioral response to stimuli was radically changed and their ability to adapt within a normal setting, even with family, was seriously diminished. One thing to consider is that these individuals showed the most dramatic changes during and following the winter season. I suspect the weather and environment had some addtional role beyond substance abuse in causing brain damage during this relatively short period.