Homelessness

Homelessness has been a prevalent issue not only in the United States but all over the world. Finances are the most dominant reason, although a lot of people, from writers to government agencies to private institutions try to explain why, even in economic superpowers like the United States, Japan and all over cities in Europe we have vagabonds. It could all be a matter of not having enough money to eat, let alone find a place to live.

The statistics are staggering, often contradictory because one cannot really logically keep track of the homeless who by the very definition of it, doesn't have a fixed residence. Buffalo Latham, a writer for the magazine The Humanist decided in February 2002 to live the life of the homeless to experience it first-hand, stating that the "Department of Children and Families, with the assistance of Florida's twenty local coalitions, began counting the homeless in the early 1990s and estimate that there are 57,000 in this state alone. Of these, 59 percent are Caucasian, 34 percent African American, 8 percent Hispanic, and 2 percent belong to 'other populations'. Seven percent are age sixty and older, 64 percent are age nineteen to fifty-six, and 29 percent are age eighteen or younger. Forty-six percent are in families, 21 percent are single women, 2-3 percent are women veterans, and 46 percent are single men. Twenty-five percent are mentally ill, 37 percent are alcohol- or drug-dependent, and 8 percent suffer from HIV or AIDS". The figure he says are approximately three times more with other homeless people unaccounted for.

The United States Department of Health and Human Services (2005) states that "over a five-year period, about 2-3 percent of the U.S. population (5-8 million people) will experience at least one night of homelessness". The National Law Center on Homelessness and Poverty estimates that each year, two million individuals experience homelessness - 700,000 each night. Momeni (1990) has pointed out that homelessness 'is defined as the simple absence of shelter; sometimes it refers to people who are trapped in or have chosen a deviant life-style". However, it has also been widely defined as literal homelessness, as 'a condition of disaffiliation, a lack of bonds, a pathology of connectedness, and not an absence of proper housing, or a necessary concomitant of abject poverty of deviant lifestyle" (Momeni, 1990: xxi). The truth is homelessness can also be a lifestyle to some, a form of freedom that cannot be achieved in a society that adheres to strict rules in all aspects of life. It can, however, be also a biological disorder which without proper diagnosis and treatment can lead to a life of wandering.

The National Mental Health Association estimates that of the 700,000 Americans which are homeless on a given night, one-fourth of them have serious mental illnesses. Homeless mentally-ill individuals, aside from needing the basic care and necessities of regular homeless people also require treatment and psychiatric care. "Homeless mentally-ill people are frequently described as treatment resistant" (Morse, Calsyn, Allen and Kenny, 1994:661). The main problem here is that it is hard to diagnose mentally ill individuals especially when they are not placed in a controlled environment where you can observe their symptoms.

Characteristics of the Homeless Mentally-Ill

Mental illness has been described to be "baffling" since they manifest more behaviorally than physiologically. Majority of the mentally-ill were described as attention-seeking, prone to night disturbance, drinking, violence, drug abuse and suicidal (Tessler & Gamache, 2000). Some exhibit embarrassing behavior such as walking outside with no clothes on. This results to a potentially embarrassing situation for the family members.

Mental illness may be classified as schizophrenia, major depression or bi-polar disorder which may differ in symptoms and treatment. Schizophrenia is exhibited by intense paranoia, delusions of grandeur or persecution. Depressives usually have long bouts of sleeping and are always exhausted to seek food and shelter. Individuals who are manic can be very talkative and fidgety. Symptoms vary from person and person and it is difficult to determine the extent and progression of the mental illness since majority of them cannot afford health care. Because their mental illness remains undiagnosed, they are misunderstood and unrecognized members of the homeless community.

Mental illness, if untreated, can be a life-long illness, with majority of the sufferers drifting from place to place unable to carry on normal conversations with people. It is difficult to get their identities and impossible to refer them to their families. Disheveled and dirty, facial recognition is also improbable. Majority of their family members, out of fear and embarrassment, will not make efforts to locate them.

They also have the tendency to abuse drugs and alcohol or both. Some also develop mental illness due to the abuse of substances. Robbed of their normal thinking process and finances, they will have no other option but to roam the streets as one of the homeless. Studies have shown that the onset of schizophrenia (the most common mental illness in homeless people) occurs typically between the ages of 16 and 30 (USA Today: 9) and a lot of the homeless are usually between eighteen above. Some people may start with the onset of the mental illness and continue on their lives as homeless and mentally-ill without the benefit of diagnosis and subsequent treatment.

The Making of a Socioeconomic Problem

It would be redundant to say that the problem of homelessness and mentally-ill stemmed from poverty as a root cause. The U.S. Census Bureau in 1997 that approximately 35.6 million Americans are poor. When you think of the US as an economic power, it would seem baffling that 13.3 percent of the population is poor. It has increased alarmingly in the recent years. The recent recession that has plunged the real estate market in the past two years have added more and more people to the list of not only the poor, but also of the homeless.

Homelessness became a great concern during the Depression of the 1930s where 'federal money was made available for the destruction of building local governments determined to be undesirable". Downtown areas and residential buildings were torn down with the intention in mind "to make decent housing available to every American citizen" (White, Jr., 1992: 117) which inevitably resulted to a number of families losing their homes since the houses that replaced theirs were in a much higher rent bracket. The building of bigger and better housing facilities that were expensive continued on until much of the lower-income level workers who depended on inner city affordable housing were unable to keep up with the rent increases. White (1992) said that the 1960s and the 1970s were periods in American history where increasing number of mental patients were released from mental hospitals. Two thirds of them went to live with their families but as time went on, majority of those released lacked family ties. Although halfway houses and boarding houses were available for them, others joined the low-income workforce who at this time, were already unable to find suitable affordable housing. "By the mid-1970s it was reported that almost a quarter of the 100,000 persons living in New York City's SROs were 'severely mentally dysfunctional'. As older structures continued to make way for office buildings, convention centers, condominiums, highways, and other more profitable uses and as the discharge of mental patients continued, derelict alcoholics and mental patients were increasingly living outside" (White, 1992: 118). The vast homelessness of the mentally ill individuals continued on to the 1980s.

People are unable to keep their homes and their jobs. With the overall national economy affected by outsourced labor, declining wages and smaller and smaller number of job opportunities, sustaining basic necessities has become a battle for survival. How much more for the mentally-ill who needs special circumstances when it comes to getting and keeping a job? Majority of them, in the severest form, will be unable to take care of themselves and without support from family and the government for institutionalized care and treatment, will be left to wander the city.

The Center for Mental Health pointed out several factors why mentally-ill individuals are homeless: (1) lack of affordable housing; (2) lack of services; and (3) lack of income. These are three logical effects of poverty and an ineffective system of governance.

Healthcare Issues: the Lack of Basic Services to Answer the Issue of the Homeless and Mentally Ill

The state has always assumed health responsibility for institutionalization of the mentally ill. "In the 1960s, however, Federal aid enabled discharged patients to live in the community, and Medicaid began to cover some mentally-ill people who could be cared for in nursing homes. States welcomed Federal funds but not the dilution of their power. Another new source of Federal funding and power was the 1963 Community Mental Health Centers Act, which President John Kennedy signed with great fanfare. This 'bold new approach' was motivated by the same sense of national purpose as the Federal stand on civil rights-the belief that Washington had to set certain standards to protect citizens in the less enlightened states... Today, there are nearly sixteen times as many mental health patients in outpatient facilities as in state hospitals, yet roughly 70 percent of public funds allocated for mental health goes to the hospitals" (Hope and Young, 1987: 782).

Hope and Young (1987) have stated that a large number of the mentally ill has never been inside a state hospital because most states would not order institutionalization unless they pose a great danger to themselves and the community. Institutionalization in this sense becomes synonymous with incarceration. The untoward and violent behavior which is the effect of mental disorder becomes consequential, with institutionalization as punitive action.

Rights of the Homeless Mentally Ill Citizen

The decline of public service and its availability to the masses have been quite surprising. The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 which repealed the Aid to Families with Dependent Children (AFDC) program, has provided needy families with benefits and food stamps. Although this at least helps those below the poverty line to get by, long-term opportunities such as stable jobs are harder to come by and most jobs pay below the poverty line. Affordable housing is also rare and subsidized housing is limited.

The responsibility for caring for the mentally ill has always been on the shoulders of the government and the respective states. Federal funding is available for institutionalization and outpatient care for the mentally ill. Some states, according to studies, 'remove patients from hospital care to left the money to be used for inpatient acute care' (Talley and Coleman, 1992: 34). Some patients can return to normal leaving with a solid support system of family and friends, however, most of them, lacking these are left to the mercy of the streets. "Others had no services available or did not have the ability or will to gain access to the mental health-care system and the other supportive services needed. The result was homelessness or a marginal existence. Many were returned to families who no longer knew them, did not know how to cope with them, and did not want them. Some, because they could not care for themselves and had no other place to go, became inappropriate nursing home residents where physical care was received but little psychiatric care was available" (Talley and Coleman, 1992: 34).

The same article by Talley and Coleman (1992) also relates that in the early 1980s, the federal government applied the definition of disability to those suffering from mental disease and ruled that those receiving Social Security Disability (as such those suffering from mental disease) were disqualified and removed from their Social Security roles leaving them without recourse to welfare programs. The mentally ill were often abused and exploited and majority succumbed to drug and alcohol addiction. Hospitals and law enforcement officers were not prepared to handle these kinds of situations. Most local hospitals lacked the necessary mental health facilities and even psychiatric care units to manage the mentally ill. There were no wards especially made for them, nor beds for the severely ill. Local laws and policies did not have special provisions to address this issue. Most of them, they would be mixed with the common offenders often causing violent outbursts that endanger them and other inmates.

The legal recourse for this is usually institutionalization. But as mentioned above, this is only reserved for the violent mentally ill offenders. Those who do not qualify or have the judge's sympathy often were released to the community without proper referral to even outpatient care. They become the homeless mentally ill individuals.

These are the basic rights that are being ignored by most states. Although most of the states, through federal and local laws have enforced certain solutions, most of them are hardly enforced or carried out, for lack of funds or lack of enforcement provisions on the law. Federal and state funding are usually tied up in bureaucracy. Talley and Coleman (1992) have criticized the current 'community based mental health system' as largely an 'uncoordinated mass of inconsistent and fragmented services'.

The Role of Social Work in this Issue

The National Association of Social Workers (NASW) has recognized the 'prevalence of mental disorders and the costs they exact'. The NASW further states that "In addition to the inadequate access to mental health services for financial reasons, social workers are aware of other problems that stand in the way of effective prevention, assessment and treatment" and "among these problems are lack of public and private investment in a continuum of care that provides for adequate transition among institutional, residential, partial hospitalization, and outpatient services that an individual may need".

Social work practice dictates that education and consultation is an important aspect in their work. It also covers early diagnosis, treatment, habilitation and rehabilitation which in the long-run could help save a life. The NASW has always emphasized its "commitment to seeking social and economic justice for all groups and its special mission to serve those who are vulnerable, oppressed and poor".

Homelessness and the mentally-ill is essentially a social problem that needs to be addressed by all aspects of society. The need for basic social services is a work designed for social workers to help find a solution. Knowing that mental health disorders have a profound and lasting effect on the family and the community, social workers need to address certain needs such as housing and treatment.

Social Work Intervention Program

The problem has already been stated. Homeless and mentally ill, these individuals are the most vulnerable of all and devoid of any logical thinking, even the most basic needs are hardly fulfilled by them. They are not fit to work and some of them to function as normal human beings, let alone walk the dark and often dangerous alleys of the cities.

The first step is to lobby for a more effective law accompanied by a detailed addendum comprising of rules and enforcement regulations to give teeth to it. I decide to start with one city or state since a submission of a proposal for a federal law would take me years. I believe that the law should contain a realistic view of the homeless mentally ill individuals and proper classifications.

I also would want to include funding as co-equal in importance and relevance to the lobbying of a law. Government funding would be hard to come by without following the usual and regular legal routes so I propose instead to appeal to non-government, non-profit institutions, charitable institutions and local businesses for funding. The money should be funneled into local hospitals for the improvement of facilities and personnel that will specifically address mental health. I believe that there are never enough halfway houses and residential facilities for the homeless. The problem, I believe, with housing facilities or homes are that they do not have a staff or personnel that can help the homeless mentally ill individual. That is why diagnosis is hard to come by. If we can install or employ a medical health officer in city shelters that can help diagnosis mentally ill people, I believe that would be easier for the accounting and subsequent treatment for these people.

It could also make identification a possibility for them and, as a social worker, I could then contact immediate family of relatives. Education is still a great factor in my program. Families, especially, need to be properly informed of the realities of mental health. I understand that a majority of them would rather have their father, sister or son wandering aimlessly than have them near them, a burden and a shame. Deeper understanding of this social question is important, not only for the families but also for the community, and even my fellow social workers.

Treatment is the next step. With proper diagnosis will come proper treatment. I would prefer mentally ill individuals to undergo a compulsory 30-day rehabilitation program in a mental health facility even with only mild mental illness. The idea of a fixed residence could somehow stabilize their lives for a while. The 30-day period should be followed by intensive outpatient care and medication. If I could, I would like to include in this program livelihood for the homeless and mentally ill individuals. Job opportunity should be provided to them as equally as it is provided to people with mental and physical disabilities.

Conclusion

A 2005 article by Gustavo Capdevila gave an estimate of 100 million people worldwide as being homeless. This is very frightening. The fact that homelessness and the mentally ill as being prevalent only shows the breakdown of society and our inability to cope with the socio economic phenomenon. While we can pump millions of money to a senseless war in another country and channel the national budget on national defense, our government is missing a long going problem. Although total eradication of homelessness and the mentally ill is unrealistic (some people are voluntarily homeless and mental illness is genetic), a need for large reduction of the homeless through the provision of basic services such as affordable housing and secure-paying jobs can spell a huge difference.

Society too has a role to play. Homelessness and the mentally-ill is not anymore a government problem to be contended with. It is also a societal problem that needs every individual's help to be addressed. The spirit of volunteerism is a much needed virtue today.

References
Carolyn J. Tompsett, Paul A. Toro, Melissa Guzicki, Manuel Manrique, Jigna Zatakia.
American Journal of Community Psychology. Volume: 37. Issue: 1-2. 2006: 47+.
Hope, Marjorie; Young, James. Who Cares for the Mentally Ill? The Nation. Volume: 245.
Issue: 22. December 26, 1987: 782+.
National Association of Social Workers website, Policy statement approved by the NASW
Delegate Assembly. August 2002. retrieved March 30, 2008. http://www.socialworkers.org/practice/children/statements/266274%20Mental%20Health.pdf
Momeni, Jamshid A. Homelessness in the United States: State Surveys. New York: 1990.
Morse, Gary A.; Calsyn, Robert J.; Allen, Gary; Kenny, David. Helping Homeless Mentally Ill
People: What Variables Mediate and Moderate Program Effects? American Journal of
Community Psychology. Volume: 22. Issue: 5. 1994: 661+.
Romeo, Jim. A Roof of One's Own: Homelessness Is Growing, but Solutions Are out There.
Planning. Volume: 71. Issue: 11. December 2005: 12+.
Talley, Brenda S.; Coleman, Martha A. The Chronically Mentally Ill: Issues of Individual
Freedom Versus Societal Neglect. Journal of Community Health Nursing. Volume: 9.
Issue: 1. 1992: 35.
Tessler, Richard; Gamache, Gail. Family Experience with Mental Illness. Westport, CT.
2000: 49-59.
What Do People Know about Mental Illness? USA Today. Volume: 126. Issue:
2631. December 1997: 9.