Homelessness: causes, impacts, and policy responses

Homelessness, Mental Illness and the Failure of Public Agency

For many Americans, the gamut of social crises such as domestic abuse and drug addiction, while troubling, may be easy to avoid. These, like a significant number of infirmities that plague the population quietly and persistently, occur largely behind closed doors. Until such crises effect individuals personally, said individuals may never have to encounter them anywhere outside the realm of mere theoretical consideration. This unaffordable luxury is what sets homelessness apart from a broad range of social problems. Homelessness is right out in the open and, on occasions that are familiar and frequent to urban and metropolitan communities, it is won't to demand attention. Indeed, as a reflection of those who are living in the greatest despair in an otherwise prosperous society, they homeless problem speaks to a fundamental failure in public agency, which is addressed in this discussion with intent to provide recommendations for reconciliation of this failure.

As we examine this problem, it is the set of public agencies given the responsibility of attending to the nation's homeless problem that will direct our gaze. The agency which is most primarily responsible for the administration of programs designed to assist the homeless, and especially those who are homeless and suffering with mental illness, is the U.S. Department of Health and Human Services (HHS). Its central role in monitoring or sponsoring all programs, services and campaigns related to public health makes it an important vehicle through which legislation is implemented to aid the homeless.

Specific aspects of its relationship to America's homeless problem are derived through its role as the arbiter of grant moneys for a variety of programs which either directly or indirectly attempt to meet the issues of the specific demographic at hand. The groups which directly attempt to assist the homeless and which, in this role, are recipients of HHS grant allocation, fulfill a range of distinct needs or problems affecting the homeless. Each of these is correlated to some aspect of public health, such as in Health Care for the Homeless (HCH), which is centrally focused on helping the homeless gain access to primary health attention, consultation of substance abuse issues or referrals in some capacity for in-patient treatment. All of these opportunities directly relate to the root needs of those homeless individuals suffering from mental illness and, moreover, the program attends to the inextricable relationship between these factors and the continuity of one's homelessness by offering counseling on services relating to housing and welfare eligibility. That stated, the prominence of homelessness, its relative recurrence amongst vulnerable individuals and its affiliation with mental illness collectively render it a treatment strategy which is demanding of refinement. This points to the main problem in this discussion, which is the need for a policy change which more effectively attends to issues of mental illness and habitual homelessness.

Case for Action:

Efforts to this end would be concentrated in those urban locales most demonstrative of a social problem. To the point, the greatest number of homeless people, according to data as recent as 2001, is concentrated in major cities. Here, over 70% of America's homeless fall across a spectrum of categories, though there is a particularly disproportional number of African-American men who are homeless when compared to the percentage population of this demographic (CMHS, 1). While the problem of homelessness is generally believed to be a chronic one, this is not actually the case for the majority of homeless people. In fact, most homeless people are only temporarily out-of-doors, with an overwhelming 80% of them finding some form of temporal or makeshift shelter within two to three weeks of their eviction from a residence. Though these individuals are accounted for in assessing the annual total of homeless people to be somewhere in the approximated range of 3.5 million, they do not represent the most vexing facet of the homelessness problem.

While these individuals may find personal, communal or legal resources to draw on for assistance, those who are chronically homeless are most consistently sufferers of mental illness, substance abuse or both. Those with severe mental disorders are of greatest concern due to the complexity and abstruseness of the topic itself. While only 4% of the American population is considered severely mentally ill, homeless individuals are some six times more likely to be mentally impaired. At twenty to twenty-five percent of the homeless population, this group is undeniably indicative of a larger social incapacity to handle severe mental disorders (USDHUD, 1).

By and large, the popular association between homelessness and mental illness is well-founded and fueled by routinely explicit evidence. As the likeliest candidates for habitual homelessness, and in addition the most visible and distressing homeless individuals, the mentally ill strike observers immediately as those unable to help themselves. Moreover, due to the severity of their illnesses, these individuals are unlikely to have any remaining familial or social networks that could potentially provide support.

Those suffering from disabilities of such a nature as to be considered severely mentally ill are usually people with debilitating depression, bipolar disorder, schizophrenia or multiple personality disorders. Among the symptoms of these and other such mental disorders are paranoia, social dysfunction and cognizance deficiency, all of which can make it difficult or impossible to negotiate ordinary functions such as employment and residence maintenance. Lacking the proper initial resources for treatment, such individuals often will find themselves on the street as a result of unraveled family structures, a background of poverty, chemical dependency or various manifestations of socialized discrimination that single out the mentally ill. This is a situation that is only compounded by the individuals' lack of wherewithal to seek assistance through the appropriate venue.

Without the ability to comprehend any number of legal and social services that may be available, disturbed individuals are extremely vulnerable to sustained, isolated homelessness. In addition to the variety of social circumstances that will obstruct the disturbed individual from reconciling the situation, the pitfalls commonly associated with homelessness are likely to dramatically worsen his chances of making a transition into residency. Exploration of the heightened susceptibility of mentally ill individuals to homelessness also reveals some alarming resultant trends. They are substantially more likely to contract HIV / AIDS while homeless due to a perilous combination of a cognizance deficit and financial desperation, both of which can invoke the individual to behave in a healthfully compromising manner. They are also uniquely vulnerable to substance abuse, with 50% of all severely mentally disabled homeless people simultaneously grappling with addictions as well. There is also a well-documented relationship between mental disorders and severe hygiene and health deficiencies. Beyond the already prodigious difficulty of contending with the mental disorder, an individual is likely to be suffering from additional health problems that will range anywhere from treatable to fatal.

Surprisingly, most of the individuals accounted for in this census of mentally disabled homeless people (derived from the National Resource Center on Homelessness and Mental Illness) have had encounters with various forms of treatment or shelter. But on a whole, the most severely disturbed individual, though on record as having been an in-patient or out-patient for a state or municipal mental health facility, has maintained residence only for brief and fleeting periods. In many instances, individuals have been ejected for amassing the consecutive days of stay permitted by those shelters that levy such limits. In other cases, the mental disorders themselves may be too disruptive to tolerate. Also arriving at halfway houses and jails by way of frequent arrest, it is often the case the mentally disturbed people have removed themselves from those undesirable situations intentionally, opting instead for homelessness. This demonstrates a degree to which the treatment of the homeless falls short both of providing tolerable living conditions in lieu of homelessness and a regard in which mental illness contributes to a somewhat elusive social problem. Changes in agency approach would be fundamentally guided by the demand to improve upon the mental health support services that might prevent homeless recidivism.

Analysis:

In our analysis, we find that the brief history of the homeless problem in America pertains directly to the absence of meaningful human support services.

In the early 1980s, America first began to acknowledge that it had a homelessness crisis on its hands, but with little concentration on the mental illness factors contributing to this problem. At the time, a rash of new economic factors, from the re-integration of two-million Vietnam War veterans to a sustained rise through the 1970s in the overall unemployment and poverty level, rendered the United States' major cities with considerable quantities of homeless people. In the ensuing years, it would become a major issue for public servants on all level of governance. President Ronald Reagan, by reason of political necessity (refer to the above-mentioned visibility of the homeless problem), became the first president to enact serious legislation to the end of creating publicly funded housing for the homeless (Burt, 34).

In the wake of this collective revelation, a wide variety of advocacy groups and government helmed agencies began to take up the gauntlet for the homeless. But mentally disturbed individuals, being confined to a greater proclivity toward chronic homelessness, are a separate problem, addressed most directly by the Center for Mental Health Services, which is a federally chaired organization. The CMHS is a channel through which policy regarding disbursement of social resources is implemented. It garners all of its data from the National Resource Center of Homelessness and Mental Illness, which is the only agency specifically designated toward providing information on this demographic. As a publicly funded group, it is not designated to any political agenda, but it is subject to a wide variant in allocation depending on the policies of the prevailing political party. Both of the former Bush administrations, for example, have delivered annual allocations to the CMHS that were trimmed to about 20% the size of President Clinton's yearly disbursement. The ability of the agency to function at its fullest current potential is always at the mercy of the controlling party's priorities. (CMHS, 11)

This may have a reciprocal relationship with the voting public's desires however. At the inception of popular advocacy for the cause of sheltering the homeless, there was widespread public sympathy and outright indignation. The American public clamored for a merciful solution, asserting that there was some failing in the system of democracy if individuals were able to fall so far through the cracks. This helps to inform the array of options at our disposal in terms of agency refinement.

Options:

Among options for dealing with the homeless problem, one that seems to have taken on a greater popularity amongst city administrators is a ratcheting up of police presence and an enforcement of vagrancy and panhandling laws, Unfortunately, the policy of enforcement has become increasingly popular. Twenty-six states have laws or allowances for laws restricting panhandling. And many major metropolitan cities like Washington D.C., Baltimore, Chicago and Phoenix have begun engaging in a systematic crackdown on vagrancy. Using law enforcement to curtail the inconveniences caused by homelessness is not a new phenomenon by any means. Certainly there have always been laws on the books restricting an array of begging forms and venues of operation.

However, the recent invigoration of implementation of these laws is illustrative of a broader intent to incarcerate the homeless. Mentally disturbed individuals are targeted with primacy due to their conspicuousness and their greater likelihood to behave in a fashion that is disruptive to passersby. And this motivation is what's at the crux of the policy. Enforcement and arrest are utilized to discourage the homeless presence in heavily traveled and populated areas. By threatening encounters with police officers, municipalities have fundamentally sought to push the homeless problem out of visibility. To that end, it has proven somewhat effective. Many have been inclined to laud Mayor Guliani's groundbreaking policies that 'cleaned up New York.' It is a fact that there has been a significant decline in the occurrence of panhandling.

But this is not necessarily indicative of a decrease in the homeless population. Rather, many have simply been relegated to alleyways and less-frequented locations, thus incapable of generating even the meager sums acquired theretofore by way of begging (O'Hara, 16). Dismissing all ethical and humanitarian considerations as both secondary and far too subjective to weigh with any real validity, there is still a very serious logistical objection to be brandished against this policy. All prior evidence suggests that this type of societal response is one of the greatest factors in inciting sustained homelessness for the mentally disturbed. Conflagration with law enforcement, followed by either time in jail or containment in a state of temporary, mandatory hospitalization has had the tendency of compounding the mental disturbance and worsening the situation of the sufferer. Tactically, this is a policy that opts to address the problem only cosmetically. On a far more applicable level, those who are suffering both from mental illness and homelessness are pushed deeper into a cycle of decline.