Half of the Homeless Have Mental Issues

[Guest Writer, Angelo Tsoukalas, has been living in Bellingham since February 2011 and loves it. He has degrees in Economics and Political Science from UCF in Orlando, FL and in part at FSU. After three years of working in his field, he opened his own business in the computer industry. He has been in business almost 30 years.] 

On any given night throughout the United States, including here in Bellingham, over half a million people are homeless: sleeping on the streets, in cars, abandoned buildings, tents, or in places like the Lighthouse Mission or other emergency shelters. Almost half of these unfortunate people (250,000), have mental health problems, and as many as a quarter (140,000) have serious mental problems like schizophrenia.  [“In January 2015, the most extensive survey ever undertaken found 564,708 people were homeless on a given night in the United States.” While as many as 250,000 or 45% had some kind of mental illness, 140,000 or 25% had a serious mental illnesses."  References here and here.] Knowledge of this sad state of affairs would cause people like Dorothea Dix and Thomas Story Kirkbride to turn in their graves. 

A Brief History

Who is Dorothea Dix? She was a 19^th century nurse administrator and early activist who had a huge influence on medicine in the U.S. It is believed she was born to abusive, alcoholic parents who gave her first hand experience in dealing with mental health and addiction issues. They also instilled in her an interest in helping with these problems. Dix was a tutor during her youth, but was often ill, so her physician suggested she spend time in Europe. While there, she met other people who were also interested in reforming the treatment of the mentally ill. Upon her return, she visited and evaluated U.S. mental hospitals. She kept politicians informed of the abuses she saw and advocated for reforms of the way mental patients were treated. During the Civil War, she was appointed the superintendent of Union Army nurses. At that time, nurses were all male, but she quickly helped change that. She brought more women into nursing by setting up more training and encouraging them to join. After the war, she continued to advocate for social reforms. By the end of her life, she had restructured mental hospitals in the U.S. and abroad to better care for people with mental disorders.  

          At about the same time, Dr. Thomas Story Kirkbride was also trying to radically change the treatment of the mentally ill. Have you ever noticed there seem to be two types of mental institutions? One has beautiful Victorian buildings set in countrysides with wonderful airy gardens. The second has big, ugly, boxy buildings like you see in creepy movies or on YouTube where people are hunting for ghosts. You can thank Dr. Thomas Story Kirkbride for the former. He is also known for establishing what later became the American Psychiatric Association. And much like Ms Dix, he believed in reform to promote the well being of the mentally ill by designing hospitals with beautiful architecture. His hospitals allowed plenty of light and fresh air, in serene country settings with grounds for gardening and farming to allow for patient exercise and well being. Unfortunately, by the early 20^th century, many psychiatric professionals felt the Kirkbride Plan, as it came to be known, did not produce results and was too expensive. So, big, ugly, mundane buildings became the new standard.  

What Went Wrong?

          By the 1950s and 1960s, mental hospitals had become overcrowded and were festering with abuses. Unproven, dangerous, and debilitating treatments, such as insulin shock or the most infamous, lobotomies, were applied all too often. Lobotomy proved to be a quackery of abuse that resulted in brain damage rather than treatment, and often even death. Then, influencers ranging from authors to sociologists to even President Kennedy helped change that. Books like “The Snake Pit” and “The Myth of Mental Illness” helped educate the public as to what was happening. In 1961, sociologist Erving Goffman’s writings described the prison-like state of these hospitals and how the terrible treatment was actually making patients worse than when they entered. And finally, President Kennedy had a strong dislike for the asylums because his sister had been  a victim of the lobotomy quackery. 

This all led to a defunding movement by the federal government and states. A single quote from Dr Mark L. Ruffalo D.Psa., L.C.S.W. succinctly captures how we got here from there:

 "The idea was to close the massive state hospitals and instead care for patients with mental illness in community settings that would end their isolation from the world and recognize their rights as citizens. When funded and practiced well, community psychiatry was an enormous success. But, sadly, the money saved from closing the custodial state hospitals was often misallocated to tax cuts and prison construction—depriving the mentally ill of adequate community treatment and housing. The result has been a broken American mental health “non-system” that over treats the worried well and vastly under treats the seriously mentally ill. Instead of 600,000 in state hospitals, we now have 350,000 mentally ill in prison and 250,000 homeless-because the vast majority is unable to obtain decent housing and access to treatment." [Reference here.] 

And may I add, growing exponentially! 

A Solution

          If we step back and look where we went wrong, would we not find the solution? Since community psychiatry “was an enormous success” when funded, it should be the solution. It should include addiction treatment, since most mentally ill are also addicted. Advocacy groups need to encourage people to contact their representatives and urge them to fund community psychiatry and addiction treatment in a community type hospital or tiny house community with a local office, providing these much needed services – otherwise we have to go back to the big state hospitals because this is not working. When people with mental health issues are moved from the streets and the nonviolent from jails, and instead provided housing, addiction services, and psychiatric treatments in this kind of setting, people will begin to see the benefits: fewer people sleeping in the cold or terrorizing neighborhoods with crime, drugs, debris, used needles, urine, feces and violence. 

          This will free shelters to help individuals and families who are down on their luck. It will free law enforcement to spend the majority of their time dealing with criminals instead of mental health and drug related issues. Once we see some success, support will grow to make this the standard way of getting people off the  streets and into treatment.           

          In the 1970s and ‘80s, we systematically began shutting down our mental institutions without adequately replacing those services. Our homeless population burgeoned. Recently, state after state has been taking steps to “Defund the Police,” and/or adding more rules on how they police, hoping to prevent abuses but also causing the police to be less effective. Our homeless problems and related issues are about to get exponentially worse. We need to acknowledge that we cannot have a civilized society, cannot expect humanity, peace, and safety, at the same time we have an ever growing underclass of homeless people suffering on our streets from drug addictions and mental health problems. We need to take care of this by taking care of each other. Above is a graph from Whatcom County displaying the rising crime rate in the past six months. Of course it doesn't account for non-reported crime and unfortunately counts the biggest crime only in cases of multiple crimes during an incident – see note on chart.

.