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Homeless mentally ill in the U.S.

  1. Jul 4, 2005 #1

    Math Is Hard

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    In large cities in the U.S., it is not uncommon to see homeless people in the streets who are obviously suffering from severe psychiatric disorders. I wondered if this was also common in large cities of other countries. I have been trying to figure out why the U.S. seems to have given up the social responsibility (and I feel that there is one) of caring for these people.

    Any thoughts?
     
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  3. Jul 4, 2005 #2
    Well the answer here in Michigan is, money. The state closed all the doors to state funded mental hospitals, except for the criminals who are mentally ill.
    The few who had families, or people who care about them were lucky. They got help with the extensive paper work for social aid, and were put into group homes. The others, some who couldn't even walk, were dumped onto the streets.
    The Salvation Army scooped some up, and housed them for a while, and others simply vanished. It was the states contention that the public/not for profit groups should handle this.
    Its been a nightmare.
     
  4. Jul 4, 2005 #3

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    I seem to remember someone telling me that a similar thing happened in California in the late 1970's. The funding was cut off and the mental hospitals were emptied.

    I work very near one of the best neuropsychiatric research centers and hospitals in the state. It always strikes me as ironic that just outside the building you'll see homeless schizophrenic people wandering around, eating out of trash-cans, urinating on the sidewalks, and sleeping in the bushes. The people who desperately need help are separated from the people who know best how to help them by only a pair of glass doors.

    I am amazed that state governments expect groups like the Salvation Army to handle this burden on their own. I am sure these organizations do their best to feed and shelter these people, but they also need psychiatric care. The expense for the medication alone would be enormous I imagine.
     
  5. Jul 4, 2005 #4
    I would agree that there is a social responsibility to care for the mentally ill. After all, is mental illness a "choice"? No, it is a disease, be it a biological or emotionally cognitive "disorder"
    Speaking for myself, I would have no problem with financially assisting in the care and hopeful remediation of these people. They do not want to live that life, they are victims, in my opinion.
     
  6. Jul 5, 2005 #5
    That would require raising taxes. I think this is the main deterrent.
     
    Last edited: Jul 5, 2005
  7. Jul 5, 2005 #6

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    pallidin, I agree with you. I feel the same way. I'm a person who is very skeptical of any new social programs (and the existing ones) but I think this is something that needs attention.

    smurf, what is the situation like in Canada? Of the homeless people there, do you think a significant number are severely mentally ill? Or are they just "street people" who are, for the most part, there by their own choice?
     
  8. Jul 5, 2005 #7
    Well, the rare times that I do see a homeless person they're usually quite polite and very normal with the exception of being rather dirty. Usually able-bodied too, I believe they could work if they wanted to. Doubt it's drugs either, or they're just really good at hiding it. They're great if you need directions though!

    Having said that, I live in a town of several thousand (maybe as low as 6?). I imagine Vancouver (and even Nanaimo - where I'm moving) would be worse. Especially with the drugs, none of the heavy stuff is in town here, so I wouldn't expect to see any with the homeless!
     
    Last edited: Jul 5, 2005
  9. Jul 5, 2005 #8

    honestrosewater

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    Some information about problems and proposed solutions in the US can be found at The President’s New Freedom Commission on Mental Health. The final report looks like a pretty easy read. The commission identified 6 goals:
    Goal 1: Americans Understand that Mental Health Is Essential to Overall Health.
    Goal 2: Mental Health Care Is Consumer and Family Driven.
    Goal 3: Disparities in Mental Health Services Are Eliminated.
    Goal 4: Early Mental Health Screening, Assessment, and Referral to Services Are Common Practice
    Goal 5: Excellent Mental Health Care Is Delivered and Research Is Accelerated.
    Goal 6: Technology Is Used to Access Mental Health Care and Information.

    and made several recommendations for reaching them. Comments from the APA et al regarding the commission's recommendations:
    I wanted to see what the situation is in Florida and found this:
    (More info is available on their site, http://www.psychlaws.org/default.htm.) This is the same explanation I see other places. I found many medical and mental health organizations that think the "Medicaid IMD Exclusion" should be repealed- in fact, every one I found agreed. For an example of their arguments, which I happen to agree with, see http://www.nasmhpd.org/general_files/position_statement/exclusion.htm.
    More info about the exclusion: An Analysis of the Medicaid IMD Exclusion.
    According to http://www.mhamd.org/policy/alert.030805.html, Maryland, Arizona, Delaware, Hawaii, Iowa, Massachusetts, Oregon, Rhode Island, Tennessee and Vermont have had IMD Exclusion Waivers but risk losing them. I'm not sure how much of a problem it really is- apparently there are ways to get around it if you really try- but it still seems ridiculous to have the exclusion in the first place. The US has already made a commitment to helping people receive medically necessary treatment, and I think doctors should decide what constitutes medically necessary treatment.
     
    Last edited: Jul 5, 2005
  10. Jul 6, 2005 #9

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    Thanks for those excellent links, hrw. :smile: One of the things I became very interested in while reading them was the renewal of something called "Kendra's Law" in New York. Under this law, severely mentally ill people can be court ordered to remain in outpatient treatment

    It seems to be working:
    http://www.psychlaws.org/BriefingPapers/BP18.htm
     
  11. Jul 6, 2005 #10

    Astronuc

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    My wife worked as a drug and alcohol counselor at a local mental health clinic in Texas. Deinstitutionalization began during the Reagan administration when they decided to reduce social services in order to cut taxes, although the official excuse (justification) was to put people in a less restrictive environment, i.e. give them liberty. States jumped on the bandwagon and basically decided to shift responsibility to local governments, which were not set up to treat the severely mentally ill. There were local programs that were euphemistically termed "community-based" health care - but no funding!

    The net effect was to take the mentally ill and put them on the streets. But it saved taxes!

    Local jurisdictions in Texas and across the nation dealt with the problem by arresting the mentally ill and putting them in jail. Sometimes as was the case in our community, mentally ill people (no longer patients) showed up in the community with a one-way bus ticket from elsewhere (both from in Texas and out-of-state).

    Mistreating the mentally ill editorial by Rich Lowry, editor of National Review, a TownHall.com member group.

    The devil in deinstitutionalizing by Sean Paige, Treatment Advocacy Center (TAC).
     
  12. Jul 7, 2005 #11

    honestrosewater

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    Wow, http://www.psychlaws.org/BriefingPapers/BP4.htm says "Forty-two states permit the use of assisted outpatient treatment (AOT), also called outpatient commitment. The eight states that do not have assisted outpatient treatment are Connecticut, Maine, Maryland, Massachusetts, New Jersey, New Mexico, Nevada and Tennessee. Florida adopted an AOT law on June 30, 2004."
    I guess if someone refuses treatment as a result of their disease or poses an immediate danger to themselves or others, forcing them to receive treatment may be justified in some of those cases. Are you guys comfortable with the government forcing people to receive treatment?
     
  13. Jul 7, 2005 #12

    Good question. My opinion is that such a determination should NOT be in the governments hand. Where it should reside is within an impartial non-governmental psychiatric review board, which itself is monitored by a public advocacy group.
    That the government might make defined legal guidelines is somewhat OK, but the adjudication on a case-by-case basis should be done by non-government entities with serious public oversight.
     
  14. Jul 8, 2005 #13
    apparently a lot of the mentally ill homeless turn up in the prisons system. a big problem with that is that the majority of the prison system is not set up to deal with mentally ill. in the following link, there is a guy who has been in the system for over 10 years for stealing a purse.

    this link is to a TV program on PBS that is also published on the internet called frontline

    "Fewer than 55,000 Americans currently receive treatment in psychiatric hospitals. Meanwhile, almost 10 times that number -- nearly 500,000 -- mentally ill men and women are serving time in U.S. jails and prisons. As sheriffs and prison wardens become the unexpected and often ill-equipped caretakers of this burgeoning population, they raise a troubling new concern: Have America's jails and prisons become its new asylums?"

    http://www.pbs.org/wgbh/pages/frontline/shows/asylums/view/


    iv posted this link before on another thread but i think the content is closely related to this topic
     
    Last edited: Jul 8, 2005
  15. Jul 8, 2005 #14

    Kerrie

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    interesting this topic came to light at this time in my life...currently, i am dealing with someone who has possible mental illness. it's very easy for society to have no compassion for those dealing with illnesses because they are "strong minded" and can't understand why they can't move with society.

    i hope that someday, societies can open their hearts and arms for those who suffer. many of them want help.
     
  16. Jul 8, 2005 #15
    Indeed, and if one looks deep into their eyes, or listens to their private screams at night, most of them sense that there is something wrong with them and would love to change but don't know how. On that realization comes more tears from them in the middle of the night.
     
  17. Jul 8, 2005 #16

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    My friend's brother suffers from severe schizophrenia and for many years he was cared for by elderly parents. When he is on his meds he is one of the nicest guys you'd ever want to meet, but when he slips up and stops taking them he is completely out of control. He's destroyed furniture and even injured his frail parents on several occasions. He lives in a group home now where they make sure he takes his meds. He has done well in this situation.

    I think some people might be nervous about the government forcing treatment on people because it would violate their freedom, but I feel that when you see someone with such severe mental problems having an "episode", you know that it is when they are off the meds that they are not free. They are imprisoned by the disease, unable to control their thought and actions.

    Of course, this sort of enforcement should only apply to the extremely sick, the non-functioning - the absolute worst cases.
     
  18. Jul 9, 2005 #17

    Kerrie

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    this is absolutely true...they are not in control of the disease, but rather it is in control of them...
     
  19. Jul 9, 2005 #18
     
  20. Jul 9, 2005 #19
    Mental health is a serious issue. In Canada, we still have problems with how we deal with mental problems. I applied for mental health assistance because I was not depressed, but indifferent - I was rarely happy or sad. I didn't get any help until I was verbally abusive and suicidal, and, even though I have medication, I am not always treated properly. I get rewarded by our government if I exploit my illness and act out. As soon as you start applying yourself and recovering, you lose out on benefits or are pushed down a list. The triage system is abhorrent here, in my opinion.

    Mental illness is definately a disease that can be difficult to deal with. I have a hard time explaining to people how I feel sometimes. If I don't do my homework, I am asked why I didn't do it. I might have watched t.v. instead - but not because I wanted to watch t.v. I can't even explain it now. Sometimes I just get depressed and feel like I'm not in control of my own body. I just become a traveller on a unpredictable ship. Luckily, I'm getting better.

    However, you're definately correct that people should be forced to get help; however, there should be strick controls. It's cruel to force a severely depressed person to get help then, after years of treatment, find they are still no better. Suicide, as taboo as it is, needs to be made avaliable to even the mentally ill - perhaps after a certain time. Imagine being tortured indefinately and drugged - that could happen if such action was legislated improperly. Despite that risk and others that may exist, something definately needs to be done to ensure that people are forced into getting assistance when necessary.
     
  21. Jul 19, 2005 #20

    SOS2008

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    In response to this and the earlier thread on the topic, my own view is that the homeless are a result of different factors.

    Arctic Fox mentioned those who are anti-establishment (or so they will say). I was watching a program on MSNBC this last weekend about run-aways in Portland. On one side of the coin, most have a home, but the home life is dysfunctional, often abusive. In addition to emotional problems, many use drugs, most migrating to harder drugs over time. To solve this problem we must improve family services and address the issue during childhood.

    On the other side of the coin, it was amazing how quickly they could raise $40 from pan handling spare change, usually for a heroin fix. They would complain about people who would tell them to get a job, and when people would give them groceries instead of money. They seem to get by, and they seem to choose this way of life. In general, I know folks who contribute time to the Salvation Army, and they say most are alcoholic and/or addicts who game the system as best they can.

    Then there is the "bag lady" with psychological problems--often the family searches for her, finds her, takes her home only for her to run away again. These types of homeless people usually don't seek services at all. Like MIH says, these kinds of people need to be on meds, and really should be supervised/institutionalized in some way. Currently people can only qualify if they are a danger to others or themselves.

    Many people experience homelessness for at least brief periods of time due to loss of job or medical bills. Many Americans live beyond their means or month-to-month with no savings, family network, etc. and can fall through the cracks more easily than we all realize. Despite what people think, it is difficult for these folks to get Access health assistance, food stamps, welfare, etc. because you have to be destitute, not just struggling. The people who obtain these benefits are those who know how to game the system and have no intention of "getting back on their feet" if they ever were.

    It all comes down to government programs and how these are administrated. And in the meantime, those who lack understanding or empathy may find themselves homeless as well one day.
     
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