Mad Assumptions Too Expensive to Reverse?

We all have seen the wandering homeless, more in warmer climates, but they are all over the United States, sad and abandoned. Some are addicts – hard drugs to booze – others are just mentally ill with no place to go or anyone to care for them. A few are hopelessly unskilled and jobless. Sure good Samaritans have set up soup kitchens, and some cities are trying to grapple with their plight with food, shelter and clothing… with dashes of sparsely allocated medical care along the way. For homeless veterans, the VA is now trying to build housing for their charges, but for too many others, screaming at the sky, pushing their world in old grocery carts, living with crime, sleeping in doorways or under bridges, life is a confused, deeply uncomfortable and unsanitary misery.

With half of all incarcerated inmates charged with some drug-related crime (half of that group, in turn, for possession or dealing), we seem to prefer expensive jail time to dealing with the societal drug issues. Prisons have also become the repositories of choice for the mentally-ill as well. “Occasionally policymakers and activists will talk about how the justice system needs to keep mentally ill people out of prisons. If it did that, prisons would be very empty indeed. A new Urban Institute report points out that more than half of all inmates in jails and state prisons have a mental illness of some kind.

“The numbers are even more stark when parsed by gender: 55 percent of male inmates in state prisons are mentally ill, but 73 percent of female inmates are. Meanwhile, the think-tank writes, ‘only one in three state prisoners and one in six jail inmates who suffer from mental-health problems report having received mental-health treatment since admission.’” theAtlantic.com, April 7^th. 20% of the inmate population has serious mental illnesses. We have big budgets for prisons, very little in the way of dedicated facilities for rehab or mental illness.

How did we get here? Back in the 1950s, it became popular among some segments of society to believe that treatment for the mentally was a waste of government tax dollars, that too many were just faking it and that they would be better off released back into society. “Beginning in the late 1950s, California became the national leader in aggressively moving patients from state hospitals to nursing homes and board-and-care homes, known in other states by names such as group homes, boarding homes, adult care homes, family care homes, assisted living facilities, community residential facilities, adult foster homes, transitional living facilities, and residential care facilities. Hospital wards closed as the patients left. By the time Ronald Reagan assumed the governorship in 1967, California had already deinstitutionalized more than half of its state hospital patients. That same year, California passed the landmark Lanterman-Petris-Short (LPS) Act, which virtually abolished involuntary hospitalization except in extreme cases. Thus, by the early 1970s California had moved most mentally ill patients out of its state hospitals and, by passing LPS, had made it very difficult to get them back into a hospital if they relapsed and needed additional care. California thus became a canary in the coal mine of deinstitutionalization.” Salon.com, September 29, 2013

This “debate” moved across the following years, with California’s Governor, Ronald Reagan, strongly supporting this movement closing mental hospitals and letting the patients back into the world. By the time Reagan became president, his perspective became national policy. The folks living in our streets today are his legacy.

“One month prior to the [November presidential 1980 that put Reagan in office] election, President Carter had signed the Mental Health Systems Act, which had proposed to continue the federal community mental health centers program, although with some additional state involvement. Consistent with the report of the Carter Commission, the act also included a provision for federal grants ‘for projects for the prevention of mental illness and the promotion of positive mental health,’ an indication of how little learning had taken place among the Carter Commission members and professionals at NIMH. With President Reagan and the Republicans taking over, the Mental Health Systems Act was discarded before the ink had dried and the CMHC funds were simply block granted to the states. The CMHC program had not only died but been buried as well. An autopsy could have listed the cause of death as naiveté complicated by grandiosity.” Salon.com. The die was cast.

Society structured around these assumptions. “Prisons or the street” unless the suffering individual lucked into family care or a rare governmental/charitable program that lifted them out for a moment or two. The facilities for these abandoned members of society don’t exist, and the press for austerity, led heavily by a move further to reduce social support systems even more, suggests that the problems will get a whole lot worse in the near term.

In some cities, social welfare support provides some subsidies, but for most the funds have not remotely kept up with the cost of living, leaving too many to turn to the streets. In New York City, for example, the monthly housing allowance is $215 for a single adult. For the few places where you can get a room, you can imagine what most look like: “The homes, often decrepit and infested with vermin, overflow with bunk beds and people. Exits are blocked and fire escapes nonexistent. [Such] homes are considered illegal because they violate building codes on overcrowding. Many have become drug dens, where people seem almost as likely to die of overdoses as they are to move on to a home of their own.

“The state’s Office of Alcoholism and Substance Abuse Services hands out millions in Medicaid money for their treatment… But for years none have paid attention to what happens inside. There are no regular inspections. No requirements. No registry. The city’s Department of Buildings, overwhelmed and ineffectual, often fines the landlords, but the city does little to collect.

“The system, such as it is, dooms tenants to a perpetual cycle of treatment and relapse, of shuttling between programs and three-quarter houses… ‘The city knows it’s happening,’ said Paulette Soltani, who works at the Three-Quarter House Tenant Organizing Project, which advocates better housing conditions. ‘The city is sending people to these homes, but the city is not regulating these homes.’” New York Times, May 29^th. And that’s the story in “liberal” New York City.  But all across the land, the plight of the homeless varies from bad to worse to horrible.

Those who claim the highest fealty to Christian values – where charity to the unfortunate, forgiveness, brotherly love and non-judgmental kindness form the focal point of the New Testament – seem often to be those who embrace policies aimed at cutting governmental programs and support for those desperately in need. Some of us understand the New Testament’s stand on this kind of hypocrisy… but the bigger question is if we do not break this callous cycle, will it just get worse and cost us vastly more in hard cash than facing the consequences now?

I’m Peter Dekom, and we have this mythical belief that not dealing with problems, not paying for immediate preventative solutions, will work and that the problems will just go away on their own.