The paths to homelessness are more complicated than we think


To me, my white coat symbolizes a willingness to care for my fellow man, and every day I strive to fulfill that challenge. But even the brightest white coat has a few stains. Growing up in a small Midwestern town, I just didn’t “get” the homeless community. They were completely isolated from my day to day life. Surrounded by my local community, I just assumed that the homeless were either lazy, addicts or some combination of both. Somehow, I concluded that their position was their own doing. I mean how else could you end up on the street?

I now realize that homelessness often manifests itself as a series of events that leaves a person helpless and broken. Recently, I became involved with Back on My Feet, a non-profit organization that combats homelessness through running, community support and resources for housing and employment. This inspiring organization allowed me to gain extended one-on-one time with homeless men and women. During our runs, I slowly learned the stories of the homeless persons around me. Often, their path to homelessness revolved around divorce, family troubles or unemployment. I vividly remember one man describing to me how difficult it was to lose his house and family after his divorce. “I showed up one day and the locks on the doors had changed.” Listening to him describe sinking into a deep depression, I began to understand how rapidly his life deteriorated. Sadly, his story and others like it became all too common as I met new Back on My Feet members. Their narratives helped bring to light the challenge of mental illness facing them and the rest of the homeless population.

Mental illness, like homelessness, is also a buzzword that leaves most people uncomfortable. However, mental illness in the homeless population is long overdue for discussion. In 2016, the Treatment Advocacy Center found that up to a third of the homeless population in the United States suffers from severe mental illness. Additionally, a study of public mental health system in California found that 15 percent of adults with serious mental illness spend at least one year homeless. According to the National Alliance to End Homelessness, the U.S. currently has over 550,000 homeless adults and family members, meaning up to 160,000 are mentally ill and in need of treatment.

When considering the statistics above, you’d assume that there would be a concerted effort in addressing mental illness and preventing their entry into homelessness. You’d be wrong. Liz Szabo’s article describes that care for the mentally ill is not improving, but, in fact, is getting worse. Due to the Great Recession, states slashed $5 billion in mental health services and reduced approximately 10 percent of psychiatric hospital beds. The result from these cuts is that fewer mental health patients receive the treatment and care that they desperately need. With few options available, the mentally ill often land in the emergency room, county jail or on the streets. In fact, the Centers for Disease Control and Prevention stated that 5.7 million emergency room visits every year are caused by mental illness. However, what is most startling is that about 2 million people suffering from mental illness are sent to prison every year and account for 25 percent of the total prison population in the United States.

But what’s the solution? Like many others, I’d strongly argue early intervention and housing support. I’ve seen first-hand the dramatic impact resources can have on the lives of the homeless. The idea is simple. Medical care and a safe home provide a stable environment, which then aids in a better recovery from mental disease. Further, a recent study in San Diego, California found that full-service partnerships (FSPs) — organizations that provide treatment and housing to the mentally ill — helped reduce the days spend homeless by 68 percent. Additionally, they found that reductions in costs of inpatient/emergency departments and justice system services offset 82 percent of the cost of the FSP. These numbers are more impressive if you consider that they do not include increases in productivity, reduction in social services costs and an increased quality of life. Washington, DC organizations like So Others Might Eat, Pathways to Housing and Coalition for the Homeless are excellent examples of housing and health care resources for the homeless. In fact, we are in desperate need for more programs like them. The obvious objection from state and local governments is that there are substantial costs in implementing these types of programs.

In reflection, my mistake seems obvious. After all, it is more comfortable to assume one’s hardship is their own doing rather than a product of a broken system. Back on My Feet showed me that paths to homelessness are often much more complicated. These social issues are our stains, and we need to come together to wipe them clean. Volunteering, donations or simply interacting with the homeless are important first step in understanding and combating these problems. Our obvious objection is that we are too busy, suspicious or uncomfortable to take action. Maybe we should try explaining that to the man in the street.

Max Bergman is a medical student. 

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