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Homelessness and mental health: How can this cycle break?

Classic panoramic view of San Francisco skyline with famous Oakland Bay Bridge illuminated in beautiful golden evening light at sunset in summer, San Francisco Bay Area, California, USA
Image source: Newman, Katelyn. “San Francisco Is Home to the Highest Density of Billionaires.” U.S. News & World Report, U.S. News & World Report, 10 May 2019

[The homeless living condition] in San Francisco and Oakland, California, United States of America, constitutes cruel and inhuman treatment and is a violation of multiple human rights.

Leilani Farha
UN SPECIAL RAPPORTEUR HOUSING

 

what prompted my research

I became interested in the relationship between mental health and homelessness on my first trip to San Francisco and as a Bay Area resident. The number of people lingering, sleeping on the streets, the sanitation of the Civic Center, and the times I’ve heard parents whispering to their kids to stay away from those crazy people surprised me. Naturally, I was curious about why things are like this in the first place, but all of the people I’ve asked told me that it’s because a lot of crazy people were dumped in SF maybe a decade ago. Their tales caught me by surprise since most of these people have been living in SF and coping with this issue for a decade or longer. Their negligence and lack of will to investigate showed how people with mental health issues have been and still are a marginalized group. Their struggles are invisible to the general public even though they are seen regularly by the public daily. Furthermore, the word the public often uses to describe these people, “crazy”, reflects the widespread stigma against mental health patients, and the attitude of alienating and objectifying them. Therefore, I decided to do some research on my own to find out the reasons.

Go here for the complete essay. 

 

The History Behind 

Mental health patients in the United States have been struggling for decades to receive adequate treatments and support, resulting in an increasing homelessness rate among mentally ill people. Mental health conditions and homelessness are very interconnected not only because one perpetuates the other in the long term, but also because mental health has been the cause of sudden, widespread homelessness in the 20th century. 

That historical cause is the deinstitutionalization movement (De La Rue). The deinstitutionalization movement was a movement to stop patients from being indefinitely admitted into mental health hospitals once diagnosed, to integrate patients back into the community, and to provide humane care that did not exist in most large, public mental health facilities (Scallet). The movement officially started in 1960 when The Supreme Court ruled forced hospitalization as “the least restrictive alternative”, meaning that unless hospitalization is proved to be the option that gives the most freedom to a mentally ill person, forced hospitalization is not allowed (Osborn).

Image source: Salinsky, Eileen, and Christopher Loftis. “Shrinking inpatient psychiatric capacity: cause for celebration or concern?.” (2007).

Psychiatric hospitals started releasing most of their patients, except the chronically ill ones, into the community centers built under the Community Mental Health Center (CMHC) Construction Act 1963 passed under the Kennedy Administration (Cutler). These centers allowed patients to stay at home while receiving treatments. However, in many cases, people became homeless, because they did not have a home to stay after they left the large institutions. 

The situation worsened when the Reagan administration cut a large portion of the funding from CMHC, drastically reduced programs that provided housing alternatives, and shifted money that provided income subsidies away in the 1980s (Sparks; Scallet). The funding change started a trend of either closing down or selling off many large public mental health institutions (Cutler). The result is a further increasing homeless population. Some of the most extreme examples include the 363% growth in the homeless population, in which 70% were receiving mental health services, in Roanoke, Virginia between 1987 and 2007 (Kuo). Fortunately, many efforts were put in to alleviate the problem. Services such as the Program of Assertive Community Treatment were created to provide treatments for people with chronic, severe mental illnesses (Torrey). However, many issues remain today.

Go here for the complete essay. 

 

The Current Problem

It is clear that homelessness is still a big problem currently, and aside from the historical causes, some more recent causes led to this large homeless and mentally ill population we see today. One of those causes is The Great Recession in 2008. During the aftermath of The Great Recession, many states moved as high as $4.35 billion worth of funding from mental health services away to subsidies the economy (Spross). The funding cut is very problematic because even before the great recession, mental health services were in high demand and any cuts meant directly rejecting individuals from specific services (Lippman). 

Image source: Spross, Jeff. “State Mental Health Services Have Been Cut By Billions During The Great Recession.” ThinkProgress, 17 Dec. 2012

Image source: Dale-Harris, Mieke. “Graphics: Mental Illness and Homelessness.” Development Roast, 14 Jan. 2013

Aside from the service cuts, multiple states also cut funding for many overnight hospital beds which resulted in a 50% decrease in the conservator referral rates between 2012 and 2019 that exacerbated homelessness (Knight). Conservator referral is a legal procedure that compels a mentally ill person into treatments when he or she is gravely disabled. In this case, hospitalization will give them the most freedom, because they face a 73% to 87% chance to become lifetime targets of victimization otherwise (Roy). 

In addition to the main causes of the current problem, other issues are impeding the support services from their best performance. These issues include ineffective communication, a lack of coordination, and a mental health care staff shortage. The ineffective communication resulted in some patients receiving overlapping care while others receiving no care at all (Haller). The lack of coordination resulted in an inconsistency in the total homeless population reported and may cause inaccurate estimation for the necessary resources. The staff shortage caused a service shortage that keeps many from accessing help (Haller). Fortunately, there are some possible solutions that will help to resolve a few of the problems mentioned.

Go here for more detailed reasons. 

 

 

Existing Organizational Efforts

Many efforts has been put in already. There is the Program of Assertive Community Treatment which provides comprehensive, locally based treatment for the people with chronic, severe mental illnesses, and the assisted outpatient treatment which is a court-ordered program to get treatments for those that meet the criteria. These treatments have been proven to decrease hospitalization (Torrey). Furthermore, in the Bay Area, the San Francisco Department of Public Health (DPH) and Behavioral Health Services (BHS) have helped to fund many hospitals and community-based services (Haller). This funding problem is also confronted by Proposition C (2018) which will provide $300 million tax dollars for “legal assistance and rent subsidies, and mental health and substance use services” (Haller). For the decreasing referral rates, in the past year, the Mayor has added funding for more beds which will allow more conservatorship referrals (Knight). Lastly, for the underlining housing issue, San Francisco’s Housing First Model has provided 7400 units of permanent housing, which is a big success considering that the metropolitan is undergoing gentrification (Haller).

 

The Macro Solutions

  • For the coordination and communication issue, one possible solution is to incorporate information on patients’ housing status and all support services received in their medical records, and then share this information with all service providers and hospitals in San Francisco. The only additional task is to collect information about the social support services the patients are receiving and their housing status, and connect these data to their medical records. This kind of data collection will not require a massive investment with the existing electronic health record system, Epic, which integrated 21 independent record systems (“Health Department”). However, it will help to provide the much needed data in a more unified way and improve communication.
  • For the employment issue, one possible solution is to widen the use of the behavioral health care model provided by the Hummingbird Place Psychiatric Respite as recommended in a report from the Tipping Point Community. Hummingbird Place Psychiatric Respite, located at 887 Potrero Avenue, San Francisco, is a center where people with mental health conditions can join peer support groups and receive daycare and overnight services (Hummingbird). A wide use of this model can lessen the need for staff because it does not require as many workers, and it is much more accessible. 

The Micro Solutions (What You Can Also Do):

On an individual level, students can go and volunteer at organizations helping the homeless. For example, The Head-Royce School encourages its students to volunteer at the East Oakland Collective, an organization that focuses on resolving displacement in Deep East Oakland, to perform simple tasks such as packaging and distributing food and hygiene kits. These services do not require a lot of training, but they take up a lot of time and effort. Therefore, even though student volunteers might not be able to perform tasks such as approaching people in need or give therapy sessions, they can help with other necessary tasks, and help free up many trained staff to go out and perform field tasks.

Go here for more detailed solutions. 

 

Works Cited

You can find all of my sources here

 

Comments

Please comment below and tell me your thoughts, ideas, suggestions, and questions. Please be constructive and respectful!  

I would love any suggestions on:

  • How could I improve my explanation on the historical cause and the present day problem?
  • What can I improve on my overall website layouts?
  • What other information or content would you like to see additionally?

It would be great if you can also tell me what kind of contributions you have done to help this social issue if you have any!

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COMMENTS: 7
  1. April 24, 2020 by Sandhya

    Hi Laura,

    Your article is very informative. Living in a large city, I often see homeless camps under freeways that have little to no sanitation. I can see from the clearly laid out statistics that more government support, both local and national level, is needed to improve conditions. The cycle of homelessness is especially striking to me, showing how in many cases people are victims of their circumstances. I appreciate the Micro Steps that people can take, because those programs do so much for the community and are very accessible.

    -Sandhya

    • April 24, 2020 by Laura

      I am very glad that my presentation gave you new information!

  2. April 24, 2020 by Mathieu Leclerre

    Hey Laura, this provided me with lots of new knowledge on interesting things. I’ve been to San Francisco before and I know what you mean when you say that the amount of people on the streets is surprising. It’s super shocking and I think that your project is very important for people to understand what’s going on.

    • April 24, 2020 by Laura

      Thank you so much for your encouragements. I am very happy that my research helped to spread new knowledge to you!

  3. April 25, 2020 by Luke

    I really liked that your article spread awareness on a problem that has affected the Bay-Area so much in the past few years. The connection you drew about the Great Recession was really eye-opening as well. Overall, I really felt your presentation impacted the way I will think about this issue in the future. Great Job!

    • April 26, 2020 by Laura

      I was also surprised about it when I first learned about it. Thank you!

  4. April 26, 2020 by Charlotte

    Hi Laura! I think your presentation was beautifully made and presented a lot of important information necessary to raise awareness on this topic. It was great how you connected it to larger events such as the 2008 Recession to provide a certain level of background in connection to the budget-cuts that have been taken throughout the US. This issue carries quite a few stigmas, behind both mental health and homelessness, so its great that you provided a voice behind this topic to change the future of this topic. Great job!

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