The sight of disheveled individuals, many suffering from visible mental disorders, wandering the streets with nowhere to sleep and little to eat is an all too familiar sight in the United States. Mental illness is a significant contributor to homelessness in the United States. People with mental health disabilities, like other historically oppressed communities, face starvation and desperation — a form of systemic and systematic discrimination and oppression against people who have been diagnosed with psychiatric disorders or are perceived to have emotional distress or mental differences. Unfortunately, millions of Americans are affected by this irrational prejudice of the same quality and character as other irrational prejudices such as sexism, homophobia, ethnic bigotry, and racism. As a result, disproportionately high rates of poverty, criminalization, housing, and employment discrimination are typical, which forces many with mental disabilities into homelessness.
The mentally disabled homeless population had increased steadily since the early 1980s when federal funding for institutional care facilities was slashed, shifting the burden of care to state governments who are ill-prepared or unable to meet the demand in most situations. The steady release of patients into communities created urgency for creating community-based services to treat mental illness. However, the whole concept of community-based care was misguided as it relied on a strategy of institutionalization primarily based on drug therapy to calm people with mental disabilities enough so they could function in society—along with outpatient treatment at local community clinics.
Homelessness among the mentally disabled is touted as evidence of the failed policy of institutionalization which was initiated in response to the historical evils of institutional warehousing. Institutionalization aimed to depopulate state mental hospitals by expanding community-based mental health care and supportive services. In theory, preventing institutionalization by ending inappropriate psychiatric hospital admissions and shortening inpatient stays. However, institutionalization and funding cuts have enhanced the homeless crisis among the mentally disabled throughout the United States.
For millions of Americans, mental health care is inaccessible and un-affordable. As public resources for income support, housing, and medical care are squeezed, persons with mental disabilities were left to fend for themselves. Individuals with severe mental illness tend to be vulnerable along all three key dimensions that impact homelessness. Their incomes are low. Affordable housing is inadequate, and they are further disadvantaged because they sometimes require unique accommodation, which is in an even shorter supply. They may also not have the abilities and social supports to manage their limited income and acquire assistance from others. While institutionalization is not the answer to this growing public health problem, the abandonment of the mentally challenged by releasing many unequipped people to society clearly increases homelessness.
State hospitals once housed and cared for persons deemed unfit to care for themselves. Unfortunately, institutionalization closed many state hospitals, and those that have remained opened now serve mainly patients committed through criminal court actions. This is not a suggestion to revive the once massive and often poorly run public mental hospitals or asylums. That is not the answer to assisting the mentally disabled homeless among society. Instead, this is a call for providing supportive housing to treat this marginalized segment of the population.
Supportive housing is the answer. Providing modest residences much like single-room hotel occupancy with a clean bathroom and small kitchen is preferred. These supportive housing residences will provide on-site help and supervision to ensure critical medications are taken and residents are treated with dignity and respect. Currently, there are dozens of abandoned hospitals and other extensive facilities throughout the United States. Repurposing and transforming these now closed buildings into livable communities where our mentally disabled homeless can work and live normally is necessary and achievable.
It is time for the federal government to step up and assist local and state agencies with funding and support for the mentally disabled. Re-opening and transforming these abandoned hospitals and commercial buildings is the right thing to do. The benefits to these souls and their families will be lasting and immeasurable. The current revolving door policy of managing mental health is inhumane. Extreme social stratification and years of deliberate policy designed to unravel the social safety net for the mentally disabled must end. An investment in permanent housing solutions along with expanded food assistance and elimination of barriers to public assistance and health care are necessary now. Investing in the social determinants of mental health and redressing the decades of oppressive policy-making would ensure that any mental health interventions deployed currently and, in the future, do not bolster the return of oppressive power structures of the past mental health care.
Institutionalization left behind the untreated street homeless. We do not need a return to expanded mental health hospitals that treat an entire population. Instead, we need to supply housing that supports and cares for our citizens’ physical and psychological health. Repurposing and transforming closed hospitals can significantly impact a growing segment of our society that faces the many challenges of mental disability.
I am here now to make some good trouble.
Veteran author/writer Jay North has written 40 books and 1000’s of articles as seen at oneglobepress.com