Would reopening mental institutions help with the homeless problem?

You could call them whatever you like, but the problem is in the word “institution”. Institutions of this sort, by whatever name we call them, are run by groups of people who like regular hours, routine processes, conformity, standardized rules of conduct, etc. And one of the problems that the homeless face, for various reasons, whether mental, psychic, disease or simple contrariness, is an inability or unwillingness to conform to those standard rules. Those can be rules of conduct, “hours of operation”, mealtimes and diet, drug addiction, you name it.

Sooner or later the people running the institution deem it more and more reasonable (for all kinds of rational-sounding reasons: general and public hygiene, more efficient operation of the facility, less friction among inmates excuse me, wards ahem, “clients”, there we go, and the rules become more and more oppressive (at least in the eyes of the clients), and then out come the strait jackets, barbiturates, shock treatment, locked wards and padded cells. That kind of institution seems to attract the kinds of people who enjoy work as prison guards to that kind of employment, too.

So whatever noble ideal drove the reopening of the kinder, gentler institution, it will sooner or later turn into Bedlam, despite the good intentions.

I do not agree. Mental health practices have changed so much. I worked within a system and there is no way what happened in the past can happen today.

I think it would. Many homeless people have mental issues and don’t / can’t / won’t get the help they need. If they lived in a compound, they’d have a roof over their head, food to eat, and mental counseling and medication. Someone to watch over them.

We used to have one in this town. It was way up on the hill. It closed down in 1996 and a new industry opened up. Instead of being housed in one huge building, various business like Mosiac sprang up. Now the people live in actual homes, 6 or so client to a home. A demand for CNA’s has arisen too. Unfortunately it’s doesn’t take much to get a CNA license. I’m sure there are some great CNAs but the opportunity for a low quality of service is there.

I think it’s an excellent idea. We closed the snake pits but didn’t really replace them with anything.

@tinyfaery “Mental health practices have changed so much. I worked within a system and there is no way what happened in the past can happen today.”

Don’t count on it.

If we really want to help the homeless the way to go about it isn’t by institutionalizing them. A better approach would be akin to what they’re in Portland, OR with Dignity Village.

@Darth_Algar Unfortunately, there is no mention of mental health treatment or job training, etc. The place you mentioned seems like it’s more for people in a transitional phase not for those who have been on the streets for years and years.

@Darth_Algar Please tell us what “institutionalizing” means to you. I can’t help but think of lunatics screaming in the halls, ignored, abused when I hear that word.

A basic guaranteed income helped me.
Hospitals are expensive.

@tinyfaery

There are similar sets ups in other cities (though Portland is one of the few that doesn’t try to drive them out). A lot of the folks in them have been homeless for years and aren’t “transitioning”. Believe it or not many people simply don’t fit neatly into normal society, never will and have no desire to. These folks will always remain “homeless”, but can capably see to their own sheltering, etc if allowed to.

Certainly some homeless folks are simply down on their luck and will gladly return to nice, normal, neat society if they can.

As for mental illness – there are, again, better ways to go about that. We could spend a lot of money locking folks away in institutions that will, inevitably, become prone to abuses. Or…..we could spend that money instead on ensuring there is adequate access to non-abusive, non-coercive mental health services in places where people can actually get to on their own.

And anyway – for you proposal, how would we go about it? Are we counting on people checking themselves in, or do we go around rounding up the homeless and tossing them into these institutions “for their own good”?

@Dutchess_III

Really? You need me to define a very simple word for you? Okay:

”the process of committing a person to a facility where their freedom to leave will be restrained, usually a mental hospital”.

There’s also this nice little side effect of long term institutional living.

Or to place in or commit to the care of a specialized institution.

Probably

Surely you don’t have to be mentally ill to be homeless? For many of them all they require is a home. The problem as I see it is that with the closure of ‘mental hospitals’ many would be patients are now in prison.

I haven’t read the previous responses yet, and obviously living in a country with universal health care means the situation here and in the UK is quite different. However, I know in Australia, and I think in the UK, there was a push years ago to move people with mental illness out of hospitals and back into the community. I think the argument was people would be better off integrated into community situations. However, unless you also provide sufficient support services in the community then people are just left to fester and fall by the wayside. I suspect that’s exactly what has happened. People were moved out of the hospital system, but the resources required to ensure they received the ongoing care they need wasn’t funded and so wasn’t provided.

So now people with mental health problems are released from hospital too quickly, but they don’t have district nurses visiting or anyone now monitoring how they’re going once they are on their own. Nobody may be checking that they take medication or providing the help needed to find and keep a home, to get a job etc. It’s left to family or the person themselves to cope. So while the idea (community integration) might have started from good intentions, the investment wasn’t made to ensure people with mental health problems continued to get the help they needed. The outcome is that in Australia and I’d guess the UK too, many people with mental health problems DO end up on the street or just not functioning well.

I think there is an argument for people to be treated in the hospital system (or specific care facilities but not ‘institutions’) until they are stable enough to be able to care for themselves. I’m thinking something similar to aged care. If someone has a physical illness, we give them hospital care if necessary. I don’t see why we treat mental health differently. We certainly have to find better ways of providing ongoing treatment and care for the mentally ill. Turning a blind eye is not the answer.

@flutherother You don’t have to be mentally ill to be homeless but it often is the case. As @Earthbound_Misfit explains, we have often closed the institutions or care facilities where the mentally ill were institutionalized and left them to fend for themselves with little or any support systems. Remember that most mentally ill people are not violent so most of them don’t end up in jail but some do end up homeless. I agree with @Darth_Algar that large facilities are not a good answer but some kind of housing with support services is needed.

@janbb ‘Care in the Community’ is how mental health issues are often dealt with in the UK. This scheme seems better at saving money than providing care but it should at least ensure those released into the community have a home. On the other hand economic circumstances can force anyone into homelessness and we shouldn’t forget that either.

I think it would to a degree yes.

@Darth_Algar I don’t have all the answers and neither do you. I reject your inevitably argument.

It doesn’t have to be a huge. building with thousands of people in it. Maybe it can be small communities, but with hospital like care and treatment.

I think if the right people with the same values could come together and change the paradigm all together, it could be life changing for a lot of people.

And of course I’m not talking about every kind of homeless person, just those with moderate to severe mental health problems.

I did not fully read the OP, and I completely skipped the thread.

We have the highest homeless population per capita in the US in Hawaii. Only 11% are mentally ill. It is an economic problem.

I have now read everything in this post.

First, @tinyfaery, thank you for asking this question and starting this dialogue.

I work in Hawaii’s mental health system. I work on the inside. I know this problem extremely well. Homelessness is an economic problem. It is the direct result of the growing inequality of the distribution of economic resources. It is not the result of abolishing mental institutions. Fully 33% of the homeless people on the streets of Oahu are there because they lost a job and couldn’t pay rent. That is an enormous percentage.

Now, I want to tell you all to reread what @RedDeerGuy1 wrote. He is the single voice in this entire thread with lived experience of mental illness and homelessness, yet not one single person acknowledged what he contributed. He gave us the answer, but because he is viewed as a lesser member on this forum, he has been ignored. Why is he viewed as being less-than? That, my friends, is the deadly stigma he and I live with every single day. Persons with mental illness are ignored everywhere and at all times. I know this is true, because I experience it. I happen to be a good communicator, so I can battle it forcefully. My friend, @RedDeerGuy1, is regularly mocked on Fluther. I see it often. He is very patient and rolls with it.

Several members have correctly written that the institutions were closed for very good reasons, but the necessary programs to give the tools to persons with mental illness to live their lives productively were never funded. They closed the institutions and gave people freedom, but they never gave them the programs to help them live fully independent lives.

Reopening institutions is not the answer.

Fund the programs we need to live full lives adequately, and we will. The homeless problem—as far as it affects the mentally ill—will disappear. If you believe that giving us the resources we need to live our lives fully won’t help, then you are still believing the lies that stigma preaches everyday and everywhere.

I think that funding local programs to help mentally ill is a wonderful proposition, but any politician nowadays who is going to raise taxes for any reason is probably not going to get re-elected.

The alternative is taking money from one part of the budget and putting it toward homeless programs. Government budgets are often stretched so tight now that it would be very hard, if not impossible, to take money from one area of the budget to put it toward new social programs. Cut police and fire? Nobody wants that. Cut services to education, especially special ed? Nobody wants that. Cut maintenance of roads and bridges? You can’t have crumbling roads (if they’re not crumbling already) and they need to be maintained when there’s snow or flooding. You can’t cut programs for public health because we need that, too.
The list goes on and on.

There are people out there that would gladly pay a modest local tax increase to help the homeless, the mentally ill or for many other types of social programs. Sadly, I think people that would be in favor of a tax increase are few and far between.

@tinyfaery

I repeat – how would we go about it? Are we counting on people checking themselves in, or do we go around rounding up the homeless and tossing them into these institutions “for their own good”?

@Hawaii_Jack

To be frank, @RedDeerGuy1‘s single post in here doesn’t really leave a lot to elaborate upon within the context of this particular discussion. If you want to talk about guaranteed incomes that is another discussion (and one I’d be happy to have).

I’ve not seen @RedDeerGuy1 made fun of on Fluther, at least not more or less than any other Jelly.

@Darth_Algar (It’s @Hawaii_Jake, not Hawaii Jack.) :) That is precisely what he wrote. He has a guaranteed income. But it’s being overlooked. Reread his statement.

@jca I included actual government statistics about the number of homeless persons with serious mental illness as opposed to those who are homeless due to economic reasons. I wrote about the serious repercussions of stigma against people like @RedDeerGuy1 and myself. You wrote about the difficulty with funding programs to assist the homeless and the mentally ill. You are correct; it is very difficult. I work in government. I know extremely well how difficult funding issues are. We as a nation chose to close mental institutions and not fund the necessary programs to aid those affected. We as a nation need to decide if this is acceptable to us. We are living with the consequences. Are these consequences acceptable? They aren’t to me, but I am only a single voter.

Your other comment about how @RedDeerGuy1 is treated is incorrect and can be read as very defensive on your part. He likes to dream about different types of jobs and different types of fields of study available at colleges. A quick visit to any of these threads will show you that he is ridiculed and berated for his dreams. If we are going to concentrate on that instead of the government statistics I have included, then my participation in this thread is not needed. I brought up the point about mental health stigma, because it kills. Kills. That is not hyperbole. Individuals with mental illness are highly unlikely to seek medical care precisely because of the stigma they will endure, and those individuals are 30% more likely to attempt suicide. Many of them succeed. Only 20% of persons with mental illness in the US are currently receiving treatment.

The mentally ill die 25 years younger on average than people who do not have a mental illness. That is a federal statistic. 25 years. We die from co-occurring illnesses that are not properly treated such as diabetes. We also kill ourselves for many reasons.

For the record, I have been told by people who work in the agencies caring for the homeless in LA that their statistics closely match ours. The homeless problem is mainly an economic problem. It is not wholly a problem of mental illness.

Also, I have not paid enough attention to the comments of @flutherother. He is correct. Our jails and prisons have become our defacto mental institutions. I haven’t written about this, because I do not have any facts to share. I can tell you that I sit on policy panels that address this very issue. The percentage of persons in jail or prison who have a serious mental illness is outrageously high. This is due to many causes mostly economic. The mentally ill are often exceedingly poor and commit crimes to obtain basic necessities. They do not receive care for their mental illnesses inside the jails and prisons. They are warehoused.

@Hawaii_Jake

Yes, I know what he wrote. I read the post. As I said, I do not see how it leaves much to elaborate upon within the particular context of this thread.

^You stated you’d like to have a discussion about guaranteed incomes, and he stated he had one. I think that’s opening enough to talk about the subject, and it is pertinent to this thread. It is one possible solution to the homeless problem.

@Darth_Algar What would you like to know about guaranteed incomes?

Is it like welfare? In the US, if you have 0 income and have children you qualify for a few hundred dollars a month. I used it twice in my life. 4 kids. I got $400 each time. That certainly didn’t help much. Plus I had to pay it back.

@Dutchess_III Its like welfare, but is a higher amount paid out . welfare is $402 a month , in Alberta ,and gets clawed back over $165 earned. Mine is called AISH. Assured Income for then Severely Handicapped. You get free dental and medication and free ambulance and eye exam/glasses. You are allowed to earn $800 a month before it gets clawed back 50/50. Everyone on the plan gets paid $1588 Canadian a month. You lose most of it if you get married to someone who earns $30,000 or more or with someone who has AISH. You get $100 extra per child per month. Canada also has disability pension payments but I didn’t qualify because I had three years of post-secondary.

@Dutchess_III A doctor needs to sign off that you are permanently severely ill. I qualified pretty fast so that they could put me on expensive medication .

We have much greater access to welfare services in Australia than I believe people would in the US. I would think the UK system is closer to Australia and Canada’s too. If you are unemployed, suffering from a disability (including mental health problems), you are entitled to government benefits. However, this document suggests that “between 48% and 82% of homeless young people have a diagnosable mental illness”. This Salvation Army report suggests 15% of homeless people are mentally ill before becoming homeless and 16% of the sample represented suffered mental health problems after becoming homeless. It also cites figures suggesting between 44% and 82% of homeless people suffer mental illness. These figures relate to Australia but I would be surprised if the situation was so much better in other countries.

I don’t think the answer is just providing money. We also have to ensure those suffering mental illness have access to safe housing with support workers if required. We need to make sure vulnerable people with mental health problems have advocates who can negotiate with rental authorities and private landlords if necessary. Someone suffering from mental illness may be too vulnerable or may lack the capacity to negotiate to either obtain a home or keep a home when problems arise.

We have a housing crisis in Australia. I’m pretty sure the same is true in the UK. If a person with mental illness wants to rent a home and their mental health problems are known, that’s going to put them at the bottom of the queue, whether they have the money to pay rent or not. Obviously, we have laws to prevent discrimination, but prove you were refused because of your mental illness. Most people would again lack access to legal help or the capacity and mental strength to take on such a fight. So I agree with @tinyfaery that we need to ensure forms of sheltered housing are available to the most vulnerable groups in our communities.

And with respect @Hawaii_Jake, I think there were a lot of responses in this thread that members ignored. I don’t think @RedDeerGuy1 was singled out. I do acknowledge that on occasions people mock his questions, answers, however, I suspect people would be even harsher on a new member who posted such questions. I think most members of the community actually temper their responses because we do care about him and we are aware of his situation. @RedDeerGuy1, I apologise for writing about you here. I hope you understand why I did this. Thank you for your contribution to this thread.

@Earthbound_Misfit All is ok. A little nervous from all the attention.

Thank you @RedDeerGuy1.

@Earthbound_Misfit I guess I should declare that I am in Schizophrenia housing with discounted rent and 24/h access to a supervisor. My situation has improved, with my doctor saying that I am allowed to work part time.

@RedDeerGuy1, yes you have been rather singled out. And it’s great that you can provide a real world view of this situation, but please don’t share more than you feel comfortable sharing. You are not obligated to discuss your private situation here.

I think it’s great that your country looks after you. I’m sure they could do better, but it sounds as though it’s a good start and it allows you to live independently and with dignity. I wish my country would do more for those with any disability. We have implemented many more resources in recent years and mental health has been a hot topic for our politicians. I think all countries can do better.

@Earthbound_Misfit Ok Thanks. I was homeless 14 days in 1990’s and 14 days locked out of my dorm room and 2 days in Red Deer when I got evicted. I had a place to say all the time except the 14 days in summer at the university when it closed down while I got special permission to live on campus. I think the 14 days in the sun and cold day and nights caused some of my illness. Living on the street isn’t fun.

@Earthbound_Misfit I lived in a homeless shelter on those days in 1990’s and Red Deer I lived in the computer lab for the 14 days I was locked out of my dorm room. In August 25, 2000. My computer friends were all I had back then.

We do have SSDI in the US which is permanent disability payments for the mentally ill or physically disabled but it is a lengthy and onerous process to go through the application and qualification. A former friend was on it and I believe he got between $1,000 and $1,500 a month. He had to jump through hoops to get on it though and when his therapeutic services changed, it took him some time to find new ones. I believe his health coverage was through Medicaid.

@janbb It took me two months to complete the paper-work. I told them that I couldn’t afford my medication. It now costs $600 a month, AISH disability covers it 100%. I Also had my federal student loans forgiven all expect one $5,000 provincial loan.

@Hawaii_Jake: I understand and agree that services for the mentally ill are very important. I,too have been working in local government for almost 25 years. What my point was about other issues that are equally critical (crumbling roads, police and fire, etc.) is that there’s very limited funding and raising taxes is not an answer in this environment.

@RedDeerGuy1 Thank you very much for your willingness to share your personal information.

@Earthbound_Misfit I brought attention to the only answer from a person with lived experience of homelessness and mental illness. This OP is about those very topics. It is my point that his experience should rate a great deal of thought and discussion, yet it was completely ignored, which is the fate of most of what people with mental illness face.

@jca You are correct about the very difficult funding choices that governments face at present. It is a difficult time.

***

I lived on SSDI for about 10 years. The amount you receive is determined by how much you paid into Social Security while you were able to work. The application process is ridiculously complex and seemingly arbitrary. Once I was approved, I then had to wait an additional 2 years to qualify for Medicare. The amount of my SSDI was too much to qualify for Medicaid, so I was without any medical insurance for those 2 years. After a 3-year wait, I qualified for Section 8 housing assistance. That helped tremendously. However, once approved for Section 8, one must find a willing landlord. In some localities, that is next to impossible. I got lucky. I was looking for a rental during a slump, so landlords were interested.

I just want to jump in here and say, I rarely respond to anyone. That way no one feels left out. (;

We love you @RedDeerGuy1 and you know it! ♥ and ((( )))