> When I see people screaming and walking down the streets talking to themselves, I see people that need love
If they're talking to themselves, they need more than that. They probably need to be cared for in a mental institution. Unfortunately the overall national trend has been funding cuts, with the irony being that it doesn't save money overall; since the costs are just shifted over to hospitals and other emergency services.
This isn't a new subject. For those without severe mental issues, the end result is the same when we provide housing: it costs less
> If they're talking to themselves, they need more than that. They probably need to be cared for in a mental institution
The statement that they should probably need to be cared for in a mental institution isn't true. That some or several may need to be cared for is true, yes, but the probability of that need is less well know. Schizophrenia and other schizophrenia-related disorders can often 'mellow out' on their own over time. [1] It is important to give someone a stable and loving and validating environment for them to be able to recover. There are several kinds of people who, while they talk to themselves, really just have their symptoms exacerbated by stress (e.g. schizotypal personality disorder can have quasi-psychotic symptoms triggered by stress).
To be clear, we're discussing homeless people with mental issues, and not people who aren't homeless. The homeless have less access to resources than a non-homeless person with family and friends.
> It is important to give someone a stable and loving and validating environment for them to be able to recover. There are several kinds of people who, while they talk to themselves, really just have their symptoms exacerbated by stress
Yes, which is why a mental institution is a good starting point for a homeless person with mental issues. Let's not confuse these institutions with the mental asylums of the past. Are there better alternatives for the mentally ill homeless that I'm not aware of? I don't feel that most if not all homeless shelters are equiped to fully deal with individuals suffering from schizophrenia.
Yes, there are. The only real difference between a mentally ill homeless person and a normal mentally ill person is the home. Why wouldn't a stable home be the answer?
A short-term stay in a mental hospital might be necessary while getting the patient adjusted to their medication. But once someone is stable, there is no need for such things. Even though the institutions have changed, they are still pretty horrible places to stay in, with all sorts of lifestyle restrictions that aren't generally needed.
A small apartment is appropriate for most folks once they are stable, along with access to someone to call. Some communities have social workers that visit once or twice a week and help with grocery shopping, bill paying, and general "how are you" sorts of things. Group homes are another option if someone chooses it: Private space with shared kitchen and whatnot, staffed with someone to help with cooking and cleaning. My ex, diagnosed with schizophrenia, would have been a candidate for such a thing. I was his primary caregiver, fair or not, and his doctor didn't want him living alone for his own protection.
Give support for family members as well - this is something seriously lacking in the US system. He had help, I didn't.
A small amount of folks might need some help for substance abuse, but many short-term mental health facilities are equipped to do this. A fair amount of folks would be helped by police that are capable of helping mentally ill folks with training and a marker on their ID so the cops know what to change in their approach.
You have some of the best ideas. I would love to get more involved in helping with programs like these. Substance abuse can be the most challenging to approach. From my experience, some people are on a self-destructive path and they forget how to take care of themselves. Some drugs are almost zombifying in that they are begin to only think about their next fix.
I would like to see more options here for medicine and research. Truly, recovery can be a long process for many and it takes time for the brain and body to heal from trauma. Some of that may be emotional trauma as well. I would love to see more options for preventive mental health services in the United States.
If you are in the US, contact the National institute for mental health. You might be able to contact your local hospital as well - that's where I ran into the social care. My ex had a person visit him for a while after we split up and I had a friend that was employed by a different hospital in the area. If anything, they might tell you where to go to get involved, depending on how much time and money you have to spare. If you are high on the time and/or money and are willing to use some of it for good use, you might be able to organize a volunteer program that works with different agencies. Even if it is just a program that makes wellness visits with or without small care packages would help some folks greatly, if they are up to that sort of thing.
What is available for drug users, I'm not sure. It seems one of the major problems in the states is that substance abuse help is difficult. Some charities help folks by donating things like hygiene items and things like that. As you said, some folks nearly forget how to take care of themselves, having fallen out of the habit for such a long time. The same can happen with some mentally ill folks.
Most importantly, though, these programs need funding. Some of these things nearly need laws to happen (like police training). Having worker protection laws that allow folks to take care of themselves would help. One of the better ways to do this is by contacting your state and local government.
> The only real difference between a mentally ill homeless person and a normal mentally ill person is the home. Why wouldn't a stable home be the answer?
if the mental illness is as serious as schizophrenia, a home isn't enough. The issue isn't just about the mentally ill person's welfare, but also if that person poses a danger to others who live nearby. There is a strong correlation between schizophrenia and violent crime. Without treatment in a controlled environment like a mental hospital, it's hard to see a mentally ill homeless person being able to safely integrate with society when they also lack a family and friends support network.
> I was his primary caregiver, fair or not, and his doctor didn't want him living alone for his own protection.
This is the issue. The homeless will not have the luxury of having a caregiver to be able to live independently at least initially. I'm sure why it's so hard for people to accept that the homeless people, who also have mental issues, just don't have access to the same resources that a non-homeless person with mental issues has access to.
A mental institution is not always a good starting point, especially if they are committed involuntarily. It can actually make things worse as the experience of being committed involuntarily is often traumatic to the individual. Inpatient treatment is not always loving or validating, especially in environments where the inpatient treatment is for poor or homeless individuals. Homeless shelters aren’t always equipped for individuals suffering from schizophrenia, but homeless shelters are not really the loving and validating spaces someone who is mentally ill may need anyways. I know there are apparently programs that House the mentally ill in small apartments or with willing caretaker families That are paid for it.
I’m not saying “you are wrong and I have the answers”, merely that thmakes perception that anyone who talks to themselves needs inpatient and medication may not be necessarily true. They could just need some time in a safe place, while inpatient treatment can actually not be safe and incredibly traumatic.
Yes those people probably have homes, jobs, and a family and friends support network. With the homeless, they are missing more than one of those things, if not all of them. Is it even possible to have a prescription when you don't have a mailing address?
Not really in actual, regular, uninterrupted practice. There are so many problems with the US healthcare system at every level of it when you have excellent health insurance, especially in terms of regular maintenence medication for something as garden variety as asthma, that when you get down to the level of real emergency help absolutely medically required, it is usually a severely delayed and often interrupted swampy mess. I've been at both ends of this spectrum of care. Both are unreliable, but obviously, it is far worse-- a nightmare of indifference really, at the bottom. And many meds (like inhalers even) require ridiculously expensive, regular tests. The homeless and impoverished are often given less effective medication or ineffective medication to treat serious ongoing conditions.
You'd need to pay the doctor, and for prescribed drugs. Some doctors treat indigent patients at reduced prices, or pro bono. Also, food and drug chains often sell generics at discounted prices. And some US states prvide drug-discount services.
I guess the institution should be a transitory step in a social reintroduction process, not an asylum where to lock them away. (hopefully a system that does not chronicize them to assure funding streams.)
Those living on the streets with severe mental issues probably don’t want to be in a mental institution. And unless they’re a danger to themselves or others (and not just in the sense of making bad life decisions), they can’t be held against their will. This is a free country.
That’s not what I’m saying. We most definitely should offer mental care to people who need it, regardless of ability to pay. My point is simply that many of them don’t want it, and we can’t force it on them.
What is a more important duty to our neighbors? To lock up and force drugs on homeless people who have no one to talk to but themselves; or preventing them from becoming homeless in the first place?
> And unless they’re a danger to themselves or others (and
> not just in the sense of making bad life decisions), they
> can’t be held against their will.
Technically if somebody suffers from a mental illness, including addiction, they could be forced off the street. In fact, refusing housing and other assistance to live in patently unsanitary conditions could, perse, be construed as evidence of incapacity.
We just choose not to. AFAIU, the Supreme Court decisions in the 1970s that, arguably, precipitated the dismantling of the archaic mental health institutions never even came close to suggesting that such people couldn't be forced off the street. For example, in the famous case of O'Connor v. Donaldson the patient, Donaldson, had actually been living in an apartment of his own in Philadelphia. He traveled to Florida to visit his parents, and it was his parents who had him committed after he shared paranoid delusions about his neighbors in Philadelphia. I've seen people use that case to argue against forcing people off the streets as-if we had no legal choice, but it's just plain wrong. Donaldson wasn't living on the streets; his ramblings notwithstanding he was clearly capable of taking care of himself, and in any event the case was never about his initial confinement but his continued confinement 15 years later.
We choose to let people live on the streets because we've somehow internalized the perverse logic that to do otherwise would result in a tyrannic state oppressing the mentally ill. (Myths about SCOTUS opinions come into being to bolster the logic.) That such an approach happens to require little or no budget outlays while simultaneously absolving us from moral blame is, I'm sure, merely coincidental....
Some, maybe. Others live perfectly happily without being alone in their heads. I know a story or two about people for whom just talking with the voices was the way they found themselves again. Sure there are people who can't deal with another constant presence or who have deeper issues to work out, but saying that everyone who's part of a plural system needs institutional help is part of the feedback loop that makes them reject their headmates and so need institutional help finding solitude. The key is finding a way to a stable life, not finding a way to a single life.
If they're talking to themselves, they need more than that. They probably need to be cared for in a mental institution. Unfortunately the overall national trend has been funding cuts, with the irony being that it doesn't save money overall; since the costs are just shifted over to hospitals and other emergency services.
This isn't a new subject. For those without severe mental issues, the end result is the same when we provide housing: it costs less
https://www.vox.com/2014/5/30/5764096/its-three-times-cheape...