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Homelessness: Focus Shifts to Shelters with Integrated Wellness Services
The
pictures are in textbooks and on the History Channel; tent cities, men cooking
over open fires in rail yards and hitching rides on the trains to the next town
in search of a job or a regular source of food.
That was the Great Depression, and homelessness was widespread and
visible.
After World War II, the economy more or less stabilized and we pretended that homelessness
had gone away. It hadn't, it had just
assumed a different profile; it was less common and less apparent.
There
were scattered homeless panhandling on city streets or rifling through trash
cans and sleeping on parks benches. They were predominantly adults, primarily
male and they were notable mostly because there were so few - or at least so
few that we could see - and we generally assumed they were lazy, substance
abusers, and/or crazy. They were easy to ignore. In the
1980s, however, their numbers began to rise, and their presence to be felt...
According to the National Alliance to End Homelessness, "the
seeds of homelessness were planted in the 1960s and 1970s with de-institutionalization
of mentally ill people." The Community Mental Health Centers Act of 1963, was
passed with the best of intentions, but was never adequately funded. Beds in public residential institutions for
the mentally ill were severely cut - in 1970 there were over 400,000 beds in
state and county hospitals in the United States, by 1998 there were 63,526 -
without a commensurate increase in services to deinstitutionalized patients,
leaving tens of thousands of people to fend for themselves. Today estimates of the percent of single
adult homeless with some form of severe and persistent mental illness range
from 16 to 40 percent, with the higher end reflecting studies of the
chronically homeless.
Since the 80s, the problem of homelessness has been on a ragged upward
arc. In good times the numbers of
homeless recede a bit, only to increase again when employment lags or inflation
increases. The recently released Opening
Doors: Federal Strategic Plan to Prevent and End Homelessness, to which we
have referred several times says, "Economic downturns have historically
led to an increase in the number of people experiencing homelessness. In the last three decades, however, the
number of people experiencing homelessness has remained high even in good
economic times."
Opening Doors places the blame for homelessness on what it calls the convergence of
three key factors:
-
The loss of affordable housing and foreclosures;
-
Wages and public assistance that have not kept pace with the cost of
living, rising costs, job loss and underemployment with resulting debt;
-
The closing of state psychiatric institutions without the concomitant
creation of community based housing and services.
Initial responses to the issue of homelessness originated with local
governments and non-government organizations (NGOs) and took the form of
emergency, stopgap measures.
Depression-era style soup kitchens started up in neighborhoods where the
homeless congregated and shelters were opened in church basements and abandoned
facilities (ironically sometimes the very mental hospitals that had been
closed, forcing patients into the streets) and armories. Typically these only provided
overnight housing; clients were sent back out into the streets in the morning. Many shelters limited the number of visits each
week or month and some were open only in months when temperatures - hot or cold
- were the most extreme. Many of the homeless
avoided shelters, feeling they were dangerous either to themselves or their few
possessions; others were unable to comply with shelter restrictions on drugs,
alcohol, or tobacco. Some preferred the
streets to separation from a friend or family member when a shelter prohibited
adolescent males or served only one gender while other families were
involuntarily split.
Even as shelters became entrenched as institutions, individuals and agencies
working on the front lines were realizing that temporary shelter did not break
the cycle. According to Opening Doors, an estimated 17 percent
of the homeless and 26 percent of individual homeless individuals are
chronically so, spending years "on the streets or cycling between
hospitals, emergency rooms, jails, prisons, and mental health and substance
abuse treatment facilities at great expense to these public systems."
The solutions are several, but, according to Opening Doors, they are basic:
"jobs that pay enough to afford a place to live, affordable
housing, better access to income and work supports, and expanded access to health
and behavioral health care, including trauma-informed care." Consequently, on the community level, the
focus has moved toward creating 10-year plans in order to focus funds strategically
on solving the problem through social services and housing.
While the original federal response to homelessness was also to treat
it as a short-term crisis and promote emergency responses such as shelters, as
the problem grew larger and more entrenched, the approach became one of a
continuum of care, "the theory being that people experiencing homelessness
would progress through a set of interventions, from outreach to shelter, into
programs to help address underlying problems, and ultimately be ready for
housing."
Today that thinking too has
changed. The emphasis is now on what is
called a Housing First approach.
Housing agencies concentrate on getting people into a stable housing situation
as soon as possible. It is no longer
seen as a goal, but as an important part of the solution. Once housing is secured, the client can be
plugged into appropriate support services.
This makes sense from several standpoints; the client has a permanent
address and can thus apply, not only for benefits but also for work. With the recurring if not constant need to locate
shelter removed, the client can concentrate on other aspects of recovery, and
finally, there is the simple psychological benefit of security.
Two models of Housing First
have evolved. In the first, housing
developments or apartment buildings are designated as supportive housing with
services built into the location itself.
In the second, participants are given vouchers to obtain housing in the
private sector and support home visit services to address mental health, substance abuse issues.
The effectiveness of
homeless prevention and treatment initiatives, however, still suffers because
responsibility is so scattered. A 2005
study by the Congressional Research Service of the Library of Congress found
federal programs operating in the U.S. Departments of Housing and Urban
Development, Health and Human Services, Veterans Affairs, Homeland Security,
Labor, Education, and Justice. On the
state and local levels there are housing finance agencies, state and locally
operated shelters, mental health and school based programs to name just a few, plus
countless initiatives operated by NGOs. Many of these public and private programs mix
state and private funds with a multiplicity of funding from the federal
agencies named above.
For the last few weeks we
have been trying to show that homelessness is a real human and fiscal problem
in this country, but there is a second, very serious problem in the country and
this second problem may provide a solution to the first. More about this in a future article.
More from MND:
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This email was sent to you by:
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Anonymous Loan Representative University Mortgage Hackensack NJ 07601 |
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Message:
YOUR MESSAGE HERE
Homelessness: Focus Shifts to Shelters with Integrated Wellness Services
The
pictures are in textbooks and on the History Channel; tent cities, men cooking
over open fires in rail yards and hitching rides on the trains to the next town
in search of a job or a regular source of food.
That was the Great Depression, and homelessness was widespread and
visible.
After World War II, the economy more or less stabilized and we pretended that homelessness
had gone away. It hadn't, it had just
assumed a different profile; it was less common and less apparent.
There
were scattered homeless panhandling on city streets or rifling through trash
cans and sleeping on parks benches. They were predominantly adults, primarily
male and they were notable mostly because there were so few - or at least so
few that we could see - and we generally assumed they were lazy, substance
abusers, and/or crazy. They were easy to ignore. In the
1980s, however, their numbers began to rise, and their presence to be felt...
According to the National Alliance to End Homelessness, "the
seeds of homelessness were planted in the 1960s and 1970s with de-institutionalization
of mentally ill people." The Community Mental Health Centers Act of 1963, was
passed with the best of intentions, but was never adequately funded. Beds in public residential institutions for
the mentally ill were severely cut - in 1970 there were over 400,000 beds in
state and county hospitals in the United States, by 1998 there were 63,526 -
without a commensurate increase in services to deinstitutionalized patients,
leaving tens of thousands of people to fend for themselves. Today estimates of the percent of single
adult homeless with some form of severe and persistent mental illness range
from 16 to 40 percent, with the higher end reflecting studies of the
chronically homeless.
Since the 80s, the problem of homelessness has been on a ragged upward
arc. In good times the numbers of
homeless recede a bit, only to increase again when employment lags or inflation
increases. The recently released Opening
Doors: Federal Strategic Plan to Prevent and End Homelessness, to which we
have referred several times says, "Economic downturns have historically
led to an increase in the number of people experiencing homelessness. In the last three decades, however, the
number of people experiencing homelessness has remained high even in good
economic times."
Opening Doors places the blame for homelessness on what it calls the convergence of
three key factors:
-
The loss of affordable housing and foreclosures;
-
Wages and public assistance that have not kept pace with the cost of
living, rising costs, job loss and underemployment with resulting debt;
-
The closing of state psychiatric institutions without the concomitant
creation of community based housing and services.
Initial responses to the issue of homelessness originated with local
governments and non-government organizations (NGOs) and took the form of
emergency, stopgap measures.
Depression-era style soup kitchens started up in neighborhoods where the
homeless congregated and shelters were opened in church basements and abandoned
facilities (ironically sometimes the very mental hospitals that had been
closed, forcing patients into the streets) and armories. Typically these only provided
overnight housing; clients were sent back out into the streets in the morning. Many shelters limited the number of visits each
week or month and some were open only in months when temperatures - hot or cold
- were the most extreme. Many of the homeless
avoided shelters, feeling they were dangerous either to themselves or their few
possessions; others were unable to comply with shelter restrictions on drugs,
alcohol, or tobacco. Some preferred the
streets to separation from a friend or family member when a shelter prohibited
adolescent males or served only one gender while other families were
involuntarily split.
Even as shelters became entrenched as institutions, individuals and agencies
working on the front lines were realizing that temporary shelter did not break
the cycle. According to Opening Doors, an estimated 17 percent
of the homeless and 26 percent of individual homeless individuals are
chronically so, spending years "on the streets or cycling between
hospitals, emergency rooms, jails, prisons, and mental health and substance
abuse treatment facilities at great expense to these public systems."
The solutions are several, but, according to Opening Doors, they are basic:
"jobs that pay enough to afford a place to live, affordable
housing, better access to income and work supports, and expanded access to health
and behavioral health care, including trauma-informed care." Consequently, on the community level, the
focus has moved toward creating 10-year plans in order to focus funds strategically
on solving the problem through social services and housing.
While the original federal response to homelessness was also to treat
it as a short-term crisis and promote emergency responses such as shelters, as
the problem grew larger and more entrenched, the approach became one of a
continuum of care, "the theory being that people experiencing homelessness
would progress through a set of interventions, from outreach to shelter, into
programs to help address underlying problems, and ultimately be ready for
housing."
Today that thinking too has
changed. The emphasis is now on what is
called a Housing First approach.
Housing agencies concentrate on getting people into a stable housing situation
as soon as possible. It is no longer
seen as a goal, but as an important part of the solution. Once housing is secured, the client can be
plugged into appropriate support services.
This makes sense from several standpoints; the client has a permanent
address and can thus apply, not only for benefits but also for work. With the recurring if not constant need to locate
shelter removed, the client can concentrate on other aspects of recovery, and
finally, there is the simple psychological benefit of security.
Two models of Housing First
have evolved. In the first, housing
developments or apartment buildings are designated as supportive housing with
services built into the location itself.
In the second, participants are given vouchers to obtain housing in the
private sector and support home visit services to address mental health, substance abuse issues.
The effectiveness of
homeless prevention and treatment initiatives, however, still suffers because
responsibility is so scattered. A 2005
study by the Congressional Research Service of the Library of Congress found
federal programs operating in the U.S. Departments of Housing and Urban
Development, Health and Human Services, Veterans Affairs, Homeland Security,
Labor, Education, and Justice. On the
state and local levels there are housing finance agencies, state and locally
operated shelters, mental health and school based programs to name just a few, plus
countless initiatives operated by NGOs. Many of these public and private programs mix
state and private funds with a multiplicity of funding from the federal
agencies named above.
For the last few weeks we
have been trying to show that homelessness is a real human and fiscal problem
in this country, but there is a second, very serious problem in the country and
this second problem may provide a solution to the first. More about this in a future article.
If you would like to opt-out of receiving email forwards from this person please click here to remove your email address.