Homelessness and Mental Illness: Do We Accept the Myth?

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Clearly, not all people who are homeless are mentally ill. In a society where many have been, due to economics, just one paycheck away from living in their car, not every person in need has a psychiatric illness. I live in Loudoun County, Virginia, which for several years in a row has been ranked as the fastest growing county in the US, and where the median annual household income is $114,179, the unemployment rate is 2.2%, and we can’t develop the homeless shelters fast enough. Our largest men’s shelter had to be closed a little over a year ago, because here, we place the shelters and group homes for the mentally ill and mentally retarded/developmentally disabled in the general community (often as a building development’s requirement, they must provide so many group homes per houses sold). When the men’s shelter was determined to be housing primarily registered sex offenders (and we can decide in another articler if criminal behavior and deviants should be classified the same as schizophrenics) the community uproar closed it down.

I live around the corner from three of the mental health group homes that I used to be the nurse for, and frankly, while I LIKE that my community provides these services, and even on my street, I don’t like the idea of pedophiles standing at the fence looking into the school playground where my son is every day. So I understand the uproar. Also, since I know the MH group home patients by name, know their histories, and have spent hundreds of hours with many of them, they are my neighbors in the truest sense.

Albert is a paranoid schizophrenic whose parents were the primary household staff for a wealthy family in Middleburg, and he was raised on their horse farm. Even after his parents died, the employers kept him there, and it wasn’t until the next generation took over that he was sent off to the State Hospital. He was one of the very first clients to be discharged from the hospital into the newly opened group home over 20 years ago.

Albert could be the poster image of a psychiatric patient who was successfully reintegrated from the hospital into a SUPPORTED community environment. The support that he has received from the county department of mental health service staff, which include supervised housing, medication management, day treatment programming, assistance in every aspect of daily living- this is how he has been able to live successfully in the community. He has his own room, and staff to make sure that he does his laundry, showers daily, takes his medications, and eats a balanced diet (after they take him to the bank to cash his check, take him to the grocery store to shop, and supervise his meal preparation).

It is possible that Albert might have done well without this support. He might have found a way to deal with his auditory hallucinations, which occur in the form of voices telling him that his Clozaril (antipsychotic medication) is poison. It’s hard to imagine, though. Today he walks through our little town daily, and everyone knows him, “G’morning, Mr. Albert”. He goes to the post office, the town hall, and if it’s a slow afternoon one of the police officers will give him a ride back to the group home (which he really enjoys).  

Albert’s life has been significantly different than that of another paranoid schizophrenic, of about the same age, who was recently admitted to our inpatient unit.

John was at Dulles Airport, floridly psychotic, malnourished, filthy, and with a tinfoil “helmet” covering his dreadlocks because “it helps block the tracking devices”. John resisted the airport police who were trying to figure out how to help him, and so was brought to our unit. John also hears voices telling him not to take medicine, but he has no support or means to get his medication on a regular basis anyway, so the point is moot. While he was on our unit, we were visited by the Secret Service, who apparently have an open file on John, because he was arrested several months previously for, honest to God, trying to pee on the eternal flame at JFK’s grave at Arlington cemetery. According to John, JFK was his father ( and Queen Elizabeth bought him a Ford pick up truck) and he himself is the King of Russia.

Based on what we were able to piece together, John has been in and out of psychiatric hospitals for decades, mostly in the VA-MD-DC area. He may stabilize briefly when given antipsychotic meds in the hospital, but as soon as he is discharged, he is back on the streets, until his next outrageous act gets him readmitted. Is he dangerous? I don’t know, he hasn’t been so far, but I also don’t know if his voices are going to start telling him something different at some point in time. The fact that he can’t be detained against his will for a longer period of time may be legally in his favor, but is it really? Do we honestly believe that anyone would chose to live in rags, eating garbage and with tinfoil on their head as a civil right? Is it possible that a few decades ago, with the right support, John could have had a life more like Albert’s? I would think so.

According to the Treatment Advocacy Center, John is certainly “Gravely disabled: may be shown by establishing that a person is incapable of making an informed medical decision and has behaved in such a manner as to indicate that he or she is unlikely, without supervision and the assistance of others, to satisfy his or her need for either nourishment, personal or medical care, shelter, or self-protection and safety so that it is probable that substantial bodily harm, significant psychiatric deterioration or debilitation, or serious illnesswill result unless adequate treatment is afforded.” (TAC, 2007) and based on the Treatment Advocacy Center’s proposed Model Law, which recommends eliminating the need for dangerousness to be considered before treatment can be provided against the will of the person who does not accept that they are ill.

I don’t know how we will deal with the issue of providing services to the mentally ill who are homeless, until we alter the current standards of treatment provision which usually only allow for involuntary treatment if someone is an imminent danger to themselves or others. Since that determination seems to vary widely, from perspective to perspective, and region to region, until we come to agreement about whether or not John is exercising his rights, or being tormented by his disease, how are we going to address the mental health of the homeless? It is hard enough to provide services for those people who are willing to accept treatment, and a huge enough financial burden, that my personal opinion is that our society doesn’t want to address the needs of the homeless we can’t see- we barely want to accept the responsibility for the needs of the people we see on a daily basis.

Almost every day I hear someone make a statement alluding to the fact that people with mental illness need more “choices” or have to accept the choices they have made. That in itself is such a bizarre statement, it leaves me almost (but not quite!) speechless. No one chooses to be mentally ill. They may make certain decisions based on their perception of their illness, or because of the illness itself, but I have yet to meet someone who was psychotic who had that listed as their lifelong goal.

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