Derelict Minds
Joe ignores mental-health roots of homelessness
TEAM Biden is asking mayors, governors and tribal leaders to pledge to reduce homelessness in exchange for new federal rental assistance and support for new housing construction. The initiative is called House America, but it should be dubbed Misunderstand America.
Yes, housing prices are up post-pandemic: Demand is growing, supply stalled. But that isn’t why there are massive homeless encampments plaguing cities like Los Angeles, San Francisco, Portland, Seattle — and even New York, where the de Blasio administration is forced to play whack-a-mole with tent encampments.
Some rough-sleepers would relish permanent housing, yes. But many would also choose to stay on the streets. That’s because untreated mental illness, not a housing shortage, is the real source of the problem for a significant share of the homeless.
In 2015 (the most recent such survey), the Department of Housing and Urban Development found that at least 25 percent of the US homeless, or 140,000 people, were seriously mentally ill; 45 percent suffered from mental illness of some kind. Serious mental illness isn’t garden-variety anxiety or melancholy. It’s the sort of paranoid schizophrenia that can involve voices instructing the patient to push a young woman toward an oncoming subway train.
Others are haunted by the demon of addiction. As the Substance Abuse and Treatment Center has reported, “tragically, homelessness and substance abuse go hand-in-hand. The end result of homelessness is often substance abuse, and substance abuse often contributes to homelessness.” The National Coalition for the Homeless has found that 38 percent of homeless people are alcohol-dependent, while 26 percent are dependent on other harmful chemicals.
What links all these troubled populations is a desperate need for treatment. There was a time not long ago when we understood this — and every state
maintained an extensive network of residential psychiatric hospitals to provide care, or at least try to do so.
Now tent encampments (and jails and prisons) have replaced those inpatient facilities. The Treatment Advocacy Center reports that 20 percent of those in jails and 15 percent of those in prisons are estimated to suffer from serious mental illness: “Los Angeles County Jail, Chicago’s Cook County Jail and New York’s Riker’s Island Jail each hold more mentally ill inmates than any remaining psychiatric hospital in the United States.”
The total behind bars: as many as 383,000.
These are unfortunate souls who could be helped by treatment — but who lack the financial means to get private care or a practical publicly supported alternative. In other cases, their disease itself prevents them from realizing they need help, and the autonomy-obsessed, libertarian approach pushed by activists bars governments from offering involuntary inpatient treatment.
For a sense of how effective such help can be, read the powerful memoir by the writer Donald Antrim in The New Yorker of his time in a private psychiatric ward — and how electro-convulsive therapy made it possible for him to avoid suicide and return
to a high-functioning life.
“There were several wards at the institute, one dedicated to schizophrenia and other strong psychotic illnesses,” Antrim recalls. “I was a clinical patient, admitted because I was in need. There were a handful of us with clinical status, and we became a circle within the larger group, wishing one another well, consoling, hoping for happy outcomes, saying good luck when it was time for one of us to be discharged, good luck, good luck out in the world.”
We don’t leave those suffering from most ailments to forage for food from garbage cans, as many homeless must. We provide treatment, including through Medicare and Medicaid. Yet we pretend that the mentally ill, addicted souls on our streets just need more government housing.
They are being cruelly used by subsidized-housing advocates, the activists who first started applying the very term homeless to them and who believe that government-provided housing is the universal substitute for a flawed private housing market.
Yes, by all means, let’s help the homeless — and get them off the street, where they pose a publichealth and public-safety hazard to themselves and others. But for God’s sake, let’s get them the treatment they need.
Howard Husock, a senior fellow at the American Enterprise Institute, is author of the new book “The Poor Side of Town — and Why We Need it.”