What we should do about the mentally ill homeless
astralcodexten.com
astralcodexten.com
So there is a mixture of types of homeless -- some of the examples Scott gets into for "draconian" are for what I would call transient/short-term -- those folks some welfare type intervention (housing vouchers, cash) to smooth over their instability is all they need. Those are not the homeless people are complaining about!
The "pollution" homeless though Scott is mostly talking about are the people who cause public disorder. And those are very hard to deal with. So everything will be difficult, but I think caseworkers being able to help them as much as possible is IMO the best approach I've seen work in some cases.
But the reason is the rest of the countries that don't have this problem take care of their people (positively and negatively, e.g. social services or prison).
For example much of the EU has:
- A social safety net that allows people to reintegrate into society if a catastrophic event happens, rather than throwing them out and letting natural selection decide who gets back up on their feet
- Better health care (for mental health and addiction, to simply not being a constant drain financially and emotionally on patients)
- Housing is more accessible and egalitarian, leading to -- unsurprisingly -- less homeless. The ones that do end up homeless will likely be able to find state-funded housing with reintegration programs (rather than homeless "shelters" and halfway "homes")
- Less income inequality and less "otherism." Homogenous populations and a lack of individualism == "that could be me at any point; I should help when I can, so if I ever fall into such straits, others will do the same." Reminds me of how I haven't heard of the "golden rule" (treat others the way you want to he treated) in decades
- Notable mentions: homelessness in the U.S. pretty much guarantees you do not have: a permanent address, so you most likely cannot apply for jobs or other programs (which necessitate a permanent address). Bank account? Good luck with the prehistoric KYC laws. Also in most of the country barring massive cities with public transport, you need to own a car for transport to most jobs. Don't? You're automatically disqualified from 95% of jobs that you could be eligible for. Cars are expensive
Basically, a lot of systemic problems that culminate in a not insignificant portion of homeless being forever locked out of society
One thing this article avoids, and most other advocacy articles do also, is acknowledgement of the vast numbers of mentally ill people who do prioritise their own care and participate in a structured treatment. It's disrespectful and ableist to group the worst behaviours of people that abandon their own care for street drugs, with the condition itself. Those people need to be held responsible for those decisions.
Consequences for destructive behaviour are crucial for a functioning society. Even many low functioning people understand consequences. What we have done is slowly remove the consequences for multiple tiers of progressively worse behaviour.
I have seen many freakouts and assaults in large cities and have also seen them act right up to the threshold of a consequence. Then when police show up, suddenly they know exactly what to say to get out of it. That is not someone who doesn't understand what is happening.
Involuntary hospitalisation needs to remain a tool, even as a last resort, to prevent escalation of conditions and for the safety of the general public.
1) A comfortable bed
2) Engaging entertainment/task (eg folding laundry is helpful for some disorders)
3) Safe from abuse
4) Basic medical care
5) Place to sit for sunshine
6) Opportunity to hold hands / human touch
The pharmaceutical companies however have successfully lobbied to medicate instead of house the mentally ill. As well we have largely replaced those mental health beds with prison beds. The largest expenditure after staffing for most correction departments is inmate medications.
We simply need to bring back an intermediary between the streets and jail. As well I would argue we may need something as an intermediary between jail and the military like the pre-ww2 CC camps.
https://en.wikipedia.org/wiki/Mental_Health_Systems_Act_of_1...
This is a good example of a really hard problem.
I mean, there is so much overlooked here, I'm truly confused by this post.
The housing cost is very clearly related to the issues of homelessness. Of course it's not the only thing, but it's a significant factor.
Fix housing, provide housing for the mentally ill.
Voila! You no longer have mentally ill homeless people. Like, of course the system which doesn't support people until they're able to stand on their own legs results in people repeatedly falling over.
Fixing the mental illness epidemic is another problem, one which may require better policy around housing, food, mental health services, and taxation of the wealthy. Even then we may not have the tools to 'fix' all the people who've been broken by the current system, during the lifetime, because the human brain is so complex.
But if we fix these issues, the next generation wouldn't have so many mentally ill homeless people in the first place, and we'd have better tools in place to treat people before their mental illness spirals to the point where it's beyond our current mental health care industry's capability to treat.
Obviously I do not share this worldview and me myself border on homelessness for past years, but the world is a world of financial incentives and there is none big enough to do that.
This sounds so simple. So how would that work in practice?
Step 1, every mentally ill homeless person in SF gets free housing (free, because they often have no income - if you make them pay even a small rent, many will drop out).
Steps 2 to N? Homeless people from the entire rest of the world will have incentive to get free housing in SF. Even in the US proper there is enough of them to swamp the system of one city, and the city which starts with the policy first will receive a stream of outsiders, given one-way bus tickets from their original locations.
At that moment, you cannot avoid introducing barriers for newcomers, because the system is too open to exploitation. And "newcomers" include both people from afar and locals who suddenly turn up at the office and say "well, I am mentally ill and I want a free apartment".
It's not a perfect system, but it's better than leaving them homeless. Maybe it's the model we need to follow for our own homeless.
$35 a month housing projects. Then we even have loads of "Human Service Homes" or halfway houses for people that need more help. They get food, clean clothes and transportation provided daily. They even have planned outings like bowling or they get $20 to go shop at a thrift store.
Some people make it work, but the housing projects tend to have lots of drug addicts that are functional but would prefer to spend their money on drugs instead of housing but the low price point keeps them mostly off the street. Of course they frequently get too high and cause issues. The large concentration of addicts also leads to gangs being present which causes other issues. So overall it's just not a great environment.
The DHS homes are dispersed throughout the community. A high amount of drug addicts but also more mentally unstable. They frequently leave the houses, often times entering other people's property. They will cause scenes and messes in the yards, many of them are sex offender. Sometimes they wander off and can't be found. Nothing like wondering where the schizophrenic person nextdoor might pop up.
And at least once or twice a year someone gets killed or seriously injured by a halfway House resident.
Then on top of that we still have a few homeless people that are so disconnected from reality they just won't go indoors.
So to me the biggest issue is that even if you provide housing WHERE can you put it because most people simply don't want to live in close proximity to the mentally ill / drug addicts.
Once you cannot, which is quite characteristic of some mental diseases, the entire system becomes a lot more complicated.
But actually I'll go a step further and say everyone should have access to housing. Don't make it glamorous. People will choose to work to have a nicer quality of life.
Aligning the state against capital might actually result in meaningful changes. The government can increase their holdings of property and develop subsistence housing on it. Right now a big problem is also that there isn't enough housing.
I think this would need to be implemented at the federal level to avoid the issues you're talking about. Also, at least at the start, people shouldn't be able to move to new cities and receive free housing. Instead they should be limited to free housing in a place nearby where they've been living, or the option to move somewhere that the federal government is able to provide an adequate housing supply.
Basic housing shouldn't be seen as a 'luxury'.
The hidden catch is "everywhere?". Because the most salient parameter of housing is its location.
Taken globally, perhaps 100 million people would gladly move into, say, NYC or London if housing there was very affordable.
Of course, they wouldn't fit there.
It didn't use to be this way, it was possible to live in the projects with a middle class income, and crime was far lower then.
Also, there was as a result a severe lack of funds for maintenance and operations because rents were no longer high enough to cover maintenance, which causes a downward spiral in maintenance and enforcement.
As far as mentally ill outsiders, you can initially restrict it to people who have some sort of history in California, and anyways many mentally ill homeless people come to California even if just for the weather.
Dealing with people who just want an appartment wouldn't be too difficult, on top of the psychiatric evaluation, you can charge for the apartments on basis of income - it would be free for homeless people, and for people making a decent SF wage, it would be more expensive than an appartment at a similar distance, with some kind of grace period for people who recently saw their income increase and were already living there. I strongly doubt that people would want to live in a village for people with extreme mental illness for a minor monetary advantage.
This is precisely what Scott Alexander addresses in the article linked quite extensively.
Things like psychiatric evaluation are, in fact, major barriers. That person has to attend some meeting at a given time, but they may not have a subway pass, they may lose their notes, or they may just be so confused by the disease that they forget / decide not to.
You cannot expect genuinely mentally ill homeless people to turn up on time in front of some panel at X:00 in a certain location. Tasks like that sound easy to us normies. Not to people who are in throes of a mental disease and, on the top, don't have any money or place to call their own. Possibly not even a phone.
There is a very silly attitude towards progressive solutions to social problems where people act as if there are unsolved problems where there are none, and then exaggerate them to silly proportions : this is a prime example. In this case, there aren't. Scott Alexander's article is about involuntary commitment, and we are talking about voluntary institutionalization here, where the institute is specifically designed for people who aren't a threat to themselves or society (yet), as an implementation of a housing first strategy.
Voluntary institutionalization has existed for a hundred years now. It exists. It works. There is no point arguing it couldn't work, it's already here. Everything has already been figured out about the intake process and logistics. The only difference is the institution itself, and there isn't really any argument that we have something better than a housing first solution with psychiatric support, which is the subtextual conclusion of the linked article to begin with.
How does a country with significant housing resources for homeless people, say Germany, mitigate this problem?
> and taxation of the wealthy
Why would this help anything? The services you describe are paid for through inflation not taxes.
Vibes matter. When walking down the street, a person isn't going to do a full evaluation on a homeless person. They are going off vibes, and if the vibe is unsafe, it makes the city feel unsafe. People with money to spend tend not to go to cities and areas that feel unsafe, which over time will cause a city to die, which is bad for everyone.
>Best-case scenario, they’re completely sane. Now what? Do you keep a completely sane person locked in the mental institution forever?
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>the social workers can’t show up at their door, because these patients are homeless and hard to track down.
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>Okay, sounds like you need to get them homes. But there’s not enough government-subsidized housing.
Why does the mental institutions have to be "lock up"? It seems like there could be levels to this. Lockup for those who are still potentially dangerous out in society, and have something more akin to a halfway house where someone can live and are free to go and do stuff, but have a place to come back to to keep tabs on them and make sure they are taking their meds. Provide a path to full independence, but with some guardrails to make sure they are doing it in a way where they have a place to live and are taking their meds, and not just throwing them back on the street and expecting things to be different than when they were picked up off the street.
This will probably be expensive, but looking at what the homeless problem has cost some very expensive cities, it seems like it would be worth it.
Those wasteful usages of our absurdly BS priced medical system balloons how much a "homeless" person "costs". It doesn't matter that the only actual resources used where a hospital bed and some OTC medication, the hospital will claim that expense as 10k and bitch and moan that they can't afford it.
Then you have the secondary effect that a 100 bed shelter in California will be absurdly expensive to operate simply due to rent, like disproportionately so.
There are a lot inbetween those where people will wander off and then get confused.
Basically, a purpose built building with 30-50 small apartments and social services co-located. Residents have to meet conditions to get in, to remain in and progress to the point that they can function in more regular market housing, thus freeing the slot for another resident.
https://ottawainnercityhealth.ca/programs-services/supportiv...
' Our supportive living units are run in partnership with other organizations and provide specialized supports for individuals exiting homelessness. This includes substance use support, mental health care, and peer support. Our programs are designed to be client-centred with a harm-reduction-focus. [...] Carruthers is a supported housing program operated in partnership with the John Howard Society with 46 units. Originally, the substance use treatment available focused strongly on Injectable Opiate Substitution (IOAT) with 20 of the available apartments being reserved for people who were enrolled in that program. Many of the original residents have now migrated to other forms of treatment and to different lives where volunteering, work and time spent with family and friends are a priority. [..] The Richcraft Residence was the first OICH housing program which offered all available substance use, physical health and mental health treatments in one location providing a full menu of care options for residents. '
Upstream of supportive housing you need good street facing services with social workers and police well coordinated and tracking clients.
Downstream of supportive housing you need to help people maintain the progress they made at living more indepently as a functional part of their wider community.
Remaining problems include:
- keeping clients alive long enough to recover before they die from opiod poisoning
- having enough of supportive housing capacity to meet the need.
- the candidates who do not want to participate, even space was available.
...at exactly when architectural Brutalism is having a critical revival, don't tear down the Moriyama Science Centre, look at those beautiful Brutalist churches...
We scrounge ratty old buildings for inadequate, dangerous shelters, and haggle and whinge to the point of inaction about housing people in shipping containers or surplus hotels, but laud "jail cell chic".
It goes to show that "The cruelty is the point", that "We'll give you the world if only you bow down before [our economic truisms]". Some people have taken into their hearts that human suffering is a renewable resource.