Addressing the Mentally Ill Who Are Homeless

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The mentally ill and the addicted are dying in the streets.
Photo: JOHN ALLE/SM COALITION

(EDITOR’S NOTE: A reader, tired of hearing about how homelessness programs were ineffective, challenged people to offer solutions, rather than just criticize existing programs. This editor took the challenge and has said there are three components. There are homeless that are addicted or drug problems. This piece speaks about the mentally ill.  The number of addicted and those with mentally illness is sometimes given as nearly three-fourth of those on the streets. To read about addiction/homelessness https://www.circlingthenews.com/how-to-fix-the-h…s-in-los-angeles.)

Part II: Treating the Mentally Ill on the Streets

Anyone who lives in Los Angeles has seen these people. They talk to themselves; they walk out in traffic; they throw things at passing cars; they attack pedestrians with no warning, and some commit violent crimes.

While at Oxford University, Elyn Saks suffered mental illness, and was put in a mental hospital. With medication and therapy, she was able to finish her degree and then attend Yale Law School, where once again schizophrenia momentarily took over her life.

Saks, who is now an associate dean at the USC Gould School of Law convinced her doctor, Kaplan [a pseudonym], to lower her dosage of Zyprexa. She writes in her book that he agreed with the caveat that “If, in his judgment, I was in trouble and he decided that I needed to go back on my dosages, I’d do it immediately – no bargaining, no equivocation.”

Saks writes, “As I dropped my levels over the next few weeks, I faintly sensed the fog drifting in, the early signs of disorganization beginning. I gritted my teeth and concentrated on work. I can adjust to it, I thought. I’ll get better. Just wait. I flew east for my tenth law school reunion . . .and for most of the evening’s program at Yale, I sat next to Steve [her best friend] and struggled with the urge to jump out of my chair and scream at the terrifying creatures hovering in the air around me.”

Kaplan insisted that she go back on the dosage, which she does, but then attends a conference in San Francisco. “But the delusions and the disorganization accelerated; I was coming apart at the seams. I called Kaplan.”

Her doctor suggested that she return to Los Angeles, but she decided against his advice. “At which point my sickness took a new, horrific turn. For some reason, I decided that Kaplan and Steve were imposters. They looked the same, they sounded the same, they were identical in every way to the originals – but they’d been replaced by someone or something. Was it the work of alien beings? I had no way of knowing, but I was terrified.”

Her journey of coping with schizophrenia, is documented in The Center Cannot Hold.

If a woman with resources, friends, and doctors, has trouble battling this disease, what about the people on the street?

Suffering psychosis and schizophrenia they sleep on the street and scavenge for food while battling the voices they hear. They do not recognize people they know or even understand they need help. Housing first will not help these people – and will not help addicts. Stabilizing them has to come first.

With all the money that is given for housing first and “Inside Safe” – a majority of those dollars need to go for drug rehabilitation and mental help. It is not.

Rosemary Kennedy

People still like to blame Ronald Reagan forty-three years later, but that is wrongly placed. President John F. Kennedy’s sister Rosemary had intellectual challenges and was given a lobotomy, which left her institutionalized for  her adult life. Trying to help his sister and others like her, he appointed a Mental Health Commission.

That commission in 1961 said state mental health hospitals should be replaced by “community mental health centers” and that the federal government would take over management of mental health care from states.

In 1963, that Act closed the hospitals, with no plans for discharged patients. By 1964, the country had gone from need to care for mental illness to refusing to do so, unless there was a risk of “harm to self or others.”

People read the book One Flew over the Cuckoo’s Nest and saw the movie and determined that people had incorrectly been placed in institutions, although there were no statistics to support that conclusion.

Under President Lyndon Johnson, Medicare and Medicaid were created.  Medicaid rules stipulated that funds could not be used for people in mental institutions.  This became the Institutions for Mental Disease (IMD) exclusion.  Somehow, the government arrived at the threshold of 16 beds constituting an institution. Federal dollars will not go to institutions with more than 16 beds.

The mentally ill are left on the streets.
Photo: JOHN ALLE/SM Coalition

Dr. Drew Pinsky writes that most of those mentally ill on the street have Anosognosia, which means those people are unaware of a disability and don’t feel they need treatment.

With stroke, dementia and other diseases, doctors will go to great lengths to save a patient, but with mental illness, because of civil rights, the disease is privileged by the law. Patients don’t get the help they need.

Pinsky in a talk, said, “Currently, we can intervene in the case of dementia where there is no hope of changing the progression of the disease.  In the case of schizophrenia, if we intervene early, we can change the course of the disease. Yet anosognosia, mental illness, is “privileged” by the law.”

In the book Tomorrow was Yesterday: Explosive First-Person indictments of the U.S. Mental Health System – Mothers Across the Nation Tell It Like It Is – 64 mothers talk about trying to save their children. Readers will learn about terrible group homes, suicides, adult children killed by police, incarcerations, solitary confinement, lack of beds, family chaos, substance abuse, ineffective medications, heart-breaking HIPAA restrictions, hallucinations, homelessness, sorrow, hurt and anger. The author Dede Ranahan wants the public to know these families’ stories.

Right, now if one’s young adult child is going through a mental episode, there is little a parent can do. The CARE Act, SB 1338 was passed that can allow a parent to file to have their child assessed. The program is voluntary, and the child, who may be in the midst of mental illness has to agree to treatment.

Bottom line, the mentally ill need to come off the street. Too often they commit some crime, whether to survive or in the throes of schizophrenia, and end up in jail.

Or they just end up dead in the streets.

Finding a way to treat the mentally ill and those with drug addictions could reduce those on the streets by nearly two-thirds.

Some say not treating the mentally ill is a right’s issue.
Photo: JOHN ALLE/SM Coalition

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