A prison, an asylum, or both?

Why are there so many homeless people in the US, so often suffering from mental illness? Because we closed the asylums, of course! That Q&A has become canon. But what would happen if we opened large psychiatric institutions again?

Fort Lyon. Photo (c) The Pueblo Chieftan

NPR has a piece on such a proposal: Colorado Weighs Reopening Psychiatric Hospitals for Homeless (including a short audio segment from All Things Considered). Though much of the impetus seemed to come from creating jobs and reusing an existing campus — Fort Lyon, which was once a veterans’ psychiatric hospital and then a prison — the plan would bus up to 300 of Colorado’s homeless people to the Fort, which would serve as a rehabilitation and transitional housing facility. At the end of the week, the bill to make this happen was shot down, but it will be added as an amendment to another bill.

Improving the plight of mentally ill homeless people should just be a matter of balancing cost/benefit of allowing things to continue as they are or bringing back the institutions, right?  The solution is not a simple binary (and neither was the problem, I’d argue, though that has become the prevalent discourse). Even if we imagine a Utopian care and rehabilitation facility and not a dumping ground like Vita, is the best option to remove homeless people from the community, sweep them out of sight, and hope that budget priorities don’t empty them onto the streets en masse again?

Sam Tsemberis of Pathways to Housing is quoted in the NPR piece. “Having someone in transitional housing teaches people how to manage living in transitional housing.”  I’ve heard a bit about the Pathways to Housing model in the past: it provides housing first — immediately taking homelessness out of the situation — and then adds needed counseling and treatment. (The website is very broken in Chrome; I didn’t check other browsers.) PBS NOW did a half-hour piece about the success of this approach, despite the obvious concerns it raises. [Watch video.]

The head of Colorado’s Coalition for the Homeless, John Parvensky, sees a need for both approaches to reach the range of people who find themselves long-term homeless.

“It’s not really a question of either-or: Should the state support community-based options or should they support Fort Lyon?” says Parvensky. “They really should be doing both, but historically they’ve been doing neither.”

Reading a number of Colorado news articles, it quickly became clear that what’s being debated is not the question of what’s best for homeless people. It’s about budget and jobs and veterans (an earlier proposal had Fort Lyon as transitional housing explicitly for homeless veterans). It’s about the corollary to the American Dream that says that everyone should pull himself up by his bootstraps and take personal responsibility for improving his life.

I’m not convinced that large inpatient institutions are the solution — my personal opinion is that they cause new problems without solving anything but how to hide inconvenient people — but it’s hard to argue that ignoring the problem is better for anyone involved. On my future reading pile: a list of psychology/psychiatry and social work studies on the Housing First approach (anyone have a good anthropological study to recommend on this?) The claimed cost savings of it soothe my fiscal conservative side, while a humanistic method that treats those on the streets as people first — not as junkies or crazies — appeals to my inner anthropologist. The phenomenological experience of being treated worthy of shelter must be so different than that of trying to get clean, find work, or stay on a psychiatric regimen while homeless in order to be considered for a housing program.

Spirit of 1848 group

A great way to keep up to date with some of the most important conversations going on re: health and social justice.  It’s open to anyone, just send a ‘subscribe’ email to spiritof1848-subscribe@yahoogroups.com.  Because anyone can join, you get some fantastic conversations between activists, academics, nurses, doctors, patients etc. that you don’t find anywhere else.  Also because it’s open to everyone, you sometimes have to wade through a lot of noise and take some statements with a grain of salt.  But it’s worth it- and generally the commentary is excellent and informed.