Homeless and Helpless: How the United States has Failed Those With Severe and Persistent Mental Illness.

The United States has failed its citizens who suffer from severe and persistent mental illness (SPMI). Homelessness is one of the most obvious manifestations of this failure. The combination of a lack of effective treatment, inadequate entitlement programs such as Social Security Disability Insurance (SSDI), and subpar housing options form systemic barriers that prevent people suffering from mental illness from being able to obtain adequate housing. Cultural beliefs within the United States regarding who is homeless and what homelessness means also play a significant role in the development of positively impactful social welfare programs. Part II of this Note reviews the history of treatment for persons with SPMI--specifically how that treatment has evolved, the history of federal policies regarding SSI, SSDI and housing, and societal beliefs regarding homelessness and mental illness that have impacted policymaking decisions. Part III looks at these same areas from a current perspective and addresses the current issues and some possible solutions. Part IV discusses how lack of effective treatment, poor disability programs, and the need for better housing options work together to form systemic barriers for people with SPMI. Part IV also address how the cultural beliefs in the United States regarding people who have SPMI and are homeless serve as an independent barrier to policy change. Ultimately, this Note argues that homelessness is a product of system failures rather than individual factors.

Award for Distinguished Professional Contributions to Independent Practice: Sam J. Tsemberis.

The Award for Distinguished Professional Contributions to Independent Practice is intended to recognize outstanding independent practitioners in psychology. The award is given to a psychologist working in an area of clinical specialization, health services provision, or consulting, and services provided to any patient population or professional clientele in an independent setting. The 2016 recipient is Sam J. Tsemberis, who "has applied the best of psychological practice and science to address the complex social, health, and economic factors involved in chronic homelessness among persons diagnosed with mental illness and addictions." Tsemberis's award citation, biography, and bibliography are presented here. (PsycINFO Database Record

O discurso sobre a vadiagem na Praça da Sé (SP) / El discurso sobre la vagancia en la Plaza de La Sé (SP) / The discourse on vagrancy in Praça da Sé (SP)

Resumo Este artigo apresenta uma pesquisa de mestrado que buscou investigar se o discurso acerca da vadiagem está presente entre os frequentadores da Praça da Sé (SP), em relação àqueles que se "deixam ficar" nas imediações do logradouro em período comercial dos dias úteis. A realização de um trabalho de campo, de cunho etnográfico, na praça entre 2012 e 2013, aliado a uma análise documental de jornais sobre a temática, permitiu verificar a estigmatização de certa plêiade de pedestres que têm em comum o fato de sentar-se/deitar-se nas muretas ou no chão da praça. Neste cenário, a rua torna-se um espaço onde é preciso seguir certas regras de apresentação pública a fim de se discriminar daqueles que são vistos como "acomodados" que "não querem saber de trabalhar". Conclui-se ainda a presença da norma salarial identificada na figura do trabalhador, em oposição à "viração" das classes pobres associada às representações de vadiagem.

Resumen En este articulo se presenta una pesquisa de maestría que se propone a investigar el discurso sobre la vagancia presente entre los frecuentadores de la Plaza de la Sé (SP), en comparación con aquellos que se "dejan quedar" en las inmediaciones de la calles en los periodos comerciales, de lunes a viernes. La realización de un trabajo de campo en la Plaza, etnográfico, entre 2012 y 2013, combinado con una análise documental acerca de la temática, se he demonstrado con la estigmatización de cierta cantidad de de peatones que tienen en común el hecho de estar sentado o tumbado en paredes bajas o en el piso de la plaza. En este escenario, la calle se convierte en un lugar donde es necessário seguir con ciertas reglas de presentación pública con el fin de discriminar a aquellos que son vistos como "acomodados" o a que "no les importa trabajar". La conclusión es todavia la presencia de la norma salario identificada en la figura del trabajador, en contraposición a la informalidad de las clases pobres asociadas con las representaciones de vagabundeo.

Abstract This study introduces a master's degree inquiry that investigated whether or not the current idea of vagrancy is present among the frequenters of Praça da Sé (SP) when compared with those who "just stay" in the vicinity during commercial time on weekdays. The accomplishment of an ethnographical fieldwork at the place between 2012 and 2013, together with documental analysis of journals about this theme, empowered an examination about the stigmatization of a certain group of pedestrians who share the habit of sitting/lying on low walls or the ground of the square. In this scenario, the street becomes a place where it is necessary to follow certain rules of public presentation in order to become differentiated from those that seem "settled people who do not want to work". We also concluded that the presence of the wage norm is related to the worker's appearance, as opposed to the poor people's occasional work associated with the representations of vagrancy.

Griffith Edwards, the Addiction Research Unit and research on the criminal justice system.

BACKGROUND: This paper reviews the early work of Griffith Edwards and his colleagues on alcohol in the criminal justice system and outlines the direction of research in this area in the Addiction Research Unit in the 1960s and 1970s. The paper outlines the link between that work and work undertaken in the more recent past in this area. METHODS: The key papers of the authors are reviewed and the impact of this work on policy and practice is discussed. CONCLUSIONS: There is a rich seam of work on deprived and incarcerated populations that has been under way at the Addiction Research Unit and subsequently the National Addiction Centre, Institute of Psychiatry, London. Griffith Edwards initiated this work that explores the risks and problems experienced by people moving between the health and criminal justice system, and demonstrated the need for better care and continuity across this system.

Creating a science of homelessness during the Reagan era.

UNLABELLED: POLICY POINTS: A retrospective analysis of federally funded homeless research in the 1980s serves as a case study of how politics can influence social and behavioral science research agendas today in the United States. These studies of homeless populations, the first funded by the National Institute of Mental Health, demonstrated that only about a third of the homeless population was mentally ill and that a diverse group of people experienced homelessness. This groundbreaking research program set the mold for a generation of research and policy characterizing homelessness as primarily an individual-level problem rather than a problem with the social safety net. CONTEXT: A decade after the nation's Skid Rows were razed, homelessness reemerged in the early 1980s as a health policy issue in the United States. While activists advocated for government-funded programs to address homelessness, officials of the Reagan administration questioned the need for a federal response to the problem. In this climate, the National Institute of Mental Health (NIMH) launched a seminal program to investigate mental illness and substance abuse among homeless individuals. This program serves as a key case study of the social and behavioral sciences' role in the policy response to homelessness and how politics has shaped the federal research agenda. METHODS: Drawing on interviews with former government officials, researchers, social activists, and others, along with archival material, news reports, scientific literature, and government publications, this article examines the emergence and impact of social and behavioral science research on homelessness. FINDINGS: Research sponsored by the NIMH and other federal research bodies during the 1980s produced a rough picture of mental illness and substance abuse prevalence among the US homeless population, and private foundations supported projects that looked at this group's health care needs. The Reagan administration's opposition to funding "social research," together with the lack of private-sector support for such research, meant that few studies examined the relationship between homelessness and structural factors such as housing, employment, and social services. CONCLUSIONS: The NIMH's homelessness research program led to improved understanding of substance abuse and mental illness in homeless populations. Its primary research focus on behavioral disorders nevertheless unwittingly reinforced the erroneous notion that homelessness was rooted solely in individual pathology. These distortions, shaped by the Reagan administration's policies and reflecting social and behavioral scientists' long-standing tendencies to emphasize individual and cultural rather than structural aspects of poverty, fragmented homelessness research and policy in enduring ways.

Consultório na rua: atenção a pessoas em uso de substâncias psicoativas / Street outreach office: attention to people on psychoactive drug/substance / Consultorio en la calle: atención a las personas en el uso de substancias psicoactivas

O estudo objetivou investigar os modos de atuação e as características do trabalho de intervenção com adultos jovens em situação de rua e usuários de substâncias psicoativas, segundo percepções de profissionais do Consultório na Rua (CR) do município de Goiânia (GO) e de pessoas atendidas pelo mesmo. Os participantes foram nove profissionais de diferentes categorias com idades entre 24 e 64 anos e quatro usuários beneficiários do CR com idades entre 23 e 37 anos. A metodologia foi qualitativa com aplicação de roteiros semiestruturados de entrevista e realização de análise de conteúdo. Os resultados, a partir dos relatos dos profissionais, configuraram eixos temáticos, tais como: atuação profissional no CR; aspectos facilitadores e dificultadores e apoio necessário para o trabalho. Para os usuários, os eixos foram: primeiro contato com a equipe; atuação dos profissionais do CR e o mais interessante nesse trabalho. Observou-se consonância entre as percepções e predomínio de aspectos positivos nos relatos dos profissionais e dos usuários acerca da atuação do CR, caracterizada por acolhimento, escuta e vínculo. Quanto às dificuldades, foram citados: preconceito e falta de aceitação do usuário pela sociedade civil; atuação agressiva da Polícia Militar e da Guarda Municipal e falta de insumos para o trabalho. O estudo indicou que os modos de atuação do CR vão ao encontro daqueles preconizados nas políticas públicas de álcool e outras drogas do país, pautados no respeito aos direitos humanos, ampliação do acesso a ações e serviços e redução de danos à saúde da população usuária em situação de rua.

The present study aimed at investigating professional practices and characteristics of intervention with young adults living in the streets who make use of psychoactive substances (PAS), according to perceptions of Street Outreach Office (SOO) professionals in the city of Goiânia and of people served by the SOO. Participants were nine different categories of professionals, aged between 24 and 64 years old, four PAS users aged between 23 and 37 years old, alcohol and crack users. The methodology was of qualitative type with semi-structured interviews and used content analysis. The results based on reports from professionals configured the following theme axes: professional work at the SOO; facilitating aspects; difficulties; support needed for the work. The users’ themes were: first contact with the team, the work of the SOO professionals, the most interesting thing about this work. There was consistency between the perceptions and positive aspects in the reports from professionals and PAS users about the work of the SOO, characterized by listening, reception and bond. The difficulties cited were: prejudice and lack of acceptance from civil society towards users; aggressive actions by the Military Police and the Municipal Guard; and lack of provisions for the work. The study indicated that the governing principles of the actions of the SOO are in accordance with those recommended by the public policy in the area of alcohol and other drugs in Brazil, based on respect for human rights, expansion of access to actions and services, and harm reduction to the users’ health.

El estudio tuvo el objetico de investigar los modos de actuación y las características del trabajo de intervención con adultos jóvenes habitantes de la calle y usuarios de sustancias psicoactivas, según percepciones de profesionales del Consultorio en la Calle (CC) del municipio de Goiânia (GO) y de personas atendidas por el CC. Los participantes fueron nueve profesionales de diferentes categorías con edades entre 24 y 64 años, y cuatro usuarios beneficiarios de CC con edades entre 23 y 37 años. Fue utilizada la metodología cualitativa con aplicación de guiones semiestructurados de entrevista y la realización de análisis de contenido. Los resultados, a partir de los relatos de los profesionales, se configuraron en ejes temáticos, tales como: actuación profesional en el CC; aspectos facilitadores y dificultadores; apoyo necesario para el trabajo. Para los usuarios, los ejes fueron: primer contacto con el equipo; actuación de los profesionales del CC; lo más interesante en ese trabajo. Se observó una coherencia entre las percepciones y el predominio de aspectos positivos en los relatos de los profesionales y de los usuarios, respecto a la actuación del CC, caracterizada como acogida, escucha y vínculo. En cuanto a las dificultades, fueron citados: prejuicio y falta de aceptación del usuario por la sociedad civil; acciones agresivas de la Policía Militar y Guardia Municipal; y la falta de insumos para el trabajo. El estudio indicó que los modos de actuación del CC cumplen aquellos preconizados en las políticas públicas de alcohol y otras drogas de Brasil, basados en el respeto a los derechos humanos, ampliación del acceso a acciones y servicios y la reducción de daños a la salud de esta población usuaria.

Psychiatry, homeless patients and welfare reforms: historical links and chains.

The birthplace of the specialty of psychiatry was in the asylum, which was created to divert patients from workhouses where the most disadvantaged and destitute people with mental illness were to be found. The current welfare reforms are endangering the welfare and livelihood of the most disadvantaged of our patients. These reforms in the authors' opinion are related more to the historical cycle of societal attitude to homeless people than to seeing them as the undeserving poor. This is particularly true since the current economic crisis was not caused by the poor, so it is very unfair that our poorest patients should suffer most as a result of the welfare reforms.

Confrontations and donations: encounters between homeless pet owners and the public.

This study examines the interactions between homeless pet owners and the domiciled public with a focus on how the activities of pet ownership help construct positive personal identities. Homeless people are often criticized for having pets. They counter these attacks using open and contained responses to stigmatization. More often, they redefine pet ownership to incorporate how they provide for their animals, challenging definitions that require a physical home. Homeless pet owners thus create a positive moral identity by emphasizing that they feed their animals first and give them freedom that the pets of the domiciled lack. Through what we call "enabled resistance," donations of pet food from the supportive public provide the resources to minimize the impact of stigmatization.

"Near and far": social distancing in domiciled characterisations of homeless people.

For domiciled individuals, homeless people provide a disturbing reminder that all is not right with the world. Reactions to seeing homeless people frequently encompass repulsion, discomfort, sympathy and sometimes futility. This paper considers domiciled constructions of homeless people drawn from interviews with 16 participants recruited in the central business district of a New Zealand city. It documents how, when trying to make sense of this complex social problem, domiciled people draw on shared characterizations of homeless people. The concept of "social distance" is used to interrogate the shifting and sometimes incongruous reactions evident in participant accounts. "Social distancing" is conceptualised as a dynamic communal practice existing in interactions between human beings and reflected in the ways that domiciled people talk about their experiences with homeless individuals.

Faith-based social services: saving the body or the soul? A research note.

Faith-based organizations might be ideal social service providers, claiming to transform clients' lives with holistic support while meeting immediate needs. While organizations have such goals, their success is impacted by constituencies with differing goals for the organization. Clients with goals not commensurate with an organization's may compromise its ability to attain its goals. Three questions are examined here: What are the goals of faith-based service providers? When asked what they think about the services, do clients share the organizational goals? Are organizations likely to meet either set of goals? Homeless persons patronizing faith-based soup kitchens were interviewed; service activities of organizations were observed. Clients' goals focused on survival in their current situation. Organizations' goals ranged from meeting clients' immediate needs to transforming clients through spiritual restoration. Congregations studied met clients' immediate needs. However, clients' accommodational goals were potentially problematic for organizations with spiritual goals.

The exclusion of (failed) asylum seekers from housing and home: towards an oppositional discourse.

"Housing" - the practical provision of a roof over one's head - is experienced by users as "home" - broadly described as housing plus the experiential elements of dwelling. Conversely, being without housing, commonly described as "homelessness", is experienced not only as an absence of shelter but in the philosophical sense of "ontological homelessness" and alienation from the conditions for well-being. For asylum seekers, these experiences are deliberately and explicitly excluded from official law and policy discourses. This article demonstrates how law and policy is propelled by an "official discourse" based on the denial of housing and the avoidance of "home" attachments, which effectively keeps the asylum seeker in a state of ontological homelessness and alienation. We reflect on this exclusion and consider how a new "oppositional discourse" of housing and home - taking these considerations into account - might impact on the balancing exercise inherent to laws and policies concerning asylum seekers.

"Weak-Center" Gentrification and the Contradictions of Containment: deconcentrating poverty in downtown Los Angeles.

This case study of recent efforts to deconcentrate poverty within the Skid Row area of Los Angeles examines processes of "weak-center" gentrification as it applies to a "service dependent ghetto," thus filling two key gaps in prior scholarship. We document the collaboration between the government, business and development interests, and certain non-profit agencies in this process and identify two key mechanisms of poverty deconcentration: housing/service displacement and the criminalization of low income residents. Following Harvey, we argue that these efforts are driven by pressures to find a "spatial fix" for capital accumulation through Downtown redevelopment. This process has been hotly contested, however, illustrating the strength of counter-pressures to gentrification/poverty deconcentration within "weak-center" urban areas.

Exiting shelter: an epidemiological analysis of barriers and facilitators for families.

This study examines the role of individual- and family-level factors in predicting the length of shelter stays for homeless families. Interviews were conducted with all families exiting one of six emergency family shelters in Worcester, Massachusetts, between November 2006, and November 2007. Analyses, using an ordinary least squares regression model, find that families with a positive alcohol or drug screen in the year prior stay 85 days longer than those without a positive screen; families leaving shelter with a housing subsidy stay 66 days longer than those leaving without a subsidy. Demographic factors, education, employment, health, and mental health are not found to predict shelter stay duration. Consistent with prior research, housing resources relate to families' time in shelter; with the exception of a positive substance abuse screen, individual-level problems are not related to their time in shelter. Efforts to expand these resources at the local, state, and national levels are a high priority.

Rising inability to obtain needed health care among homeless persons in Birmingham, Alabama (1995-2005).

BACKGROUND: Homeless persons depend disproportionately on the health-care safety net for medical services. National reports identify financial strains to this safety net. Whether this has affected homeless persons is unknown. OBJECTIVES: We quantified changes in the proportion of homeless persons reporting unmet need for health care in Birmingham, Alabama, comparing two periods, 1995 and 2005. We assessed whether a period effect was independent of characteristics of persons surveyed. DESIGN: Analysis of two surveys conducted with identical methods among representative samples of homeless persons in 1995 (n = 161) and 2005 (n = 161). MEASUREMENTS: Report of unmet need (inability to obtain care when needed) was the dependent variable. Two survey periods (1995 and 2005) were compared, with multivariable adjustment for sociodemographic and health characteristics. Reasons for unmet need were determined among the subset of persons reporting unmet need. RESULTS: Unmet need for health care was more common in 2005 (54%) than in 1995 (32%) (p < 0.0001), especially for non-Blacks (64%) and females (65%). Adjusting for individual characteristics, a survey year of 2005 independently predicted unmet need (odds ratio 2.68, 95% CI 1.49-4.83). Among persons reporting unmet need (87 of 161 in 2005; 52 of 161 in 1995), financial barriers were more commonly cited in 2005 (67% of 87) than in 1995 (42% of 52) (p = 0.01). CONCLUSION: A rise in unmet health-care needs was reported among Birmingham's homeless from 1995 to 2005. This period effect was independent of population characteristics and may implicate a local safety net inadequacy. Additional data are needed to determine if this represents a national trend.