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.

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.

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.

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.

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.

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

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.

Mad, homeless, and unwanted. A history of the care of the chronic mentally ill in America.

The history of the care and treatment of the mentally ill in America for nearly four centuries offers a sobering example of a cyclical pattern that alternated between enthusiastic optimism and fatalistic pessimism. In the nineteenth century an affinity for institutional solutions led to the creation of the mental hospital, an institution designed to promote recovery and to enable the individual to return to the community. No institution ever lives up to the claims of its promoters, and the mental hospital was no exception. Plagued by a variety of problems, its reputation and image were slowly tarnished. When it became clear that hospitals were caring for large numbers of chronic patients, the stage was set for an attack on its legitimacy after World War II. Its detractors insisted that a community-based policy could succeed where an institutional policy had failed, and that it was possible to identify mental illnesses in the early stages, at which time treatment would prevent the advent of chronicity. Between the 1940s and 1960s, there was a sustained attack on institutional care that finally succeeded when Congress enacted and the president signed a piece of legislation that shifted the locus of care and treatment back to the community. The community mental health policy proved no less problematic than its institutional predecessor. Indeed, the emergence of a new group of young chronic mentally ill persons in the 1970s and 1980s created entirely new problems, for the individuals who constituted this group proved difficult to treat and to care for under any circumstances. Each of these stages was marked by unrealistic expectations and rhetorical claims that had little basis in fact. In their quest to build public support and legitimate their cherished policy, psychiatric activists invariably insisted that they possessed the means to prevent and to cure severe mental disorders. When such expectations proved unrealistic, they placed the blame either upon callous governments, an uninformed public, or an obsolete system that failed to incorporate the findings of medical science. If American society is to deal effectively, compassionately, and humanely with the seriously mentally ill, several elements must be taken into account. First, the seriously mentally ill include individuals with quite different disorders, prognoses, and needs. Secondly, outcomes vary considerably over time. Some schizophrenics, for example, have reasonably good outcomes; others lapse into chronicity and become progressively more disabled. Finally, serious mental disorders are often exacerbated by poverty, racism, and substance abuse. Although psychiatric therapies can alleviate symptoms and permit individuals to live in the community, there is no "magic bullet" that will cure all cases of serious mental illnesses in the same way that antibiotic drugs are effective against acute infectious diseases.(ABSTRACT TRUNCATED AT 400 WORDS)

The old homeless and the new homelessness in historical perspective.

In the 1950s and 1960s homelessness declined to the point that researchers were predicting its virtual disappearance in the 1970s. Instead, in the 1980s, homelessness increased rapidly and drastically changed in composition. The "old homeless" of the 1950s were mainly old men living in cheap hotels on skid rows. The new homeless were much younger, more likely to be minority group members, suffering from greater poverty, and with access to poorer sleeping quarters. In addition, homeless women and families appeared in significant numbers. However, there were also points of similarity, especially high levels of mental illness and substance abuse.

Homelessness, mental illness and the law.

One major difficulty that faces both researchers and practitioners who work with the homeless is the lack of definitions and frameworks that assist better understanding of such people's problems and society's response to them. This article reviews the legislation dealing with homeless people's social, civil and legal problems. We tried to give this legislation's historic and social background, including a section on psychiatric disorders in this group because of their relevance to current debate on homeless offenders. We then reviewed the legislation relevant to homeless people in general and the homeless mentally ill in particular, including the recently introduced court diversion schemes.

[Deinstitutionalization and modern history]. / Désinstitutionnalisation et histoire moderne.

The authors trace the history of ideological or socio-economical-political conditions of desinstitutionalisation. They try to analyse the consequence of it about the constitution of a new pathology of homeless and careless chronic mental ill. This pathology was described first in the states and Canada. It begins to be described in France. The authors go on to show it's a new kind of mental pathology, needing to take place in the new classifications of mental illness.

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.

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.