Let

Homelessness, aggressive panhandlers and the opioid crisis have become mainstays in the gulf coast news cycle. Anyone who hasn’t been living under a rock in Manatee County knows that they’ve all continued to get worse in our community and, despite a tremendous amount of attention from local governments and nonprofits, there is no relief in sight. Let’s take a closer look at this complex web of issues.

I began working firsthand with the homeless on a regular basis in 2011. My son was seven years old, and I was in search of ways he could better understand the world around him, not only for its beauty and grace but for its problems and challenges. After all, it was a world him and his generation would one day inherit. I began by taking him with me to volunteer at soup kitchens and soon became a founding board member of the non-profit Feeding Empty Little Tummies, which takes aim at the county’s massive population of homeless public school students.

In search of a way to more directly impact and engage with the people we were attempting to help, another journalist and I started what we coined our "mobile soup kitchen“ project the following year, a simple effort to go to where the homeless were and put food in their hands without the umbrella of an organization. We wanted the answer to "Who are you guys with“ to be "humanity.“

For years, there was no Christmas or Thanksgiving feast until after we’d dispensed "hamburgers for the homeless,“ attempting to engage with people who had less while gaining greater perspective for what we ourselves were lucky enough to have. Admittedly, there was a selfish aspect to the endeavor in that I was using their circumstances to instill a greater understanding in my son’s outlook. I had also hoped to offset a bit of the consumer culture indoctrination the world was going to relentlessly bombard him with and give him something to think about when he caught himself lusting after material items, wondering why he didn’t have more or as much as the other people he found himself envying.

It was a rewarding project that also allowed me to study the crisis firsthand, rather than from a political perspective, as hearing the stories of the people we encountered further informed my view. Combined with my work as a journalist on public policy and the efforts of local organizations to combat the crisis, I eventually began to feel as though I had a somewhat solid understanding of the issues at play, as complex as they can at times be.

The biggest takeaway was that we too often mistakenly view and attempt to address homelessness as the problem itself when it would be more beneficial to look at it as a result of other issues. The issues are often unrelated and very different from each other, which is part of the reason, in my opinion, that addressing it in the monolithic manner we tend to proves unproductive.

From my experience, most cases of homelessness arise from three broad areas: untreated mental health issues (particularly schizophrenia and bipolar disorder), drug and alcohol issues, and people of limited means without an adequate support system who suffer a financial hardship or physical ailment and slip into homelessness when they can’t manage to recover from it in time. In my experience, this third group is the smallest. However, I’m often surprised how many people and public officials assume it accounts for a majority of cases, and how many attempts to address homelessness at large are made from such a perspective.

According to the Department of Health and Human Services, 6 percent of all schizophrenia patients are homeless at any one time. Those suffering from bipolar disorder are also overrepresented. One of the largest challenges with both is getting those suffering from the disorders to stay on their medication, especially if they do not have an adequate support network. Unlike most other health disorders in which people suffering typically seek out medical help wherever it can be found, people who are schizophrenic or bipolar typically become less likely to accept medication the further they get from their treatment.

Homelessness and all that comes with it will often compound their symptoms. Even more problems may be caused by the stress of living on the streets, which includes inadequate nutrition and hygiene, lack of sleep, and anxiety brought on by the very real dangers they face. Should they choose to attempt to manage their symptoms with drugs and alcohol, as many do, it can have an even more detrimental effect. It’s no surprise that many descend into psychosis while homeless.

Now consider those suffering from severe PTSD, whether from combat military service or other life traumas, for whom the story is quite similar. It should be no surprise that our veterans are also overrepresented among the homeless population.

Together, schizophrenia and bipolar occur in nearly 4 percent of adults. According to the Veterans Association, about 7-8 percent of all people will experience some form of PTSD during their lives. Among those suffering from mental illnesses, there will always be a percentage who are not capable of self-managing their condition. Some of them have a strong support system of family and friends who can help. Some don’t. Others are beyond such assistance.

For much of history, the option of last resort had been state-operated mental hospitals. However, over half a century, those institutions were all but eviscerated. The number of mentally ill people who were in public psychiatric hospitals peaked at 560,000 in 1955. The dawn of Medicaid in 1965 had an unforeseen consequence in that states had an incentive to move patients out of state mental institutions and into other facilities like hospitals and nursing homes, because Medicaid did not cover patients that were institutionalized for "mental diseases."

In 1977, there were 650 community health facilities in the United States that served nearly 2 million of the nation's mentally ill. That year, President Jimmy Carter signed the Mental Health Systems Act, improving the program. However, in 1981, President Ronald Reagan repealed the act, converting federal support to block grants, while slashing federal mental health funding by nearly a third in 1981 and even more in 1985, in order to make up for deep cuts in income taxes and increases in military spending.

Consequently, more mentally ill Americans who would have wound up in state hospitals or other government-funded health facilities wound up in prison. By 2004, there were approximately three times as many mentally ill people incarcerated than hospitalized. Of course, this makes such people less employable, further isolated, and more out of touch with potential sources of support from family and friends, making it more likely that they slip into homelessness upon their release and repeat the cycle.

The Great Recession brought the next big wave of budget cuts, with states cutting $4.35 billion in public mental health spending and, by 2010, the number of beds at public health institutions per person in the United States fell to a low not seen since 1850, at 14 beds per 100,000 Americans. This massive reversal in the approach to managing the severely mentally ill is undoubtedly responsible for much of the growth in our homelessness epidemic. Though it is occasionally mentioned, there’s been virtually no serious talk of reinvesting in such efforts.

This gigantic portion of the homeless population is not on the streets because of the reasons we typically think, addiction and poverty, even if there is crossover among such factors in that they come to suffer from one or both eventually. Their circumstances are largely the result of deliberate policy decisions, and like so many other public policy areas–environmental stewardship, public education investment, etc.–proof that if you don't address a problem now, you'll simply face a much larger (and more expensive) one later.

When it comes to the mentally ill, our government has tried to cut corners. Make no mistake what the cuts in public mental health were made for: lower taxes. And they were made in this arena because no one was getting rich off of public mental institutions the way they are off of pharmaceutical sales, for-profit healthcare, and so many other graft-laden enterprises that enjoy significant public investment via research grants and direct payments from things like Medicare and Medicaid.

But like so many sales, the pitchmen never explained the fine print that amounted to the real costs that would ultimately come due. Today, everyone wants a solution to the overwhelming presence of homeless people in our community, especially those who are not mentally stable, but no one seems willing to make such an investment. However, if we continue down our current path of recycling this particular portion of the homeless population from prison to the streets, we will only get more of the same with a problem that will only grow larger and more costly.