Ending The Ignorance Around Mental Illness And The Potential for Recovery, One Example At A Time

SAMHSA has been at the forefront of trying to rectify the misconceptions, ignorance, and assumptions around mental illness, addiction, and the potential for full and holistic (health, home, community, purpose) recovery for a very long time now and this has not been an easy effort, I assure you.  

I know this, because I currently toil in the wasteland between the field of Addiction and Mental Health, endeavoring - with so many others - to build a bridge between them both.  This of course is in addition to attempts to raise the awareness and remove the misconceptions, ignorance, and assumptions of the general public and frankly among many individuals within each cohort of service providers.   

 Some days, it truly feels as if we've all collectively been banging our heads against the wall while speaking into the proverbial black hole, so I've come to appreciate on a much deeper level information that helps dispel the ignorance in a succinct and concise way. 

Case in point:

Do people really recover? And if so, why don't I see them?

Philippe Pinel, often considered the father of psychiatry, wrote in 1808, "To consider madness as a usually incurable illness is to assert a vague proposition that is constantly refuted by the most authentic facts" (Pinel, 2008). Pinel, in fact, reported a recovery rate of 93 percent for people who had been admitted to his hospital within a year of onset of their mental health difficulties and who had not received prior treatment at an asylum (treatment that was often violent and that Pinel viewed as detrimental). Similar recovery rates were seen in other moral treatment retreats prior to the creation of large State mental hospitals, which unfortunately came to resemble the pre-moral treatment-era asylums in providing primarily custodial care in overcrowded institutions.

It is from this approximately 100-year period of large asylums, between 1850 and 1950, that we owe our beliefs about the incurability of mental illnesses and why the questions above have become two of the most common raised by mental health professionals when confronted with the long-term outcome literature that has been consistently produced since the 1970s (Carpenter & Strauss, 1974; Harding et al., 2005; Strauss & Carpenter, 1974).

45–65% of people diagnosed with schizophrenia will recover from the disorder over time.

This literature suggests that between 45 percent to 65 percent of people diagnosed with schizophrenia—the most severe of the severe mental illnesses—will recover from the disorder over time. The recovery rate Harding and colleagues (Harding, Brooks, & Ashikaga, 1987; Harding et al., 1987b) found in rural Vermont was around 65 percent, while a World Health Organization study found about 45 percent in Boston and Washington, D.C. (World Health Organization, 2001). These are the percentages of people who recovered fully (that is, no longer appeared to have any signs or symptoms of mental illness). The percentages for people who experienced significant improvements would be even higher than that. In contrast, most studies found only about 20 percent to 25 percent of any given sample experiencing a deteriorating course over time (Carpenter & Strauss, 1991; Davidson & McGlashan, 1995; Harding et al., 1987a; Harding et al., 1987b).

Despite the consistent literature documenting recovery over the last 40 years, this good news still has not made its way into the training of most mental health professionals. So, many mental health professionals, when exposed to this body of research, ask the questions above. If so many people get better, then why don't I ever see them? A reasonable enough question, to be sure, and one to which there are several answers.

Clinicians do not see people who are, or when they are, well.

The first answer comes from a husband-and-wife team of statisticians in the 1980s, Cohen and Cohen (1984), who wrote the seminal paper cited below about what they described as the "clinician's illusion"; in essence, a sampling error of patients within the clinical setting. The Cohens showed that people who work in clinical settings, i.e., clinicians, see people who are ill when they are most ill and often only when they are ill; clinicians do not see people who are, or when they are, well. If I only see you when you are sick, I am going to assume that you are always sick. And if I work in a clinical setting, and therefore typically see people when they are sick, I am likely to draw the erroneous conclusion that the people I see are always sick. What I may not stop to consider is that I am not seeing people who are well because they are, in fact, doing well.

In less-ambiguous or better-understood illnesses, there may be no such illusion. For example, for a pediatric nurse practitioner in an endocrinology clinic, a reasonable assumption when she doesn't see a teenager in her clinic is that the teen is probably doing fine in managing his or her diabetes. When the teen gets sick, then she would see him or her, either in the clinic or in the hospital, but otherwise, odds are that things are basically okay. What has been different in psychiatry is the legacy of the 100-plus years previously noted, during which people diagnosed with serious mental illnesses were confined to institutions and assumed to be chronically and seriously ill, often for the remainder of their adult lives.

This 100-year period of institutionalization both gave birth to, and perpetuated, the belief that these conditions were permanently disabling. As it turns out, what was permanently disabling was being confined to an institution, not the conditions themselves (Davidson, Rakfeldt, & Strauss, 2010; Gullickson, 2004; World Health Organization, 2001). Since the end of that era, epidemiologic and longitudinal studies have found that many people do well over time, and that when they do well, they often see no reason to seek or use mental health services (Narrow et al., 2000). As a result, mental health professionals in fact do not see these people, at least not as patients in public sector settings. They do, of course, encounter people with mental health conditions all the time, in their families, in the grocery store or mall, at the Parent¬–Teacher Association or swim club meetings, at work and at social events, in their neighborhood, and at church, synagogue, or mosque. But since people do not introduce themselves as having a history of psychiatric disability, there is no way of knowing that history unless the person chooses to disclose it.

Some people respond to the explanation provided above by saying that their own experiences suggest a different picture, in which they encounter people who had dropped out of treatment but who were having even more difficulties than when they were in care, rather than fewer. They wonder about the people who they see on the streets, in homeless shelters, or in prisons, or who show up at a later time having experienced significant deterioration in both their mental and physical health; phenomena that appear to be more common, perhaps, in urban areas. Doesn't the presence of such people with serious mental illnesses who, by almost any criteria, are not recovering over time call into question the very notion of recovery? More succinctly stated: is the clinician's illusion really an illusion after all?

It unfortunately is true that most, if not all, of us have had such experiences of seeing people who are not in treatment and who are struggling with significant difficulties. It is a tragedy that there are any such people out there, but this is not only due to the severity of the mental illness. It also is due to multiple system failures and a cascade of harmful social determinants, such as poverty, unemployment, limited education, prejudice and stigma, poor health and lack of access to health care, and other social inequities.

There are, however, many more people out there doing well—but you would have no way of knowing who they are unless they told you about their experiences with illness. And since people are more likely to remember those people they see over and over again, they tend to generalize from those clients who may be having the most difficulty to all clients, past, present, and future. As a consequence, we assume that the folks who we see who are still struggling with significant difficulties are in the majority, while research suggests they are not.

So while the people we see on the streets, in homeless shelters, in prisons, or in hospitals are certainly there, they comprise "only" about one out of four or five of the people who have had the illness for that period of time. If you stop to consider how many people you typically will see over a 20-year career in mental health, and compare that to how many people you have seen who remained very sick for an extended period of time, you most likely will end up with around the same number. This number is, of course, not trivial (which is why we put quote marks around "only"), and the challenges faced by these individuals are not to be overlooked or trivialized. If anything, their presence should inspire us to redouble our efforts to promote recovery among all people affected by mental illness.

But the fact that one out of four or five people may experience significant distress and disability for an extended period of time with our current treatments does not justify rejecting the reality of recovery. Research shows that many of those deemed most profoundly disabled by the illness at any given time nonetheless recover fully at a later point, meaning that there is currently no way to predict who will recover, when, or to what degree. To treat any individual as if his or her fate were predetermined and hopeless based on a psychiatric diagnosis—as in any other chronic illness—is to limit the resources and imagination of both clinicians and clients. To apply this thinking to the entire range of people with the disorder also goes against the primary ethical responsibility of health care practitioners, to "first, do no harm."

The fact that 1 out of 4 or 5 people may experience significant distress and disability for an extended period of time with our current treatments does not justify rejecting the reality of recovery.

As a result of being underresourced and overworked—as well as having few, if any, opportunities to see people recovering and doing well—practitioners have been denuded of hope, as many clients have as well. Yet, as in many other serious health conditions (of which serious mental illness is one), a broad range of clinical outcomes is possible at any juncture. Despite the medical breakthroughs of the last half-century, for example, many people continue to die of cancer. This fact does not dissuade us from doing everything we can to ensure their access to effective care, to encourage quality in their lives, and to promote their recovery in the face of serious illness; neither should it do so when the illness in question is a mental illness.

Article on Clinician's Illusion:
P. Cohen & J. Cohen. (1984). The clinician's illusion. Archives of General Psychiatry, 41, 1178–82.

A selection of outcome studies from the past 30 years:
Ciompi, L. (1980). The natural history of schizophrenia in the long-term. British Journal of Psychiatry, 136, 413–20.

Harding, C.M.; Brooks, G.W.; Ashikaga, T.; Strauss, J.S.; & Brier, A. (1987). The Vermont Longitudinal Study of persons with severe mental illness, I: Methodology, study sample, and overall status 32 years later. American Journal of Psychiatry, 144, 718–26.

Harding, C.M.; Brooks, G.W.; Ashikaga, T.; Strauss, J.S.; & Brier, A. (1987). The Vermont Longitudinal Study of persons with severe mental illness, II: Long-term outcome of subjects who retrospectively Met DSM-III criteria for schizophrenia. American Journal of Psychiatry, 144, 727-735.

Strauss, J.S., & Carpenter, W.T., Jr. (1974). Characteristic symptoms and outcome in schizophrenia. Archives of General Psychiatry, 30, 429–34.

Strauss, J.S., & Carpenter, W.T., Jr. (1972). The prediction of outcome in schizophrenia I: Characteristics of outcome. Archives of General Psychiatry, 27, 739–46.

Strauss, J.S., & Carpenter, W.T., Jr. (1974). The prediction of outcome in schizophrenia II: Relationships between predictor and outcome variables. Archives of General Psychiatry, 31, 37–42.

Strauss, J.S., & Carpenter, W.T., Jr. (1977). Prediction of outcome in schizophrenia III: Five-year outcome and its predictors. Archives of General Psychiatry, 34, 158–63.

Strauss, J.S., & Carpenter W.T., Jr. (1991). The prediction of outcome in schizophrenia IV: Eleven-year follow-up of the Washington IPSS Cohort. Journal of Nervous and Mental Disease, 9, 517–25.

For further general reading:
Bleuler, M. (1978). The schizophrenic disorders: Long-term patient and family studies (Clemens, S.M., Trans.). New Haven, Conn.: Yale University Press.

Carpenter, W.T., Jr., & Kirkpatrick, B. (1988). The heterogeneity of the long-term course of schizophrenia. Schizophrenia Bulletin, 14, 645–52.

Ciompi, L. (1980). The natural history of schizophrenia in the long-term. British Journal of Psychiatry, 136, 413–20.

Davidson, L., & McGlashan, T.H. (1997). The varied outcomes of schizophrenia. Canadian Journal of Psychiatry, 42, 34–43.

Harding, C.M.; Zubin, J.; & Strauss, J.S. (1987). Chronicity in schizophrenia: Fact, partial fact, or artifact? Hospital & Community Psychiatry, 38, 477–86.

Lin, K. M., & Kleinman, A. M. (1988). Psychopathology and clinical course of schizophrenia: A cross-cultural perspective. Schizophrenia Bulletin, 14, 555–67.

McGlashan, T.H. (1988). A selective review of recent North American long-term follow-up studies of schizophrenia. Schizophrenia Bulletin, 14, 515–42.

Warner, R. (1985). Recovery from schizophrenia: Psychiatry and political economy. Boston, Mass.: Routledge & Kegan Paul.

World Health Organization. (2001). The world health report 2001. Mental health: New understanding, new hope. Geneva, Switzerland: World Health Organization.

The Shirt Off Our Backs....

When Cops Go Good

I spend a lot of time listening to my brothers and sisters on the street rail against what a good and decent person would probably consider crimes against them perpetrated by police officers acting under the color of authority and laws designed specifically to cause hardship and used for coercive purposes (e.g. "trespassing waivers" that are "on file" at the police department and therefore do not have to  be posted in a spot visible so that you know when you stand under an awning of a business on a city sidewalk that your are in fact trespassing upon that business's location). 

I know that a great many cops have become hardened to the plight of those experiencing homelessness because let's face it and be real and honest; there are times when some folks experiencing homelessness have acted in inappropriate and illegal ways, and I'm not talking here about activities associated with their survival (like breaking into closed building in the middle of the night when the temperature is below freezing. Not saying this is okay or acceptable behavior, but I am saying that the perpetrator is clearly acting in a self-preserving way here and has no interest in stealing, destroying, or otherwise molesting the premises once they've gained entrance). 

The old adage "one bad apple" stands pretty tall here, especially for cops, and most cops with any real street time under their equipment belts will tell you that police work changes your perceptions about humankind and makes them a little more cynical, suspicious, and less likely to be swayed by tales of hardship, excuses, etc.

But just like those of you reading this piece who noticed I was extremely careful to say "'some' folks experiencing homelessness" as I described the situation, it's unfair to lump all cops into the "bad" category because of the actions of a few "rotten apples" within the ranks of our men and women in blue. 

Case in point of course is the action of NYPD officer DePrimo, whose act of kindness, compassion and humanity was caught on camera by a passerby. 

But the truth is, DePrimo's act I think is replicated hundreds of times every month, all over the country, by cops doing the real "protect and serve" duty they swore themselves to do when they joined the force; we just don't see or hear about them.

Now, I believe I know this because I've had the incredibly good fortune to work alongside cops who I know are good and kind and decent people at their core.  One officer in particular, Nashville city police officer Andrea Swisher, who I've written about before here, comes immediately to my mind, but there are others - many others - who do unbelievably good and kind and humane things for people who often don't get a second glance from many in the community.

And before any of you think I'm somehow slanted towards the efforts of police, let me assure you that I've been the victim of an incredibly hateful and targeted campaign by crooked cops to destroy me, and they damn near did, so I come to the table with my own bias towards cops who behave badly.

But I'm smart enough to recognize that blanket assumptions about a particular group of people are not only worthless, they're dangerous and unfair on more levels than I could possibly list here.  It does none of us any good to lump all cops into a "crooked" or "bad" category when at the same time, we ask them to stop doing this same exact behavior to those who find themselves on the street. 

Officer DePrimo, Officer Swisher, and hundreds of thousands of other officers stand as prime examples to this, and don't request or require anything in return.  At a time in our country when it seems like everyone asks "what's in it for me," this is refreshing, honorable, and admirable, indeed.

 Officer DePrimo's kind act (via NYPD Facebook page) (Credit: Jennifer Foster of Florence, AZ)
http://www.salon.com/2012/11/29/cop_gives_boots_to_homeless_man_becomes_online_sensation/

Cop gives boots to homeless man, becomes online sensation

While campaigns against police brutality struggle for attention, one heartwarming NYPD-promoted photo goes viral

By Natasha Lennard
The NYPD have received the gift of holiday-period good P.R.: A tourist in Times Square snapped a photo of an NYPD officer giving a pair of boots and warm socks to a barefoot homeless man. The image — an undeniably heartwarming scene of protection and service — became an online sensation once the NYPD posted it to its Facebook page on Tuesday. More than 370,000 users “liked” it as of Thursday morning, and over 109,000 shared it.
Officer Larry Deprimo, the cop who gifted the boots and reportedly told the recipient, “I have these size 12 boots for you, they are all-weather. Let’s put them on and take care of you,” showed the sort of human kindness worthy of sharing online and “IRL” (in real life). Little wonder the NYPD would use the photo of Deprimo as an image boost over social media. There is, however, something galling about the viral celebration of the image as something representative of NYPD’s attitude toward the homeless when there is an ongoing battle by homeless advocates in New York to combat mistreatment by cops. Equally, it’s worth noting that images of severe police brutality get far less online attention. Meanwhile, reporters and citizen journalists have repeatedly in the past year been physically prevented from filming NYPD aggression.
Bronx-based homeless organizing group Picture the Homeless has for over 10 years been conducting a citywide civil rights campaign specifically aimed at curbing police abuses against individuals sleeping on the streets. PTH highlighted that police regularly use force, arrest and ticket homeless individuals for “disorderly conduct” without citing an offense, essentially (and technically illegally) criminalizing homelessness.

“The NYPD has been on a warpath against the homeless, going back decades,” Jean Rice, a PTH member and longtime civil rights campaign leader, told Salon Thursday, adding, “The kindness of one individual officer is a drop in the ocean of the NYPD’s pattern and practice of violating homeless people’s civil rights. The level of corruption and illegal police behavior that exists in our current city government has not been seen since Teddy Roosevelt  was this city’s police commissioner. Random acts of kindness and mere cosmetic adjustments will not provide the progressive reform that disproportionately communities of color in this city need to ensure their survival.”
Through surveys and testimonies, PTH is building a case for a possible lawsuit against the NYPD. This hard-fought and ongoing campaign does not, of course, detract from Officer Deprimo’s generosity, but it does highlight a counter-narrative about the NYPD that is deserving of vastly more attention.
The disturbing footage of two NYPD officers brutalizing a shirtless, shoeless homeless man found sleeping in a Brooklyn Jewish community center is not undone or counteracted by the photo of Deprimo giving a homeless man boots, nor does the brutality undo the kindness — that’s not how it works. But the NYPD is an institution and should be judged as far as possible by the sum of its acts and effects. Thus, when evidence of police goodness is splashed over social media at a rate and an extent far outweighing evidence of brutality, it’s clear that some skewed judgment of the institution is being produced.
It’s worth noting too that in New York and other major cities, journalists both professional and citizen have been prevented on numerous occasions from filming or photographing police acting aggressively or brutally. Famously, journalists and photographers were physically removed (some with force) and cordoned off at a distance while police evicted Occupy Wall Street’s Manhattan base in Zuccotti Park last year. A New York Times freelance photographer was on one occasion arrested and on one occasion physically roughed up by NYPD officers attempting to photograph arrests (which is legal in New York). It was only this week that the Supreme Court ruled against Illinois prosecutors seeking to enforce a law that banned people from filming police. Items of media showing police kindness must then be viewed in a context wherein conveying police wrongdoing has been prevented both legally (in some states) and at street level.

Stefanie DeLuca:"...tenants often avoid reporting their landlords for fear of eviction, the loss of their voucher, or having to endure yet another move"

"Families receiving housing assistance become used to retreating into their units. They often choose unit quality over neighborhood quality, rarely considering, for example, such factors as the quality of local schools and recreational facilities in their home search. In effect, these families tend to select units, not neighborhoods."

DeLuca raises some incredibly important points here around subsidized housing and offers a couple of recommendations that are of particular importance to those who work with individuals and families experiencing homelessness.  Perhaps two of the most important of these recommendations, imho, are 1. extending the search times available to voucher holders so they are not forced into taking the first unit they find in order to ensure they don't lose the voucher; and 2. "providing families with the means to make fully informed housing choices, through up-to-date lists of available properties in safe neighborhoods with good schools and other community amenities."

This second recommendation literally shouts the need for some form of city housing coordinator who: A. works with landlords to maintain and update regularly lists of available units.  B. Knows the bus routes, walking distances to units from the nearest stops, as well as distances and access (or lack thereof) to available grocery stores in the areas housing units are available in. C. Advocates for affordable housing procurement, rehabilitation and expansion. D. Collaborates across agencies to ensure key personnel (outreach, case managers, VA homelessness services providers, etc) and stakeholders have easy access to the coordinator and are kept updated regularly of changes in policies, rental unit availability, and new units coming online in their service districts.

One of the biggest struggles I've seen with folks is the challenge they face in transportation from the unit to everything else.  If they cannot access a nearby grocery store without having to walk a half mile from the store to their home, they cannot really rent the unit, no matter how nice it or the neighborhood may be. If the individual suffers from a physical disability, it makes the issue of transportation that much more important, and frankly rules out a large number of potential units simply because of the challenges faced in caring for basic needs within the community.  And by the way, a gas station convenience store is NOT an acceptable substitute for a grocery store. 

Reflections on Recent Fieldwork in Mobile, Alabama, and Baltimore, Maryland

Researchers have offered several explanations for why voucher families, who are free to rent units in the private market in neighborhoods where greater opportunity for employment and education exist, are concentrated in poor, segregated areas. 

These include cost, racial preferences, social ties, proximity to relatives, and fully informed decision making. Dissatisfied with these explanations, Stefanie DeLuca, associate professor of sociology at John Hopkins University, designed a study to understand the social contexts that influence low-income family mobility. DeLuca offered preliminary results from her field research in a recent presentation, “How Housing Policy Intersects With the Lives of Poor Families: Reflections on Recent Fieldwork in Mobile, Alabama, and Baltimore, Maryland.” The presentation was part of a speaker series hosted by HUD’s Office of Fair Housing and Equal Opportunity.

Begun in 2009, the study tracked the fortunes of 100 families in Mobile, Alabama. By fully immersing themselves in the field and living among the families, DeLuca and her team of researchers developed in-depth residential biographies of participating families. Gathered through in-home interviews, community meetings, and informal interactions, these biographies chronicle the moves of each family. Although the study’s families used several types of assisted housing (including vouchers and public housing), all were low-income black families with children between the ages of 10 and 18. The study was expanded in 2010 to include low-income black families in Baltimore, Maryland.

A high percentage of participant families were subject to reactive moves, and several factors influenced the frequency of those moves and the families’ subsequent housing choices. Reactive moves are those resulting from events outside of a tenant’s control. More than 70 percent of study families had experienced a recent reactive move, with approximately 80 percent experiencing a reactive move at some point in their lives. The most common cause of reactive moves is unit failure, in which the tenant is exasperated by the landlord’s lack of proper maintenance or the unit fails a Section 8 inspection.

When a unit fails, the process of finding another unit is both pressing and challenging. Families are under intense pressure to find another unit before their voucher expires. Adding to the time crunch are other difficulties, such as those felt by single, employed mothers without a vehicle or the time to search for new housing. Compounding these logistical challenges is the high failure rate of units undergoing Section 8 inspections. In fact, one family recounted viewing 20 houses before finding a unit which passed the Section 8 inspection.

A family’s housing choice is also affected by landlords, the lists of available properties supplied by housing authorities, and their own low expectations for neighborhood and housing quality. For many families, landlords and the housing authority lists play a central role in their hunt for new homes. Landlord practices vary widely; whereas some are accommodating and flexible, more commonly, needed maintenance is not provided. Deferred maintenance results in substandard housing and inspection failures. An additional complication is that tenants often avoid reporting their landlords for fear of eviction, the loss of their voucher, or having to endure yet another move. 

Although the lists housing authorities provide prospective tenants were intended to help low-income families find homes, evidence presented by DeLuca suggests that these lists actually channel low-income families into low-income neighborhoods. This prospect is particularly troublesome because many families view these lists as complete catalogs of available properties and rely heavily on them for their housing search. These lists, however, are often not updated and do not include all available properties. 

Low expectations stemming from a lifetime of exposure to poverty and neighborhood violence affect how a family lives and participates in the community. The end result is often isolation motivated by concern for family safety. Families receiving housing assistance become used to retreating into their units. They often choose unit quality over neighborhood quality, rarely considering, for example, such factors as the quality of local schools and recreational facilities in their home search. In effect, these families tend to select units, not neighborhoods. 

DeLuca shared several policy recommendations to improve mobility and housing options for low-income families. The first is to extend search times for families, especially for those who are interested in moving to low-poverty areas or are actively searching there. The second is to reform counseling programs and tools to focus on deconcentrating poverty. Her final recommendation is to provide families with the means to make fully informed housing choices, through up-to-date lists of available properties in safe neighborhoods with good schools and other community amenities. 

Although the voucher program was intended to increase mobility for low-income families, its limited success speaks to the value of studies such as DeLuca’s, which demonstrate how the voucher program actually plays out in the lives of low-income families. Some of the unintended consequences that perpetuate urban poverty might be preventable if the right policy adjustments were made.

" I totally understand the 'no money, no mission' paradigm. I also know that without collaboration and resource sharing, true, lasting change is not possible."

Dr. Centrone elucidates a common situation those experiencing homelessness know all too well in just about every city in the country.  It is certainly true that in some towns providers have more effectively collaborated to accomplish far more together than they ever could have individually, but the truth is that even in most of those places, increased collaboration among agencies, services and resource allocators continues to be elusive and below the level that is actually available.

Homeless services have never been at the top of the priorities list for funding opportunities from their local, state and federal purse-holders.  They've always had to fight for very scarce resources and for a very long time, because so little was known about both the numbers of homeless in a given community and how best to serve them, oversight was....tepid; how does one provide oversight if one doesn't know the scope of - or the remedy(ies) needed to - correct the problem?  

As a result, agencies have learned to be protective of their funding streams while at the same time figuring out for themselves how best to address the niche they carved out as a result of the funding stream.

Let me explain:

 WARNING: BRAIN GLAZING FUNDING INFORMATION COMING!

grants are narrowly targeted. It's not like an agency can send in a "proposal" with a vague and overly broad request to "help people who are homeless" to someone like Housing and Urban Development (HUD) or the Substance Abuse and Mental Health Services Administration (SAMHSA)  That proposal must be pretty specific to the announcement of funding opportunity (a Request For Proposal/RFP. or Request for Application/RFA).  As a result, organizations often find themselves building their approach around a specific RFP, which then also essentially ties their hands to remain within the parameters of the requirements laid out in the RFP.

Because these funds originate at the Federal level (usually), it's challenging, to say the least, for Federal policy makers seeking to provide some help to local entities for their problems or issues to know exactly what this might entail.  They work around this in a couple of ways; first, by providing "block grants" to states so that the state itself can decide what priorities it will set and then release RFPs for the available funds. Second, the feds put out federal RFPs (duh) targeting specific approaches known as Evidence Based Practices (EBPs) or Promising Practices.   

Understand I'm being overly broad and vague myself on this as I don't want to put you to sleep, nor am I in any way, shape or form a Subject Matter Expert (SME) on grants and funding procurement.  But I do know probably just enough about them to be dangerous to myself and others with it, and part of this danger I think many of us share when we apply for funding at the local level.

This is because as I mentioned earlier, we find ourselves tied to the requirements - and the restrictions - within the grant itself.  And if the grant is disbursed over a period of years, as many of them can be, whole departments; hell, whole organizations may be built upon them.

This is a key point, because what then becomes an issue - sometimes the overarching issue - is keeping that funding in order to keep the staff employed in order to keep bringing the service(s) to the population being served; the “no money, no mission” paradigm. 

There's little incentive to collaborate or to share resources because a. the requirements of the grant narrow the scope of what the agency is able to do, and b.the agency is already running on a shoestring and the last thing they want to do is to give a competitor for those scarce resources any of the goodies - or the inside info around the grant requirements -  they worked their tails off to get for themselves. There's also little incentive to change funding streams, since winning a grant is always "iffy" and it used to be much easier to write a continuation application rather than a new RFP. 

Let be LOUD and clear here; agencies DO want to collaborate, and they often DO SO even when they know it can be potentially harmful to the funding they receive for the job they're doing.  It's just that for a very long time, there wasn't really a directive to find ways to to collaborate, nor was there a paradigm shift from - and this is a critically important point - managing homelessness to ending homelessness. 

Over the last 5-7 years, the Federal government has ramped up their investigative efforts around homelessness and have begun to understand much more clearly the scope of the problem. This in turn has helped to identify the remedies needed to accomplish this shift.

What they've discovered is what most folks on the ground providing services have known for quite some time; the precursors leading to - as well as the issues chaining people to - homelessness are varied, complex, and there is no "one size fits all" answer.

And, s it is so often, when we figure out one thing, new challenges and barriers suddenly materialize or come more sharply into view as a result.

Now one of the bigger problems we're all facing is getting people to understand the need for the paradigm shift from management of homelessness to the idea of ending homelessness, and this is no easy task.  People have some very deeply held beliefs around the causes and conditions of homelessness, and there are widely held stereotypical beliefs that, while often erroneous, continue to be pervasive and hard to eliminate.

All of this "discovery" and tactical shifting takes time, especially when it must come from something like the Federal government, who is as far removed from the realities of the daily life on the ground in Murfreesboro, TN or Round Rock, TX or Davenport, IA., as is a citizen of Zimbabwe.

The key here of course is to raise awareness, but it is also to ensure that as money flows from federal to state to local programs, those programs are evaluated based on outcomes tied tightly to ending - not managing - homelessness.  If, as your program has contact with individuals experiencing homelessness, you are releasing them back onto the streets when your "treatment" is complete rather than being able to release them into housing, we need to rethink continuing funding to this organization under a homeless services grant. 

Let me be crystal clear here; services to address the immediate needs of those experiencing homelessness are essential and must be continued.  HOWEVER, these services should NOT be stand alone services, and we must begin to hold agencies accountable for helping to end homelessness with every individual they engage with who is currently experiencing homelessness. If your service is not directly connected in some way, shape or form in the measurable reduction of people experiencing homelessness in your community, funding for your program should come from some other source to allow the scarce dollars allocated to homelessness to be used solely to assist with ending it. 

I know this sounds a little extreme, but if we want to reduce the costs associated with homelessness and bring an end to the scourge itself, there is only one real answer:
we must put people into houses. 

Slaying the Ego in Homeless Services Delivery by Wayne Centrone

Posted on September 11, 2012 by C4 Thought

At the end of our talk today at the San Diego, California Region IX Health Care for the Homeless Conference, I had an opportunity to speak with a service provider. He told me about his efforts to get organizations to build a coalition in his community. He told me about the six months it took him to schedule the first meeting of the homeless services agencies in his area.
He told me that he had not given up hope that the coalition will pay off with great dividends. I complimented him on his efforts and reassured him that his efforts would indeed pay off. I told him that he may never know the impact of his efforts, but, I told him, if his efforts led to ending the experience of chronic homelessness for one person, then it was worthwhile.
I enjoy speaking at these conferences. They are full of amazing people working in homeless services. I love to reconnect with old friends, inspiring thought leaders, and change agents. The people who work in homeless health clinics, supportive housing programs, mental health and substance use treatment programs around the country are gifted and courageous people.
I spoke at this conference with my colleague Steven Samra. We talked about our work on a new model of outreach we are calling “Housing-Focused Outreach” (HFO). Steven and I, along with the leadership and thoughtful intellect of Ken Kraybill, have been incubating the ideas of HFO for a few years. Our ideas are not unique. They are born from the work of Dr. Sam Tsemberis at Pathways to Housing, and the visionary work of the 100,000 Homes Project. Our ideas are also born from our years of experience in serving people experiencing homelessness and the work we have all been doing over recent years in visiting supportive housing programs around the United States.
The talk was about shifting the paradigm of service delivery. We are considering how to develop and operationalize a new model to impact agency level activities. A summary of our conversation, a work in progress, looks like this:
(1) In order to truly end chronic homelessness, we [homeless service providers, peers, and advocates] need to lead with housing and build effective bridges to supportive services.
(2) The only way to ensure adequate access to housing and supportive services is to build bridges of collaboration with a number of organizations and resources.
We talk about the fact that most communities around the country have the pieces to put together a really effective model to end chronic homelessness. The issue, however, is that these pieces are fractured and disjointed from one another. Our main predicate for the Housing Focused Outreach model is training service providers to be experts in building partnerships.
When we give this talk, we hear repeatedly how little collaboration actually occurs on the ground. I hear over and over again at talks like this: “Oh, that [collaborating with partner agencies] won’t work . . . we are all fighting for the same pot of money, and we can’t really collaborate or we will lose our agency level effectiveness.”
Don’t get me wrong, I totally understand the “no money, no mission” paradigm. I also know that without collaboration and resource sharing, true, lasting change is not possible. I am not sure how we can get more people invested in the idea that collaboration is one of greatest and most underutilized tools. One thing I do know: it will take some serious ego slaying and a strong commitment to service.

The Journey of Recovery Continues...

Whenever I'm in my home in Tennessee and I get to pining away to return to my home of 25 years in the mountains of the West, I go often in my mind to the glorious sunsets; the breathtaking beauty of the morning after a heavy (6-8 feet) snowfall when the sun rises and turns the snow into a trillion sparkling diamonds and the snow underneath is a translucent, glacier-blue; the smell of pine so heavy in the air after a summer rain you can cut it with a knife; the intricacies and mysteries of the granite that reminds me the world is alive below the surface; the crystal clear rivers that make waterfall seekers crazy because there's just not enough time to go sit next to them all. So much stunning beauty that it almost creates a "beauty-fatigue" because you just can't absorb any more, yet the flow is continuous, like the flow of the rivers throughout the mountains. 

I remember the dreams I had as a young man, who,

was born in the summer of his 27th year
Comin' home to a place he'd never been before
He left yesterday behind him, you might say he was born again
You might say he found a key for every door...

I came West convinced that Id been born again, hoping to start a life of honorable intent and community engagement. 

And then I remember the pain of the culture shock, the failure of my dream, again and again, the return to that which I knew best, a life of drug use, abuse and survival. I remember the unspeakable misery of a heroin and cocaine addiction and a life out of control; the poverty and anguish I forced upon myself and my family. Perhaps worst of all, I remember living homeless, strung out and time spent not caring whether I lived or died.   And I remember why I don't live in the mountains of California and Nevada any more.  

Visiting the West periodically for my work as I continue into my 13th year of recovery is a bittersweet time for me, and I can't tell if I'm maturing further - growing emotionally each time I come here - or I'm being tugged to return here by old hopes and the omnipresence of the Ancients that are infused in everything around me.  There's a sense of spirituality I only get when I'm in the West, and it's I think because I can connect to the cycles involving the earth; wind, water, rock, that remind me everything is renewed, over and over, and we are a part of it all because the atoms that make up our bodies have been around since the earth began precipitating out of the dust cloud in space.

I'm trying to figure out for myself what keeps me longing for a return to the West, yet when I get here, I'm filled with angst, a level of dread, a desire to leave just as quickly as I've come back even, tho I want to wander into all the beauty and rekindle my relationships with the Ancients.

But I've never had a better life than the one I've made with my loving significant other, Dorothy while in the state of Tennessee, and while I'm not in agreement at all with the politics of ANY area of the South, I have to say that Tennessee has treated me beyond well, allowed me to build a life I only dreamed of when I was eking out an existence in the West.

The recovery journey continues, but once again, I'm reminded with my visit to Santa Cruz, CA this week, that the journey does not include a return to the Golden State....

"Pew surveys and economic data have shown the middle class is smaller, poorer, and less optimistic than ever."

"While the Great Recession destroyed many decent-paying jobs, the recovery has mainly added low-paying ones, according to the National Employment Law Project. And most of the people who became re-employed after losing jobs during the recession are earning less than they used to, according to the U.S. Department of Labor."

As a person in my 50s, the news for those of us who are older and trying to survive the economic climate that Obama inherited from devastation of the Bush Presidency is very disconcerting and alarming.  It also helps me understand why elderly homelessness is increasing and is projected to worsen considerably through 2020....

Arthur Delaney Become a fan

arthur@huffingtonpost.com

 

Middle Class Meltdown At DNC

Posted: 09/04/2012 6:49 pm Updated: 09/05/2012 3:00 am

CHARLOTTE, N.C. -- As a lawyer, city council member, and former mayor, Jill Duson figured she would not be unemployed for long when she lost her job as director of Portland, Maine's Department of Rehabilitative Services following a change of administration in January 2011.
She was wrong: Duson spent six months unemployed before taking a part-time seasonal sales job at L.L. Bean.
"I've experienced the meltdown of this economy," Duson, 58, said in an interview next to a melting ice sculpture outside the Democratic National Convention on Tuesday. The 2,000-pound sculpture, a project by artists Nora Ligorano and Marshall Reese, had spelled "MIDDLE CLASS," but "CLA" was all that remained after three hours in the Carolina sun. (The artists crafted a similar sculpture last week for the Republican convention in Tampa, Fla.)

Melting ice is an apt metaphor for the middle class. Pew surveys and economic data have shown the middle class is smaller, poorer, and less optimistic than ever.
Workers in their 50s are less likely than the overall working population to be unemployed, but more likely to experience prolonged unemployment if they do get laid off -- even if they have advanced degrees.
Duson got educated, married, and had saved money. She said the repercussions of losing one job seemed too severe.
"I was first-generation out of poverty and it didn't take much to push me back," she said. "I've done what I thought I was supposed to do."
Now she's doing what she can. In addition to her retail job and position on the Portland City Council (which she said pays a $5,000 annual stipend), Duson said she's picked up another part-time gig as a city agency's compliance manager.
"Between those three jobs, I will make just about half of what I made before," Duson said.
No wonder: While the Great Recession destroyed many decent-paying jobs, the recovery has mainly added low-paying ones, according to the National Employment Law Project. And most of the people who became re-employed after losing jobs during the recession are earning less than they used to, according to the U.S. Department of Labor.
Duson and her son, Nathan Davis, a 20-year-old college student, are both delegates to the Democratic National Convention and strong supporters of President Barack Obama. Republican presidential candidate Mitt Romney has contended that Obama can't tell voters they're better off than they were four years ago. HuffPost asked Duson if she's better off.
"Certainly not financially," Duson said. "But in terms of feeling my government is going in the right direction, yes."
Duson has directly benefited from the Obama administration's policies. She was one of the few beneficiaries of the short-lived Emergency Homeowner Loan Program, which offered forgivable loans to homeowners who suffer dramatic reductions in income. Republicans in the U.S. House of Representatives voted to repeal the program.
"We would have lost our house," Duson said.

Demographics of Homelessness Series: The Rising Elderly Population

National Alliance to End Homelessness Report | April 1, 2010 This is a small excerpt of the report. For more information and to read the full publication, please download the PDF provided There is some troubling evidence that homelessness is beginning to increase among elderly adults. In addition, there are demographic factors — such as the anticipated growth of the elderly population as baby boomers turn 65 years of age and recent reports of increases in the number of homeless adults ages 50 to 64—that suggest a dramatic increase in the elderly homeless population between 2010 and 2020. While the country’s changing demographics may make this finding unsurprising, it has serious implications for providers of homeless services and should be deeply troubling to the policymakers that aim to prevent poverty and homelessness among the elderly through local and federal social welfare programs. This paper provides an assessment of the recent and projected changes in homelessness among the elderly and assesses the ability of public affordable housing programs to handle the projected growth in elderly persons at-risk of housing instability and homelessness. Homelessness Among the Elderly While there is a fair amount known about elders experiencing poverty and about the general homeless population, there is relatively little known about the elderly homeless population. There are some things, however, that we do know: Incidence The elderly population has historically been underrepresented among the homeless population. The limited national homelessness data that have been collected over the past two decades are consistent in revealing that homelessness is much more prevalent among younger adults than among older adults and the elderly. A 1996 national study by the Urban Institute found that, while those over age 55 represented 28 percent of the general adult population, they made up only 8 percent of the homeless population. Changes There is very limited national data on the changing demographics of the homeless population, but the data that do exist show that homelessness among the elderly and older adults is modestly increasing. HUD’s first Annual Homelessness Assessment Report to Congress (AHAR), which covered a three-month period ending in April 2005, estimated that 2.4 percent of sheltered homeless adults were older than 62 years of age.3 HUD’s fourth AHAR, which covered the twelve-month period ending September 2008, showed that 2.8 percent of sheltered homeless adults were older than 62 years of age.4 To the extent that the two data points are comparable, they suggest very modestly increasing representation of the elderly among the homeless. Demographic Changes Among the Elderly There are two primary demographic factors that contribute to the projected increase in homelessness among the elderly. One is the overall growth in the elderly population, which is expected to more than double in size between now and 2050. The other factor is the relative stability in the proportion of the elderly population facing economic vulnerability. Together, these factors signal an increase in elder economic vulnerability and homelessness. The Growing Elderly Population There are more Americans over the age of 65 today than ever before and the number is rapidly increasing. During the past century, the number of elderly people has grown from 3.1 million in 1900 to 37 million in 2008—an increase of over 1,100 percent. The proportion of elderly Americans has also increased since 1900, when adults ages 65 and older made up only 4.1 percent of the population.9 Today, at 37 million, elderly Americans make up 12.6 percent of the population. Economic Vulnerability among the Elderly Poverty among elderly Americans has been relatively low since the 1960s. In 1959, the poverty rate for elder Americans was 35 percent. This fell to approximately 15 percent by 1975, due in large part to increases in government programs such as Social Security. Since that time, poverty rates among the elderly have steadily declined, remaining between 9 and 11 percent for the past decade. According to the 2008 American Community Survey, 9.9 percent of people over 65 years of age had annual incomes below the poverty threshold of $10,326 for a single person and $13,030 for a couple. A measure of even greater economic vulnerability is the proportion of elderly persons in deep poverty — earning only half of the poverty threshold. In 2008, there were over 969,925 elderly persons, or 2.6 percent of the elderly population, in deep poverty. Projected Increase in Homelessness among Elderly In the most recent AHAR, HUD estimates that there were 43,450 sheltered homeless people over the age of 62 in 2008. Because of anticipated increases in the elderly homeless population as the general population ages, a projection of the elderly homeless population is made in this paper. It is based on the following assumptions: The elderly population will increase as projected by the U.S. Census Bureau through 2050. The rate of deep poverty in the elderly population will remain constant at 2 percent through 2050, as it has remained since 1975. The 2008 ratio of 1 sheltered elderly homeless person to every 22 elderly persons in deep poverty remains constant thorough 2050.  As such, homelessness is projected to increase by 33 percent from 44,172 in 2010 to 58,772 in 2020 and will more than double between 2010 and 2050, when over 95,000 elderly persons are projected to be homeless.

The $64,0000 dollar question: How To Increase Housing Availability In Your Community

In about four days from now, I will be standing in front of an audience at the National Healthcare for the Homeless regional training in San Diego with friend, mentor and colleague Dr. Wayne Centrone, sharing with peeps in attendance a presentation Wayne and I have been doing for some time now, Housing Focused Outreach: Building a New Model of Outreach and Engagement. On September 20th, I will be doing the same presentation for a SAMHSA webinar, this time with Ken Kraybill,  another friend, mentor and colleague, as well as the man who is responsible for encouraging me to share my experiential knowledge and expertise gained through lived experience alongside him.

I've done this presentation, or variations of it, a number of times in the past, and I'm intimately familiar with the topic, as well as the many of the questions that arise in an audience when we're presenting it.  For most of the questions that come my way, I am able to offer some guidance and options for folks, but perhaps the most important two questions we're asked during the presentation I'm often at a loss to provide adequate answers for. So what are these questions, you ask?

For those of you who work in my field, you already know the answer and are probably shouting it at your computers right now, but for those who do not, I'm paraphrasing a bit here, but it goes something like this:

"We all get that Housing-First outreach is the way to go, but we don't have any housing to offer folks, and even if we did, we don't have vouchers or the money necessary to get them into the housing that might be available. How do we fix that, oh great gurus of outreach training? Huh?  HUH?"

Yes, this is indeed the $64,0000 dollar question, isn't it?  Because if we had good, viable answers for these two questions, much of our homelessness would end, coming to a screeching halt pretty much overnight. The bad news here is that there aren't a lot of easy answers, and to achieve both a supply of affordable housing and a means to pay for both the units themselves and the rent that is charged for the individual without an income - especially in terms of sustainability of those payments - takes a lot of thought, partnerships, hard work, diligence, persistence and perseverance. 

The research I'm doing around the barriers and challenges to affordable housing at the moment aren't creating any real sense of excitement for me that things are getting better for folks, either.

The Housing and Urban Development (HUD) agency considers housing "affordable" if it costs less than 30 percent of a family's income.  So, if you're living in a residence that costs you $700 a month, you'd need to be earning somewhere in the neighborhood of about $2,300 a month, or around $28K a year to actually "afford" it.

To make $28K a year, you'll need to be earning about $13.50 an hour, and if you want to take home $28K a year, you'll need to earn about $16.50 an hour. There was a report done some years ago here in Nashville by Vandy Proff Melissa Snarr who set the "living" wage in Nashville at about $10.35 an hour.  That number has since jumped to $11.50. For many struggling to find affordable housing, the typical hourly wage paid in the Nashville area for the kind of work that is usually available to them doesn't come close to what is needed to survive. 

So what's the difference between a "living" wage and a "minimum" wage?

Living Wage
According to Merriam Webster's Online Dictionary, living wage is defined as a wage sufficient to provide the necessities and comforts essential to an acceptable standard of living. With an ideal living wage, an individual working 40 hours per week (2,080 hours per year) would be able to afford food, child care, medical, housing, transportation and other expenses for his family if he is the sole provider.

Minimum Wage
According to Merriam Webster's Online Dictionary, minimum wage is defined as a wage fixed by legal authority or by contract as the least that may be paid either to employed persons generally or to a particular category of employed persons. In the U.S., minimum wages are set both nationally and statewide.

And by the way, if you've found yourself an apartment at $700 a month in many American cities, consider yourself damned fortunate, since the median rental price in the US is $1,218, according to the January 2012 Zillow Rent Index (ZRI). In my current hometown of Nashville, TN, there are some one bedroom apartments available around this price, but if you need two bedrooms, you'll be paying considerably more, just about anywhere in the country.

Most of us know damned good and well that there are very few of folks out there in poverty who are actually falling within this 'affordable' housing designation, and typically the few who do are those who are receiving a Section 8, VASH, or Shelter Plus Care voucher to make it so.  I think this holds pretty true as well for a whole buncha folks in the working and middle class as well.  I think those folks, when they're able, try to buy something that both escapes the "low income" housing they are forced into and allows them to experience a piece of "the dream."  If that means they spend more on their housing, than "affordable" be damned. 

But one has to reach the point where they're able to first get some housing so that they can stabilize, begin the efforts to improve their situation, whether through education, employment or a combination of both.  And unless you're born into a family that puts the silver spoon in your mouth, or are particularly lucky in the limited opportunities that present themselves to those without education or connections in the wealthy sphere of influence within our country, you're going to need both employment and education in order to achieve some semblance of 'the dream."

In the meantime, folks are going to need something that tides them over, and that's where the problems begin for them, because finding resources to help a city deal with trying to increase the supply of affordable housing ain't easy.  Purchasing, building and/or renovating multiple dwelling homes or apartments is costly.  There's pushback in just about any neighborhood, as residents come out in force to keep 'those people' from locating nearby and supposedly lowering the property values while - again supposedly - generally destroying the neighborhood with their 'bad behavior."
Developers don't jump at the chance to build affordable housing, either, since their profit margin is tiny or non-existent compared to building higher end homes and condos. But one of the "primary reasons " affordable housing is sparse, according to HUD, is due to  

"local government policies that increase building costs and/or restrict the supply of housing."

So how then, can we work to increase the available supply of affordable housing?  PolicyLink has a pretty nifty toolkit that lays out what's needed:

"Creating housing opportunities located near jobs, transit, schools and other neighborhood amenities for residents of all incomes is key to building prosperous regions. Strategies can Protect Tenants and Rental Housing; Stabilize and Improve Neighborhoods; Promote Community and Resident Ownership; Leverage Market Activity; Generate Capital; and Expand the Affordable Housing Stock."

I won't pretend to tell you I know this information like the back of my hand, because I don't. I was more concerned with pointing the folks on the street to the folks who rented the housing.  It was only when I realized that we didn't have any housing within reach of most of the folks I know who are eking out their existence with day labor or low-wage jobs.   Now, I want to make sure YOU know it's available so that you're not scratching your head wondering where even to begin when this issue of increasing affordable housing arises in your community; because it does on a regular basis. 

To be sure, there are other resources available, and one of the critical "must have" items is the National Low Income Housing Coalition's Advocate's Guide. Also essential is spending some time with the good folks from the Pathways to Housing 100,000 Homes Campaign, Becky Kanis and Linda Kaufman.  Becky and Linda are easy to reach and want - WANT - to help your community increase its supply of affordable housing.  They do this by raising awareness of the impact a community suffers when people in it are living homeless and prioritizing those who create the biggest impact to that community.

http://welcometocup.org/Projects/EnvisioningDevelopment

The Center for Urban Pedagogy has some nifty info as well that's worth checking out, too, and helps to demystify the process.

Another resource I would point you to comes from the National Healthcare for the Homeless Council's website,  "The Advo-Kit." This is a critical resource because it helps dispel the myths and stereotypes associated with persons experiencing homelessness.  Half the battle is raising the knowledge level of the general public to understand the causes of homelessness and the people who are experiencing it and until that is addressed, the battle for affordable housing has a much steeper climb.

There are undoubtedly more good resources available, as I know there are a number of people and organizations that are currently engaged in creating toolkits and curriculum's designed to help those interested in increasing affordable housing in their own communities.  The resources I've provided here are simply a start, and even if you're not actively involved in ensuring affordable housing is available in your area, it behooves you to know the challenges and the benefits of increasing the stock, since the lack of housing directly affects you and your community, whether you want to believe it or not.

I won't kid you either, increasing the stock of affordable housing in a given area is challenging.  It can be demoralizing and disheartening work as well, since the results of the effort take time to realize. But for those of us who're watching our brothers and sisters die on the streets, we're running out of time, which is a luxury we simply don't have anymore....

Pathways to Housing

100,000 Homes Campaign

PolicyLink Affordable Housing Tool Group

National Low Income Housing Coalition Advocate's Guide

National Healthcare for the Homeless

Advo-Kit

Center for Urban Pedagogy

Envisioning Development

Military Spending: $600+ Billion / Homeless Assistance spending: $1.79 Billion

I don't think there is anything in the public sphere that outrages me more than the obscene and morally reprehensible difference between what we spend on the military and what we spend on affordable housing in this country.

My good friends over at the National Coalition for the Homeless drive home this point succinctly with a great fact sheet:

Military Spending vs. Affordable Housing and Veteran’s Affairs Spending

Published by the National Coalition for the Homeless, July 2009

---

“In the councils of government, we must guard against the acquisition of unwarranted influence, whether sought or unsought, by the military industrial complex.”
-Dwight D. Eisenhower, Farewell Address, Jan. 17, 1961

The President’s Budget request for FY10 suggests giving the Department of Defense a budget of $533.7 billion.  The Budget includes funding to increase the size of both the Army and the Marine Corps by sustaining permanent forces. Additionally, there is a request for $130.0 billion in supplemental appropriations in order to draw troops away from Iraq and into Afghanistan (Department of Defense).
The amount that the government spends on the war compared to what it spends on affordable housing and taking care of its war veterans alarmingly show where the values of our nation lie. As we have seen from our history with the Vietnam War and the War on Poverty, armed conflict distracts our nation from the dire domestic problems.
The Department of Housing and Urban Development has a remarkably smaller budget compared to the Defense budget at request at $46.3 billion for FY 2010. Only $1.79 billion from the entire budget is devoted to “homeless assistance grants”. This amount might be able to alleviate homelessness in one state.
For the Department of Veterans’ Affairs, the President has a budget of $112.8 billion for FY 2010, increasing 15% from 2009.  The Department of Veterans Affairs also boasts that its homeless assistance programs constitute the largest integrated network of services in the United States.  Veterans’ Affairs budget allocates $3.222 billion to combating homelessness (Department of Veterans Affairs). The National Coalition for Homeless Veterans says that of the 400,000 homeless veterans on the street any given night, the Department of Veterans Affairs reaches only about 25% of them.
Obviously, the federal government has the resources to provide significant aid to homeless people but still lacks the will to end homelessness in America.

RESOURCES:

Veterans’ Affairs. “VA 2010 Budget Fast Facts,” 2009. 1722 I Street N.W. Washington D.C., 20421.
National Coalition for Homeless Veterans. “Background & Statistics,” 2005. 333 ½ Pennsylvania Avenue, SE, Washington, DC 20003-1148.

That we spend something like 5 times what the next nearest country spends on their military - some $600 billion plus annually - while even one person in our country goes homeless, hungry and mired in ever-increasing poverty- should not only give pause to everyone who cares about their community, it should also rise to the level of a national discussion. Yet we rarely hear from those we "choose" to represent us in our government about this lopsided and frankly conscience-shocking comparison.

And when the issue is raised, rational voices expressing shock and dismay about this ratio are immediately drowned out by hawks and warmongers who claim those voices make America "weak" or that reducing the Defense budget will mean job losses.  Military spending props up a lot of cities and pours billions into local coffers, so it doesn't take a lot of brainpower to realize that politicians have a vested interest in not just maintaining the status quo. but increasing military spending whenever and wherever it is possible.

My answer is simple, really, but of course will be screamed down by those who think gunbarrel dipomacy is effective and that "everyone wants to live like an American": cut the military budget in half and use that money in one of two ways - either pay down the National Debt, or use the money to raise the minimum wage, provide subsidies to small businesses that hire people with "living"-wage rates based on the cities they're in rather than a "minimum" wage, and invest in improvements in education and workforce development across the board for the American people.   

We won't end homelessness simply by providing additional housing.  We've got to assist people in learning how to be successful contributors within our communities.  We do that by paying a person a livable wage, ensuring they have the education and skills to function in a technologically sophisticated environment, and we need to ensure they have at their disposal all the tools they will need to become successful in that process.

Until we begin addressing the systemic issues facing our country, reassess our priorities, and make some fundamental shifts about the way we support our own people, I'm afraid all of our efforts at ending homelessness, reducing poverty, and providing people with a real opportunity to live an "American Dream" will simply be like arranging deck chairs on the Titanic for the best views of the iceberg.

"new face of homelessness in a deepening foreclosure and economic crisis: the American family"...And the Elderly

My friend and colleague Diane Nilan and I recently shared a brief discussion on the issue of family homelessness and that discussion reminded me of my own experience with the "new faces of homelessness," especially during time time I was the Veteran Services Coordinator at Operation Stand Down Nasvhille, Inc(OSDN).

Prior to working for OSDN, I was providing street outreach for a co-occuring service provider and in that capacity, was working primarily with the folks most people immediately think of when they think of the stereotypical image of someone experiencing homelessness.  Since I would certainly have been considered one of those "stereotypical" individuals prior to entering my own recovery back in 1999, I know first-hand that they are far from the stigmatized view so many have, since each one of those individuals comes to the table with a life, loved ones who care or at least once cared, and none ever saw their lives travel the course that left them destitute, homeless, and broken on a city street.

To be sure, plenty of the veterans experiencing homelessness I worked with at OSDN would have- and have been - inappropriately "stereotyped" and as a result stigmatized because of their appearance.  But something else was happening at OSDN as we moved into 2010 that provoked emotions of fear and trepidation among many who had for a long time been working with those experiencing homelessness and had seen a lot of misery and heard a lot of sad stories.

That "something else" was a frighteningly large wave of couples and families who, to the very last one, would always start their client intake with, "I've worked all my life and never thought this would happen to me." This "wave" continues crashing down upon direct service providers across all areas of our community, but what made it particularly powerful to those of us at OSDN was that we were dealing with veterans, and veterans who'd been actively engaged in work, community and family for their entire lives.

That these veterans, who were well connected, had well established networks of support and employment resources, and even qualified to receive preferential hiring status in some jobs were suddenly out of work and desperately seeking jobs that were non-existent, was a very scary wake-up call for all of us, indeed.

In 2012, the entire nation has awakened to the new face of homelessness, although ignorance and stigma still abound within many communities and continues to hamper even the most herculean efforts put forth by those currently homeless and struggling to get back on their feet and regain some sense of normalcy in their lives again.

To make matters worse, the federal government has been unable to change policy fast enough to be able to provide critical early assistance to people, exacerbating further the plight of those stuck on the streets as a direct result of a slowed economy and a housing foreclosure crisis.

What this means to them - and to those who provide direct services - is that when families, couples or individuals finally set aside their pride and their longstanding, inculcated sense of self reliance to humble themselves enough to ask for help, they discover that there is very little help available to them beyond some time at a typically filled to capacity shelter. That shelter often splits up the men and women, and can even split up children - especially male children - who reach a particular age and are then regulated out of the shelter with their mom and into the men's shelter.
For most families, this is simply unacceptable, since they've been clinging to each other for strength and comfort since they began experiencing problems.

For single parent women faced with more time on the streets together or sending their oldest son into a men's shelter, just about any mother out there will tell you what the decision is going to be, since mom needs the kids close at hand as they cope and overcome the challenges together. 

All of these new faces realize early on that something is horribly wrong with a system that can't step in with a small level of assistance before they end up homeless on the streets, and then force some of them to wait for months while homeless before they even qualify as 'homeless."  To its credit, HUD has worked to change the definition of "homelessness" and has tried to be more inclusive and proactive by making it slightly easier to intervene earlier. 

But the truth is, by the time most of these families reach the point of qualifying for help, they've left a trail of debt, eviction and default in their wake, which makes extricating themselves from the systemic issues that bring about homelessness that much more challenging to overcome.

Think for a moment about your own response to a job loss; most likely, you'd first go through your savings trying to stay on top of the basic bills (rent, utilities, car payment) as you desperately hunt for a job, and the "non-essential" things would start to fall behind (cable bills, insurance premiums for health and vehicle, healthier foodstuffs, etc).  As the month ends with no job offer in sight and your savings starts showing severe signs of depletion, you begin trying to work deals with your creditors, only to find that because you haven't yet received eviction or turnoff notices, you don't yet qualify. At about the three month mark, the eviction and turnoff notices arrive, and if you're unaware of the timing of application for local community assistance sources, chances are that by the time you learn they are available to assist you, they're out of funds for the month.

Now, with credit ruined, turnoff notices for essential utilities stacked on the table, and forced removal from your residence imminent, you begin to consider government social services.  But even if you're lucky enough to actually qualify, the application period can take up to 90 days to begin receiving food stamps, and the days of big welfare checks are long gone, so this is not going to help you catch up on your utility bills and your rent.

Finally the day comes, the Sheriff arrives and sets you, your family and the possessions you have left after you've pawned and yard-saled everything you had of value,  onto the curb, destitute, terrified, and trying to keep some dignity and hope alive for the rest of your family. With all pride long since stripped away, you humbly try to find someone - anyone - that might be able to help you, because surely that lavish safety net we hear the politicians saying needs to be reduced further has some help available to you.

Unfortunately, there's not a lot we as providers can offer you yet.  Your efforts to sustain yourself, you discover, have worked against you, and you discover that the safety net you thought protected those who'd hit bottom has been so gutted that the only assistance available is typically for the most vulnerable, the "chronically" homeless, the addicted, the severely mental ill.  To reach this eligibility, you realize that things are going to have to get worse, much worse, before you have a chance at making them better, and for many, this is the last straw.

If there is any bright spot to any of this, it is that many of these people will succeed in spite of the challenges they face, because they are inculcated and determined and motivated to do so.  And what they will remember about this experience is that we as a nation have failed to ensure that our safety net works for everyone, and not just the very worst of the worst.  These people traditionally vote, and they also speak out, both of which they will be doing as they recover their dignity and their lives over the next several years.  And they will remember how hard it was for them, and I'm counting on the fact that these people will be the ones who help drive our public policy in the proper direction, so that anyone who finds themselves facing homelessness has options long before they ever have to begin the slide into it.

New Face Of Homelessness: The American Family

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  December 25, 2010

A new study reveals a new face of homelessness in a deepening foreclosure and economic crisis: the American family. Host Guy Raz tells the story of three families who have faced homelessness in the past year. Raz also speaks to Maria Foscarinis of the National Law Center on Homelessness and Poverty.

GUY RAZ, host:
From NPR News, this is ALL THINGS CONSIDERED. I'm Guy Raz.
If you look at the year in economic statistics, you could tell two different stories of two different Americas. The Dow Jones Industrial Average reached a two-year high this week: retail sales, industrial production, factory orders, all are up. And the biggest corporations are posting healthy profits. And yet, hidden among all these trends is one that was released this past week by the U.S. Conference of Mayors.
In 2010, cities across America saw a 9 percent increase in the number of families seeking emergency shelter. One out of 200 people in America slept in a homeless shelter this past year. The homeless crisis now affects more families, people who just a year or two ago had jobs, apartments, relatively stable lives that affects more families in that any other time in recent history.
And so on this Christmas Day, we bring you the stories of three of those families: the Gibsons from Washington, D.C.; the Stewarts from Salt Lake City, Utah; and the Browns, also from Utah.
We start with the story of Jamie Stewart(ph).
Ms. JAMIE STEWART: I have to be here with my daughter and grandson. I mean, not being able to have our own house and - because I know I'm better - well, not better than that, but I mean, I know I can do it. It's just - the work is just hard after hard. You know, you go to an (unintelligible), there's 15 people there. And (unintelligible) always is to having my own place and being able to provide for my family, which I can't right now.
RAZ: Jamie Stewart lives in the shelter for homeless families with her 18-year-old daughter Emilia(ph) and Emilia's 3-month-old son in Salt Lake City. You just heard Emilia patting his back in that clip.
Jamie left Arizona earlier this year with Emilia and the baby to tend to her dying father in Utah. They lived with her sister for a few weeks; eventually in a car for another week. Jamie thought she'd find a job pretty quickly. She's a nurse, and maybe getting apartment. But she hasn't, except for some seasonal work with UPS.
Ms. STEWART: It's sad. In the first place, I don't have, you know, we don't have our own place. We don't have it free. I just haven't really even thought about the holidays. I haven't. I'm not shopping. I'm not buying for anybody. I'm not - because, of course, I'm saving my money to get a place and to...
Ms. EMILIA STEWART: It's definitely hard just because it's my son's first Christmas and we can't really celebrate out. We can't really buy him the things that we need for him. And so definitely makes it a lot harder knowing and having to look at my mom and not watch her open Christmas presents, Christmas morning and (unintelligible) people say that they know how it is. They - but they don't.
So I tend to ask them, have you ever looked down at your 3-month-year-old son not knowing where you're going to be next, or if you're going to have a roof over your head, or diapers to put on him, or a bottle to feed him? It's hard.
RAZ: That's Jamie and Emilia Stewart in Salt Lake City, Utah.
Mr. DAVID BROWN: My name is David Brown. I'm 31. I'm living currently out here in Magna, Utah.
RAZ: Exactly a year ago, David Brown lost his job at Wal-Mart. And for most of this year, David and his wife Nicole and their four kids, 11-year-old Chloe, 9-year-old Seth, 5-year-old Cameron, and J.J.(ph) who's 2, have been homeless.
Mr. BROWN: You know, we were avoiding the actual shelter itself at all cost. You know, staying with family member here or family member there, ending up staying in the pop-up trailer in your friend's driveway. You know, we were doing pretty much everything we had to to avoid the shelter.
RAZ: At one point, the whole family slept in their van.
Mr. BROWN: You know, when you're in that type of situation, it's not easy to sleep because, you know, kids are scared, of course, and, you know, that's who you're there for, is you're there to let the children know that everything is going to be okay and you're not going to let anything happen.
So, you know, constant cars driving by, you never know what's about to happen. If, you know, someone's looking the brake into a car and they'd stop in the pit the wrong one, you know? So I'd remember there was like very little to no sleep at all. I think I slept maybe a total of 45 minutes.
RAZ: The family did end up in the shelter for sometime. Luckily, David Brown found a job a few months ago, and the family now lives in an apartment in Magna, Utah.
Mr. BROWN: You know, there's a lot of things you look at in life and there's a lot of times in life where you would look at a situation, and that's the first thing that comes in your head, and that happened to me, you know? And I can honestly say that as far as being homeless, I was one of those skeptics that believed it will never happen to me.
You just never know where life's going to take you. And you may think that everything is fine and great one day and wake up the next and have everything passed down around you. And it's possible to (unintelligible).
Mr. ANTONIO GIBSON: My name is Antonio Gibson. I'm 28 years old. And I reside in Washington, D.C.
RAZ: Statistically, Antonio Gibson doesn't even exist. It's not often academic studies or towering speeches are devoted to single black fathers. Antonio raises his two kids, 9-year-old Navia(ph) and 3-year-old Antonio Jr., by himself.
Last year, the mother of his two kids left after she lost her job at Bank of America. At the time, Antonio was a part-time janitor. He cleaned floors at NASA headquarters at night.
Mr. GIBSON: I tried to, with my part-time job, maintain the bills and the household and all the other necessities. But after a while, I guess it became a little bit too much, and we've gotten debt with the rent and with other bills and everything and we received our very first eviction threat.
RAZ: That was last November. And for most of the past 13 months, Antonio, Navia and Antonio Jr. lived in a car. He would tell Navia that they were camping or that the house was being renovated. He tried to find temporary housing, but all of them were full. And each time, he was turned away.
So at night, Antonio would park the car in the garage of an abandoned house. He'd crack the windows for ventilation and say goodnight to his kids.
Mr. GIBSON: Looking in the backseat while they were sleeping in the car, it was just breaking me down, emotionally and mentally, you know? And I can also see a change in my daughter, you know, like she didn't talk no more. She was afraid to go to school, you know? And she always loves school since she was like 5 years old. So I just saw their big change, and then I knew that that's where it was coming from.
I would wake up at 7 a.m. in the morning and (unintelligible) tap water to (unintelligible), wash our face, brush our teeth or try to change their clothes. And I'll first drop my daughter off to her school at 8 o'clock. And drop my son off the daycare around 8, 8:30.
You know, I used to read them a story in the car, little books. They have this thing at my son's school called lending library, where you can get a book every day, bring it back every day. So, and we get a different book every day, and it was cool because they would go to sleep real easy with that, you know? So that was my daily routine.
RAZ: After 11 months in the car, the Gibsons finally managed to get a place through the city's Housing Authority. He's on food stamps now and paying rent with help from a local church.
Now, a moment ago, I mentioned new figures that show a 9 percent increase in homeless families in cities across America this year.
Maria Foscarinis with the National Law Center on Homelessness and Poverty says as dramatic as that number sounds, it's probably even higher.
Ms. MARIA FOSCARINIS (Founder/Executive Director, National Law Center on Homelessness and Poverty): Because what they are measuring is numbers of families who are seeking emergency shelter.
RAZ: Showing up at shelters.
Ms. FOSCARINIS: Yes. And so by definition, that number is limited by existing shelter capacity, which we know is grossly insufficient to meet a need. The national estimate is that only about half of all homeless people are actually sheltered, and that's due to lack of shelter capacity.
RAZ: How do budget cuts in states and municipalities begin to make the problem worse? Because, of course, we haven't really seen the full impact of this budget cuts yet.
Ms. FOSCARINIS: Exactly. Just this week, the D.C. City Council, since we're here in Washington, the local government passed a law that limits services here in Washington to people who can prove that they're D.C. residents. And this is supremely ironic and misconceived in our view because a big problem when you're homeless is you don't have ID, or it becomes very difficult to prove residency. But it's an indicator of the city trying to conserve its own resources.
RAZ: You're hearing reports of homeless shelters having to turn people away very, very frequently.
Ms. FOSCARINIS: Absolutely. And the U.S. Conference of Mayors report that was just released earlier this week show - said that 27 percent of requests for emergency shelter on average were turned away.
RAZ: Twenty-seven percent.
Ms. FOSCARINIS: On average. And again, this is likely understating the problem, because at a certain point, people just give up.
RAZ: I mean, realistically, what could be done over the next two years? I mean, you're well aware that Congress is on a budget-cutting kick, the American public is demanding this. What can be done to begin to tackle this issue?
Ms. FOSCARINIS: Budget is obviously critical and it's really a matter of where our priorities are as a nation. So I think we know that if something is considered important, money can be found and money can be spent.
Banks were considered too big to fail. Well, I think we have to start thinking that in a country, such as the United States, that allowing people to be homeless, allowing children to go without a place to lay their heads at night is not something we will tolerate, and we have to be able to find the money to stop that, to ensure that everybody has a place to live.
RAZ: That's Maria Foscarinis. She is the executive director of the National Law Center on Homelessness and Poverty here in Washington, D.C.
Maria, thank you for being here.
Ms. FOSCARINIS: Thank you, Guy.
RAZ: If you're interested in finding out more about the groups that have helped the families we heard from earlier in the segment, here are a few websites: The Washington Legal Clinic for the Homeless helped Antonio Gibson find public housing. They're at legalclinic.org. Family Promise helped the Browns and Stewarts. They're at fpsl.org. And thanks to Catholic Charities in Washington, D.C., for helping us this week with the story. You can find their website at catholiccharitiesdc.org.
You're listening to ALL THINGS CONSIDERED from NPR News.

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Mills: The new face of homelessness

Published: July 19, 2012 6:00 PM
By NICOLAUS MILLS

Photo credit: Donna Grethen / Tribune Media Services | "These days poverty is less and less a remote phenomenon," writes Nicolaus Mills. 

She has picked the perfect spot to be noticed -- right between a subway stop and an upscale deli on New York's Upper West Side. But she seems to crave privacy. Never does she initiate eye contact. Never does she start a conversation. Her preference is to sit quietly on a foot stool reading a book.
Yet more often than not, the aluminum beverage cup that sits in front of her stool has dollar bills in it.
I have given her some of those dollars. "God bless you," she said once. Another time, it was simply "Thank you."

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The homeless men who in the past asked for handouts on the same block did not do so well. They rarely got more quarters than nickels. Even holding the door open for the customers of a nearby bagel shop rarely worked for them.
The woman to whom I and others walking along this Upper West Side sidewalk having been giving dollar bills looks different from the homeless men she has replaced. She is tastefully dressed. Her gray hair is clean. She doesn't talk to herself. She is white.
She is the new face of homelessness, and from what I can tell, her presence frightens passersby. They see themselves in her, and they are right to do so. "Homeless, Scared, and Hungry" she wrote one day on a cardboard sign she put next to her stool. It was easy to believe her.
These days poverty is less and less a remote phenomenon. In the last decade, those living under the poverty line in the suburbs grew by 66 percent while the overall suburban population barely changed. Even having a job is no guarantee of staying out of poverty any longer; 7.2 percent of those the government says are employed are living below the poverty line, and 150 million Americans are no more than two paychecks away from falling into poverty. In our high cost-of-living region, the stakes can be even higher.
In the case of the woman on the stool, it is hard to imagine that she became homeless through her own fault. Her neat appearance and visible shyness make it seem more likely that terrible luck, rather than a personal failing or mental illness, is the source of her trouble. She resembles a kindly aunt who has, for the moment, sat down to rest on a hot summer day.
I hope she keeps getting dollars rather than loose change. But I worry that the dollar donations I am talking about say something terrible about the way we have in the past stereotyped homelessness. It should not take a middle-class-appearing woman asking for money to jar us into giving.
During the Great Depression John Steinbeck in "The Grapes of Wrath" and James Agee and Walker Evans in "Let Us Now Praise Famous Men" took us inside the heads of the poor, making sure we didn't just see them as anonymous Okies or faceless sharecroppers. We have lost that egalitarian sensibility, and we need to get it back. If it takes a woman who looks as if she has always had a roof over her head to help accelerate that change, so be it.
Anything is better than the quiet racism that let so many passersby pay scant attention to the African-American homeless people who, in the past, dominated this small New York block.