"“Caffeine-induced psychosis, whether it be delirium, manic depression, schizophrenia, or merely an anxiety syndrome, in most cases will be hard to differentiate from organic or non-organic psychoses…."

Who knew I could have simply cut down on the number of pots I drank each morning and saved myself untold grief and misery???

Toxicologists: Caffeine poisoning masquerades as anxiety, manic depression, schizophrenia

“Caffeine-induced psychosis, whether it be delirium, manic depression, schizophrenia, or merely an anxiety syndrome, in most cases will be hard to differentiate from organic or non-organic psychoses….
The treatment for caffeine-induced psychosis is to withhold further caffeine.”

Clinical Management of Poisoning and Drug Overdose, 3rd ed., 1998 Link
Michael W. Shannon, MD, MPH, Director, Lead and Toxicology Clinic, The Children’s Hospital; Associate Professor of Pediatrics, Harvard Medical School; Staff Toxicologist, Massachusetts Poison Control System
Lester M. Haddad, MD, Clinical Professor in Family Medicine, Medical University of South Carolina; Emergency Physician and Active Staff, Bon Secours St. Francis Xavier Hospital
James F. Winchester, MD, Professor of Medicine, Division of Nephrology, Georgetown University Medical Center

Medscape: “Patients who become caffeine-toxic may not even realize it.”

“Too often, patients presenting with complaints of some form of anxiety do not have a careful caffeine history taken. Caffeinated beverages, particularly strong ones, have become immensely popular in social situations and need to be asked about. Television shows popularize sitting in coffeehouses for long periods of time drinking coffee. Multiple new beverages have entered the market place with increasing amounts of caffeine.

Virtually none of the media associated with all of this mentions anything about caffeine toxicity. As a result, patients who become caffeine-toxic may not even realize it. They may need to be educated that the amount of caffeine they are ingesting simply to be social is making them feel uncomfortable.”

Medscape: Dual Diagnoses, New Perspectives Link

Renowned allergist: Thousands are in mental institutions because of caffeine

“Thousands are in mental institutions today because of no greater matter than that of the use of caffeine. Psychiatrists are now publishing articles indicating that there are numerous cases of depression and anxiety in mental institutions who need no other treatment than to be taken off caffeine. It would seem that with such a simple remedy available, many thousands of people could be returned to their full usefulness promptly.

“However, the use of caffeine is so traditional and firmly entrenched that it is almost impossible to remove caffeinated drinks from the diet of patients in the mental institutions. Soft drink machines, coffee dispensers, and the traditional coffee break are common pastimes in mental institutions, and with those who are mentally ill at home.”

Calvin Thrash, M.D., Author, Food Allergies Made Simple

British Journal of Addiction: 1 in 10 people caffeine-intoxicated

“Although infrequently diagnosed, caffeinism is thought to afflict as many as one person in ten of the population.”

JE James and KP Stirling, “Caffeine: A Summary of Some of the Known and Suspected Deleterious Habits of Habitual Use,” British Journal of Addiction, 1983;78:251-58. Link

British medical journal survey finds 40% of hospital inpatients caffeine-intoxicated

“[When caffeine is taken in excess], anxiety-related symptoms become increasingly apparent. A case of caffeinism, which presented as a paranoid delusion, is reported as an extreme example of this. A study of 60 hospital inpatients revealed that about 40% of them consumed sufficient caffeine to produce symptoms of caffeinism. It is thus recommended that all patients should be questioned on their caffeine intake. Also, caffeinism should be considered as a differential diagnosis of anxiety states.”

DC Mackay and JW Rollins, “Caffeine and caffeinism,” Journal of the Royal Naval Medical Service, 1989;75(2):65-7. Link

Johns Hopkins University School of Medicine: Patients may fail to recognize caffeine-induced symptoms

“The potential for caffeine intoxication to cause clinically significant distress is reflected by the inclusion of caffeine intoxication as a diagnosis in DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition)(American Psychiatric Association, 1994) and in ICD-10 (International Statistical Classification of Diseases and Related Health Problems, Tenth Edition)(World Health Organization).”





“Studies have shown that high dietary doses of caffeine (200 mg or more) increase anxiety ratings and induce panic attacks in the general population. In the United States the average per capita daily intake among adult caffeine consumers is 280 milligrams (the equivalent of 17 ounces of brewed coffee).”

“Although highly anxious individuals tend to be more likely to limit their caffeine use, not all individuals with anxiety problems naturally avoid caffeine, and some may fail to recognize the role that caffeine is playing in their anxiety symptoms.”

“It has been noted that caffeine intoxication can occur in someone who has been using caffeine for many years with no prior apparent problems.”

Roland R. Griffiths, Ph.D, The Johns Hopkins University School of Medicine
Professor of Behavioral Biology, Department of Psychiatry & Behavioral Sciences
Professor of Neuroscience, Department of Neuroscience
Link

The Institute of Legal Medicine: “Coffee overindulgence is overlooked many times because the bizarre symptoms may resemble and masquerade as an organic or mental disease.”

“Coffee excesses can elicit symptoms of violent behavior in some persons; but what a feeling of relief to both physician and patient to see the symptoms completely disappear on the physician’s order to stop drinking coffee….”

“The symptoms vary with acquired or inborn tolerance, but in general the patients may complain of light headedness, dizziness, breathlessness, chest discomfort, nervousness, irritability, tremulousness, muscle twitching, tension headache, insomnia (difficulty in getting to sleep or staying asleep), psychoneurosis (anxiety), lack of appetite, loss of weight, restlessness, silliness, elation, euphoria, confusion, disorientation, excitation, and even violent behavior with wild, inanic screaming, kicking and biting, progressing to semi-stupor.”

“The symptoms of caffeine overdose are varied and bizarre and could be easily misinterpreted….Coffee overindulgence is overlooked many times because the bizarre symptoms may resemble and masquerade as an organic or mental disease.”

Sidney Kaye, PhD, of the Institute of Legal Medicine

DSM-IV on “Caffeine-Induced Psychiatric Disorders”

“The 4 caffeine-induced psychiatric disorders include caffeine intoxication, caffeine-induced anxiety disorder, caffeine-induced sleep disorder, and caffeine-related disorder not otherwise specified (NOS).”

Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) Link

Clinical nutritionist: Caffeinated persons are routinely “misdiagnosed as neurotic or even psychotic”

“In over a decade of practice as a clinical nutritionist, I have seen firsthand, with thousands of clients, that caffeine is a health hazard. Anxiety, muscle aches, PMS, headaches….However, if that’s all caffeine has done to you, you’re lucky. What about people misdiagnosed as neurotic or even psychotic, who spend years and small fortunes in psychotherapy–all because no one asked them about their caffeine intake?”

Nutritional biochemist Stephen Cherniske, in Caffeine Blues: Wake Up to the Dangers of America’s #1 Drug

Journal of the American Medical Association: Caffeine induces “psychological problems”

“The existence of a caffeine dependence syndrome, which includes evidence of continued caffeine consumption depite medical or psychological problems from caffeine consumption and unsuccessful efforts to quit caffeine use, provides a further similarity between caffeine and classic drugs of dependence.”

EC Strain, GK Mumford, K Silverman et al., “Caffeine Dependence Syndrome: Evidence from case histories and experimental evaluations.” Journal of the American Medical Association, 1995;273:1418-19. Link

Psychiatrists: “Psychosis can be induced in normal individuals ingesting caffeine at toxic doses.”

“Psychosis can be induced in normal individuals ingesting caffeine at toxic doses, and psychotic symptoms can also be worsened in schizophrenic patients using caffeine….Prevention of caffeine-induced psychiatric symptoms is possible by recognizing, educating, and treating patients using a tapering approach.”

Broderick P, Benjamin AB, Caffeine and psychiatric symptoms: A Review; J Okla State Medical Assoc, 2004 Dec; 97(12):538-42

Caffeine expert: Caffeine produces anxiety, psychotic states, toxic dementia

“An allergic reaction to caffeine manifests as anaphylaxis. During a state of caffeine anaphylaxis, the body enters the fight or flight mode, which may be mistaken as hyperactivity, anxiety, or panic disorder. Caffeine anaphylaxis causes cerebral vasculitis, leads to the breakdown of the blood brain barrier, and generates toxic dementia.”

“Symptoms range from minimal reactions to severe psychotic states, which may include irrational behavior, disruptions in attention, lack of focus and comprehension, mood changes, lack of organizational skills, abrupt shifting of activities, delusions, hallucinations, and paranoia.”

“An allergic reaction to caffeine results in poisoning of the prefrontal cortex. Damage to the underside area on the prefrontal cortex, above the eye sockets, generally renders a person absent minded and interferes with the ability to monitor personal activities (Carter, 1998). Injury results in loss of verbal and social inhibition….”
“While others may notice menacing changes in behavior or personality changes, the victim may not.”

Ruth Whalen, MLT

Material Safety Data Sheet on caffeine exposure: Hallucinations, nervousness, psychosis

While the FDA labels caffeine as GRAS (”Generally Regarded As Safe”), chemical manufacturers are required by law to label caffeine “potentially fatal if inhaled, swallowed or absorbed through the skin” when handling and transporting it. Following is an excerpt from one Material Data Safety Sheet, courtesy of the University of California:
CAFFEINE:
TOXIC.

  ACUTE EXPOSURE- Ingestion of large amounts may result in headache, lightheadedness, dizziness, chills, fever, excitement, restlessness, nervousness, insomnia, mild delirium, hallucinations, tinnitus, constricted pupils, decreased visual fields, amblyopia,diplopia, photophobia, and scintillating scotoma. Neurologic symptoms may persist for several days….Other effects may include alternating states of consciousness and muscle twitching, tremors, hyperesthesia, hypertonicity or hypotonicity, trismus, opisthotonus and convulsions.  Seizures generally precede death.

  CHRONIC EXPOSURE- In addition to the effects detailed in acute exposure,  agitation, disturbed sleep, caffeine-induced psychosis, heartburn and hyperventilation may occur. Prolonged use of high doses may result in tolerence, physical and psychological dependence. Symptoms of withdrawal may occur following abrupt cessation.

University of California Material Safety Data Sheet

Eminent pharmacologist: Caffeine causes depression

“There is no doubt that the excitation of the central nervous system produced by large amounts of caffeine is followed by depression.”

J. Murdoch Ritchie, Professor Emeritus, Department of Pharmacology, Yale University School of Medicine, in The Pharmacological Basis of Therapeutics, Goodman and Gilman eds.

 

Biochemist finds 50% of anxiety cases caffeine-induced

“If a person were injected with 500 milligrams of caffeine [less than the dosage recently discovered in some 16-ounce Starbucks brews], within about an hour he or she would exhibit symptoms of severe mental illness, among them hallucinations, paranoia, panic, mania, and depression. But the same amount of caffeine administered over the course of a day only produces the milder forms of insanity for which we take tranquilizers and antidepressants.”

“For five years I worked in a team practice with physicians and psychotherapists. Often, the psychological evaluation would include one or more anxiety syndromes, and the recommendation was for counseling. I would point out that the person was consuming excessive amounts of caffeine and request a trial month off caffeine prior to therapy sessions. In about 50% of cases, the anxiety syndrome would resolve with caffeine withdrawal alone.”

Nutritional biochemist Stephen Cherniske, Author, Caffeine Blues: Wake Up to the Dangers of America’s #1 Drug

“Too many clinical histories fail to record caffeine use.”

“Diagnosis of any caffeine-related disorder begins with clinical awareness. Beverage caffeine is such a common component of social activity that its consideration as a psychostimulant often is neglected.”
“Too many clinical histories fail to record caffeine use. A complete caffeine history includes doses associated with beverages and medications….The observable signs associated with caffeine consumption are dose dependent. For most individuals who consume caffeine in the average range, the physical stigmata will include arousal signs. Expect to see nervousness, elevated heart rate, increased respiratory rate, flushed face, and an exaggerated startle response. Caffeine is a mild diuretic and may contribute to vague gastrointestinal complaints. In rare cases where an individual’s dose exceeds 1 gram per day, the picture changes. Gross muscle tremors, highly disorganized speech, and possible arrhythmias herald a more sinister outcome.” [CaffeineWeb note: One gram has long been considered the toxic dose of caffeine, but it may not be as rare as supposed. A recent study published in the Journal of Analytical Toxicology found that two 16 oz. Starbucks coffees may contain in excess of one gram.]

R. Gregory Lande, DO, FACN, Deputy and Director of Professional Services, Department of Clinical Administration, William S. Hall Psychiatric Institute, University of South Carolina

Journal of Orthomolecular Psychiatry: Caffeine-induced psychosis may be mistaken for true psychosis

“Recently published studies and reports of personal observations have shown without doubt that caffeine abuse (caffeinism) may result in a syndrome which resembles and may be confused or confounded with true psychotic states. This may lead to misdiagnosis and mistreatment. A question arises from the varied reports of caffeine consumption in psychiatric populations: Does caffeine stimulate psychosis or does psychosis stimulate caffeine consumption?”

Sanford Bolton, PhD and Gary Null, M.S., Journal of Orthomolecular Psychiatry Link

The New England Journal of Medicine: Patient’s mania a result of caffeine intake

Psychiatrists’ initial verdict on one caffeine-poisoned patient, in a case cited by Dr. Edward M. Brecher in the landmark “Consumers Union Report on Licit and Illicit Drugs”:

“Hysteria without question. When she failed to improve and remained wildly manic for several days, she was transferred to a psychiatric hospital, where she was at first kept tied to a bed. After almost two months in the hospital, during which she slowly recovered, a mild relapse occurred. Investigation showed that she was drinking coffee, four cups a day. At this point, suspicion for the first time turned to caffeine. Coffee and tea were removed from her vicinity and soon she again became entirely normal, and was dismissed from the hospital.”

MC McManamy and PG Schube, “Caffeine Intoxication: Report of a Case the Symptoms of which Amounted to a Psychosis,” New England Journal of Medicine, 1936;215:616-620. Link

Journal of Affective Disorders: Woman’s bipolar disorder vanishes as caffeine intake is discontinued

“A longitudinal case report shows a sudden remission of the severe course of a seasonal bipolar disorder after 10 years of psychopharmacological treatments. The discontinuation of heavy caffeine intake appears to have contributed to the outcome.”

Abstract of: L Tondo and N Rudas, “The course of a seasonal bipolar disorder influenced by caffeine,” Journal of Affective Disorders, 1991;22 (4):249-251 Link

NASA’s Caffeine Findings

In 1995, NASA’s Dr. David Noever and his fellow researchers at the Marshall Space Flight Center studied the webs spun by common house spiders (Araneus diadematus) dosed with several drugs, including LSD, marijuana, benzedrine, chloral hydrate and caffeine. The more toxic the drug, the less organized the web the spider created.

The spider on marijuana drifted off before finishing the job. The spider on benzedrine, an upper, worked energetically but without much planning. The spider dosed with chloral hydrate, a sedative, soon fell asleep.

To the surprise of Dr. Noever et al, caffeine did the most damage of all the substances tested. The spider dosed with it proved incapable of creating even a single organized cell, and its web showed no sign of the “hub and spokes” pattern fundamental to conventional web design.

What does the web of a caffeinated spider (which can hardly be accustomed to the jolt of a morning latte) have to do with human behavior? Unlikely as it sounds, it may be the most vivid illustration of caffeine’s disorienting effect on caffeine-sensitive people, many of whom may be misdiagnosed as mentally ill:

“Caffeine-induced psychosis, whether it be delirium, manic depression, schizophrenia, or merely an anxiety syndrome, in most cases will be hard to differentiate from other organic or non-organic psychoses….The treatment for caffeine-induced psychosis is to withhold further caffeine.”

Clinical Management of Poisoning and Drug Overdose, 3rd ed., 1998
Michael W. Shannon, MD, MPH, Director, Lead and Toxicology Clinic, The Children’s Hospital; Associate Professor of Pediatrics, Harvard Medical School; Staff Toxicologist, Massachusetts Poison Control System; Lester M. Haddad, MD, Clinical Professor in Family Medicine, Medical University of South Carolina; Emergency Physician and Active Staff, Bon Secours St. Francis Xavier Hospital; James F. Winchester, MD, Professor of Medicine, Division of Nephrology, Georgetown University Medical Center

Important: The information on this web site is not a substitute for an informed discussion with a health care professional. In certain cases caffeine is the primary cause of symptoms that mimic mental illness, which vanish when caffeine is eliminated from the system. But caffeine is also known to exacerbate preexisting mental disorders, in which case withdrawing from caffeine is only one ingredient to improving your health. If you have been diagnosed with one of the illnesses caffeinism mimics, be sure to consult your doctor before acting on the information at CaffeineWeb.com.

What happens underneath an overpass is now tangled in bureaucracy.

Well, technically the camp isn't really located "underneath and overpass" but instead, parallel to it.  But tangled in bureaucracy it is, and it probably will continue to be until the camp actually closes, which ultimately was, I think, the only real decision the committee came to yesterday.

Not only am I heartbroken that residents at the camp are living in a state of semi-permanent confusion and trepidation about what might happen next, I also feel terribly sorry for Mr. Jones, who is simply trying to do something good and decent for the current residents at the camp and has been stopped at about every step of the way by confusion and a bureaucracy  that often seems to do more harm than good.

While I believe sincerely this is not the intention when city officials gather round the big shiny tables, the fact is that some of those decisions made at these meetings often tie the hands of those who want to help and tosses up barrier after barrier in front of those who need the help.

One of the key players in the effort to bring the containers to the camp said something that stuck with me:

"They've looked the other way for all these years while the camp was operating illegally down there.  Why can't they look the other way when someone wants to actually do something for the good down there?"

We struggled for a long time trying to figure out who had control over the area in order to determine whether we could make improvements that would clear up the perceived problems with the camp.  Each time we felt we were close to achieving a solution, we repeatedly ran into a brick wall about who to contact in order to get "permission" to move forward with solutions.  We never did actually determine who the heck ran the show down there and I believe there's a reason we haven't......

It's the liability, stupid.

No one wants to get caught in the position of having responsibility for the camp because of the potential liability that will come with it.  Can't say as I blame them frankly, but leaving the camp in limbo has caused such confusion and fear that folks on all sides of the issue can't make up their minds what they want to do.

Case in point: we were able to set up 10 units of housing for folks at the camp and were working on finding housing and/or alternatives for those who did not qualify  for immediate assistance based on the Vulnerability Index (VI) scoring.

Sorry to go tangential for a moment, but to me, this is perhaps the only real troubling aspect of the VI, and I know some of my colleagues feel similarly.  But the unfortunate truth is that when you have very scarce resources, it's just smart to use them where they'll do the most good.

And using the VI provides perhaps the best and fairest use of those resources, although I'm sure there are going to be many who must spend another night on the street who don't quite feel that way, and who can blame them?

But when the rumor of housing coming to the camp began, a few folks backed out of the housing we had set up for them.  That's their prerogative, of course, but I am not so sure they would have refused housing had they unequivocally known what was actually going to happen at the camp.


Still others had made plans to leave, but changed their minds when they heard the camp might be saved, and, well, you can't blame them, either, since many of them have what can only be considered semi-permanent encampments and some of those are downright homey, indeed.

But while I continued to hold out a smidgen of hope, after talking to a number of people who spoke off the record about the camp's future, I don't think there ever was a real question in my mind whether the camp was going to close but rather, when.

I continued to work on that assumption, both because I  did not want to provide false hopes to residents at the camp and because in my feeble mind, there just seemed to be simply too many variables and 'what-ifs" on that property to be able bring everyone into agreement on how to make it a true and officially sanctioned homeless encampment.

And now t it appears that those folks with the power to make the decisions have aligned themselves around the idea that the camp needs to go away.  How that is done while causing the least amount of misery, hardship and stress to the residents is about all thats left to figure out.

Unfortunately, no matter how ya slice it, many of the homeless who remain at the camp are gonna lose bigtime....

as usual..... 

*****************************************************

Finding Housing For Residents In Homeless Camp

Posted: Nov 20, 2008 10:40 PM

Video Gallery <1> Finding Housing For Residents In Homeless Camp 3: 01

NASHVILLE, Tenn. - For many of Nashville's homeless, a place called Tent City is home. But city leaders want to shut it down.


It may take months before plans are in place to close one of Nashville's largest homeless encampments.


Tent City is south of downtown Nashville off Hermitage Avenue.


On Thursday, members of Metropolitan Homelessness Commission met to discuss the encampment's future.


Tent City was originally scheduled to shut down on Nov. 1. Many residents left. But now with plans to shut it down on hold, some people have returned.


To outsiders the shacks are substandard, but to the people who live in Tent City "it also offers a feeling of community," according to Michael Cook.


His home became the streets six years ago. He moved into the encampment earlier this year.


"I now know the people that live around me," Cook said.


What happens underneath an overpass is now tangled in bureaucracy.


"So we are still having problems down there," said Metro Lt. Andrea Swisher.
"I don't think that any of this is going to be permanent," said Herschel Warren, senior adviser to Mayor Karl Dean.


"It is our hope that we can come to some conclusion pretty quick," said Steven Samra, homeless outreach specialist for the Park Center, a nonprofit organization that serves adults diagnosed with severe and persistent mental illness.


On Thursday, Cook met with Metro Police, homelessness commission members, and outreach coordinators to discussing shutting down Tent City and finding the homeless homes.


"I think there is a decision that needs to be made," said Metro Councilman Erik Cole.


To this point, there are plenty of ideas. Volunteers offered donating 20 temporary shelters.


"But these little cottages would not look that bad. They'd be very comfortable and insulated on the top, bottom and sides," said Charles Jones of Otter Creek Church of Christ.


"I mean once people find out that these nice structures are going to be there there's going to be people down there just like there's people moving in now," Swisher said.


While there is no concrete plan, Cook remains optimistic.


"And I think this is a wonderful opportunity to really finding solutions to managing homelessness," he said.
When decisions are ultimately made, Cook expects the resolution will be one that benefits the homeless in Tent City and across Nashville.


It's estimated about 30 people currently live in the encampment.  That is reportedly an increase over a couple of weeks ago.


The Metropolitan Homelessness Commission will meet again in the first week of December.
It is not known when members will set timeline for the closure of Tent City.


During an appearance Thursday night on OpenLine, Metro Police Chief Ronal Serpas said the city must work to find better and safer options for people who live in Tent City.


"We're gonna continue to help find humane ways to deal with this but at the end of the day we still feel strongly that it should be closed," he said. "It's trespassing. That is property owned by somebody and it's trespassing and it needs to be moved on."


Serpas appears once a month on OpenLine on NewsChannel 5 Plus (Cable Channel 50).
END

Nashville Public Radio weighs in on the meeting with their own take on how it went....

Homelessness Commission Raises Questions about Improving Tent City

Friday, November 21st, 2008

Nashville leaders are divided on whether temporary shelters should go up
in the homeless encampment known as Tent City.

A local developer is poised to begin setting up temporary, insulated shelters as a way of getting the thirty or so people who live there through the winter.

That idea has the support of the sheriff’s department. Mental health coordinator Jeff Blum says Sheriff Daron Hall is willing to go so far as to provide inmate labor for constructing and maintaining the shelters.

”It’s a short-term fix for a long-term problem. And it’s something that could be effective for the period, the waiting period of time we need before we get into the spring. It was give us six, seven, eight months to do the kind of planning we need to do, to do something more substantial.”

But at a meeting of the Homelessness Commission’s Tent City committee yesterday, many had their doubts. Questions were raised about whether codes would apply to the buildings. Who would be allowed to occupy them and who would decide?

Commission member Luvenia Butler says the structures would undermine the commission’s stated goal of eventually shutting down Tent City.

“If you make it pretty and you keep adding stuff, then people never want to leave. And it makes it harder. You have people that constantly want to come.”

The encampment lies directly below the Silliman Evans interstate bridge, so the land belongs to the state department of transportation. A representative of TDOT said the agency doesn’t want Tent City to stay in place long-term but is willing to go along with whatever plan the city devises for phasing it out.

By Nina Cardona

It is not just about quality of life; often, it is about life or death.

Someone at a meeting I attended today - yes, a meeting, even though I'm technically on vacation - told me that there was a whole bunch of stuff in the Tennessean related to homelessness and the work we've been doing....

Survey brings health aid; next step, housing

Today's Topic: Health dangers for homeless

Our View

FILE / ALAN POIZNER

Volunteer Steve Samra, left, talks with Nelson Johnson in an October survey of health needs of Nashville's homeless.

Help is on the way, and none too soon.

After a survey in October found that homeless people in Nashville visited hospitals at three times the rate of homeless in other U.S. cities, the nonprofit United Neighborhood Health Services took action, committing a $1.2 million federal grant and a $400,000 Metro grant toward making primary care accessible for Nashville's homeless.

United deserves all the praise Nashville can muster for this compassionate, heroic and just plain sensible act. Thanks to these renewable grants, an estimated 5,000 homeless people a year will be able to get free medical, dental and behavioral care at a network of clinics citywide.

It is a shining reply to what was dismal news, indeed, when the nonprofit Park Center sent teams around the city in October. They surveyed 320 homeless people about their medical histories and their experiences living on the streets.

They found 134 of the 320 had one or more health problems that put them at the highest risk of dying. Among other questions, respondents were asked whether they'd ever been treated for drug or alcohol abuse, mental-health issues, or if they had cancer, HIV or AIDS.

Park Center assessed their findings according to a vulnerability index created by the New York-based nonprofit Common Ground and used in cities throughout the United States.

According to the index, people living on the streets longer than six months who have a history of one or more ailments such as kidney or liver disease, mental illness or cold-weather illnesses have a 42 percent chance of dying within seven years.

The survey sparked United Neighborhood Health Services to help, but there is so much more to be done.
Nashville's homeless population is estimated at 2,500-3,000, though as many as 11,000 experience short- or long-term homelessness each year, according to social-service agencies.

About 500 of that number live constantly on the streets each year. In 2007, there were 50 deaths.
In many of these cases, the Park Center and homelessness advocates say, housing would make the difference. To that end, Park Center in August identified eight people living in "Tent City" off Hermitage Avenue as ranking high on the vulnerability index, resulting in housing vouchers for the eight. Metro Development and Housing Agency followed up with a pledge of 35 additional vouchers over the next few months.

All too gradually, Nashville's overall population is beginning to see the severity of the problem. Women and children without permanent homes can be found in shelters around the city every day. Some, but by no means all, suffer from substance abuse or mental disorders. Many have simply become economically unable to buy food or put a roof over their heads. And they certainly have no money for medical care.

When the problem becomes too great, many of Nashville's homeless have ended up at hospital emergency rooms. Not only would primary care be a better solution for the homeless individuals, but the ER costs for them alone are estimated at more than $600,000 a year.

It is just one more clear sign that the problem of homelessness is a problem that we all share. Our city's social-service agencies need all the support we can give to get more people off the streets, especially in this season of hard weather and tough economic straits.

It is not just about quality of life; often, it is about life or death.
END

And here's a piece written by my close friend and colleague, Big WillyC....

Safe housing is ultimate goal

By Will Connelly • November 20, 2008

Connelly

Two weeks ago, a group of nonprofit and government agencies joined hands to complete a study called the Vulnerability Index.

We surveyed 320 individuals experiencing homelessness to determine their health status. The results are troubling. Forty-two percent of those surveyed are at risk of dying because of chronic health conditions that include mental illness, HIV/AIDS, diabetes and heart disease. If housing is not provided soon, a wealth of research indicates that hundreds will die on our streets in the upcoming months and years.

To address the health-care needs of the homeless in Nashville, I find inspiration and guidance through Ken Kraybill of the National Healthcare for the Homeless Council. Ken believes that we all reside in "three homes." The first home is the self, "our very being and identity." We are given our first home at birth. This home needs to be properly maintained, supported and kept safe for us to be in proper working order.
Our second home is where we live. It protects us from the rain, the heat and the cold. It stores our possessions, keeps us stable and allows us "to welcome guests, share in celebration and suffering, be creative and silly, be still and mindful, be intimate with loved ones, and find renewal of energy and purpose."

Our third home is the larger community or "multiple communities." Here, we play various roles. "We give and receive, produce and consume, lead and follow, serve and are served." This third home connects us to health care, work and social activities and helps us meet the requirements of our first and second homes.

Study could galvanize community

The "three homes" idea helps us realize that merely providing better health care to those sleeping outside is not sufficient. Having healthier homeless people on our streets should not be our end goal. Our ultimate goal should be to provide safe, affordable housing to those who lack it, to address their health-care needs, and to facilitate the re-entry of our homeless neighbors into the larger community as healthy, working and independent adults. Despite what caused someone to be living outside, we all want the same things — we all want to reside in three homes.

We are at a pivotal juncture in Nashville. The implementation of the Vulnerability Index study has brought private and public agencies to the table. It has already incited action around housing our homeless neighbors. For the first time in a long time, business groups like the Nashville Downtown Partnership, government agencies like the Metro Homelessness Commission and MDHA, and social-service providers like Park Center, Urban Housing Solutions and others are working together to provide housing and services to individuals in a timely, cost-effective manner. We need to capitalize on these partnerships and shift existing resources and funding toward this effort.

We know what works, and we know what can save lives and money. We just need to implement it, and to do that, we need the political will to make it happen. Together we can do this. Together we can end homelessness and change the face of Nashville.

Will Connelly is the coordinator of homeless outreach services at Park Center and is a proud native of Nashville. www.parkcenternashville.org.

END

Finally, Gerri Robinson rounds out the discussion....

City can be model for homeless care

By Gerri Robinson • November 20, 2008

Robinson

Exit polls from the presidential election confirm that access to health care is a major concern of many Americans. One aspect of health-care reform that needs to be included, once the issue is addressed, is access to care for the homeless.

Local agencies, including Metro Social Services, the Metro Action Commission and private social-service agencies, see increasing numbers of Nashvillians seeking assistance during a time when the current economic downturn has not yet reached a peak in the unemployment rate and other hardships poor families face. These individuals' health costs have a similar, if not greater, impact on taxpayers as the cost of serving homeless people.

Looking at homelessness, The New England Journal of Medicine reported that homeless people spend an average of four days longer in the hospital per visit than comparable non-homeless people. This extra cost, approximately $2,414 per hospitalization, was attributed to homelessness.

In addition, the Tennessee Hospital Association found the number of uninsured individuals seeking care at hospital ERs is the fastest-growing group, increasing almost 50 percent in the past three years. Experts agree the cost of primary care delivered in a hospital emergency department is much greater than the cost of the same care in a physician's office.

Therefore, I believe that the expansion of health-care resources for the homeless in Nashville should be used as a model for what can be done for all uninsured.

Better coordination within reach

The United Neighborhood Health Services continuum of health care for the homeless is a classic "best-practice" model of planning and collaboration. It shows how to leverage available resources from federal, state and local governments and the private, nonprofit sector.

Another example is the work of Park Center, which facilitates access to public benefits such as Supplemental Security Income for the chronically homeless. Trained staff act as champions, advocates and navigators of a complex system. The project, which provides recipients with health insurance and income, is funded by Metro via the Homelessness Commission and the private sector and has received national recognition.

A number of local ad hoc and permanent groups convene regularly to address health needs of the vulnerable. The MAC and the Chamber of Commerce held a meeting of all sectors of the community to develop a plan to reduce poverty over the next 10 years. The mayor supports this and the work of the Mayor's Task Force on Seniors. Both initiatives are grappling with the lack of health care.

Health care for the homeless is very important; of equal importance is the need for a comprehensive plan to address all uninsured. However, coordination of the work of these groups is lacking. With this gap in mind, the Board of Commissioners of Metro Social Services (MSS) appointed an ad hoc committee to review the role of planning and coordination within MSS.

A draft recommendation authored by Dr. Frank Boehm, a member of the commission and the ad hoc committee, makes a strong case for tracking data on service needs in Davidson County, identifying and quantifying resource capacity to address gaps in services, and bringing together all interested parties to develop and implement a comprehensive plan to fill existing gaps — such as social services for the most vulnerable.

Gerri Robinson is executive director of the Metro Social Services Department.