You are tragically DEAD WRONG about this homeless issue. Much of this problem is based in some sort of abuse. With the prostitutes, they've found incest and sexual abuse problems and maybe some violence. A significant percentage of the so-called schizos are a product of domestic violence. Schizophrenia is a garbage can word. They use it indescriminately. And half the time it is not at all applicable, but they've used it fraudulently for their own convenience.

Sounds like you're shilling for the drug companies and this worries me. They are always trying to increase their addicts and get everyone in America hooked on some expensive drug. Maybe Prozac or maybe something even more expensive. They'd like everyone in this country stoonahd. Or too zonked out to think.

Ask a family whose mentally ill daughter is somewhere on the streets, location unknown...

Most of these kids are throw-away kids whose families are glad to get rid of them and do not want them back. If asked, they always make some excuse why they can't take their kids back. You are very naive about this.

If the day comes when society conducts an honest discussion abou this topic, it will probably have a collective nervous breakdown.

People should to be free to rise up or down and accountable for their choices, but it seems like a social responsibility of government to establish an humane 'bottom'. How far are we willing to let another person fall? They're free to screw up, but dying of malnutrition or exposure or scurvy on the streets of our cities should not be a right. (Yes I've seen people with what appears to be scurvy in NYC)

Second, provide means of rising back up. Rehabilitation programs of some sort or another. These might include addiction treatment, but they should also include psychological counseling, job training, education, nutrition, literacy programs, mailing addresses and hygiene facilities. Provide the opportunity and means for people to learn from and recover from failure.

Misery trickles up. Societies are judged as much by their slums as their parks and museums.

That would make two of us, button. And you should be more careful in attributing motivations. Some of this post comes from personal experience with which I am very well acquainted. More so than you, it seems, especially if you're opining about Prozac for schizophrenics.

I would ask one simple questions. Let's grant your premise, for a second, that schizophrenia comes from abuse. Not exactly a psychological mainstream opinion, but let's ignore that. At the end of the day, the cause is irrelevant - the fact remains that the person has schizophrenia. If they wish to go off anti-psychotic drugs against medical advice and end up wandering the streets in a delusional state, what homelessness program is going to help them as long as their "right" to do so is legally protected?

Answer: none.

But having them wander the streets, beg, and occasionally freeze to death at least has the benefit for you of not enriching the drug companies.

you are mostly right joe. i do think you would agree that what you are suggesting is not enough however. homelessness and the dependencies and traumas associated with it are very extensive problems that require being aggresively chiped away at and prevented in a way that is a bit bigger than just dealing with drugs and mental illness (yeah ive got a lot of up close experience with those also so i understand your reaction).

the situation in toronto is a little different than say the situation here in nyc, and your suggestions would be a very very good start for your area. here, there is a lot more that needs to be done about economics, the overall housing market, and health. of course actually having a thriving eduation system wouldnt hurt none either.

what any location has in common when it comes to these problems is the central importance of the attitude of those trying to dramatically reduce homelessness, and of course also the attitude of those who are homeless. in toronto, you are right to focus on how the response has been to ignore or enable. changing that would do as much good as the seemingly superficial changes of attitude at the begining of the 90's did for new york's confidence in the reality of drastic change.

bottom does make a good point though that quite a large number of the families of the homeless (specifically of homeless youth - which are a very large portion of the american homeless population) are not as friendly and innocent as you made them out to be.

I agree that these 3 initiatives are not enough by themselves. I do contend, however, that without them there will be a large group of homeless resistant to all other approaches - and many people who could be helped that won't be.

As for the families of the homeless, I did not actually make a blanket judgment about them one way or the other. I do know from personal observation, however, that the mental health laws in Ontario tie the hands of families who do care, and are the cause of a great deal of genuine suffering and frustration. They definitely contribute strongly to the problem.

Interesting how the one comment defending the right for disturbed people to remain on the streets was venomous. And full of hopelessness.

Spot on, Joe. There's no policy more callous than one letting people destroy themselves under the auspices of "respecting autonomy and individual rights."

So what protections are you going to put in place if you take away the patient's right to refuse medication? Remember, those laws were passed to address serious abuse of the system, often by families of kids who simply didn't do what they were told (i.e., wouldn't marry the guy dad picked, or were gay, or promiscuous), and were then committed and medicated to get them out of the way rather than embarrasing the family (kind of the western civ. version of honor killings).

Joe, I haven't thought about this long enough to have formed a comprehensive opinion about the whole matter as described here (my thoughts about homelessness are further developed in other terms and based on what I see in NYC) but I cannot help but take you up on the question of voluntary cessatin of medication.

I understand and in principle agree that it is not compassionate to allow a truly sick person to be their own downfall by permitting them to go off meds without which they cannot function. However, I've also seen too many cases of medication being forced on individuals who were not, in fact, seriously mentally ill, but rather had families who didn't want to deal with a "black sheep." I've seen a great many smart kids medicated into submission by parents and teachers who couldn't handle their intelligence. I've seen victims of abuse put on anti-depressants so as to allow them to cope with the abuse while the abuse itself is allowed to continue.

I've seen kids run away because there was no other choice, because the social net is not designed to catch them. They become the city's young homeless population. Many of them have gone off meds, but their downfall is not mental illness, but rather a system stacked against them which allows for the use of medication as a cure-all, that tells them that the problem, no matter what it is, is with them.

Acknowledge your points, grs. That stuff does happen. It's real.

Maybe this will help: mild anti-depressants like Prozac or drugs like Ritalin should be off the table here. When I say "treatment," I'm talking about serious anti-psychotic medication here - and coercive power should be confined to that.

And here's something else that's real: I've watched people die because the people deeply interested in an individual's welfare and trying to help had no legal means of doing so while the warning signs piled up, and the person in question was too deep in psychosis and paranoia to ever ask.

Certainly individuals who have had psychotic breaks in the past that led to deeply irrational actions should have a harder time successfully refusing treatment, for instance.

There has to be a happy medium. Imagine a system in which diagnosed individuals designate one or more guardians once stabilized, with the option of requiring a certain number of them to agree. But if that agreement is there, action should be swift. And then the medical profession becomes a definite part of the equation - they have a judgment role here too. That may be one option.

But we have to be looking for options like that in the first place, rather than just mindlessly screaming "patients' rights" without any examination or context. Which is what happens now in Ontario. Designing solely for the extreme cases means that many salvageable cases end badly.

If we postulate a situation where the person in question has no allies, then in some ways the debate is hopeless because injustice is possible under any system we can imagine. If someone is going to mandate medication so that abuse can continue then yeah, running away may be your only option. Once you hit the social welfare radar screen (which you will), counselling can and should help you report the abuse, change doctors, and maybe get doctor #1 on charges or in front of an OMA board for good measure. But if the new doctors says "you need to keep taking X and attending counselling Y while you live in the shelter / participate in the housing program," you better be doing it.

Otherwise, all we've done is create is a temporary way-stop on the road back to abuse or the street, and that's not acceptable.

Nor are these suggestions the only options. There are ways for intelligent people to design a system that does the best it can with the extreme cases, while salvaging as many of the hopeful situations as possible. Right now, that's not what the system is tuned to do - and the costs of that are real, too. I see them every day.

Joe,

What you call an enabler may actually be a person giving a person in pain their prefered pain relief.

Looked at that way it kind of changes the moral calculus doesn't it?

It all goes to the core question: is addiction a thing in itself or a symptom of something else?

Joe,

If you do some research on 12 step programs you will find that they do two things: substitute coffee and tobacco for the drug of choice and work for about 5% of those involved per year.

With no intervention about 5% a year quit their drug of choice.

When you act as if we know how to fix substance abuse you are dealing with the "rehab industry" fantasy. In order to get all those insurance and state $$$$ from you rehab has to work. But it only need do so in your mind. The facts are out there but there is no profit in getting them heard.

Rehab works as a way to part the suckers from their $$$$$$. So when they say rehab works I'd agree. For some. Not necessisarily the "clients".

In any case what makes "addicts" homeless is the high cost of their pain medications caused by prohibition. So that gets most of the addicts off the street. That leaves the mentally ill.

Once you lose the right to go off your meds even if such a move is likely to cause death means you have no rights. Such cases burn the heart and sink the belly but they are the price of liberty. Either you keep yourself or the State keeps you. Both ways have risks.

What you are asking for is a risk free world.

Perhaps we might allow forced medication once or twice. Not indefinitely. A man has to be allowed to make his own decisions. Or else someone will be making those decisions for you. Not good. At some point compassion must give way to liberty.

I forgot to ask: at what point does motorcycling become too dangerous?

What dangers ought the state be allowed to control or make laws about?

The laws you want will harm many in order to save a few. Giving the state the power to force medication on people is a bad idea.

button,

I am in total agreement with you and have been working this issue from the drug angle. It is so obvious as to be a criminal disgrace. 70 to 90% of our social problems are caused by child abuse. Some of the remainder are caused by war. Now it may be that we must accept that war will break some warriors. A price that must be paid.

What we must not continue to accept is broken children.

We must give a little less attention to the alligators and more attention to draining the swamps.

As an attorney who has defended scores of mentally ill, homeless and drug addicted people over the years, I would say that Joe's analysis is mostly correct.

Joe said "substance or mental illness." I see many cases of both, the frequently encountered (in court) "dual diagnosis" or "self-medication."

I disagree that an overwhelming root cause like child abuse can be identified.

Schizophrenia and its variants are well identified illnesses: usual onset in young males about 15-25, give or take. It is thought of as organic and there are good medications for this.

Then the bipolars, who also often show up in court on public order offenses.

I see a lot of crack-smoking schizos or bipolar types. Then it gets complicated.

People also want to get high for no reason other than for it's own sake or because of their social mileau: some end up in a long slide into alcoholism.

Heroin, crack cocaine are not limited to the ghetto and have been the ruin of many middle class girls who fall first into shoplifting, later prostitution. The boys? Shoplifting, then armed robbery.

It's usually tough to get a bed in a treatment program on short notice unless you have medical insurance.

klaatu,

Let me simplify the drug issue:

People with chronic pain chronically take drugs. Seems obvious no? Taking drugs does not interest those not in pain because in that case drugs reduce function. Fine for a night on the town. Of no interest as a habit.

A Dr. Shavelson found that 70% of female heroin users were sexually abused. He wrote a book tying a lot of drug abuse to child abuse. You can look it up.

The evidence is out there. We are just trained to ascribe it to other causes than the actual. We have to. Other wise a revolution in parenting would be in order.

The reason various drugs are not limited to the ghetto is that pain is not limited to the ghetto. Novelty wears off. Pain is the long term motivation to take drugs.

On another point that you brought up: the lack of treatment beds. If there is no advantage to treatment other than the feel good aspect of "doing something" what is the point of treatment?

In any case treating the symptom - drug abuse - does nothing about the underlying pain. Real treatment would be about treating the pain. Of course that is way more difficult than monitoring drug consumption and giving pass/fail based on zero tolerance. Or what is commonly refered to as rehab.

As far as I know when some types of pain get embedded in the brain they become essentially untreatable. It just takes time for the pain memories to decay. Sometimes more than a lifetime.

There is some hope in research being done an the amygdala (the part of the brain involved in long term pain memories), but so far all we have are indications and possibilities. Nothing definite. We are several years at least away from even experimental results. A useful drug might be ten or more years away. BTW this research is being done in the context of combat PTSD induced drug use: i.e. trauma causes an internal pain state not commonly recognized by law or medicine. Certainly neither law nor medicine recognise embeded pain as a consequence of PTSD inducing events.

In the mean time the persecution of those in pain will continue. For their own good. Because every one knows drug addiction is bad.

I look at this issue the way I look at the gun issue. Guns will cause a certain amount of unnecessary deaths. The question then are we safer overall with guns in the hands of people or not? The same question has to be asked about forced medication. Is it good for the government to have that power? I come down on the no side. Knowing that people will die or be injured by the policy.

I'm still trying to find out if motorcycles and skydiving will be legal if the state becomes our protector. No one has answered.

M. Simon - the state is not everyone's protector. But it is the default protector of last resort when dealing with someone not of sound mind. In the cases we're discussing here, the people involved pretty obviously are not. I could as easily show up the foolishness of the comparison by asking if you would also support letting 4 year olds drive those motorcycles as an exercise of their liberty. There are reasonable limits.

Then Klaatu says:

"As an attorney who has defended scores of mentally ill, homeless and drug addicted people over the years, I would say that Joe's analysis is mostly correct."

Thud

Owww, my head... OK, regaining consciousness. I'll back Klaatu up by saying that even if Simon's analysis is correct, the question is what to do in the immediate term. Stabilization has benefits even in the absence of a cure, by allowing people to live - well, not a normal life perhaps, but at least not in cardboard boxes. Every "stabilization success" (vs. full success) can perhaps build a work history of some kind, and gain the time to work out the deeper issues.

But they'll never get that if we shrug our shoulders and decide we have no responsibility, or grants those who are clearly not of sound mind the same rights as those who are, or treat drug addiction as a right. Even if I grant that drugs & alcohol are self-medication, the side-effects are too problematic for someone who has fallen to a homeless state. Since that person has become a burden on society and is nable to be responsible for themselves, trhe polis has the right to insist on conditions that will lessen that long-term burden and foster some level of responsibility in exchange for its help.

A link to this article popped up on Best of the Web for the 23rd (yesterday): How a regular guy gets homeless: Former 'Wall Street Journal' reporter shares his story

Also, Joe, I cannot agree with you more. I'm delighted to see that there are others who feel this is a problem we can and should be doing more to change.

Sorry about the thudding joe it must have been the anvil I dropped while juggling.

Let me remind you that the gulags of the Soviet Union were filled with people of an unsound mind. Medically approved even. Any one who did not approve of socialist ideal was obviously of unsound mind. N'cest pas?

All done in the name of doing the right thing. Protecting the defenceless.

Think of ceding the power to do good to the government and then getting a bad government. Happens all the time. Fortunately it can't happen here.

Except that it did happen in America to a friend of mind who was put in a mental ward for 90 days for "observation" when there was no crime he could be charged with. Other than annoying a judge. Fortunately the doctors didn't go along with the charade. But what if they had? There is no appeal from a mental incapacity sentence. And the sentence is indefinite.

Look up the Gary Kaeding case in Rockford, Illinois if you want all the lurid details. If the news reports do not conform to my description get back to me and I will explain. I visited my friend while he was locked up and saw the real deal go down. And I followed his case before he was sent up for a mental evaluation. The guy Kaeding acused the judge of letting off was later convicted of child abuse. in another venue.

Nice to have the lawyers swearing that the system is meant only for the defence of the incapacitated. Raises my faith in the legal system to a much higher level.

Kind of like this case:

http://www.sierratimes.com/03/09/23/ar_tn_kara.htm

Why is it when there is a hard problem people always think the answer is to put a gun to a person's head. Things would be so much easier if we could just force people to do the right thing.

So true. So true. For a while.

We could solve the drug problem if only we could force people to quit. In fact there is just such a system in place to do good. And we know just how well that system is working.

Criminalizing mental states is such a good idea.

I go by a simple rule. Personally help those who wish to be helped and other wise leave others alone. And could we please leave the children out of it?

It always starts out with doing good at the point of a gun. It rarely ends that way.

Now I'm not an absolutist in that respect. Taxing to give the bottom a chance to rise or at least keep it stable is probably a good thing in terms of civil order. But I get balky when it comes to forcing otherwise competent people to do the "right thing" against their will. If they prefer "hearing the voices" to being "normal" when they have had the experience of both then that ought to be their choice.

I am not an absolutist on the subject. Perhaps we let help be forced on them for 60 or 90 days under a competent court's supervision. Then maybe once again. After that no way.

The day is coming when a person will be able to get his neurons readjusted. Do we want to give the government the power to decide if you will be a Clark Democrat and love your wife but hate children by giving you the right pill?

What I'm talking about is as little as ten years away. The preliminary research is already being done in the hopes of preventing PTSD in military men. No after battle problems or remorse. Is this a good idea? In any case it is just the start.

To address some of the points raised by Joe and M. Simon:

First, I'm surprised to see M.Simon basically repeating all the Andrea Dworkin-type statistics on the extent of child sexual abuse. Yeah, it's there, but in my opinion nowhere near a majority of substance abuse, homelessness or prostitution can be traced to it.

It's substance abuse or organic mental illness or both first, then the homelessness.

A lot of kids are no doubt damaged by adults; that's why Philip Larkin said, "Your parents, they fuck you up." Most people deal with it, even somewhat extreme situations.

You say substance abuse is the result of "pain." If you take as a given that alcohol is a "drug" subject to being abused, when you took your first drink, did you do so because you were in "pain?" Or smoked your first joint?

Years ago many middle class people were using cocaine: in the early 80s a friend told me about how he had gone out on some wild bender with friends and smoked "rock cocaine." So I said,

"Wow, you smoked crack, WTF!"

"No, rock cocaine."

"That's crack, you s-head, How was it?"

"It was real f-in good, I just wanted to smoke more and more"

He had the sense to stay away from it after that, but others don't.

These drugs are STRONG: I still remember the euphoria that I got from morphine and demerol when they took my appendix out long long time ago. It was so good it was too good.

I asked one 20 y.o. woman how she fell into prostitution: She comes to the big city for a computer school. She hangs out in a park with some new "friends." The new "friends" invite her to drink, smoke weed, then crack. She smokes, then wants to smoke "more and more."

She runs out of money. She's walking downtown, guy pulls up, offers $20 to her to expose her breasts. She does that. Then later the hand-jobs, the BJs, etc.

Couple of weeks ago I was in court on a bail hearing representing an extremely emaciated young woman, a college student.

Methamphetamines.

We will always be walking a line between freedom and protection of individuals and society on matters like these.

Since humans are involved, the laws and application of those laws requiring discretion will never be perfect.

Taking into account the natural imperfections, I think things go about right from what I've seen. There are exceptions. A few people who should be confined by any standard are free, usually due to lack of resources, and a few who are no danger on any level to themself or others are confined.

I once saw an elderly woman (abt. 65 y.o.) committed to a hospital on the petition of her daughter by a "liberal" judge.

The daughter alleged she was a danger to herself because she: (1) drank about a six pack a day, but took the whole day to drink it; (2) smoked two or three packs a day; (3) once had left a pot on the stove, burning the contents.

The court psych. opined she was not a danger to herself, but the judge kept pressing him on the issue of the drinking, the smoking (!!), etc. To his credit, the psych. didn't budge.

The lawyer appointed was utterly incompetent: didn't question the daughter about what would happen to the house and its contents if the mother was committed (could have been a property grab, right?), didn't raise the defense of simple liberty to smoke cigs and drink beer.

Another lawyer and I were watching and biting our tongues. The judge committed her.

Here's the way prostitution, shoplifting and disorderly conduct, three drug-or-drink homeless associated offenses, are usually handled:

People are arrested. If they have no record, they are released without having to post bail.

Eventually, if they continue to get arrested or not show up to court, they are held on a high bail.

Probation usually follows, with first outpatient, then inpatient substance abuse treatment programs ordered. If there are more arrests or repeated failure to do probation, they are committed, say, for six months.

People can do this for years on these misdemeanor offenses, "doing life on the installment plan."

Sometimes the mental illnesses which often give rise to this stuff are diagnosed and treated in the course of this.

And some people do get cleaned up, or "age out" of offending, or get comfortable and sober enough in a little welfare-and-housing situation, sometimes with social workers helping out.

Here's a horror story, via Atrios: Guy get arrested for warrants. A victim of identity theft. He's black, a Columbia and Haravrd Law grad. When he tells the duty public defender this, she tells him he suffering from a mental illness.

http://www.villagevoice.com/issues/0339/bain.php

For another horror story (lawyer tells client he's crazy because he maintains his innocence), see Wagenmann v. Adams, 829 F.2d 196 (1st Cir. 1987).

klaatu,
You're right it's a delicate balance, but you're scaring me dude. The 3 horror stories you mentioned, especially the first about the 65yo woman, are making M. Simon's case for him.

What kind of safe guards are in place to prevent a small group of people, or a single judge, from depriving someone of the freedom without justification? And why couldn't you and the other lawyer do something, instead of biting your lip, when you witnessed an injustice? The right to appeal doesn't seem like enough, if you don't have any money, or you've just been declared incompetent.

You're right, Lurker, I should have done something, it bothers me, but if I jumped up and intervened every time I saw an injustice in court and thought that I had something to say about it, I'd probably would have been committed myself or at least held in contempt.

I understand klaatu. It's just hard to see where the checks and balances come into play with respect to the rights of what are fundamentally throw-away people. Of course we want to help people who need it, but M. Simon has a good point, it's got to be balanced against the rights of those least equipped to defend themselves.

It seems from your comments that public defenders aren't a complete solution...

Public Defenders, Police and Judges are a part of the human factor/human error built into the system.

The standard is flexible/vague: immediate danger to self or others by reason of mental illness or substance abuse.

I just don't think there are too many mentally-ill/homeless people being deprived of their freedom without cause or consent.

That's really just an observation about those I see on the streets/subway, many obviously crazy people ranting or mumbling, and in the courts, where your basically harmless nut or drunk is usually cut some slack and let free.

I knew one court where a crazy/drunk guy just hung around all day, like a mascot, mumbling incomprehenibly, sometimes sweeping the floors.

Every once in a awile he'd get agitated, shout, start pestering people for money. The judge would have the court officers bring him in and say "Okay, time for a rest cure in detox."

And he'd go away for a month and then come back to the court.

My modest proposal for handling those with substance abuse problems: Put them in isolated island communities where it is hard for them to get their substance of choice. Test them regularly for drugs and alcohol. Have aggressive investigation to track down their sources if any turn up positive.

In a nutshell: admit these people can't control their cravings and deny them access to what they crave.

As for the mentally ill: I think most have organic problems. Putting them on *better diets* would help for the same reason it appears to help criminals. Some schizophrenics might not be helped all that much but people with other forms of mental illness would be helped. So there'd also be an advantage to separating them out into isolated communities where they had no access to simple sugar or other low nutritional density foods.

But I don't think we are anywhere near the point where policies toward the street people are going to change to deal more effectively with those who are mentally ill or addicts.

Not only you but everyone gets frustrated with this core issue of homelessness.