Unraveling the Complicated Question of Mental Health and Homelessness

This post is an attempt to begin to answer a question that someone recently asked me:
What do you think about mental condition induced homelessness in terms of a solution?
Mental health issues are hard to solve because they have many contributing factors and it can be hard to tease apart what the cause is. As best I understand, they have three primary components or root causes:
  1. Biochemical
  2. Social
  3. "Bugs in the wetware"

Biochemical (aka Medical)

Biochemical causes have to be treated medically. Drugs may help, but there is increasing evidence that things like diet and exercise can also be useful in mediating brain chemistry issues.

Therapy does nothing for biochemical causes of mental health issues. If you need intervention with your brain chemistry, no amount of talking it out will move that needle.

When I was really mentally and emotionally unstable due to medical stuff while homeless, my sons had a policy of "Do not engage teh crazeh" and of taking care of me physically. Often, if they could get me fed, hydrated and warm enough, I would fall asleep shortly thereafter and wake up the following morning completely rational.

So helping homeless people get their physical needs adequately met is one way to help people with mental health issues to become more functional and have some shot at returning to a more conventional life. In theory, this means that soup kitchens, food pantries and the like help.

In practice, they often provide such poor quality food that they really don't. It became our policy to avoid soup kitchens and the like precisely because we were trying to get healthier and we learned on the street that we were better off not eating at all than eating stuff that was bad for us.

I sometimes overheard other homeless people say things indicating that they had a serious medical condition, like diabetes, and the food being made available to them was making their condition worse. This is an issue that most people are unwilling to hear.

It gets met with an attitude of "Beggars can't be choosers." It is typically treated dismissively and it is one of the ways that homeless programs so often entrench homelessness.

If you are homeless in part because you are too sick to work and the free food you are being given is making you sicker, then every bit of so-called help you accept just makes it that much harder to get your life back. And you best not complain to anyone about it, you "ingrate" you.

If you want to do something about this aspect of the problem, you could work on finding ways to help homeless individuals access actually healthy foods of their choosing. Some food pantries give some degree of choice in what you get and that was helpful to me when I was homeless.

I also attended one (and only one) really excellent free meal site sometimes while homeless. Recent online conversations make me suspect it was hosted by Sikhs.

I only ever heard them called "The Vegans" when I was in downtown San Diego. They served fresh vegetarian food, gave away sack lunches to take with you and sometimes had things like fresh watermelon.

Among other things, I think providing access to actually healthy sack lunches for the homeless is a wonderful best practice that I seldom see. Meal sites usually want you to eat there.

I have heard other homeless individuals express the desire to be fed a hot breakfast and given a sack lunch to take with them so they could go about their business and not be imposed upon to be at a particular place at a particular time to get fed. Most homeless services are enormously disrespectful of the time of homeless individuals and you can basically be prisoner of their schedule.

I quit going to soup kitchens as soon as possible because if you have to stand in line for two hours for every free meal, that's six hours a day during the day if you want three meals a day. This is a huge barrier to trying to job hunt or look for housing or do anything at all.

Social

People on the street are often treated in a dehumanizing manner. If you weren't crazy before you ended up homeless, you may become crazy simply because of how literally crazy making your social experiences consistently are while homeless.

I was able to work out my problems and return to housing in part because I was on the street with my two adult sons. They had known me their entire lives and their image of me was as someone very competent, among other things.

So this helped serve as a protective factor in the face of otherwise almost universally consistently terrible and even outright abusive social experiences. It gave me some on-going positive social experiences and some on-going positive feedback in terms of self image.

It is possible to help provide this for homeless individuals, even those with serious mental health issues. If you interact with them in the course of your work (or for other reasons), treat them with dignity and respect and humanely.

It can also help to follow the policy my son's had to "not engage teh crazeh." We saw this a few times while we were homeless. One very memorable incident occurred in downtown San Diego where we had no real choice but to interact with other homeless individuals.

There was a woman with very serious mental health issues who would wander around downtown screaming at people who weren't there and reliving some past trauma. It sounded like she had been sexually assaulted or perhaps prostituted at a young age.

This set everyone on edge. It really bothered my oldest son, but it was a very disturbing thing for everyone in the downtown area.

Me and my sons often would buy lunch at the Ralph's and go to a park two blocks away with some tables so we could eat. Since we had no means to store or preserve fresh food -- leftover pizza or cold milk, for example -- we tended to give it away to other homeless people in the park when we were done eating.

My oldest son usually handled this. One day, he walked up to this woman while she was talking to herself in a very crazy-sounding fashion and simply asked her if she wanted the milk and potato wedges he was giving away.

She was clearly startled. No one ever tried to engage her while she was talking to herself or, I guess, if they did, they wanted to talk to her about "teh crazeh."

He didn't engage "teh crazeh." He just wanted to know if she wanted our leftovers and that was it.

After that, she stopped wandering around downtown loudly reliving her past trauma and screaming at people who weren't there. She certainly wasn't normal, but she was vastly better.

There was another incident when he offered her food and she said "no" in a manner that suggested to him she was suspicious of the motives of a man offering her food and also didn't trust that she would be allowed to just say "no." He simply moved on to the next person and asked them if they wanted the leftovers he was giving away.

That also seemed to make a big positive impact on her, which I can readily understand. I was, myself, sexually abused for years as a child and had similar experiences as an adult with some man I barely knew doing something that made a big positive impact on my mental health because it so flew in the face of what I expected from men.

Here are some resources for further exploring the issue of social stuff and homelessness:

"Bugs in the wetware"

We all end up with mental models that sometimes don't work for some reason. In some cases, they become entrenched and end up having a lot of baggage attached to them.

In many cases, the origin of these "bugs" in our programming is benign.

You get a lot of stories about this, such as the one about the woman who learns that she has been cutting perfectly good meat off her roast all her life because her grandmother's pan was simply too small. Her mother did what her grandmother had done without ever asking why it got done that way and the habit got passed on.

Sometimes these "bugs" take on a life of their own and become a huge problem in their own right that is resistant to change.

This can happen if someone was raised in a strictly religious family and lectured a lot about "bad" behavior being sinful, condemning you to hell, etc.

This can happen because parents were abusive or suffered serious mental health issues themselves, such as bipolar or schizophrenia.

This can happen because it has to do with hot-button topics, like sexuality.

Talk therapy is probably the most helpful in cases where "bugs" of this sort are part of the problem. Journaling can also help a person sort out "what do I think and why on earth do I think that?"

Here is a previous piece I wrote that may help cast some light on how something minor with a benign origin story has the potential to grow into a serious problem and how it got resolved in this case:

The Hand Licking Incident

And here is a piece about addressing your own internalized serious bugs in the wetware related to social stuff:

Putting Victimhood Behind You

There is often no clear demarcation between the three issues. Social expectations -- to eat a certain way or smoke because people around you do -- can significantly impact your physical health and brain chemistry. Social stuff can also cause or contribute to bugs in the wetware. But, also, bugs in the wetware can create social issues for you.

You don't need to fully understand all of it to find a thread to pull to begin to help it unravel.