Mental Health Blogs

I read an interesting article at the SLO Homeless website, “Absurdity of the Bureaucratic Mindset” regarding the strategies needed to end homelessness and the absurdity of the current measures being employed and I couldn’t agree more.  Providing more affordable housing will not solve the homeless problem.  What will?

I’ve worked in the family dorm of a homeless shelter for more than 3 years now.  I sit in meeting after meeting listening to bureaucrats, administrators, social workers and funders talking about increasing affordable housing and providing rapid rehousing programs for homeless families.  What most of them do not realize is that lack of housing is not the problem.  Most of our families have been in affordable housing and have lost it.  Some are actually banned from accessing it again.  So how is more affordable housing going to help them?  I think the problem is much more profound.

What people do not seem to realize is that homeless families are not your average family who has had a setback.  They do not enter the shelter, get another job and leave the shelter system.  The majority of homeless families do not behave like middle class working families.  Nor is their stay in a homeless shelter their first, or their last.  The majority of them are cycling through the shelters over and over again.  We set them up in affordable housing and provide supportive services to them, yet they still fail to maintain housing and return to the shelter – again.  Homelessness, therefore, is a lifestyle for most of them.  This is so prevalent that when a true working family does have a problem and enter the shelter they stick out like a sore thumb. 

Research shows us that homeless children grow up to raise homeless families of their own and indeed, most of our homeless parents grew up in nomadic families who moved through the shelter system when they were children.  But bureaucrats never look at names, just numbers.  So – if our shelter shows that we house 200 families per year for 5 years people think that we housed 1000 different families.  That is not true.  We probably housed 500 of the same families over and over and 500 new families.  And most of those 500 new families are only new to us.  Most of them have been in other shelters in our city or shelters in other cities.  For the majority of the homeless population, homelessness is a lifestyle, not  an event. 

When a middle class, working family does happen to enter a homeless shelter their behavior is so out of the ordinary that you can spot them a mile away.  I am thinking of a family which is staying in our shelter now.  The staff here calls them “The Perfect Family” because of their extraordinary behavior.  Extraordinary, that is, for a homeless shelter.  You would not notice them out in public.  What is this behavior?  Neither of the parents are in the alley trying to score drugs or dates.  Both of the parents display responsibility for their children and pay very close attention to them.  Both parents are working - full time.  The children are taken to school or daycare everyday.  The family is not breaking every rule in the shelter.  They get up, eat breakfast, get dressed and leave for the day.  They come back in the evening before curfew, eat their dinner, take their baths and go to bed.  We hardly know they are here.  This is “abnormal” behavior in a homeless shelter.  What are the behavior patterns of the typical homeless family? 

I do not want to get into blaming the victim, but I do want to face reality.  Chronically homeless families do not behave like housed families.  I have worked with people living at the poverty level for more than a decade, but they maintain their housing.  It may be affordable housing.  It may be in the projects.  But they maintain it.  We do not see them in the homeless shelters.  Chronically homeless families display a pattern of behaviors which seem pervasive and profound and these behaviors are the root of their homeless problem.  These behaviors also create “barriers” which make accessing future housing difficult.  What are these behaviors? 

When we look at the histories of chronically homeless families we see that they typically do not:

• Pay their bills
• Maintain employment
• Follow rules or procedures
• Avoid criminal activity
• Take their children to school
• Have stable relationships
• Have familial support
• Play well with others
• Keep appointments or manage time well
• Follow through with referrals for services
• Maintain affordable housing, even when they are placed in it with extended supports

When social workers try to place these families in affordable housing they often face the following barriers:

• Recent criminal charges including substance abuse, assault, domestic violence or theft
• Poor credit histories
• Poor or non-existent employment histories
• Current warrants due to unpaid parking or traffic tickets or failure to appear in court for various charges
• Truancy charges
• A history of evictions
• A history of unpaid utility bills

My purpose here is not to blame the victim, but to talk openly about the severe dysfunction I see in chronically homeless families.  Unless we identify the true problem, we will not be able to form a lucid solution.  Homeless families typically do not function well on any level.  Children are frequently truant from school and display numerous behavior and developmental problems.  Dorm rules are constantly broken and there is constant turmoil between the families on the dorm.  Relationships are fleeting, intense and severely dysfunctional including domestic violence, substance abuse and exploitative.  Interactions with other people are inappropriate or dysfunctional.  Most homeless families have burnt all their bridges with every social service agency and with their own families because of their severe dysfunction.  Shelter staff often feel like we are running a middle school rather than a homeless shelter.  This behavior is what needs to be addressed rather than giving them more money or building more homes. 

Instead of building more affordable housing we need to find out what prevents these families from staying in affordable housing and keeps them coming back into the shelters.  It seems obvious to me that they are unable to function in most every viable way.  Most of our families have problems functioning within the rules of most any system in which they participate.  They display impulsive, short-sighted decision making and most of them have no idea where they are going when they leave the shelter.  They do not seem able to think or plan ahead.  The majority of them do not maintain stable employment.  Many of them display unrealistic ideas about what is required to maintain independent housing or to function in general.  If we can identify the factors which contribute to these behaviors and address them with counseling, we might actually help them avoid returning to the shelter system over and over again.  This would greatly reduce the homeless population in a very real way.   

What are some of the issues which contribute to these behaviors?  I am not certain.  My colleagues and I discuss this frequently.  We have been watching this population for several years and are trying to formulate a theory as to what contributes to repeated homelessness.  Personally, I believe there is a mindset which the chronically homeless have which the housed do not.  Many suggest mental illness and substance abuse as factors.  However, I have worked with the mentally ill and with substance abusers for more than 15 years and most of them manage to maintain affordable housing once they obtain it.  The cluster of behaviors I see in the homeless population seem unique to the homeless.  What are the elements of the homeless mindset?  I’m still trying to work this out in my mind, but here are some of them which I see frequently:

• An external locus of control –
• • the belief that they have no control or responsibility for their choices, actions or behaviors but they are the victim of circumstances  
  • the belief that the causes for good or bad events in your life are totally outside your control or responsibility
• Sense of entitlement –
• • the belief that the worlds owes them something and they should be able to collect immediately
  • the belief that they should be taken care of by others, by the government or by social service agencies
  • the belief that they should be given things they have not earned (i.e. free housing, clothing, food, etc.)
  • the belief that others should “help” them (i.e. by paying their unpaid bills or appealing their housing denial)   
• Impulsivity
• Poor boundaries
• Emotional immaturity
• Need for instant gratification
• Dependency issues
• Predatory/antisocial behaviors 
• Pathological relationships

Below, I have addressed some of the factors which I believe contribute to this mindset and their possible causes.  I have also addressed some of the factors frequently cited by others as contributing to homelessness and my thoughts about them.  I have will also discuss the part that our current social services system plays in fostering these behaviors. 

I would like to open a dialogue between people who are or have been chronically homeless or who work directly with the homeless population about these proposed factors in hopes of identifying the actual problems and developing real solutions.  Our current strategy of throwing free services and money at them and providing more affordable housing is clearly not working.  Please feel free to provide comments or feedback. 

Arrested Development

(I work primarily with women and children in the shelter so my focus tends to be from that angle, but many if not all of these issues are relevant to men in a homeless shelter as well.)

I would estimate that this one element contributes to the majority of the behavior problems we see in the homeless shelter.  A vast majority of our clients seem to have endured some sort of trauma(s) during their childhood which has(have) halted their emotional development.  The result is immaturity, impulsivity, dependency, a sense of entitlement (that someone should take care of them rather than being responsible for themselves), an external locus of control (seeing problems as existing outside of themselves and therefore being outside of their control and/or responsibility), immature relationships and emotional lability.  These factors result in behavior which appears erratic and irresponsible.  Clients will not keep appointments because their boyfriend (whom they met in the alley 3 days ago) needs them to go somewhere with them.  They miss curfew for the same reason.  They lose jobs for erratic attendance or simply failing to show up at all.  They fail to pay off old bills because they assume someone else will do it for them (and some social service program usually does) or they see something they want now and impulsively purchase it.  They enter into relationships just as impulsively and typically make very poor choices in partners, often ending up with abusers, drug addicts or worse.  They live in the here and now and appear unable to plan ahead.  When asked about their planned destination for when they leave the shelter, most are unable to grasp the concept or give a canned response they know you expect to hear.  They have no planned destination.  Their only goal is to get into the shelter and stay as long as they can in the safety they find there.  For many, the shelter is the safest place they have ever known.

Now imagine handing over money or free housing to someone who is this emotionally immature.  You can imagine what happens.  The money is immediately blown and all of the rules of the housing community are broken.  The new boyfriend or girlfriend moves in with them (in violation of the lease agreement) and contributes their own pathological behavior onto the heap.  If the new partner has a drug problem, the client gets evicted for having drug activity in the unit.  If the new partner is violent, the client is evicted for numerous calls to the police, damage to the unit and/or the disturbance caused to the community.  The client then returns to the shelter with an eviction on their record and unpaid utility bills.  Social workers jump in and find programs that will pay off their utility bills (so they do not learn to clean up their own messes or take responsibility for their poor choices).  They then mount an appeal with the housing authority casting the client as a victim of their partner’s bad behavior (instead of encouraging the client to take responsibility like an adult for their poor choices) and get them back into housing.  Or they find another community to accept the client despite the eviction.  The pattern then repeats itself.  A year later, the client returns to the shelter again with more utility debt and another eviction.  The pattern continues this way until they have burned so many bridges and have so many barriers that housing becomes untenable. 

Predatory/Antisocial Behaviors

First let me define the word “antisocial” as used by psychologists.  Someone who is antisocial is not an introvert.  When a clinician uses the word antisocial they are referring to a specific pattern of behaviors that shows a callousness for others, predatory behavior, lying and manipulative behavior, a lack of remorse and more.  For a complete description of antisocial behaviors please see the diagnostic criteria for Antisocial Personality Disorder.  For every person in a homeless shelter with dependency issues we seem to have an predator waiting for them.  Half the population seems to be working or receiving some form of assistance and the other half seem to be trying to hook up with them to take advantage of that income.

Pathological Relationships

Sometimes both parents in a homeless family have a drug problem or a mental health issue that compromises the family, but that is not the usual pattern.  I recently looked at my roster of women and children in the family dorm and tried to determine the cause for each woman’s homelessness.  As I went down the roster it became obvious, “a man, a man, a man, a man, a man, etc.”.  I took the same roster and asked the family dorm case manager to go down the list and tell me what he thought the cause of each woman’s homelessness was.  I was careful not to give him any further information.  He looked at the list thoughtfully, then started to move down it with the same results.  With few exceptions (one client had a drug problem and one had a mental health issue) the answer for every woman in the family dorm was that they picked out a man who brought them down.  Though I have no single fathers in the dorm at this moment, they have been here and I see the same pattern with them.  An honest, hard working man partners with a woman who has some pathology and this is what brings him and the children to the shelter. 

It is important to realize that single parents contribute to the problem of picking the wrong partner with their own pathology.  The single mothers in the family dorm are not simply victims of the men they pick out.  There seems to be a predominant attitude of these women that the man should “take care of them”.  They believe it is just a matter of picking out the right one.  The first problem is that their “picker” is broken.  They do not pick out a good one.  They usually pick out one of the predators roaming the alley behind the shelter.  The second problem is that you cannot sit at home expecting to be taken care of in our modern economy.  That might have worked in the 1950′s, even in the 1970′s, but June Cleaver is no more.  The modern American household takes two paychecks.  Two full-time paychecks.  The third problem presents it self when the man expects to be supported by the woman.  Even if the woman is working full-time and picks out a man who wants to live off of her, women traditionally earn much lower wages than men.  So the family’s financial stability is even more shaky.

This predatory – dependent dyad seems to play out in most of their relationships and I wonder if it is not the source of their alienation from their families of origin.  A person who constantly expects to be taken care of can be quite tiring.  By contrast, a person who is constantly preying on others also becomes quite tiring. 

Mental Illness

Mental illness is often cited as a factor in homelessness.  A significant number of homeless clients suffer from debilitating mental illnesses and many researchers sight the high numbers of mental illness in the population.  However, each researcher seems to define it in their own way.  Some include only the big three Axis I diagnoses (Schizophrenia, Bipolar I  and Major Depression).  Others include substance abuse (since it is an Axis I diagnosis in the DSM IV) which dramatically inflates the numbers of the “mentally ill”.  Others include Axis II personality disorders, but only some of them, usually Antisocial Personality Disorder.   Still others include Post Traumatic Stress Disorder.  In my experience, mental illness is a factor in about 10-20% of our homelessness clients and it is a serious problem.  However, it does not explain the other 80%.  These 80% use an unusually high percentage of services and monies devoted to the homeless and they are repeat customers. 

Substance Abuse

The percentage of clients suffering from substance abuse issues is very high in a homeless shelter.  We are literally floating in a sea of alcohol, heroin, crack, methamphetamine, marijuana and anything else you can think of in and around our downtown shelter.  Step out any door and you can buy anything you want.  The problem with saying this is that it is hard to tell which came first, the chicken or the egg.  Having worked with hard core heroin addicts in a methadone program for more than 3 years I found that the majority of them were not homeless and once they obtained affordable housing, they managed to hang on to it, despite continued drug use.  Even those who were constantly using crack or regularly drinking were not homeless.  So obviously, substance abuse alone is not the factor causing the homelessness.  It may contribute, but I think there are other factors not present in the substance abuse community itself.  I have to wonder if homelessness contributes more to substance abuse than the other way around.

Trauma

There is a very high incidence of traumatic histories in the homeless community, even before they became homeless, usually during childhood.  I believe that a majority of the substance abuse problem in this population is an effort to treat trauma symptoms.  However, this can be said of other populations as well, including the substance abuse community.  Most trauma survivors manage to maintain housing despite their trauma symptoms.   Though trauma symptoms may play a factor in homelessness, I do not believe they are the sole cause. 

Impaired Social Supports

This, I believe, is another major factor in homelessness.  Most homeless clients do not have family support systems.  If they did, the family would take them in and they would not be homeless.  Many homeless clients come from families who are themselves very nomadic and teetering on homelessness.  Some come from families rife with substance abuse, sexual abuse or domestic violence.   Others have been rejected by their families for various reasons.  These reasons often involve their dependent and/or dysfunctional behaviors.  The problem here is measuring the dysfunction of their families of origin.  Since they are estranged from their families, their families don’t interact with shelter staff, so I am unable to assess this accurately.   I can only observe that homeless clients consistently have little to no familial support and speculate as to why that is.  I would be interested in hearing the opinions of others on this matter.

The Enabling and Infantilizing Social Services System

In my humble opinion, our current social services system and is a major factor contributing to the homeless mindset.  This is a complicated element to explain.  But I think it is important to make an attempt.  

I see two major problems with the social services system:  1) the system itself – how benefits are applied and eligibility determined and 2) the people working within the system – the mindset of caseworkers and social workers working with the homeless population. 

The System – Administration

The social services system seems to be designed to punish attempts by the poor to achieve independence.  I do not mean in any way to suggest that this is by design or on purpose.  I believe that bureaucrats and administrators mean well when they implement the parameters by which programs are run, but the unanticipated effects are often deleterious to the psychology of the poor. 

Rewarding Bad Behavior

This is a frequent problem within social service agencies.  These systems often reinforce irresponsibility and impulsivity while punishing people who try to work and plan ahead. 

Example:

A father of four (two children and two parents) is working full-time for $8.00 per hour.  His wife applies for state funded daycare so that she too can work and contribute to the family’s income.  Their application is denied because he makes “too much income”.  So the wife stays at home with the children and the entire family is forced to live on his income alone.  When he loses his job after suffering a heart attack the family quickly becomes unable to keep up with their expenses and is forced to re-enter the homeless shelter to regroup. 

A county employee who has worked for the county for 23 years is laid off due to funding cuts.  She quickly obtains another job, but when budgeting ahead realizes she is going to be short next month and anticipates having trouble paying the electric bill until her new paychecks start coming.  She goes to the electric company to seek assistance for the one month she will be short and is told she will have to wait until she gets a cut off notice before they can help her.

The first example is only one way in which the state penalizes people for working “too much”.  If the father maintained a flimsy part-time job the family might have been better off and the mother would have been able to get the daycare she needed to work as well.  Of course, if she obtained full-time employment the daycare assistance would have again been terminated and the problem revisited.  So maintaining just enough employment to keep the daycare in place becomes the goal.  This also happens with rental assistance, medical assistance and food stamps.  Working ”too much” is punished by removal of benefits and the level of what is “too much” is preposterous.  In the city in which I live, I can’t live on $8.00 an hour as a single (and very frugal) person.  I have no idea how the state expects four people to live on that much less to say that it is “too much” to warrant daycare assistance. 

The second case is a clear example of penalizing the client for planning ahead and trying to address a problem before it actually becomes a problem.  Many social services programs seem to ”teach” clients to wait until the last minute then create a dramatic “emergency” in order to get help.  This fosters the emotionally immature and histrionic displays in lobbies often seen in social service agencies.  Then the staff rolls their eyes and wonders why the clients behave so badly.  Because that is what we have trained them to do.  Imagine this scene in our shelter lobby:

Clients are instructed to sign in to see a caseworker in order to request a bed in the shelter.  Five clients sign in, sit down and quietly wait for their turn.  A sixth client comes in, inquires about bed availability and is instructed to sign in and wait.  She immediately goes into a dramatic (and loud) display complaining of her many ailments, how weak and faint she is feeling and how she doesn’t know if she will be able to wait or not.  Staff rush out to the lobby upon hearing the disturbance and take her back to be seen, ahead of the five people who are waiting patiently. 

Now imagine you are one of the clients waiting patiently.  What have you just learned?  You know it.  Make a big, emotional, dramatic scene and you get put ahead of everyone else sitting and waiting like a sap.  You will see this played out in many social service waiting rooms, but the staff never address their part in teaching clients to act this way.

Giving It Away Free

Now enter the faith based initiatives and have churches giving away monies, services or products and you further exacerbate this problem.  Clients quickly learn that someone, somewhere will clean up their messes for them.  Someone will hand them money to fix their problems.  They learn to be dependent on others rather than working off the debt.  This also prevents them from learning not to make the mess in the first place.  If there is always someone around to pay off my light bill, why not run it up? 

This same problem can be seen with the welfare system.  I recently had an older single father who entered the family dorm with his son after having a heart attack and losing his job.  His family would take him in, but he preferred to handle the situation himself.  He was one of those rare people who had never been homeless before and did not fit into the homeless mindset.  He immediately got a job and went to work paying off bills which had accumulated while he was in the hospital and establishing a savings account.  He quickly worked his way out of the shelter and I don’t expect to see him back.  He was shocked and appalled at the attitudes displayed by the other families in the shelter and talked to me about it one day.  “I blame FDR and JFK” he said.  He explained his belief that the welfare programs initiated by these two presidents and exanded upon by LBJ were the source of some of the beliefs of the homeless families in the dorm.  I think he may be on to something.  Personally I do not think the WPA and CCS programs incorporated by FDR were problematic because people still had to work for their paycheck.  And they wanted to.  But our current welfare system does not allow this.  Benefits are given away free.  As this single father observed, “these people (the families) think the government owes them something, they expect to get everything for free”.  I think he might be right.

So what have clients learned so far?  Don’t work too much.  Don’t plan ahead.  Don’t wait your turn or follow procedures.  Expect someone else to provide you with what you need.  What else do we teach clients through social services? 

Don’t take responsibility.  Someone else will fix it for you. 

The People – Caseworkers, Case Managers and Social Workers

I worked as a caseworker in the social services system for almost 15 years, so I do not mean to be unkind or overly critical of caseworkers.  I have been guilty of the following behaviors myself at various times in my career so I know how easy it is to do.  I also want to say that I do not think any case worker, case manager or social worker does these things intentionally or with any kind of malice, but out of the goodness of their hearts and their desire to help people.  However, our desire to help people has to be examined.  Are we trying to help someone to truly empower and free them?  Or are we helping them to make ourselves feel better?  It’s great to save, “I saved this client from being homeless!”  But that does not empower the client.  That glorifies you.  I think we need to examine the methods and motivations of people working with the homeless community and train them to recognize the following issues.

Infantilizing and Enabling

Caseworkers and social workers have a bad habit of doing things for clients, rather than expecting the client to do it or teaching them how.  I am reminded of the wise saying, “Give a man a fish and he eats for a day.  Teach a man to fish and he eats for a lifetime.”  Workers in social services would do well to remember this philosophy as they seem to be geared more toward giving away fishes rather than teaching people how to fish.  I constantly see caseworkers doing things for clients which infantilize them and enable their sense of helplessness and incompetency.  I have seen caseworkers in their office, on their computers, looking for jobs for the client.  The client is not even in the office.  I constantly hear caseworkers talking about what they have figured out to solve the client’s homeless issue without even bothering to consult with the client or find out what their goals or plans are. 

And clients learn this.  A constant scenario I witness in our shelter is this:  A client comes to the caseworker with a problem, let’s say an unpaid electric bill of over $500.  No apartment will rent to them unless they can turn the lights on.  So they present this unpaid bill to the caseworker then sit back to see how the caseworker will get it paid for them.  And this is their attitude.  What are you (the caseworker) going to do about this?  It is the caseworker’s problem, not theirs.  I truly believe we have taught them to think like this.  And this keeps them helpless.  Their fate lies in the hands of others.  And every time we fix a problem for them we reinforce the idea that are not competent enough to handle it themselves.  We also find solutions for them we would never employ for ourselves.  If my electric bill were overdue I would not run around town looking for someone else to give me a handout to pay it.  I would economize or work overtime or work a second job in order to get it paid off.  But this is not what we teach our clients. 

Putting It All Together

Now combine all these factors. 

Solutions?

I’m not sure what the solutions might be.  I am constantly searching for real solutions which address the real problems and I’m open to any suggestions anyone has.  I’m not trying to provide a pat answer.  I’m trying to educate people about the real problems contributing to homelessness so we can discuss real solutions and stop throwing money at the problem. 

I think counseling should be provided liberally.  Teach people how to fish.  Teach them how their maladaptive behaviors impair their ability to function.  Stop rewarding bad behavior.  Stop giving away money.  Stop cleaning up their messes for them.  Stop giving away free stuff. 

What I would propose instead would be an earned benefits program.  If you want housing from the city, you provide labor for the city in return for your housing.  If you need food stamps from the county you work for those, and so on.  Government offices have many, many jobs that require little physical labor, education or training.  So even people with minor physical or mental handicaps would be able to do something.  At the mental health system where I worked we had a developmentally disabled client shredding confidential documents.  She just shredded day in and day out.  She saved us from doing a boring job and kept our files cleared and our offices free of shred boxes full of papers.  She was very proud of going to work everyday.  She was proud that she was able to provide service everyone appreciated – and she was greatly appreciated.  She also enjoyed participating in the “real world” just like everyone else.  We also had another program many years ago which providing a boarding home environment for schizophrenic clients.  In return for room and board the mental health contracted with local businesses to provide janitorial services at night when the offices were closed.  Schizophrenic boarders were driven to the various sites in a bus and cleaned the offices late at night.  They loved this work.  They could peacefully go about their work without having to interact with people (which is very stressful for most schizophrenic patients).  They also got to work with other mental health clients who understood their symptoms and didn’t disparage or make fun of them for having them.  These are just two examples of how a program like this might work. 

If government agencies required that people work for their benefits labor costs for running the city would be reduced.  Formerly homeless clients could clean parks, clean office buildings, pave roads or file papers.  The city would also save not only on the costs of their labor, but would not be required to provide them with standard medical benefits (they currently utilize the city’s medical clinics and that would be included in their earned benefits package) and retirement.  Working shoulder to shoulder with people who do have regular medical benefits, retirement and higher paying positions would motivate earned benefits clients to want to obtain a regular position within the city offices and eventually work their way out of the earned benefits program and into regular work and housing. 

Once homeless clients are assigned jobs, they would be provided with counseling to address the behavior problems that interfered with their ability to maintain employment.  If they failed to come to work due to a poor work ethic, substance abuse problems, domestic violence or other relationship issues, etc. instead of getting fired – again – and having another black mark on their work history, they would be required to participate in counseling or group work to address it.  This would help permanently resolve whatever problems are contributing to the homelessness and prepare clients for a successful return to the work force instead of merely paying off their bills and throwing them back into society to repeat the same behaviors and create the same problems which bring them back into shelter.

This is just my idea of how to address the actual problems facing homeless clients.  I would like to hear others.  Feel free to use the comments area below for discussion.

 

 

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