Helping the Homeless Who Don’t Want Help

As a member of a mobile outreach unit that serves the chronically mentally ill homeless population, I am frequently asked why these people inhabit the streets. While there are many contributing factors to this problem, one of the most difficult to deal with is that the laws don’t help us help the people who don’t want help.

Resistance to treatment, shelters or even financial assistance is one of the most predictable aspects of dealing with the chronically mentally ill homeless.

Although it is important not to generalize when considering the reasons for this, the majority of the people we deal with suffer from some sort of delusional and/or paranoid thinking. This frequently inhibits them from making healthy, sound choices for themselves. Their illnesses can render them intolerant of some of the solutions we may feel are right for them.

For some, the mere thought of a change in status from street person to tenant or patient causes extreme anxiety. It’s also possible that they have had negative experiences with mental health systems in the past. Understandably, their ability to trust is quite impaired.

Most of these people are unable to go to mental health agencies for help. That is why a few programs are starting to do outreach, or are going to the streets to meet these people. But building a trusting relationship can take a long time. What shall we do about the ones who have more urgent needs, e.g., serious medical conditions that they won’t acknowledge?

The current laws for hospitalizing persons against their will are good laws designed to protect patients’ rights. However, they also allow seriously disabled people to fall through the cracks at times. The law allows for a person to be held against his will if he is suicidal, homicidal or gravely disabled. “Gravely disabled” means unable to provide for one’s food, shelter, clothing or general safety. Unfortunately, this category is largely subjective.

Many of the judges who preside over these cases do not consider street people gravely disabled because they, somehow, manage to get by for years on the streets. We often see people who miraculously survive, despite extremely impaired judgment. We must modify these laws in order for them to become more efficient and humane.

If we are going to reach the homeless mentally ill population, we must tailor our approach to the individual. Conservatorship (legal guardianship) is an alternative that is sometimes indicated. The conservator can make appropriate decisions for the client, and insure that the basic needs, including mental and health care, are being met. Again, the individual must fit into the gravely disabled category to qualify for this assistance.

There is also the problem of lack of conservators. The Public Guardian’s Office is woefully overburdened, and the private agencies involved in conservatorship don’t begin to make up the difference. It is a frustrating situation that must be dealt with, if we intend to make a dent in the problems of the severely mentally ill living in the streets.

If we do manage to become more effective in helping this special population, the demands on the existing resources will increase. There are already too few county hospital beds, psychiatric shelters and long-term living alternatives, and it’s going to get worse. All of our ideas, energy and good intentions will not compensate for the county budget, cut from $7.5 million down to $4 million, for the homeless mentally ill, during the next fiscal year.

GINA GOLDE RN

Studio City