On the Streets, Our Promise Unkept

In New York, officials have begun taking some of the homeless mentally ill off the city’s streets for compulsory treatment and hospitalization. The homeless get no choice in this matter; they are involuntarily incarcerated once professionals judge them to be incapable of caring for themselves.

One day after New York’s program commenced, a Los Angeles County mental health official announced that we intended to follow New York’s lead, although there is no equivalent program in effect.

It is estimated that as many as half of the nation’s homeless are judged to be mentally disabled. Most are people who have been “deinstitutionalized” over the past two decades. They were discharged from asylums with the promise that a community-based system of care would be developed for them. This system never materialized. So now the deinstitutionalized roam the streets, joined there by disturbed young people who would have been institutionalized if we had kept our asylums open.

This new development is a dangerous precedent, even though its proponents may be well-intentioned. The desperate plight of the homeless is being used as an excuse to reopen old institutions and to invest in new ones. Already, the “reinstitutionalization” of the homeless mentally ill is well under way. Many have found themselves part of the critically overcrowded prison population. Los Angeles County jails are now operating at nearly twice their capacity, and more than one-eighth of California’s jail inmates are considered to be severely mentally disturbed.

Two centuries ago, with jails bursting at their seams, philanthropic reformers called for the separation of the mentally ill from the regular criminal population. This plea led to the birth of the “asylum,” which dominated care of the insane in the United States until the deinstitutionalization movement of the 1960s.

Now, packed jails and highly visible groups of disoriented homeless provide a fresh impetus to an obsolete philosophy. For instance, the city of Irvine plans to convert a remote animal shelter into a “centralized” homeless shelter. The city of Los Angeles has plans for a “regional” facility for the homeless. And in New York, the street sweeps are heralded as the beginning of a new recognition of the need for asylums.

This is the wrong approach. It is vitally important that we provide help for the homeless, but there is no reason to retreat to institution-based care. Deinstitutionalization was, and is, a good idea. It argues that community-based care is better for the client, and that prolonged incarceration actually damages the chances for recovery-- and infringes on clients’ civil rights as well.

We cannot say that the idea of deinstitutionalization has not worked, because we never properly tried it. The best way to care for the homeless mentally ill is to deliver on deinstitutionalization’s promise. This requires the provision of shelter and services through small-scale facilities in all communities. Such facilities need to be located relatively close to each other, although they do not necessarily have to be on the same block. The grouping of housing options, direct services and social opportunities would enable the homeless mentally ill to become part of the community.

There are homeless people in all communities now. Everyone must expect to share the burden of caring for them. There is a striking absence of political leadership in favor of a “fair-share” approach to housing the homeless. This reinforces and legitimizes the exclusionary behavior of local groups intent on excluding all “different” people from their neighborhoods.

This year, in Australia, Britain and Canada, there have been formal observances of the International Year of Shelter for the Homeless. In the United States, not one event of any prominence has yet occurred. All that we have is an embarrassed, shameful silence. There may still be time to act to “celebrate” the International Year of Shelter for the Homeless. Locking up the homeless mentally ill in asylums is not the way to do it.