#747 Musings Beyond the Bunker (Monday September 11)
Good morning,
Remembering the attacks of September 11th and recalling that was 22 years ago. It’s hard to believe.
Back when Andrea were watching on the news the plane flying into the second World Trade Center tower, I remarked to her, “the world will never be the same after today.” It isn’t, but in ways unimaginable back then. While we didn’t see successive attacks on our shores or much domestic violence in the ensuing months and years, we saw multiple foreign wars, the expenditure of considerable resources, and the descent of our civil political order. One would hope we are emerging from the morass, but I’m not so sure.
THE HUMAN THERMOMETER?
As many of you know, I think nothing replaces the pleasures of a jacuzzi. I like to call it “Jewish Holy Water.” In any case, I like it hot. Most hotels keep their spas at 101. It’s tough to find it cranked up to 102. I like it at 103, and I can tell the difference. 104 and I can only stay in for a few minutes. 105 is impossible and unpleasant. In deference to others, I lowered our jacuzzi’s temperature to 101, it was totally unsatisfactory (so it’s going back up!). Perhaps my body is so attuned to temperatures that I can discern a mere degree difference—or perhaps I’m just deluding myself.
FINDING LETTERS
I’ve been digging through boxes from days gone by—everything from 1920s India through the New York of the 1950s and my childhood in the 60s and 70s. Recently, I’ve unearthed some letters and cards written to me by various friends over the years. I’m not sure why I kept them (well, some of it is humorous and amusing and helps expand memories of friendships). In any case, I’ve decided to begin sending many of these back to the authors. After all, these letters really belong to them and not to me. After all, the letters are windows into their pasts, and what they were thinking about (and joking about). I hope they will enjoy them as much as I have.
CARING FOR THE MENTALLY ILL
We have a housing crisis and we have a mental health crisis. They intersect when discussing the number of unhoused and uncared-for seriously mentally ill who are roaming our streets.
There is a cohort of well-meaning people trying to convince us of the universality of homelessness and that it is the temporarily economically challenged that represent the bulk of the homeless. It certainly is true that there are a large number of homeless for whom that life isn’t a question of choice, but is the result of unfortunate circumstances. And, while I believe this is true, it tends to avoid addressing a large percentage of the homeless for which solutions like housing and financial assistance may be necessary conditions to their recovery but are hardly sufficient in addressing their complex needs. “The homeless” isn’t a singular subgroup of the population. Those who live on the streets have different stories and will require different solutions.
The statistics about the number of mentally ill in the homeless population are unclear. The Stanford Institute for Economic Policy Research estimates 52% of the homeless are mentally ill. SMI Adviser, described as “a clinical support system for serious mental illness,” estimates that 20-25% of the homeless in the United States suffer from a serious mental health issue (compared to approximately 4-6% in the general population). Other estimates generally vary between these two numbers. Suffice it to say that it’s a large percentage of the homeless population that suffers from significant mental illness.
Providing beds alone will not solve the problem for these people. They are in need of more of our help. And that help only can be provided if we open more centers capable of both housing and treating these people. Their continued presence on the streets is bad for them, bad for us, and bad for the balance of the homeless population.
The mentally ill homeless comprise the most visible and disturbing members of the homeless community. They often suffer from physical disease and/or poor hygiene, talking to themselves, yelling in public, and urinating and defecating on our streets. It is easy to see they need help. More catastrophically, their presence detracts from those people on the streets whose primary needs are food, shelter, and a chance to succeed. And they detract from the street life so important to any cosmopolitan city. There is no “one size fits all” solution to the homeless problem. To not provide help to this group that clearly requires medical intervention not only exacerbates the homeless problem but detracts from “seeing” the balance of homeless and filling their needs. To not provide necessary services to those who are ill is an indictment of our society.
There are those who suggest that forcibly removing these people from the streets and housing them in hospitals or group homes to provide them care and safety is denying them their rights. There is an argument that it is paternalistic to treat these people, presumably against their will (if, indeed, many of them can even formulate what their desires might be) violates their agency and their freedoms. I would respond that we are paternalistic with another subset of the population that we deem unable to take care of themselves or make decisions for themselves. We call them children. One can be paternalistic with those who require parenting. There are limits to the freedoms certain people can exercise, especially when exercising those freedoms endanger themselves and others. And we, as a society, have a duty to care for these people and help make decisions that are in their best interest. Any treatment program must incorporate the employment of professionals capable of providing care and, hopefully, enough stabilization to live productive lives. Obviously, there must be standards and legal processes to govern how one can be committed to treatment when such treatment may not be voluntary. But these are the details to be worked out.
California, but other states as well, made a decision a number of years ago to reduce state supported mental health facilities. In retrospect, this was a mistake. It is time we realize that we have a duty to care for these people and live up to our duty.
Have a great day,
Glenn