Homelessness and the Mentally Ill

The other day in class I was lecturing about the advent of anti-psychotic medication and how it has been both a blessing and a curse.

The blessings are obvious. Before the discovery of anti-psychotic medications in the 1950s, those suffering from severe mental illness were locked up and put in straight jackets. Schizophrenia was treated with lobotomies and electroconvulsive (i.e., shock) therapy.

So great hope accompanied the advent of anti-psychotic medication. A hope that promoted a process called deinstitutionalization where, starting in the 1960s, the large, publicly-run psychiatric hospitals were emptied out so that families and local communities could treat the mentally ill with psychopharmacology.

But both families and communities were unprepared and ill-equipped for this burden. Good intentions and a handful of pills were not enough. Infrastructure was required. And lacking this, deinstitutionalization effectively created the mentally ill homeless population.

To this day, estimates have 1 out of 4 homeless persons as suffering from severe mental illness. And while deinstitutionalization is not the primarily or sole cause of homelessness, deinstitutionalization did make the mentally ill much more vulnerable to homelessness, particularly among those with lower incomes.

The legacy of deinstitutionalization is still with us. You see it on the streets of every American city where the mentally ill sleep in doorways and on park benches. It is a reality I see every week at my church Freedom Fellowship where we feed and worship with the homeless.

As I was describing this problem and its history to my class one of my students raised his hand, clearly distressed by the plight of the mentally ill in America today, and asked, "Dr. Beck, is there anything we can do about this?"

And I said, "Socialized medicine."

In retrospect, I answered that question a bit too quickly and provocatively. Most of my students are conservative, politically and religiously. So they are not too keen on the notion of "socialized medicine." That's a bad thing in their eyes.

Regardless, the fact remains that in America today there is no public safety net for the chronically and/or severely mentally ill. Mental illness brings about homelessness among the economically vulnerable. And once on the street the mentally ill will remain there until they die. There is no way for them, given their mental illness, to secure employment and the income necessary to pull themselves back out of homelessness.

And yet, wanting to address the beliefs of my most conservative students, after mentioning socialized medicine I went on to say that, if you are conservative, that churches (rather than the government) should step in to care for the mentally ill of the community, especially those who are homeless.

And yet, I noted, I know of no churches (in our city at least) that actually do this work in any consistent and comprehensive way.

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