This and the similar initiative in Utah are the kinds of governmental problem solving I really like to see. More effective services for the populace in the form of helping people better their lives while at the same time benefitting society at large and being less expensive than traditional approaches. I count myself reasonably liberal, but these type of solutions have largely popped up in traditionally conservative places, which is a pleasant surprise and makes me take another look at my understanding of the spectrum.
I think this has more to do with the nature of Albuquerque than republican/democrat. This as someone who grew up there. I now live in Las Vegas. The two cultures are very different. There's a lot of hostility in LV in a general sense that isn't there in Alb.
Albuquerque is deeply Catholic. Catholicism, Latin American Catholicism in particular is very big on social/economic justice, charity, 'works theology'
Albuquerque (NM as a whole really) is quite poor and it's a lot easier to convince poor people to help poor people.
I lived in Albuquerque for nine years (2003-2012). The Catholicism is certainly part of it, but it's more complicated than that.
One gets the feeling that it's a more egalitarian city than other US metro areas. I didn't feel like it was that racist of a city, certainly nothing compared to Pittsburgh, where I now live.
And there are very few establishments that are designed exclusively for the wealthy. The Frontier restaurant near UNM is a great example of what I'm talking about. You would regularly see news anchors, professors, doctors, etc. dining there in the same room as people who were homeless.
> And there are very few establishments that are designed exclusively for the wealthy.
This is an excellent description. Some people still flaunt their wealth, which is true everywhere, but I feel a sense of the city belonging to everyone that lives in it.
Of course, that's my view as a fairly well-off white male who's never experienced anything close to homelessness. People from different circumstances may have different opinions.
You can still find those places in Alb and the rest of NM. They have a hard time establishing a real presence though, as there really aren't so many people there. It still needs more industry/business. Something to pull the average income up and employ everybody.
For the most part, there's also very little geographic separation between the poorer parts and the richer parts, unless you end up east of Tramway or north of Paseo. This does tend to mean a bit more property crime, but for the most part people are relatively accepting of that.
There are still parts that are a bit scary (south valley, south of central especially around Zuni/San Pedro) but it's not that scary if you are from Abq. As for the racism, a lot of that goes back to the makeup of Abq historically and today, with an extremely diverse (and distributed!) population that most places can't match.
I think they're also places with cheap land reasonably near the city center (look at some of these housing prices: http://www.zillow.com/albuquerque-nm/home-values/). I don't know where you could easily build tiny houses or any other kind of new public housing anywhere near NY or SF.
Look at the efforts San Antonio has been making over the last decade to help the homeless mentally ill. They've gone from having virtually no system in place to being on the vanguard:
Most problems that have hard line solutions, i.e. drugs and crime, have much cheaper alternatives which are usually much less hard line and much more humane. This also includes a lot of hard line management theories about how to get the most work out of workers. Better and more humane treatment of people usually leads to better and cheaper results... and better overall outcomes. These are usually arrived at by idealists and dismissed by rationalists and supposed realists.
It is mind-boggling that one of the richest countries in the world and definitely the most powerful one has such a big problem with homeless people. My first impression when I came to US 4 years ago and in CA specifically was the amount of homeless people. I have not seen so many even in my home country that has a LOT of illegal immigrants. So far I have not seen any progress, at least in the state of CA. Does anyone know if those people are doing that by choice, is the system "punishing" the people that made a bad choice maybe in the past and lost everything, is it something else ? I have heard that it is very difficult to find a new job once you reach that level, not because you don't want to, but because of formalities (e.g. no home address, etc). Is that true ? It is not fair for people to not be able to sleep under a roof or to not be able to have food and clean water (see Africa), and at the same time to have so many technological advances and to have so many millionaires/billionaires that care only about their pockets.
It's just a very hard problem to deal with, and places like CA attract homeless people from other places, because they have good services. The US lacks a comprehensive national plan to deal with homelessness.
Part of the problem is that even when services exist, they're often fragmented and hard to administer. That's what led to ideas like "Housing First", where they've found just providing a home for a year fixes most homelessness problems (particularly when combined with other services). Having a home gives them a base to operate from to organize the rest of the services, finding a job, etc.
Part of the problem is that the US doesnt have a good plan for what to do with crazy people. We had a lot of problems with long-term institutions, but when we shut them down, we didn't actually start a new solution. We just left them on the streets.
Part of it is just social myth that people deserve their caste. If the homeless don't deserve their place in the increasingly vitrified social system, then perhaps the wealthy and powerful don't either, and so a large amount of anti-poor propaganda has been generated in the US by the elite.
> places like CA attract homeless people from other places, because they have good services.
California's winter weather is more survivable than most parts of the country.
> Part of the problem is that the US doesnt have a good plan for what to do with crazy people. We had a lot of problems with long-term institutions, but when we shut them down, we didn't actually start a new solution. We just left them on the streets.
Institutions were replaced with drugs. In 'Anatomy of an Epidemic' [1], Robert Whitaker says that before the drugs were available, many people were able to recover enough to get out of the institutions.
The book makes the case that commonly-used psychotropic drugs take an episodic illness and make it chronic.
This HN submission was from 2 days ago:
Psychiatrists Must Face Possibility That Medications Hurt More Than They Help (scientificamerican.com) - https://news.ycombinator.com/item?id=13186201
This has been my observation of the system... My friend was doing well until they got hold of her.
This is getting downvoted with no explanation, rude if you ask me;
The points are salient: I personally know a man in care who's been seemingly "kept stupid" with drugs while in an assisted living facility receiving treatment, and yes you can sleep outdoors most winter nights in CA, not comfortably but it's doable.
> This is getting downvoted with no explanation, rude if you ask me;
If I check my comments frequently enough I sometimes notice oscillations. That one was voted up once, then down twice, then I didn't check for a while. 2 people have since appeared to cancel out those two downvotes.
After I posted that comment I thought about editing it to say something about how the nicer weather is "in addition to the state's services...".
Perhaps some of the downvoters thought I was disagreeing with the comment I was replying to, whereas I actually meant to supplement his/her good points with my experiences.
Where is the data for the point about making psychotic chronic? Because there is peer-reviewed medical literature (meaning double-blind clinical trials) about their effectiveness in reducing symptoms, and "longer lasting symptoms" would have been a reportable adverse event that could/would have been seen.
Additionally: to advance this model, you have to think that the people caring for these individuals (both families and doctors) are either unable to see that the treatments make it worse, or that they see it but are motivated by something other than the patient's best interests. My uncle had schizophrenia. In my experience, neither of these were true.
Finally: these symptoms are chronic and intractable by nature, if you talk to people that have them. Look at the homeless people who are clearly mentally ill: they react to things we can't see all the time; not episodically.
Asking iconclastic questions like Whitaker does is important; we need to have a discussion about it and make sure we're not completely off base, but when you look at a persons total ability to function and their global quality of life, antipsychotic medications are helpful.
Just to comment on a case I know personally: the person had semi-regular psychotic episodes, a few per quarter, but every day meds to prevent them definitely made him less smart and... "there" on the good days (in addition to stopping episodes). That's how he was treated until about 20, when he managed to convince a doctor he should just have an as-needed supply of fast acting ones.
I know it's anecdata, but my experience is that there are a fair number of borderline cases where they can't hold it together sporadically, but the meds definitely lower the quality of the "good days" to fix that. Sometimes there's a fast acting med that can work; often there's not and patients are faced with a stark choice.
I think we see a lot more homelessness in that group of people than we should, because we basically trap them there after one or two episodes, even though if we fixed it and got them some help (usually better coping techniques; occasionally meds), we'd see a lot less homelessness.
I do think that meds have become a substitute for real coping technique teaching, and that in many of those cases, the caregiver isn't making the optimal choice for the patient, because they're optimizing cost or time invested, rather than long-term quality of life.
There are obviously things like hardcore schizophrenia where that isn't the case, but even for more sporadic delusion disorders, it can be.
> I think we see a lot more homelessness in that group of people than we should, because we basically trap them there after one or two episodes,
yes, this exactly: the system "traps" its patients with medications that do not address the cause of their psychotic presentations.
My friend just needed sobriety, but all she got were tranquilizers and other "bad prescriptions". She briefly escaped from her court-ordered medications, but then she got an SSRI which destroyed all the progress I'd made with her. See my comment history.
> Where is the data for the point about making psychotic chronic?
The term for psychosis which is worsened by its treatment is Supersensitivity psychosis, or tardive psychosis [0]. I think it originated in the early 1980's. Whitaker references some of the early studies in 'The Case Against Antipsychotics' (link in several of my earlier comments).
There is no controversy that some psychotic presentations are caused by alcohol, cocaine and meth amphetamine, and other substances [1]. Emergency departments typically test for substances, and also for urinary tract infections.
When the cause of a psychotic presentation is determined, the psychosis is said to be 'secondary' to its cause. If no cause is determined, the psychosis is said to be 'idiopathic' [2]:
Finally, we discuss how careful studies of secondary
psychotic disorders can help elucidate the
pathophysiology of primary, or idiopathic, psychotic
disorders such as schizophrenia.
> but when you look at a persons total ability to function and their global quality of life, antipsychotic medications are helpful.
When I met my friend, I figured she was "high as a kite", because she fluttered from topic to topic like a butterfly. I gradually learned that she really was supplementing her methadone (an opiate) with cocaine, and a constant dose of alcohol.
At the time, I didn't know anything about psychosis. But looking back, I now recognize that were times that she became psychotic due to cocaine, and that she recovered with sobriety.
Methadone is known to cause sugar cravings, but I think it also contributed to the 2-bottle-a-day liquor habit she developed after a month on the drug.
When my friend ran out of alcohol, she became profoundly psychotic. The hospital she was taken to used anti-psychotics. But these drugs were not indicated because they do not treat the cause of the presenting symptom (they found cocaine metabolites, and ought to have found evidence of alcohol use, which I think can be detected at up to 3 days).
There was a story submission here about how cocaine destroys mitochondria. I think this is fairly well-established. Today there's this:
Dementia is the name for a type of psychosis, when it is experienced by old people [3]. Sauna bathing is good for dementia because it supports the metabolism. Old people frequently become cold, which indicates poor metabolism, and reduced ATP (energy molecule used by cells to power everything).
From my observations, anything that helps the metabolism is also good for psychosis.
Neuroleptics (so-called "Anti-psychotics") are palliative medications that just slow people down to match their reduced energy capacity. They hurt people, and should all be withdrawn from use, in favor of treating the cause of their condition.
Edit: Adding a link to "Psychosurgery as Brain-disabling Therapy" [4], for my own future reference:
Psychosurgery merits special attention
because, as the proto...
>It's just a very hard problem to deal with, and places like CA attract homeless people from other places, because they have good services. The US lacks a comprehensive national plan to deal with homelessness.
Do you have a source for this? My understanding is that California is awful when it comes to homelessness. Quite a few cities have higher rates of homelessness than every city in California, but have lower rates of unsheltered homeless people than them (especially SF and LA)[1][2]. I interpret this as meaning that Californian cities are generally worse when it comes to the homeless.
On top of that, many cities in California make it illegal to feed the homeless, which is something you don't see as much in the Northeast[3].
I'm also curious as to how a state "attracts" homeless people. I could be wrong about this, but I highly doubt that a person becomes homeless and then thinks, "San Francisco is where I should go," and then somehow travel hundreds or thousands of miles to get there. I feel like given the numbers I'm seeing regarding homelessness per 100k people, people generally don't go to Californian cities for their homeless services.
I'm open to learning more since I'm sure that there's context I'm missing, but from what I've read, California is not the best place to be if you're homeless.
People absolutely do. Spending the winter outside in Syracuse, NY or Chicago is not fun. We used to give stuff to a homeless guy who would migrate south for the winter. I have cop friends who say it's not uncommon for some people to deliberately commit a crime in front of them to get a warm bed.
Also, some places run people out of town. Las Vegas in particular was caught putting homeless in busses to LA and SFO.
In still other cases, there are many documented incidents were social services people in red states like South Carolina sell the benefits of moving to New York or Massachusetts where services like Medicaid are much better. (Medicaid is cost shared with the state)
I personally know a man who moved to CA from the NJ (fellow HAM I met on the air) who is getting treatment for his neuropathy here in CA via Medi-Cal whereas he was homeless "back home" with no relatives to support him.
Actually, getting into the "why" opens up all kinds of cans of worms and actively gets in the way of showcasing solutions that have worked in various places! Why? Well, ... call it politics, except it's not just left/right, it's all kinds of crazy.
Things like "no home address" are actually the least of one's difficulties getting a job while homeless. Technically, one can be homeless and couchsurfing at friends' places, and that's relatively easy to recover from. And, yes, some people do do it "by choice," if you mean people living in their van and working at Google.
What's tough is being stuck on the streets, possibly with mental issues, possibly addicted to something. There are enough places to get a meal that few people starve to death, but homeless shelters are generally not good places to be, and one has to stand in line around 4 or 5 in order to get a chance at a bed for the night, which rather limits one's options for work. Then, there's the problem of maintaining hygiene, getting to and from interviews, etc., because being homeless usually means being poor.
Even without mental or addiction issues, these logistical issues can really take their toll. To have any hope of getting through it, one needs to be able to swim through a river of bullshit.
I can understand that there are people with mental issues or addicted to heavy drugs. If all of the homeless people have those issues then it is even more alarming for US and something is not right in this country, a country that is in a very strong position and that all the breakthroughs happen here. That's why I was and still am quite surprised with those issues, issues that can be solved with the amount of money that US has, but no one does anything.
I don't know if that is the outcome of capitalism or not, or it is the outcome of the housing situation in US or something else. I am quite interested in learning more why those issues happen to countries like US, I can understand why it can happen to my country where the unemployment rate is over 25% and the GDP so low, but for others that are the opposite and are worse in those issues, it is quite surprisingly.
Have you been to Seattle? It's out of control here. My sister - who lives in San Francisco - visited here and couldn't believe how much more severe the homeless problem is here compared to SF.
The homeless problem is more visible in Seattle because we have rather little indoor services for them and the services we do have also come with a lot of rules that people are unwilling or unable to follow to get a bed. Combine that with the grudging acceptance of "well, people are just going to sleep under overpasses and park RVs everywhere," and you wind up with more people sleeping outside compared to other parts of the country.
On the one hand, people need services and I want to help them.
On the other, it would be nice to be able to go to various parks' trailheads without walking through someone's "living room."
Part of the problem with conversations like this is that anything we say is going to be a generalization, so we run the risk of stereotyping whether our intentions or good or not.
There is nothing inherently wrong with wanting to live outside. I know in a "civilized" world, it seems so -- wrong -- but people have been living outside for eons. We're pretty good at it.
Of course I am not saying that people who are homeless all want to live outside. I am saying that we have to be extremely careful waving our arms around saying things like "It's mind-boggling...."
Yes, from the outside, looking at it from fifty-thousand feet, it makes no sense at all. This is the way of all human systems. Up close, however, you'll usually find that people do things for mostly logical reasons.
So I would at least change your statement to "It's mind-boggling that in this country that people who want to have a home cannot find one..." It seems like a nit, I know, but it takes us much closer to a solution by removing a subtle imposition of our values on other folks.
TL;DR: Even in environments where the community makes a very aggressive attempt to tackle homelessness, the problem persists.
I live in Santa Monica, CA. I've been her for 10-15 years and it's always had a bad homelessness problem. If you're not familiar with the area, the weather is basically great year round, we're a popular travel destination, lots of money flows through the city & by any definition, its a place that embraces social liberalism.
I used to live in downtown SM. It's upscale but you pass a lot of homeless people. I went from giving people change when I had it, to bills, to buying people meals. I eventually moved out of the downtown area to buy a house & start a family.
I figured since I was putting down my roots here, I should from applying bandaids to trying to help in a more systematic approach. I got in touch with a lot of the existing organisations. They all needed help, but I was surprised to find that outreach wasn't one of them. Long story short, if you're on the streets in Santa Monica it's more or less because you want to be.
[Side note: before people jump to the conclusion that means they don't need help, the deserve to be there, it's okay to forget them, etc. -- that's NOT the case and that's NOT what I'm saying either.]
I recently volunteered for LavaMae, who spun up an instance in Southern California. This was in Venice, so not the same people, but also not far from downtown Santa Monica (maybe a mile or two). You have time to wait to clean the showers & I got a chance to talk with a few people. I didn't want to pry, but if someone was forthcoming on their story, I asked a few why not hit up one of the shelters. My sample here is obviously tiny but I got a variety of reasons -- freedom of the streets, not wanting to wait in line, not able to bring alcohol, concerns about theft, etc.
It's a pretty tricky problem.
The presence of homeless isn't a sign of apathy on the part of the population or a lack of trying.
Hopefully next year the Federal and State money won't vanish. This is the kind of problem best solved locally, but it still requires money from somewhere.
Can we really not afford to provide very small homes (like tiny home villages) to all of the homeless (rather than just the most likely to die)? I think the biggest issue people would have with that is that people might take advantage. Certainly some would. But would there be so many that we couldn't sustain it, or that it would not match the benefit of having very few homeless?
It seems like there is just a very tiny amount of money available for these types of efforts. I really wonder why that is.
We tried this. It went poorly. [0] The currently favored approach is to require developers of new (usually luxury, since that is the only kind of apartment building that gets built) apartment buildings to provide a percentage of units at far below market rents to people on a lottery/waiting list system. But there aren't nearly enough such units (or units of any kind) to take care of everyone.
the biggest fear with some of this is that we tend to build public housing and then it turns into some sort of slum with heavy police presence. While I agree tiny housing is usually better than no housing at all, I fear for what it will become in medium to larger cities.
If there is a way to mix in these small properties into an area and have mixed-sized housing, I think this would help the issue greatly - but the logistics and politics to make neighborhoods such seems too high of a bar in most places.
What I notice (since we're talking about 'Projects' it seems relevant) is that there is a very low take up of the Tiny House concept among the black population which mostly inhabits social housing schemes similar to the Projects. The next smallest group is working class whites but this group is still influential in the movement.
This is important because any social housing policy designed to decrease poverty requires a large amount of 'buy-in' or goodwill by the residents or it shall fail.
There is of course the question of land for THs, but that thorny issue has already been overcome by most Tiny House people in a variety of ways I won't list here, although I admit it is a serious concern.
I went in search of a black person who lived in a Tiny House. She had immediately understood the nature of the question and said a bunch of things on the subject, what stood out is that you might be able to sell the idea of being frugal, minimalist, eco-friendly, outright home ownership i.e. autonomy, practicality and economy to the majority white population that makes up the Tiny House movement e.g. poor students and downsizing retirees, but selling the same ideas to the black population is a very difficult sell.
She said while many of the whites are coming from the suburbs i.e. been there, done that, the American Dream for blacks remains to have a big house with its associated trappings. That is when they know they have 'made it'. It follows that a re-imagining of the American Dream is necessary for the black population, just as has been happening for the people in the Tiny House movement, but different.
Where I don't concur with Miss Pearson, is that I think this is regression. For individuals it is a good adaption, yes, but the net affect on a society is indeed regression. Big Questions need to be asked about why that's happening.
This is such a hard problem to solve and there will only be less and less money for it. It is a good approach to start helping people to help themselves, rather than saying "we'll help you AFTER you fix your hardest problems yourself.". This makes no sense and doesn't work. As shown here and in other cities (http://gladwell.com/million-dollar-murray/), leaving homeless until they get so bad that they need ambulance and ER services is VERY expensive.
In our local town, the major hospital group did an experiment. They took a look at the top 50 patients that used the most of their ER and other services. They hired people whose job it was to make sure they stayed on track, got them to appointments (rides and public transport are big issues), made sure they stayed on their meds and followed treatment plans. It was a great success. They used ~70% of the resources that they used before. BUT, the hospital made lots of money on the use of those services, the experiment cost the hospital almost $1M!! It was not continued as hospitals exist to make money not help people.
So let's say a city takes a stance to be progressive and helps their homeless and (largely) gets them back on their feet. Pretty soon everyone in the surrounding areas hear about all the help and services and now one small town is dealing with all homeless that can get to this town. Smaller towns only have so much money to invest in an effort such as this. Additionally, what all jobs can you find to give all these people at $9/hour? There are only so many things you can have them do before you start cutting municipal jobs to create work and putting others on unemployment.
I saw a program several years ago where people that came into some of these programs, were set up with social security disability (especially those with mental issues and substance abuse issues) and give them a home base to get other program support. At least this uses federal resources and doesn't put such a strain on the local municipal budgets and resources.
This is a completely solvable problem but it takes a tremendous commitment of will. The other issue is that homeless don't vote. It is a problem that has to get fixed because it is the right thing to do, there is little political gain or public outcry in most cities. It is more expedient to work on issues like creating blue collar jobs and healthcare because of the public opinion payoff. Just my two cents.....
42 comments
[ 2.7 ms ] story [ 64.5 ms ] threadAlbuquerque (NM as a whole really) is quite poor and it's a lot easier to convince poor people to help poor people.
One gets the feeling that it's a more egalitarian city than other US metro areas. I didn't feel like it was that racist of a city, certainly nothing compared to Pittsburgh, where I now live.
And there are very few establishments that are designed exclusively for the wealthy. The Frontier restaurant near UNM is a great example of what I'm talking about. You would regularly see news anchors, professors, doctors, etc. dining there in the same room as people who were homeless.
This is an excellent description. Some people still flaunt their wealth, which is true everywhere, but I feel a sense of the city belonging to everyone that lives in it.
Of course, that's my view as a fairly well-off white male who's never experienced anything close to homelessness. People from different circumstances may have different opinions.
There are still parts that are a bit scary (south valley, south of central especially around Zuni/San Pedro) but it's not that scary if you are from Abq. As for the racism, a lot of that goes back to the makeup of Abq historically and today, with an extremely diverse (and distributed!) population that most places can't match.
https://apps.bostonglobe.com/spotlight/the-desperate-and-the...
Part of the problem is that even when services exist, they're often fragmented and hard to administer. That's what led to ideas like "Housing First", where they've found just providing a home for a year fixes most homelessness problems (particularly when combined with other services). Having a home gives them a base to operate from to organize the rest of the services, finding a job, etc.
Part of the problem is that the US doesnt have a good plan for what to do with crazy people. We had a lot of problems with long-term institutions, but when we shut them down, we didn't actually start a new solution. We just left them on the streets.
Part of it is just social myth that people deserve their caste. If the homeless don't deserve their place in the increasingly vitrified social system, then perhaps the wealthy and powerful don't either, and so a large amount of anti-poor propaganda has been generated in the US by the elite.
California's winter weather is more survivable than most parts of the country.
> Part of the problem is that the US doesnt have a good plan for what to do with crazy people. We had a lot of problems with long-term institutions, but when we shut them down, we didn't actually start a new solution. We just left them on the streets.
Institutions were replaced with drugs. In 'Anatomy of an Epidemic' [1], Robert Whitaker says that before the drugs were available, many people were able to recover enough to get out of the institutions.
The book makes the case that commonly-used psychotropic drugs take an episodic illness and make it chronic.
[1] https://www.madinamerica.com/anatomy-of-an-epidemic/
This HN submission was from 2 days ago: Psychiatrists Must Face Possibility That Medications Hurt More Than They Help (scientificamerican.com) - https://news.ycombinator.com/item?id=13186201
This has been my observation of the system... My friend was doing well until they got hold of her.
The points are salient: I personally know a man in care who's been seemingly "kept stupid" with drugs while in an assisted living facility receiving treatment, and yes you can sleep outdoors most winter nights in CA, not comfortably but it's doable.
If I check my comments frequently enough I sometimes notice oscillations. That one was voted up once, then down twice, then I didn't check for a while. 2 people have since appeared to cancel out those two downvotes.
After I posted that comment I thought about editing it to say something about how the nicer weather is "in addition to the state's services...".
Perhaps some of the downvoters thought I was disagreeing with the comment I was replying to, whereas I actually meant to supplement his/her good points with my experiences.
Edit: changed his to his/her.
Additionally: to advance this model, you have to think that the people caring for these individuals (both families and doctors) are either unable to see that the treatments make it worse, or that they see it but are motivated by something other than the patient's best interests. My uncle had schizophrenia. In my experience, neither of these were true.
Finally: these symptoms are chronic and intractable by nature, if you talk to people that have them. Look at the homeless people who are clearly mentally ill: they react to things we can't see all the time; not episodically.
Asking iconclastic questions like Whitaker does is important; we need to have a discussion about it and make sure we're not completely off base, but when you look at a persons total ability to function and their global quality of life, antipsychotic medications are helpful.
I know it's anecdata, but my experience is that there are a fair number of borderline cases where they can't hold it together sporadically, but the meds definitely lower the quality of the "good days" to fix that. Sometimes there's a fast acting med that can work; often there's not and patients are faced with a stark choice.
I think we see a lot more homelessness in that group of people than we should, because we basically trap them there after one or two episodes, even though if we fixed it and got them some help (usually better coping techniques; occasionally meds), we'd see a lot less homelessness.
I do think that meds have become a substitute for real coping technique teaching, and that in many of those cases, the caregiver isn't making the optimal choice for the patient, because they're optimizing cost or time invested, rather than long-term quality of life.
There are obviously things like hardcore schizophrenia where that isn't the case, but even for more sporadic delusion disorders, it can be.
> I think we see a lot more homelessness in that group of people than we should, because we basically trap them there after one or two episodes,
yes, this exactly: the system "traps" its patients with medications that do not address the cause of their psychotic presentations.
My friend just needed sobriety, but all she got were tranquilizers and other "bad prescriptions". She briefly escaped from her court-ordered medications, but then she got an SSRI which destroyed all the progress I'd made with her. See my comment history.
The term for psychosis which is worsened by its treatment is Supersensitivity psychosis, or tardive psychosis [0]. I think it originated in the early 1980's. Whitaker references some of the early studies in 'The Case Against Antipsychotics' (link in several of my earlier comments).
[0] https://en.wikipedia.org/wiki/Tardive_psychosis
There is no controversy that some psychotic presentations are caused by alcohol, cocaine and meth amphetamine, and other substances [1]. Emergency departments typically test for substances, and also for urinary tract infections.
[1] https://en.wikipedia.org/wiki/Substance-induced_psychosis
When the cause of a psychotic presentation is determined, the psychosis is said to be 'secondary' to its cause. If no cause is determined, the psychosis is said to be 'idiopathic' [2]:
[2] Secondary psychoses: an update, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3619167/> but when you look at a persons total ability to function and their global quality of life, antipsychotic medications are helpful.
When I met my friend, I figured she was "high as a kite", because she fluttered from topic to topic like a butterfly. I gradually learned that she really was supplementing her methadone (an opiate) with cocaine, and a constant dose of alcohol.
At the time, I didn't know anything about psychosis. But looking back, I now recognize that were times that she became psychotic due to cocaine, and that she recovered with sobriety.
Methadone is known to cause sugar cravings, but I think it also contributed to the 2-bottle-a-day liquor habit she developed after a month on the drug.
When my friend ran out of alcohol, she became profoundly psychotic. The hospital she was taken to used anti-psychotics. But these drugs were not indicated because they do not treat the cause of the presenting symptom (they found cocaine metabolites, and ought to have found evidence of alcohol use, which I think can be detected at up to 3 days).
There was a story submission here about how cocaine destroys mitochondria. I think this is fairly well-established. Today there's this:
Frequent sauna bathing can reduce the risk of dementia (sciencebulletin.org) - https://news.ycombinator.com/item?id=13204396
Dementia is the name for a type of psychosis, when it is experienced by old people [3]. Sauna bathing is good for dementia because it supports the metabolism. Old people frequently become cold, which indicates poor metabolism, and reduced ATP (energy molecule used by cells to power everything).
[3] http://www.medscape.com/viewarticle/564899_3
From my observations, anything that helps the metabolism is also good for psychosis.
Neuroleptics (so-called "Anti-psychotics") are palliative medications that just slow people down to match their reduced energy capacity. They hurt people, and should all be withdrawn from use, in favor of treating the cause of their condition.
Edit: Adding a link to "Psychosurgery as Brain-disabling Therapy" [4], for my own future reference:
Do you have a source for this? My understanding is that California is awful when it comes to homelessness. Quite a few cities have higher rates of homelessness than every city in California, but have lower rates of unsheltered homeless people than them (especially SF and LA)[1][2]. I interpret this as meaning that Californian cities are generally worse when it comes to the homeless.
On top of that, many cities in California make it illegal to feed the homeless, which is something you don't see as much in the Northeast[3].
I'm also curious as to how a state "attracts" homeless people. I could be wrong about this, but I highly doubt that a person becomes homeless and then thinks, "San Francisco is where I should go," and then somehow travel hundreds or thousands of miles to get there. I feel like given the numbers I'm seeing regarding homelessness per 100k people, people generally don't go to Californian cities for their homeless services.
I'm open to learning more since I'm sure that there's context I'm missing, but from what I've read, California is not the best place to be if you're homeless.
[1] http://acsh.org/news/2016/10/13/which-cities-have-most-homel...
[2] http://projects.sfchronicle.com/sf-homeless/numbers/
[3] http://anonhq.com/illegal-feed-homeless-city/
Also, some places run people out of town. Las Vegas in particular was caught putting homeless in busses to LA and SFO.
In still other cases, there are many documented incidents were social services people in red states like South Carolina sell the benefits of moving to New York or Massachusetts where services like Medicaid are much better. (Medicaid is cost shared with the state)
Anecdotal, but I don't question his story.
What's tough is being stuck on the streets, possibly with mental issues, possibly addicted to something. There are enough places to get a meal that few people starve to death, but homeless shelters are generally not good places to be, and one has to stand in line around 4 or 5 in order to get a chance at a bed for the night, which rather limits one's options for work. Then, there's the problem of maintaining hygiene, getting to and from interviews, etc., because being homeless usually means being poor.
Even without mental or addiction issues, these logistical issues can really take their toll. To have any hope of getting through it, one needs to be able to swim through a river of bullshit.
I can understand that there are people with mental issues or addicted to heavy drugs. If all of the homeless people have those issues then it is even more alarming for US and something is not right in this country, a country that is in a very strong position and that all the breakthroughs happen here. That's why I was and still am quite surprised with those issues, issues that can be solved with the amount of money that US has, but no one does anything.
I don't know if that is the outcome of capitalism or not, or it is the outcome of the housing situation in US or something else. I am quite interested in learning more why those issues happen to countries like US, I can understand why it can happen to my country where the unemployment rate is over 25% and the GDP so low, but for others that are the opposite and are worse in those issues, it is quite surprisingly.
https://www.quora.com/How-does-the-American-political-system...
California is like the world capital for homelessness. It isn't nearly that bad in some other parts of the US.
On the one hand, people need services and I want to help them.
On the other, it would be nice to be able to go to various parks' trailheads without walking through someone's "living room."
There is nothing inherently wrong with wanting to live outside. I know in a "civilized" world, it seems so -- wrong -- but people have been living outside for eons. We're pretty good at it.
Of course I am not saying that people who are homeless all want to live outside. I am saying that we have to be extremely careful waving our arms around saying things like "It's mind-boggling...."
Yes, from the outside, looking at it from fifty-thousand feet, it makes no sense at all. This is the way of all human systems. Up close, however, you'll usually find that people do things for mostly logical reasons.
So I would at least change your statement to "It's mind-boggling that in this country that people who want to have a home cannot find one..." It seems like a nit, I know, but it takes us much closer to a solution by removing a subtle imposition of our values on other folks.
I live in Santa Monica, CA. I've been her for 10-15 years and it's always had a bad homelessness problem. If you're not familiar with the area, the weather is basically great year round, we're a popular travel destination, lots of money flows through the city & by any definition, its a place that embraces social liberalism.
I used to live in downtown SM. It's upscale but you pass a lot of homeless people. I went from giving people change when I had it, to bills, to buying people meals. I eventually moved out of the downtown area to buy a house & start a family.
I figured since I was putting down my roots here, I should from applying bandaids to trying to help in a more systematic approach. I got in touch with a lot of the existing organisations. They all needed help, but I was surprised to find that outreach wasn't one of them. Long story short, if you're on the streets in Santa Monica it's more or less because you want to be.
[Side note: before people jump to the conclusion that means they don't need help, the deserve to be there, it's okay to forget them, etc. -- that's NOT the case and that's NOT what I'm saying either.]
I recently volunteered for LavaMae, who spun up an instance in Southern California. This was in Venice, so not the same people, but also not far from downtown Santa Monica (maybe a mile or two). You have time to wait to clean the showers & I got a chance to talk with a few people. I didn't want to pry, but if someone was forthcoming on their story, I asked a few why not hit up one of the shelters. My sample here is obviously tiny but I got a variety of reasons -- freedom of the streets, not wanting to wait in line, not able to bring alcohol, concerns about theft, etc.
It's a pretty tricky problem.
The presence of homeless isn't a sign of apathy on the part of the population or a lack of trying.
It seems like there is just a very tiny amount of money available for these types of efforts. I really wonder why that is.
[0] http://www.bbc.com/news/magazine-35913577
If there is a way to mix in these small properties into an area and have mixed-sized housing, I think this would help the issue greatly - but the logistics and politics to make neighborhoods such seems too high of a bar in most places.
This is curious because a self built Tiny House is very affordable. You can build one of these for less than 10k: https://www.tinyhomebuilders.com/images/products/simple-livi...
This is important because any social housing policy designed to decrease poverty requires a large amount of 'buy-in' or goodwill by the residents or it shall fail.
There is of course the question of land for THs, but that thorny issue has already been overcome by most Tiny House people in a variety of ways I won't list here, although I admit it is a serious concern.
I went in search of a black person who lived in a Tiny House. She had immediately understood the nature of the question and said a bunch of things on the subject, what stood out is that you might be able to sell the idea of being frugal, minimalist, eco-friendly, outright home ownership i.e. autonomy, practicality and economy to the majority white population that makes up the Tiny House movement e.g. poor students and downsizing retirees, but selling the same ideas to the black population is a very difficult sell.
http://tinyhousetrailblazers.com/2016/07/where-are-all-the-b...
She said while many of the whites are coming from the suburbs i.e. been there, done that, the American Dream for blacks remains to have a big house with its associated trappings. That is when they know they have 'made it'. It follows that a re-imagining of the American Dream is necessary for the black population, just as has been happening for the people in the Tiny House movement, but different.
Where I don't concur with Miss Pearson, is that I think this is regression. For individuals it is a good adaption, yes, but the net affect on a society is indeed regression. Big Questions need to be asked about why that's happening.
https://www.theguardian.com/society/2015/apr/01/oregon-tiny-...
In our local town, the major hospital group did an experiment. They took a look at the top 50 patients that used the most of their ER and other services. They hired people whose job it was to make sure they stayed on track, got them to appointments (rides and public transport are big issues), made sure they stayed on their meds and followed treatment plans. It was a great success. They used ~70% of the resources that they used before. BUT, the hospital made lots of money on the use of those services, the experiment cost the hospital almost $1M!! It was not continued as hospitals exist to make money not help people.
So let's say a city takes a stance to be progressive and helps their homeless and (largely) gets them back on their feet. Pretty soon everyone in the surrounding areas hear about all the help and services and now one small town is dealing with all homeless that can get to this town. Smaller towns only have so much money to invest in an effort such as this. Additionally, what all jobs can you find to give all these people at $9/hour? There are only so many things you can have them do before you start cutting municipal jobs to create work and putting others on unemployment.
I saw a program several years ago where people that came into some of these programs, were set up with social security disability (especially those with mental issues and substance abuse issues) and give them a home base to get other program support. At least this uses federal resources and doesn't put such a strain on the local municipal budgets and resources.
This is a completely solvable problem but it takes a tremendous commitment of will. The other issue is that homeless don't vote. It is a problem that has to get fixed because it is the right thing to do, there is little political gain or public outcry in most cities. It is more expedient to work on issues like creating blue collar jobs and healthcare because of the public opinion payoff. Just my two cents.....