Homeless Bureacracy

 

 

 

 

http://www.latimes.com/local/la-me-prioritizing-homeless-20160731-snap-story.html

 

“Gallegos was caught in a historic transition in housing policy as the federal government  wrestled with how to parcel out inadequate resources to the most needy. It’s a shift away from waiting lists toward what is essentially a homelessness grading system.”

 

The most vulnerable population gets hurt over and over again. Without advocacy, the mentally ill are often falling through the proverbial crack. In my experience, those well enough to “work the system” often get tremendous benefits, but those who have little insight into how a city distributes funding, or those who do not have loved ones who can help them,  suffer the most. Systems can be “gamed” and those savvy enough to understand that get to the top of the line. Cynical, you say? Maybe, but maybe also true. The issue with mental illness is that, by definition, the illness impairs their ability to navigate systems of care and as such, they often lack the mental tools necessary to deal with changing rules, and as such, homelessness often results. The homeless mentally ill, by and large, do not vote, and as such they lack political power. Having said that, there are wonderful advocacy groups such as NAMI, http://www.nami.org/ which make a large impact on helping the helpless. Still, there is work to be done. This LA Times story of Rory brought tears to my eyes. How he could fall down on the list because the rules changed on him is simply tragic. This new system is based on a paper and pencil test, which more insightful folks, will fill  out to gain priority, rather than honestly answering the questions, thereby tilting the program to the less-needy.

We know that “Housing First” programs work. http://www.endhomelessness.org/pages/housing_first . The lower the threshold to get housing, the faster people, including people with mental illness, will function independently. If we know that, why don’t we act on that? The answer is that there a huge housing shortage in LA County. Too many developers are gaining from building new apartments and homes for paying customers. They often create low-income housing along with new housing, but not enough to meet the growing need to house this population. Government must intervene to care for our most needy. As a psychiatrist, I want to shout about it. It is a baby step.

 

 

Toxic Stress

“Toxic stress response can occur when a child experiences strong, frequent, and/or prolonged adversity—such as physical or emotional abuse, chronic neglect, caregiver substance abuse or mental illness, exposure to violence, and/or the accumulated burdens of family economic hardship—without adequate adult support. This kind of prolonged activation of the stress response systems can disrupt the development of brain architecture and other organ systems, and increase the risk for stress-related disease and cognitive impairment, well into the adult years.”

http://developingchild.harvard.edu/topics/science_of_early_childhood/toxic_stress_response/

See also…http://opinionator.blogs.nytimes.com/2013/10/30/protecting-children-from-toxic-stress/?gwh=4A5E6CBAAE9D19C51946C9B4A47C3B49

Parents may facilitate development, but more likely they need to “get out-of-the-way,” as I like to say. Getting out-of-the-way means protecting kids from what is now labeled as “toxic stress”. Children are biologically programmed to develop and mature, and with a basic environment of positive affirmations, good attachments, and provisions for food, sleep, friends, and education, most children and grow and flourish and reach their biological potential. However, in the face of tension, violence, or deprivation, then the child must go into what I call “brain freeze” and this stunts the development of the brain, in terms of understanding and knowing how to please oneself. Psychotherapy steps into to deal with toxic stress, but this requires many hours of trying to understand what happened in the preverbal period, where most memories are implicit and not explicit, Uncovering the trauma, so the adult can return to the developmental train where they learn to love themselves is a lengthy process, involving struggle and psychological pain.

Emily, fifty-six, youngest of eight children, always felt like she was a “burden” and consequently, never experienced love from her mom. As a result, Emily spends her time feeling angry, at little things and big things. She is angry with her husband, her children, her friends and her co-workers. She collects all of their misdeeds and she stew over them, simmering with ill feelings day in and day out. By Emily’s account, all of these people in her life are trying to make her feel better. I suggest an alternative viewpoint that Emily is really angry at her mom, for depriving her of a loving environment, and now that anger is transferred on to the meaningful people in her life. “It is a struggle for me to see that,” she says, as she cries. “The struggle is a good one,” I say, highlighting that understanding projection is a struggle, and it is hard to see when a feeling is being displaced. “The struggle implies that you are trying to see another point of view, and in that angst, there will be growth and understanding. Emily’s toxic stress hit her pretty hard, such that the only way she can handle a feeling is to throw it out to someone else and then feel victimized by that feeling, rather than owning that feeling and then trying to metabolize it. The toxin is the neglect. The anti-toxin is her awareness of it.

Mentally Ill Are Locked Up: Where Are The Psychiatrists?

http://www.latimes.com/news/local/la-me-0717-lopez-twintowers-20130717,0,1637257.column

Today’s LA Times sheds light on the tragic situation in LA County, where the mentally ill are warehoused in the county jail. “3,200 people with a mental illness are behind bars (17% of the jail population),” Steve Lopez reports. Where are the psychiatrists in this discussion? We could ban together to talk about the need to rebuild our mental hospitals; the ones closed when Ronald Reagan was Governor of California. It is not clear to me why psychiatrists are not more involved in advocating for the mentally ill. The resources, in California, are so limited, and yet, what seems like a few years ago (30 or so), we had decent long-term psychiatric hospitals, such as Camarillo State Hospital, which gave the mentally ill a therapeutic community. We need to chime into this conversation so that we can remind the public that the brain influences behavior, and as such, treating brain disease, not just with medication, is a critical component to a civilized society. We need good systems of care which help people who cannot help themselves. Steve Lopez does a huge public service by bringing this to the media. Now, psychiatrists need to join him, by letting the public know that we care too.