homeless sleeping on bench winter
Brittany Hambleton
Brittany Hambleton
January 20, 2024 ·  7 min read

When Did It Become Acceptable For Americans With Mental Illnesses To Freeze To Death? – Opinion

On any given night in the United States, over half a million people across the country are homeless. 35 percent, or 200 thousand, of these people, can be found unsheltered on sidewalks, in parks, cars, and in abandoned buildings [1].

According to the National Institute of Mental Health, 20 to 25 percent of the homeless population in America is severely mentally ill, and 45 percent of homeless people in the United States have a history of mental illness. Compared with the national average of only six percent, it is evident that mental illness among the homeless population is a significant problem [2].

Mental Illness and Homelessness

Mental illness is often cited as a major cause of homelessness, as opposed to simply being correlated. Mental illness can put a strain on a person’s relationships with others, can negatively impact their ability to care for themselves, and can make it difficult for them to hold down a regular job [3].

People who suffer from mental illness are more likely to experience issues related to their physical health as well, due to their decreased ability to care for themselves, which can lead to a greater prevalence of respiratory infections, HIV, and substance abuse [3].

The combination of substance abuse, poor physical health, lack of supportive relationships, and mental illness make it very difficult for individuals to maintain a steady job and therefore a home.

Homelessness can also exacerbate a mental illness, and the stress of having nowhere to live could lead to even greater amounts of anxiety, fear, depression, sleeplessness and substance use [4].

People with mental health issues make up such a large percentage of the homeless population because they are often released from hospitals and jails without a proper support system in place so they can get the help they need [4].

Read: After Overcoming 11 Years of Addiction to Heroin, This Man Is Touching Millions of Lives

Paulette Wilkie’s Story

Paulette Wilkie was a homeless woman living in Morrisville, Pennsylvania. The 56-year-old had a long history of schizophrenia and had been in and out of a local community mental health facility for more than twenty years. 

After living in a group home for almost a full year, she was asked to leave when she stopped taking her medication. Her father said he was told by health officials that she would not be allowed back in until “she got back on the medication and was clean”, however she did not like to take her medication.

Wilkie’s father considered having his daughter move in with him, but he was concerned about doing that since she was not taking her anti-psychotic pills.

Finally, one night after temperatures had dropped into the mid-twenties, her body was found behind Ben’s Deli, a sandwich shop that she went to often. Paulette Wilkie had died from exposure.

The owners of the deli, as well as a Pizzeria on the same street, knew Wilkie and knew that she had a mental disorder. She was always on their street, and shortly before she passed away, both business owners had noticed a significant and sudden decline in her health. She had lost weight and had stopped bathing.

The last time anyone saw Wilkie, she was sitting on a picnic table with her shoes and socks off, smoking a cigarette.

Paulette Wilkie’s story is sad, but not unique- she is not the first homeless person to freeze to death on the streets [5].

The Problem with Shelters

Before we can find ways to prevent situations like this from happening, we have to ask the question “why was this person sleeping on the street in the first place?” 

While there are many cases where a homeless person might refuse help, it is important to look at the systems we have set up in our communities that are meant to help vulnerable people, and assess whether or not they are working.

Our most common approach to keeping people off of the streets is to provide overnight shelters. Unfortunately, more often than not can be dangerous. This is particularly true for someone suffering from a mental illness.

One formerly homeless man, David Pirtle, who suffers from schizophrenia explained that part of the reason he avoided these shelters was that his illness caused him to have paranoia and fear of large groups. 

“You hear a lot of terrible things about shelters,” he said. “That shelters are dangerous places, that they’re full of drugs and drug dealers, that people will steal your shoes, and there’s bedbugs and body lice” [6].

On top of that, many of these shelters have restrictive rules for when you can come in, and beds are given out on a first-come-first-serve basis. Many nights they fill up so fast, if you’re not lining up by 4:30 in the afternoon, you may not get your bed back [6].

What Solutions do we Have?

It is important that we find better ways to help people like Paulette Wilkie. Thankfully, there are some solutions that have been proven to be more effective, if implemented correctly.

Housing First

This approach, as the name suggests, provides an individual with housing first, and worries about the rest after. It is based on the principle that a person struggling with mental illness cannot improve mentally or physically while they are living on the streets.

These programs supply a homeless person with somewhere to live along with supportive services, without requiring them to use those services or seek treatment of any kind prior to being given a place of residence [7].

Housing First programs have been proven to be very successful, and have been shown to improve participants’ quality of life on many levels. Individuals who receive assistance from Housing First programs consistently report having better mental health, experiencing less stress, have restored relationships with friends and family, and have reduced their use of drugs and alcohol [8].

Housing First programs are also less costly. For every ten dollars invested in the Housing First model, more than eight dollars is saved on other services such as hospitalization, shelters, police services, and the judicial system [8].

Finland has implemented these programs and is now the only European nation that has seen a reduction in homelessness in the last decade.

Read: Parking Lot gets Turned Into a Safe Haven For The Homeless At Night

Assertive Community Treatment Teams

An Assertive Community Treatment Team (ACT) is an integrated team-based approach to providing a support system to help keep people in stable housing. These teams work very well in conjunction with Housing First programs [9].

These teams address the needs of clients with mental health problems and addictions, helping them to seek treatment and rehabilitation services. They typically consist of physicians and other health care providers, social workers, and peer support workers [9].

ACT teams are designed to help clients with the most significant needs and provide ongoing, 24/7 support. The following are characteristics of ACT teams:

  • A multi-disciplinary team of professionals that provides wrap-around service directly to the client.
  • The team members are available 24/7 and provide real-time support.
  • The ACT team meets regularly with the client and with each other (could be daily).
  • The team is mobile, often meeting clients in their homes.
  • The staff to client ratio is generally 1 ACT team per 10 clients.
  • The program components are informed by client choice, peer support, and a recovery-orientation.
  • Services are offered on a time-unlimited basis, with planned transfers to lower intensity services for stable clients [9].

Assisted Outpatient Treatment

Assisted Outpatient Treatment (AOT), is court-supervised treatment within the community. To be a candidate for AOT, a person must have a prior history of repeated hospitalizations or arrest.

AOT programs have been shown to reduce hospitalization, arrest and incarceration, homelessness, victimization, and also to prevent violent acts associated with mental illness, including suicide and violence against others [10].

Treatment plans are highly individual and are developed by patients and their healthcare providers. They typically include case management, personal therapy, medication and other tools known to promote recovery [10].

AOT laws permit a judge to order a mentally ill person to accept treatment, and they have been proven to be beneficial for people with serious mental illness, however, providing continuous care through AOT is problematic [10].

Community Support For the Homeless

So the question remains- who is to blame for the death of Paulette Wilkie and the many others who came before her? There perhaps is no clear answer to that question, but one thing remains clear: as a society we need to advocate for our homeless people and call upon our governments to offer better programs to help our societies’ most vulnerable populations.

While it is easy to see homeless people on our streets and believe that they are none of our concern, the reality is that ending homelessness in our country requires input and care from everyone.

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