Homeless in America
This article presents an overview of the issue of homelessness. An estimated 650,000 people are homeless at any given point in time in the United States; more than 1 million people use sheltered housing annually; and about 3 million or more people are homeless at some point each year, including more than a million minors (U.S. Office of Community Planning and Development, 2010; Dupuis, 1999). At least three different categories of homelessness can be identified: Chronic (or literal), episodic (or cyclical), and temporary. The Housing First program and, perhaps to a lesser degree, shelters and missions operated by governmental, religious, and private groups have responded to this situation commendably, if not yet quite adequately. Episodic and temporary homelessness, however, appear to be on the upsurge.
Keywords AHMI (Adaptation of the Homeless Mentally Ill); Chronic Homelessness; Comorbidity of Mental Illness and Substance Abuse; Conduct Disorders; Contact Hypothesis; Dissociation; Gentrification; Housing First; HUD (The United States Department of Housing and Urban Development); McKinney-Vento Act; Pathways Approach to Homelessness; Polysubstance Dependence; PTDS (Post-Traumatic Stress Disorder); Section 8 Housing Voucher; Skid Row Housing Trust; SRO (Single Room Occupancy); Substance Dependence
The chronic homeless comprise roughly 16 percent of the homeless population, though this number has been declining since 2007 (National Alliance to End Homelessness, 2013). The cyclically homeless tend to be those at a high risk for repeated homelessness due to persistent problems such as violent family environments and the combination of poverty and expenses related to dependent children (Davidson, 2007). This group also suffers from PTSD fairly frequently, often resulting from trauma experienced both during pre-homeless and post-homeless periods; PTSD can be traced to specific events, is common among military veterans and abused women and children, and frequently impairs the sufferer from performing tasks necessary to maintain employment and function socially. The temporarily homeless are technically homeless in the sense that they have most commonly lost a residence due to a financial crisis and sleep in vehicles, with acquaintances, or in shelters. The official definition of homelessness is the lack of a residence for more than a year or for any period of time four times over three years (Davidson, 2007).
The federal government has focused on chronic homelessness partially because that group is stable, easily identifiable, and therefore easier to address. The Housing First program has reversed the conventional emphasis on moving the chronically homeless through temporary housing and treatment programs and sought to provide permanent housing as a basis for rehabilitation; clients can then choose whether and which form of treatment or therapy are desirable (Davidson, 2007). The single room occupancy (SRO) units provided by the Department of Housing and Urban Development (HUD), however, cost more than $50,000 because they are built with private kitchens and bathrooms, whereas renovated conventional SRO units with shared kitchens and baths provided by semi-private groups often cost only about $10,000 to put on the market (Harcourt, 2005).
Recent developments in the national homeless situation are decidedly mixed. The overall homeless population is estimated to have declined by 17 percent from 2005 to 2012 (National Alliance to End Homelessness, 2013). Chronic homelessness fell by 7 percent from 2011 to 2012, though there was no change in the number of homeless families or the unsheltered homeless (National Alliance to End Homelessness, 2013). The mortgage crisis that followed the Great Recession of 2007 may have been beneficial for some low-income earners in the sense that property values have fallen and rents may have stabilized, while more property is available for shelters (Koch, 2008). After hurricane Katrina in 2005, however, rental expenses and rates of homelessness doubled in New Orleans. A well-publicized streak of "middle class homeless" emerged in the wealthy community of Santa Barbara, California. The New Beginnings counseling center has offered a safe-parking program for those who have lost homes and are living in their vehicles. The center offers a safe place to park free from harassment as method of enabling people to turn their lives around (ABC News, 2008).
Only a quarter of eligible families in financial crisis receive federal aid, and the current waiting period for a valuable Section 8 voucher is 35 months (Nieto, Gittelman, & Abad, 2008). In 2002, 38 percent of families and 56 percent of individuals seeking access to shelters were turned away due to shortage of resources according to one study (Kim & Ford, 2006). Homeless families among households that receive government assistance are also in an undesirable position. Temporary shelter for one family cost about $40,000 annually in the 1990s, and the waiting period for movement to permanent housing ranged from several months in large cities to a few years in wealthier outlying areas that tend to oppose the construction of affordable housing. Rent in an average low-end apartment would cost about 10 to 20 percent of that amount, and moving children repeatedly is known to have adverse effects. The financial scenario for homeless individuals seeking temporary shelter is often similarly wasteful (Steinberg, 1994).
Culhane, Lee, and Wachter (1996) find that family homelessness is quite predictable based on urban and demographic patterns. Three clusters of poverty in both New York City and Philadelphia account for roughly two thirds of families admitted to shelters in those cities. Those "slums within slums" were characterized by highly concentrated poverty and unemployment, a prevalence of single female African American–headed households, few adolescents, immigrants, or elderly individuals, and — surprisingly — high vacancy. These factors might be explained by increased African-American family segregation in deteriorating buildings, where families were already "doubling up" to conserve their dwindling resources. These factors may not be revealed in official data because admitting some facts following a medical, social, or law-related crisis might limit access to public resources (Culhane, Lee, & Wachter, 1996).
The number of homeless veterans has decreased significantly—by 7.2. percent from 2011 to 2012—but homeless veterans still comprise a larger percentage of homeless than does the general population: the rate for homeless veterans is 29 per 10,000 people, while that for the general populace is 20 for every 10,000 (National Alliance to End Homelessness, 2013). African-Americans comprise 40 percent of the homeless population and 11 of the total US population; for Caucasians, 41 percent and 76 percent respectively; for Hispanics, 11 percent and 9 percent (though the latter number is constantly rising); Native Americans, 8 percent and 1 percent (National Coalition for the Homeless, 2012). Almost 40 percent of the homeless population is under 18, but only 5 percent of homeless minors are not supervised by an adult. Slightly less than a third have some college, professional, or technical training, a third have a high school diploma or GED, and slightly more than a third did not complete high school; 13 percent are employed; 40 percent are in families; 14 percent are single females; 41 percent are single males; 22 percent suffer from mental disorders and 30 percent from substance dependence; 26 percent suffer from serious illnesses such as pneumonia or tuberculosis; and 55 percent have no access to health insurance (Nieto, Gittelman, & Abad, 2008). About a quarter were sexually or physically abused as children; 27 percent moved through foster care; 21 percent were homeless while children; and 54 percent have been incarcerated (Nieto, Gittelman, & Abad, 2008). Older age and an arrest record are generally predictive of long-term homelessness, whereas younger homeless individuals without a history of arrests or substance abuse treatment are more statistically likely to escape homelessness (Nieto, Gittelman, & Abad, 2008).
Earlier studies of chronic homelessness often link mental disorders and substance dependence or abuse as causal factors, which can create the impression that substance use causes mental disorders (or vice versa), and which in turn results in chronic homelessness. The anagram "MICA," which denotes "Mental Ill/Chemical Abuser," reflects this simplification (Levitas, 1990). The term "mental disorders" is now often used in place of "mental illness." Recent studies emphasize that these two contributing factors are often triggered in high-risk individuals with a history of family instability by violent events that are likely to result in PTSD, and that the experience of homelessness — in a sort of "snowball" effect — exacerbates these problems and other impediments to maintaining residence, employment, and the social supports that can prevent homelessness. In other words, individuals prone to homelessness are also prone to mental disorders and substance dependence or abuse, particularly when family instability, exposure to violence, and the experience of childhood homelessness are evident (Booth, Sullivan, Koegel, & Burnam, 2002). It is worth noting, however, that specific patterns of substance use, particularly polydependence, have distinct correlations with patterns of psychological disorders and demographic histories. These patterns can reveal both problems and past achievements (Booth, Sullivan, Koegel, & Burnam, 2002).
Accurate statistical information about the homeless is often difficult to compile due to their very absence from the information used to generate census and IRS data. Much of the information about them, therefore, derives from third-hand reports and self-reports collected by homeless advocates, service workers, and academics. Information about PTSD is especially difficult to compile because dissociation, an aversion to the trauma that caused the condition, is a symptom. Well over half homeless women are thought to suffer from depression, which is also associated with avoidant behavior; these women are self-conscious about their problems and are therefore likely to avoid circumstances related to those problems (Hicks-Collick, Peters, & Zimmerman, 2007).
Although redistribution programs such as public assistance are less generous in the US than in other countries with comparably high standards of living such as Canada and Britain, in some respects the national homelessness situation is more severe in those countries (Nieto, Gittelman, & Abad, 2008). One plausible conclusion to draw from this circumstance is that poverty-related problems are informed by cultural behavior or conditions; this hypothesis likely explains the relatively low rate of suicide and attempted suicide among the US homeless population. Another explanation might be that generous welfare programs can exacerbate problems that contribute to homelessness. A more probable conclusion is that the patchwork of community and religion-based services provided to the homeless in the US assume part of the burden that the government performs in other developed countries, and that this cluster of service groups performs its function effectively.
The "New" Homelessness
The de-institutionalization of individuals with mental disorders began in the 1960s, and yet the homelessness-related crisis did not fully arrive until the 1980s. In the 1970s, a million or more of the SRO units in which the unemployed often resided were demolished, and the gentrification of urban centers through upscale remodeling escalated (Levitas, 1990). In the 1960s, one study found that 75 percent of the homeless were over the age of 45 and 87 percent of them were Caucasian; by 1986, 87 percent were minorities and 86 percent were under the age of 45 (Nieto, Gittelman, & Abad, 2008). Even more alarmingly, many more families were newly homeless in the 1980s (Nieto, Gittelman, & Abad, 2008). The declining age of the homeless, however, is partially explained by increased government spending on Social Security (Levitas, 1990)
In the 1960s, the transient population that moved through SRO units appeared to be declining, given the high rate of vacancies in those "cubicle hotels" (Dupuis, 1999). As such, the gentrification of city centers did not present such an obvious concern until the 1980s (Rossi & Wright, 1987). Cheap SRO units were conventionally located near railroad freight yards and trucking terminals, where temporary labor was needed (Dupuis, 1999). As the demand for manual labor decreased and homelessness soared in the 1980s, the federal government also cut the budget for HUD and Section 8 vouchers in half (Nieto, Gittelman, & Abad, 2008). The McKinney-Vento Act, however, was enacted in 1987 in response to public and government concern.
Peter H. Rossi, one of the best-known sociologists associated with studying the homeless, developed a new strategy for collecting quantitative information about the homeless. A team of investigators, accompanied by off-duty police officers for protection, examined all accessible streets, buildings, and cars in a specific neighborhood at night. This "blitz" method revealed that the level of chronic, or "literal" to use Rossi's term, homelessness was not as high as expected, but also that minorities and single women with children were increasingly represented. The "modal" (or most often appearing) homeless person was found to be an African-American high-school graduate in his late thirties (Rossi & Wright, 1987). All had significant levels of mental, social, and physical disabilities; all appeared to be socially isolated and unable to maintain or form bonds, although 60 percent had experienced at least some recent contact with family members (Rossi & Wright, 1987).
Rossi argued that a new form of public assistance that provided aid to families with dependent adults was warranted to address the demographic change in homelessness. The process of de-institutionalization was also followed by the continual non-institutionalization of individuals in need of treatment or medication (Rossi & Wright, 1987). Rossi also observed that the national rate of homelessness was surprisingly low, given that 17 million individuals earned less than half of the amount designated as the official poverty line in the 1980s (Levitas, 1990).
The later AHMI ethnographic study of women on LA's "Skid Row" provides a qualification of Rossi's observation about the social isolation of the homeless. That study found that one woman who neglected to eat even when free food was available nevertheless had a network of homeless and non-homeless local acquaintances who often sought her out and provided food. Another woman who could barely communicate in any way had a "best friend" with whom she frequently met. Another who is described as "psychotic" also partook of mission meals and shopped with one close friend. A few others, however, were thoroughly isolated: they avoided companionship; one talked to trees; another's isolation and psychosis were only finalized once she obtained an apartment. In a minority of instances such as this, subjects of the AHMI study were actually worse off once they escaped from street life (Baldwin, 1998).
A Lawyer's "Walking Tour" of Skid Row in Los Angeles
Lawyer Bernard E. Harcourt performed first-hand research about the Skid Row ("Central Area East") section of downtown Los Angeles for a trial, but he was not called upon to use that information. Instead, he published a quasi-ethnographic study of his experience that also traced the activities of both an influential homeless advocate and a prominent real estate developer who had worked as a housing official for the city. These two individuals and their respective organizations were often in competition to purchase the same buildings, and each argued that their own urban development strategy was the most beneficial for the homeless (Harcourt, 2005).
The attempted gentrification of LA's 50-block Skid Row district occurred later than in the inner-city sections of New York and other large cities. Downtown LA remained "unreconstructed" — that is, filled with "wretched" Third-World-like tents and cardboard homes, increasingly surrounded by luxury apartments and corporate buildings. Local mission operators claimed that 80 percent of Skid Row residents were addicts, and drug crime was obvious at night; drug dealers commuted in and out; crack pipes lit up like "firecrackers" at midnight; used needles and various forms of public lewdness were common on sidewalks. AIDS, tuberculosis, and other diseases were about three times higher than the national average on Skid Row, and drug-related deaths were ten times higher (Harcourt, 2005).
The Skid Row Housing Trust, as it was officially termed, refurbished old SRO hotels that eventually looked gentrified with funding from City Hall and the community; it owned 19 hotels, and its real estate is worth about $100 million; it charged $56 a month for residents on General Relief and $300 a month — the market rate — for residents on Social Security disability. At that time, there were 65 SRO-type hotels on Skid Row, many of which were operated by for-profit organizations and for which there were long waiting lists (Harcourt, 2005).
The chief administrator of the Skid Row Housing Trust told Harcourt that the Trust was engaged in a "guerrilla war" with police officers, who performed semi-regular sweeps of the area. Most arrested for minor crimes had existing warrants for their arrest and were given the option of entering treatment or facing incarceration. The real estate developer Harcourt interviewed emphasized that his company and other similar organizations hired the homeless or recently-homeless as laborers and even as security guards. The private security guards that were increasingly prominent in the area often interfered excessively with the homeless and police officers intervened; ample litigation ensued. As a whole, however, serious crime declined as the presence of private security guards increased. The city had apparently decided to keep Skid Row intact rather than relocating some low-end housing elsewhere, as some homeless advocates urged. This decision is sometimes termed "segregation," and sometimes "containment." Missions and shelters had long been located there, and the city attempted to shield some main streets from housing blocks with business-related buildings (Harcourt, 2005).
Harcourt (2005) observes that rising property values on Skid Row would likely affect the homeless adversely, and that the recent decline in crime in New York likely accounted for a third of the increase in property values. Some poor communities in New York, however, were revitalized through subsidies. Harcourt (2005) mentions that the affluent are likely willing to live near Skid Row due to the lower real estate prices and the Manhattan-like flavor...
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