Tuesday, November 16, 2004
I have read with concern the articles about Herb Allair, the homeless man who assaulted a volunteer with Lift-Up, and am responding to a few of the statements in the excellent article about him by Susan Cunningham in Sunday's Steamboat Pilot.
I am not a medical professional, but I worked with homeless people and on the issues affecting their lives for nearly 20 years in Minnesota and nationally. During that time, I wrote and helped pass federal and state legislation including a Congressional bill in the 1990s sponsored by Sens. Domenici, D'Amato and Durenberger for outreach and medical services for homeless people with chronic and persistent mental illness.
I have visited with Allair, as well as with local medical and social service professionals who know him and his situation.
It appears that Allair suffers from chronic and persistent mental illness that, as Cunningham very gently described, causes him to drift between delusion and reality. If that is the case then, in contrast to statements by the Lift-Up volunteer, Allair is incapable of "moving on" without assistance. Neither can he survive without someone providing him basic needs of food, water, clothing and shelter. Allair is an unfortunate victim of more than 40 years of failed national policy toward people with mental illness and homeless people.
Tom Gangel of Colorado West Mental Health only partially described the federal policy of "deinstitutionalization." Beginning in the 1950s, mental institutions began releasing residents deemed able to live in communities with assistance, including housing with supportive services and community centers that could provide oversight and social opportunities. Unfortunately, the community centers and housing critical to the success of this program never were established. Today, in rural and urban America, people are released from mental institutions and often bused directly to the nearest drop-in center or emergency shelter for homeless people.
As Gangel acknowledged, part of the deinstitutionalization program involved tightening regulations on admissions to mental institutions. As a result, not only does a person have to be a danger to themselves or someone else to be admitted for emergency mental health care, that admission is usually limited to a 72-hour stay. "Choice," as Gangel noted, can be a wonderful thing when it comes to mental health care. However, when individuals' mental illness consistently and gravely interferes with their ability to make sound choices for themselves, they need to have options that exceed three days of care. According to national research, 40 percent of the homeless population suffers from chronic and persistent mental illness. In my experience, no one goes through the agonizing process and existence of homelessness without damage to their mental health.
Allair may be the most visible homeless person in Steamboat Springs, but he is far from the only homeless person. Rural homelessness is very different from its urban counterpart. No one stands in soup lines in rural communities, and emergency shelters are not part of our landscape. Not only is rural homelessness far less visible than in urban America, it is far more episodic as individuals and families move between different housing arrangements as their incomes allow. Except for those such as Allair who fit a stereotypical image of homeless people (middle-aged men with beards carting worldly possessions with them), "homeless" is a term rarely used in rural communities to describe people who fit the federal McKinney-Vento Homeless Assistance Act definition of people without permanent housing.
In rural Routt County, as in rural communities everywhere, social service and health care providers tell me, "homeless" people "double up" temporarily with friends or family because they can't afford housing. Others live in their cars or abandoned buildings. Still more families and individuals hover on the brink of homelessness in substandard housing, one crisis or unforeseen expense away from losing their housing.
Lift-Up acted responsibly to protect their volunteers and staff. I am not surprised Allair acted as he did, though, nor am I shocked that his mental condition has deteriorated through the years. Homeless people die younger and from a list of ailments not common to those of us with homes. Their bodies and minds simply tire from the daily struggle to survive.
As a community and nation, we need to demand housing and service options for people such as Allair and for homeless people in general. That is no simple feat. Allair's mental health status likely will call for a medical professional to spend a great deal of time earning his trust and confidence so Allair will consider housing and medical options.
My colleague and friend Kim Hopper, an internationally known scholar on homeless issues and past president of the National Coalition for the Homeless, observes that homeless people act very sanely, very normally in a very insane situation -- homelessness. We need to be careful not to demonize the victims of homelessness and failed policy such as Allair. Rather, we need to require the federal government to uphold the promises made in deinstitutionalization for housing and supportive services and in the 1949 Housing Act, an act that pledged a decent home for every American.