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Tuesday, December 16, 2008

Myths about the Homeless #1

When I tell people that I work with the homeless more often than not the topic of drugs and alcohol follows soon after. I would like to take just a minute to acknowledge that yes, many of the homeless in the Unites States have a substance abuse problem. Sometimes it is the cause of their homelessness, and sometimes it is a response to their homelessness. Sometimes the people I know with homes and jobs seem to have more of a SA problem than my patients. I've have patients whose only illegal drug use is "pot, to help with the bone pain," often admitted by a man or woman dying of cancer with mets. I would hardly classify this as a drug problem. (I see it more as a legislation problem.) Notwithstanding, I know my share of junkies.
However, I also just thought it would be nice to talk a little bit about other ways people can become homeless.

According to the National Coalition for the Homeless:

Homelessness results from a complex set of circumstances that require people to choose between food, shelter, and other basic needs. Only a concerted effort to ensure jobs that pay a living wage, adequate support for those who cannot work, affordable housing, and access to health care will bring an end to homelessness.

Although many men and women who experience homelessness have a substance abuse problem, other reasons for homelessness in the United States include the rate of poverty (Both the poverty rate and the number of poor people have increased in recent years, up from 12.5% or 1.1 million in 2003 (U.S. Bureau of the Census, 2005).), our declining economy and lower rates of employment, a lack of housing and a sharp decline in the availability of assistance on a national and local level.

It's a socio-economic perfect storm. You're born poor, the economy gets worse, and because the economy is worse the value of any public assistance that hasn't already been cut to provide tax breaks or justify more spending on war is so low that it's not going to help you a bit. The poor stay poor or get poorer. The middle class is disappearing. It's not new news.

People become homeless when health care is not affordable or accessible. This occurs particularly when the conditions are chronic and would require extensive and expensive medications and medical interventions such as cancer, HIV and AIDs, renal failure and diabetes. Or as people get older and need more assistance maintaining their deteriorating bodies. Also included in high risk for homelessness are people with medical or trauma induced disabilities (MS, MD, ALS, or victims of a spinal chord injury, stroke survivors etc). These individuals, in addition to high cost of sustainable living have the added disadvantage of being mostly unable to earn an income, and rely almost solely on SSI*.

Elder abuse and neglect causes homelessness. One of my patients was dropped off at a bus terminal by her family, never to be heard from again. Bye, bye grandma! Bye bye medical bills!

Homelessness happens in situations of natural disasters, mental illness, domestic abuse and failed immigration from foreign countries.

So, although a lot of times drugs add to the problems, causing high risk behaviors, or simply just incapacitating people from self care... it's not just about alcoholism or a meth addiction. And there is a large percentage of people to whom it can happen to.

* By the way, trying to survive on SSI these days is like saying you're going to ride a unicycle to work every day this winter. It can probably be done by a small percentage of people. Like people in perfect health with no surprise obstacles. But it's really tricky and you're going to get hurt.

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