Homeless in America

Congressional Research Service

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The Library of Congress

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Washington, D.C.

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HOMELESS IN AMERICA

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In response to numerous requests on the subject of the homeless, we have

compiled the enclosed packet of information.

This material discusses questions dealing with the number of homeless

Americans as well as trends in society's attitudes toward such people. The

incidence of mental illness and the appropriateness, or lack thereof, of

deinstitutionalization for such patients is another aspect of the problem

which is covered in this packet. A CRS report gives an overview of the

situation and of the Federal response.

Additional information on this topic, primarily in the form of

local library through

newspaper and periodical articles, may-be-foundin

the use of such indexes as the Readers' Guide to Periodical Literature,

the Public Affairs Information Service Bulletin (PAIS), and the New York

Times Index.

a

Members of Congress may obtain more information on this topic by

c a l l i n g ~ c ~at

s 287-5700.

We hope this information will be helpful.

Congressional Reference

Division

NATIONAL AFFAIRS

HOMELESS

Homelessness is on the rise, and public efforts

to solve the problem have proven sorely inadequate.

The tattered ranks of America's homehey have always been with us. The

samebeggarwhostretchedasuppli- less are swelling, and the economic recovant palmtowardthepassingtogasof ery that made this Christmas memer than

ancient Romecanbe found today on Colfax last for most Americans has not brought

Avenue in Denver, still thirsty for wine; the them even a lump of coal. As subfreezing

bruised and broken woman whoslept in the temperatures settled in last week, scattered

gutters of medieval Paris now beds down in anecdotes gave way to chilly facts. Unema cardboard box in a vest-pocket park in ploymentisatatwo-yearlowof8.4percent,

New York City. They exist on the fringes, but cities and voluntary groups across the

taking meals when they find them and countryareswampedwiththousandsmore

shelter where they can. Most have drifted requests for shelter than ever. In Philadelwell past the limits of respectability, many , phia, 15,000 received emergency family

deep into alcoholism or mental illness.The housing in 1983-five times the number

public usually views their very existenceas sheltered in 1981. In Detroit, auto sales are

ashame,adistastefulfactoflifemet-when

stronger, but the city estimates homelessit must be faced at all-with averted eyes.

ness is up 50 percent. In St. Louis, the

T

Tom l v s

Salvation Army alone received 4,155 requests, up47 percent over last year.

No region has been spared. Atlanta's

first overnight shelter opened in 1979;now

the city has 27. Salt Lake City's mayor

insists his city has become a "blinking

light" for wandering homeless, whilePhoenix and Tucson complain that hordes of

transients have descended on Arizona and

must be repulsed (page 26). "Our shelters

were full in September,longbeforeit turned

cold," saysAudrey Rowe, commissioner of

social services in Washington, D.C. With

100 city beds for about 20,000 homeHuddled against tho chill

in Phoonix: The otonomy is

brightor, but not for the

poorest of tho poor

20

G' r9h4 Newsweek, Inc. Reproduced by the Library of Congress, Congressional Research

S w s t l c awith permission of copyright claimant.

NEWSWEEKNANUARY 2,1984

less, Chicago, like most localities, relies on them, and

resist m y dfort to bring

church and community groups. Sister Car- them in. The result is an entire underclass

rie Driscoll says she turned away 112 pm- of people who have managed to slide right

ple in one day recmtly from the Catholic through the safety nets and into the gutter.

Charities shelter she runs in the city's devastated Woodlawn area. "At night 1pray,

"In the missions you sleep on a folding

chairand wke up in the middle of the niaht

'Lord, give me one more bed'."

The bedraggled homeless are walking with some m y tdking weird a d droofing

emblems of poverty and suffering-the

all overyou,"says Billy Collins, a 23-yearonlv wvertv manv Americans ever see. old ex-machine-lathe owmtor who lefi his

~ u i & l u & for &cis plight are not easily family and lit out fo; Florida and-then

found. For one thing, the forces that Crrli/omia He did not jind w r k - o r adcaused it are longstanding and complex: nnture; instead, he en& up eating scmps

everything from the disintegration of fam- out ofthe Dumpers behind McDonald's

ily ties to significant failures in America's and Kentucky Fried Chicken "The old

approaches to housing, mental health and guys riding the mils will be d y to share

welfare for the poorest of the poor. For what they've got, " says Collinr. "But peoanother, the homeless move outside the ple like me willjust beat them up and rip

wdinrry Urtructurar that might help them 08"

W.ltlnq tor lvnoh at a

Warhlngton,D.C, . w p khhon: Poverty wlth a womthe-akn

tam

Because they live without addresses,htme

homeless are unable to receive food stampS

and welfare in most states, invisible in un1employment statistics and impossible t~0

count. Estimates ranne anywhere fromn

250,000 to 2 million Gationwide, tens of

thousands of whom hPzard the elements

every night. The largeat private sponsor of

shelter, the Salvation Army. provides only

42,000 beds-a drop in the bucket. The

largest publicly sponsored shelter system

is run by New York, which now houses

6,000. That's double the capacity of two

years ago and more than during the Great

-

3

NATIONAL AFFAIRS

Angel Franc+V~rtons-Julllen

Shelter in a New York

phone booth: 'This system

doesn't make a man go up,

It makes him go downs

Depression-but

insufficient in a city

where officials estimate 20,000 homeless in

theunder-2 1categoryalone. Thechairman

of the city's Board of Health says that an

averageof one homeless person a day is now

found dead in the streets.

Like the rich, the homeless judge status

by where they sleep. The less chance of

interruption by police or other vagrants,

the more rest they get. Informal turf arrangements, say skid-row veterans, are beginning to break down under the weight of

the new arrivals. But certain distinctions

remain. The most successful find refuge in

garages or abandoned buildings, over hot

air grates or under bridges. The less discriminating settle for phone booths, park

benches, trash Dumpsters.

he people whopass thenight in such

accommodations are a much more

diverse lot than in the past-and

much younger, now averaging in their low

30s. Twenty years ago the homeless consisted almost exclusively of alcoholic skidrow men, mostly older white males. They

have been joined by huge numbers of released mental patients, who now make up

one-third to one-half of the total, and have

added thousands of women to the streets.

It's hard to tellwho wereseriously illbefore

T

becoming homeless, and who were driven

over theedge by therigors of street life. Few

aredangerous to anyone but themselves.

During the recession there was a sharp

increase in younger variations on the traditional hobo-unskilled drifters heading

south and west in a futile search for work,

many with their families. Recently, however, cities are reporting that the bulk of their

homeless aren't transients at all. Many of

the locals, says Ed Loring of the Open Door

Community in Atlanta, are young men

whocome out of housing projects and high

schools without any marketable skills.

Most male homeless have worked at some

point, but usually inmenialjobs.

The new drifters and dropouts are different from the winos and bag ladies. "You see

the embitterment and disillusionment of

life in them," says Capt. Cliff Jones of the

Grand Junction, Colo., Salvation Army.

Inside New York's Ft. Washington Armory, older men sleep gripping their shoes

so they aren't stolen by the newer arrivals.

Contrary to myth, most homeless welcome

any roof over their heads, but crime in

certain urban shelters is so pervasive that

some now take the same approach as their

psychotic brethren on the street-refusing

any offer of shelter.

The paradoxes of homelessness are practically endless. As cities revitalized their

downtowns in the 1970s by tearing down

dilapidated hotels, they threw thousands

who could afford nothing else into the

street. As states emptied overcrowded and

ill-staffed mental hospitals, they set thousands free to fend for themselves. And now,

as local governments and charitable organizations stretch to provide relief, they find,

according to some accounts, that the more

they do, the more they increase demand.

Meanwhile, what they cannot do-from

providing underwear (an item, unlike overcoats, that's rarely donated) to findinnfamily backing and-permanent housing--is

what the homeless often needmost.

he immediate reason people are

homeless, logically enough, is that

they don't have homes, and the primaryreason forthat is what wasoncecalled

the low-income-housing crisis but is nowadays more dimly recalled as "something

everyone cared a lot about in the 1960s."

One reason the issue faded from dational

view is that the government's housing policies failed. Washington warehoused the

poor in dismal high-rise projects, provided

loans guaranteed to default and wasted

billions in administratively inept programs

that ended up subsidizing middle-class

renters-and

government paper shuffle-instead

of the poor. Fewer than half

of the 6 million low-income units Lyndon

Johnson believed were needed in 1968 ever

got built.

But whileattention flagged, the problem

grew worse. Median rent increased twiceas

fast as income in the 1970s, and low-income-housing construction came to a virtualstandstill. The Department ofHousing

T

and Urban Development reports construction and renovation dwindled to 203,113

units in 1979 under Jimmy Carter and to

55,120 in 1983 under Ronald Reagan. Yet

census figuresshow about 2 million Americans living in substandard quarters and

hundreds of thousands on mind-numbing

waiting lists for public housing: 20 years in

Miami, 12inNewYork,4in Savannah,Ga.

The Reagan administration's housing

policy revolves around $200 million in

vouchers for low-income people to use for

rent-+ plan that assumesthereisnoshortageofhousing,onlyaninabilitytopay for it.

But a recent Brookings Institution study

suggests that the shortage may reach 1.7

million low-income units by 1990.And the

total housing subsidy for the poor is small

compared to what the middleclass and rich

receive. Their subsidy wmes in the form of

a home-mortgage tax deduction that a p

plies even to summer homes and will cost

theTreasury about $42.8billion in 1984.

Those who benefit from this deduction

are "gentrifying" the cities; they are helping restore the tax base and quality of life

in old neighborhoods. But the side effects

ate devastating. The first buildings to be

abandoned, converted into condomina destroyed are often the flop

houses called single-room occupancies

(SRO's) where many of the very poorest

live. About 1 million rooms-nearly half

the total-were converted or destroyed

nationwide between 1970 and 1980, according to a Columbia-New York Uni-

versity study. New York lost 87 percent

of its SRO's in this period. Cities like

Denver, Seattle and Rochester have lost

more than 50 percent.

Some of the denims of these seedy hotels and abandoned slums go directly into

the streets, but many live 51xtwith friends

and relatives. In fact, thenumberofAmerican families sharing quarters in 1982 was

up 58 percent-thetlrst such increasesince

1950. And that has given rise to a curious

development. In the past, fire tended to be

themost commondirect causeofhomeleasness; now it'softeneviction--evictioninitiated not onlv bv landlords. but increasinnlv

by friends - a h relatives:

many &

crammed into already crowded housing

with an Aunt Louise," says David Park

mi8tmkanly lava that they a n wall

waits for showers, about $3 million a yea]

pays salaries for security officers who arc

more visible on the payroll than in thc

shelter.

By contrast, private sheltersaround thc

country operate at an average cost of abou

$3 to $6 a person for smaller, more hospita

ble quarters often located in church base

ments or community centers. "There's ;

psychological efect of being in a churcl

that draws respect from guests," says Lu

Martinu, coordinator ofa Chicagoshelte~

Almost all private sponsors argue tha

SmithoftheDallasCoalitionfortheHome- while the government does a bad job c

less. "Pretty soon they wear out their wel- running shelters, its funding help is rc

come and are out on the strats."

1n 1983, ~eafile,a city sympathetic to the

nce the s c m m b g and door slam- homeless, turned down 4,000 familiesming subsides, the only refuge is about 16,000 peopleaeeking temporary

emergency shelter. In New York, housing.

where especially accurate figures are available, 2,300 families, up from 900 last year,

She was called the cellophane lady beare housed in squalid welfare hotels that cause of the woy she wmpped her legs and

charge the city around $1,400 per family fecr to protect them h m the Philadelphia

permonthan~boastmtsandp~titu~for

cold.Itdidn k work lart winterLillian Roseneighbors. The sinnle-sex shelters for indi- borough nearly lost her limbs because oj

rid-& coet the ciiy $24 per "client" per hypothennia. Even so, the 65-year-oldwomnight-most of the money going for per- an refused to be removed from the street

sonnel. In the East New York shelter, where she live-just a block from her

which regularly featuresaninchofwateron daughter's apartment. She insisted that she

a floor where people deep and two-hour was ruled by the spirit of 'Sing-jing " and

0

THE 'STREET GIRLS'

They scrounge for scraps-and

F

rom a distance, on the snowy streets of

Chicago, she could be a coed off to a

football game. But get close to the woman

called Teddy Bear-her real name is Dolores-and you see that her long woolen coat,

preppy sweater, dark pants and sturdy

boots have not been donned for a day's

outing.Shehasslept inthem. Herblackhair

hasn't been combed. It is falling over her

dark eyes and onto her bruised face.

Teddy Bear's friend Elizabeth also favors pants and sweaters for Chicago's icy

weather. She has a quilted coat for the

winter but so far has been unable to find

boots wide enough for her feet. So she

sticks to the Trax running, shoes she got

during one of her periodic stays at a Veterans Administration hospital. Elizabeth's

hair is cut tomboy short-a throwback to

her adolescent days. She can still execute a

flying leap, too, the kind she did back in

convent school. Sometimes she does one

just to try lifting herself out of depression.

The social workers call them homeless

women. They call themselves street girlsa motley group scrounging scraps and

small change, bag ladies who carry their

world around with them or stash it at a

friend's home or have nothing left to stash.

They sleep in abandoned buildings, overnight shelters, sleazy welfare hotels or with

men who take them in for the sake of

kindness or sex. They all have one thing in

common: fear. Fear of not finding a safe,

warm placefor thenight, fear of not getting

the meal--or drink-they need, fear of

rape or of losing what little they possess.

live in constant fear.

Even the most deranged bag ladies, who

just want to be left alone, are vulnerable

because of rumors that they keep money in

their bags. On the streets, says Elizabeth,

"you have to have eyes behind your head

and look like you're not scared."

She used to carry a shopping bag with

clothes and soap and a toothbrush, but it

was "too obvious a target," says Elizabeth,

wholooksolder than her 37 years. Now she

keeps clean underwear at the apartment of

adivorced woman friend who lets her takea

shower now and then. "I haven't carried a

purse since I was mugged," she says. "I've

had medication prescribed for my depression, but there's no use carrying that

around-they'll take it." Teddy Bear, 28,

carries nothing; she ends up selling everything for the price of a drink. The hulking

body that earned Teddy Bear her name is

swollen from wine. "A doctor told me my

body is going to give out if I don't stop

drinking," she says. "I was doing OK for a

few months. I have this friend and she

helped me stop drinking and made me

think I could get off the streetsfor good."

But now herwelfarecheck goes for drink

again, whm her sometime boyfriend

doesn't take it from her. She doesn't have

the strength to stay away from him when

she's drinking, even though it means she'll

end up with a black eye. "We fight all the

time," saysTeddy Bear. Soshe wanders the

streets looking for him--or anyone else

whomight haveliquor.

Like many street people, Teddy Bear's

past is hazy. She says she is an orphan, but

Kevin tioran-Plcture

Grouo

others say she has a mother and four brothers who keep trying to get her off the bottle

and the streets. Whatever the truth, Elizabeth says she understands Teddy Bear's

drinking problem, because she still carries

the scars from her own heavier drinking

days-like the one on her wrist from putting it through a saloon window. "I was

angry at the bartender for serving me when

I'dalready had toomuch," sherecalls. "It's

the whisky and vodka that makes you so

violent you wind up in jail on a drunk-anddisorderly charge. It feels like there's a

tornado in your stomach and your head

feelslike yougot hit with asledgehammer."

I

t's only since her divorce in 1979 that

Elizabeth has had to worry about a roof

over her head. "I was married four years to

an electrical-engineering student, but he

was a Pakistani from a strict Islamic upbringing where they didn't like women

going out at night. I've always been a night

person, and when he told me that I was the

camel and he was the driver, that did it. .

After the divorce I was too depressed to

work, and after four months of not being

able topay therent, Icame homeoneday to

find the locks changed. So I hit the streets.

It was cold, but I found an open Datsun to

sleep in at night. When the owner saw me

one morning he brought out a blanket and

apologized for not letting me sleep inside,

but five weeks of sleeping in that car landed

mein theVA hospital with pneumonia."

On a recent evening, Elizabeth sought

shelter in the basement of Chicago's Uptown Baptist Church, where Teddy Bear

often spends her nights, but shedidn't stay

long. "I know the shelter is safer than the

streets or the subway," Elizabeth admits.

"But the smell of dirty bodies is like rotting

flesh, and it will get worse by morning. I

worry about getting lice from the blankets

or sores on my mouth ifsomeonespitsin the

coffee." So out into the snow she goes,

hoping that the Cuban guy who sometimes

lets her stay in his room is home and sober.

"I'm kind of scared of him since he pulled a

knife on me a week ago when he was drinking that crazy rotgut vodka. But at least

he's not the typethat would makea woman

work the streets. How am I going.10 get

married again in this predicament?"

Thebest resource for thestreetwomenof

uptown Chicago is Sarah's Circle, a women's drop-in center open five days a week.

It's not only the coffee and snacks and the

Wednesday-afternoon bingo that draws

them. It's the unintimidating, lived-in atmosphere, the tattered sofas and chairs and

the old copies of House and Garden. There

is a kindness at Sarah's, not only from the

Teddy Bear (left) and her

street friend, Elizabetk:'I

never thouaht It would

hapwn to me*

volunteers but also from other women who

have been through whatever you are going

throughand want tohelp. They throw their

arms around Teddy Bear, tell sympathetic

stories about being beaten by their own

"old menw-and talk tough about wanting

to punch them out. And whereas shelters

provide the bare tssentials of existence, a

place like Sarah's also can permit a homeless woman to reorganize her life and perhaps get on her feet again. A young black

woman called Jane is trying to do thatusingasinkat thecentertowash her clothes

regularly and the comfortable lounge to

study books from thepubliclibrary. Unlike

the library, where you're asked to leave if

you're caught dozing off, Sarah's understands how tired a woman can be after a

wary night at acrowded shelter.

For everyoneon thestreet, lifeisa matter

ofimprovising. After breakfast at the Sally

(SalvationArmy), Elizabeth stops at qcity

garagewherethey let you use thebathroom

and just sit in the warmth for a while. Then

it's on to the US Submarine Shop, where

you can get a large cup of coffee in a Styrofoam cup for 50 cents-a much better deal

than at the coffee shop across the street

where you get a seat at a table, a cup and

saucer, but a lot less coffee. "I don't like to

give themmy patronage," harmmphs Elizabeth like the greatest of grandes dames.

B

ut then the high-strung, fast-talking

extrovert slows down, revealing a

Aash of the severely depressed woman who

still needs medication and periodic hospitalization. The holidays make h a introspective. "I never thought it would happen

tome," b k t h says. "It'sall my faultI can't seem toget my life together. I'm sort

of the black sheer, of a strict Catholic family. Even if I obuldn't k a nun, like I

wanted, I figured at least I'd be married

with a home. But my family hasn't spoken

to me much since 1gave m) why daughter

up for adoption 10years ago. Really, she's

far better off than I am-living in the suburbs with parents who love her-but my

mother always told me that the worst

thing you can do is give up your own flesh

and blood. I should have been strong

enough to keep my daughter. I should be

rtrong enough to get myself out of this

predicament."

Teddy Bear,meanwhile, is coming off a

binge and hardly notices the holiday season. She wins a Chnstmas tree in a drawing

at Suah'r Circle, and immediately talks

.bout adling it. She's not d y to accept a

missionary's dfer to sleep off her hangover

at an available apartment. "There's too

much pressure there not to drink," says

Dolores. As for the danger that awaits her

intheatreeta, sbesays, "Theonly thingthey

can do to me is itill me. Everything else

they'vedcmetome. I don't f a l i t anymore."

PATRICIA KING

NATIONAL AFFAIRS

that ifshe went inside before the govern-

ment provided shelterfor ail street people,

she would die.

It seemed like a good idea at the time.

Many state mental hospitals were unspeakably inhumane, and new miracle

drugs could control the psychotic without

straitjackets.So starting in the mid-1950s,

the nation's mental hospitals began releasing inmates in unprecddented numbers.

Liberals applauded the new civil rights

granted to the nondangerous mentally

ill; consmatives were happy to find

r seemingly compnssio~teway to cut

state budgets. Between 1955 and 1982

state mental institutions shrank by more

than threequarters-from 558,922 patients to 125,200.

But there is widespread agreement that

efforts to "deinstitutionalize" mental patients have backfired. While some do fine,

kns of thousands end up homeless-if not

right away, then after a few years of

bouncing among families, institutions and

the street. At the same time, it has become nearly impossibleto get the nondangerous mentally ill admitted to state asylums, or to keep them there long enough

to get a grip on themselves. In California, for instance, the median stay is now

only 16 days.

"If a doctor walked away from an opention for an appendicitis, he would k sued

for malpractice," aays New York attorney

Robert Hayes. 'VI'hertateh walked away

Driftin@undor 8 d l r d

bridge now -coon: Tho

homoleu a n younger

than ever

from these patients." H a y s felt so strongly

about it that in 1982 he quit the prominent

New York law firm of Sullivan & Cromwell and founded the W t i o n for the

Homeless, which is suing cities for the

right to shelter and coordinating the work

of 40 groups in states across the country.

Those patients sent back to what the

professionalscall "independent living" are

truly on their own. According to Dr. John

Talbott, presidentclect of the American

Psychiatric Association (APA), fewer

than a quarter of the patients discharged

from state mental institutions remain in

any mental-health program at all. When

they crack up, the lucky ones are taken to

hospital emergency rooms, .where they

routinely wait hours---sometimes tied to

c h a i e f o r a temporary bed. One out of

every five patientsat New York City public

hospitals is homeless.

ollow-up treatment has kenscarce

partly because many psychotic

street people mistakenly believe

they are well, and grow fearful that any

contact with authoritiswill lead to getting

locked up again. Large numbers have serious delusions. One woman wandered Hollywood aeowing passers-by that &hewas

Linda Darnell, r movie star of the 1940s

F

I

FIGHTING BACK

Arizona and Massachusetts represent the extremes.

H

iking her designer slacks above her

ankles, Sandy Cowen crouched,

made a face and gnarled her hands in imitation of a man she used to see from the

window of her advertising agency in downtown Phoenix, Ariz. This particular gentleman was a bit odd-a street bum who

carried around a bucket of soapy water and

washed everything in sight, from his feet to

the sidewalks. But Cowen is the brains

behind "Fight Back"-a

campaign by

Phoenix leaders to wipe out the "unacceptable behavior" of the area's 1,500 street

people-she knew how to handle the nuisance. Police weresummoned, and thebum

was forced to moveon.

'

The homeless are not welcome in Arizona. Many of them, residents argue, are

outsiders looking for a sunny place to

sponge off the state. The mayor of Tucson

was recently elected to his 13th year in

office on a platform that included a vow to

get "the transients the hell out of town,"

and beefed-up patrols of police officers

prowl the streets looking for suspicious

transient behavior. By contrast, the state

of Massachusetts is in the midst of an

ambitious effort to help the homeless help

themselves. It's more than the difference

between Barry Goldwater and Ted Kennedy; Arizonaisn't allconservative, and Massachusetts isn't all liberal. But the two

statesrepresent theextremesofcommunity

attitudes toward the homeless.

"We're tired of it. Tired of feeling guilty

about these people," says Cowen, who designed an ad campaign that features a

sketch of a man sleeping on a bench with a

red line drawn through it (like an international traffic sign). Posted around town,

these signs echo the official view of Phoenix, which in 1981 adopted an Anti-Skid

Row Ordinance that discourages blood

banks, bars, soup kitchens and flophouses.

Since 1981 four missions-including two

sponsored by the Salvation Army-have

closed their doors under pressure. After

one of his assistants had her fingers broken

by a drunken drifter, newly elected Mayor

Terry Goddard, a relative liberal, helped

found a task force dedicated to coping with

the transient problem and protecting Arizona's image as a sunny paradise.

A

s homelessness worsens across the

Southwest, a game of finger pointing

hasbegun. Skeptics in Phoenix andTucson

believe that Los Angeles, trying to clean up

before the 1984 Summer Olympics, will

soon send its problem across the desert.

Some Arizonans think they should try the

same thing themselves.

Tucson residents are divided, but the

prevailing ittitude seems to be that "Love

thy neighbor" should apply not just to the

needy but to the family down the street

alarmed by thesometimes violent vagrants.

Policescour homeless haunts with German

shepherd dogs, and one church soup kitchen will be sued as a public nuisance. "These

transients are urinating on the sidewalk,

sleeping in doorways and frightening shoppers," says Mayor Lewis Murphy, noting

that crime by the new amvals is up. "The

last thing we want to do is publicly provide

amenities."

That isone of the first things that Massachusetts wants to do. After regaining the

governorship last year, Michael Dukakis

announced that homelessness was his No. 1

social-service priority. "Homeless" plays

better politically than "poor" as a way

to win approval of state social programs,

and Dukakis, who lost his bid for re-election in 1978 in part because he alienated

liberals, had in recent years growngenuinely alarmed about the growth of the problem. Despite its frigid winters, Massachusetts has roughly the same number of

homeless as Arizona--estimated between

5,000 and 10,000.

Sofarthestatehasfunded 13sheltersona

75-25 basis with the community groups

that run them. It has also opened a 24-hour

hot line for referrals, assigned more state

caseworkers and changed welfare rules so

that people without permanent addresses

can receive benefits. Over the objections of

real-estate interests, Dukakis rammed

through a tough condominium-conversion

bill that requires that certain tenants get as

much as four years' noticebeforea building

can be converted. In mid-December, the

Massachusetts Legislature approved.Sl96

million for low-income housing, which will

translate into 2,500 new units and 2,000

renovated ones.

ne example of how the public-private

0

cooperation can work is Jessie's

House, a new family shelter located in a big

white house in Northampton. The city,

home of Smith College, has several hundred homeless people-some of them mental patients from a nearby hospital or victims of gentrification downtown. About 20

guests stay at Jessie's House for four to six

weeks under strict house rules. Staff members make a determined-and often successful-effort to find them jobs and housing, and friendly neighbors pack the

shelter's refrigerators and cupboards with

food. A city councilman who opposed the

idea was overruled by his constituents.

"Our philosophy," says Priscilla Braman, director of Jessie's House, "is to put a

lot of energy into people once and do it

right." Arizona's approach, says Tucson's

Rev. Dave Innocenti, is often "a traditional

Western-cowboy mentality-if you can't

pull yourself up by your bootstraps andbea

man, get out." There could hardly beclearerproof oftheold saw-"cold hands, warm

heartn-and vice versa.

JONATHAN ALTERwith JERRY BUCKLEY

in Nonhampton, MARILYNTAYLOR

in Phom~xand SHAWN DOHERTY

Tom lm

26

Down and out In Tucson:

'H you canY pull yourself up

by your bootstrap. and bo

a man, get O W

NEWSWEEWJANUARY 2,1984

NATIONAL AFFAIRS

who died in 1965. Another rejected food

and water for days because she thought she

was aplant and could soak up nourishment

from the rain. A man with his possessions

in garbage bags told travelers he had seen

the Ayatollah Khomeini in the basement

of a train station. When wealthier people

have mental or drinking problems they

often rely on counseling; the poor have it

harder. Navigating the bymutine mentalhealth bureaucracy, says Talbott, "would

drive even the normal person insane."

But the main reason mental-health care

has left so many homeless is that funding

iidn't follow the patients out of the hospitals and into the community. A 1963 goal

3f starting 2,000 community mentalhealth centers nationwide by 1980 is still

1,283 short. Some community-based care

is actually decreasing. Colorado, for in~tance,has released 1,172 patients since

1981, but the number of halfway houses

has fallen from 60 in 1975 to about 10

today. Even the mentally ill themselves

recognize the irrationality of the situation.

"It's amerry-go-round," says one 48-year,Id schizophrenic in New York. "You go

to the horpital, then they dump you into

thee h t e Inferno shelter8 and then you

go back again. This system doesn't make a

nan go up. It makes him go down."

Some of this results from budget squeezP, but much is the fault of administrators,

egislatore and civil-service unions. When

noncyis available,it often doesn't go to the

wmdcb8 mentally ill. In 1979,43 percent

of the $8.8 billion in total mental-health A brother and sister on

expenditures was spent by state hospitals, the streets of Hourton:Many

and only 17 percent by federal outpatient have hazy baokgroundsclinics serving the homeless. Some state and no roots left

officialsclaim that hospitals have to keepso

much of the money in order to maintain of these people are defined as clinically

specificstaffing ratiosrequired by the Joint employable by the government, but in the

canmission on Accreditation of H

o sr ~- i - real world can't possibly get jobs. Among

--.tals. But the JCAH saysthat's untrue.

those rejected for benefits in 1982, accordWhile homeless psychotics wander the ing to community workers, were an inconstreets without care, most statecmployed tinent man who wore seven pairs of pants

doctors and staff are back at the nearly at once and a woman who thought she was

empty asylums. In the last 20 years the a Vietnam War orphan.

average patient-staff ratio in state mental

For the nonmentally ill homeless, welhospitals has dropped from 5 to 1 to 1 to 1. fare isn't always much better. In many

And civil-service unions prefer to keep it states it won't pay the rent. A New Mexico

that way. Efforts to cut or transfer mainte- family of four is expected to get by on $66 a

nance and support staff in favor of more month in rent allowance. In Indiana, it's

community effortsareusually straitjacket- $100 a month for rent, regardless of family

ed. When New York Gov. Mario Cuomo size. And these states aren't exceptions.

a n n o d budget cuts for the state men- Last year Pennsylvania Gov. Richard

tal-health system, for instance, the huge Thornburgh and the state legislature

Creedmoor PsychiatricCenter cut itscom- moved to restrict all able-bodied men to 9C

munity outreach staff-and protected hos- days of welfare a year. Instead of lessening

pital workers who maintain a 315-acre dependency, as conservatives hoped, il

complex that houses one-fifth as many pa- simply made many of them homeless and

tients as it once did.

thus still dependent. William Wachob

chdrmm of the welfare subcommittee

eanwhile, citing past welfare of the Pennsylvania State Legislature

abuses, the Reagan administra- charges that "Thornfare," now being re.

tion has tightened the review vised, is "directly responsible for the in,

process so that Awer people qualify for crease of homeless."

benefits. Since 1980 more than 200,000

have km dropped from the rolls of S u p

The counselinn service in downtow,

plemental Security Income h e , a major Houston is called-ampass and it's run b~

sourceof income for the mentally ill. Many

named

~

M

-

NATIONAL AFFAIRS

who helps street people get anchored. The Helpinghomeleu familiesin

approach avoids "quickfixes and rice-bowl Texar: Volunteers must

Christianity. " she says, and attracts 600 a make a leap of faith-and

month. "I listen to them, accept what they sometimes courage

have to say and also ask myself if they 're

trying to rip me oB;" Whitesays ''Some do ors and two foundations now sponsoring a

and I tellthem to leave." Greater numbers $20 million effort to treat the ghastly array

don %-and leave with help: a bus token, an of diseases that afflict the homeless.

apartment lead, aphone numberforajob.

There are success stories of public-private cooperation: last month a Memphis

Coping with homelessness requires pilot project opened 10 HUD-owned

melding public and private efforts in ways houses for under $100,000. Still, roadthat help street people but don't hurt tax- blocks remain. On White House orders, the

payers. After all, most people take what Pentagon has offered 500 locations, mostly

Jane Malone, an activist on behalf of the unoccupiedmilitary-reservecenters,but so

homeless in Philadelphia, calls a "mini- far only a few have been put to use-largely

malist" approach to the problem-+senbecause cities and local groups would have

tially, "not in my neighborhood." That is to pick up most of the tab needed to make

understandable; the homeless do drive the places inhabitable. The Federal Emerdown property values, and it isn't pleasant gency Management Administration has

to find that someone has urinated in your distributed $140 million over two years in

doorway. Some argue that the more that is shelteraid, but admits it's aone-time effort.

done on behalf of the homeless, the more Margaret Heckler, secretary of Health and

comfortable they willbewith their plightHuman Services, says the Reagan adminisand the worse the problem will become.

tration is now studying ways to cut the red

But if government and the community tape, and NEWSWEEK

has learned that

helped worsen the problem, they can work HUD will decide soon whether to subsidize

together to ease it. As GeorgeOrwellwrote sheltersdirectly.

in "Down and Out in Paris and London,"

"the 'serve them damned well right' attiermnent housing is a taller order.

tude that is normally taken toward tramps

One reason it's so expensive for the

is no fairer than it would be toward cripgovernment to build low-income

ples." Sister Gay of Houston, who has units is that government contracts usually

adopted 10 homeless children and tended must pay the so-called prevailing wageto their families, believes that. So docs a whichalmostalwaysmatchesthe top union

consortium of the U.S. Conferen& of May- scale in any given region. Andrew Raube-

P

son, director of the Burnside Consortium,

which has renovated 450 SRO units for use

by poor people in Portland, Ore., says that

his costs are $6,000 to $9,000 a unit, less

than a fifth the expense of many government projects.

That's a big difference, and some lowincome-housing advocates suggest that

waiving the prevailing wage onlow-income

projects may be the only way to bring the

federal government into a partnership to

build more housing. Doing so would require amending the Davis-Bacon Act, a

sacred cow for most Democrats that even

the Reagan administration has not challenged. More flexible wages might also allow unskilledlaborersto help in the workof

renewing their own neighborhoods. Private tenant organizationsaround thecoun-

try have already begun this. Some, in cities

like San Francisco, have also won agreement that when developers tear down flop

houses, they will help pay for some new

low-incomehousing.

Solutions to the mental-health riddle

are following a similar logic of publicprivate cooperation. Some mental-health

professionals and government officials argue that providing community care is

~rohibitivelve x w i v e . But that assumes

It is done k~ what might k called the

"'pmailing" way--that is, with highly

paid psychiatrists and other union-scale

mental-health professionals. What homeless mental patients need first, their advoC a t S Say, i

s Simply a phce to stay and

some supervision by compassionate peopie. Many private halfway houses now

provide stable environments for former

mental patients for as little as 36,000 per

person a year, compared with about

540,000 in state hospitals. With more

charitable and government funding, these

places could make a major dent in the

number of mentally ill homeless without

sending them back to asylums.

or mental health, as for shelter and

permaaent housing, the answer

oeans to lie in the novernment's

Ktting aside its inclination-to solve the

problems itselfin favor of helping the cornmunity do its natural work. That rquiresa

leap of faith. But it is much the same leap

volunteers take as they ovacome enough

of thek nervousness about America's lost

mula to pitch in and help.

F

kattl. eh.lt.r.

W

' . all

have the urn. nodmeal, warm clothes,

oomeplace to sIa.pD

hot

In Denver, a takered group of men liner

warehouse ramp, waiting in the snowy dusk

to enter the Salvation Army Survival Shel,

ter. John Destry, 22, a navy stocking ca)

rolled on his head, describes his homeles.

life. "The streets a n dongemus, " he says

"But, vw know, we all do the same thinas

haw-;he same -needhot meal, some

warm clothes, someplace to sleep. "

JONATHAN ALTER slirh ALEXANDER

,~SHA~DOH~N~~N~Y~,~,N~KKIFINKE

GREENBERG in Wvhin n, SUSAN AGREST

in PhiLdelpbi& VERPE. SMITH in Atlanu,

GEORGE RAINE Seattle,DARBY JUNKIN

~r ~cnw

ud butau rrponr

+

~ r l f t e n ~to

t ykeep warm on a steam Orate durlng a anowfall In -on,

D.C.

jobless and broke. Lacking the fixed

address required for welfare, they cannot obtain food stamps or other benefits:

Untouched by the economic recovery,

these are the socalled new poor who

once had homes, jobs and hopes.

"If you're an alcoholic or a drug

abuser, there are beds available

through specialized agencies," notes

Jarrie Tent, director of a shelter in an

Episcopal church in Detroit. "If you're

a victim of spouse abuse, there are designated beds. But if you're just poor,

broke and out of work, it is much harder to find bed space."

Take Tom Pittson, an ahgular 301 year-old former Kentucky coal miner

seated in Lafayette Square across from

the White House. "After two years on

the street, I'm near giving up," he says.

Coatless in 25-degree cold, he was clad

in an old Army surplus sweater, torn

tennis shoes and light cotton trousers

with a long rip down the right leg. His

Behind Swelling Ranks of

America'sStreetPeople ~ ~ ~ ~ 2 ~ b ~ y ~ g ~ u r g c ~ f

a half-empty pack of cigarettes.

"After my benefits played out back

ty died in New York City alone last

year. Many more homeless will perish home, I come to Manassas, Va., looking

of pneumonia, tuberculosis or other ill- for work, then here," recalls Pittson.

nesses. For those who manage to sur- "Bad mistake. For a while, I had me a

vive, the blessings of life are debatable. big cardboard box to sleep in beneath a

How does a person sink to this rock- bridge. Another guy, he took it, along

Harsh winds of winter blowing bottom point? Many are drug addicts with my coat. Can't work now because

through streets of the nation's proudest and skid-row alcoholics, beyond any I'm sick a lot. My job now is to get by.

cities are calling fresh attention to a hope of recovery. There is grizzled, 64- It's a sorry way to live."

rapidly worsening social problem-up

year-old Ned, who relates fi familiar

Courtsrdered rebares. Even more

to a half-million Americans living and story while awaiting dinner in San troubling than people like Pittson and

sometimes dying as homeless outcasts. Francisco's St. Anthony Dining Room: Ned is the swelling number of mentalDressed in tatters, scavenging for "I thought I had it all--a wife, a job, ly ill among the homeless. Rescue-misfood and often suffering from severe some kids, a house and a car. Then my sion workers say up to a third who seek

emotional problems, these street peo- wife died, the plant closed down, my help are former mental patients with

ple are becoming an increasingly dis- kids got sassy and they took the house nowhere else to turn.

tressing part of the urban scene.

away. At my age, ain't nobody wants

Thousands of disturbed patients

The destitute are being found in ev- you. I got real discouraged and started have been released by court orders alery sizable city and in even greater drinking. That's what done me in."

lowing mental hospitals to keep only

numbers than a year ago before the

Others are simply down on their luck, those judged a threat to themselves or

economic recovery got rolling.

others. Nationwide, the number in psyIn Chicago and Cleveland, jammed A t o n m t e Nab at a garage In New Vork chiatric wards has been halved since

emergency shelters each night must Clty provides temporary ehelter.

1970. In some states, two thirds of the

turn away dozens of homeless women,

beds have been emptied--and not besome with small children in.tow.

cause patients have been cured.

An estimated 18,000 show up at New

"There's absolutely no doubt people

York's dormitorylike shelters each

are wandering around Denver today

night4ouble last winter's number. A

who, 20 years ago, would have been in

Salvation Army soup kitchen in Salt

an institution," says Dr. Frank Traylor,

Lake City is serving 11,000 free meals a

executive director of Colorado's Demonth, compared with 9,000 a year ago.

partment of Institutions. New York's

The same is true in Miami and Atlanta.

Mayor Edward Koch, whose city has at

The homeless huddle in frigid temleast 40,000 homeless, complains that

peratures on steam grates a block from

many neighborhoods have been turned

the White House, beg for handouts in

into "outdoor psychiatric wards."

Chicago's Loop and wander San fianDr. Rodger Farr of the Los Angeles

cisco's tough Tenderloin district.

County Mental Health Department esNo one knows how many street peotimates that the number of homeless in

ple there are, but even conservative

the city's downtown district doubles to

estimates put the figure at half a milmore than 15,000 in winter, many of

lion. This much seems certain: Dozens

them chronic mental cases. F a n says

will freeze to death this winter. %ensome of these drifters, called "sun

Sick, homeless, hungry and

often mentally ill, they

are growing by the thousands

despite an economic upturn.

Q 1984 US. News 8 World Report, Inc. Reproduced by the Library of Congress,

Congressional Research Service with permission of copyright claimant.

they can do to help such people. "You

can nm a ahelter with love and corn.

passion," says the Rev. C. B. Woodrich,

who assists the homeless in Denver.

"But when you get into mental problems, you're tnlking about medication

and therapy. And you've got to have

money to deal with that."

The burden of providing for the

homeless has fallen most heavily on local governments and charities. The

federal contribution consists mainly of

50 million dollars for health care, surplus food and limited shelter space in

unused federal buildings.

Prodded by courts in some instances,

city officials now are becoming more

food at the Star of Hope Minion In Houston b one ot many nowkes p r o v W by involved. But they, too, are far from

private rgoncles illling r gap ktt by govemnnnt fund cut$.

able to help everyone. Chicago, with as

many as 25,000 homeless people, probirds." are given a one-way bus ticket to

Left on their own, many of the men- vides housing vouchers to fewer than

Southern California as part of a "Crey- tally ill drifters do not last long. Police 4,000 and can sleep only 100 in its lone

hound therapy" practiced by several say women often are raped by street municipal shelter.

communities around the nation.

thugs, and both men and women freDenver budgets $400,000 for the

When hospitals began mass dis- quently are beaten and robbed of their homeless but gives no help to single,

charges, the plan was to support patients possessions. If they do succeed in finding employable people. San Francisco set

with a network of communitycare cen- refuge in an abandoned building, others aside $750,000 for the year, but it was

ters and halfway-house residences. But may drive them out.

gone in five months. New York now

with government budgets slashed at all

In Philadelphia, a fragile 50-yearold spends SO million dollars annually for

levels, there has been little to spend on woman named Ellen, formerly a mental emergency housing and other services.

follow-up care for ex-patients. Most of patient in Buffalo, N.Y., tearfully re"The help they &."

The most

the money available goes for hospital counts being robbed and attacked by generous help has come from private

winos twice in one week. "They took and church groups, whose expenses

treatment of acute cases.

Two other factors compound the everything I had--even my cough run at least 500 million dollars a year.

problem-bitter public resistance to medicine," she says. "Didn't leave me The Salvation Army alone provides

opening group homes in residential ar- nothing." Ellen was one of the lucky more than 44,000 beds.

"Every one of us needs two or three

eas and a shortage of low-rent housing. ones, however, finally finding hot meals

"If you can't hold them in hospitals and and a place to sleep at a church mission. arms to pick up these people and give

'These are very vulnerable people," them the rest of the help they need,"

no space is available in the community," says a District of Columbia official, explains Mendal Kemp of the Mississip says Frances Swartsfager, a volunteer

"you have no alternative. They must pi Health Care Commission. "People in a Houston food-distribution center.

Both private charities and governwho have been institutionalized for

fend for themselves."

mica) is the scene in the Detroit years are very subservient. If you tell ment officials are bracing for the probRescue Mission, where a tall young man them to go sit in the corner, they will. lem of the homeless to get worse.

The practice of quickly releasing

with vacant eyes, a former mental pa- You can do almost anything to them."

tient whose family would not take him

Private 0 o u- ~ are

s limited in what mental patients only now is coming under serious question by

in, explains: 'T;e been

down on my luck for the Homeleu women on r street In &n Frmcl.co. Most dtba do not have health experh, and no

change is likely for years.

past three years. There enough shelters to house the thousands wlth no place to go.

The -steadily shrinking

have been some whackedsupply of cheap housing

out people around here."

will force many more on

Another man, named

the street before t h e

Richard, sits in Houston's

crunch is over.

Star of Hope Mission

And there will always

chuckling to himself and

be people like Paul Jim h g his head from side

minez, a recovering dcoto side. Nearby, a young

holic who, before he hit

man suffering brain damthe skids, often rode past

age from sniffing glue

the Detroit Rescue Mis#tares into space saying

sion in the city's mean

nothtn He disappears peCprs COmdor.

riodic y, only to return a

"I UlCd to thtnk, man, I

week or so later. "We take

never want to end u p

people to t h e hospital

there," says Jiminez, 24.

three times a week, but if

"Well, here 1 am."

they aren't suicidal or homicidal, they're turned

out on the street," says mpervisor B i . Reed.

&

58

U.S.NEWS &WORLD REPORT

SYCHOLOGY TODAY,

F e b r u a r y 1984

O 1984 b y t h e A m e r i c a n P s y c h o l o g i c a l A s s o c i a t i o n

Reproduced by the Library of Congress, Congressional Research Service

with permission of copyright claimant.

Runaway children, immigrants, bag

ladies, displaced families, a growing

number of unemployed, alcoholics and

drug abusers and the mentally illthese are the homeless persons who

live on the mean streets of our cities.

Every winter, their plight is dramatized by the media, and every winter,

groups investigate the causes of and

possible solutions to this age-old

problem.

Approximately onethird to onehalf

of the homeless are believed to be

mentally ill and on the streets primarily because of a process known as

deinstitutionalization, which was initi-

the care of unprepared community facilities and the development of a policy

of more restrictive admissions require

ments. Almost anything was seen as

being more benevolent than putting

people in state hospitals. And to an extent, this is still the feeling.

The restrictive admiasion policies

and continuing funding and personnel

cutbacks a t state hospitals make it unlikely that many of the deinstitutionalized will be reinstitutionalized. In addition, because of these restrictive

admission policies, there is a fastgrowing population of young, chronically mentally ill persons who have

never been admitted to an institution

and are living on the streets.

The results of the massive depopulation of the state mental hospitals are

only now being realized.In 1955, there

were more than 550,000 patients in

ated more than 20 years ago, when

thousands of patients began to be released from state mental hospitals. At

the time, the idea was a noble one.

Deinstitutionalization was supposed to

bring new hope, freedom and a second

chance to those living behind the walls

of overcrowded mental institutions.

Instead of being cut off from the real

world, they would be placed in the care

of community mental-health centers,

where they could continue their treatment in more humane social settings.

The deinstitutionalization movement

was spurred on by advances in the development of psychotropic drugs

(tranquilizers) that could be used to

treat the more serious cases of mental

illness and by landmark legal decisions. In 1971, deinstitutionalization

changed from policy to law Bs a result

of the Wyatt v, Stickney suit in Alabama, which guaranteed the right to

treatment in the least restrictive setting. Other cases expanded the rights

of patients to community care. The result was hasty release of patients into

state institutions. Today the figure is

roughly 125,000, a reduction of 75 percent. Where did these people go?

Many found places for themselves in

the community, but many others ended up homeless. In Illinois, for instance, more than 30,000 patients have

been deinstitutionalized within the

past 20 years. Many were released into

the care of underfunded and understaffed community facilities that could

not provide the extensive care and follow-up treatment they needed. An

abyss of bureaucratic red tape, holes

in the treatment system and ineffective case management left many of

the mentally ill with little or no continuity of care.

Judi Berry, a senior planning specialist at the New York State Department of Social Services, offers an example of how the system can fail to

meet adequately the needs of the deinstitutionalized. One of the more common types of street person likely to be

found begging on the upper West Side

of New York, she says, can be d e

strangers. Quietly, you gather your

belongings, and forsake this place of

rest to begin another long day as one

of the nation's more than 2,000,000

homeless persons.

58

scribed as an alcoholic schizophrenic

mle. Early in his life, he was diagnosed as schizophrenic and sent to a

state hospital, where Re spent anywhepe between two and 10 years before being discharged. Upon release,

he was given a subway token to the

welfare office, a disability check, if he

was lucky and a, bed in a public shelter. Eventually he dropped out of the

system-perhaps he didn't even make

it to his first psychiatric appointm e n t a n d began drinking on the

street with other outcasts in similar

predicaments. Soon he developed

drinking pattern so close to those of

an alcoholic that when he gets picked

up off the street and taken to the

emergency room of a hospital, the intern can't tell whether he is an alcoholic or a schizophrenic. A human pinball

game follows, with this person being

bounced back and forth between the

psychiatrist and the alcoholic wards,

getting no coordinated service from either. He ends up on city comers,

~wiing.

The presence of numerous mentally

ill persons on the skid rows of the

United States is further testimony to

the failure of the private and community mental-health systems to treat

deinstitutionalized patients successfully, says Rodger Farr, head of Adult

Psychiatric Services in Los Angeles.

Many of these patients end up on skid

row, Farr explains, because of a practice known as "bus therapy." Farr has

documented cases of public institutions releasing patients and giving

them bus fare to another city as their

only form of therapy. Los Angeles,

with its mild climate and a social atmosphere that tolerates their presence, is

a natural magnet for many of these

patients. Once they get off the bus-in

the worst part of town-they lack the

resources and abilities necessary to 1e

cate the existing care facilities. They

end up as denizens of skid row. "These

people," Farr says, "have changed the

homeless population of L.A.'s skid row

over the past 15 years from the alcoholic derelict population we used to

see to a repository of chronically and

seriously mentally ill people. Because

of its allure, California is becoming a

dumping ground for what is a national

problem."

The population of skid row may

have changed in the past 15 years, but

that is a result of deinstitutionalization and economic conditions, not be-

+

An estimated 36,000persons make their homes on the sidewalks of New York.

cause alcoholism is no longer a cause

of homelessness. It is estimated that

alcoholics and drug abusers represent

up to 40 percent of the homeless population. Because of addictions, they cannot get or keep jobs, they cannot afford adequate housing and they

usually can't get organized enough to

take advantage of the services that

are available.

In addition to suffering the prob

lems associated with alcohol, drug

abuse and mental illness, many of the

homeless suffer from a wide range of

physical disabilities. A recent study by

Philadelphia psychiitrist A. Anthony

Arce and hie colleagues found that 22

percent of those who sought refuge in

the city's emergency shelters had evidence of physical illness. Their ailments ranged from frostbite to heart

problems to drug withdrawal. And as

if life on the street weren't hopeless

enough, there is also the everpresent

danger of personal violence. In Los

Angeles, Farr says, "the chances of

spending n fourhour period on Fifth

Street, or The Nickel, without being

stabbed or beaten or robbed are almost nil."

A few months ago, the president of

the Philadelphia Committee for the

59

Homeless, Robert E. Jones, cited additional causes of homelessness in an ar

ticle in the Journal of Ho8pitsl and

Community Psychiatry (Vol. 34, No.

9). He blamed deinstitutionalizationas

the major cause, but he also mentioned, as significant contniutora, economic recession, high unemployment

rates and cutbacks in federal p m

grams. In addition to blaming cutbacks in aid to individuals, he cited the

cutbacks in programs for medical

care, aging studies, alcoholism and

drug abuse, families and children and

employment training. He also cited ur

ban renewal for severely cutting into

the number of available lowcost housing units and for increasing the number of evictions.

For years, the downtowns and inner

cities of our large metropolitan areas

have been the havens of the homeless.

It was in these places that they found

church miesions, shelters, SRO's (singleroom occupancy hotels) and some

sense of community support. However, urban development is changing this

picture. In Chicago, 5,000 lowcost

room have been lost since 1970. In

Phoenix, 27 residence hotels in the inner city have been torn down in the

past 10 years. In downtown Washington, D.C.,housing and services used

by the homeless were lost when a new

convention center and hotels were

built.

The buying up and remodeling of innercity houses and changing them

from inexpensive rooming houses into

singlefamily dwellings and expensive

condos, ia also contributing to

homeles!ness. New York, for instance,

has lost +ouaands of such unita in the

past decade.

Increased unemployment has also

contributed to the homeless problems

in recent yean. In New York, for instance, the unemployment rate among

young black males is running between

40 and 60 percent. The job situation is

similar and equally serious in most

major cities in the Northeast.

Many of the unemployed, frustrated

with the lack of job opportunities

where they live, migrate from the

Northeast, making the homeless prob

lem worse for Sun-Belt cities. According to anthropologist Louisa Stark of

the St. Vincent De Paul Shelter for the

Homeless, in Phoenix, Arizona, 60 per

cent of those using the shelter have

been homeless for six months or less.

These include many Mexican nationals

is falling fast. Bundled up, you hit the '

who fled a ruined economy and Native

sidewalks.

Americans who left their reservations,

where unemployment approaches 60

Solutions t o the problem of

percent.

homelessness are likely to be as diThe employment picture is bleak

verse as the causes, and in the next

for the mentall,, ill. E. Fuller Torrey, a

few years, all of us are going to beclinical and research psychiatrist, rays

come actively involved, whether we

in his book Swviving Schhphmais

want to or not. The kind of involve

that vocational rehabilitation efforts AS DNERSE AS THE CAUSES,

ment could vary anywhere from castin the United Staka have, for the most

PRIVATEAND

ing a vote for a specific housing initiapart, excluded the mentally handicapped. The major focus of programs PUBLICSECTORSAS WELL AS tive to fighting for or against the

of a soup kitchen near where

of the Labor and Health and Human

M PLA HNG opening

we live or work. For example, for

Services departments, he says, hm THE LEGAL S

years the D.C. government has been

been the poorly educated members of

IMPORTANT ROLES;

burdened with the homeless residents

,society, especially minority groups.

of surrounding counties. It is only r e

Consequently, there is no program escently that the states of Maryland and

pecially designed for those &imphrenia who are able to return to the a lot of anti-transient, or "anti-bum," Virginia have acknowledged that they

work force on a t least a parttime ba- legidation was paseed. For example, have a homeless problem. And only resis. This is not the case, however, in anyone found scavenging through a cently have local advocacy groups

other parts of the world. Sweden and full dumpster looking for recyclable pressured those s t a t e s into

England have both job opportunities cans or food could be accused of steal- accountability.

Because of the efforts of these

and housing units for the mentally ill. ing city property.

This includes sheltered workshops for

The city also managed, through zon- groups, county facilities for the needy

long-term, partial employment of psy- ing, to shut down most of the food p m are now being opened-but not withchiatric patients. In the Soviet Union, grams and shelters for the homeless. out opposition. In Bethesda, Maryland,

employment of schizophrenia in shel- Between January and June 1982, the argument still rages among the local

tered workshops is "the rule and not city condemned two missions that merchants and the county governthe exception," Torrey says, "and such were providing shelter and two food ment, the Salvation Army and an advoworkshops work closely with psychiat- programs. In August of that year, the cacy group called Threshold AM1 over

ric hospitals."

Salvation Army shut down its shelter a soup kitchen and a shelter for home

"Homelessness probably has been a and food program because of mount- less men. Liz Farrell, a clinical social

way of life for a certain segment of ing pressure from the city. (It re- worker employed by Threshold AMI,

the human population since before Old opened this winter.)

says this type of hoopla is nothing

Testament times," says William

new. "Part of the problem with openMayer, administrator of the Alcohol,

You're standing in line, waiting for ing this kind of kitchen," she says, "is

Drug Abuse and Mental Health Ad- a lunchtime meal at Martha's Table, a community acceptance. There is still

ministration (ADAMHA). One of the soup kitchen for the needy in Wash- the old problem of what is called the

reasons that homelessness continues ingtonl D.C.m e line is long, extend- criminal element-thinking all of the

to be a problem is that our society has ing two blocks past the storefront c a r homeless are criminals. Most of the

tolerated it. In a round-table discus- ry-outs and liquor stores. Your feet people coming to eat here," she stresssion sponsored by ADAMHA last are aching from walking all day-the

es, "will. be families and local

spring, professionals who work with public bathrooms and soup kitchens residents."

the homeless cited this tolerance as an are few and far between. Ww'thg with

The merchants of Bethesda have eximportant reason that homelessness you are the city's poor, some sitting pressed several concerns in their sehas never been resolved or effectively because they are tired' others pressing ries of meetings with the county. Fore

dealt with. And when tolerance is lack- together in an attempt to shield each most on their list is the fear that the

ing, some localities simply try to hide other from the rain and sleet with b m kitchen, along with its group of indior get rid of the problem.

ken umbrellas, rags and tattered gent men, will disrupt business during

Phoenix has been especially inven- coats. You don't feel safe on this the day and create a safety problem at

tive in its dealings with the homeless. street, where drug traffickingand vie night. They are also worried that the

In 1982, the city decided to rid itself of lence are not uncommon.

kitchen might attract undesirables or

the homeless population because it felt

Inside, it's warm and the chicken "a bunch of drifting criminals," as one

these people were scaring away tour- soup is surprisingly tasty. A w s s of the merchants put it. Similar fears

ists and potentially lucrative business from you is an elderly man who has were expressed when a soup kitchen

prospects. So, Phoenix began a dis- been drinking and has problems was opened in affluent Westport, Conpersal policy. The thinking went that if spooning his soup. At the table to your necticut. But Ted Hoskins, a minister

the city had no facilities, no social-ser- left, an angry young woman is shout- of the church that helps run that kitchvice agencies and no private voluntary ing obscenities to no one in particular. en, says that since the kitchen opened

organizations, then the homeless Most of the people, though, are quiet. last year, crime in the neighborhood

would all leave-take the next bus to With the soup eaten, you're pressed to has gone down more than 20 percent.

L.A. or Salt Lake City. Consequently, go out again' where the temperatue

In Fairfax, Virginia, proposals for

mm

60

PSYCHOLOGY TODAY / FEBRUARY In84

Homeless %now bimls" flock to utim like Miami to e s c a p e h e cold winters of the'~ortheastand Midwest.

shelters or special housing for any disadvantaged group have spawned protats of all sorts from neighboring residents. Many cry that the homeless

would bring property values down.

Others say that they would cause an

increase in crime.

Despite the negative images associated with the homeless problem, their

cause is by no means hopeless. There

are several aggressive groups acting

and focusing on this issue. One of the

most prominent is the Coalition for the

Homeless, whose legal advocate R o b

ert M. Hayes successfully sued New

York City on behalf of the homeless.

The suit forced city officials to provide

emergency shelters for the needy and

to provide dining areas, lockers, toilets

and showers.

Mitch Snyder, of the Community for

Creative Non-Violence (CCNV), based

in Washington, D.C., is familiar with

this type of litigation. His group has a

suit in the Supreme Court that is set to

be decided upon early this year, Two

yeare ago, to protest President Reagan's domestic program cuts, members of CCNV, along with many of the

District's homeless, set up tents in Lafayette Park, where their large number became a vieible, but silent, p m

test in front of the White House. The

group, after beingeodered out of the

park, claimed violation of its First

Amendment rights and sued, saying

protest by sleeping is permitted and

protected by the Constitution. The

case is to be argued this month or

next.

CCNV is also trying to place an initiative on the November ballot of this

year's D.C. elections. The question

this initiative raises ii whether shelter

should be a legally guaranteed right.

If it does make the November ballot,

and wins, then all of the District's

homeless will be required by law to

have shelter. Snyder hopes this type of

initiative will set a precedent for other

cities, so that no citizen will ever be

without shelter.

On a federal level, Rep. Stewart B.

McKinney, R-Conn., hm introduced

legislation aimed a t correcting the defects of deinstitutionalization. The Me

Kinney bill, offered M an amendment

to the Public Health Servicas Act,

a

would replace the requirement for

"least restrictive setting" in the standard care for a mental patient to one

of "optimum therapeutic setting." The

bill is specific in stating that a hospital

or other form of institution may be optimum for some patients, while cornmunity living is most desirable for others. The bill also puts responsibility on

the states for insuring that the chronically mentally ill receive appropriate

care, tying that responsibility to eligibility for federal block-grant funds.

The needs of the homeless are many

and varied, but they can be met in effective ways. The participants of last

year's ADAMHA round-table discussions and the Coalition for the Home

less of New York agree that this could

be done with an aggressive outreach

program that moves the homeless off

the streets into emergency facilities,

from there to transitional shelter and

finally into permanent housing.

Outreach involves meeting t h e

homeless on their own ground and

making initial contacts that allow for

the time and care necessary to develop

trusting relationships. These first

PSYCHOLOGY TODAY / FEBRUARY 1984

meetings should offer easy access to

basic needs and should be used to increase gradually the willingness of the

homeless person to take advantage of

food services, dropin facilities and

emergency shelter. The Midtown Outreach Project in New York City is actively involved in finding street people

who frequently avoid treatment and

administering on-thespot medical and

psychiatric therapy. Along with finding those who avoid the available

treatment facilities, the Midtown

project locates people who show signs

of mental illness and those who cannot

fend for themselves without interven,tion by psychiatric professionals. Marsha Martin, director of the project,

says that they also provide information on the nearest shelters and psychiatric centers, and that they will

sometimes even take people to their

RIVATEAND

VOLUNTARY

ORGANrnTIONS HAVE B r n

SUCCWFUL LN M O W G SOME

OF THE HOlwlZms OFF

THEiulzEms.

appointments a t clinics.

In 1981, social researchers Ellen

Baxter and Kim Hopper published Private Lives/Public Spaces, about home

less people. The authors described the

Pine Street Inn of Boston, the city's

the "street pee of the big state "insane asylums"

Tmentheple,"tohomeless,

are an acute embarrass- in favor of "community treatas ordinary middle-class or ment"-which is one source of the

blue-collar types. I am still uneasy

as I remember how I felt about the

street person, seemingly an alcoholic schizophrenicin his 308, who was

sleeping in the entryway of our u p

per East Side walk-up in Manhattan

last winter--until the other tenants

insisted on a new lock on the outside door. I t is disturbing to have to

step over such a stinking person,

and it is more disturbing to feel utterly baffled about how to help.

Back home in Santa Cruz, I see

many more street people, who are

attracted by a mostly benign climate and by a civic culture that is

very tolerant, for the time being,

but is strained almost to the breaking point by the desire of the conservative business community to

must the unwelcome visitors out of

town. The situation is getting humanly intolerable.

Here is an emerging focus of

public concern where psychology

obviously has no ready, anawere,

but where psychologiets have a

special responsibility all the same.

Psychologists participated in the

movement of deinstitutionalization-cleaning out the back wards

present problem. (There are clearly

others,) After taking part as officers of the Joint Commission on

Mental Illness and Health, which

laid the basis for the deinstitutionalization that followed, Nick Hobbs

and I drafted the position paper on

The Community and We Community Mental Haalth Ceoter, in which

we placed special emphasis on the

importance of "continuity of concern" for people in trouble and on

"reaching those most in need of

help." In retrospect, "community

treatment" of the deinstitutionalized never dealt adequately with

the problems that were shoved off

on it. Since the excellent report of

President Carter's Commission on

Mental Health came to nought in

the general retrenchment of human

services under President Reagan,

unwanted incompetents have been

nobody's problem-until by sheer

numbers and intrueive visibility

they are making thermelvee every

body's problem.

--

--

By M. Breweter Smith, a psychole

gist st the University of CPlifom's st

Srrota h.

oldest and largest emergency shelter.

for men and women, as a model three

tier shelter program. The inn offers

security, meals, counseling and nursing services to more than 500 men and

women a day.

A program b:a,aed on the threetier

model has been proposed recently in

Phoenix by the Consortium for the

Homeless, a coalition of more than 30

public and private groups.

Each tier is designed to provide a

step toward complete independence

and stabilization of the homeless person. Under Tier I, armories, church

basements and school buildings could

serve as shorbterm (up to 72 hours)

emergency shelters where the basic

needs of homeless people could be met

until they are ready to move to Tier 11.

Tier I1 is transitional shelter, where

more demands are made on residents

and more services provided. The goals

of Tier I1 are independence and normalization of lifestyle. Services would

include job training, the securing of

entitlements (such as welfare or disability payments) and providing links

with clinical services.

Unlike Tier 11, which would allow

people to stay up to six months, Tier

I11 is long-term. The residences would

have lowcost housing, food services

and other services built in as part of

the structure of everyday life.

For example, Rodger Farr's Los Angeles Skid Row Project has been s u e

cessful in taking advantage of existing private community and volunteer

agencies in the area and piggybacking

mental-health treatment programs

onto them. The Salvation Army, like

other agencies in the skid row area,

Farr explains, welcomes the involvement of mental health professionals to

their program. "Our most valuable

service as a mental health department

to these nonprofit groups," he says,

"is to act as consultants, educators

and expediters to the various mentalhealth problems of their clients." The

Salvation Army has an adult rehabilitation center in Los Angeles with 180

beds. They are self-supported by their

satellite Salvation Army thrift stores.

The residents deep, eat and work in a

fowstory building donated by a local

private industry. The repair and rebuilding of various items that have

been donated to the Salvation Army

constitute the bulk of the rehabilita.

tion services. This includes such things

aa electrical and television repair and

The needs of the homeless and indigent vs. the fears of local

residents: Shelters ahd soup kitchens, like this one in Bethesda, Maryland,

remain a source of public controversy.

wood refinishing. Farr believes that

the combined effort. of the public and

private sectors of our society are needed to alleviate this reservoir of human

suffering.

The not-for-profit sponsorship and

operation of such residences, like the

St. Francis Friends of the Poor Residence in New York, exemplify the humanity of this approach. Similar p r e

grams in other cities have shown that

private and voluntary organizations

can be successful in moving some of

the homeless off the streets, sometimes permanently.

Increased federal funding, however,

will be necessary to further such efforts. With regard to dein$titutionalization, for instance, Charles Kiesler of

Carnegie-Mellon University and his

colleagues recommend in the American Psychologist (Vol. 38, No. 12) that

federal funds be used to improve existing methods of collecting data on men-

tal-health services. Too often, they

say, there are conflicting conclusions

drawn by different groups, making

the quantifying of any data nearly impossible. The report also suggests that

the government be more supportive in

the funding of basic behavioral and

biomedical research in the area of

mental health, and that it assist in the

development of guidelines for a minimally acceptable level of mentalhealth care as a national policy.

There is little doubt that the problem of homelessness will continue to

exist and will be dramatized again

next winter as more people freeze to

death on the streets. If the problem is

ever to be solved, if people are to stop

living and dying on the streets, there

will have to be a reduction in the public's willingness to tolerate the situation and a concerted, coordinated effort, involving the courts, lawmakers

and public and private organizations.

It's night, the northern winds are

snapping hard at your fingers and toes.

It's the k t day of a cold wave, the kind

that killed your buddy, Freddy, last

year. The papers are warning pe t owners to bring theiranimals inside. As you

turn the comer of L and 15th, you are

met by a screaming siren. Looking up

into the windows that icily reflect

swinging yellow andgreen streetlights,

you see the red blur of a speedingambulance. The streets are slick and suddenly vacant. Your feet are aching. Frightened, you pick up the pace. The warm

grids are far away and probably crowded, but you're sure there's a spot for

you somewhere. And so you walk your

endless walk, occasionally wandering

into dark corners, always moving, forever homeless.

n

Steven Fustero is on the staff of Psychology Today.

63

P S Y C H O L O G Y T O D A Y

/

F E B R C ' A R Y 1984

The Emergence of the Homeless as a Public

Problem

Mark J. Stern

University of Penn.iylvaniu

Using the model of social problems developed by Herbcn Bluma, this &de examines

the recent public attention directed at homelessness. B w d on this analysis, the

articbplaces the homeless issue in historical perspective, arguing that it is an element

of the recent reemergence of conservative political practices and the traditional style

of American sodai welfare.

During the past century the primary goal of social welfare has been

to provide for the needs of individuals within our society. The provision

of the most basic needs, such as food, shelter, and warmth, has been

seen as the minimum goal of the welfare state. We are shocked when

we realize our failure to provide these needs. Indeed, a popular slogan

of the early 1980s, concerned with the forced choice between 'heating

and eating," gained notoriety precisely *because it exemplified the failure

to provide two things that we believe all persons should have.

Although our failures to provide warmth and food have been much

in the news in the past few years, a third basic need-shelter-has

received the most public attention. During the early 1980s, homelessness

emerged as a significant public problem. It attracted a great amount

of news coverage and became the target of public and private efforts

at the national, state, and local levels. Yet, much confusion exists about

the nature of the problem, who the homeless are, and what can be

done about them.

In this article, I wish to address these questions from an unusual

perspective. Rather than getting to the 'faas" about the homeless, I

want to ask how the 'homeless" have been conceptualized in the public's

mind and what this tells us, not about the homeless, but about ourselves,

our officials, and our society. Thus, rather than holding the homeless

under the microscope of public and professional enquiry, I want to

use the homeless as a means of loqking at ourselves.

Reproduced by the Library of Congress, Congressional Research Service

with permission of copyright claimant.

492

Social Service Review

First, I will examine the past two years to see how the homeless have

become a public problem at the national level, and as a local issue in

the city of Philadelphia. Second, I will place the homeless in a historical

perspective and speculate about the historical significance of the emergence of this issue. Here I will make the case that the homeless as a

public problem reflect the conservative drift in public policy symbolized

most graphically by the Reagan administration's attack on the poor.

The Anatomy of a Public Problem

The starting point for my examination of the homeless is Herbert

Blumer's seminal essay, 'Social Problems as Collective Behavior."' Blumer's essential point is that 'social problems are fundamentally produas

of a process of collective definition instead of existing independently

as a set of objective social arrangements with an intrinsic makeup."2

Thus, rather than using the common geological metaphor of social

problems-their "discovery" or 'uncovering"-it is more appropriate

to use a construction metaphor: How do we build social problems?

As much as any other element of reality, public problems are socially

constructed.'

This insight has a number of impy-tant implications. Fitst, it suggests

that public problems are selective; not all phenomena become public

problems. (For example, although by objective measures poverty was

more extensive in the 1940s and 1950s, it was not until the 1960s that

we 'discovered" poverty.)' Second, once we agree that a social problem

exists, there is competition over what the natu-e of the problem is.

For example, Joseph Gusfield notes in the Cultwe of Public Problnns

that for most of the postwar period the issve of automobile casualties

was seen as a problem of individual c o m ~ e t e n c eThen,

.~

in the late

1960s, thanks to the efforts of Ralph Nader and his. suppyters, a

competing definition emerged that stressed problems of automobile

design and manufacture as the source of the p r ~ b l e m . ~

Blumer specifies five steps that comprise the career of a social problem:

its emergence (through agitation, Y~iolence,interest groups, o r political

attention); its legitimation (when the explanation of the problem is

agreed upon); the mobilization of forces to attack the problem; the

development of an official "solution"; and the implementation of the

plan. Of these steps, perhaps the most interesting is the legitimation

stage, for it is there that the issue of who "owns" a problem is decided.

Only when a paradigm of the cause of the problem emerges can we

Nobr oa Policy and Pnctice

393

be sure who has a right to 'know" about the problem, Again, uring

the automobile example during the 19b08, psychologirtr and doctor8

were the expert8 who explained the origins of the 'drunk driver," In

the post-Nader era, however, the ownership of the problem parred

to reporters and other investigators of the unsafe automobile.

A final point: at any time in its career a social problem can be

sidetracked from its course, When this happens, it recedes from public

notice and becomes part of the accepted order of things. Here again,

the example of the War on Poverty comes to mind,

The Homeless as a Public Problem

Emcrgnce.-The homeless slowly emerged as a public problem between 1980 and 1982. A combination of activism, publicity, self-interest,

and timing account for the power with which homelessness burst upon

the public consciousness.

The initial factor in the emergence of the homeless as a public

problem appears to have been the legal action undertaken by attorney

Robert Hays on behalf of vagrants in the Bowery section of New York

City. As early as 1979, the city had agreed to provide more beds for

the homeless on Ward's Island.' Howevq, it was only the consent

decree in the Callahan case signed by the city and the state in August

1981 that brought the issue forcefully to the public conscio~sness.~

The decree committed the city to provide clean and safe shelter for

every homeless man and woman who sought it and set standards

against overcrowding in the shelters.

At the national level, this legal action was supported by direct political

action. During the Democratic Convention in 1980,a coalition formed

by the Community Services Society of New York, Catholic Workers,

and other groups held a vigil at St. Francis of Assisi Church near

Madison Square Garden in New York City. This demonstration was

followed the next year by a veritable publicity blitz as first Ann Marie

Rousseau's Slwpfnng Bag Ladks and then Ellen Baxter and Kim Hopper's

Private Lives, Public Spaces were r e l e a ~ e d The

. ~ Baxter and Hopper

study, a combination of ethnographic observation and advocacy research,

was widely publicized and served to focus public attention on the issue.

In Philadelphia, local businessmen aided in pushing the homeless

forward as a public problem. In November 1981, the Inquirer reported

that businessmen in the area of the city most frequented by homeless

men were complaining that the men on the street were hurting business.

They demanded that the city take action to relieve the problem.J0At

494

Social Service Review

the same time, other cities, including Washington, D.C., began to pay

attention to the problem.

The culminating event in the emergence of the homeless as a public

problem, however, was the severe winter of 1981-82. As the newspaper

filled with grim stories of the homeless freezing to death, they gained

a kind of "newsworthiness" that made them accessible to the television

audience."

Legztzmation and mobilization.-The legitimation of the homeless is

an example of the contestable character of public problems. As I have

noted, the goal of legitimation is to forge a paradigm to explain the

nature of a problem and to suggest its solution. The resolution of this

issue determines who "owns" it. Thus, when there are competing

groups interested in "owning" an issue, as has been the case with the

homeless, there are competing paradigms to explain and legitimate it

as a public problem.

The most successful attempts to legitimate the homeless as an issue

point to the deinstitutionalization of mental patients during the 1970s."

According to this theory, most of the homeless are severely disturbed

individuals who in earlier decades would have been safely warehoused

in state facilities. However, because of deinstitutionalization they have

been dumped on the street, where they maintain a marginal existence.

As with the emergence of the homeless as a problem, this proposed

paradigm had its roots in self-interest, resulting from the overlapping

responsibilities of various levels of government. As early as 1980, for

example, New York City Mayor Edward Koch was resisting state pressure

to open more shelters, while-in turn the governor of New York reacted

angrily to city officials' attempts to link the homeless to the state's

release of psychiatric patients."

The source of this controversy was not simply disinterested social

research, but the division of responsibility between the state and city.

If the homeless were considered a welfare problem, the city had ultimate

responsibility. If they were considered a mental health problem, the

state needed to act. The deinstitutionalization theory was again voiced

repeatedly by the Koch administration, leading to the mayor's call for

legislation to allow the city to involuntarily commit the homeless."

The Callahan case rendered the issue moot by holding both the city

and state equally responsible for providing shelten.

In Philadelphia, a similar use of the deinstitutionalization issue took

place. During the winter of 1982, the city's Department of Public

Welfare attempted to draw a distinction between the "homeless" and

"street people." Department officials claimed that street people were

deinstitutionalized mental patients and should be the responsibility of

the health department, while the homeless were their responsibility."

Interestingly, the recession in the winter of 1982-83 changed the

paradigm of legitimation. More and more news reports and 'experts"

Notes on Policy and Plrctice

295

linked the homeless explicitly to unemploy~nentand fore~losures.'~

Thus, as the economic situation of the 'normal" population declined,

the homeless were portrayed as more normal.

The official plans ultimately agreed upon to fight the problem exemplified the conservativism that characterized the homeless as a public

problem. Rather than entering into a complex analysis of the multiple

causes of homelessness-housing shortages, gentrification, unemployment, mental problems, and other social and individual problemsalmost all agreed on the most simple answer to the problem: providing

food and shelter. New York City, under its commitments in the Callahan

decision, led the way, and other localities followed.

The official plan had a number of important features. First, there

was a central reliance on traditional voluntary agencies like the Salvation

Army and church groups. The new shelter that opened in New York

City in 1980 was under the authority of the Volunteers of America,

and Mayor Koch was constantly calling on or berating the city's religious

institutions to do their share. In addition, the efforts of the city were

restricted to the provision of food and shelter. In the emergency of

1982, for example, the city of Philadelphia paid Giffre Hospital $22

per day to shelter those homeless who could not be housed in existing

voluntary shelters. By that summer, the city council had passed a bill

to provide annually for shelters."

Although in 1983 the activist groups that had originally drawn attention to the homeless were still calling for more sweeping actions

to get at the root of the problem, the evidence seemed to suggest that

from a social perspective, the problem had been solved. Although the

number of homeless had not diminished, they had become part of the

accepted order of things. Much like the poor of the eighteenth and

nineteenth centuries, the homeless (outcasts, psychotics, and physically

impaired) would be with us for the foreseeable future. The only solution

was palliative: keep them from freezing or starving and keep them

out of fashionable areas where they might provide discomfort for those

who were better off. As former Haverford College President John

Coleman noted while he was 'underground," 'Watching people come

and go at the Volvo tennis tournament at Madison Square Garden,

I sensed how uncomfortable they were at the presence of the homeless.

Easy to love in the abstract, not so easy to [love] face to face."t8

A Public Problem for the Age of Reagan

The emergence of the homeless as a public problem is relatively easy

to document. A far more difficult question is why the homeless struck

'

296

Social Service Review

such a responsive chord in our culture in the early 1980s. Although

there was some evidence that the problem was getting worse, the increase in attention was totally out of proportion with the increase in

the phenomenon. I propose that the emergence of the homeless was

an element of the conservative reaction that brought Ronald Reagan

to the presidency and, in Pennsylvania, led to Governor Thornburgh's

proposals for the cutoff of welfare to "ablebodied" recipients.

The conservative nature of welfare policy in the 1980s has been

widely commented on elsewhere.lg In its first two years, the Reagan

administration took steps to reduce the federal government's role in

most of the major welfare programs, including Aid to Families with

Dependent Children, Food Stamps, federal housing and education

programs, and legal services. At the state level, in Pennsylvania, these

reductions were echoed in the governor's proposals to eliminate adult

men from the state's general assistance program.

These developments had a complex impact on our society. On the

one hand, they represent a return to a "uaditional" American approach

to poverty. Yet, at the same time, they go against fifty years of government

action flowing out of the New Deal. Thus, they present those in control

with a delicate issue of legitimation. The response to the homeless

emerged as an issue that suited the situation by allowing the better

off in society to affirm their continued belief in the New Deal tradition,

while reimposing an older vision of the relationship of the poor to

the nonpoor.

What is the basis for such a proposal? It rests on a historical perspective

of the relationship between the well-off and the poor in America, and

the changes that that relationship underwent in the postwar period.

Traditionally, the relationship of charity was meant to underline the

social position of both parties. The giver was able to confirm his benevolence and the legitimacy of his position, while the poor were

expected to understand their inferiority, the stigma attached to their

position, and the docility and' appreciation they should feel toward

the giver. As Gareth Stedman Jones has noted in his under-read Outcast

London, 'In all known traditional societies, the gift has played a central

status-maintaining f~nction."'~

Stedman Jones, following Marcel Mauss, associated the gift relationship with three conditions." The gift implies the idea of sacrifice;

it is a symbol of prestige; and it serves as a method of social control.

In Jones's words, 'To give, from whatever motives, generally imposes

an obligation upon the receiver. In order to receive one must behave

in an acceptable manner, if only by expressing gratitude and humiliation .w22

Jones goes on to note that these three conditions imply that the gift

entails a personal relationship. 'If it is deprsonalized, the gift loses

Notes on Policy and Practice

497

its defining features: the elements of voluntary sacrifice, prestige, subordination, and obligati~n."~~

He claims that much of the motivation

of the British Charity Organization Society in the 1860s and 1870s

was to reestablish this set of relationships that urbanization had 'deformed."

The United States, too, has traditionally used charity as a means of

reinforcing the virtue of the rich and the immorality of the poor. As

Michael Katz has recently noted, part of the "identifiable stylewof

welfare policy and practice in America is the "individual and degraded

image of the

Indeed, the often-used distinction between the

worthy and unworthy poor has had much to do with issues of deference

to authority. The worthy poor-widows, children, the insane, and

disabled-were expected to be grateful for the beneficence of the

welfare ladies, whiie the unworthy-the shiftless vagrants and other

ablebodied recipients-were sly, ungrateful, and mendacious.

These images of the poor and the rich held up through the Great

Depression. Indeed, the reports on the psychological impact of unemployment by Kamarovsky and Bakke suggest that self-blame, not

anger, was a typical response to the great social crisis of the 1 9 3 0 ~ . ~ ~

Yet, the dynamics of the Great Depression did set off forces that led

to change.

The spread of welfare in the 1940s and 1950s and the spark of

'community action" of the War on Poverty set off a new posture toward

welfare that was symbolized by the welfare rights movement. Rather

than seeing welfare as a gift, the National welfare Rights Organization

and like-minded groups attempted to cast it as a right or entitlement,

the product of structural, not individual, breakdown.

More important than the NWR? itself during the 1970s was a

perceptible change in the stance of welfare recipients. The use of food

stamps was no longer a stigma. A new, assertive attitude began to

characterize the actions of welfare recipients. As James Patterson noted,

'Despite the hostility of the middle classes to increases in welfare, poor

Americans refused at last to be cowed from applying for aid. Despite

the continuing stigma attached to living on welfare, they stood firm

in their determination to stay on the rolls as long as they were in

need. . . . Compared to the past, when poor people-harassed and

stigmatized by public authorities-were slow to claim their rights, this

was a fundamental change."26

This change in the attitudes of the poor had an immense impact

on the beliefs of nonrecipients. Among conservatives, there was little

need for change, since they had been preaching the moral inferiority

of welfare bums for decades. Among liberals, however, a greater discomfort set in.

Although liberals, like members of the welfare rights movement,

498

Social Service Review

had been preaching the structural origins of welfare, when the poor

actually came to believe them, they were not happy with the results.

First, the failurc of the programs of the 1960s and 1970s to reduce

poverty made it more difficult than ever to cxpose its 'roots." The web

of causality seemed too dense to penetrate. Furthermore, overlaid with

issues of race, the new attitude of welfare recipients did not include

gratitude or deference to their liberal 'friends." In short, by the end

of the welfare revolution of the 1970s, liberals no longer felt appreckted,

the poor were no longer deferential, and the gift relationship, with

its affirmation of the virtue of the rich, had broken down.

The way in which the issue of the homeless came to public consciousness in the early 1980sbroke with this pattern in three decisive

ways. First, it reestablished a direct relationship between the giver

and receiver. Second, it was based on exacting "proper" behavior

from the recipient. And finally, it simplified the web of causal attribution and strategy formulation that had so frustrated liberals

during the 1970s.

The outstanding feature of the official plan to fight homelessness

was its reestablishment of the bond between giver and recipient. Although the activists, like the Coalition for the Homeless, promoted

the 'entitlement" of the homeless to shelter and worked for government

action to achieve this, the vast majority of action was directed at voluntarism and individual responsibility. Always in the forefront of the

movement to evade governmental responsibility, Mayor Koch called

for New York City's 3,500 houses of worship to take in ten homeless

people each, and then berated synagogues for not doing their part."

Indeed, one notable feature of the homeless problem was the extent

to which churches, lay organizations, and individuals did respond to

the need by carrying out food drives, setting up shelters,and providing

aid.

One of the reasons for this response was the comportment of the

recipients. Although much attention was paid to their negative physical

characteristics (bad smell, ulcerated sores), this was contrasted with

their almost saintlike spirits. Docility and gratitude, not anger and

suspicion, were the general images of the homeless. Thus, even for

those who did not consciously advocate it, the reestablishment of a

'properw gift relationship was one element of the popularity of the

homeless.

Finally, the homeless cut through the tangled web of causality that

was typical of poverty policy in the 1970s. Although advocates attempted

to draw continuities between the homeless and the explanations of

poverty in the 1970s, the massive response of the public simplified

the situation. For example, in my experience, a discussion of whether

a shelter was a degrading form of aid for the homeless could be cut

off with the claim, 'People are hungry and cold. That's all there is to

Notes on Policy and Practice

299

it." Although true enough, the homeless may have actually functioned

to reduce the willingness of Americans to explore the complexities of

need in the 1980s.

After two decades of guilt and worry, the framing of the homeless

issue served to reestablish the gift relationship of a bygone era. Indeed,

a particular irony emerged as the old "worthy"and "unworthywdistinction

took on a new meaning. As I have noted, in the nineteenth century,

the symbol of the worthy poor was the single mother (assumed to be

widowed), and that of the unworthy poor was the vagrant and tramp.

By the 1970s, the images had been reversed. It w8s the single mother

(assumed not to be married), like those who came to Washington to

denounce President Nixon's Family Assistance Plan ('You can't force

me to work. . . . You better give mi something better than I'm getting

on welfare"), who came to symbolize the unworthy,2' while the docile

and appreciative homeless, like Bernice Martin, who asked Mayor

Koch, "Can I go to the one [shelter] on Lafayette Street?" became the

image of the worthy

The implications of this reversal are important. The distinction between worthiness and unworthiness is often seen as locked in demographic characteristics,while others have argued that it has fluctuated

with the needs of the labor market. The experience of the homeless,

however, suggests that a key element is comportment. Those poor

who are willing to be polite and quiet, grateful and guilty, have a much

better chance to be seen favorably than those who are assertive and

loud, nondeferential and unbowed. The gift relationship, with all of

its complexity, still haunts our welfare system. The American style of

welfare remain^.'^

The development of the homeless as a public problem poses a severe

dilemma for advocacy groups, such as the Coalition for the Homeless,

that have been instrumental in drawing attention to the issue. Although

the public prominence the problem has been given will undoubtedly

provide more alternatives for those who wish to avail themselves of

the services, the way the issue has been cast will frustrate the longerterm goal of activists: to use the homeless as an example of the general

inequities of the American social welfare system.

In a sense they share an old radical dilemma. As long as radical

activists clearly enunciated their position, they remained isolated from

the mainstream of American politics. Only in those times when their

concerns converged with those of a wider political sphere-the Socialist

Party's antiwar stand in 1917, the Unemployment Councils in the early

1930s-have radicals broken out of this isolation. In the end, they

have either had to face repression or surrender their issues to those

who had different goals in mind." One hopes that advocates for the

homeless will not face this choice; however, events of the past two

years do not provide much ground for optimism.

300

Social Service Review

Notes

This paper was an outgrowth of a student project that 1 directed at the Lniversity

of Pennsvlvania School of Social Work. 1 would like to thank mv coadvisor on the

project, Dr June Axinn, and the students ~nvolted Ctnth~aArmstrong. Ruth Bronzan.

Catherine Clark, Anne G~bbons,kchard Koch. Sallt Stephens, and S~sterloanne W~ll~ams

I would also like to thank the ~azarus-Goldrnan'~e&rfor the stud; of Social Work

Practice and its director, Dr. Joseph Soffen, for providing research assistance. Michael

Katz and Susan Davis provided cpmments on an earlier draft.

1. Herbert Blumer, 'Social Problems as Collective Behavior," Social Problems 18, no.

3 (Winter 1971): 298-306.

2. Ibid., p. 298.

3. Peter L. Berger and Thomas Luckman, The Social Conrhuction ofRealrfy: A Treatise

in the Sociology of Knowledge (Garden City, N.Y.: Doubleday & Co., 1967).

4. On poverty in the immediate postwar period, see James T. Patterson. Amerzca'c

Struggle agaimt Poverty 1900-1980 (Cambridge, Mass.: Harvard University Press, 1981).

pp. 78-8 1.

5. Joseph R. Gusfield, The Culture ofPublic Problems: Drinking, Drtvzng, and thr Sjmbolrc

Order (Chicago and London: University of Chicago Press, 1981).

6. This leads to an important aside: the limited role of social science in the process

of problem definition. For example, in spite of its prevalence during the 1950%poverty

was practically ignored by social researchers during that decade. Only after popular

writers such as Michael Harrington and Dwight McDonald focused public attention on

it did professional social researchers begin to 'discover" poverty (Patterson, p. 99).

7. New Ymk Times (January 4, 1980).

8. New York Times (August 27, 1981); Kim Hopper et al., One Year Latn: The Homel~ss

Poor in New Ymk City, 1982 (New York: Community Service Society, 1982), pp. 20-23.

9. New York Times (February 15, 1981), (March 21, 1981); A. M. Rousseau, Shopping

Bag Ladies: Homeless Women Speak about Their Lives (New York: Pilgrim Press, 1981);

Ellen Baxter and Kim Hopper, Private LiueslPublic Spacrs: Hom~lessA d u b on thr Stre&

ofNew York Cify (New York: Community Service Society, 1981).

10. Philadelphia Inquirer (November 11, 1981).

11. New Ymk Times (January 27, 1982).

12. N m Yorh Times (November 24r 1983).

13. New Yolk Times (December 30. 1980).

14. New Ymk Times (March 28, 19811, (March 25, 1983).

15. Cynthia Armstrong et al., 'Homeless Adults: A Participant ObSe~ationStudy"

(M.S.W. project, University of Pennsylvania, 1982), pp. 65-66.

16. NCW York Times (December 15, 1982).

17. Armstrong et al., p. 65.

18. John R. Coleman, 'Diary of a Homeless Man," New York (February 21, 1983), p.

30.

19. See, e.g.. Alan Gartner, Colin Greer, and Frank Riessman, eds., What Reagan Is

Doing to Us (New York: Harper & Row, 1982).

(London: Oxford University Press, 1971),

20. Gareth Stedman Jones, Outcast Lon&

p. 251.

21. Marcel Mauss, ThP Gqt: Form and Functionr of Exchange In Archic S O C ~ (Sew

~CS

York: W. W. Norton & Co., 1967).

22. Ibid., p. 253.

23. Ibid.

24. Michael B. Kau, Poverty and Policy in Amm'can H u t q (New York: Academic Press.

1983), pp. 239-40.

25. Frances Fox Piven and Richard Cloward, Poor Peopk's Movements: Why Th? S U C C P P ~

and How They Fail (New York: Pantheon Books, 1977).

26. Patterson, p. 179.

27. NCW York T k s (December 11, 1981), (January 20, 1983).

28. Patterson, p. 195.

29. New York T k s (March 25. 1983).

Notes on Policy m d Practice

301

30. See Katz, chap. 1, for a discussion of the charity organization movement's view

of comportment.

31. Hopper ct al., pp. 51 -55; Aileen S. Kraditor ( ' h d c a n RadM Historians on

Their Heritage: Part and Prcsenf, no. 56 [August 19723, ,136-53) p m u a provocative

theory of the role of radicals in the American politic!?syswm.

Established 1845

SCIENTIFIC

AMERICAN

J u l y 1984

Volume 25

Number 1

The Homelessness Problem

Many of the homeless people wandering the streets ofAmerican

cities and crowding into emergency shelters are mentally ill.

They require adequate housing and appropriare psychiatric care

by Ellen L. Bassuk

M

ore Americans were homeless

last winter than at any time

since the Great Depression.

Estimates of the size of the vagrant population vary widely. The National Coalition for the Homeless puts the figure

at 2.5 million for 1983, an increase of

500,000 over the preceding year. The

Federal Department of Housing and

Urban Development (HUD) estimates

that only 250,000 to 350,000 are homeless nationwide. Whatever the number

is, everyone agrees it is growing.

Particularly in the past five years government officials and private groups in

cities around the country have responded by opening emergency shelters to

try to meet the immediate needs of the

homeless. Beds in these shelters fill as

soon as they become available, and still

only a fraction of those in need are provided for. Some of the rest seek temporary refuge elsewhere, for example

in hospitals, but most probably fend

for themselves on the streets, huddling

in doorways or over subway ventilation grates. When the weather turns cold,

some die.

At night in New York City 18 public

shelters house some of the thousands of

men and women who roam the streets

during the day; 16 of these shelters did

not exist before 1980. Private groups

in New York have also stepped up their

efforts. In ,1982, 10 churches offered a

total of 113 beds to homeless people; by

the end of 1983, 172 churches and synagogues were providing a totai of 650

beds in 60 shelters. In Boston two large

shelters recently doubled their capacity.

Nevertheless, on a snowy night in January, Boston's largest shelter, the Pine

Street Inn, reported a record number of

"guests": the 350 beds were filled, as always, and 267 people crowded onto the

Inn's bare cement floors.

40

, Who are these people? Unfortunately

there are no reliable national data on the

homeless, even though they have always

been numerous in American cities. Anecdotal evidence suggests that in the

decades before 1970 most of the homeless were unattached, middle-aged, alcoholic men-the denizens of Skid Row.

Since about 1970 the population appears to have been getting progressively younger. Moreover, the sparse literature on the subject and my own experience as a psychiatrist working with

homeless people in Boston leads me to

believe a more important change has

taken place: an increasing n u m b e r 4

would say a large majority-of the

homeless suffer from mental illness,

ranging from schizophrenia to severe

personality disorders.

homeless are mentally ill does not in

itself explain why their number is growing or why a particular individual joins

their ranks. Without reliable data it is

difficult to answer the first question, but

several factors may have contributed to

the recent swelling of the homeless population. The most obvious one is the re-

t a time when the accepted solution

A

to the homelessness problem is to

establish more shelters, this finding has

disturbing implications. Shelters are invaluable: they save lives. The trouble is

that many shelters d o little more, and

the mentally ill need more than just a

meal and protection from the elements.

Those whose disorders are treatable or

at least manageable require appropriate psychiatric care; which they d o not

get at shelters. The chronically disabled

people who will never be able to care

for themselves deserve better than to

spend their lives begging on the streets

and sleeping on army cots in gymnasiums. Shelters have been saddled with

the impossible task of replacing not

only the almshouses of the past but

also the large state mental institutions.

At this task they must inevitably fail,

and thus American society has failed in

its moral responsibility to care for its

weakest members.

The statement that a majority of the

D 1984 by S c i e n t i f i c American. Inc.

Reproduc.ed by the Library of Congress, Congressional Research Service

with permission of copyright claimant.

HOMELESS PEOPLE sleep in mn armory in

New York City. As the number of homeless

cession. Unemployment reached a peak

of 16.7 percent in November, 1982, its

highest level since the 1930's. Some of

those who lost their jobs and incomes

undoubtedly lost their homes as well.

The effects of unemployment are intensified by another problem: the dearth

of low-cost housing. According to an

analysis of the Federal Government's

Annual Housing Survey by the Low Income Housing Information Service, the

number of renter households with incomes below $3,000 per year dropped

by about 46 percent, from 5.8 to 2.7

million, between 1970 and 1980; at the

same time, however, the number of rental units available to these households

a t 3 0 percent of their income fell by 70

percent, from an estimated 5.1 to about

1.2 million (excluding dwellings for

which no cash rent was paid). As the

"housing gap" widened, the median rent

paid by households in the lowest income bracket rose from $72 a month

in 1970 to $179 a month in 1980.

That works out to 72 percent of an annual income of $3,000 and leaves $71

a month to cover all other household

needs. A family devoting such a large

fraction of its income to rent is in a precarious position: it may easily be dislodged by a drop in its income or by a

further rise in its expenses. Unemployment and the lack of low-cost housing

help to account for the increasing number of homeless families (as opposed to

individuals), which once were rare.

Recent cuts in government benefit

payments may also have thrown some

people onto the streets, although the evidence is inferential. One of the Federal

Government's most controversial measures in this area has been its effort to

reform the Social Security Disability Insurance program, which in 1983 provided monthly benefits to a total of 3.8

million disabled workers and their dependents. T o receive payments a worker must be physically or mentally unable to perform any kind of "substantial

gainful work" for which he is qualified, regardless of whether such work is

available where he lives. Following a report by the General Accounting Office

that as many as 20 percent of the beneficiaries might be ineligible under the law,

the Reagan Administration launched a

"crackdown on ineligibility" in March,

1981. Between 150,000 and 200,000

people lost their benefits before the Administration halted its review of the

beneficiary rolls in April, 1984, amid

charges that truly disabled people, including some who were too mentally

disabled to respond to termination notices, had been stricken from the rolls.

Again, a lack of data makes it impossible to draw definite conclusions. but it

h

i~ ~ d l oc vda the prst few y a r s govwnmeats and private group

have responded by providing emergency shelter& AMbeugb the food

seems not unreasonable to infer that

the loss of disability benefits reduced

some people to not being able to pay for

their housing.

more important, however, in its

Farimpact

on the homeless poj-ulation

has been the long-term c h a n g ~in the

national policy for dealing with the

mentally ill. A little more than 20 years

ago state and county mental institutions

began releasing large numbers of patients, many of whom suffered from

severe illnesses. The "deinstitutionalization" movement followed the widespread introduction in the 1950's of psychoactive drugs, which seemed to offer

the possibility of rehabilitating psychotic people within a community setting,

under better living conditions and with

greater respect for their civil rights. It

was also thought the "community mental health" approach would be cheaper

than operating large state hospitals. The

movement was launched in 1963 when

Congress passed a law promising Federal funding for the construction of community mental health centers.

Deinstitutionalization was a well-intentioned and perhaps even enlightened

reform, but it has not proceeded according to the original plan. The first step has

been accomplished: the patient population at state and county mental hospitals

and refuge they offer save lives, most of tbese shelters offer no psychiatric care and thus do not meet the needs of many of tbe homeless.

41

ANNUAL LESS THAN $3,000

INCOME

$3,000-$6,999

MEDIAN RENT paid by low-income households increased between

1970 and 1980, as did the fraction of income tbey devoted to rent

hallucinations, they have trouble coping with the demands of daily life.

A 42-year-old man, at one time a

talented artist, is an extreme example.

When he was 24, he killed his wife with

a baseball bat because she had been unfaithful to him. At the time he believed

he was Raskolnikoff, the protagonist

in Dostoevski's Crime and Punishment.

The court psychiatrist diagnosed him as

schizophrenic, and he was hospitalized

in an institution for the criminally insane for the next 16 years. Since being

discharged more than two years ago,

he has lived both in shelters and on the

streets; not long before we saw him he

had been arrested for trespassing in a

cemetery, where he was living in a tomb

he had hollowed out. He says he receives messages from spirits who speak

to him through spiders.

The story of an 18-year-old shelter

guest is less striking but no less tragic.

Until he became psychotic he was enrolled in an Ivy League college. He was

hospitalized briefly in a state institution,

where he was given antipsychotic.medication, but when we saw him, he was

receiving no treatment. For a while after

his discharge his mother cared for him;

eventually, however, she became too

depressed to continue. Frightened and

too confused to care for himself, he

now wanders the streets by day, muttering incoherently and responding to

voices he alone hears. At night he goes

to a shelter where the staff are too busy

feeding and clothing people to devote

themselves to individual problems.

Many of the people we interviewedwe estimated 29 percent-were chronic

$7,00&$9,999

(colored wedges). The 1980 figures indicate tbat tbe bwsebolds with

higher income generally spend a smaller fraction of it on housing.

alcoholics. One 33-year-old man had

lived on the streets of Boston for 20

years and like many homeless alcoholics

had been in and out of hospitals, detoxification centers and various treatment

programs. In the past year he had made

several suicide attempts, and he had

recently been treated for pulmonary

tuberculosis. (About 45 percent of the

study group reported serious physical

problems, including heart disease and

cancer, in addition to their psychological difficulties.) Finally, about 21 percent suffered from personality disorders

that made it hard for them to form and

maintain relationships or to hold a job.

hronic mental illness, even when it is

severe enough to impair the ability

to function in society, does not by itself

cause homelessness, any more than unemployment does. For the great majority of shelter guests lack of a home

is symptomatic of total disconnection

from supportive people and institutions.

Consider for a moment what would

happen if a crisis were to strike your

life-if you were to lose your job, say,

or contract a serious illness. Most likely you are surrounded by family and

friends, by co-workers and even by professional caretakers at various social

agencies whose help you could call on to

prevent a downward slide You are Insured, both in the literal sense of having

coverage against financial loss and in the

figurative sense of having a reliable support network.

T o talk with homeless people is to be

struck by how alone moat of them are.

The isolation is most severe for the men-

C

tally ill. Family and friends grow exhausted or lack the ability to help; overburdened social workers may be less responsive; the homeless themselves may

be unwilling or unable to communicate

their needs and to make use of the support available. Some 74 percent of the

shelter residents we interviewed said

they had no family relationships, and

73 percent said they had no friends,

even within the shelter community.

Those who had been hospitalized before

for psychiatric reasons (about one-third

of the group) reported even less social

contact: more than 90 percent of them

had neither friends nor family. About

40 percent of all the guests said they had

no relationship with anyone or with

any social institution; although only 6

percent worked steadily, only 22 percent received any financial assistance.

There is usually no single, simple reason for an individual's becoming homeless; rather, homelessness is often the final stage in a lifelong series of crises and

missed opportunities, the culmination

of a gradual disengagement from supportive relationships and institutions. A

final example illustrates the point. A 45year-old man whom I shall call Johnny

M. has lived on the streets and in the

shelters of Boston for four years. The

youngest of four siblings in a lowermiddle-class family, Johnny spent most

of his adolescent years in an institution

for the mentally retarded. He remembers washing dishes, going to classes

and looking forward to the visits of his

mother and older sister. When he turned

16, he moved back home and spent time

watching television and puttering in the

43

,

35

garden. Ten years later his older sister

died suddenly and Johnny had a "nervous breakdown." He became terrified

of dying, he cried constantly and his

thoughts became confused. Because he

was unable to care for himself, he was

involuntarily ~omrnittedto a state hospital, where he remained for the next

eight years. He became very attached

to a social worker whom he saw twice a

week for therapy.

Although the hospital had become

Johnny's home, he was discharged at

the height of deinstitutionalization into

a single-room-occupancy hotel. His father had died, his mother was in a nursing home and neither his remaining siste; nor his brother could afford to support him. Within six months he had lost

contact with the hospital. Johnny was

forced out of the hotel when it was

converted into condominiums; unable

to find a room he could afford, he

roamed the streets for several months

until an elderly woman and her daughter took him into their rooming house.

When the daughter died unexpectedly

of a stroke, Johnny became depressed,

thought the other residents were trying to harm h i m and grew increasingly

belligerent. His. landlady evicted him.

Without resources or supports and with

an incipient psychosis, he ended up

homeless. Resigned to street life, he now

spends his days walking endlessly, for-

aging in dumpsters. Occasionally he collects bottles, sells his blood for transfusion or takes part in medical experiments to make pocket money, Itching

from lice, wearing tattered clothes and

suffering from cellulitis of one leg, he

feels lucky that he can depend on an

ellening meal at the shelter and that on

most nights he has access to a bed.

helters help to keep Johnny M. and

S

his companions in misfortune alive.

That is a shelter's function: to provide

food, clothing and a bed. At a typical

shelter guests line up outside until the

doors bpen in the early evening. A security guard checks each person for alcohol, drugs and weapons. New guests are

also checked for lice. At some shelters

volunteers cook hot meals; at others dinner consists of soup, sandwiches and

coffee. Some guests spend the evening

socializing and playing cards, but most

are too weary or too detached and go

directly to sleep. The dormitory is typically a barren auditorium-size room

with rows of cots or beds and one or two

cribs. Sometimes groups of six or more

beds are separated by partitions. Shelter

guests usually have few opportunities to

wash during the day, and so at night the

bathrooms at the shelter are generally

overcrowded. By 10:OO P.M. the lights

are turned out, and the next morning

the guests are awakened early, given

JOHNNY M. (a pseudonym) w u one of the shelter guests intervlewd by the author. He L seen here in line waiting to check into a

44

coffee and a doughnut and sent out, even

if the temperature is below zero.

The atmosphere in a shelter is sometimes volatile, and occasionally violent

fights erupt that have to be broken up by

the staff or the police. On the other hand,

the anonymity and invisibility fostered

by shelters is comforting to many of the

guests, who spend their days as highly

visible social outcasts. Shelter providers

try to treat their guests with dignity and

respect, asking n o questions and attaching no strings to the .help they offer.

D o they offer enough? In my view

they do not. Shelters would be the appropriate solution if the homeless were

simply the victims of unemployment, or

of disasters such as floods or fires. Although these factors undoubtedly con-.

tribute to the problem, the overriding

fact about the homeless is that most are

mentally disabled and isolated from the

support that might help to reintegrate

them into society. Moreover, many are

chronically, permanently ill and will

never be able to live independently.

Although various innovative model

programs exist, including one sponsored by Sl. Vincent's Hospital in New

York City, shelters as a rule offer only

minimal medical, psychological and

social services. They are generally understaffed and have few personnel specifically trained to care for the severely disabled. Because they are open only

Boston shelter (I@) and waiting for dinner to start at the shelter on

Easter Sunday (right). Treated in an institution for the mentally re-

at night, they cannot offer the continuing support and supervision that many

chrortically ill people need. People

whose condition might improve with

properly supervised treatment (for example the 18-year-old student I mentioned above) do not get it at the shelters. And it hardly needs saying that

shelters are not a humane solution to the

problem of providing a place to live for

those who suffer from permanent mental disabilities.

The precise extent to which mental

illnesses are prevalent among the homeless remains a matter of controversy.

Recent clinical-studies-atshelters in Los

Angeles, New York and Philadelphia

support my contention that a majority

of the homeless suffer from psychiatric

disorders, but other estimates have put

the incidence of mental illness among

shelter populations as low as 20 percent.

All these studies, including our own,

have been largely descriptive and have

been plagued by methodological problems. Differences in results can be attributed to the different theoretical biases of the various investigators, to the

use of different standardized scales as

the basis for psychiatric evaluation and

most of all to the difficulty of obtaining

a representative sample of a constantly

shifting population. In addition, there is

no reason to expect the characteristics

of the homeless population to be con-

stant throughout the country when mentkl health policies and economic conditions vary regionally.

he public debate on .homelessness

T

would undoubtedly be enlightened

by more rigorous research into the causes of the problem. It can already be said,

however, that at the very least a significant fraction of the people who frequent

shelters have diagnosablemental disturbances. Public servants of all ideologies

have failed .to recognize the imptications of this fact. Many political conservatives seem to believe the Government has little.obligation to care for.the

homeless: this attitude is w r h a ~ sbest

exemplifi'ed by President ~kagan'soften

quoted remark that "the homeless are

homeless, you might say, by choice."

For political liberals the plight of the

homeless serves as ammunition in their

attack on the Administration's economic policies, but the solution they tend

to support is the expansion of emergency shelters: simply putting a temporary

dressing o n what has become a large,

festering.wound in the social body.

There is no mystery about the nature

of a more appropriate solution. Essentially it would call for carrying out the

aborted plans of the 1963 community

.mental health law by providing a spectrum of housing options and related

healthcare and social services for the

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mentally ill. These would entail living

arrangements with varying degrees of

supervision, from 24-hour care at therapeutic residences for patients with severe psychoses'to more independent living at halfway houses for patients with

less severe disorders. Some patients

would receive counseling and therapy

with the goal of rehabilitating them and

even getting them jobs in the community. The one major change needed in

the community mental health program,

however, is a greater recognition of the

limitations of psychiatry: given the current state of the art many chronically

disturbed people simply cannot be rehabilitated, and the goal in these cases

would be to provide the patient with

comfortahle and friendly asylum.

The community mental health movement failed primarily because the Federal and state governments never allocated .the money needed to fulfill its

promise. American-society is currently

trying to solve the problem cheaply, giving the mentally ill homeless at best

emergency refuge and at worst no refuge at all. The question raised by the

increasing number of homeless people is

a very basic one: Are Americans willing

to consign a broad class of disabled pcople to a life of degradation, or will thcy

make the commitment to give such people the care they need? In a civilized society the answer should be clear.

of d ~ s l i z a l i o m

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45

DISPATCHES

Taking Aim at Panhandlers

ust billowed in thick, acrid clouds un- ducts that lace the city. Gentrification is

D

der the viaduct above Alaska Way eating relentlessly into their turf, turning

when they broke up Dave Deppen's camp. cheap hotels and warehouses into condoAs Deppen and his pals watched sadly and

police stood by warily, city crews dragged

mattresses, bundles of clothing and boxes of

food to a dump truck. "We lived here out of

necessity," sighed Deppen, stripping laces

from a pair of boots left by one of dozens of

drifters who passed through his compound

on a ledge overlooking Puget Sound. "The

missions are full of people who talk to walls

and don't remember what a shower is for.

We did what we could as honestly as we

could. It's all over now."

Growing up around the original Skid

Road, Seattle has long cast a tolerant eye on

the growing number of poor who sleep under its bridges and beg in its streets. But here

as elsewhere in Reagan's America, tolerance is eroding as the gap between rich and

poor grows. When merchants in Washington, D.C., complained that the homeless

were turning a small park outside the State

Department into an eyesore, the government built sheds over heating grates to keep

derelicts from sleeping on them, In laidback Santa Cruz, Calif., a civic stew is brewing over violence against trolls-indigents

who live under bridges and in parks. Even

sophisticated San Francisco has targeted

punks and drunks who roam Market Street

and hang around Civic Center. The operative approach to urban poverty these days

seems to be out of sight, out of mind.

Coafrontariolland Contempt: In Seattle,

society's failures litter the steep, mile-long

stretch from Pike Place Market to Pioneer

Square, cadging spare change, eating in missions, sleeping under the bridges and via-

miniums and trendy restaurants. And confrontation breeds contempt, on both sides.

After a workout at a -new Pike Place

health club, two young executives turn onto

Lenora Street and run into a sullen line of

people outside a food bank. They retreat

uneasily. "Let's go another way," says one.

"I feel out of place here."

In Market Park, office workers lunch on

croissant sandwiches and white wine while

-- ----

-- -

Tolerance for street

people is eroding in

Reagan's America as

the gap between rich

and poor widens.

red-eyed drifterspassabottle in a paper bag.

At a nearby ice-cream shop, a young couple

buy macadamia-nut ice-cream cones with a

hundred-dollar bill while bums rummage

through street receptacles for aluminum

cans. "There's never been a homogeneous

community here," says Laurie BeckerKiner, who chats with a friend while their

children romp in the sun. "That's always

been one of its attractions. But lately it's

been a problem." Dining recently at a fashionable fish restaurant that adjoins the

park, she was startled by a drunk spreadeagled against the window, his tongue

rased against the nlass. Less-fortunate

- - -

14

diners in the area have been treated to impromptu strip shows by drunks who stand

outside, undulate suggestively, and drop

their pants.

"If you sit on the south side of the dining

room," says restaurant manager Rick

Boller, "you can see everything from breakdancing and clowns to people urinating and

fighting." One night a man sleeping in the

park was doused with kerosene and set on

fire. One restaurant's art-deco elegance was

shattered when a man who had been

stabbed reeled in the front door and fell

bleeding in front of the pasta chef. "We've

been hounding the police to move these

people," says Boller. "They have no place to

go, but that's not really my concern."

Chmgiq Atdtude: Sitting on a stool in

The Rose and Thistle, shopkeeper Karen

Howe has seen a decade of change in Pioneer Square and takes a different view. "The

area has changed," she says. "They'vealways been here. Now we're here." Philip

Showstead, who runs a county alcoholabuse program, agrees: "When poor people

hassle poor people, no one cares. The attitude is changing because of the people who

frequent these areas." While all poor people

suffer from eroding services and disappearing housing, the most visible of them, the

public drunks, panhandlers and hustlers,

inspire little public sympathy.

Too often, official efforts to help only

make things worse. A local alcohol program provides $300 a month, food stamps

and medical care to almost anyone who

wanders into town, gets loaded and shows

up at a detox center. "It's like being paid to

drink," complains Brad Edstrom, a clerk at

the Union Gospel Mission. Steve Burger,

who runs the mission, longs for the older

bums who shared traditional values even if

they violated them. "The young guys come

in demanding help," says Burger. "They

think they have a constitutional right to be

taken care of." It's a new "me generation"

of indigents. Downwardly mobile and aggressively amoral, the worst of them turn

panhandling into a form of extortion, sell

their bodies to buy lunch, roll the older

drunks and even steal from the missions.

As gentrification increases conflict between urban haves and have-nots, the havenots are bound to lose. "As society becomes

more conservative," says Showstead, "concerns about providing services are given a

back seat to social control." Seattle may

pass apanhandling law, as many cities have,

but it won't go as far as Phoenix, which

adopted a tough anti-skid row ordinance in

1981. Indeed, as the winter rains begin, the

climate will solve some of Seattle's problems. And creative street people will get by.

City crews were still picking up the oddments of his former home as the 26-year-old

Deppen and his pals sunned themselves on a

knoll in Market Park. "We done relocated

already," he grinned. And where will he

spend the night? "1'11 just go stay at my

girlfriend's house."

O 1984 Newsweek, lnc.'~eproducedby the Library of Congress, Congressional Research

Service with permission of copyright claimant.

GERALD C. LUBENOW in Seattle

NEWSWEEK~OCTOBER 29, 1 9 8 4 ~