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The Homeless and Schizophrenia

Thanks to Samantha Sangenito for sharing research about holocaust survivor children with schizophrenia on ACEsConnection. The source of schizophrenia is an important issue we should address as a member of the ACEs community. Although you can find advocates who state that there is no relationship between childhood adversity and schizophrenia, the research is starting to show that those diagnosed with schizophrenia actually have a higher rate of childhood adversity that the general population. And as we have learned, this alone would lead to higher adverse outcomes for mental health later in life. [LINK HERE] How can we use this information to help change policy in a way to help address childhood adversity in meaningful and productive ways. Here is one possibility by addressing the issues faced by the homeless.

Early in my career, I was inspired by a community activist who was addressing the needs of the homeless in Anchorage, Dr. Lynn Ballew. [STORY HERE] Bean’s Cafe was founded to help feed the homeless Anchorage street population. A few years later, the Brother Francis Shelter opened and offered a place for homeless to spend the night. [STORY HERE] The Anchorage Gospel Rescue Mission is another haven for homeless men in Anchorage. I became aware of its existence when I saw that my mother contributed some of her small income, and later when my nephew became homeless and spent many nights there and at Brother Francis. For me, being around homeless people seemed ordinary. Many of the homeless I encountered were like adults who came in and out of my life through my mother. 

I have listened to homeless people being demonized for all of my adult life. They are told to pull themselves up by their bootstraps, get an honest job and stop panhandling, give up drinking. I thought I would share some facts about the homeless. First, there are approximately 575,000 homeless people in the U.S. on a given night. [LINK HERE] Of that number, a third have serious mental issues, primarily schizophrenia and bipolar disorder. [LINK HERE] And because of their higher level of ACEs, they have all of the other issues we face and have to fight against. The research article I cite has a table that shows the correlates for the studied population of 569 people with schizophrenia. [TABLE 4] So with 200,000 homeless who have either schizophrenia or another serious mental disease, any public policy must address the issues faced by this population. 

Fortunately, there are various policies that help address this population. Housing First is a program started in Anchorage in 2011 with the conversion of a hotel into housing for the homeless. [STORY HERE] The converted hotel was where a relative died in a fire, probably assisted by alcohol abuse, so it doesn't hold fond memories for me. Its conversion though, offers a beacon of home to some. But as you can tell from the story, misconceptions are guiding the effort, along with data stating that Housing First programs save money in communities where implemented. [LINK HERE] With cost savings in excess of $40,000 per homeless person housed, the benefits are significant.

The Housing First program was initially conceived without any barriers to acquiring housing. There are no tests, income requirements nor social services forced upon the applicant. This is not appreciated by many citizens. The first goal was to provide housing and save the costs associated with homelessness. To do this in a way that provides a possible pathway to the homeless should be a part of policy. Can we find ways to inspire and motivate those who are housed with a pathway to healthier and happier lives? For some we might, and others we might not.

If we address homelessness as the tip of a system that produces poor outcomes for many who experienced significant childhood adversity with a lot of ACEs, then we need to include addressing this adversity early on, in prevention as opposed to reaction. Think of this way. Table 4 that I referred to earlier lists 276 of the 569 people with schizophrenia studied as having children. The number of adverse events inflicted on those children starts with having a parent with a mental illness and extends to many of the traumatizing events studied. If we don’t help this population of homeless, one third with severe mental disease, we steal hope from their children.

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Good day, Corinna. I appreciate readers who make their views known. This community is a caring community, and in my experience, very willing to learn. The purpose of my post was to make it clear that we do need to treat the homeless with respect, and start by meeting their first need, that of shelter and safety. I live in a community that is just starting to do that, and we have had to endure many deaths of our homeless to get to our modest start. During my research, about a third of our homeless population in the U.S. are there because of mental illness, specifically schizophrenia and bipolar disorder. I always cite the research I used, and am always open to reviewing new information. 

Jane is right on when she asks you what it is you want. The trauma community is well aware that prevention of trauma infliction is the best course, but as one working in this field since 2008, change is exceedingly slow. If you are interested in sharing your perspective, it can join the small, but growing voice, advocating for policy change in this arena.

Thanks for participating and we look forward to more information from you about your passion. 

This blog post, in a nutshell, is the disease model view that badly needs new language. As long as you call us "schizophrenics," you're not going to get truma messaging taken seriously. If we have trama experiences, it's not an ilness called "schizophrenia," it's trauma.

Just ask those of us who recovered what we want. Google "Alternatives 2016." Our national conference is going on now. Ask US what we need, instead of asking for a new paradigm with both feet in the old one.

 

Thank you for telling us about your family, Heather. It's so great that you and your kids are able to talk about their dad's illness. I think educating youth about ACEs science will allow them to develop a language to talk about what is shared, common, and normal, so that it is no longer secret and shameful.

I did not see any 'Prevention' issues addressed in one of the Presidential candidate's "Comprehensive" Mental Health Plan, recently put forth. I think the issue of "Prevention" should be an integral part of any "Comprehensive" Mental Health Plan. I'm curious if any other ACEsConnection members concur.

This topic resonates deeply.

Raising children who have a father who is both homeless and schizophrenic, I have watched the love, heartache and fear as they tried to figure out how to maintain a relationship with their father, and also allow themselves to be 'healthy' and grow-up 'independent' of him and his history and illness. One of the facts I have repeatedly returned to again and again in supporting/building my children's 'toolboxes' as they confronted fears of 'what if someday I have schizophrenia like Dad?' is recognizing that their father's childhood was beyond severe, and for unknown reasons, he was unable to recover from it. That this in itself, creates examination of family history vs genetics. 

The hardest part throughout, remains that there is no 'language' for youth to talk about their fears when they have a parent who is mentally ill and homeless. The private isolation can stack on its-self. Schools are afraid, uninformed and bewildered if you mention it. Medical and therapy fields rely on built-in labels which enforce stigma and fear, the 'illness' seen before the person, making it hard to seek and obtain lasting resources for support, both for the individual and for the family. Family and friends can't understand the daily challenge and decisions that come with each day. To name/identify the complex  plethora of feelings, and not succumb to the weight, takes constant re-set of awareness and flexibility. That my kids and I can talk about our family challenges straight-on...this ability took us a long time to figure out how to do, as there was no 'model' for it.

Understanding ACE's has been, in all my research, truthfully, the most instrumental. For the first time, as a parent, I feel like I can articulate clearer what I was striving to explain to my children their whole lives. That they are going to be better than simply 'okey.' They will live fully and resiliently.

I have a peer, who was given the diagnosis of Schizophrenia, as an adult....who described witnessing his alcoholic father taking out a pistol, in the hallway, when he came to [unannounced visit]  [? domestic violence/restraining order?] the rest of the household on Christmas eve, and [his father] shooting himself, when my peer was only eight years old. He also described experiencing an injury, and applying a tourniquet, to himself, at age 12-having learned it in Boy Scouts, as well as experiencing a severe fall and head injury where the bleeding required his mother to have a family doctor come to the house to stitch a scalp wound, without anesthesia. He also described having the friend who had taught him how to apply the tourniquet in Boy Scouts, later being electrocuted on a power line-which my peer also witnessed.

A former neighbor of my peer, who had witnessed his father abusing his mother, during his childhood, had once commented to me, what an abusive man his father had been.

After 12 years in 'stable housing', in visual proximity to the power line where my peer had watched his friend die of electrocution, he finally accepted his mental health case manager's guidance to move, and began another portion of his life addressing homelessness. He recently [after about three years] moved into a new apartment in another state, just a few miles from here, two months ago. His three year period of homelessness was the subject of a number of front page articles in our local newspaper. I probably do not know, or immediately recall, just how many other ACEs he may also have experienced.

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