Streets are the new asylums
Oregon has the highest prevalence of mental illness in the United States.
When you step foot into any concentrated homeless area in any large city in America, you immediately realize we don’t have a homeless crisis; we have a mental health one. Everywhere you look, you see intense sadness, extreme irritability, unpredictable behaviour, violent outbursts, mood swings, and sorrow. Self-harm is common, and witnessing a psychotic person bash their head against a wall or repeatedly punish themselves is not uncommon.
Despite the shocking behavior, there is very little the community can do to help them as long as they refuse. As the current law stands, they must be a danger to themselves or others for them to get placed on a hold, go to court, and be committed and sent to a locked mental health facility.
I was the discharge planner at a mental health locked subacute for four years. It was a sixteen-bed facility, and on average, we had two to three committed individuals. Their length of stay varied, but generally it was 60-90 days before being released on their recognizance. My job was to try to place them in a higher or lower level of care after they were stabilized and a thorough assessment was made.
Even after trained mental health professionals all agree that the person qualifies for commitment, they still have to go through the highly complex legal system. If at any step there is a problem, the process starts over. The problem with that is the person they are trying to get committed may be on hold, which only lasts a maximum of five days. So every bump in the road eventually leads to a failed attempt, and they end up back on the streets.
This is Jackie, a severely mentally ill woman who has been on the streets for many years. You will often see her violently hitting her head with her fists. She has done it so many times that she has lost hair in some areas of her head. When she is not hitting herself, she is often half naked, wandering around bumming cigarettes. It's almost impossible to ask her what’s going on. She is barely coherent and usually only responds to you if you offer her food, drink, or cigarettes.
I interviewed a homeless couple who know Jackie, who shared that once a month over the last several years, men pick Jackie up, take her to a motel, make her shower, and then she's passed around for days. When they are done with her, she is dropped off back on the streets. They calculate she has been raped over a thousand times. This is a common practice and not just from certain depraved homeless men. I have interviewed dozens of homeless people who share that the main perpetrators
are men in nice cars. They often look for the most vulnerable, severely mentally ill woman, get them in their car to perform sexual acts. It almost always happens in the early mornings. I’m told some of these cars are brand new and luxury, which tells me these are likely married men with a family living a pretend-perfect life who seek out these vulnerable people to fulfill a dark kink they have.
I have made multiple attempts to get Jackie help, and she has always refused. When she sees a paramedic, she will always run.
Even she rarely meets the criteria for a mental health hold. What clinicians strongly prefer is that she voluntarily agrees to go on a hold, thereby removing the risk of liability. She, though, as far as I know, has never done this. When she is not hitting herself, I have found her multiple times crying uncontrollably. I have never met a person in more emotional pain.
Mental illness exists on a spectrum of severity ranging from mild to severe. The sad reality is that the more severe you are, the less likely you are to get help, because if you can’t verbalize it, the system is placed in a conundrum when deciding how to help the person.
There is also a range of behaviors of the mentally ill, from docile to aggressive. I filmed this homeless man with a weapon, screaming that he was going to kill someone. He then boarded public transportation filled with people.
Other homeless people are extremely docile and will let themselves lie on the ground till they freeze to death. Sometimes, even with hours of encouragement, they are either too mentally acute to comply or emotionally are so down that they no longer care.
The state of Oregon has the highest prevalence of mental illness in the United States. The reasons vary. Oregon has a significant and long-standing lack of access to mental healthcare. Bureaucracy is so bad that even if everyone agrees something is needed, it takes much longer than average to build it. Oregon also has a very high substance abuse rate. A good example of bureaucracy is when Oregon decriminalized drugs in 2021; it took thirty-four months to build the first treatment facility. In that time span, we had the most significant increases in overdoses in state history.
Governor Kotek, who is currently ranked as one of the worst governors in the United States, declared a state of emergency for homelessness on January 10th, 2023. This was appreciated, but saying something and doing something are two different things. I am on the streets daily and did not see any uptick whatsoever with help. If this were treated like an emergency, we would see swift action, a significant influx of trained professionals and volunteers using all their energy to end the crisis.
Portland, Oregon, spent $724 million last year alone on homeless services. Even if one million was re-allocated towards outreach, you could hire 5-6 full-time professionals for two years and have them stationed in the most concentrated area of people experiencing homelessness, mentally ill, in the state. The area is 0.20 square miles, which can easily be walked in five minutes.
The difference that would be made would far exceed expectations. Daily contact builds trust and restores hope. I am confident that fifty percent of those who saw these workers every day for days, weeks, or months would be far more likely to accept help.
When the public is confronted with a large, overwhelming number of people suffering, they experience a loss of sensitivity or numbing. Over time, that numbing becomes ignoring. They also believe the problem is so massive that no single person can make a difference. This is a common psychological phenomenon. My attitude is that even if I spent an entire day helping only one person and learn about a dozen others, replacing that one person, I was still on the side of helping. Maybe my effort will inspire others, and before long, two people will be helped, and so on. Eventually, more people are being helped than not, and given time, this crisis will be alleviated. This crisis is an uncomfortable truth to many, but you can’t solve a problem without acknowledging it.
Working in crisis mode long-term has emotional side effects, which is why healthy boundaries and self-care are essential. I am writing an article about my experiences working on the streets for many years, and how it took its toll.
We don’t have a homeless crisis; we have a mental health and addiction crisis. Unfortunately, many still treat the homeless crisis as if it’s a housing crisis and push for more and more shelter beds. The problem is these shelters are far too low a level of care for the majority of our mentally ill, and this is why it’s rare to place one and for them to stay. Shelters are crowded, loud, sketchy, and with strict rules; many severely mentally ill people don’t understand. What we need is a significant increase in locked mental health facilities and a streamlined system that can get a person committed quickly.
Many activists have compared locked facilities to a concentration camp and said the mentally ill are better off on the streets. I worked in one for four years. They are given three healthy meals a day, have a comfortable room, access to a psychiatrist and psychologist daily, peer support, art therapists, and others. It is safe and clean, and I have seen many have a remarkable recovery. These programs are not for life, and many became successful, highly functional, productive members of society.
Any crisis can be solved, but that requires collaboration between multiple complex systems and local governments. It also requires setting aside ideological differences and finding a way to work together for the greater good.
My experience with the mental health machine in Multnomah County is that the workers primary interests are in maintaining their employment and protecting the mental ill person's rights (meaning no intervention whatsoever). I made the mistake of calling for a welfare check on a neighbor and wound up in court and in the crosshairs for two years because her case managers were too stupid do see the forest through the trees. Once I saw the lies, dysfunction, lack of empathy, and virtually no help offered, I left the liberal mindset and never looked back.
I lived in Montana and people talked about the psychiatric unit in Missoula and the worse mental institution called Warm Springs in hushed tones... they had a very very bad reputation. It seems when power is given to those working for $8/hr and working for a broken medical system, those vulnerable on the street are like fish in a barrel, vulnerable in the mental institution. I have read how criminal psychiatrists hold releasable patients hostage for the insurance money and hospitals stand behind the criminals.
I am not sure what the answer is other than a grass roots movement because government and medicine have shown it is predatory at worst and broken at best.