In this video, Kim Hopper, PhD, an adjunct professor at Columbia Law School in New York City, discusses the systemic shortfalls of New York City Mayor Eric Adams’ involuntary removal initiative to get homeless New Yorkers with mental illness off the streets and subways. Hopper is also a medical anthropologist who served as president of the National Coalition for the Homeless and teaches in the Bard Prison Initiative.
The following is a transcript of his remarks:
I’m not sure I know what it would really take from the inside of the bureaucracy at the city and state level to mount what would be a durable, long-term commitment to addressing not just the emerging needs or the emergent needs on the street, but the long-term need for supportive and affordable housing. That’s what has been missing from the equation ever since the start.
What we’ve had are a number of, I think, remarkably promising small-scale efforts at providing exactly that for exactly this population, and they have an enviable track record of almost unblemished success even over the long haul. In 5-year follow-ups, we’ve had 85% retention rates, which is sort of unheard of in mental health research.
I think the most remarkable one is the one that began in the early 1990s and became known as Housing First. It asked a really simple question: what would happen if in doing street outreach, instead of threatening people with coercive placement elsewhere, we offered them a chance to say, “What would it help me to get from you?” And when they asked that question in 1990, remarkably enough, in a randomized controlled trial, the people said, “I need a place to live.”
These were seriously mentally ill people, often with long-standing substance use problems. And they said, “I really could use a place of my own.” And over the next decade or so, that program rehoused voluntarily over 500 New Yorkers from the street directly, often, again, with long-standing issues of psychiatric disability or substance abuse problems.
The key has always been that once people had a place of their own that was affordable, secure, and regularly visited by case managers, once that was in place, it didn’t take long for them to develop a stake in holding onto it.
I mean, mistakes were made. Sometimes people brought their friends from the street into their apartment and it didn’t go very well. They had to be resettled and the landlord reassured that this was not going to happen again. But the beauty of the program was its security. Once you had a place, you were a member of Pathways to Housing forever.
It was just remarkable what a difference it made. You actually see it in the shelter statistics in the early 90s in New York City, you actually see a decline in the numbers of people there and in Westchester County from the shelter population, because they weren’t simply circulating through that system and the hospital system and the jails and the detox facilities, they were actually leaving that circuit for a place of their own.
New problems arise like, now what do I do for a social life? But that’s a different kind of problem than being paraded as the public enemy number one on the streets and subways of New York City.
Bringing those up to scale is not something any public authority has taken on in a serious way, and that’s what we need. It probably can’t be done at a city level alone, even at a state level alone. I mean, we’ve just seen the effects over the summer of erratic political moves in the American South suddenly overwhelming the shelter systems in the American Northeast. It’s not something that can be done, I think, on a local level, but pretending to be able to do it on a local level is a real disservice. That’s the read I have or the feeling I have when faced with the mayor’s most recent initiative.
It’s not that the hospital doesn’t have a stake in this, because the clinical work they’re doing is undone by the homelessness that follows discharge if they have no place to go. It’s not that the hospitals aren’t trying hard or the social workers aren’t putting the effort in, it’s just that the resources aren’t there.
You see this not simply with respect to mental health, but you see it in clinical interventions all over the country. Internally, clinicians are weighing the option of going ahead with a procedure contingent upon this person having some place to go after they can be discharged. Homeless people are really low on the eligibility scale judged by that rubric. They just don’t have that option, and you can’t conjure it up out of thin air as a discharge plan if the actual resources aren’t there.
The stock of housing isn’t there, and unless we tackle that really fundamental issue of resource scarcity, we’re just tinkering around the edges and imaginatively developing workarounds that manage to get our guy placed when somebody else is going to be pushed back. It’s a terribly demoralizing place to be as a clinician.
Source: MedicalNewsToday.com
