KQED Public Radio’s “Forum” hit the airwaves this morning with a conversation with Robert Okin, the former chief of psychiatry at San Francisco General Hospital, who recently published a new book on homelessness and mental illness. He said the common belief that the homeless choose to reside on the streets, from his experience profiling them, is false.
“Most people do not want to be on the streets — they’re on the streets because they do not have other options,” Okin told host Michael Krasny. “If they have homes, and they have a case manager, they can do well.”
Okin’s book, “Silent Voices: People With Mental Disorders on the Street,” narrates Okin’s two-year project interviewing and photographing homeless residents of San Francisco battling varying degrees of mental illness, shedding light on the inefficiencies of city policies to provide sufficient housing and medical care.
Okin said the homeless are “by and large people who have spirit,” despite the onslaught of institutional failures and trauma. Many harbor memories of troubled upbringings and sexual abuse.
He estimated that 90 percent of those he approached on the street ended up talking to him — desperate for someone to see them as more than an invisible backdrop to their morning commutes. “I expected them to brush me away, and I also expected that if they did talk to me, they would be very guarded,” Okin said. “But I was wrong.”
His book documents shocking statistics about the connections among homelessness, jail and mental illness. Around 200,000 people with mental illness are currently behind bars, with many of them flowing in from the streets. “The number of mentally ill people on the street actually represents an underestimate of the homeless mentally ill people in the United States, because the rest of them are in jail or in prison and are totally out of sight,” he said.
The San Francisco Public Press’ Fall 2014 edition cover story tackled several aspects of the current paradigm for helping the homeless, a policy called “housing first.” San Francisco first embraced the approach 10 years ago, devoting hundreds of millions of dollars to expand basic housing options for thousands of people, paired with supportive services. The plan, the authors said, would “abolish chronic homelessness” in San Francisco.
The takeaway? The policy has done little to combat rapidly rising demand and prices for housing. Two reasons stand out: competition among various programs at the Department of Public Health and the Human Services Agency, and the lack of a citywide policy on housing qualifications for applicants. And the expanded funding for housing, critics say, could have been used to boost funding for outpatient services in the community to care for people with mental illness.
Some of the findings you can expect to read up on:
- How one homeless resident interacts with the bloated bureaucracy that provides supportive housing to people off the streets and into shelters.
- A Q-and-A with Sheriff Ross Mirkarimi, who claims that San Francisco jail is looking increasingly like a psychiatric institution.
- A review of new research pointing to homelessness as harmful to mental health.
- How an alternative court provides a lifeline to people struggling with mental illness.
- The plight of formerly homeless supportive housing residents, who face higher eviction rates than other San Francisco tenants, for financial and behavioral problems.