Showing posts with label Tracy Kidder. Show all posts
Showing posts with label Tracy Kidder. Show all posts

Wednesday, August 21, 2024

Rough Sleepers September book club selection

Our book club assignment for September is Rough Sleepers by Tracy Kidder.  Here is a summary of a model program from 1985 to the present at its website with a description of the book. Our History | Boston Health Care for the Homeless Program (bhchp.org)

"2023:  Rough Sleepers: Dr. Jim O’Connell’s Urgent Mission to Bring Healing to Homeless People by Tracy Kidder is published. Kidder tells the story of Dr. Jim O’Connell, (Boston Health Care for the Homeless Program) BHCHP’s founding physician and the BHCHP Street Team as they offer medical care and friendship to “rough sleepers”, our patients living on the streets. Tracy Kidder, a Pulitzer prize-winning author followed the Street Team for 5 years resulting in this New York Times bestseller.

Rough Sleepers appears on the cover of the New York Times magazine with a 10,000-word author essay by Tracy Kidder and a photo montage of patients cared for by the BHCHP Street Team.

Barbara McInnis House respite program [in 2023] opens the Complex Addiction Treatment (CAT) team specializing in the respite care of people with active SUD using best practices from addiction medicine, harm reduction, and trauma informed models of care. This is a unique model of care: The team’s goals are 
(1) to provide effective care to respite patients at BMH who are at high risk for adverse outcomes related to drug use 
(2) to retain these patients in care at BMH to address the medical need(s) for which they were admitted and 
(3) to decrease triggers and trauma for patients in respite who are not using drugs by cohorting and better supporting patients for whom cessation of use is not an option."

Additional information


"SAMHSA’s SOAR program increases access to Social Security disability benefits for eligible children and adults who are experiencing or at risk of homelessness and have a serious mental illness, medical impairment, and/or co-occurring substance use disorder." However I found it so complex, I couldn't figure it out. Find Treatment Locators and Helplines | SAMHSA  Definitely would require a whole department of specialists. But I also looked at the number of applicants in 17 years this department has helped, and I was not impressed.

"Under federal disability rights laws, alcohol addiction, whether current or past, is typically considered a disability due to the effects it has on a person’s brain and neurological functions and is protected by the ADA. 7 On the other hand, though drug addiction is generally considered a disability, the ADA only allows protections for those in recovery and not currently engaging in illegal drug use. 7



Thursday, August 01, 2024

Research for Tracy Kidder book on Rough Sleepers

Our book club is reading Tracy Kidder's book, Rough Sleepers (2023). I was researching some of his information on homelessness, and saw the subtle but common myth some of our current burden was the Reagan policies "with its deep cuts in programs for the poor and policies that led to declines in the supply of inexpensive housing." ( p. 55) I'll skip over the housing supply (single room occupancy) because that is a local/city problem. I did find the article in "Behavorial health news," by Michael B. Friedman, which I then checked further, since it also brought up Reagan. Yes, there was a 1983 SSDI law passed to stop fraud and he signed it. Then it was revised twice in 1984 and actually eased the requirements so the disability awards shot up, not down. Since I was a Democrat then and only believed the worst about Reagan (same media treatment that Trump gets, and Bush before him) I had always believed Reagan was the reason people were put on the streets.

But as the author himself wrote, the deinstitutionalization which is closely tied to the SSDI recipients finding housing began in the 60s and 70s, long before Reagan was in the White House. And truly, one can't deny that most of the programs that make it to Congress and the White House begin in academe (where I worked). Congressmen are so busy raising money to campaign they have no time to dream up billions in social and economic programs, or even read the bills they vote on.

But I want to pass along two experiences with government programs for the disabled, one from the late 1960s and one from 2020. In the late 60s at church coffee hour I met a former pastor of the Church of the Brethren (Anabaptist tradition) who was a social worker in one of the rural Ohio residential institutions for the blind and deaf mentally challenged. It was in the process of "deinstitutionalizing" his clients because he said, "they deserved their civil rights like any other citizen." Joe was thrilled with the idea. At that time, I was a giddy humanist in my early 30s, so he convinced me they would do fine on the "outside" because there would be community programs and smaller homes (not yet established) that would help them. So, many of them lost the only home they knew and life long friends.

In October 2019, our son was diagnosed with glioblastoma. He was 51, employed and a homeowner with a mortgage, but no wife or adult children, only his 80 something parents. However, he could not work, especially not after the surgery and chemo which is the same "slash and burn" method of 30-40 years ago. The SSDI application was brutal. I can't imagine how anyone, let alone someone who has been on the streets, completes it. Our daughter who works in the medical field and her cousin who was a lawyer for Social Security in DC worked together on it. Probably took eight hours with both working on it. The sick, unemployed person usually waits 6 months--to prevent fraud (which vastly increased during Obama years as people lost their insurance). He died about 6 months and 1 week after the application went to Washington. He paid his bills with his IRAs and retirement account, he had family to help, and it was all used up in 6 months plus he was charged a penalty for closing out his retirement funds and he had to pay income tax on it (or rather his estate did since he was deceased).

Between the green local laws to save the environment which adds thousands to every home purchase/rental and the new codes for safety and transportation, all types of housing have become prohibitive. Plus this is not the 1930s culture where people let even cousins or childhood friends sleep or rent a room at their home. Let's not point fingers at the 40 year old Reagan administration; there has been plenty of mischief since then. 

Are you old enough to remember or have studied the housing shortage after WWII? Low income, inadequate housing was taken off the market through special codes. A lot of livable housing was condemned. There was no actual shortage. Reagan was a movie star then, not a politician. There were the same number of housing units in 1945 as in 1940--it was the liberal policies that destroyed them by law.

California has become a cesspool of homelessness by fixing the tax system with Prop 13 so no one would dare move and it weakened the tax revenue for supportive services. The grifting of non-profit agencies and probably thousands of California state employees to "fix" a problem has contributed to the now mushrooming homeless population who suffer from legal and illegal drugs, alcoholism, mental illness, illegal immigration, an aging population, lack of general life skills, and mentally challenged (probably some blind, deaf).

It wasn't Reagan and it isn't Trump. But it is government at all levels working with academe. It's liberal, pie in the sky programs that don't work which began in academe by people who need to publish and who don't live in reality or a low income neighborhoods.

*                                         *                                   *                                    *

Growth of homelessness--who caused it? Reagan policies, loss of SRO housing, closing of institutional care facilities, 1968-1973 (about 1/3 of the increase), https://www-origin.ssa.gov/benefits/disability/

https://www.forbes.com/sites/theapothecary/2013/04/08/how-americans-game-the-200-billion-a-year-disability-industrial-complex/

Why Are the Disability Rolls Skyrocketing? The Contribution of Population Characteristics, Economic Conditions, and Program Generosity, pp. 337-379, chapter 11 in "Health at Older Ages: The Causes and Consequences of Declining Disability among the Elderly" (2009) https://www.nber.org/system/files/chapters/c11119/c11119.pdf  

Deinstitutionalization Did Not Cause Homelessness: Loss of Low-income Housing and Disability Benefits Did By: Michael B. Friedman, LMSW Mental Health Policy Advocate
April 1st, 2020 https://behavioralhealthnews.org/deinstitutionalization-did-not-cause-homelessness-loss-of-low-income-housing-and-disability-benefits-did/

"At the height of deinstitutionalization in New York (1968-1973), people who were discharged (with wildly inadequate discharge plans) were not homeless. Most went to live with family. Some went to adult homes. Many went to nursing homes because they had dementia. And quite a few went to single-room occupancy hotels (SROs) and other places where poor people lived. To be sure, this resulted in huge family burden, inadequate care in adult homes, transinstitutionalization to often unprepared nursing homes, and squalid sometimes dangerous living conditions in SROs and poor neighborhoods. But they were not literally homeless. In fact, the scandal that led to the creation of the community residence program for people with mental illness in NYS was not homelessness. It was the squalid and dangerous conditions in SROs."