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

Find Immediate Homelessness Assistance | SAMHSA

Need Housing Assistance? - HUD Exchange

"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

Is Addiction a Disability? ADA Protections & Disability Benefits (americanaddictioncenters.org)

Dr. Jim O'Connell wrote a memoir in 2015. House Calls To The Homeless: A Doctor Treats Boston's Most Isolated Patients : Shots - Health News : NPR

Medicaids-Role-in-Housing-1.pdf (macpac.gov)

Thousands in Columbus are waiting for affordable, Section 8 housing (dispatch.com)

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.

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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."

Middle aged increases in binge drinking in U.S.

"The total annual number of binge drinks consumed per U.S. adult who reported binge drinking increased significantly by 12% from 2011 to 2017, including among non-Hispanic white adults and those aged ≥35 years." https://www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6902a2-H.pdf

One is tempted to ask who was in the White House and Congress during the years of study?  I'm not making light of binge drinking, but it was during the Obama years that the hate and division really escalated--but then, so did the nastiness on social media. That said, when we see this, the federal government is quick to see $$$ in grant money for more study of socioeconomic causes, when maybe it needs to look in the mirror.

This was reported in Morbidity and Mortality Weekly Report from the CDC and you should read carefully rather than accepting the headline version you'll see on internet news (like my source did using Yahoo instead of CDC). Just saying though, Ohio was one of the 9 states reporting a significant increase. And Wyoming? What's going on? The CDC backed up its claims with data on increase in alcohol sales.

I mention my source because it is a pet peeve that I receive “Healthbeat” in my e-mail from Ohio State University Medical Center Communications Center, and it is citing Yahoo!  Do they have no experts of their own who can read a CDC MMWR report?

Five lifestyles which will prolong your life. . . maybe

Have you ever seen this statement--"Americans have a shorter life expectancy compared with residents of almost all other high-income countries." I wish they'd qualify that by race, ethnicity, immigration status and age. Are Swedish Americans less healthy than ethnic Swedes in Sweden? Finnish Americans worse off than those born in Helsinki? German Americans? Drugs, auto accidents, and gun deaths wipe out a big swath of young Americans which unfortunately drastically alters our life expectancy national statistics. Losing weight, eating a healthy diet, and exercising more are good for you as an individual, but probably won't change national statistics as long as those 3 killers are present.

Here's what the journal "Circulation" determined: "Adherence to 5 low-risk lifestyle-related factors (never smoking, a healthy weight, regular physical activity, a healthy diet, and moderate alcohol consumption) could prolong life expectancy at age 50 years by 14.0 and 12.2 years for female and male US adults compared with individuals who adopted zero low-risk lifestyle factors."

Simple, right? Popular health journals and websites (usually sponsored by pharmaceutical companies) have jumped on that one. Buckets of articles and bags of advice have come from that. But. As young adults, people (like me in the 1960s or my parents in the 1930s) observing those five lifestyles were probably not involved in violent gangs, car chases while drunk, stealing to support an opioid habit, or eating wings at the local bar and washing them down with 12 beers several times a week. Those five lifestyles often include a monogamous marriage, higher education levels, stable jobs, church attendance, strong family and friend relationships. It's not that grandma who smoked like a chimney and drank six beers a day didn't live to be 105, or that cousin Ralph dropped dead jogging at age 40, but they are the exception.

I haven't read the whole article, but I know how it will be cited: support take over by the government of our health insurance because look how unhealthy Americans are. Studies in countries with socialized medicine that compare their healthiest and their least healthy show the same spread as the U.S. and that there are income gaps, education disparity and socio-economic differences which government health insurance doesn't change.

This article is free access.  “Circulation” is one of the best peer reviewed journals you can read on cardiovascular issues. https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.117.032047

A great talent destroyed by a family disease--alcoholism

Gerry Rafferty (1943-2011) The Ark



"Gerry Rafferty, the Scottish singer-songwriter best known for the hits 'Baker Street' and 'Stuck in the Middle With You,' died Tuesday [Jan. 4], the Guardian reports. The 63-year-old was hospitalized in November 2010 with liver failure and had been ill ever since.

Born in Paisley in 1947, Rafferty was the third child of a hard-drinking Irish miner who frequently abused his family. After his father died when he was 16, Rafferty left school to work and play music. . ."

Will we see long term change for these women?

Last Tuesday I heard a very inspiring talk on our local NPR WOSU station, Ann Fisher's All Sides, with Judges Paul Herbert and Scott Van Der Karr about a court program to rescue women from prostitution. Link. They talked about drug treatment, safe housing, workshops, and Johns Schools, to go after the buyer.
Saving money, changing lives | The Columbus Dispatch

While browsing resources for women involved in prostitution, I've come across many sites that as a Christian, I wouldn't support, even if they are fighting prostitution. For instance, look what the curriculum for "Sanctuary for change" (funded in part by the HHS) provided its students, whose minds and bodies had already been abused for years!

"Women identified the following components of the curriculum as the most important piece of information that they would put into practice:

•“That I will use protection if I engage in sex ever.”
•“My learning to be assertive and living without my worrying about what others think of me. Living my life as being worthy.”
•“To be able to have an open dialogue about safe sex with a partner.”
•“My feelings are valid and I am in control of my body.”
•“Taking time out for me and safe sex.” "

Dana Jacobson

If she'd been this insulting to blacks as she was to Catholics, her bosses wouldn't be excusing her for being drunk. She would have been fired. People who customarily drink too much should always bring along duct tape to public functions as well as a driver. And why didn't the people at her table or in her party just take her home? Women get drunk on less alcohol than men, BAC chart.

“My actions at the roast were inappropriate and in no way represent who I really am,” she said. “I have personally apologized to many of the people involved. I won’t make excuses for my behavior but do hope that I can be forgiven for such a poor lack of judgment.” MSNBC

You are forgiven. Now get help.

Needed: a savvy editor

I haven't yet finished Clarence Thomas' autobiography, My Grandfather's Son, but unless he makes a big reversal before I get to the end of the book, I think his editor made a huge, huge boo-boo. It's about Thomas' first marriage and alcohol problems.

Never, never let your author say he knew before the wedding that it was a mistake. This strips the woman (and child) of all dignity, no matter what nice things are later said about her, her parents, and other good things. It makes your author, whom you were hired to protect from himself, look like less than a gentleman.

Second, never, never let your author continue to say, "when I left her," "when I left the marriage," or "after I left her," because it makes him look like a pompous fool who doesn't realize two people make up a relationship. To a man, it might sound innocuous; but to a woman reader, it makes him sound like a first class clod. If he says it once, OK, maybe your editorial skills are shoddy and you missed it, but several times? Back to school for you!

Third, (and I haven't come to the part where he gets sober) don't let your author go on and on and on about how poor he was after his Yale Law degree and several government appointments and never have him acknowledge how expensive it is to drink away all your discretionary income. Whether liberals or conservatives read it, that's a financial lesson it's never too early or late to learn.

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Are you serving alcohol to underage drinkers?

About a month ago there was a big hoop-la in our community because a limousine driver reported to school officials that his passengers on the way to the Upper Arlington prom in the Arena District had alcohol. About 10 other limos were searched and 125 kids didn't get into the prom that night, even those who didn't know there was alcohol in the vehicles. Some parents were furious; some kids were heart broken.

And where are you on this? Are you serving alcohol to kids? The parents of the guilty, or older friends of the teens, obviously purchased it. If you own stock in any alcohol related industries, you too are serving children. An article published in Archives of Pediatrics & Adolescent Medicine (2006;160:473-478) reports that the short-term cash value of underage drinking to the alcohol industry was $22.5 billion in 2001--17.5% of total consumer expenditures for alcohol. Well-designed public service announcements about "responsible" drinking are a drop in the ocean of booz. But the study didn't stop with that. It went on to figure the consumer expenditures for underage drinkers to maintain their consumption as adult drinkers with abuse and dependency, which equaled at least $25.8 billion in 2001. Teen age brains are still forming and alcohol and cigarettes consumed before adulthood have much more serious consequences for addictions and health. If you can get to 21 without starting, you probably won't have a problem and will be responsible.

So, the combined value of illegal underage drinking and adult pathological drinking to the industry was at least $48.3 billion, or 37.5% of consumer expenditures for alcolhol in 2001. Some estimates mentioned in the study place it even higher than that, at $62.9 billion and 48.8% of consumer expenditures.

If any business were to lose over 17% of its consumers' purchases, it would be hurting. But how much are they, and stockholders, hurting us? The alcohol industry needs to cultivate the underage drinker in order to be profitable, and no amount of chit-chat or sweet talk about "responsibility" is going to change that. But you don't have to participate in this fairy tale--just get it out of your portfolio. Just say No to alcohol profits.

The abstract of this article appeared in JAMA, July 26, 2006, Vol. 296, no. 4, p. 373.

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How much did they spend on this study?

A survey of University of Iowa students has confirmed the suspicion that heavy drinking can hurt a college student's grades.

Amazing break through research here.