Homelessness Causes and Solutions

[Vol8188]

You serious Clark?

Other than my typo, what’s the issue?

 

[Vol8188]

Our posters who are in healthcare are invited to correct my post.

McRib had a mandatory psyche rotation in her rounds as a therapy intern. The unsolved challenge of stabilizing the mentally ill is that once their meds are dialed in, they feel so normal many stop taking the medicine. And then they relapse back to their unmedicated psychosis which they try to manage with street drugs. Unless they have a family member dedicated to the constant battle of giving and verifying the meds are taken, the relapse rate is daunting.

Of the many who can reach a point of stabilization, very few stay there.

(Her experience was 30 years ago so meds and protocols may have improved since then).

I had to physically take a guy’s lisinopril from him once. Not sure why his pcp placed a black man on lisinopril in the first place. But he came in looking like Will Smith in Hitch. I’m trying to explain to him angioedema and that he had to discontinue his med and that I would replace it with amlodipine.

He had cut some of the pills in half and was convinced they were different. So he was telling me “these are the ones I’m allergic to”, “but not these” and he fully believed they were two separate pills

So yes, medication compliance with severe mental illness is a huge obstacle. There are long acting injections (some work up to 6 months, there may be longer acting that I’m not familiar with) now that are a major benefit in that regard. But you still have to get someone with severe mental illness to show up once every 6 months. That’s not easy.

 

[K-town Vol Fan]

Other than my typo, what’s the issue?

Of course they are better off in mental health facilities. How is that even debatable?

 

[Vol8188]

Why are we seeing such a big increase in mental illness around the country? Answering that question would be the place to start.

I’m curious as to your thought on the overall. When I thought of the question, I thought “hog will oppose this”

 

[McDad]

I had to physically take a guy’s lisinopril from him once. Not sure why his pcp placed a black man on lisinopril in the first place. But he came in looking like Will Smith in Hitch. I’m trying to explain to him angioedema and that he had to discontinue his med and that I would replace it with amlodipine.

He had cut some of the pills in half and was convinced they were different. So he was telling me “these are the ones I’m allergic to”, “but not these” and he fully believed they were two separate pills

So yes, medication compliance with severe mental illness is a huge obstacle. There are long acting injections (some work up to 6 months, there may be longer acting that I’m not familiar with) now that are a major benefit in that regard. But you still have to get someone with severe mental illness to show up once every 6 months. That’s not easy.

Middle Tennessee had a facility for the mentally ill for years. Cloverbottom. Had to close it because of all the reports of abuse (including sexual) of the patients. Now, the most vulnerable...what we used to call retarded...live in small group homes with full time rotating attendants. I rented a house to the program. I don't know of any such program for psychotic patients.

 

[Vol8188]

Of course they are better off in mental health facilities. How is that even debatable?

It’s obviously debatable. That’s why the courts decided in the 70s that their free will should be protected.

You are aware that you can’t legally hold people with schizophrenia against their will right now, right? I see patients with severe delusions all the time who refuse to be treated. I don’t like it. But I can’t do anything about it. And I’m truly on the fence about how much we should be able to do and when.

How far are you willing to take it? As in specifically who do you believe should be held against their will and when?

There’s a lot of elements to debate here

 

[Vol8188]

Middle Tennessee had a facility for the mentally ill for years. Cloverbottom. Had to close it because of all the reports of abuse (including sexual) of the patients. Now, the most vulnerable...what we used to call retarded...live in small group homes with full time rotating attendants. I rented a house to the program. I don't know of any such program for psychotic patients.

One sad thing I’ve seen more than I wish I have, is severely autistic males, living with single moms who can’t control them, and eventually have to get them placed into a home.

That can’t be an easy decision for any parent to make.

 

[volbound1700]

Causes: Drug addiction and mental illness.

Solutions: Forced drug rehab and rebuilding our mental institutions. It's really the only solutions we have. Many drug addicts are homeless because of their choices. They burned too many bridges with family and friends because of their habits, and no one wants them around anymore. Moreover, some get used to the homeless life...no rules.

Anyone who is legitimately homeless because of something other than these two things is quite a rare case, and most of those can get out of it relatively quickly.

While helpful, I think we need more. I think we need to have career paths/work for them as well. The sad truth is that not everyone can take care of themselves and need their life managed.

 

[McDad]

One sad thing I’ve seen more than I wish I have, is severely autistic males, living with single moms who can’t control them, and eventually have to get them placed into a home.

That can’t be an easy decision for any parent to make.

This post and your other about holding people makes the second part of your OP so challenging. Solutions are very hard to consistently implement. There are so many situations which are workable at one stage of life but fall apart at another. Much like your example posted above.

 

[McDad]

While helpful, I think we need more. I think we need to have career paths/work for them as well. The sad truth is that not everyone can take care of themselves and need their life managed.

ARe you talking about those who seek out drugs and fall into addictive patterns?

 

[Vol8188]

While helpful, I think we need more. I think we need to have career paths/work for them as well. The sad truth is that not everyone can take care of themselves and need their life managed.

I see a lot of patients from our local rehab facilities and some of them are roughly year long programs that allow the patients to work the last x number of months there. So the patients aren’t just thrown onto the street without a job or any money. I think that’s a step in the right direction

 

[McDad]

I see a lot of patients from our local rehab facilities and some of them are roughly year long programs that allow the patients to work the last x number of months there. So the patients aren’t just thrown onto the street without a job or any money. I think that’s a step in the right direction

I have always thought Heroin was the worst drug for addiction which destroyed a person's life. I think of cocaine as a more of a party drug.

Are there other drugs as bad as heroin for putting people on the street and into a desperate situation?

 

[UTFanForLife]

One of the largest hurdles in treating mental health issues in this country is the stigmatism that comes along with mental health. A lot of people do not want to go get help due to the fear of being labeled “crazy”.

I have experienced this first hand with an adult child, would rather have medicines thrown at a dart board to see what worked instead of being admitted somewhere for a short time to be fully evaluated. Luckily it never got to a point that they had to be involuntarily admitted, and decided after multiple months of setbacks to get themselves checked in. But the fear of being labeled “crazy” and the fear that they would never be let out was real for them.

It took 2 separate stays, and one psychiatrist to actually take interest in their case to get the diagnosis and medicines in a correct place. They are to the point where they can hold a steady job, go out and do things in public, and function mostly normal as an adult.

They still get nervous, and we have to remind them that everyone gets nervous. The difference is knowing that being nervous is ok, but letting being nervous control what you do is not ok.

 

[Vol8188]

I have always thought Heroin was the worst drug for addiction which destroyed a person's life. I think of cocaine as a more of a party drug.

Are there other drugs as bad as heroin for putting people on the street and into a desperate situation?

Methamphetamine for sure leads to a lot of homelessness. They have a lot of delusions similar to schizophrenics (both are dopamine related), which makes it hard for family members to help them.

Your heroin addict son is probably just going to sleep a lot. Your meth addict son is going to be up all night taking down the drywall because the government is spying on him

 

[Vol8188]

One of the largest hurdles in treating mental health issues in this country is the stigmatism that comes along with mental health. A lot of people do not want to go get help due to the fear of being labeled “crazy”.

I have experienced this first hand with an adult child, would rather have medicines thrown at a dart board to see what worked instead of being admitted somewhere for a short time to be fully evaluated. Luckily it never got to a point that they had to be involuntarily admitted, and decided after multiple months of setbacks to get themselves checked in. But the fear of being labeled “crazy” and the fear that they would never be let out was real for them.

It took 2 separate stays, and one psychiatrist to actually take interest in their case to get the diagnosis and medicines in a correct place. They are to the point where they can hold a steady job, go out and do things in public, and function mostly normal as an adult.

They still get nervous, and we have to remind them that everyone gets nervous. The difference is knowing that being nervous is ok, but letting being nervous control what you do is not ok.

I think that’s a bit different. Sounds like you’re talking about severe anxiety.

My severe schizophrenics don’t have enough personal awareness to worry about social stigma.

 

[Grand Vol]

Of course they are better off in mental health facilities. How is that even debatable?

The problems arise from the lack of both mental health facilities (specific designated facilities) as well as mental health professionals in the field to work them. There just aren't enough of them.

I work on the staffing side of this equation and most hospitals aren't set up for long term treatment and are temp holding areas until a spot opens. The normal med-surg, IMC and ICU facilities just can't keep up with "demand" for lack of a better term.

The other thing we've become far more dependent on is the over medicating the problem rather than admitting into a facility. We've become far more likely in the health industry to throw medicine at the problem and hope it goes away rather than trying to find the best treatment. Of course, you can blame big pharma for that one... different subject though.

 

[UTFanForLife]

I think that’s a bit different. Sounds like you’re talking about severe anxiety.

My severe schizophrenics don’t have enough personal awareness to worry about social stigma.

He does not have schizophrenia. He is Bipolar, has OCD, and severe anxiety.

Sorry my comment was more on mental health as a whole.

 

[Vol8188]

The other thing we've become far more dependent on is the over medicating the problem rather than admitting into a facility. We've become far more likely in the health industry to throw medicine at the problem and hope it goes away rather than trying to find the best treatment. Of course, you can blame big pharma for that one... different subject though.

Is this really a big pharma issue or an issue of the courts?

My understanding is various rulings in the 70s greatly diminished the ability to hold anyone against their will. Which lead to far less in patient treatment

 

[Vol8188]

He does not have schizophrenia. He is Bipolar, has OCD, and severe anxiety.

Sorry my comment was more on mental health as a whole.

My true bipolar patients for sure could benefit from mandatory holds at times. Anyone who has not seen true bipolar mania, it’s a wild thing. They come in talking your head off, haven’t slept in days, and you’d be convinced they’re on meth or cocaine but their urine comes back clean.

 

[McDad]

One of the largest hurdles in treating mental health issues in this country is the stigmatism that comes along with mental health. A lot of people do not want to go get help due to the fear of being labeled “crazy”.

I have experienced this first hand with an adult child, would rather have medicines thrown at a dart board to see what worked instead of being admitted somewhere for a short time to be fully evaluated. Luckily it never got to a point that they had to be involuntarily admitted, and decided after multiple months of setbacks to get themselves checked in. But the fear of being labeled “crazy” and the fear that they would never be let out was real for them.

It took 2 separate stays, and one psychiatrist to actually take interest in their case to get the diagnosis and medicines in a correct place. They are to the point where they can hold a steady job, go out and do things in public, and function mostly normal as an adult.

They still get nervous, and we have to remind them that everyone gets nervous. The difference is knowing that being nervous is ok, but letting being nervous control what you do is not ok.

This may be too personal so no worries if you decline to answer.

Does your son have a support network outside of you and other family members?

 

[Willy P]

Maybe I'm a pessimist when it comes to this topic because my wife has worked for three non-profits, but I think a growing problem is some of the non-profits themselves. Maybe there is an official name for them, but I call them non-profit conglomerates.

These groups have more executives and directors and back-end staff than direct support staff, and therefore their overheads are huge. My wife and her team were working with victims, holding masters degrees, and making $40k while they had three or four levels of management and directors above them making more than six figures, only applying for grants and attending meetings.

I think I saw a veterans housing facility here in Knoxville being built for $15m in grant money and donations, but has 32 1-br apartment units. Almost half a million per unit. AND the land was donated by the county.

 

[Grand Vol]

Is this really a big pharma issue or an issue of the courts?

My understanding is various rulings in the 70s greatly diminished the ability to hold anyone against their will. Which lead to far less in patient treatment

Look at the DSM5 and tell me we aren't digging so deep we might be causing more problems than we had before...

Look at kids that are "diagnosed" with mental health issues such as ADHD that honestly just need to burn off energy. But what's the answer for that mostly?

Medicating the problem instead of looking for holistic remedies like "get the **** out of the house and play".

Regardless, we don't have the facilities or personnel any longer to treat the problems on a large scale.

 

[UTFanForLife]

This may be too personal so no worries if you decline to answer.

Does your son have a support network outside of you and other family members?

He has tried many therapists, but he says it makes things worse for him. Most want to dive into things besides what bothers him. He has appointments with a psychiatrist regularly.

He is now married, and they are living on their own, but still within short driving distance to us and also her family. I will say having to rely on himself more and knowing he needs to help provide for his own family now, has helped him a ton in the anxiety area.

 

[UTFanForLife]

My true bipolar patients for sure could benefit from mandatory holds at times. Anyone who has not seen true bipolar mania, it’s a wild thing. They come in talking your head off, haven’t slept in days, and you’d be convinced they’re on meth or cocaine but their urine comes back clean.

Yeah, lots of talking and never staying on the same subject for more than a minute. Also not being able to do something for more than like 10 mins. Would get mad, wanting to do one thing and then decide that something else was better, but then going to something else, all the while wanting to do the first thing and going back to it, but then feeling bad about not doing the 2nd thing. All in like a 30-45 mins span.

Then out of control spending. Feeling like you have to have everything of something.

 

[hog88]

I’m curious as to your thought on the overall. When I thought of the question, I thought “hog will oppose this”

I have no ideas why when it comes to true mental illnesses like schizophrenia. Others like depression, bipolar ADHD and similar are in my opinion used as an excuse for bad/irresponsible behavior often by parents for their lack of disciplining their kids. Also because people want a pill to "fix" whatever ails them even though what is causing their problems is their own dumbazzness, laziness or feeling of entitlement.