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Report on Homelessness Table of
Contents INTRODUCTIONIn order to research homelessness I reviewed information from many different sources. A few of them include, relevant newspaper and magazine articles, AGRM supplied information and survey results, five books that dealt with various aspects of the homeless condition, internal data base reports, various studies on the subject and Bethesda staff observations. Some of the best local information came from a survey sponsored by the Central PA Psychiatric Institute and the Dauphin County Mental Health/Mental Retardation Program. The report, entitled "The 1992 Survey of Mental Illness, Substance Abuse, AIDS, and other Disabilities Among the Shelter Homeless of Dauphin and Cumberland Counties," was a survey of 81 clients of nine homeless shelters in Dauphin and Cumberland Counties, including our men's and woman's shelters. The sample size was about one-third of the total shelter residents in our area and was the only local study I could find. It provided local statistics which more or less validated the findings of the previously mentioned national studies/reports. There were problems in analyzing the data. The main ones were the general lack of good data and the fact that very few studies sampled the same homeless sub-populations. For example, some studies measured only homeless persons who live on the street, another measured only those who live in shelters and others measured street persons, soupline users and shelter residents. It was very difficult to compare results. However, I did try to make comparisons whenever I had "apples and apples." Another problem was the fact that I was not able to find any scientific research on the spiritual condition and sexual orientation of homeless persons. In order to get some hard data on these subjects, I am contacting local college social service departments to see if a class or individual would like to conduct a study of our shelter residents in order to secure "hard" data. I do want to note another small problem in data interpretation. You could call it the "chicken or the egg" syndrome. This was addressed in the discussion section of the local shelter survey. James Hales explained it this way, the "question could be framed as, did these disorders (substance abuse and mental illness) cause or play a role in the homelessness of the individuals involved, or conversely, were the disorders brought on by the homelessness itself." Attached to this report is a lengthy document called "Report Statistics. " It contains twelve pages of detailed statistical information on homeless person's mental health, substance abuse, veteran status, spiritual condition, general demographics, employment history and other relevant issues which shed light on the nature of our clients. Also, attached is a document called "Combined Summary Statements" which gives a concise one-page overview of the report statistics. This has been an exciting and educational process. My understanding of the nature of homelessness has increased. I trust the following information will be useful in your understanding of the subject as well. It is my intent to consider this a living document by adding new information as it
becomes available. DEFINING THE TERMProbably, the best way to begin is to define the term "homelessness." One weighty definition of the term was provided by The Coalition on The Homeless in PA in 1987. It states: "Homelessness is a condition in which individuals and families have no residence, owned, leased or shared in which they can live safely, healthful and legally both day and night and in which they can meet their social and basic needs in privacy and with dignity." However, the following comments from the book, "A Nation in Denial -- The Truth
About Homelessness" provides greater insight into the nature of homelessness, They
write, "The term 'homeless' is actually a catch word, a misnomer that focuses our
attention on only one aspect of the individual's plight: his lack of residence or housing.
In reality, the homeless often have no job, no function, no role within the community;
they generally have few if any social supports. They are jobless, penniless, functionless,
and supportless as well as homeless." MENTAL ILLNESS & RETARDATIONI was able to find a lot of very good data on the homeless mentally ill. Probably the best research was done by H. Richard Lamb, MD and John A. Talbot, MD. Their work was entitled "The Homeless Mentally Ill -- The Perspective of the American Psychiatric Association." It was published in the July 25, 1986 issue of JAMA. They state in their article -- "The most methodologically sound studies performed thus far indicate that among the total population of homeless persons, there is a prevalence of about 40% with major mental illness (that is, schizophrenia and major affective disorder)." Further in their article they provide insight into how the chronically mentally ill become homeless. They write: "The chronically and severely mentally ill are not proficient at coping with the stresses of this world. Therefore, they are vulnerable to eviction from their living arrangements, sometimes because of an inability to deal with difficult or even ordinary landlord-tenant situations and sometimes because of circumstances in which they play a leading role. In the absence of an adequate case management system, they are out on the streets and on their own." They go on to say that, "Many, especially the young, have a tendency to drift away from their families or from a board and care home; they may be trying to escape the pull of dependency and may not be ready to come to terms with living in a sheltered, low-pressured environment. If they still have goals, they may find an inactive life-style extremely depressing. Or they may want freedom to drink or to use drugs. Some may regard leaving their comparatively static milieu as a necessary part of the process of realizing their goals, but this is a process that exacts its price in the terms of homelessness, crises, decompensation, and hospitalizations. Once the mentally ill are out on their own, they will more than likely stop taking their medications and after a while will lose touch with the Social Security Administration and will no longer be able to receive their Supplemental Security Income checks. Their poor judgment and state of disarray associated with their illness may cause them to fail to notify the Security Administration of a change of address or to fail to appear for a redetermination hearing. Their lack of medical care on the streets and the effects of alcohol and other drug abuse are further serious complications. They may now be too disorganized to extricate themselves from living on the streets -- except by exhibiting blatantly bizarre or disruptive behavior that leads them to their being taken to a hospital or jail." Over the years, I have seen former mental health clients go from the mental health system to the criminal justice system because they have stopped taking their medication. Often their behavior is controlled while they are medicated but some become unmanageable without their prescriptions. I witnessed many such individuals "directing traffic" on Sixth Street and getting violent with anyone they meet, including the Harrisburg Police Department. The latter types of activities almost always results in some type of detainment or incarceration. Recently, I saw a client running up and down the porch waving his arms like he was an eagle flying through the air. He stopped in front of me, and at that point I asked him, "How are you doing?" His reply was "I have a master's degree in masturbation." Later the same day I was walking down the soupline hall and heard a very loud conversation. When I got to the end of the hallway I saw the source of the "conversation." It was a white male, about age forty who was having a two-way discussion with himself. I could not determine the nature of his "talk." Later, this same man told our director of social services that he has spoken with the FBI to tell them that "he is not getting his fair share of oxygen in the world." I could cite many examples of this type of behavior. There has been an increase in the number of mentally ill clients. On the day I saw the two men mentioned above, I asked our directors of social services and men's ministries about the number of men in the Mission with that level of mental health problem. Their answer was about ten. A major factor in the increase of the mentally ill homeless is the deinstitutionalization of the mentally ill in state hospitals. E. Fuller Torrey, M.D. states in his book, "Nowhere to Go -- The Tragic Odyssey of the Homeless Mentally Ill" that "A study from Ohio published in 1988 showed that 36% of patients discharged from state mental hospitals had become homeless within six months." Additionally, he points out that the number of patients in Public Mental Health Hospitals dropped from a high of 552,150 in 1955 to 118,743 in 1984. Conventional wisdom seems to point to the lack of supervised group housing units and outpatient support services as the reason for the high number becoming homeless. I am aware of individuals who were released from the State Hospital at Cameron and MaClay Streets who traveled directly to our men's shelter. Often, they have difficulty functioning in our less-structured living conditions without considerable "hand holding" that requires a lot of staff time and emotional energy. Also, a problem is the fact that mentally ill inmates are often released from prison without a supply of their medications and without any referrals or support systems. They are released from a highly structured environment where all aspects of their daily routine are controlled to the "free world," where they have to make all the decisions. Many have a difficult time coping and end up at a shelter. The mental health problem for homeless females is greater than for homeless males. Jennifer Burroughs in "Under the Safety Net" writes, "Single women are more likely to be mentally ill than single homeless men" and Burt and Cohen in "America's Homeless" adds "...homeless women...are five times more likely than women in the general population to be suicidal and severely depressed." Mental retardation is also a small problem among the homeless. Fisher and Breakey in
"Findings from the Baltimore Homeless Study" report that the rate of mental
retardation among the homeless may be as much as two or three times greater than the
population as a whole. However, mental retardation services in central PA are easily
assessable and placement in group homes are less of a problem than for our mental health
clients. SUBSTANCE ABUSEAnother issue that plays a major role in homelessness is substance abuse. Estimates range from 40% to 80% of the homeless who have a drug and/or alcohol problem. I personally believe the 70% number is about right for the clients at our shelters. This is based upon the number enrolled in our Helmsman and Pre-Helmsman programs and the personal observations of staff. A quick sort of our men's shelter data base indicates that only 28% of our clients admit they have a substance abuse problem during the intake process. This is less than half of the actual total. The reason for this is their "denial" of a problem. A simple definition of denial is "the inability to recognize a problem in the face of compelling evidence." Many homeless persons will not admit their substance abuse is causing a problem in their life, even if it caused their divorce, was the reason they lost their last few jobs, or kept them from seeing and supporting their children for years. The drugs of "choice" at our shelters are alcohol and cocaine ( usually in the form of crack). The next most popular drugs are marijuana and heroin. The Helmsman staff have reported to me that they are seeing a decrease in the use of injectable forms of drugs because of HIV awareness and an increase in power of street heroin, which can now be inhaled. The number of our clients with a substance abuse problem is increasing. We have found crack cocaine vials on the steps leading into the men's shelter and in the laundry room. Additionally, several clients have told me that drugs are both used and sold on our premises. The authors of "A Nation in Denial -- The Truth About Homelessness" write, "crack addiction has become epidemic among homeless mothers, with some reports indicating that majority of all sheltered mothers have crack addiction problems" and "the advent of crack has been devastating and is intimately related to the increase in homelessness, especially family homelessness. Crack cocaine is perhaps the most invidious of all illegal drugs-it is cheap; it is readily available; its effects are almost instantaneous; it does not require the use of needles, making it more attractive to women...and it is one of the most addicting drugs ever observed by medical researchers. Crack addicts, give up work, family, and financial responsibility to spend time feeding their addiction, and addicts and their families are joining the ranks of homeless people in increasing numbers." I am aware of local women who tried to sell their children to get more crack! It is that powerful. They go on to report, "studies have reported that close to 100 percent of homeless youth use or abuse drugs and that drug use starts, in some cases, as early as age eleven. As in society at large, drug use is a phenomenon related to age: Homeless people over the age of forty tend to use alcohol, while homeless people under the age of forty tend to use both drugs and alcohol." A negative consequence of homeless persons who start using drugs at a young age is a general lack of maturity. In simplistic terms a person beginning regular frequent alcohol/drug usage at age 15 and, somehow stopping at age 30 will be found to have 15 year old value systems, views of relationships, emotions, goals, and self concept. All, of course, distorted by regular ingestion of a mood and mind altering chemical. There are two main reasons why homeless persons(and housed persons) fall into substance abuse. Richard L. Gorsuch of the Fuller Theological Seminary Graduate School of Psychology wrote in the Religious Aspects of Substance Abuse and Recovery", "In brief, two major pathways into initial substance abuse have been identified and empirically supported. The first path is taken by a person unsocialized into any value system that would discourage substance abuse; therefore, when such people have an opportunity to try a substance they do. The second path is followed by those who are socialized by a pro-drug subculture -- such as a family in which a tranquilizer is taken whenever one is upset, alcohol is used to "relax after a hard day's work," and aspirin is immediately taken whenever one is not feeling well." He goes on to report that "...seventh grade coffee drinkers were twice as likely to abuse a substance than non-coffee drinkers." Mr. Gorsuch also reported in his paper that many studies indicate that persons who
belong to religious groups have lower levels of substance abusers than those found in the
nonreligious population. I believe that our clients general lack of formal tries to
religious groups is a factor in their high level of substance abuse. DUAL DIAGNOSESI believe our most difficult client to help is the "dual diagnosed" person.
These are individuals who are mentally ill and abuse drugs or alcohol. They generally have
more family conflicts, high rates of incarceration, less contact with their friends, and
have burned many bridges with social service agencies. Additionally, they have problems
maintaining simple daily routines, managing their money, and keeping appointments which
could provide much-needed assistance. Generally speaking, they are in a constant state of
"crisis." Fred C. Osher in "Assessing Dual Diagnosis", reports,
"40% to 50% of the homeless mentally ill suffer from alcoholism or drug addiction or
both or use alcohol or drugs to self-medicate their psychiatric symptoms." It should
be noted that these persons have the highest recidivism rates of homelessness. In fact,
some of our clients have been coming to our men's shelter two or three times a year for
over a decade. SPIRITUAL CONDITIONThe spiritual condition of homeless persons is very difficult to analyze. I was not able to find even one survey or study that addressed it. Many of my comments on spiritual matters were based solely on personal observations of myself and the Mission staff. I believe that most of our older clients, say age 50 and up, had some church involvement at some point in their lives. Often it was many years ago when they were children. However, many of our younger clients have never or rarely darkened the door of a church, temple or synagogue. My best guess is that 10 to 40 percent of our clients are born-again Christians at the time of check-in. This verifies our need to maintain a very strong evangelism effort to reach the large number who are lost. However, it is impossible to provide a more precise number because many of our clients will say the "prayer of salvation" if they feel it will improve their status at the Mission. Also, for that same reason, it is common for some homeless persons to "accept Christ" at every shelter they visit. It is very rare to see a Jewish person at our shelters. In the last several years, only three persons said they were Jewish. This is out of a data base of 1,700 records. I think the reason for the small number is the strong family structure and excellent social service network in the Jewish community. Plus, the fact that it is not culturally acceptable for a Jewish person to be homeless. We do see a few Muslims at our men's shelter. Most are black. Out of 1,707 persons 14 were black Muslims and one was an Indian Muslim. I expect to see the number of black Muslims increase in the future because of the religion's fast growth in that community. Mormons are almost non-existent at our shelters. We only had one in recent years. Probably for the same reasons that I outlined in the Jewish paragraph. When a person checks in we ask them what their religion is. The categories we use are: Protestant, Catholic, Other or None. The information we gather is of little value since many clients do not even know what a Protestant is. Some will say, "they are a Methodist but not a Protestant." Also, many just make something up at the "spur of the moment." Many of our clients have been to other shelters and know how to play the
"religion" game. They know from past experience that they can stay longer if
they say religious words and sit in the Rev.'s Bible class. Because of this game playing,
it is difficult to tell who is sincere. VETERANSA significant minority of our adult male clients are veterans. Our men's shelter data base indicates that 24% of our clients are veterans. A check of our women's shelter files showed we had one women veteran in the last five years. The national percentage for homeless persons is about 33% for men and 7% for women. I cannot explain our very low women's shelter number. Generally, homeless veterans are older, better educated and have a higher occurrence of
substance abuse problems (80%+) than the average homeless person. Most are single men. EMPLOYMENTThe past employment record of our clients is at best dismal. According, to the previously mentioned local shelter study, most of our clients have not worked for pay in the last three years. As bad as that number is -- it gets even worse. Because, for clients that ever held a job for six months, on average, the last occurrence was about five years ago. There are many barriers to our clients in regard to their obtaining employment. A few
of them include: the lack of basic life skills and/or education, clothes/hygiene problems,
mental health issues, substance abuse problems, no transportation, poor conflict
resolution skills, employer prejudice against homeless persons and rehabilitated
ex-convicts, child care, mobile lifestyle, poor communication skills, and lack of work
experience. EDUCATIONAs far as educational attainment, 66% of our men's and women's shelter clients are high
school graduates. This compares unfavorably with the 79.1 of the general population in
Dauphin and Cumberland Counties, but is close to the 67.2% of the general population of
The City of Harrisburg. INCARCERATIONOne of the most staggering statistics concerning our clients is their incarceration history. About 21.9% of local shelter females have been in jail or prison on an average of 2.1 occasions. The men's history is even worse. According to the local shelter survey, 76.6% of local shelter men have been incarceration on an average of 6.8 occasions. Author Peter Rossi points out , "the homeless and the criminal justice system have always had frequent contact...clearly the homeless have much higher conviction rates for felonies and minor crimes than the general adult population." My guess is that, once again, mental health and substance abuse are major factors. HEALTHThe health of our clients is poorer than the general population. The National Coalition on Homelessness says homeless persons, both adults and children, suffer from chronic health problems twice as often as housed persons. One reason for this is the fact health care is not a priority for them. Many will only seek medical attention if a problem is causing them pain or impairs their mobility. Some of the mentally ill will not see a doctor because many health care environments are not "user friendly" for special needs clients. Another issue is, that many mentally ill homeless will not keep appointments even if they are reminded of them. As a result, a number of our male clients have not seen a doctor for years. This is less of a problem for our female clients because most have become connected to the health care system during the birth of their children. The two biggest health issues are the AIDS virus and TB. According to the National Commission on AIDS, 15% of the people living on the street are infected with the AIDS virus. That is a national figure. However, I would not be surprised if our numbers are higher because of the large numbers of substance abusers and gays in Harrisburg. Most City of Harrisburg statistics that I have read seem to mirror big-cities like New York or Philadelphia rather than small city numbers. The Center for Disease Control reports 2% to 7% of shelter residents have clinically active TB and 12% to 50% have latent TB infections. Many suffer with both conditions. A depressing health issue is the short life-span of homeless persons. They have mortality rates 3.1 times higher than the general population and die some twenty years earlier on average than the rest of us. The authors of the report "Health Care for The Homeless" write' "alcohol is the direct cause of death in at least 16% of the case reviewed(homeless deaths), and a contributory factor in perhaps half of them." They add, "drug use among the homeless leads directly to serious health problems, especially those associated with intravenous drug use and the sharing of needles. Skin lesions and skin ulcers, hepatitis, sexual transmitted diseases, and other infectious diseases are common..." An indirect health problem among homeless persons, especially substance abusers, females, older men, and weak adult males is the physical or sexual injuries they acquire while on the streets. I do not have concrete numbers on the frequency, but we do see clients from time to time who have been attacked, raped or "rolled" while living on the streets. A lesser, but still serious problem is the lack of dental care. I am aware of only two dentists in Harrisburg which accept medical cards as payment. Peter Rossi points out how homelessness itself and poor health are directly related; He
writes --"There is undoubtedly a reciprocal relation between physical illness and
becoming or being homeless. Severe illness and its aftermath may seriously impair earning
capacity, pushing some people into the very low income classes and thus making them
vulnerable to homelessness. Also, the conditions of homelessness are at best minimally
healthful and more usually undermine good health. Those who live on the streets are
subject to the vicissitudes of climate, substandard sanitation, uncertain nutrition, poor
access to health care, and numerous other illness-producing conditions. Those using
shelters may be better off in many respects, but dormitory conditions make transmission of
disease easy, and facilities for self-medication or access to health care are far from
optimal." OTHER FACTORSIn reviewing the history of homelessness of our clients I found a minor surprise. The number of clients that are from the local area has increased. The local shelter survey reported that almost 60% of shelter clients in our area said their last permanent address was in Dauphin or Cumberland Counties. This is higher than the 50% we found in an informal survey taken at our men's shelter ten years ago. However, this is still lower than the national average of 70%. Some other interesting local numbers include: 31.5% said they were homeless at least half the time in the last two years, 11% said they lived in Philadelphia in the last two years, 10.1% said they left their last address because of drug/alcohol abuse and 15% reported losing their last residence because of interpersonal conflict. There are a small group of individuals who are homeless because of a single problematic event in their life like, a loss of a job, a fire in the home or a medical crisis. This group are usually homeless for a very short period of time. Generally they are not interested in long-term recovery programs. Many times they feel they do not need them. Their stay at our shelter may range from seven days to a month. The race of homeless clients was not a surprise. Our shelter percentages were very close to the national statistics... 50% of the homeless are black and appoximately 40% are white with 5% to 10% Hispanic. People of color make up a disproportionate percentage of the homeless. In reviewing the gender and age, I found about half the homeless are men and unaccompanied women account for about 12%. The average age is 33 for shelter females and 42 for men. I predict the average age will drop another four or five years over the next decade because of the crime, substance abuse, and educational/supervision problems we are now seeing with inter-city youth. The marital stats seem to indicate a profound inability to develop and maintain long term relationships. The numbers show that over 50% of homeless adults never married and only 6.4% considered themselves married. The rest considered themselves widowed, separated or divorced. I suspect this poor showing is a result of their mental illness, substance abuse and mobile life style. I was not successful in finding documented information concerning homeless persons
sexual orientation. However, my best guess is that 5% to 15% of our clients are either gay
or bi-sexual. My estimate is based upon the "elephant" method of research. That
is... if it has a tail, big ears, and a trunk then it must be an elephant, i.e. gay. The
5% to 15% ballpark rate is much higher than the general population. The best, recent study
on the general population was conducted by The Battelle Human Affairs Research Centers in
Seattle. Their findings indicate that only 2.3% of men reported any homosexual activity in
the last decade, and only 1.1% said they had exclusively homosexual relations. DISINTEGRATION OF THE FAMILYThe homeless family situation is very alarming. The Homes for the Homeless organization reported that the typical homeless family is a 20 year old mother with children under the age of six and only 15% of the families lived independently before becoming homeless. Additionally , they reported that 22% of homeless mothers grew up in foster care, 22% reported living in shelters as a children, and 50% return to shelters in less than a year after they have left. A 1991 report by the Multnomah County Youth Program Office states, "Teen parents most at risk of homelessness come from families of severe dysfunction. They share with their own parents histories of substance abuse, criminal involvement, unemployment, health and mental health problems, multiple domestic partners, domestic violence, overcrowded living quarters, and emotional/physical/sexual abuse." Alice Bum and Donald Burns shed some light on the multigenerational nature of homelessness, they write, "Research confirms that multigenerational domestic violence is a primary characteristic of homeless families; parents who have suffered abuse during their own childhood's trend to repeat familiar parenting styles, thus perpetuating the cycle of substance abuse and physical violence that often leads to homelessness." The typical homeless mother has probably never been married, has an incomplete education, and has never been employed. These factors seem to indicate a general lack of family stability among our women's shelter clients. One "family" trend that appears to be increasing is the number of men who use
our shelter as a place to "crash" immediately after they have a fight with their
girlfriend or wife. Many times they show no interest in dealing with their problems and
will only stay a short time. Most often, only until they have "patched things
up" with their partner. I am becoming convinced that we may be doing these
individuals a disservice by allowing them to repeatedly use our shelter in this fashion.
It could be argued that we are enabling their dysfunctional behavior. CONCLUDING REMARKSAfter reviewing the research, it appears to me that the four problems which are most directly connected with the homeless are; mental illness, substance abuse, the need for the Gospel of Christ and the lack of special needs housing. I believe the demand for our services would be much smaller if there were more supervised, group homes for the mentally ill, recently released inmates and substance abusers. Frequently, it is portrayed in the media that our clients are homeless, for most part, because of economic reasons such as the lack of jobs or low income housing. I believe this position is promoted by well-intention homeless activists who are either blind to the true facts or make a conscious decision to ignore reality because they feel it would be hard to garner support for the homeless based on the truth. The truth being, that the homeless are, for the most part, dysfunctional persons with a lot of problems. Another big problem, according to the authors of "A Nation in Denial -- The Truth About Homelessness" is that "Homeless people...lack social support systems, often because they have used them up by making too many demands on them or because their emotional problems make them fearful of close contact and enduring relationships with others." Our director of social services agrees that many of our men's shelter clients have "burned bridges" with social services agencies in our area that could provide them with assistance because of their anti-social behavior. Some issues which play a lesser role include: a generally lower education level, a poor employment record, marital instability, criminal behavior and for a few -- poor health. One local development that is starting to have an impact is the fact that managers of low-income housing projects are developing a zero tolerance for drugs and violence. It is my understanding that they are now evicting after just one offense. This is quite a change from their past history of ignoring these problems altogether. I expect many of these displaced, problematic persons will end up at our doorsteps. Additional conclusions are: 1) our clients have major problems unrelated to economic issues that cause and maintain their homeless condition and if left without help, will get progressively worst 2) the rehabilitation of our clients takes a long-term program with a heavy emphasis on Christian salvation and faith, practical life-skills training, substance abuse therapy, mental health counseling and educational/vocational training. and 3) our program graduates need some type of support program for a six month to one year period once they leave our shelters. One thing that complicates the recovery process for our clients is their denial of a problem. Often, they will not admit to having a crisis in their life even though their best thinking and actions caused them to wind up homeless in a rescue mission. Many times they will try to join the kitchen staff, laundry crews or New Life class in order to avoid dealing with their problems. The proposed reduced government funding for programs like Aid to Families with Dependent Children and non-profit organizations in general will have some impact on the homeless. Which are, generally speaking, our clients. I believe the affect of these changes will require us to increase our services in a few areas including our medical clinic and social service departments. Homelessness is a very complicated problem. It may appear after reading my report that homeless persons are all in neat, definable categories, i.e. this one is a substance abuse client or that one is a mental health client. Unfortunately, it is much more complicated. Many of our clients fit into several categories at the same time. For example, it is very common to have a unsaved client, who lacks a high school diploma , who is HIV positive, and has both mental health and substance abuse problems. And on top of all that, he may have not had a job in the last five years. This makes programming very difficult. Fortunately, the grace of our Lord and Savior Jesus Christ gives any of our clients, even the dual diagnosed, a reason for hope and the possibility of a full recovery. The facts show that a typical client of Bethesda Mission is, a local, previously incarcerated, black or white male in his mid to upper thirties, who has a substance abuse and/or mental health problem, who has been homeless for several months and unemployed for a few years, is in declining health, and is often not involved with his family, friends or a church. The general homeless trends I expect to see in the future are:
PROGRAMMING IMPLICATIONSThe information provided in this paper paints an admittedly pessimistic, yet realistic, picture. Any serious inquiry into the nature of homelessness reveals that there are no simple cause and effect relationships, no neat solutions. We can't make much of a dent in the homeless problem just by securing employment for our guests; it won't help much to just help the individual secure housing, to get a GED certificate, to defeat an addiction or even to get "saved". If I can leave the reader with but one insight about the nature of homelessness it would be that the dysfunction's of our clients are complex and chronic. Once recognized, this truth has profound implications for the design of effective shelter programming. Some of the queries which demand a response as we proceed with the strategic planning process include:
Report StatisticsMental HealthSummary: The homeless have a 33% to 40% rate of major mental illness, appoximately 20% have attempted suicide and 5.5% are psychotic. According to H. Richard Lamb, MD and John A. Talbot, MD in their July 25, 1986 JAMA article, "The Homeless Mentally Ill -- The Perspective of the American Psychiatric Association" at least 40% of the homeless have a major mental illness. They state in their article -- "The most methodologically sound studies performed thus far indicate that among the total population of homeless persons, there is a prevalence of about 40% with major mental illness(that is, schizophrenia and major affective disorder).' Another source, E. Fuller Torrey, M.D. states in his book, "Nowhere to Go -- The Tragic Odyssey of the Homeless Mentally Ill" that "A study from Ohio published in 1988 showed that 36% of patients discharged from state mental hospitals had become homeless within six months." Additionally, he points out that the number of patients in Public Mental Health Hospitals dropped from a high of 552,150 in 1955 to 118,743 in 1984. Peter H. Rossi, in his book "Down And Out In America -- The Origins of Homelessness" writes: "Averaged over ...twenty-five (different) homeless studies...about one in four of the homeless had been in a mental hospital at least once" and of that number "60% had hospitalized more than once and 30% had experienced four or more hospitalizations." Also, from the same book Mr. Rossi refers to a Chicago Homeless Study conducted in the winter of 1986 which reported that 11% of the homeless had suicidal thoughts in the past several weeks and that 16% reported actual attempts to take their own lives. According to The National Coalition for the Homeless' home page on the World Wide Web: * Homeless people are 38 times more likely to have a diagnosis of schizophrenia, 5 times more likely to be diagnosed as having a major depressive disorder, and three times more likely to have a primary diagnosis of alcoholism than a general population sample. * Mentally ill homeless people are more likely to be homeless for longer periods of time, have less contact with family and friends, have more barriers to employment, be in poorer physical health and have more contact with the legal system, than homeless people who do not suffer from mental illness. * According to the National Resource Center on Homelessness and Mental Illness(1992), at least 50 of the mentally ill homeless people are dually diagnosed with an alcohol or drug problem. The report "The 1992 Survey of Mental Illness, Substance Abuse, AIDS, and other Disabilities Among the Shelter Homeless of Dauphin and Cumberland Counties." provides the following local homeless mental health information. * 63.5% met the criterion for an episode of a major affective disorder sometime in their lifetime. This is well above the estimated 7.8% rate of the general population. * 30.3% of the total sample reported a suicide attempt, with a mean frequency of 2.3 attempts. * 30.3% gave a history of hospitalization for their "nerves" or emotional problems. * 5.5% met the criterion for psychotic thinking over the past year. This is much higher than the estimated 1.0% of the general population who experience a schizophrenic disorder over a year. * 25.9% of the sample had taken medication for their "nerves," and, of these, 64.9 % took such medication in the past 12 months. Ellen Bassuk, a psychiatric researcher at Harvard University Medical School was quoted in the June, 1991 issue of Readers Digest in an article called "Myths About The Homeless." She said -- "More than a third (of the homeless) suffer from chronic mental illness, including schizophrenia and severe personality disorder." 49% of the users of shelters and soup kitchens in cities(100,000+) needed immediate
treatment for psychological distress and 19% had attempted suicide. Substance AbuseSummary: 60 to 70% of the homeless have a substance abuse problem. Alcohol and crack are the most popular drugs. The report "The 1992 Survey of Mental Illness, Substance Abuse, AIDS, and other Disabilities Among the Shelter Homeless of Dauphin and Cumberland Counties." provides the following local homeless substance abuse information. * 46.8% met the criterion for an episode of alcohol abuse or dependence sometime in their lifetime. This is considerably higher than the estimated 13.8% of the general population. * 44.2% met the criterion for an episode of drug abuse or dependence sometime in their lifetime. This is considerable higher than the estimated 6.2% of the general population. * 59.6% met the criterion for alcohol and/or drug abuse or dependence. "Substance
abuse is a major problem among homeless veterans. National data collected... establish
rates of substance abuse of 80% and higher." The National Coalition for the Homeless' own study and review of 21 other literature produced the following findings. * It is estimated that 50% of all homeless "single" adults have a drug or alcohol problem. * Longs waits for alcohol and drug treatment for the poor continue to be a serious problem. The traditional treatment system often fails to meet the special needs of homeless persons. 80% of local treatment programs surveyed by NCH were forced to turn away homeless people seeking help. * Homeless persons with substance abuse problems are at higher risk for HIV infection and are more likely to have serious health problems and severe mental illness, to be arrested, to be victimized on the streets and to suffer an early death. According to the International Union of Gospel Mission s' Fall 1992 Survey 40% of shelter residents were drug abusers. Our own client data base indicates that only 28% of our clients reported a substance abuse problem on their own. Finding of a 1992 report by the New York City Commission of the Homeless include: * 80% of men in barracks-style shelters tested positive for drugs, mostly cocaine. * 29% of the residents in family shelters tested positive for drugs. * The rate of drug use among homeless female heads of families is four times greater than among housed poor mothers. Veteran StatusSummary: 25% to 33% of our male and less than 1% of our female clients are veterans. "Homeless veterans tend to be older and more educated than homeless
non-veterans." According to the International Union of Gospel Mission s' Fall 1995 Survey 33% of male shelter and 7% of female shelter residents are veterans. "Overall, over a third of the adult homeless population has served their country
in the armed services. Many other veterans are considered at risk because of their
poverty, lack of support from the family and friends, and precarious living
conditions." The results of an Urban Institute study in 1988 concluded that about 40% of homeless men were veterans. Substance abuse is a major problem among homeless veterans. National data collected...
establish rates of substance abuse of 80% and higher." "Increasingly veterans with a substance abuse problem tend to abuse more than one substance. Analyses of age cohorts show that substance abusing veterans in the age ranges from 30 to 50 (the most common range for homeless veterans) abuse, on the average two or three different substances." -- Richard A. McCormick, Ph.D., Cleveland VA Medical Center. According to The National Coalition for the Homeless' home page on the World Wide Web: * Appoximately one-third of single men who are homeless have served in the United States armed forces. * The vast majority of homeless veterans are single men, although an estimated 10% are homeless with families. Women comprise less than 2% of those using federal services specifically designed for homeless veterans, * Over 80% of veterans who are homeless are high school graduates, and one-third have attended or graduated from college. * Approximately 40-60% of veterans who are homeless served in the military during the Vietnam War. An estimated 20-40% served post-Vietnam, and the reminder served during the Korean War, World War Two, and periods in between. Veterans of the Gulf War have also become homeless. According to our Men's Shelter data base 24% of our male clients are veterans. A search of our Women's Shelter data indicated that less than 1% of our female clients are veterans. Spiritual ConditionSummary: Most of our clients do not know Christ as their Lord at admission. Health InformationSummary: The homeless are in much poorer health than the general population. Their life span is about 20 years shorter than the general population. Up to 50% of all HIV positive individuals are either homeless or about to become so and
at least 15% of the people living on the streets are infected with the HIV virus. "...homeless people both adults and children -- suffer from at least one chronic
health problem almost twice as often as housed persons." 13% of homeless patients surveyed in a national study in the 1980's stated poor health
was a factor in their becoming homeless. The report "The 1992 Survey of Shelter Homeless of Dauphin and Cumberland Counties." provides the following local homeless health information: * 38.6% of the sample described their current health as "fair" or "poor." This compares unfavorably to a national sample of the adult United States population in 1982 which lists the general population number at 18% (Robert Wood Johnson Foundation Special Report 1- 1983). * 33.9% said they have a disease, injury, or disability that restricts their daily life or makes their daily life difficult. * 43.2% of those with a disability (or 14.7%) of the total sample) said their disability caused them to be homeless. * Of those who said a disability caused them to become homeless, the most common cause reported was losing or being unable to get a job because of the disability. No respondents said a disability made them unable to maintain their apartment or access their apartment building. 56% of the users of shelters and soup kitchens in cities(100,000+) had at least one
health problem and 26% had two or more health problems. CDC's Advisory Committee for the Elimination of Tuberculosis provides the follow homeless tuberculosis statistics from "A Strategic Plan for the Elimination of Tuberculosis in the United States." * 2 to 7% of shelter residents have clinically active TB. * 12 to 50% of shelter residents have latent TB infections. "Homeless people die some twenty years earlier on average than the rest of
us" Employment InformationSummary: Most of the homeless have not had a steady job in three to five years. 18% of today's homeless population work - (1993 report by US Conference of Mayors) The "Chicago Homeless Study" in 1986 reported the following: * 3% of the homeless currently had a steady job. * 31.5% of the homeless currently had temporary job(s). * When the homeless were asked when was the last time they held a steady job for more than 3 months -- the average time elapsing was 4.5 years. * 22% have been without a full-time job for more than 10 years. The report "The 1992 Survey of Shelter Homeless of Dauphin and Cumberland Counties." provides the following local homeless employment information: * On average, 2.9 years had elapsed since the respondent's' last work for pay. * For those individuals that ever held a job for 6 months, it was on average 4.9 years ago when it last occurred. Results of the International Union of Gospel Mission 1995 Fall Survey produced the following information: * 51% of AGRM shelter residents were unemployed for over 6 months. * 48% were looking for work. * 51% would like job training. 90% of the users of shelters and soup kitchens in cities(100,000+) had not a steady job within 3 months and 33% has not had one for over 4 years. -- Urban Institute Study in 1987 A search of our Men's Shelter data base of 1664 admissions indicates that only 24% of our clients leave our men's shelter with some type of employment. EducationSummary: The homeless have a slightly lower level of educational attainment than the general population. The report "The 1992 Survey of Shelter Homeless of Dauphin and Cumberland Counties." and a search of our Men's Shelter data base(1664 records) provides the following local homeless education information: Local Shelter Survey Bethesda Men's Shelter 1.9% completed grades 0 to 7. 5% completed grades 0 to 7. 38.0% completed grades 8 to 11. 28% completed grades 8 to 11. 36.1% are high school graduates or GED. 52% are high schools grad. or GED 13.0% have some college or post high education 14% have some form of post high without a college degree. school education. 9.3% have an Associate's or Bachelor's degree. 1.9% are college graduates with post-graduate or professional training. The 60.3% and 66% of the above local homeless who were high school graduates compares disfavorably with the 79.1 of the general population in Dauphin and Cumberland Counties, but is close to the 67.2% of the general population of The City of Harrisburg. "The proportion of homeless adults with high school diplomas is about 45 to 50 percent. The National Academy of Sciences cited 45 percent as the overall average..." -- "The Visible Poor - Homelessness in the United States", Joel Blau "The most recent reports of states to the Congress and the Department of Education cited that 18% of homeless students were not attending school." -- The National Coalition for the Homeless 48% of the users of shelters and soup kitchens in cities(100,000+) had not graduated from high school. -- Urban Institute Study in 1987 History of HomelessnessSummary: About half of our clients have been homeless for more than a year and most are from the local community. "Overall, rescue missions are also becoming increasingly population by residents
of the local community. (AGRM survey)...indicates that 71% of the homeless have been
residents for than six months in the city where they receive service, a rise from 67% in
1994. 64% of those questioned say they have no plans to move to another city, up from 61%
last year." 46% of the homeless at AGRM member shelters have been so for more than a year. "Nationally, 76 percent of the sheltered population have lived more than one year
in the area where the facility was located." The report The 1992 Survey of Shelter Homeless of Dauphin and Cumberland Counties provides the following local history of homeless information:
GenderSummary: Half the homeless are men and unaccompanied women account for 12%. "Single men make up slightly more than half - 51 percent - of the total homeless
population. While unaccompanied women account for only 12 percent..." The "Chicago Homeless Study" in 1986 reported that 75.5% of the homeless in Chicago were male and 24.% were female. AgeSummary: The average age for the adult homeless is the mid to upper thirties.
"Most studies place the average age of the adult homeless at about thirty-five
years old...and the general tendency (is) for homeless women to be somewhat younger."
Results of the International Union of Gospel Mission 1995 Fall Survey and a search of our Men's Shelter data base(1664 records) produced the following age information on sheltered persons: Bethesda AGRM Survey Men's Shelter 8% are under age 18 0% are under age 18 17% are 18 to 25 10% are 18 to 25 25% are 26 to 35 33% are 26 to 35 23% are 36 to 45 34% are 36 to 45 21% are 46 to 65 21% are 46 to 65 6% are 65 plus 2% are 65 plus RaceSummary: 50% of the homeless are black and appoximately 40% are white with 5% to 10% Hispanic. People of color make up a disproportionate percentage of the homeless. Results of the International Union of Gospel Mission 1995 Fall Survey , The 1992 Survey of Shelter Homeless of Dauphin and Cumberland Counties and a search of our Men's Shelter data base(1664 records) produced the following race information on sheltered persons: Bethesda AGRM Survey Local Shelter Survey Men's Shelter 51% are Black 48.1% are Black 52% are Black 35% are White 43.5 are White 38% are White 11% are Hispanic 4.6% are Hispanic 9% are Hispanic 1% are Asian 1.9% are Asian 1% are Asian, NA or other 2% are Native American 2.8% are Native American FamiliesSummary: Families make up 34% of the homeless population in shelters. Nationally, families make up 34% of the homeless population in shelters. The Homes for the Homeless report entitled "The Creation of Poverty Nomads" provided the following information regarding families and homelessness.
Marital StatusSummary: The homeless have trouble staying married. The report The 1992 Survey of Shelter Homeless of Dauphin and Cumberland Counties provides the following local homeless marital status information:
Incarceration HistorySummary: Most homeless men and many local homeless women have spent time in jail or prison on multiple occasions. "The homeless and the criminal justice system have always had frequent contact...Clearly the homeless have much higher conviction rates for felonies and minor crimes than the general adult population..." -- Peter H. Rossi, "Down And Out in America - The Origins of Homelessness" Chicago Homeless Study in 198716.5% served sentence in state or federal prison. 40.6% served sentence in city or county jail. 28.3% were given probation by a court. The report The 1992 Survey of Shelter Homeless of Dauphin and Cumberland Counties provides the following local homeless incarceration information: * 21.9% of local shelter women have been in jail or prison with an average of 2.1 occasions. * 76.6% of local shelter men have been in jail or prison with an average of 6.8 occasions. Combined Summary StatementsMental Health -- The homeless have a 33% to 40% rate of major mental illness, appoximately 20% have attempted suicide and 5.5% are psychotic. Substance Abuse -- 60 to 70% of the homeless have a substance abuse problem. Alcohol and crack are the most popular drugs. Spiritual Condition -- Most of our clients do not know Christ as their Lord at admission. Veteran Status -- 25 to 33% of our male and less than 1% of our female shelter residents are veterans. Health Information -- The homeless are in much poorer health than the general population. Their life span is about 20 years shorter than the general population. Employment Information -- Most of the homeless have not had a steady job in three to five years. Education -- The homeless have a slightly lower level of educational attainment than the general population. History of Homelessness -- About half of our clients have been homeless for more than a year and most are from the local community. Gender -- Half the homeless are men and unaccompanied women account for 12%. Age -- The average age for homeless adults is the mid to upper thirties. Race -- 50% of the homeless are black and appoximately 40% are white with 5% to 10% Hispanic. People of color make up a disproportionate percentage of the homeless. Families -- Homeless families are dysfunctional in just about every way. Marital Status -- The homeless have trouble staying married. Incarceration History -- Most local homeless men and many local homeless women have spent time in jail or prison on multiple occasions. Sexual Orientation -- The homeless are more likely to be bi-sexual or gay than the general population.
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