Saturday, October 17, 2009

Meet The Homeless

As most of you know, I am a Registered Nurse and work in an inner city Emergency Room. We are located in the good part of town. Our locals are the homeless, prostitutes, and other fine people.

This is not to say that all of the people we see are like this, some are regular, everyday, average folks.

It is further not true that someone that is homeless is automatically a bad person. There is a pervasive and hard to shake misperception of what the homeless population is like. Granted, some are dirtbags. Many have substance abuse problems that they have largely brought upon themselves.

Anybody reading this knows I am not a bleeding heart liberal. Further realize that I believe a lot of these people are where they are because of choices they have made in life.

There is a large portion of these people though that are mentally ill. These people genuinely do not choose to be where they are. They are a failure of the mental health system. I will not go into detail about this because it is not what the post is about but just realize that our mental health system seems to spend most of it's time enabling people who do not really need help and ignore the people who do. It's a f'ed up system.

Like I said above, a lot of them are dirtbags. We have them pee on the floor, pee in the sinks, try to kick, punch, bite, and spit on us. All the while spewing the most vile hatred at us that one can imagine.

At the same time, some are basically decent people who through their mental illness cannot function in life. It is hard for most of us to understand how bad mental illness can be. It's easy to sit in our comfortable life and pass judgement on these people. There are few of you though that can understand how debilitating something like schizophrenia, or bipolar, or psychosis can be. We cannot understand how someone can't do things as basic as remember to take their medications, or remember to eat, or bathe themselves.

Many have substance abuse problems which we sneer at, it's clearly the reason they are where they are. Sometimes this is true. Sometimes though, alcohol or drugs are self-medication.

We cannot imagine what it is like to hear voices in our head. Voices telling us we are worthless, telling us to harm ourselves, voices telling us the people that are trying to help us are actually trying to harm us. These are not metaphorical voices, they are as real to them as the voices you hear when someone is talking to you. They actually hear them, constantly. The alcohol is a way to shut the voices up for awhile.

"Why don't they just take their medications?" Why? Because the voices are telling them it is poison. It is often a seesaw. If we can keep them on their medications, they don't hear the voices. If they stop for some reason, the voices return and they spiral down.

Finally, realize that a lot of these men are veterans that are not getting the help they need from our federal government.

I am not making excuses for any of the homeless. I just want to point out that sometimes the problem is not quite as simple as it seems. Just food for thought.

12 comments:

Brenda Jean said...

Not sure what inspired this post-- I should just ask you huh? People want a solution to homelessness, but it's complicated. Many want help, others can't trust enough to accept it...there is no simple solution.

Brooke said...

What were you going to say? :)

Chuck said...

Brenda, because, as you know, I see it a lot and there is a lot of misconceptions about the subject

Brooke, try reading it again, my formatting was off. Those were not ..... it was more text.

Chuck said...

Actually, writing the post about Emergency Nurses Week started it. I started writing that post and went off on this tangent. It was not what I wanted for that so I made it a seperate post.

LomaAlta said...

Chuck, I agree with most of what you said. The do-gooders of the 1960's dumped many of the inmates from the state mental institutions under the mistaken belief that all were being abused.

These people don't function, so they dont vote. The states were glad to save millions by closing many state insane asylums (not realizing that it would cost many times that to have the inmates on the streets) and the federal government does not care. Hence, the mentally ill homeless.

However, it very often works the other way; it is the alcohol and drugs which cause mental illness. These people had a choice.

So, not all mentally ill are free from responsibility of their condidion.

Brooke said...

Not always, but often you can tell the losers from the ones that are mentally ill.

The thing that pisses me off about the law is that once they are on meds and 'normalized', they feel good or run out so they stop taking them, and then they go right back into a spiral. Even though they are mentally ill, the courts will not compel them to take the meds because 'it's their choice.'

Such a mess.

Chuck said...

LomaAlta, agreed on the mental institution part. With the people that are truly mentally ill though, the alcohol is not the cause but a symptom. Alcohol abuse causes a lot of problems and we see those problems in the ER. It does not cause clinical bipolar or schizophrenia though.

Brooke, I actually would be comfortable with hospitalization of some of these. Not the old Hell holes of before but a place they can be safe and supervised.

MK said...

Good post Chuck. And i'll add to it by saying that your problems with the mentally ill are only going to get worse under obama's healthcare plans.

Out here they are pretty much thrown out onto the street and have to fend for themselves. They live under bridges and some of them have even killed innocent people because of their illness. The cops are defacto mental-health workers and the law-abiding are left defenseless and abandoned too.

Chuck said...

MK, sounds a lot like home. We in the ER are the same, defacto mental health workers.

LomaAlta said...

Chuck, I beg to differ, alcohol causes mental illness serious enough to lead to death. It is called:
Wernicke-Korsakoff syndrome
Please see.
http://www.nlm.nih.gov/medlineplus/ency/article/000771.htm

Alcohol is also often a factor in dementia, malnutrition, and other things leading to mental illness, DT's etc. In these cases alcohol is the cause not the result of mental illness.

Randy said...

Wasn't there a push of people out of institutions during the early Reagan years? I don't know the details, but the father of a college buddy was an administrator at one of these places. He was brought in to evaluate the residents and see which ones could be mainstreamed. I think he took the population down about 50%. Many of those put on the streets should not have been.

I'm a Reagan fan, but this has always bothered me. This would have been the early 1980's.

Chuck said...

I don't disagree. This is why we give our aqlcoholics thiamine. You can also see hepatic encephalopathy as a result of alcoholism, fetal alcohol syndrome , etc.

The people we see in the ER primarily and the people I am writing about are the bipolar, the schizophrenics, the personality disorders. These conditions are not caused by alcohol although they certainly are exacerbated by it.

I can say that while we give good care to all, I am not quite as sympathetic to someone who we have tried for years to get to quit drinking that then develops one of the alcohol related dementias/psychosis.

Randy, yes. I was kind of young then but my understanding is that a big part of the problem is that some of the old institutions were horrendous. This caused the typical government reaction of throwing out the baby with the bath water. Instead of fixing the problem, they closed them down. A lot of these people had nowhere to go but the street.

This also happened with the developmentally disabled adult population. They pushed them all into group homes so they could integrate with society. The integration didn't happen and in fact often neighbors fight the placement and/or continuing presence of the group homes in their neighborhoods. Further, I can say from working temporarily in the field, they took a bunch of institutions that they were not monitoring and created a lot more group homes that they could not monitor. I think a lot of the old abuse is going on, it's just harder to police now.