By Connie Mitchell
July 6, 2017
When most people think of homeless people they very often imagine those who are chronically homeless on the street either drunk or under the influence of other drugs. Among the chronically homeless (those who remain homeless for more than a year or repeatedly so), drugs and alcohol do in fact play a significant role in why they remain so. Some use alcohol to relieve anxiety or to calm the symptoms of mental illness or to simply numb themselves to the state of abject poverty and loss.
Rendered destitute by illness or injury that caused loss of employment, some have become addicted to opiates as an alternative to prescription narcotics when prescribed pain relievers didn’t work as well anymore or because their supply was cut off. Others began using cocaine or “ice” (methamphetamine) as a way of getting high and escaping the realities of their lives which often included dealing with past trauma or loss of some kind or just a way of injecting some excitement into a life that was unsatisfying.
The disinhibition of alcohol and other drugs have been implicated in well over 80% of crimes that end in incarceration. Substance abuse results in hundreds of millions of dollars from our economy due to lost employment productivity annually. And worst of all, children are left without the guidance of parents and families are torn to pieces by the personal violations and criminal acts that are often precipitated by chronic substance abuse. If we pause to think about it, it’s not hard to see that all of these scenarios contribute significantly to homelessness as well.
About 15 years ago, when I was still working at the Hawaii State Hospital, I observed a neverending parade of patients admitted on court orders that had rendered them “unfit to proceed” to trial. I realized that while we were treating symptoms of mental illness, many of them also where suffering methamphetamine-induced psychosis. I predicted then what I see now among many chronically homeless persons: severe cognitive impairment that sometimes mimics paranoid schizophrenia or major impulse control looking a lot like manic mood disorders.
What I had not foreseen was the way “ice” would eventually poison the physical body and cause permanent multi-system damage heart, kidney, liver and immune system failure. So many people have lost their talents and abilities to prolonged “ice” use. Sadly, these physical system shutdowns are what finally lead chronically homeless persons with addictions into accepting services because they finally cannot deny the reality of their physical needs.
What can be done? Our community must come to terms with the disease nature of addiction and fund treatment for it like it does for other physical diseases. We have for too long treated addiction as moral failure. Science tells us that some people have genetic predispositions toward alcoholism and substance abuse because of the makeup of their brain chemistry. Furthermore, one’s neurochemical make-up can be altered by chronic trauma over time as an adult or early trauma as an infant or child. This fact is not offered as an excuse for people’s behavior. Rather, it means that we need to understand that the underlying vulnerability of a person’s addictions may not have been their choice, despite current behavior remaining their responsibility.
Much like the economic crisis being experienced in our healthcare system that has defaulted to expensive urgent and emergency care for chronically homeless persons, a lack of strategic direction and shortsighted crisis management within the Department of Public Safety has led to misplacement of resources that are causing tremors that indicate a coming seismic quake that could soon push our correctional and behavioral health systems to the brink of failure. A whole generation of talented men and women are being discarded through our correctional system that withholds the treatment necessary for recovery.
The cycle of chronic homelessness continues in significant part due to ineffective responses to chronic substance abuse and mental illness and our public safety system. A significant investment in treatment, housing and employment is needed now.
Our State’s courts and correctional systems need to align and while holding a person responsible for their actions, be given the opportunity to receive treatment and embrace rehabilitation. Furthermore, when offenders with substance abuse histories re-enter our communities, we need to be aggressive about connecting them with appropriate treatment or ongoing recovery supports, a clean and sober place to live and meaningful employment to help them regain a sense of confidence that they can once again be a contributing citizen of our community.
Right now, a concerted effort needs to be made to review the population of inmates that are non-violent offenders and determine how much more treatment is needed and providers contracted to deliver it.
An analysis should be done to determine how many inmates are expected to be released in the different categories and discharge plans developed for each one based on their individualized needs. Persons “maxing out” their sentences need to be given as much attention as those who are under parole or probation. If these needs are quantified, our Legislature would place greater confidence in funding these efforts. Let’s give them a solid plan of action to fund and provide the management updates throughout the year to the public who actually provide the tax dollars to make change possible.
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