Last week I highlighted four scholarly articles published before Housing First! became the one-size-fits all national policy in 2010. This column focuses on a fine scholarly book written in 2010, Russell Schutt’s Homelessness, Housing, and Mental Illness (Harvard University Press).
Schutt starts with a hard realization: Once state asylums for the mentally ill closed down from the 1950s to the 1970s, many who would have been housed were on the streets: “As the number of single adult persons (and families) who were homeless skyrocketed in the 1980s, surveys revealed that a substantial proportion were seriously mentally ill.”
What were the percentages? “Estimates based on multiple studies suggest that in the late 1980s and early 1990s about one- third of homeless adults were chronically mentally ill” and perhaps half were alcoholics or addicts, “with about a 50 percent overlap between substance abuse and chronic mental illness.” A study published in 2001 based on a “nationwide survey of persons using homeless assistance programs indicated a total of 66 percent with alcohol, drug and/or mental health problems in the last month and 86 percent on a lifetime basis.”
To gain more precision, Harvard professor Schutt and Massachusetts officials asked 100+ dwellers in big shelters whether they wanted to leave. More than half said they wanted to “move out now” but almost one-third wanted to stay for at least another six months (and one in ten wanted to stay for years). Three-quarters wanted their own apartments, but some would be disappointed: The Schutt team set up a study where half of the participants received apartments, and the other half gained placement in group living homes.
The results: The type of housing did not make much difference in most measurable outcomes, but it made a big difference in one. “Executive functioning” (thinking ahead to attain desired goals, going beyond the selfish “my car, not your car” reasoning of two-year-olds) separates most adults from children. Schutt writes that functioning scores “improved for those assigned to group housing and deteriorated for those assigned to independent apartments.”It’s not hard to suggest a reason such as “living with others makes certain cognitive functions work better.”
Breaking down the data further leads to two other lessons. First, the gap between executive function improvement in group homes and worsening for those in independent apartments was most evident among those who were not alcoholics or addicts. The group home vs. apartment difference was not as substantial among substance abusers: If we really want to help the abusers, we have to have them stop the abuse. The difference is both immediate and long-term: “Substance abusers were much more likely to lose their housing during the eighteen-month follow-up period, and they were less likely to gain in cognitive functioning after housing placement.”
Second, many who are Pelagian believers in natural goodness rather than Augustinians (who recognize natural sinfulness) push for “tenant empowerment” by which those in group homes plan and carry out budgeting, chores, and other shared responsibilities. Pelagians were disappointed: At one purportedly empowering tenant meeting, “the empowerment coordinator paused, “visibly upset, appearing close to tears, [with] dead silence in the room, everybody looking down.”
The coordinator eventually said, “This is two years now. We’re now in the process of phasing out staff, but if we phased out now, we’d have drug people in and out of this house constantly, and you know it!…I’m not your mommy, the mental health center is not your mommy, and you don’t need others to take care of you.” Well, alcoholics and addicts do need someone: Otherwise, as one staffer said, “there are roaches again. There’s food half-eaten and spilled all over the floor and the counters, there’s candy half-eaten—the roaches are gonna thrive here!”
The empowerment idea is that individuals left alone would learn to choose wisely, but as one staffer learned, “It’s actually disempowering because they can’t make choices when using drugs. No one could quit drugs without a lot of support. [We] tried leaving people alone and look what happened: it didn’t work…. Maybe this model is no good anymore. Only some people can do it.”
“I am almost always alone,” actress Greta Garbo wrote in 1939. She’s been quoted (or misquoted) as saying, “I want to be alone.” She was also desperately unhappy. Homeless people given their own apartments are often the same. We are apparently made for community with at least one other person.