Bipolar 2 From Inside and Out

Posts tagged ‘homeless’

Brian Kilmeade’s Apology

On Sept. 10, Fox News host Brian Kilmeade was having a discussion with his co-presenters on the show “Fox & Friends,” discussing the death of a woman in North Carolina, who was said to have been stabbed by a man who was both living in a homeless shelter and reportedly mentally ill at the time.

Kilmeade’s cohost, Lawrence Jones, expressed the opinion that people like the accused man who refuse treatment for mental illness should “be locked up in jail.” Kilmeade replied that they should be subjected to “involuntary lethal injection.” Euthanasia, in other words. Death not for the murder, but simply for the “crime” of being mentally ill and unhoused.

Refusing treatment for medical conditions, including mental illness, is still a right, although there is an alternative in place in many locations—AOT, or Assisted Outpatient Treatment—a procedure with safeguards and rules that benefit a person who doesn’t recognize their own incapacitation. Apparently, Kilmeade has no knowledge of such programs—nor, I suppose, should we expect him to, as he’s one of the hosts of an entertainment talk show.

The talk of getting the homeless mentally ill off city streets is in service of the growing clamor to get rid of “useless” people by one means or another—jail, “wellness farms” (as proposed by Secretary of Health and Human Services Robert F. Kennedy, Jr.), institutionalization, or, apparently, summary execution. The unhoused and mentally ill are seen as a drag on society, consumers of resources who do not produce anything of value. Their problems are attributed to “bad choices.” They are thought to be not worth the money that society spends on them and their indolent, nonproductive lifestyles.

I don’t know about you, but I took this personally. I’m far from homeless, and I have been productive and earned a living, but I am mentally ill. And it’s only a short step from threatening the unhoused mentally ill to threatening the mentally ill themselves with involuntary euthanasia. (I’ve read the Martin Niemöller poem. They could conceivably come for me, too.)

Mr. Kilmeade apologized during another episode of “Fox & Friends” and posted a video of the apology on social media. “I am obviously aware that not all mentally ill homeless people act as the perpetrator did in North Carolina,” he said. “And that so many homeless people deserve our empathy and compassion.” (Not all, note.)

Sorry, but that’s too little too late. Forgive me if I doubt the sincerity of the apology and attribute it to a backlash from the public, or maybe from his bosses realizing that he had stepped over a line.

I, for one, do not accept his apology. It doesn’t contain the elements of a valid apology: admission of a fault, recognition of why it was offensive, a promise never to make that transgression again, and action that will help repair the fault or prove the sincerity of the apology. For example, Kilmeade could have said that involuntary lethal injection was appalling and inhumane (indeed, illegal) and that most unhoused mentally ill people pose no physical threat to the populace. He could have said that he had learned his lesson and would never again talk about the homeless mentally ill in that cavalier manner. And he could have made a donation to an organization that helps people who live on the streets or people with mental illnesses.

I was taken to task for expressing this opinion on the timeline of someone who posted that the apology was sufficient and laudable, that it gave Kilmeade an opportunity to learn, grow, and do better. While I admit that I should have kept my opinion on my own timeline rather than responding in that person’s space, I still don’t agree that forgiveness is required. In my opinion, the person who has been injured (or, in this case, insulted and threatened) has the option to accept the apology or not. Forgiveness doesn’t come automatically just because you said, “Oops, sorry.”

And if there’s any doubt that Kilmeade made a sincere, lasting apology and learned his lesson, he recently said that “what we need to do is either leave the U.N. or we need to bomb it. Maybe gas it?…we need to destroy it. Maybe can we demolish the building? Have everybody leave and then we’ll demolish the building.” The other program hosts could be heard laughing.

I suppose it’s laudable that he pulled back from suggesting demolishing the building while it was occupied, but that’s what he first proposed. Apparently, human lives mean nothing to him unless they’re people that he approves of. And that approval is conditional, based on the people’s utility and their agreement with his political stances.

And that’s simply not enough for a sincere apology.

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Mental Health

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Mental Illness and Homelessness

By Halfpoint / Adobestock

There are a lot of assumptions made about mental illness. One is that all of the homeless population are – or at least predominantly are – mentally ill. That’s far from the truth.

Homeless people get that way for a variety of reasons. Some lose their jobs or are evicted from their housing. Some have no friends who can put them up when that happens to them, so they have time to pull themselves together and find a new job or living situation. Some live on the streets because of alcohol or drug addiction.

And yes, some people are homeless because they are mentally ill. Disorders such as depression and bipolar disorder, schizophrenia, anxiety disorders, and substance abuse disorders are frequently seen in the homeless population. According to the Harvard Medical School, “about a quarter to a third of the homeless have a serious mental illness — usually schizophrenia, bipolar disorder, or severe depression — and the proportion is growing.” 

Psychiatric Times states, “There is clearly a link between psychiatric disorders and homelessness; disentangling the nature of this relationship is complicated….Mental illness had preceded homelessness in about two-thirds of the cases. Homelessness in turn has been associated with poorer mental health outcomes and may trigger or exacerbate certain types of disorders.” 

PTSD is also a factor among homeless veterans and others with traumatic pasts. Many military veterans suffer from it as a result of their experiences in combat situations. A traumatic event such as witnessing or being victim of an attack, sexual assault, and so forth experienced during homelessness can itself cause PTSD. And homelessness itself can be the traumatic event that leads to PTSD.

The system is rigged against homeless people. With no address, phone, no reliable transportation, no place to bathe, it is hard to get and keep a job. Many times homeless people are taken advantage of when they can get day labor such as mopping a store, cleaning toilets, or sweeping a parking lot. The job “broker” for casual labor can easily demand a kickback from the homeless person in exchange for finding the person a job.

Some homeless people have been kicked out of their houses because of their alcoholism, drug addiction, or disturbances caused by mental illness – or because of “tough love” philosophies.

And let’s not forget people who have been released from jail or a mental health facility. It can be almost impossible to find a job and an affordable rental. Thanks to a broken system of both prisons and psychiatric facilities, the recently released have no place to go but the streets. When Reagan closed down and defunded “asylums,” he took away the most common way for the mentally ill to get help. Where did these people end up? Either in prison or a homeless camp.

In fact, being in jail is a luxury for some homeless people. They may commit petty crimes in order to be arrested and put where they know they will receive “three hots and a cot” for at least a couple of months. But there is little to no psychiatric care for homeless people in jails or prisons. Despite this, the prison system is clogged with mentally ill people who have no way to get better and nowhere to go when they are released.

With a few exceptions, people do not choose to be homeless. Many people look down at the homeless, sure that they know what would be best for them or clinging to the outdated notion that a homeless person can “pull themselves up by their bootstraps” and conquer both mental illness and homelessness. People who experience schizophrenia or psychosis are particularly hard to place, even in shelters.

What about those shelters? To begin with, they are overcrowded. Not everyone who needs one is able to get a place. Many are horrible, crowded places, where theft, assault, and rape occur. Many make the residents leave at 7:00 a.m., whether they have a place to go or not. Many others make residents adhere to codes of conduct little better than jail, or insist that a resident profess the preferred religion of those who run the shelter. And don’t forget bedbugs, lice, and infections linked to too many people being in an enclosed space. COVID restrictions make it even harder to find a place in a shelter. There are more shelters for women – and especially women with children – than can accommodate the women who make up 29% of the homeless. 

And what about the violence associated with both the homeless and the mentally ill?

Lynn Nanos, in her book Breakdown: A Clinician’s Experience in a Broken System of Emergency Psychiatry, makes an excellent case that schizophrenic and psychotic patients, especially those with anosognosia, are the most likely of all psychiatric patients to commit violence and be victims of violence. 

But murderous violence is not the only kind. An NCBI study reported that “mental illnesses only moderately increased the relative risk of any violence, that is, assaultive behaviors ranging from slapping or shoving someone to using a weapon in a fight.” In addition, they said, “the absolute risk was very low; the vast majority of people with diagnosable serious psychiatric disorders, unless they also had a substance use disorder, did not engage in violent behavior.”

In terms of the myths about the mentally ill homeless, much of that is related to the stigma surrounding the seriously mentally ill. When we look at the facts we find that, while mental illness may be one cause of homelessness, it’s wrong to say that all the homeless are mentally ill – just as wrong as it is to say that all of the seriously mentally ill are homeless.

It’s often said that most of the U.S. population is one paycheck, spouse, illness, job loss away from homelessness. Let’s add mental illness to that list of potential causes. As the sign in the accompanying picture says: Once I was like you. We need better programs to serve the homeless, the mentally ill, and the homeless mentally ill.

 

 

 

 

 

 

 

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Mental Health

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