Map of life expectancy at birth from Global Education Project.

Sunday, February 20, 2005

Down and out in America

Speechless, over at the Dialogue, talks about the dilemmas of city-dwellers faced with panhandlers. There are many complexities and layers to this problem, both personal and political. Here is the place to talk a bit about the political.

There are various reasons why people become beggars. In much of the world, the economy just doesn't offer enough viable niches, and many people beg on the street simply because they have been squeezed out. In the U.S., though, it usually takes major misfortune and some form of disability for people to end up in that position. We had a huge increase in the numbers of homeless street people starting a couple of decades ago, when states unanimously adopted a progressive policy of deinstitutionalizing the severely mentally ill, who until then had been warehoused in horrific, dungeonlike "hospitals." The idea was to create sufficient supportive services -- staffed group housing, day activity programs, supported work environments, intensive outpatient treatment, etc. -- to enable people to live more independently, and be part of the community.

Unfortunately, the states did the first half -- shut down mental hospitals and discharge the people -- without doing very much of the second. Now, innumerable people with severe mental illness live in shelters, on the street, or -- and this is very common -- are in jail. I visited my state's maximum security prison a few years back in the company of a judge, and we met with a group of lifers -- men with long sentences, including life in prison. They were surprisingly accepting of their situation, but it was also very grim. Most of them had started spending time in correctional institutions as teenagers, and they said one thing had definitely changed: the prisons today were full of people who really belonged in the Pine Street Inn. (That's Boston's biggest private shelter.)

The judge said there were two reasons for this: desintitutionalization of the mentally ill, and determinate sentencing. He no longer had discretion, as a judge, to give mentally ill defendants probation and force them into treatment. Even if he did, there probably wouldn't be adequate options for them anyway, but he would have liked to have tried in many cases. But the legislature wouldn't let him -- it was off to jail with them. These people are very difficult for the prisons to manage, of course. They usually go unmedicated, get no counseling, and just get sicker. This is a national disgrace.

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