{"id":7145,"date":"2020-09-28T16:10:03","date_gmt":"2020-09-28T16:10:03","guid":{"rendered":"https:\/\/beta.homelessvoice.org\/?p=7145"},"modified":"2021-02-22T09:50:33","modified_gmt":"2021-02-22T09:50:33","slug":"florida-de-emphasizes-effects-of-mental-health-and-substance-use-on-homeless-population","status":"publish","type":"post","link":"https:\/\/beta.homelessvoice.org\/?p=7145","title":{"rendered":"Florida De-Emphasizes Effects of Mental Health and Substance Use on Homeless Population"},"content":{"rendered":"

Florida now reports only extreme cases, causing a 20% drop in cases, while pushing for a systemic interpretation of homelessness<\/strong><\/h2>\n
By Katie Aulenbacher<\/h6>\n

Mental illness and substance abuse are likely more prevalent in Florida\u2019s homeless community than official reports lead organizations and the public to believe.<\/p>\n

In 2017, the Florida Council on Homelessness \u2014 a state government council that \u201cdevelop[s] policies and recommendations to reduce homelessness,\u201d according to their website \u2014 increased the requirements necessary to be considered mentally ill in their reports, without public explanation. This led to a 20% drop in cases, a possibly misleading drop as it shifts focus to only chronic or severe cases rather than all cases, and could create a wide ripple effect impacting policy, funding, and outreach decisions.<\/p>\n

The Florida governor, the State Surgeon General, the Executive Director of Veterans\u2019 Affairs, and the Commissioner of Education are only some of the organization heads that use this data to lobby the legislature and make decisions impacting families, veterans, criminal justice, healthcare, and education.<\/p>\n

In Florida, the shift from reporting total incidence of mental illness and substance abuse in 2016 to only chronic or severe cases in 2017 led to this 20% drop. The 2016 report found that 33.2% of homeless individuals were suffering from substance abuse and 34.2% from mental illness, while in 2017 those numbers were 13.3% and 14.8%, respectively. For comparison, a 2001 Urban Institute brief noted that \u201conly one in four homeless adults did not report any mental health or substance abuse problems during the past year.\u201d<\/p>\n

Rick Butler, Vice Mayor of Pinellas Park, Treasurer of the Florida State Homeless Leadership Board, and member of the Council on Homelessness commented, \u201cYou see, we don\u2019t gather the data. We just sit there and listen to what they\u2019re reporting to us. All we can do is sit there and hope everything that they\u2019re telling us is the right information…To me, number-wise, that percentage drop doesn\u2019t make sense.\u201d<\/p>\n

To the best of Florida Council on Homelessness Chairperson Shannon Nazworth\u2019s recollection, the switch to reporting only extreme cases reflected an attempt to align with the United States Department of Housing and Urban Development (HUD) reporting guidelines. HUD oversees federal housing initiatives including the annual point-in-time (PIT) count of homeless persons.<\/p>\n

\u201cI do believe that was around the time that HUD kind of started changing different things that were required. And, so, the Council and Office on Homelessness, really it was the Office on Homelessness that shifted its reporting requirements and other things to align with the HUD requirements, trying to streamline the reporting requirements on the CoC\u2019s [Continuums of Care, the local organizations that facilitate PIT counts],\u201d Nazworth said.<\/p>\n

A similar attempt to align with federal guidelines in California led to a dramatic underreporting of the prevalence of mental illness and substance abuse in Los Angeles\u2019 homeless community, according to the LA Times. Using the same raw data as the city, LA Times found that 67% of unsheltered individuals suffered from mental illness or a substance abuse disorder, while the city reported a figure of only 29%. In their own words, the Times\u2019 reporting raised \u201cquestions about whether government officials are taking the right approach and doing enough for people on the street who have little hope of getting into housing anytime soon.\u201d<\/p>\n

\u201cIt\u2019s like, the question is, \u2018Do you feel like you have a mental illness.\u2019 The guy\u2019s looking at me like, \u2018Not if I have another beer, I don\u2019t!\u2019 That\u2019s the reality of what you\u2019re dealing with out there,\u201d<\/strong><\/p><\/blockquote>\n

One expert interviewed by the Times, Executive Director of the California Policy Lab at UCLA Janey Rountree, said, \u201cThere really needs to be an examination of the inflow of the unsheltered population, and are there issues of access to medical care, mental health care and to substance abuse treatment that are just as important as thinking about how to house them immediately when they do become homeless.\u201d<\/p>\n

Asked if the design of the PIT count, when volunteers go out and individually count the unsheltered homeless, could lead to undercounting important cases, Butler said, \u201cAbsolutely. Yeah. I think most of the time, the sad part about it is [if] they don\u2019t answer truthfully, they don\u2019t get any follow up help. So I think a lot of people are just too embarrassed to say, \u2018Yeah, I\u2019ve got a problem. I need to get some help.\u2019 I could absolutely see it being undercounted.\u201d<\/p>\n

This amounts to the statistic of mental illness and substance abuse being wholly self-reported by those possibly with these ailments.<\/p>\n

\u201cLet\u2019s be honest, we take one day a year to go out and count our homeless. Does that even sound right? But that\u2019s all that we can go on,\u201d continues Butler. \u201cThere are some people that we can\u2019t get to…Given what HUD guidelines are, as in, \u2018You will do this, and here are the questions that you will ask, no matter how stupid they are,\u2019 and you\u2019re dealing with sometimes sitting in the middle of the woods with five or six people in the middle of a rainstorm trying to ask questions and trying to get straight answers. And it\u2019s a very hard thing if you track that…I\u2019ve been out there a few times.\u201d<\/p>\n

The HUD guidelines state that in order to be counted as substance misuse disorder or a serious mental illness, a case must meet three conditions:<\/p>\n

1. Seriously limit an individual\u2019s ability to live independently<\/p>\n

2. Be for a long-continuing or indefinite duration<\/p>\n

3. Could be improved by the provision of more suitable housing conditions.<\/p>\n

This means if someone doesn\u2019t report that their condition prevents them from \u201cholding a job or living in stable housing,\u201d their case goes uncounted.<\/p>\n

\u201cIt\u2019s like, the question is, \u2018Do you feel like you have a mental illness.\u2019 The guy\u2019s looking at me like, \u2018Not if I have another beer, I don\u2019t!\u2019 That\u2019s the reality of what you\u2019re dealing with out there,\u201d Butler said. \u201cThe ones that are [obviously struggling] are like, \u2018Oh no, there\u2019s nothing wrong with me. I\u2019m fine.\u2019 But you have to mark down what was said…It\u2019s an antiquated system to get that type of information, that\u2019s required by HUD…Is the data correct? Maybe 60%, 65%, 70%. But there is going to be flaws in the system.\u201d<\/p>\n

Asked if the Council\u2019s policy recommendations would change if the data gathered were different, Nazworth commented that \u201cpolicy recommendations are based on the data available, so if the data changes, and there was an uptick in one group or another, we would definitely look at what are things we could try to do to address that.\u201d<\/p>\n

Crisis counselor and director of New York\u2019s Neighborhood Coalition for Shelter Jeff Grunberg, when asked if this change in definition of mental illness could affect funding, said, \u201cabsolutely.\u201d<\/p>\n

\u201cIf the government\u2019s going to fund a substance abuse division, that division has to set up their parameters, who is worthy of their treatments\u2026\u201d Grunberg continued. \u201cThat division is going to fund local programs. The local programs are told, \u2018We\u2019re going to give you 150k, you have to serve 35 addicts, here\u2019s the definition…\u2019 The funding stream dictates who gets treated. Of course, what becomes the funding stream is dictated by lobbying and advocates.\u201d<\/p>\n

He further explained that focusing on specific ailments \u201cdoes help you lobby for particular funding to bolster your outreach efforts to hopefully succeed in getting someone indoors who otherwise might not come indoors without that focus,\u201d concluding that statistical changes resulting from definitional changes \u201cwill affect lobbying.\u201d<\/p>\n

\u201cIt is a public document,\u201d said Nazworth, referring to the Florida Council on Homelessness\u2019 annual report. \u201c\u2026and of course [stakeholder groups] can use it to advocate with the legislature or others on best practices and, of course, legislative recommendations as are outlined in the report.\u201d<\/p>\n

Grunberg described a personal example of a negative byproduct of altering mental health definitions that took place three decades ago, while he was running a treatment program at Columbia Presbyterian Medical Center. According to Grunberg, the Commissioner of the New York State Office of Mental Health redefined the segment of the population the department was responsible for helping saying, \u201che changed the definitions of who could be considered severely mentally ill. Now suddenly, his agency was only responsible for taking care of a smaller number of people.\u201d<\/p>\n

As a result, \u201ca lot of people didn\u2019t meet the criteria necessary to be called functionally disabled, therefore they didn\u2019t qualify to be in my program…There were a lot of people who were absolutely disabled, but weren\u2019t \u2018crazy\u2019 enough.\u201d<\/p>\n

Alongside the transition to tabulating only more extreme cases, Nazworth shared that the Council has mirrored HUD\u2019s emphasis on a systemic understanding of homelessness. \u201cThe shift to focusing on systemic causes is because, in the end, this is a systems issue. It\u2019s a systems failure issue. People are not homeless because of individual choices they made and decisions they made…And we\u2019re just trying to help people understand, with systems issues we can change systems and align systems better so that we can better address homelessness. And I do think that\u2019s what HUD was trying to do with its shifts as well, is look at the systemic level things that you can influence, and help incentivize best practices to help reduce the number of people who are homeless on our streets.\u201d<\/p>\n

Butler expressed doubts that overly powerful systems could be the solutions to the problems they create saying, \u201cIt is frustrating. I know I\u2019ve been on [the receiving end of HUD guidance] I don\u2019t know how many years, and I kind of chuckle every time, like, \u2018This is so ridiculous.\u2019 But you ain\u2019t going to change it. You ain\u2019t changing it. The whole system is the system, and the system says this is what you need to do.\u201d<\/p>\n

“The shift to focusing on systemic causes is because, in the end, this is a systems issue. It\u2019s a systems failure issue. People are not homeless because of individual choices they made and decisions they made…”<\/strong><\/p><\/blockquote>\n

As a result of this shift to a systemic understanding of homelessness, the Council\u2019s annual reports have gradually transitioned from a more neutral characterization of the causes of homelessness, as a combination of individual and societal factors, to accentuating the societal factors.<\/p>\n

For example, the 2015 report stated, \u201cThere are a host of issues that may lead to homelessness including job loss, family crisis, disabilities, and struggles with mental health and substance abuse,\u201d while in 2019, the report reads, \u201cThe systemic causes of homelessness are, however, often overlooked while personal issues tend to be overemphasized\u2026For elected officials, policymakers, and planners, it is especially critical to recognize the societal and systemic issues that contribute to homelessness.\u201d There is no source cited for the claim that individual factors are overemphasized at the expense of systemic causes.<\/p>\n

The 2019 report includes the further uncited claim that \u201cmental health issues and substance abuse do not directly cause [homelessness],\u201d in apparent contradiction of the HUD surveys, which require individuals to state a causal connection between their mental health and substance issues and their homelessness in order for their condition to be counted.<\/p>\n

When asked about the basis for that claim, Nazworth responded, \u201cWell there is no data to say that they directly cause homelessness. There are people with mental health and substance use issues who are not homeless. Again, I don\u2019t know of any data that directly says that that is a cause. It may be an exacerbation to a challenge. It may make things more challenging for certain individuals, but it\u2019s not the reason they\u2019re homeless. If that were the case, then all people with serious substance use issues would be homeless, and that\u2019s just not the situation.\u201d<\/p>\n

This is in contrast to Grunberg\u2019s experience, where the vast majority of people explain their homelessness in terms of personal decisions: \u201cThey disagree with their own advocates. Imagine that. Advocates disagree with the homeless people they\u2019re advocating for. We asked the homeless who they blame. We found that…70% blame themselves…The homeless are Americans too. They believe in bootstrapping–\u2019lift yourself up by your bootstraps\u2019–they want to work.\u201d<\/p>\n

Nazworth continued by saying that \u201cpart of it is to help policymakers who are not directly involved with homelessness and don\u2019t live in this space the way the rest of us do on this Council and others understand that while there may be exacerbating issues and it may cause more challenges, it isn\u2019t the reason. It may contribute to the cause, but it\u2019s not the reason that the person is homeless.\u201d<\/p>\n

An earlier report endorsed legislation aimed at improving mental health and substance misuse treatment facilities in order to \u201caddress two major contributing factors for homelessness,\u201d Grunberg commented. \u201cIt is very touchy, very important, how we label \u2018why.\u2019 We should not soft-sell this. Having mental illness and being homeless is a one-two punch.\u201d<\/p>\n

The 2019 report also includes the claim that \u201cthe majority of people who become homeless do not have behavioral health issues.\u201d Nazworth, when asked if this could be misleading, since only more extreme cases were tabulated, said, \u201cI don\u2019t think so. We were trying to highlight that most people when they think of homelessness think only of chronic homelessness, and homelessness is a much broader group of individuals in our community.\u201d<\/p>\n

She clarified that while \u201cthere is obviously some correlation between mental health and substance use and homelessness, whether one is exacerbated by the other, chicken and egg scenarios, I don\u2019t know that there\u2019s real good research on that aspect of it, but most people don\u2019t have a chronic behavioral health issue.\u201d<\/p>\n

Nazworth also stressed that the goal of de-emphasizing mental illness and substance abuse in the reports was to educate policymakers that homelessness comes in all shapes and sizes saying, \u201cHomelessness is about all homeless individuals. School kids right through to the persons with the greatest demons that we\u2019re all striving to help.\u201d<\/p>\n

Jeff Branch, Legislative Advocate for member organization Florida League of Cities, commented, \u201cThere\u2019s a whole host of factors that may cause people to become homeless. I would just speak very broadly that no report should overlook all the different contributing factors of homelessness, whether it\u2019s caused by individual actions or external factors that they have no control over. Our focus is how do you end it, and how do you prevent it.\u201d<\/p>\n

\"\"<\/p>\n","protected":false},"excerpt":{"rendered":"

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