smi Archives - No One Cares About Crazy People

Trump to Homeless: Get Lost

The good news is that President Trump wants to do something about homeless Americans on the streets.

The bad news is that President Trump wants to do something about homeless Americans on the streets.

On Monday, newspapers and television networks broke the news that the President of the United States, whose name is Donald Trump, had at last swiveled the full attention of his very, very large brain to one of the most appalling crises confronting American cities: the crisis of homeless people on the streets.

Social scientists and others of sadly lesser intellect have noticed the crisis as well, of course, and analyzed it to the best of their limited ability: as a vast ongoing human calamity with dire implications for public health (the containment of hepatitis and opioid epidemics, for example); community and family stability, criminal justice and law enforcement, the control of dangerous drugs, productivity and the employment base.

These are vitally important but largely utilitarian considerations. They do not contemplate the profound moral/religious dimension of this malady: the obligation to reclaim disintegrating human lives.

Few agents of disintegration are more darkly effective than mental illness–serious mental illness (incurable brain diseases such as schizophrenia) in particular. A 2015 survey by the The U.S. Department of Housing and Urban Development, the latest available, reported that of the nearly 565,000 people who were homeless on a given night, fully one-quarter, or 140,000, suffered from a S.M.I. (Serious Mental Illness). Nearly half, or 250,000, were in the grip of some sort of mental disorder.

S.M.I. victims, their reasoning powers diminished or gone, are essentially helpless on the streets. Cut off from providers of stabilizing medication, they are prey to robbers, thugs, thieves, and sometimes rogue police officers. On rare occasions, they become predators as well: upon others, and upon themselves, via suicide.

That is the context of the societal predicament which, nearly three-fourths of the way through his term of office, has activated the engines of President Donald Trump’s very large intellect.

And here is the distillation of Donald Trump’s mighty cogitating, as explained in this July 1 interview conducted by his pal Tucker Carson on Fox News. The relevant part of the interview begins 3 minutes and 22 seconds in. https://www.foxnews.com/politics/trump-tucker-exclusive-interview-homelessness

It is clear from this interview that Donald Trump does not see homelessness as a social-justice problem or a humanitarian problem. He sees it as a cosmetic problem. One that “started two years ago [sic]”

It is further clear that the homeless are inconveniences. Disgraceful pests who make beat-walking police officers sick. “I mean actually they’re getting very sick.” They are affronts to civic pride: human (or semi-human) obstacles to decent upstanding work-loving citizens. The homeless make it very difficult for office-workers to get to work, you see, and thus are ruining our cities. “You have people that work in those cities,” Donald Trump revealed to his pal Tucker Carlson not long ago. “They work in office buildings. And to get into the building, they have to walk through a scene that nobody would have believed possible three [sic] years ago.”

–And let Donald Trump tell you something: the threats posed by the homeless reach far beyond those that menace nauseated beat-cops and nimble-toed office workers. The homeless strike at the very foundations of America’s might. Take Washington, D.C. (before Donald Trump got in): “When we have leaders of the world coming in to see the President of the United States and they’re riding down the highway . . . they can’t be looking at that [sic]. I really believe that it hurts our country.”

–Don’t get Donald Trump wrong. Nobody is more ruefully forgiving of the barbaric horde than Donald Trump. “San Francisco–I own property in San Francisco; I don’t care, except it was so beautiful.”

–Because, you see, Donald Trump is very, very educated about mental illness: In fact nobody knows more about mental illness than Donald Trump: ” . . . the people living [on the streets] are living in hell, too . . . although some of them have mental problems where they don’t even know they’re living that way; but perhaps they like living that way.” (Emphasis added)

No doubt! Just like those African slaves in the antebellum South were “happy with their situation,” as my innocently bigoted mother used to assure me.

–But not to worry. Donald Trump’s very large, very beautiful mind has not only identified the issue at the heart, as it were, of the homeless problem: bad cosmetics. He has fingered, as it were, the Masters of Evil responsible for the atrocity. “And this is the liberal establishment . . . When you look at some of these, they’re usually sanctuary cities, they’re run by very liberal people, and the states are run by very liberal people.”

–Donald Trump has clashed with these evil forces before–and sent them packing with a strategy that was stellar in its simplicity. “When I first became president, we had certain areas of Washington, D.C., where that was starting to happen. And I ended it very quickly; I said, ‘You can’t do that.'”

–And now Donald Trump is poised to expand that breathtaking solution into a national plan of action. As he told Tucker in the July 1 Fox News interview I have been drawing on here: “So, we’re looking at it very seriously. We may intercede. We may do something to get that whole thing cleaned up. It’s inappropriate [!]. Now, we have to take the people, and do something. We have to do something.”

Take what people where? And do what? one wonders with a shudder. The loyal Tucker Carlson didn’t ask, and Donald Trump didn’t say. But the national press, those damned “enemies of the people,” did not wait for the president’s second-favorite cliche, “You’ll see.” They checked some sources. Here are some of the headlines that resulted on Monday:

Trump pushing for major crackdown on homeless camps in California, with aides discussing moving residents to government-backed facilities (The Washington Post)

Trump Reportedly Wants to Destroy Homeless Camps in California. Officials Say He Doesn’t Have a Clue. (Vice)

Trump officials look to fix California homeless problem, state officials say back off (USA TODAY)

Below the headline of this particular article, a team of three reporters quoted the executive director of the Sacramento Regional Coalition to End Homelessness, as saying:

“My first reaction is that it felt like internment camps for people experiencing homelessness. The president doesn’t seem to have any grasp of the homeless crisis not only in California but around the country.”

It doesn’t take a very, very big brain to suss out Donald Trump’s entire, unabridged spectrum of thought about mental illness. (1) He does not know diddly-squat about the disease. (2) He doesn’t care diddly-squat about its victims. And (3) coming as they do from the lips of a self-styled “man of the people,” Donald Trump’s remarks are about as consummately elitist and plutocratic as you are ever likely to hear outside the Clarence Day Room of the Yale Club.

If you are homeless and mentally ill–hell, if you are homeless, period–you are to Donald Trump as a speck of acne on the Ivanka-like face of America.

You are an impediment; an inconvenience; an ugly flaw to be hidden under a cosmetic treatment. (The “cosmetic treatment” in this case seems to require “facilities.” Camps. And this much is true: Donald Trump does know a little about camps.)

But in a darkly intuitive way, Donald Trump may know what he is doing. Rounding up homeless m.i. victims and sweeping them away out of sight behind walls and locked doors would place his aims squarely on a plane with history’s first institution designed to, let us say, cosmeticize urban streets of “lunaticks,” “morons,” and “idiots”: the notorious Bedlam Asylum in London, which opened for business in the 13th century and brutalized generations of “patients” until it was closed in 1815.

Bethlem [Bedlam] Hospital, London: incurables being inspected, 1789. Credit: Wellcome Library, London CC by 4.0

Of course, that sort of barbarism is unthinkable in enlightened, humane, modern-day America. As unthinkable as separating small refugee children from their parents at our southern border and placing them in cages.

In case you thought I was making up or paraphrasing the Donald Trump quotes above, please carefully review the clip I posted above, from his July 1 interview with Tucker Carlson.

My next blog will focus on the impending public-policy threats–and promises–vis-a-vis the homeless population.

JUBILATION ALERT: Democratic Candidates and Grass-Roots Advocates Combine to Urge Seminal Reforms in Criminal Justice and Mental Health Care!

Two mobilizations of historic enlightened reform are abruptly converging in American politics and policy. Their aims are intertwined: to bulldoze and rebuild our blighted structures of criminal justice, and to reclaim our dispossessed mentally ill brothers and sisters from the hellscape of danger, pain, and early death that the blight of justice confers on them. And the economic drain that it exacts from all of us.

The symbiotic forces are (1) the elite tier of progressive candidates for the 2020 presidential election, and (2) the sleeves-up cadre of activists working at Ground Zero who toil because they daily confront serious mental illness up close, and witness its effects for what they are: cancers upon our societal health and sense of decency.

(The first of two parts)

At first glance, justice and mental-healthcare reform may seem but a marginal sliver of all the issues pressing in on America in the 2020 elections. (The physical salvation of the planet comes to mind, and abolishing the immigrant gulags at our southern border.)

This is a distorted, damaging perception, made more dangerous because the crisis is so easily concealed. It can sometimes seem as though insanity and incarceration are like two undersea predators, their tentacles wrapped around each other in a death-struggle of futility. The quality of courts, jails, and prisons has been weakened by years of tending people who should be under psychiatric care. The essentially helpless 11.2 million seriously mentally ill population in turn is vulnerable to suffocation in the folds of feckless court rulings and inhumane treatment behind bars, including deprivation of essential meds and the beckoning maw of solitary confinement (about which more—much more—later.) The one in five adults with less chronic afflictions—nearly 47 million—are within range of the tentacles as well.

Yet that perception, or lack of perception, prevails. It prevails because to open our eyes to the full truth of these abominations is to risk scorching the soul. “I’ll do what little I can in writing,” lamented the great James Agee in another, and again oddly similar context some 75 years ago. “Only it will be very little. I’m not capable of it; and if I were, you would not go near it at all. For if you did, you would hardly bear to live.”

Thus we banish the ghastly effects from our attention as “normal” Americans, until it is too late. The entwined crises strike quickly, and from nowhere, and spread ruin: in households and communities (black and poor ones especially), in the workplace, in public places, in our economic state, and in the less tangible spheres of our collective optimism, hope, and peace of mind.

America has needed an “intervention” for more than two centuries. Intervention seems, at last, to be on its way.

To review the Democrats’ reform plans:[efn_note] I have drawn on several sources, including the candidates’ websites and the excellent summarizing of Vox’s German Lopez, in this essay.[/efn_note]

Pete Buttigieg photo credit: Gage Skidmore

The most ambitious manifestos, in my unscientific reckoning, were issued within the last ten days by Senators Bernie Sanders and Elizabeth Warren and South Bend, Indiana Mayor Peter Buttigieg. Nearly as powerful were the earlier justice reform announcements of Cory Booker, Amy Klobuchar, and Julian Castro. Joe Biden and Kamala Harris submitted strong, if not notably comprehensive, reform ideas.

This ranking hierarchy is not as fixed as the tiers might imply. The eight plans are far more significant for their overlapping reform goals they stress than for their differences.

Slashing into federal prison glut is high on most lists. Sanders, Warren and Buttigieg unveiled proposals that would cut into mass-incarceration, each by roughly 50 percent: by reducing long sentences, ending the “cash bail” system that pauperizes poor families of those arrested, tightening up on police oversight, legalizing marijuana, and abolishing private prisons. Sanders’s document, at 6000 words, is by far the most minutely detailed. Warren would go after policies that “criminalize” homelessness, poverty, and mental health problems (critically, she has not elaborated on this last). Booker would scale back inmate numbers via a clemency program that would free many elderly inmates under the theory that criminals “age out” of their impulses to commit violent crimes. Klobuchar also embraces clemency via a restructured reform plan and would modify the “tough-on-crime” stances she held as a prosecutor in Minnesota.

Castro’s vision is likewise far-ranging, but he places special emphasis upon overhauling violent and clueless behavior of policemen. He wants to curb the use of force, end stop-and-frisk, holding police more accountable for misconduct, and restoring trust among police and the communities they are sworn to protect.

As for Biden and Harris, their reform plans are similarly comprehensive and replicate the bold ideas of their rivals as listed above. Both candidates—and to some extent Klobuchar as well—are preoccupied with freeing themselves from the taint of the “tough-on-crime” stances that they adopted in the mid-1990s.

That is my personal survey, unfairly truncated perhaps, of the generally ground-breaking flurry of criminal-justice reform ideas released by eight of the leading progressive presidential candidates.

An obvious but important caveat: none of these audacious ideas will tap-dance its way into law or policy should its sponsor get elected. (The proto-autocrat decrees of our current incumbent might lull some into that assumption.) A new chief executive will need to inspire the House and Senate to a pitch of pro-active fervor not seen since the First Hundred Days of Franklin D. Roosevelt’s presidency when the New Deal took form in a blizzard of “relief, recovery, and reform.” For our present stumbling and divided Congress to suddenly sprout capes, masks, and flippers and get busy cleaning out the present rot may seem a stretch. Yet things can happen quickly, as the last midterms showed, and a whiff of activism does linger in the air.

With all this in mind, let us turn to the symbiotic manifesto that has arisen from those ordinary heroes at Ground Zero: “Grassroots 2020: A 5-Part Plan for Mental Illness SMI.”

As I’ve mentioned, this inspirational document is largely the labor of the advocate, blogger, and author Dede Moon Ranahan (“SOONER THAN TOMORROW –A SAFE PLACE TO TALK ABOUT MENTAL ILLNESS IN OUR FAMILIES” / SOONER THAN TOMORROW – A MOTHER”S DIARY ABOUT MENTAL ILLNESS, FAMILY, AND EVERYDAY LIFE 2019. Dede’s mentally ill son Patrick, a luminous man of 45, died under medically muddled circumstances in a California hospital in 2014. To paraphrase myself from an earlier blog, her compilation proceeds from “a wide-ranging national canvass of those in the ‘sub-nation’: the mothers, caretakers and advocates of people suffering from serious mental illness: schizophrenia, bipolar disorder, and related incurable afflictions.”

Grassroots: 2020 has been personally distributed to visiting Democratic candidates or mailed to their offices by Leslie and Scott Carpenter of Council Bluffs, Iowa. The Carpenters’ tireless work has helped join the reformist trajectories of these politicians and the people.

I lay it out below with minimal editing, in summary form. You will note that each part of the plan delineates action that a president can undertake, sometimes independently of Congress. And unlike the candidates’ ideas above, Grassroots: 2020 addresses justice-reform issues (incarceration-trimming, for example) only incidentally. It focuses on existing rules, many of them arcane to the non-specialist, that nonetheless have caused decades of frustration and despair for those struggling to reclaim their afflicted loved ones from a decayed system:

A FIVE-PART PLAN TO ADDRESS SERIOUS MENTAL ILLNESS (SMI) 2020 PRESIDENTIAL CANDIDATES. PLEASE ADDRESS THESE TOPICS IN YOUR CAMPAIGN APPEARANCES AND DEBATES:

1. RECLASSIFY SERIOUS MENTAL ILLNESS (SMI) FROM A BEHAVIORAL CONDITION TO WHAT IT IS – A NEUROLOGICAL MEDICAL CONDITION

WHY RECLASSIFICATION IS IMPORTANT:

Re-classification will unlock more research funding and help eliminate discrimination in treatment, insurance reimbursement, and the perception of SMI as a “behavioral” condition. SMI is a human rights issue. The National Institutes of Mental Health ranks SMI among the top 15 causes of disability worldwide with an average lifespan reduction of 28 years.

PRESIDENTIAL ACTION:

• Create a cabinet position exclusively focused on SMI. • Push for Congressional appropriations to include schizophrenia in a CDC[efn_note]The federal Centers for Disease Control I nstitute[/efn_note] program that collects data on the prevalence and risk factors of neurological conditions in the U.S. population.

2. REFORM THE HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA)[efn_note]The outdated and burdensome Health Insurance Portability and Accountability Act[/efn_note]

WHY HIPAA REFORM IS IMPORTANT

Overly strict HIPAA laws make it extremely difficult for families and caregivers to partner in the treatment of their loved ones, resulting in important life-saving medical information gaps. By eliminating this barrier, family support will be strengthened, reducing the chance of relapse, homelessness, imprisonment, and death.

PRESIDENTIAL ACTION:

Work with legislators to change HIPAA law to ensure mental health professionals are legally permitted to share and receive critical diagnostic criteria and treatment information with/from parents or caregivers of SMI.

3. REPEAL MEDICAID’S INSTITUTES FOR MENTAL DISEASE EXCLUSION (IMD).

WHY IMD REPEAL IS IMPORTANT:

The Medicaid IMD Exclusion prohibits Medicaid payments to states for those receiving psychiatric care in facilities with more than 16 beds for those in the 21-65 age group. This demographic represents the majority of SMI cases. Repeal of the IMD Exclusion will increase the availability of acute care, inpatient psychiatric beds. The IMD exclusion not only discriminates against those suffering from neurological brain disorders, it’s a leading cause of our national psychiatric hospital bed shortage.

PRESIDENTIAL ACTION:

• Work with legislators to repeal the IMD exclusion.

4. PROVIDE A FULL CONTINUUM OF CARE FOR THOSE WITH SMI

WHY A FULL CONTINUUM OF CARE IS IMPORTANT:

A continuum of care insures that SMI patients receive early intervention at all stages of their illnesses, long-term care when needed, and follow-up treatment (medications and therapies) when they’re released. Providing a continuum of care reduces: incarcerations, emergency rooms visits, homelessness, and death. A continuum of care provides life-time management that permits a patient to move without penalty from one level of care to another as needed.

PRESIDENTIAL ACTION:

• Create federal incentives to states which are addressing a full array of inpatient, outpatient, and supportive housing care.

5. DECRIMINALIZE SERIOUS MENTAL ILLNESS (SMI)

WHY DECRIMINALIZATION OF SMI IS IMPORTANT:

People suffering with other neurological conditions like Alzheimer’s and dementia can get treatment promptly without being kicked out of their homes to wander the streets until they are arrested and put in jail or prison rather than a hospital. Serious mental illness is the only disease where the doors to treatment are shut unless a crime is committed. This is pure and simple discrimination with the disastrous results we see in our country today — homelessness, incarceration, the disintegration of families, and death.

PRESIDENTIAL ACTION:

• Work with legislators to change “must be a danger to self or others” criteria. • Work with legislators to change involuntary commitment criteria, alleviating the subjective nature of “gravely disabled” and redefining it in objective terms based on scientific medical need for treatment. Psychosis, like a stroke, is a traumatic brain injury and needs immediate treatment for the best outcome.

Returning to the candidates’ manifestos, I have omitted two demands that show up in most of them, yet are given no more than lip-service by none except Bernie Sanders: abolishing capital punishment and solitary confinement. Both are urgent. Deciding which is the most urgent depends, I guess, upon the morbid calculation of whether continued existence in the “hole,” with its barbaric history of destroying human personality, is worth the torture. I have felt my way to an agonizing decision. In my next blog I will urge the candidates to meditate on solitary confinement for exactly what it is, and to treat it as primary target for abolishment.