Like most states, Colorado is in a deep budget crisis with some very difficult choices to make. One significant expense (larger than higher education) is our prisons. Another very large expense is Medicaid, within which mental health has sustained large cuts in the past and is being viewed as an opportunity for further cuts in this budget cycle. What is the connection? Taking a look at Texas, which ranks 50th on per capita spending for mental health, the largest mental institution in the state is now the Harris County Jail in Houston. When mental health services are cut back, those with severe problems wind up in prison and on the street, and many times in a repetitious cycle between the two, often punctuated by visits to the emergency room. This isn’t cost effective, nor is it humane.
To find a real solution, we must address misperceptions about the homeless: that they “prefer” homelessness, and they aren’t motivated to improve themselves, acting in a way that perpetuates their problems. Like most generalities, these don’t apply to everyone.
One of many studies on trauma and the homeless concludes, “in addition to the experience of being homeless, an overwhelming percentage of homeless individuals, families and children have been exposed to additional forms of trauma, including childhood neglect, psychological abuse, physical abuse and sexual abuse; community violence; combat-related trauma; domestic violence; accidents and disasters.” Looking at the “difficult” behaviors of many homeless people, we find a close correspondence with the symptoms of trauma: depression and diminished interest in daily activities, flashbacks and triggered responses, irritability, outbursts of anger, difficulty concentrating, feeling unsafe or helpless, difficulty trusting, a loss of a sense of order in the world, and use of alcohol or drugs to manage emotional responses.
Without an understanding of the issues, we may make cuts that wind up costing us more, both in dollars and in human terms. An investment in appropriate care and healing for the homeless will help reduce the cost of prisons and healthcare while improving the quality of life and community for us all.