Jonathan is one of the homeless men psychiatrist Robert Okin met on the Streets of San Francisco.  Okin spent two years interviewing people with mental disorders on the street.

Jonathan is one of the homeless men psychiatrist Robert Okin met on the Streets of San Francisco. Okin spent two years interviewing people with mental disorders on the street.

On any given night, more than half a million people in the U.S. are homeless, and up to 50 percent may be suffering from mental illness. One psychiatrist says these people have become invisible to the rest of us, and set out to learn about their lives. He spent two years talking to and photographing men and women living on the streets of San Francisco. What he found were histories of abuse, neglect, and resilience. Now he argues that legislation to help the homeless mentally ill is only possible if we stop averting our eyes, and start seeing these people as “fully human” members of society. Stories from the mentally ill and homeless in America.

Guests

  • Dr. Robert Okin Practicing clinical psychiatrist and author; head psychiatrist for Disability Rights International; Professor Emeritus in psychiatry at UCSF School of Medicine; former chief of service of the San Francisco General Hospital Department of Psychiatry; former commissioner of mental health in Vermont and Massachusetts.

Photos: The Silent Voices On The Street

How do the homeless end up on the street, and how do they survive that kind of life? Those are the questions Dr. Robert Okin asked as he spent two years on the street in San Francisco.

Here’s a look at some of the people whose stories he’s sharing.

Transcript

  • 11:06:53

    MS. DIANE REHMThanks for joining us. I'm Diane Rehm. The homeless mentally ill have become a fixture in the American urban landscape. Seeing them on the street can make many of us feel uncomfortable and even frightened. Dr. Robert Okin set out to confront his own fears. He got to know more than 40 mentally ill homeless men and women in San Francisco over two years.

  • 11:07:23

    MS. DIANE REHMNow, he's sharing their stories in a new book titled, "Silent Voices: People With Mental Disorders On The Street." Dr. Okin joins me in the studio. We'll welcome your questions, comments. Join us on 800-433-8850. Send an email to drshow@wamu.org. Follow us on Facebook or send us a tweet. Dr. Okin, it's good to have you here.

  • 11:07:55

    DR. ROBERT OKINThank you very much, Diane.

  • 11:07:58

    REHMMy pleasure. Dr. Okin, tell me about that moment in time when you realized you wanted to get started on this project.

  • 11:08:12

    OKINWell, I had been chief of psychiatry at San Francisco General Hospital for about 17 years and when I left that position, I just have this craving to try to understand how people on the street actually lived. You know, I, obviously, had understood that from a clinical point of view, from my position in the hospital, but it's very different trying to understand it actually on their turf.

  • 11:08:46

    OKINAnd I suppose there was a moment when I decided that I just had to do this. I was going to my car, hurrying to my car one winter, rainy night in San Francisco and I saw a woman lying on the street getting rained on. She was shivering and obviously cold and I just couldn't get her out of my mind. Here I was with an umbrella, hurrying to get to my car.

  • 11:09:21

    OKINI had someplace to go. I could get out of the rain. She was going no place and I wondered how she was going to stand it that night and then the next day and the next night and so on. And for some reason, I just couldn't get her out of my mind and I wondered how she was going to get her clothes dry, how she was going to go to the bathroom when there weren't any public bathrooms around, how she was gonna eat, where she was gonna sleep the next few nights and so on.

  • 11:09:56

    OKINSo I decided I was going to spend a couple of years on the streets talking to people and trying to find out the answers to these questions.

  • 11:10:09

    REHMObviously, not living on the street yourself.

  • 11:10:11

    OKINNo. No, I didn't live on the street. I got there about 6:00 in the morning and I left about 11 o'clock at night.

  • 11:10:19

    REHMI see. And early on in your book, "Silent Voices," you talk about a woman named Bridget. Tell us about her.

  • 11:10:31

    OKINWell, Bridget was a woman who told me that she had fallen from the Empire State Building to the curb. She had been sexually abused by her stepfather in her early life and had actually done quite well for herself during her adolescence and during her adulthood she actually got a good job. But her daughter was raped by her daughter's uncle and that brought back all of the memories of her own sexual abuse.

  • 11:11:13

    OKINShe began taking drugs and alcohol and lost everything. She was on the street for some years, became seriously addicted to alcohol and ultimately, and despite the efforts of a lot of people to help her, ultimately died one night of alcohol poisoning.

  • 11:11:37

    REHMYou know, I think that there are a lot of us who do see people on the street, bundled, no matter what the temperature. It might be 90 degrees and people are in layer after layer of clothing. And we do tend to shy away from them, assuming that they, number one, wish to be left alone and number two, have established a life pattern for themselves and that any attempt on our part to interrupt that life pattern would be met with hostility. What did you find?

  • 11:12:31

    OKINWell, first of all, I expected, when I approached people and wanted to find out about their lives, I expected that they would really treat me with disdain. You know, I was obviously the well-heeled guy on the street. I didn't have the authority of being a doctor in a hospital. I was a doctor, but I was on the street on their turf. And I thought that they would turn me away and I was actually quite anxious that that would happen.

  • 11:13:04

    OKINBut what I found was just the opposite. About 70 percent of people really seemed to welcome my approach and wanted to talk about their lives.

  • 11:13:14

    REHMGive me, if you can, take us back to that first encounter you had the courage to make, what you said and how you were received.

  • 11:13:31

    OKINWell, first of all, I have to say I was so uneasy about this project that I actually had to stalk somebody before I worked up the courage to talk to them. I wasn't afraid of them. I was just afraid that they would turn me away, basically, because now I was the supplicant. I was the panhandler with the tin cup. I needed something from them, their stories, their photographs and so on.

  • 11:14:02

    OKINSo I approached someone and I said to them that I was thinking of working on a book that allowed people who were obviously struggling with mental illness and homelessness to tell their stories to the public and I asked them whether I could also photograph them because -- while they were telling about their stories because I found their faces beautiful in some way, you know.

  • 11:14:32

    OKINThe hardship that they lived with was just etched onto their faces.

  • 11:14:37

    REHMAnd, of course, this book is made up not only of the narratives, but of those very photographs.

  • 11:14:48

    OKINYes. I had hoped that the photographs would draw people into the narratives, that when people actually looked at these people and didn't turn away from them, but looked at them -- looked at their photographs, as it were, that they would get interested in what made this person homeless.

  • 11:15:08

    REHMSo what happened the first time you attempted?

  • 11:15:15

    OKINYeah, so I asked them and the person said...

  • 11:15:18

    REHMMale or female?

  • 11:15:19

    OKINI was a man and he told me about his story.

  • 11:15:27

    REHMWhat did you say to him?

  • 11:15:29

    OKINWell, I said to him that I wanted to give people who were obviously struggling a voice in the public arena. I knew that they were stigmatized. I knew that they were seen, at best, as invisible and at worst as pariahs and that people -- and that I believed if people really heard their stories, they would extend kindness to them, rather than blame. That's what I said.

  • 11:16:00

    REHMAnd how did he respond?

  • 11:16:04

    OKINHe said that he was willing to talk to me. And what I expected was a kind of sanitized story and instead, I got a story that was very moving and was, obviously, told to me with candor. He had tears in his eyes through most of the interview.

  • 11:16:27

    REHMWhat made you think he was mentally ill if he could relate that story to you?

  • 11:16:33

    OKINWell, there's a kind of common misperception that people who are mentally ill can't interact in any kind of normal way with someone else and that's just not true. So as I began to talk to him, he initially was a little defensive, but -- although he welcomed my approach, but he warmed up to me after he saw that I was really interested in him as a human being.

  • 11:17:05

    REHMAnd once again, how did you know he was mentally ill?

  • 11:17:13

    OKINWell, he was talking to himself and he seemed very distracted and he had several of the stigmata of mental illness.

  • 11:17:25

    REHMOf course, the question I would raise would be whether he was mentally ill before he began living on the streets or whether living on the streets had created that kind of mental illness. Dr. Robert Okin is with me. He's a practicing clinical psychiatrist, professor emeritus at the University of California, San Francisco School of Medicine. His new book is titled, "Silent Voices." Short break.

  • 11:20:02

    REHMIf you've just joined us, Dr. Robert Okin is with me. He's a practicing clinical psychiatrist, professor emeritus at the University of California's San Francisco School of Medicine. He's former commissioner of mental health in both Vermont and Massachusetts. He's written a new book. It's all about people with mental disorders who live on the street. His book is titled, "Silent Voices."

  • 11:20:40

    REHMDr. Okin, earlier you talked about Bridgette and the fact that she began to use drugs. Now, was she using drugs before she became a person who lived on the street or did the drugs come afterwards?

  • 11:21:08

    OKINWell, she was using drugs before, but she had them under control. But after he daughter was raped she completely lost control and she became strung out on the drugs and then lost everything. So it was a little of both. And once she got on the streets her drug intake increased, because the harshness of the street was so great that she kind of treated herself and changed her mental state so she didn't have to deal with just how grim life was on the streets.

  • 11:21:47

    REHMYou talk about the fact that 40 percent of the women you interviewed on the street had been abused as children.

  • 11:22:00

    OKINYes. It's -- it was shocking just how many of the women had been sexually abused as children. What tended to happen is they were abused and some of them -- most of them were neglected in one way or another. And they began to become symptomatic as children. They developed stomach pains and headaches. They got distracted. They couldn't follow in school. And when they entered their adolescence they began using drugs and acting out.

  • 11:22:35

    OKINSome of them became promiscuous and engaged in other kind of self-destructive behaviors. They fell further behind in school. And they entered adulthood with really no employable skills. And they -- between the fact that they didn't have any employable skills and their symptoms from their early abuse, homelessness was almost guaranteed.

  • 11:23:07

    REHMAfter working as a clinician for so long in a hospital -- the University of California, at San Francisco -- and treating individuals with psychiatric problems, what did you hope to accomplish by writing the book?

  • 11:23:31

    OKINWell, I wanted to try to destigmatize this population. I wanted to try to give these people a human face. I wanted to try to give the reader a sense that underneath their rags and behind their carts and strange behaviors, that they were really people like us. And people with longings and joys and dreams and regrets. And that there were more commonalities between us than differences. Now, why did I want to do this?

  • 11:24:06

    OKINBecause I thought that since the real struggle and the real solution here is at the ballot box, I thought that if people developed a kind of empathy for this group of people, that the public would respond by voting for additional housing and case management, which are the real solutions to this problem.

  • 11:24:37

    REHMAn awful lot of people would say that the deinstitutionalization of this population is what started the homeless crisis to begin with, back in the '70s when institutions like St. Elizabeths, here in Washington, was closed down. That somehow those in power -- and maybe physicians themselves -- decided that institutionalization was not the answer.

  • 11:25:13

    OKINYes. There was a broad consensus on both the left and the right that institutionalization was not the answer. On the right there was the desire to save money. I would say on the left there was an interest in civil liberties of these people and getting them treated in the community. There was a promise that when institutions were closed that the money for the -- from the institutions would follow them into the community.

  • 11:25:42

    REHMA promise not kept.

  • 11:25:44

    OKINA promise absolutely not kept. Now, I have to say that the better functioning of the patients left the institution and for them deinstitutionalization was really a blessing.

  • 11:25:57

    REHMBut that was a…

  • 11:25:59

    OKINBut that was a small…

  • 11:25:59

    REHM…surely a very small number.

  • 11:26:00

    OKINIt was a small population. The rest of the population entered communities that weren't prepared to accept them, that were actively hostile to them, government agencies that were totally disorganized and uncoordinated, and basically with no services. And it was -- it should have been obvious that what people needed most was they needed housing and they needed human relationship with a clinician.

  • 11:26:32

    REHMBut, of course, there are many shelters to which the homeless population refuses to go.

  • 11:26:40

    OKINWell, there are two answers to that. First of all, in general there aren't anywhere near the number of sheltered beds…

  • 11:26:48

    REHMNeeded.

  • 11:26:49

    OKIN…needed. In San Francisco, for example, there are about 1,000 sheltered beds and there are approximately 8,000 people on the street. So it's ridiculous to think that the number of shelter beds is adequate. So that's one issue. The second issue is that there are some people who don't want to go to shelters. And when I asked them, "Well, how can you stand being out in the weather rather than go into some kind of shelter?" They said, "Look, we're afraid of shelters. We're -- our experience in them has been that our possessions get stolen.

  • 11:27:29

    OKIN"We're afraid that because we are sleeping so close to other people that we'll get their infections." And some people who are somewhat paranoid, just can't tolerate the closeness of other people.

  • 11:27:43

    REHMI want to go back to something I said just before the break. And that is to ask you about how many people who are now homeless were mentally ill before they got on the street? And how many became mentally ill once they began living on the street?

  • 11:28:09

    OKINYeah, it's a complicated question. People who -- there's no question that living on the streets really aggravates the symptoms of mental illness. It compromises their physical and tenuous psychological stability. It tends to increase their propensity to take drugs. It just -- it wipes them out, basically. So living on the street definitely can create mental illness, especially for people who are vulnerable, either because of their childhoods, childhood trauma or because of some biological predisposition. But a lot of people were mentally ill before they got onto the streets.

  • 11:28:57

    REHMAnd how many would you say have been drug users/addicts before they got on the street, as opposed to after?

  • 11:29:12

    OKINWell, one person told me that you either needed to be crazy or stoned to survive on the street. So with that as a backdrop, I would say that most people who got on the street, who were mentally ill, were mentally ill before they became homeless. But there were -- but once they become homeless their symptoms get aggravated. And it's very hard for them to take medication once they're on the street.

  • 11:29:42

    REHMDr. Okin, what was your goal? Did you have a sense that what you could do by both photographing them -- and we should point out that you not only asked permission beforehand, but at the end of each interview you wanted to reconfirm that they were okay with your using their photograph and using their narrative. What did you hope? I mean, people can look at this book and think, oh, my God, there but for the grace of God. They can look at this book and see a man who has lost so many teeth, he's ashamed to be in any company whatsoever.

  • 11:30:43

    REHMYou can look at a photograph of someone who has perhaps 10 layers of clothing on, who's wrapped up in the corner of bus shelter. Is that photograph or is that narrative likely to change our behavior, those of us who do not dwell on the street?

  • 11:31:12

    OKINWell, that's what I hoped. I hoped when -- at the simplest level, that when people pass someone who is homeless and caught their eye, that they would, first of all, just simply acknowledge their existence, rather than looking away. So at the simplest level, I wanted there to be some human connection. And I did think that if readers really heard the stories of these people, that it would change their behavior in that respect. I always carry an extra pair of socks with me and give them to people whose feet I can see are infected and beaten up.

  • 11:31:58

    OKINIt's a simple thing. So just as individuals we can do little things like that. But what I hoped mostly was that people would demand that their senators and legislators and the president do something about this problem, rather than just abandoning these people.

  • 11:32:23

    REHMTo what extent have you gotten reaction from professionals or ordinary people who've read the book?

  • 11:32:36

    OKINI have gotten reactions. And I would say 90 percent of the reactions have been something like this, we didn't really know what it was like before we read the book. We didn't know the nitty gritty of what it was like to be on the street, how harsh it was, how difficult it was to climb out of homelessness once you got into it, and just how little chance these people had right from the beginning of their lives. And it increased our sense of empathy for this group of people.

  • 11:33:12

    REHMHow did they find food?

  • 11:33:16

    OKINWell, that's a tough question. Some of them go to soup kitchens, but others who are less functional, frankly, dig into dumpsters and garbage, grab a half-eaten sandwich and half a cup of coffee. And basically live like that.

  • 11:33:41

    REHMAnd you're listening to "The Diane Rehm Show." Would you read us a couple of paragraphs, starting on Page 112? There's a story here about that gentleman who was so concerned about the way he looked.

  • 11:34:07

    OKINWell, it begins by saying, "I turn away and cover my mouth when a woman smiles at me. She'd never look at me again if she saw I had no teeth. Even if I got dentures, it wouldn't help because it's not going to fool her. As soon as we kissed, she'd realize it. She'd be completely disgusted and think I'd misled her. She'd drop me like a hot potato. Better not to let anything start. It would be too painful. I've been telling myself, quit looking at women, you're just torturing yourself. It's not going to happen.

  • 11:34:50

    OKIN"You're going to be alone all your life. It's wicked sad, but that's the way it is. I'm just doomed. You know, if you have big nose, well, no one can blame you. It's just the way you were born. But if you have no teeth, it's proof that you've screwed up real bad. That you must be nothing but a screw-up."

  • 11:35:17

    REHMSo you -- Jeff was referred to you by a case management program at San Francisco General Hospital. And he had been using drugs shortly before you met him. Tell us how that conversation between the two of you went.

  • 11:35:44

    OKINWell, he told me about his early life, first of all. He -- his mother had been schizophrenic and had been in and out of mental hospitals. And he was always terrified at night that she would come and stab him with a knife. So he always slept, in a sense, with one eye open. He, however, despite this background, was able to get a job as a garbage man. But he lost it when some pot was discovered in his urine. He then became very depressed because his job was everything for him. He felt like he had really transcended his childhood.

  • 11:36:32

    OKINHe lost his job. And when he did he became very depressed, couldn't get out of bed, began using drugs and then lost his girlfriend as well. So every -- he lost everything. And he was basically thrown out onto the street because he had no money at all. And he lived on the street for 10 years. He developed dental abscesses, which are very common on the street, because people can't brush their teeth.

  • 11:37:02

    REHMAnd very painful, I would imagine.

  • 11:37:03

    OKINAnd very painful, yeah. I have to say when I -- I had breakfast with him every month for a couple of years. And I could see how difficult it was for him to eat. You know, he would chew with his gums and then swallow the rest of his food whole.

  • 11:37:23

    REHMDr. Robert Okin. His new book is titled, "Silent Voices: People with Mental Disorders on the Street." Short break, your calls when we come back.

  • 11:40:01

    REHMDr. Robert Okin is with me. He's a practicing clinical psychiatrist, professor emeritus at the University of California, San Francisco School of Medicine, former commissioner of mental health in Vermont and Massachusetts. He's written a new book titled "Silent Voices" all about people with mental disorders living on the street. Before we open the phones or read email, you were talking about Jeff who suffered so terribly from loss of teeth. Tell us what became of him.

  • 11:40:50

    OKINWell, he developed a dental infection which traveled to his heart. And he had to be hospitalized and was hospitalized for many months at a cost of about $500,000...

  • 11:41:09

    REHM...through the taxpayers.

  • 11:41:11

    OKINYes, yes. You know, this is an expensive problem not to solve. It's less expensive to solve it and there's good evidence for that. But anyway, getting back to Jeff, a social workers visited him in the hospital and developed a relationship with him. She got him housing and got him on SSI. And ultimately he stopped using drugs and he is now working halftime. So this is a real success story. And I would say that the credit goes to that social worker who developed a relationship with him.

  • 11:41:53

    REHMI should say. All right. Let's go to Phoenix, Ariz. and to Leonard. Hi, Leonard, you're on the air.

  • 11:42:10

    LEONARDWell, Diane, first of all, I just want to say what an honor. I've listened to you and been educated by you for many decades. And so it's finally an honor and I will cherish the fact that I got to speak with you. You're one of my heroes.

  • 11:42:24

    REHMThank you.

  • 11:42:26

    LEONARDYou're welcome. I'm calling because we have a lot of nice people here in the Phoenix metro area and in Arizona in general but I and a lot of my friends, you know, we care about our homeless shelter we have here but we're greatly concerned because we believe our public and our elected officials, while telling us their concern about the homeless and mentally ill, are criminalizing them.

  • 11:42:52

    LEONARDAnd to just illustrate that, Diane -- and thank you to the author because I'm definitely going to get a copy of your book somehow, someway. But to illustrate that, last week at our Phoenix City Council meeting, they passed an emergency rule because we have our Super Bowl coming here in February, stating that people asking for food, asking for money, whatever have you, cannot stand in the medians where they have been for many decades.

  • 11:43:21

    LEONARDSo now these poor people, they're going to have $250 fine the first time. If they don't pay, from what I understand, they can be jailed. And then the second time they'll be given the punishment of a crime that's up there with the DUI, six months in jail, and I'm not sure if it's several thousand dollars fine.

  • 11:43:39

    LEONARDBut I'm just worried -- we're worried the folks that we know here, like one man I work with, he -- I can't get him to go in the shelter. He's obviously mentally ill. He goes off on these rants about conspiracies against him and all of these things. I can't get him to go in. What happens when they criminally -- when they criminalize him, his mental illness. And so that's what I'm hoping that our leaders here in Arizona will listen to this author on your show and put their actions towards not to criminalize people for being mentally ill or hungry, you know.

  • 11:44:15

    OKINYes, you're absolutely right. About 15 to 20 percent of people in jails and prisons are there because they're mentally ill. And unfortunately jail and prison tends to aggravate their symptoms. And the treatment in most of these facilities are either bad or nonexistent. So the fact that political leadership, often supported by the public I have to say, passed laws that criminalize these people is just absolutely criminal in itself, in my opinion.

  • 11:44:52

    REHMNow, do you know of communities that make public feeding of homeless people illegal? Gail has posted that question on Facebook.

  • 11:45:08

    OKINI don't but it seems to be a trend that in some -- at least in some urban areas there are laws against feeding people, against panhandling. And there're actually about 30 communities that have passed what are called sit lie laws which make it illegal to either sit or lie on the sidewalk during the day.

  • 11:45:33

    REHMAnd apparently Florida was recently in the news for this. Here's an email from Mary who said she's just returned to Baltimore after a weekend in New York City. She was shocked to see so many homeless people there in New York. One young man approached her on the subway begging for money for a bus ticket home to Montana. She says, "I so wanted to give him money but was afraid it would just go to alcohol or drugs. Was I wrong," she says, "or were my suspicions sadly correct? What does your guest believe I should've done?"

  • 11:46:25

    OKINWell, I think you have to make a decision on a case-by-case basis. I sometimes give money to people when I have talked to them for awhile and believe that they're really going to use it for what they say. But I'm prepared to be wrong about that. In a way I'd rather be wrong than be withholding in certain cases. In other cases where it's obvious that it's going to go for alcohol or drugs, I tend to buy people a sandwich rather than give them money.

  • 11:46:58

    REHMAll right. To Steve in Lansing, Mich. Hi, you're on the air.

  • 11:47:05

    STEVEThank you, Diane, for taking my call.

  • 11:47:07

    REHMSurely.

  • 11:47:09

    STEVEI am a recovering addict of 13 years. I struggled with drugs and alcohol after I came out of the service in the '70s and carried it on into civilian life. But because of circumstances really, you know, hitting bottom I was able to seek treatment. I believe there's such thing as acquired mental illness. I feel when I was growing up, I had learning disabilities. And I just sort of built onto that with, you know, that was the people that accepted me. I was told in school I wasn't smart, I wasn't good.

  • 11:47:49

    STEVEAnd I sort of acquired a lot of my thoughts, but once I got acclimated back to the human -- because we do, we get detached from humanity and we get isolated and lonely, but once we're able to come back and reattach to humanity, then all the help that's out there for us will work. I just wondered what his feelings was on that.

  • 11:48:13

    REHMOne eloquent statement.

  • 11:48:16

    OKINYes. Well, I think the caller is absolutely right. And I think his experience has been replicated by other people. What is first needed with people who are detached and people who feel like a failure from the beginning -- it seems like our caller really eloquently stated that, he just felt like a failure right from the beginning of his life and got thrown into drugs that way -- the most important thing we can do is to have social workers that have the time and the caseload to develop a human relationship with these individuals to reattach them.

  • 11:49:02

    OKINAnd that takes time. They've got to meet them where they are. They can't expect them to come through a clinic. They have to -- the social workers have to go out into the street and meet them in bars, on the street, in churches and so on and so forth. And overtime most people, even people who are very psychotic or very involved with drugs are able to respond to that kind of clinical wisdom and caring.

  • 11:49:33

    REHMLet's see, we had an email from Rhonda who says, "The quote from a mentally ill person describing his suffering due to loss of teeth really touched my heart. My own stepson who is paranoid schizophrenic almost died last year due to a dental abscess. I've written a proposal to increase the availability of dental care for persons with mental illness in Montgomery County, Md. first by finding dentists willing to do pro bono work and ultimately to advocate for legislation that would include dental care for adults on Medicaid."

  • 11:50:30

    OKINCrucial, absolutely crucial. What tends to happen is when people develop dental abscesses on the street, which they're very susceptible to, if they go to a hospital, it's much cheaper for the dentist to simply pull the tooth rather than repair it. And that's why so many people have lost their teeth. So including dental care in Medicaid I think would be a tremendous boon.

  • 11:50:58

    REHMBut the idea of the man Jeff that you profiled here costing the hospital and taxpayers some $500,000 ought to be a wake-up call for everybody.

  • 11:51:16

    OKINWell, it should be. And I think one of the reasons it's not is because this group of people is so stigmatized, we treat them with such revulsion that we either want to forget them and marginalize them and push them to the edges of society and just ignore them because we don't like them. We don't like them, we're afraid of them and we blame them for their own homelessness.

  • 11:51:45

    REHMLet's go to Bonita Springs, Fla. Hi, Jim, you're on the air.

  • 11:51:52

    JIMGood morning here. I guess it's still morning there too...

  • 11:51:56

    REHMSure is.

  • 11:51:56

    JIM...San Francisco. Hey, this is a great program. I just want to thank this Dr. Okin for doing this project. I can't -- I don't know where to begin but this is -- everything he's saying is so true. I experienced all this firsthand myself along with many colleagues. I was a paramedic for over 20 years in the Bay area in Oakland and San Francisco. I began in 1985. That was 30 years ago. The problem in '85 was exactly how he is describing it now.

  • 11:52:30

    JIMSo we go on decade after decade and every once in awhile somebody comes up and exposes this problem or brings it to the public's attention. And then we move on and in another ten years get exposed again. It's not because of a lack of resources or a lack of people that are willing to go out and actually work with these folks. What's missing is the fabric, the individual thread of our society. For every single taxpayer, every voter, every member to do their little teeny, teeny part. That's how it's going to be solved. When we...

  • 11:53:08

    REHMSo the question becomes, what's wrong with the systems we have in place now for helping people like this?

  • 11:53:20

    OKINWell, at the deepest level, the problem is that we do not have the political will to solve this problem. And it's not just because of the politicians. The public elects the politicians. And the politicians are responding to the feelings of the public. So I believe it is a cultural phenomenon. And when these people become less stigmatized then things will change. I also want to say that there are some states that have done something about this. This is an imminently solvable problem. Utah is an example of that.

  • 11:54:05

    REHMAnd you're listening to "The Diane Rehm Show." What has Utah done?

  • 11:54:13

    OKINWell, it's developed a program that's being sponsored actually by the federal government called Housing First. And it basically provides housing -- it's a simple project. It provides affordable housing for chronically homeless people without requiring that they take their medication first or that they become clean and sober first, which has been unfortunately the traditional approach to this. So this new approach, which has put people in housing and then you can treat them. The result of that is that they're chronically homeless population has decreased by 70 percent in the last eight or nine years. Proof that this can work.

  • 11:55:00

    REHMBut how realistically are they able to maintain even the living quarters they have and still be on drugs or alcohol or what have you?

  • 11:55:15

    OKINWell, first of all, about 85 or 90 percent of people who are housed under this project remain housed. They did not blow out of their housing as was expected. And the fact is that it's very hard to treat people who are actually living on the street. They can't take their medications. They can't store them. They can't keep track of them. They can't get them. And the only way that they have a hope of being treated is being housed first.

  • 11:55:46

    OKINI mean, just think about what it would be like to live on the streets and try to take care of yourself, try to deal with your substance abuse problem, your psychiatric problem. It's impossible when you're on the streets. When you're housed, there's really a chance. And the experience is that when people are housed, they're much more willing to take psychiatric medication, much more willing to have their substance abuse problems treated because they're not struggling for physical survival every day of the year.

  • 11:56:19

    REHMAnd are we seeing more and more children on the street?

  • 11:56:25

    OKINWell, there's been a report released recently that suggests that there's been an 8 percent increase in homeless children. That's a discouraging figure. HUD did what's called a point in time study recently that showed that there were 140,000 people -- kids on the street under 18. This new study suggested that using a different methodology that about 2.5 million children were homeless at some point during the year.

  • 11:57:05

    REHMAnd finally an email from Jen in Maryland who says to you, Dr. Okin, "Thank you for doing this project and bringing these voices to the fore. We need more people like you." Dr. Robert Okin. His new book is titled "Silent Voices." Thanks for listening all. I'm Diane Rehm.

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