General Description of Place and Population:

In a city so often seen as glitzy and glamorous, as prosperous and care-free, a very unglamorous fact stands out: Los Angeles is the homeless capital of the United States. Nearly 12,000 of the city’s estimated 82,000 homeless live in Skid Row Los Angeles (Homeless Census Findings, 2005). Located in Downtown Los Angeles, Skid Row extends from 3rd Street in the north, to Main Street in the west, 7th Street in the south, and Alameda to the east. This segment of Greater Downtown neighbors the Financial District, the Historic Core, Bunker Hill, the ethnic communities of Little Tokyo and Chinatown, and the produce, flower, seafood, and garment centers. Skid Row has long addressed the needs of a homeless population desperately in need of shelter and social services (Spivack, 1998). Korean toy merchants – attracted to depressed land values in this long neglected and forlorn area – began to settle here en masse during the 1980s (Hong, Duff 2003).

Homeless mentally ill men of Skid Row make up a large and diverse crowd who suffer from a wide array of mental illnesses. This list ranges from acute depression and anxiety, to schizophrenia, psychosis and other bipolar disorders. The mentally ill make up 33 percent to 50 percent of the total homeless population in Skid Row (USC, 2004). Many in this group are war veterans and a large number experience substance abuse problems and poor physical health. Being the hardest victims to house and treat, and the most likely to get arrested, mentally ill men are some of the most vulnerable to the vagaries of street life (USC, 2004). In short, the problems here are complex and widespread: a look at the services and policies targeting this group will shed light on the complexities surrounding Skid Row.

Comparison of Service Programs:

Services offered to the mentally ill men on Skid Row share one common theme: to be helped, these persons must be drawn out of their isolation into a stable and safe environment and reintegrated back into “mainstream” society. This is a ready response given that the social order has failed to draw these persons back into the fold. The following programs offer comprehensive services and housing to mentally ill homeless men on Skid Row: the JWCH Institute, Inc (1979), L.A. Mission (1936), SRO Housing Corporation (1984), Union Rescue Mission (1891), Weingart Center (1983), and LAMP Community (1984). I will examine their differing styles on how best to transform and reshape the lives of mentally ill homeless men through housing, treatment, and coordinated services.

Skid Row’s mentally ill men must be housed first before being treated for their many near-intractable needs. When it comes to housing, it is not solely a question of finding shelter but one of keeping these individuals housed. That is to say, shelter alone cannot solve the problem – rather services must step up to keep the mentally ill from failing in and out of homelessness. In their study, “Quality of Life of Homeless Persons with Mental Illness” Sullivan et al. explain: “This study and others suggest that persons with mental illness may cycle in and out of homelessness more often. To address this pattern, providers should emphasize programs that ensure not only that mentally ill persons obtain housing but also that their housing situations are stable and durable over time. (Sullivan, 2000:8) The glaring weakness in the service system is in this link between mental illness and chronic homelessness.

At some levels, the system of charitable services prevents and discourages people from finding stability and care. The L.A. Mission (LAM) and Union Rescue Mission (URM) offer help to nearly all who enter their doors providing mental health services for men on Skid Row. However nice their intentions, these services uphold numerous rules and restrictions, and push an unyielding set of religious beliefs. In short, these requirements often prove too overbearing for those in need. Likewise the SRO Housing Corporation (SROHC) and the Weingart Center (WC) have similar limiting restraints. For example, each provide programs to treat substance abusers that requires sobriety in order to qualify.

LAMP Community (LC) turns away from this model offering instead a “no strings attached” view to treatment and housing. Here, the LA Times editorializes that LC is a “place short on rules and long on services. Residents come and go as they please, taking or leaving the generous supply of mental health and substance abuse programs on site” (1). LC programs advocate that housing must be dealt with in both in the short-term and long-term. The SROHC takes this a step further by purchasing old hotels, refurbishing them, and offering them as affordable housing units. Once placed in a safe albeit impermanent environment, mentally ill men on Skid Row can begin to improve their quality-of-life.

The proper treatment of mentally ill homeless men on Skid Row involves directly improving their destitute quality of living. A survey of their needs brings this into focus: these men suffer from acute and chronic health problems, they lack accessibility to health care, and have problems finding adequate shelter, food, and clothing (Sullivan, 2000:8). Service programs on Skid Row have not effectively changed all of this. In fact, many of these men would go untreated if not for emergency room visits (USC, 2004). Sullivan et al. argue the following: “Interventions most likely to improve the quality of life of homeless persons with mental illness include those that stress maintenance of stable housing and provision of food and clothing and that address physical health problems and train individuals to minimize their risk of victimization. Interventions that decrease depressive symptoms might improve subjective quality of life” (2).

Shelter gives mentally ill homeless men relief leading to an improvement in quality of life. This can be offset when these individuals are barred by their program for disciplinary reasons. LC is the only program to seriously and unequivocally do away with this. Given mentally ill homeless men’s limited access to services, street-level intervention is also critical. The JCWH Institute, Inc. (JWCH) initiates such a service with their Skid Row Medical Outreach Team: “Outreach workers walk the streets, alleys, and under freeways engaging individuals in conversation, while offering referrals” (JWCH Institute: 2). A current trend in service provision has been the push to coordinate services.

In short, effective approaches are light on eligibility requirements and disciplinary rules, heavy on street outreach and access to integrated services. Programs targeting homeless mentally-ill chronic population offering holistic, multi-faceted approaches to treating their clients can rehabilitate and thus lessen homelessness in this population group. Frances Randolph et al. define this approach in their work “Creating Integrated Service Systems for Homeless Persons with Mental Illness”: “The term ‘services integration’ has been used broadly in the human services field to refer to a range of service delivery and systems reform initiatives aimed at improving outcomes for people with complex needs” (Randolph, 1997: 370). JWCH, working on site in the Weingart Center, provides medication, and health care to the homeless mentally ill, SROHC, through the Golden West-Transitional Program, provides this group with substance abuse rehabilitation, clinical guidance and training for independent living. URM and WC likewise offer mental health service, with the WC setting up a clinical services department. Furthermore, each of these programs help resolve benefit-related problems. Gaining access to these benefits can transform a person’s life while decreasing homelessness long-term. The problem with coordination is summed up in the following: “Coordination among agencies to facilitate access is hampered because of different funding restrictions, service eligibility requirements, geographic boundaries, treatment or service philosophies, and administrative policies” (369).

(WORK IN PROGRESS TO BE CONTINUED)

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