Fusing Fitness With Mental Health Treatment in Supportive Housing and Related Settings

The New Social Worker magazine published a piece I wrote last summer shortly after earning my MSW in their Summer 2017 issue [Available for Download here].

Here is an excerpt: 

Four Attributes of an Effective Program

During the past year, I have identified four core attributes of the programs that effectively foster an atmosphere of health within the community and that enable individuals to attain their physical health, mental health, and recovery goals.

First, the programs provide preventive, holistic healthcare by addressing chronic health problems proactively—a key to improving quality of life and reducing emergency room visits.

Second, the programs fuse fitness with mental health in a setting that contrasts the traditional seated, face-to-face counseling experience. The transference experience is quite different when a client and worker chat while pedaling stationary bicycles next to one another. Individuals often seem more comfortable talking while exercising and frequently share information with me that they have not yet talked about with their social workers or case managers. For example, a client recently disclosed to me how his family dynamics influence his substance use while he rested between sets of 10 push-ups. I am able to discuss such experiences with clients and encourage them to share these issues with their social workers.

Third, clinical evidence indicates that exercise serves as an effective tool in the substance abuse intervention toolkit by affecting the brain’s reward system and serving as a positive, non-drug reinforcer (Smith & Lynch, 2012). In a practical sense, exercise provides a structured alternative to substance use during the period in which one prepares for and engages in it.

Fourth, exercise programs build community among staff and tenants and promote egalitarianism in the client-worker relationship. Typical barriers disintegrate when a case manager and client try to complete one last squat or shoulder press together.

Health services need integrative fitness - especially for homeless veterans

Independence Day presents us with an important opportunity – amid the cookouts and fireworks – to reflect on the needs of our nation’s military veterans who continue to experience a significant rate of homelessness despite prominent efforts by the federal government and nonprofits to develop housing and end veteran homelessness. According to the Department of Housing and Urban Development, roughly 40,000 homeless veterans remain, as of August 2016. 

Read the rest in the Walnut Health Weekly Journal: 

Data obtained through a Freedom of Information Law request suggests less than 5% of shelter population from out-of-town

Shelter population data obtained from the New York City Department of Homeless Services through a Freedom of Information Law (FOIL) request demonstrates that less than 5% of the city shelter population provided a most recent zip code outside New York City on February 28, 2017.

Nearly as many people provided the Bronx zip code of 10456 (2,252) – which includes parts of Morrisania and Claremont Village – and the Brooklyn zip code of 11207 (1,910) – which covers parts of Bushwick, East New York and Brownsville – as provided 'No Verifiable Associated NYC Address' (2,278).

Newark arrival

We pulled into Penn Station and rushed off the train.

On the ivory tile, we noticed a stain.

A man on the floor like a spill or a smudge,

Which we all stepped around – the man didn't budge.

The manager knocked on the maintenance door,

And told them ‘Go clean up the mess on the floor.’

The janitors sick of such mopping and sweeping

Propped up a sign that said Caution: Man Sleeping. 

An abandoned campsite near my apartment

I went down to the subway at about 6:30 this morning and came across the remains of a campsite just outside the turnstile. 

I rarely ride the train so early and, in four years, I have never encountered an intimate scene like this at my local station. A new box of toothpaste sits in a plastic basket. There's a 2L bottle of Coke – with a few sips left –  and a package of disposable razors in a cardboard box on top of a bathrobe. The not-quite-empty bowl of soup and the frozen, half-eaten banana seem to suggest that the squatter left in a hurry. What made them leave?

I wonder if they'll come back for their stuff. 

Eight Asleep

I peeled my face off my phone this morning and noticed eight people slumped in the subway sleeping, each person spaced just about evenly through the car – an old one with the red, yellow and orange seats; the faux wood paneling.

One, a hipster in a blue peacoat and brown desert boots who clutched the canvas knapsack on his lap. He roused himself near 125th Street and headed above ground.

The others, well, they at least looked homeless, hunched in a light blue pleather jacket, bulging workboots, a natty patchwork skirt under a brown trench coat.

with layers. Too many layers on a 70-degree day. Black winter coats over hoodies with scarves dangling to the floor.

This must be the quiet car.

The A Train at 9:30 am may be the ideal subway for sleeping as it completes its route from Far Rockway to Inwood with long, uninterrupted periods between a few stops. The cars rock gently, squeak lightly as the train whooshes under Central Park. Too early for Showtime, too late for work. Out of the shelter and down underground.

With bags. Shopping bags on the nearby seat or on the floor, tucked under the chair.

The ideal subway for sleeping. What amenities. What solitude.

An old woman in an inflated beret like a bowling ball rested her head on her chest and tried to sleep.

My story on NYC's protections for undocumented immigrants in DHS shelters

After about a month of reporting and researching, I wrote a piece for City Limits about New York City's protections for undocumented immigrants connected with city agencies, including the Department of Homeless Services. When Trump announced his immigration executive order threatening to defund “sanctuary city” localities that did not comply with federal government requests for information, I first wondered what would stop federal immigration forces from indiscriminately raiding homeless shelters – often barracks-style converted basketball courts that house scores, or even hundreds, of the city's most vulnerable residents.

I remember going to school in Boston during Immigration and Customs Enforcement raids on factories in New Bedford and at a supermarket in Chelsea. And those people were workers who clearly contributed to the economy and paid taxes. Fear and suspicion pervaded immigrant communities in New England and, likely, the rest of the country. I feared the harassment of non-citizens in shelters who depend on city resources – in this case, incurring costs for housing, case management and meals.

In the past, NYPD, as well as police departments from Long Island and New Jersey, regularly accessed DHS records to identify and arrested individuals with outstanding warrants. ICE, however, cannot do the same. In fact, the federal government cannot access city records related to immigration status except for immigrants with felony convictions.

I spoke with several shelter staff, immigration advocates and legal experts. The consensus is that the city's protections remain strong for safeguarding the information of undocumented immigrants. Federal immigration law sounds scary but remains quite vague. It also lacks the power to compel cities and states to record or turn over confidential and protected information.

An oz. of prevention more realistic than a lb. of cure in our weak welfare state

The City, State and Federal Government, in descending order, do a very poor job of helping those who experience homelessness get a home. Hundreds of thousands of New Yorkers contend with an insane rent burden (>50% of income on rent) and there's little relief in sight. The State has not fulfilled its commitment to affordable housing – a commitment announced to much fanfare by Gov. Cuomo in January 2016 – while the City has faced huge opposition from neighborhoods wary of any rezoning plan, even if creates affordable housing.

Yesterday, Dr. Kim Hopper – Columbia professor, cofounder of the National Coalition for the Homeless and an eminent activist-scholar on homelessness and homeless policy – wrote a CityViews editorial in which he summarized the seemingly intractable systemic roots of homelessness and expressed some cautious optimism about the efforts of the DeBlasio administration and some State lawmakers at homelessness PREVENTION:

Advocates argue that shelter should be a buffer, a last dignity-shielding redoubt, not a degrading penalty for failure to plan or cope. In a weak welfare state, it will probably never be that. But we can commit to making it a decent way-station, not a grim terminus. Better still would be targeting resources where they can do the most good—in prevention.

Unfortunately, because of out-of-control rent and little commitment to affordable housing development, shelters will remain an important part of dealing with the homelessness crisis, Hopper continued.

So there’s no evading this awkward truth: Whether as prevention, deterrence or respite, the shelter system will continue to anchor and belay the housing struggles of low-income New Yorkers. What was once a rude salvage operation targeting the disreputable poor is now an integral part of how those disfavored by fortune get by.

In such an environment, it’s folly to subscribe to “disparate missions” for housing and homelessness divisions within city government. It’s cynical for the state to play coy. Intensified preventive efforts and set-asides in existing housing will surely help; so would more rational institutional placement. But without a serious reckoning with what it will take to integrate affordable housing and shelter policy in the long run—and a significantly greater commitment from the city and state to creating housing affordable for those earning 30 percent of area median income or less—the specter of enduring mass homelessness will continue to haunt New York.

But if we can’t “build our way out of” this crisis, there is promising news on a parallel front. The “Housing Stability Support” policy being developed by State Assemblymember Andrew Hevesi draws upon the demonstrable success of a host of targeted (if often time-limited) rental subsidy programs, programs that have operated at varying degrees of visibility. Left to its own devices, of course, the private market is an inconstant partner. But the focus on enhanced demand (rental subsidies to be used in existing housing), in addition to expanded supply (developing affordable units as contingent “set asides”), is a welcome one. The devil, as always, will reside in the details.

There’s a work requirement for the right to the opportunity to access your rights

We’re discerning with our rights here in the United States. Critics might call it stingy, but that’s because they’re extravagant suckers, handing out rights to everyone and their immigrant mother.

You have to earn your rights here in this country.

You don’t have a right to your rights. Rights are a privilege and we’re teaching you responsibility and gratitude by distributing them in increments.

I’ve read the United Nations’ Universal Declaration of Human Rights. I know that Article 25 states:

(1) Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.

(2) Motherhood and childhood are entitled to special care and assistance. All children, whether born in or out of wedlock, shall enjoy the same social protection.

But that’s just phony universalist BS. Where’s the incentive to work if food, clothing, housing, medical care and social services are all guaranteed??? Whenever my kid tells me he's hungry, I'll just tell him to go into the kitchen, grab a red pen and punch up the verbs on his resume.

I concede that some rights are sacred. Like the right to a work requirement. We are, of course, bestowed by our creator with certain unalienable rights, among them life, liberty and a work requirement to access a basic standard of living. What does that work requirement mean in practice? Who the fuck knows? Citizens have debated it since the nation's founding.

I think it means that if you find yourself homeless, you gotta be a cashier at a Dollar Tree to get a studio apartment. Or maybe that, if you can't afford healthcare for your children, you have to fold Little Caesars pizza boxes for at least 35 hours a week to enable them to see a pediatrician. Something like that. Who cares. WORK REQUIREMENT. Just flows off the tongue all easy and memorable the way the Framers intended. 

Now, if you're asking about an individual's right to work, you're asking the wrong question (again, we don’t just give out rights all willy-nilly).

Right to Work actually refers to the unalienable right of employers to erode the workers' rights that don't really apply anymore. Like the right to organize. Or to receive compensation when your hand gets crushed by a pallet of Ragu jars.

Still confused? I recently came across this opinion piece in the New York Times by Howie Husock, vice president of the  Manhattan Institute, a think tank that pumps out vital policy papers about why basic human rights are dependent on low-wage work at corporate behemoths.

Husock captures how this notion of a "right to housing" actually harms homeless kids and inspires them to be unemployed and pregnant later in life:

“For the families with children — many headed by single parents who had been doubled-up with family but were not literally on the street -- our strategies [for housing] should not be the same [as with single adults with mental illness]. We must acknowledge the risk that offering housing units will increase demand and even the formation of more such households, which are often homes to children who will face toughest type of poverty and greatest economic disadvantage. In other words, the “homeless” family problem is actually a subset of our challenge in assisting low-income, single-parent families without encouraging their formation.

Indeed, we must take care to avoid the risk that expanded government benefit programs—such as housing based on the combination of low-income and the presence of dependent children—may discourage the steps that will help improve a household’s long-term economic condition. As the University of Maryland poverty researcher Douglas Besharov observed in 2013 Congressional testimony, “Means-tested benefit programs undermine much of the good they do because their very structure creates substantial disincentives to work and marriage.”

This guy gets it. If a four-year-old had a job, she wouldn't be homeless. These kids needs to learn that there’s a work requirement for the right to the opportunity to access your rights. It just makes sense.

Ten gentle strategies for motivating low-income tenants to move out so you can jack up the rent guilt-free while maintaining plausible deniability

Upwardly mobile hipster kids are eager to fork over a few thousand bucks for any modest studio in a trendy neighborhood. Do you own a building in one of those up-and-coming spots? Well aren’t you are a savvy speculator.

Unfortunately, you’re probably saddled with a handful of low-income or, even worse, rent-stabilized tenants. You need to get them out of there so you can double the rent for some graphic designer who just moved from Ohio! But, understandably, you don’t want to be mean about it.

Therefore, you have to avoid all the standard slumlording strategies. You can’t neglect maintenance and repairs. You can’t cut off the heat and hot water. You can’t send fake eviction notices. You can’t bribe them with pitiful buyouts that seem like a ton of money to a poor person. You definitely can’t threaten them.

So here are ten gentle strategies for motivating low-income tenants to move out so you can jack up the rent guilt-free while maintaining plausible deniability.

1. Frame your tenants for a victimless crime that carries a relatively light sentence at a minimum security prison. Insurance fraud or tax evasion would work. 

2. Host a community-building backyard cookout. It won't be your fault when the s’mores campfire accidentally sweeps through the first-floor apartment (Bonus points for collecting insurance money and jacking up the rent).

3. Commence relentless doxxing campaign in which you share your tenant's home address and vital information.

4. Borrow your tenant's computer and stumble upon some shameful photos, texts or internet search results that inspire your tenant to change cities once they are shared online. 

5. Play the long game: Begin dating your tenant. Encourage him/her to break their lease and move in with you. Cohabitate for roughly two months. Gradually lose interest in them. Retreat from their touch. Mysteriously fail to come home after a work party. Sit them down for an important talk later that week. Tell him/her it’s not working out. 

6. Another long game: Find out where your tenant works. Research the company. Apply for a job in a supervisory role. Prepare for interview. Nail it. Get hired. Conduct quality review. Propose a cost-saving employee reduction plan. Receive praise from budget-conscious administration. Lay your tenant off. Expect them to pay rent despite reduced income.

7. Pump marijuana smoke through the radiator. Only a herb with no chill would complain. Your tenant would likely save face by quietly moving. 

8. Be too nice.

9. It would be pretty messed up if some of those notorious “sewer alligators” crawled up through the pipes. Just saying.

10. Cut off the cold water.

sewergator

Health care is a right, which makes health insurance a right, which saves people money, which enables them to afford housing

I took me a while to comprehend that there are people who I will never agree with. We just have fundamental philosophical differences that we will never reconcile. I used to believe that goodwill and empathy eventually win out. That with enough exposure to alternate ideas and experiences with people who share those ideas, people will find middle ground or shift toward inclusiveness. Unfortunately, that isn't true. 

In his book Don't Think of an Elephant, which discusses how liberals can effectively frame issues to present an inclusive, progressive moral vision for our country, George Lakoff writes:

"The . . . mistake is believing that, if only we could present facts about a certain reality in some effective way, then people would 'wake up' to that reality, change their personal opinion and start acting politically to change society . . . The reality is certain issues have to be ingrained in us – developed over time to create an accurate frame for our understanding." 

Like the issue of health care.

Consider this excerpt from an interview with Iowa Rep. Steve King, who introduced the House bill to repeal the Affordable Care Act, on NPR's All Things Considered last night

HOST ROBERT SIEGEL: Donald Trump's adviser Kellyanne Conway recently told an interviewer, we don't want anyone who currently has insurance to not have insurance. Would that be for you the test of a new law or the test of what happens after Obamacare is repealed - no one who's gotten health insurance through Obamacare losing it under its repeal and replacement?

KING: I think that's a fine and shining ideal, but it wouldn't be my standard. We have about 20 million people that they say would be pushed off of Obamacare if we just repealed it and did nothing. I look at the numbers on the 20 million. It's about 10.8 million that were pushed onto Medicaid, and so I don't really look at Medicaid as a health insurance policy that you own.

I would argue there is no constitutional - you have no right to a health insurance policy. Whatever our hearts tell us, we can provide those things, but there's not a right to them. The roughly 9.2 million people that are insured under Obamacare that would presumably lose their insurance if it were repealed - they're living under a subsidized premium, and that subsidized premium is paid for almost a hundred percent by the taxpayers.

"You have no right to a health insurance policy." That is simply an ideological position I fundamentally oppose. 

Health care is a human right.

In our society, access to health care largely depends on access to health insurance because without health insurance, we tend to forgo health care, settle for haphazard remedies and neglect preventive care.  Therefore, there is an implied right to a health insurance policy because that policy is a prerequisite for affordable, appropriate and necessary health care.

Lakoff chastises liberal leaders for failing to present the right to health care as a moral imperative and for not reaching enough people with their vision.

Here's Lakoff: 

"Conservatives understood that politics is a matter of morality and decided to attack [the Affordable Care Act on moral grounds. They chose two moral domains: Freedom and Life. On Freedom, they attacked it as a "government takeover." On Life, they said it contained "death panels." And they repeated "government takeover" and "death panels" over and over, month after month. And every time the president said "It is not a government takeover" he used the words government takeover, which activated the idea of a government takeover, thus reinforcing the conservative attack."

"If the president had understood the conservative framing tactic, he could have undercut it in a simple way. He could have adopted the same two moral issues, Freedom and Life, from a progressive perspective."

"If you have cancer and you don't have health care, you are not free. You are probably going to die (a Life issue) . . . Even if you break your leg, do not have access to health care and cannot get it set, you are not free . . . Ill health enslaves you. Disease enslaves you."

Seven years later, is the rejection of the ACA still an issue of insufficient framing and presentation? Or is that rejection actually a GOP rallying cry, a piece of conservative canon, a repudiation of Obama and progressivism fueled by mythical individualism and infused by racism against the perceived undeserving recipients of Obamacare (poor people of color)? 

I think commentators tend to overstate the framing argument. I think a certain segment of the population would reject anything Obama championed or achieved.

But with Trump and the GOP about to invalidate expanded health coverage, kick millions off health insurance and prevent millions more from obtaining affordable coverage, I constantly dwell on the threat to Life and Freedom, as Lakoff put it.

Poor people who lose or who are denied health insurance –– like those covered by the ACA Medicaid expansion or those who do not get coverage from their jobs but received access to subsidized health insurance through the ACA –– will suffer injuries and illnesses catastrophic to their health, their finances and their tenuous housing. Many people live paycheck to paycheck and spend a significant chunk of their income on rent or mortgage – often more than half their income. If they incur a medical expense - such as an ER visit or diagnosis of a chronic illness – and lack health insurance, they will owe thousands of dollars that they do not have. They can't pay the bill and their rent at the same time. The medical debt collectors will never let them off the hook. So they'll have to stop spending money on other things, like housing. In other words, they won't be able to afford rent or mortgage payments.

So health insurance preserves peoples' finances and enables them to afford housing. Coverage preserves their life and freedom. Conservatives either don't consider that position or don't care. Many of them will never change their minds. So we have to stand up for our convictions and outnumber them. 

 

Improving safety without building a Shelter-to-Prison Pipeline

Department of Homeless Services security guards – called peace officers or special officers – earn a starting salary of $31,482/year to maintain order at shelters where many of the residents have severe mental illness and where everyone experiences the anxieties, agitations and heightened stress levels associated with poverty. At family shelters, young children mingle with teens and adults and domestic violence is common. So is substance use. 

Here is a list of special working conditions copy and pasted from the DHS Special Officer application:

"Some of the physical activities performed by Special Officers and environmental conditions experienced are: working outdoors in all kinds of weather; walking and/or standing in an assigned area during a tour; driving or sitting in a patrol car during a tour while remaining alert; running after a fleeing suspect; climbing up stairs; may assist in carrying an injured adult; gripping persons to prevent escape; restraining a suspect by use of handcuffs; may be required to detect odors such as those caused by smoke or gas leaks; engaging in hand to hand struggles to subdue a suspect resisting arrest; being physically active for prolonged periods of time; understanding verbal communication over a radio with background noise; reading and writing under low light conditions; carrying or wearing heavy equipment and wearing a bullet-resistant vest."

It's a demanding, physical job. As the face of authority and of the shelter itself, peace officers tend to bear the brunt of shelter residents' anger. Yet, they lack the de-escalation training of a social worker or the authority of a police officer. Social service staff and mental health workers do not spend nights at the shelters - the special officers are the only ones there. The officers deserve extensive social service training and support to better work with clients who experience emotional disturbances as well as those who need to save face and never back down from perceived challenges. Meanwhile, residents deserve compassion, patience and understanding of their day-to-day frustrations, including those that stem from discomfort, powerlessness and lack of solitude.

Two days ago, the City announced that the NYPD will broaden oversight at city shelters and assign additional cops to manage the whole force of 771 peace officers. This could be a positive development: NYPD will provide more training on working with emotionally disturbed persons (EDP) and victims of abuse. The move will likely foster more accountability.

Nevertheless, When the law enforcement presence increases, arrests increase. The new chain of command could lead to many unintended consequences.

For every 'bad apple' violent offender who makes the environment dangerous or unhealthy for everyone else, there are certainly many more low-level offenders whose minor misdeeds (open containers, sex work, marijuana use) ensnare them in the criminal justice system. That's what happens at public schools where the presence of police officers means the criminal justice system now punishes issues (like petty theft or hallway scuffles) previously handled in-house by the school. That has led to more children and young adults yoked with records that weigh them down for life, lead to more severe sentences after violations (accumulating offenses or 'strikes') and inhibit employment and housing opportunities. 

NYPD Deputy Chief Edward Thompson said the new oversight structure will promote collaboration between peace officers and police. Again, that is a mix of good and bad. 

Would police encourage peace officers to carry broken windows policing into shelters in order to make more arrests for minor quality of life violations? Would they impose a form of indiscriminate stop-and-frisk? Would police and collaborating peace officers safely and reasonably manage individuals with mental illness? Or would they try to overpower emotionally disturbed people rather than patiently work with them? 

Last year, NYPD officers, plus cops from New Jersey and Long Island, combed shelter rolls to hunt residents with outstanding warrants. Such warrants often relate to unpaid citations for quality of life violations like open containers or public urination, the violations that already disproportionately punish low-income people. Such fines also pose a more severe financial burden to the working poor or individuals on a fixed income.

Perhaps this is a smart structural change when we consider the sprawling, unsafe shelter system, but, we gotta remember, the move does not treat the core issues of an over-reliance on temporary shelters and the failure to prioritize and develop permanent supportive housing. It's just a different style of managing the warehouse.

Bottom line: However the City restructures the security system within shelters, we really, really need more supportive services to assist homeless individuals and to prevent homelessness. A smaller homeless population means fewer problems at overcrowded homeless shelters.  

 

The New York Post loves homelessness

The New York Post loves homelessness. The paper uses stock images of disheveled men with matted beards and old sneakers shuffling along the sidewalk as a weapon against the leaders, laws and causes they oppose. Look at their Rotting Apple coverage. It's basically a series of photographs of adults in dirty clothes napping in uncomfortable positions with some unflattering photos of Bill de Blasio at press conferences mixed in. Homeless person - de Blasio. HomelesspersondeBlasioHomelesspersondeBlasioHomelessdeBlasio. Get it? 

Even stories that seem like red meat for scandalized conservatives immediately adapt an unexpected anti-de Blasio bent. In December, cops cleared a group of men from the area beneath the MetroNorth tracks on Park Ave. in East Harlem. After sanitation workers threw out their possessions, including vital documents, the men sued the city. The city, meanwhile, claimed the men had slept on school grounds, which created an unsafe environment for kids.

In that case, I would expect the Post to just hammer the quality-of-life angle: homeless men are invading our children's schools??? Rotting Apple indeed! Instead, they ignored that easy narrative in favor of another. Here's the very first quote from the story: 

“I’m praying to God because I don’t believe in Mayor de Blasio,” said Jesus Morales, 42, who has lived on the street since 1999.

Morales became homeless when Guiliani was in office? He was homeless through all three of Bloomberg's terms? The Post exploits homelessness to stoke anger among their small-minded audience?

It's almost like they have an agenda. 

Earlier this week, the city agreed to pay the men $1,515. The short Post story features a large picture of a homeless stereotype above a few words. 

We only have so much attention to pay and critical-thinking time to invest. How we gonna use it?

It's uncomfortable and depressing to consider the roots of a social problem because that means taking a broad view and not just defaulting to individual experiences or anecdotal information ("I knew this one guy in high school who was super lazy, dropped out and never wanted to get a job– no wonder he kept getting evicted and ended up back at his mom's house."). It's also straight-up hard. We have to devote time to learning, reading and listening; we have to challenge some of our default narratives and biases.

We only have so much capacity for compassion, so much attention to give! Digging into the complex causes of homelessness is time-consuming and confusing. It's way easier to direct our attention and outrage to the nasty symptoms of poverty, like a guy pissing on the street, or the sad consequences of poverty, like two little girls burned to death in a steam explosion. Lucky for us, that particular story has a very convenient plot line: Apparently, the girls' parents abused drugs. Therefore, we can blame them for killing their daughters because if they didn't use drugs, they wouldn't be poor. If they weren't poor, they wouldn't have had to live in a shelter. If they didn't live in a shelter, their kids wouldn't have been burned to death. If that sounds cruel, know that a lot of people hold on to that notion. We gotta blame someone and it's just so much easier to blame a specific person or family. Check out the comments on this blog post to see those thought-processes at work.

That kind of blame narrative is also very helpful for distracting us from the roots of homelessness.

It goes like this: Shelters are shitty and poor people are disgusting with no self respect. Comfortably focus your anger on that shit instead of deeper causes of homelessness.

Again, we only have so much attention to pay, so much critical thinking time to invest. Why sink it all into understanding uncomfortable, complex crap when we don't have to? It's certainly not regarded as a social responsibility. 

Growing up in a small, conservative, rural town, I was constantly exposed to those simple, convenient responses, usually presented as anger, world-weariness and superiority. From a pretty young age, I knew that blaming poor people for poverty or ranting about more superficial storylines didn't seem accurate or honest. I couldn't put my finger on it and I definitely didn't have the vocabulary to express what I sensed, but I could tell that there were structures and systems that punished, obstructed and screwed certain people while rewarding others. In order to understand better, I needed to keep questioning the simple narratives and seeking the alternative ideas and explanations. These were generally more comprehensive and certainly more accurate.

It's hard to break away from the easy-to-parrot narratives, especially if you're young and lack a foundation of knowledge.  I needed jump-off points to better understand and to express my positions. Reading the 2016 State of the Homeless report composed by the Coalition for the Homeless reminded me of my early experience with struggling to put words and arguments behind what I perceived. It is a clear and concise resource we all need.

This particular paragraph, for example, serves as a handy summation of a key cause of homelessness:  

Rents in New York City once again soared in 2015, the market continued to hemorrhage affordable units, and incomes have not kept pace with housing costs – most significantly for the lowest-income New Yorkers. Between 2010 and 2014, the median household income across New York City rose by 2 percent, while the median rents rose 14 percent. In the lowest-income neighborhoods, the median income decreased by nearly 7 percent, while rents rose by 26 percent. At the same time, the number of units renting for less than $1,000 (including both regulated and unregulated units) decreased by over 175,000. This dramatic and growing gap between incomes and rents continues to drive countless New Yorkers into financial crisis, all too often culminating in homelessness.

The bad news is, ending homelessness requires prioritizing affordable housing (attitudinal change) and then actually building and preserving an adequate amount of truly affordable permanent housing (policy and system change). That's a lot of work.

The good news is, it's possible to end homelessness because homelessness/poverty is not an inherent trait. Massive homelessness is the obvious outcome of bad housing policies and trends, which we can change.

I think those who are new to advocating against homelessness might start from those two positions and then fill in the details. 

2017 National Health Care for the Homeless Coalition Conference

In June, my supervisor and I will discuss our work integrating fitness and health counseling services at supportive housing and affordable housing sites at the NHCHC Conference and Policy Symposium in Washington, D.C. We have titled our presentation Move Toward Wellness: Integrating access to exercise in programs serving individuals impacted by homelessness.

People who have experienced homelessness die, on average, 15-20 years earlier than the general population. Individuals with severe mental illness–a significant proportion of the homeless population– die, on average, 25 years earlier than the general population. In order to most effectively implement preventive health programs for low-income individuals and people who have experienced or currently experience homelessness, we need to bring the programs to them - the places they live and frequent. 

In social work, we often say we need to "meet people where they're at." Usually, it's metaphorical. For example, if a woman uses heroin, we need to consider the physical, mental and social factors that influence her getting high and support her without expecting her to immediately cease abusing drugs. We also can't expect individuals from diverse backgrounds and complex experiences to conform to our standards of behavior and ways of thinking. 

But in the case of preventive health strategies, like fitness programs and health counseling, we need to literally meet people where they're at by doing the work in their buildings' community rooms, lobbies, patios or dining rooms. 

The presentation will share experiences and ideas for implementing such programs at sites with significant resources (like NYC's HIV/Aids Services Administration-funded supportive housing sites, which tend to receive more funding than most other supportive housing facilities) as well as the typical mixed-use supportive/affordable housing site that tends to operate with sparse funding and few frills. 

Come check us out if you plan to attend the conference in late-June.