At least 80% (the vast majority) of homeless people are sane,

Mental Illness: Approximately 16% of the single adult homeless population suffers from some form of severe and persistent mental illness (U.S. Conference of Mayors, 2005). Despite the disproportionate number of severely mentally ill people among the homeless population, increases in homelessness are not attributable to the release of severely mentally ill people from institutions. Most patients were released from mental hospitals in the 1950s and 1960s, yet vast increases in homelessness did not occur until the 1980s, when incomes and housing options for those living on the margins began to diminish rapidly...

Although obtaining an accurate, recent count is difficult, the Substance Abuse and Mental Health Services Administration (2003) estimates, 38% of homeless people were dependent on alcohol and 26% abused other drugs. Alcohol abuse is more common in older generations, while drug abuse is more common in homeless youth and young adults (Didenko and Pankratz, 2007).

The U.S. Department of Veterans Affairs (VA) says the nation's homeless veterans are mostly males (four percent are females). The vast majority is single, most come from poor, disadvantaged communities, 45 percent suffer from mental illness, and half have substance abuse problems. America’s homeless veterans have served in World War II, Korean War, Cold War, Vietnam War, Grenada, Panama, Lebanon, Operation Enduring Freedom (Afghanistan), Operation Iraqi Freedom, or the military’s anti-drug cultivation efforts in South America. 47 per cent of homeless veterans served during the Vietnam Era. More than 67 per cent served our country for at least three years and 33 per cent were stationed in a war zone.

Here are some statistics concerning the veterans homeless <2>:

23% of homeless population are veterans
33% of male homeless population are veterans
47% Vietnam Era
17% post-Vietnam
15% pre-Vietnam
67% served three or more years
33% stationed in war zone
25% have used VA Homeless Services
85% completed high school/GED, compared to 56% of non-veterans
89% received Honorable Discharge
79% reside in central cities
16% reside in suburban areas
5% reside in rural areas
76% experience alcohol, drug, or mental health problems
46% white males compared to 34% non-veterans
46% age 45 or older compared to 20% non-veterans

Female homeless veterans represent an estimated 3% of homeless veterans. They are more likely than male homeless veterans to be married and to suffer serious psychiatric illness, but less likely to be employed and to suffer from addiction disorders. Comparisons of homeless female veterans and other homeless women have found no differences in rates of mental illness or addictions.

2/27/2009

Every war has left us with a hard core of spiritually injured veterans who subsist somehow on the margins of society. With the unprecedentedly high incidence of subtle brain injuries, Post-Traumatic Stress Disorder, and similar conditions in our new crop of veterans, combined with our failure to evaluate and treat them during the Bush years, I suspect that we may be facing a set of problems that will profoundly affect the character of our society for many years to come.

The vast majority of vets from previous wars have managed to reintegrate themselves into society, not always quickly, and usually painfully, but nevertheless in some measure successfully. What's different about the ones who didn't make it, the ones living under the bridges or sleeping on heating grates or freezing to death in an abandoned basement somewhere, dressed in tatters, hand locked around the neck of a liter of rotgut?

Well, most of those people are addicts or alcoholics or both. Some are psychotic as well. Most of them began their addictions when they were still in the military. The psychoses mostly showed up a little later.

A funny thing about addictions and addicts--people say "He's an addict" and lean back as if they have not only explained something, but have given themselves an excuse not to get emotionally involved. They treat the addiction as if it were the root cause of the problem, then they assume that the addiction arises because of some moral failing in the addict, so it's really the veteran's own fault that he's sleeping under the bridge, and that relieves us of the obligation to be concerned. What a wonderful, comforting blanket of self-justification for inaction one can weave.

The problem is, addictions don't just arise out of thin air. People start using drugs and alcohol for a reason. And, incidentally, the addictions are not primarily physiological problems. Cut off the supply to one drug, and they will simply switch to another. The meth epidemic began when people could no longer get cheap cocaine.

Addictions are not about poor moral fiber, and they are not primarily about physiological dependence. They are about something else. They are about drugging away psychospiritual pain. People do drugs for the most part because the drugs quiet the demons in their heads. People get those demons, for the most part, as the result of experiencing severe, emotionally damaging abuse, neglect, or trauma. The dry psychiatric term for these demons is Post-Traumatic Stress Disorder, or PTSD for short.

There is nothing quite as effective as a war for creating psychospiritual demons. Thousands of veterans are still living with the demons they acquired in Vietnam, and we are about to be flooded with hundreds of thousands of new demon-haunted veterans from Iraq.

Most drug and alcohol treatment programs are quite ineffective. One massive study of inpatient VA programs showed that only 20 to 25 percent of the graduates were still abstinent after one year. The reason for this is that the treatment programs work on what is often termed a "medical model." They believe that they are dealing with physiological problems, that the major issue for the user is coping with physical cravings for a substance to which his body has become habituated. But the physical habituation is only part of the problem, and in most cases is the least part of the problem. Conventional treatment does not address the real issues, which are the psychological ones.

We have a new generation of techniques for coping with PTSD and related emotional problems brought on by exposure to extreme abuse and trauma. One such method is called EMDR (short for Eye Movement Desensitization and Reprocessing). Another involves a combination of brainwave biofeedback and talk therapy. However, these methods are relatively expensive because they are conducted in series of individual treatment sessions and require extensive training on the part of the therapists.

Thus the veteran problem is by no means an easy one. Most of these individuals will require a combination of expensive psychotherapy and substance abuse treatment. Some of them, particularly those with severe mental illnesses, will require hospitalization while treatment is provided. They will need help learning new job skills. They will need housing, food, clothing, medications, training, and jobs.

We will only manage to cope with the problem of homeless veterans when we own up to its enormity and commit ourselves to providing the care and help that they need. Are we willing to do that? Are we willing to do that at a time when we find ourselves trembling on the verge of a new global depression?