Before I write about “homeless psychiatry”, let’s talk about homelessness.
In New York City, most people are familiar with the sight of people who are clearly homeless. These men and women, sometimes pushing carts and often saddled with several overflowing bags, are in city parks, on subway cars, and under bridges. People grow so accustomed to the homeless that, after a while, they don’t see them anymore, even if they’re looking directly at them. (Once you are actively looking for them, however, you will see them everywhere—and where they sleep, even if they aren’t there.)
Would you believe that New York City has one of the lowest ratios of street homeless individuals in the country? (Please note that there are differences between people who are homeless on the street and people who are homeless in shelters. More about this below.) In New York City, there is one street homeless person for every 2,688 people in the general population. In Los Angeles, there is one street homeless person for every 154 people. [1. See the last page of the document that compares street homeless populations of different US cities. Briefly, this data comes from volunteers who survey the city on one single night, usually during the coldest month of the year.]
What could explain this? Maybe it’s because of the cold, snowy winters and the sweltering summers. Perhaps people who are homeless leave the city and move to places with temperate climes. Those who have worked in hospitals too long might argue that many of the homeless aren’t on the streets; they’re in the hospitals. Those who work in the correctional system may make the same argument, except they replace the word “hospitals” with “jails”. Or maybe they’re hiding somewhere to avoid encounters with the police.
While those reasons may hold true for some people, one major reason that explains the low ratio of street homeless people in New York is the class action lawsuit Callahan v. Carey. The result of this lawsuit decreed that the City and State of New York must
provide shelter and board to all homeless men [and, later on, women] who met the need standard for welfare or who were homeless “by reason of physical, mental, or social dysfunction.” Thus the decree established a right to shelter for all homeless men in New York City, and also detailed the minimum standards which the City and State must maintain in shelters, including basic health and safety standards. [2. Excellent summary of Callahan v. Carey.]
As far as I know, New York is the only state where people have a legal right to shelter.
Even though New York City has a low ratio of unsheltered homeless individuals, there are many people who are homeless who stay in shelters. The Department of Homeless Services in New York (which also shares the acronym “DHS”) keeps a count of homeless individuals throughout the city.
Take a guess: How many people stay in a New York City shelter on an average night?
Those of you who have witnessed the New York City Marathon can attest to the endless waves of people who are running (plodding, whatever) in the streets. Tens of thousands of people make their way towards the finish line. About 45,000 people finished the marathon in 2010.
New York City’s Department of Homeless Services publishes the shelter census every day. The number has recently been around 37,000 people. While there is a difference between the shelter census number and the marathon finisher number, you now have a sense of the size of the shelter population.
Take another guess: How many of those 37,000 people are children?
About 16,000. [3. Statistics about the population of homeless people and children in New York.]
That’s right: In New York City shelters, there are more homeless children than homeless single adults.
These numbers tell us only about people who are willing and able to go through the process of registering for and staying in shelter beds. There are people who are homeless who either cannot or choose not to stay in shelters. [4. Here is a literary example.] As far as I know, there is no literature that describes the differences between these two populations, though I suspect that the differences are significant.
Furthermore, there are major differences between people who are homeless for a shorter period of time versus those who are “chronically” street homeless.
But before we get into those distinctions, let’s think about the definition of “homeless”. Many scholars, politicians, and advocates have tried to provide an accurate description of this word. How would you define it?
Maria Yang, MD 