So you’ve thought about the definition of the word “homeless”. Question: Which of the following people would you consider “homeless”?
Ms. Alfa was living in a one-bedroom apartment until the entire building burned down in a fire. She’s been “couch surfing”—spending a few nights at a friend’s apartment, then a few nights at her sister’s house, etc.—for the past two weeks.
Mr. Bravo works in the pizzeria around the corner. He’s the guy tossing the pizza dough in the window. For the past year, he’s had an agreement with his boss: He closes the restaurant every night at midnight and cleans up the shop. He can then sleep on some cardboard in the pantry until seven o’ clock in the morning.
Ms. Charlie is in jail. She was renting a room, but still has another six months left in her sentence. She has been evicted from the room because of unpaid rent. She lost her job due to her incarceration and has no other sources of income.
Mr. Delta lost his job as a construction worker after his left leg was amputated. A man pushed him onto the subway tracks when a train was approaching. While he was in a physical rehabilitation center, his landlord evicted him on false allegations. Mr. Delta was discharged from the rehab center to a men’s shelter, where he now shares an efficiency apartment with a roommate.
So? Who’s homeless?
The United Nations has offered a definition of homelessness [1. I can only find the United Nations definition of homelessness on Wikipedia]. Everyone described above would meet that definition.
The United States Code, however, has its own definition of homelessness. Here it is:
For purposes of this chapter, the term “homeless” or “homeless individual or homeless person” includes—
(1) an individual who lacks a fixed, regular, and adequate nighttime residence; and
(2) an individual who has a primary nighttime residence that is —
A. a supervised publicly or privately operated shelter designed to provide temporary living accommodations (including welfare hotels, congregate shelters, and transitional housing for the mentally ill);
B. an institution that provides a temporary residence for individuals intended to be institutionalized; or
C. a public or private place not designed for, or ordinarily used as, a regular sleeping accommodation for human beings.
Ms. Alfa would NOT be considered homeless. Though she is “couch surfing”, which implies no fixed or regular housing, she is not spending her nights in a shelter, an institution, or a place “not designed for, or ordinarily used as, a regular sleeping accommodation for human beings”.
Mr. Bravo would likely be considered homeless. The pizzeria is “fixed” and “regular”, though not necessarily “adequate”. The pizzeria meets criteria 2C. Individuals who live in cars, subway stations, and abandoned buildings would also be considered homeless for the same reasons.
Ms. Charlie would NOT be considered homeless, though this is not evident from the definition provided above (see 2B). In practice, it doesn’t matter if someone loses her housing while incarcerated: If she had housing prior to jail, she is not considered homeless, even though she has no place to go upon release. The same applies to hospitalizations. [2. This is often a significant problem. Those who may need housing the most are often deemed ineligible.]
Mr. Delta would be considered homeless (see 2A).
Next: Who would you consider “chronically” homeless?
Does someone have to homeless for at least six months? one year? two years?
Would he have to be homeless for 365 consecutive days? What if he crashed at a friend’s house one week out of every month? What if he rented a hotel room when he had the money to do so?
The federal government has a definition for “chronic homelessness”, too: [3. Chronic homelessness is defined on page 3 of this document. I curiously can’t find it in the United States Code directly.]
… either (1) an unaccompanied homeless individual with a disabling condition who has been continuously homeless for a year or more, OR (2) an unaccompanied individual with a disabling condition who has had at least four episodes of homelessness in the past three years.
Compare this definition to that for “homeless” only. What’s different?
The definition for “homeless” says nothing about duration, nor does it say anything descriptive about the individual. For the definition of “chronic homelessness”, the individual must have been homeless for certain periods of time. Additionally, the person must have a “disabling condition”. [4. I’m not sure what to make of the qualifier “unaccompanied homeless individual”. Does this mean that children with a parent are not considered “chronically homeless”? That doesn’t seem right.]
The government has a definition for “disabling condition”, too: [5. “Disabling condition” is defined on page 4 of this document. I also can’t this in the United States Code.]
… a diagnosable substance abuse disorder, a serious mental illness, developmental disability, or chronic physical illness or disability, including the co-occurrence of two or more of these conditions…. [ In addition,] … a disabling condition limits an individual’s ability to work or perform one or more activities of daily living.
And that is how medicine, including psychiatry, has a role in the care of the homeless.
If you’re thinking that the definition of “chronic homelessness” suggests the medicalization of social issues, you’re not alone. If you’re thinking that medical and social issues are obviously intertwined, you’re also not alone. More on this to follow.