Inspired by Dr. O’Connell’s social justice commitment along with his written stories, titled ‘Stories from the Shadows’, this paper will explore the importance and compulsoriness to treat homelessness as a social justice issue to solve homelessness problem in America. While being homeless was traditionally viewed as a personal failure and personal inequality, through the stories written in the book, readers can see that the most marginalized people were inherently disadvantaged under social, cultural, economic and political conditions. They are elderly people, disabled people, people with mental disease and people with traumatic, abused histories, etc. Individual efforts from charity organizations such can only temporarily relieve some hard conditions of the homelessness population. The measures that structurally address the social determinants of homelessness are recommended, and the governmental and political responsibilities are emphasized in this paper. Expansion of affordable housing and establishment of federal housing assistance programs and solutions to alcohol and substance abuse epidemic in America are especially essential to solve homelessness problem in the long-term.
Stories from the Shadows is collection of short stories about homeless people in Boston, written by Dr. O’Connell, who treats and advocates for people of the streets of Boston for over 30 years as a street physician. People in the books are victims of rotten childhood, victims of family abuse, victims of mental illness, victims of substance abuse disorder, victims of violence, victims of old age, victims of unemployment, victims of learning disability, etc. They struggle to survive, battle for hope, build up resilience and optimism under the worst conditions. At the same time, gifted, compassionate and empathic healthcare providers, hospitals and shelters work together to treat and care these people at no cost.
However, most of these people did not have a happy ending after treatments. In most cases, they were discharged directly to the streets and then they were brought back to hospitals again. The circle of hospital and street was unceasing until they died. Although the book does not offer solution to solve the homeless problem, the author expresses his opinion that caring the homeless people is a commitment to social justice, not charity. This paper is inspired by the author’s social justice commitment and stories of the homeless community and explores the importance, compulsoriness to treat homelessness as a social justice issue to solve homelessness problem as well as interventions to prevent the homelessness in the long run.
Social determinants play an important role in the production of homelessness. We traditionally view the homelessness as a personal failure and personal inequality, and claims it takes saints to give them help. However, through the stories written in the book, readers can see how the most marginalized population were not born equally and how the life did not deal those people equally’. Besides personal circumstances, homelessness in America is mostly caused by social inequality and system inadequacies, such as poverty, lack of affordable housing, failure of social support system, failure of pain management and pain medication prescription system.
First, poverty is the basic cause of homelessness. Most characters in the book were poor. Poverty significantly damages them physiologically, psychologically, behaviorally, and socially, and makes it hard for them to become secure financially. When children are born to poor parents and live in unhealthy living conditions, such as toxic exposure of mold, lead or other environmental pollution, poor nutrition, exposure to violence, and parental insecurity, they have suboptimal cognitive, emotional and behavioral development, which leads to poor school performance and low education attainment and thus poor job prospects as an adult (Harkness& DeMarco, 2016). Poverty also put them at higher risk for unhealthy behaviors, which make them more vulnerable to alcohol, drugs and violence (Harkness& DeMarco, 2016). Poverty makes the poor poorer, the vulnerable more vulnerable.
Secondly, the lack of affordable housing and housing assistance programs directly causes some of the homelessness problems. The lack of governmental housing support is well evidenced in the book. Some people were forced to the streets because they were the most disadvantaged and have nowhere but the streets to live in. Some used to have stable place to live at but were also forced to live on the streets when they experience personal crises due to the lack of emergent housing assistance. This usually happens when divorce, domestic abuse, the onset of acute or chronic diseases and pain, or an addiction challenge is involved, and they have no other resources to turn to for help. They are forced to give up their house or get evicted from the rented apartment because housing cost takes a big portion of their income and they must spare housing expense for more critical and urgent needs, such as food and clothing. After they are thrown into the streets, being homelessness will worsen their previous problems. They unfortunately became chronically homeless.
Third, alcoholism and substance abuse accelerate and worsen the production of homelessness. There is a stereotype that people are homeless because they are alcoholics or drug addicts. In the book, we do find a high percentage of homeless population have addictive disorder. But addictive disorder and homelessness are both causes and effects of each other. For homeless people, alcohol or substance are like nectar and nemesis (O’Connell, 2015, p. 148). On the one hand, alcohol or substance destroy their relationship, damage their health and jeopardize their job, and subsequently cause them to lose housing; on the other hand, people in the streets use drugs to self-medicate themselves for pain and they also use drugs to cope stress and depression. Homelessness cannot be conquered without solving the alcoholism and substance abuse disorder.
In conclusion, the production of homelessness reflects a complicated interaction between social environments, systems failures, and individual circumstances. Homelessness, poverty and sustenance abuse are inextricably twisted. Few people can do better if he/she face the same situations under same living environments and similar health conditions. It is time to stop blaming individuals and it is time to face it as a social justice issue.
The Boston Health Care for the Homeless Program (BHCHP), where Dr. O’ Connell practices, was born 30 years ago, and became the largest and most comprehensive homeless program in America, serving 12,000 people and have 400 full-time employees. Health care providers there are dedicated to the welfare and justice of homeless people (O’ Connell, 2015). BHCHP not only demonstrates to the public the imperatives to solve the homeless problem in America but also provide precious lessons and enormous experiences on how to take care of the homeless people efficiently.
Just as California Newsreel claimed that social problems have significant effect on both people’s life and people’s organs (2008), most of the homelessness can be traced to unequal economic and social statuses, and are systemic and avoidable and thus inherently unjust and unfair (California Newsreel, 2008). If we perceive homelessness as an issue of social injustice, then the solution to it will be obvious: we need broader interventions that not limited on the individual level efforts such as giving away blankets in the cold winter, offering free hot meals on holidays, and the society and government must take responsibilities to address the problems structurally and systematically at the all levels.
The most direct solution to end homelessness is the expansion of affordable housing and federal housing assistance programs. First, more government funding is needed for the existing programs. According to the National Low-Income Housing Coalition, among those eligible for federal housing assistance, only 25% households receive assistance, and only three affordable rentals available on the market per ten households in extremely need (2018), which is far behind demands. Prevention of homelessness is important, or it will cost the governments more money indirectly through medical bills and shelters management costs. Second, the governments may consider offering low-income housing voucher to reduce the gap between rental cost and income so that people who work can afford a place to live in.
In addition, governments can offer emergency housing assistance for those people in urgent needs. Emergency housing assistance can prevent people from becoming homeless at the first place. Finally, stable housing- first policy for homeless community will help reduce the case of chronic homelessness. We read from the book that some people keep trying to stay sober for several months and show huge resilience and optimism. However, after they go back to unstable environment, they start to use alcohol to solve their problems again. Dr. O’ Connell stated that according to the Medicaid report, 119 homeless individuals visit emergency room for 18384 times in a five- year period (2015). Dr. O’ Connell claimed that the main reason for readmission is that homeless people were discharged to the streets because no stable place was offered after they released from the hospital or detoxification center.
The other important method to solve homelessness problem is to solve alcohol and substance abuse epidemic. One critical time for preventing alcohol abuse and drug addiction is during adolescence (NIH,2018). Thus, it is essential that the school, community and society provide intensive alcohol and substance abuse teaching, counseling, and consultation among children and adolescent on regular basis along with social resources to help young people cope with a variety of life stresses. In America, increased prescription pain medications also have contributed dramatically to the epidemic of substance use disorder (NIH, 2018). Thus, stricter federal regulations are needed to overwatch pain medication prescription. For example, all the patients should be informed the risk of addiction and sign the consent form that educates about risks of the opioid pain medication has been given and understood before prescription; all the pain medications must be prescribed through network database to prevent patients from shopping around; only special trained pain specialists can prescribe opioids.
Stories from the Shadow calls for a shift in thinking about homelessness from the view of personal inadequacy to social injustice. Poverty, lack of social support system, especially housing assistant system, alcoholism and substance abuse epidemic in America all largely contribute to the production of homelessness. Subsequently, in order to solve homelessness, social and governmental level interventions rather than individual-focused case management are justified. Strategies to end homelessness include expansion of governmental affordable housing program, initiation of housing voucher and establishment of emergency housing assistant system for poor people, and creation of stable place for the homeless community. Measures to fight against alcoholism and substance abuse epidemic are also essential, which include primary prevention among young people through education, counseling, and consultation, and which also requires public surveillance of opioid prescription. The society has paid price for the neglect of homelessness and it is time to face it.
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