Podcast: Untold Stories: Homelessness and Mental Illness

Inside Mental Health Podcast Guest and Host Bio

Robert L. Okin, MD, is a world-recognized expert on human rights for the mentally disabled. He served as chief of service of the San Francisco General Hospital Department of Psychiatry, where he oversaw the development of crucial services for patients with acute and chronic mental illness. He was also professor and vice chair of the UC San Francisco School of Medicine’s Department of Psychiatry. In 2009, he received the American Psychiatric Association’s prestigious Human Rights Award for his work in developing countries. He is the author of “Silent Voices: People with Mental Disorders on the Street” (2nd edition, August 2023).

Our host, Gabe Howard, is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, “Mental Illness is an Asshole and other Observations,” available from Amazon; signed copies are also available directly from the author.

Gabe makes his home in the suburbs of Columbus, Ohio. He lives with his supportive wife, Kendall, and a Miniature Schnauzer dog that he never wanted, but now can’t imagine life without.

To book Gabe for your next event or learn more about him, please visit gabehoward.com.

Episode Transcript

Producer’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Announcer: You’re listening to Inside Mental Health: A Psych Central Podcast where experts share experiences and the latest thinking on mental health and psychology. Here’s your host, Gabe Howard.

Gabe Howard: Thanks for being here and listening, everyone. I’m your host, Gabe Howard. Calling in today we have Robert L. Okin, MD. Dr. Okin is the recipient of the American Psychiatric Association’s prestigious Human Rights Award and the author of “Silent Voices: People with Mental Disorders on the Street,” which is available now. Dr. Okin, welcome to the podcast.

Robert L. Okin, MD: Thanks very much for having me, Gabe.

Gabe Howard: I want to say when I found out that in order to write your book, you spent two years on the streets meeting and talking with homeless individuals with mental illness, I immediately thought to myself, how exactly did that work? For example, did you sleep outside? How did you approach people? What was your process over those two years?

Robert L. Okin, MD: Well, it really began when I was walking to my car one night in San Francisco. It was raining, it was cold, and before I got into my car, I saw this little woman huddled up on the sidewalk, you know, trying to protect herself from the rain and. After I got home, I just couldn’t forget her. And for the next three weeks, she kept coming into my mind. I couldn’t imagine how she bore the stresses of being on the street night after night, day after day. You know, I decided to leave my office in the hospital and meet these people where they lived, basically on their turf rather than on mine. I wanted to get closer to these people who were homeless and, at least putatively mentally ill, in order to hear from them about their lives, directly and personally. I wanted to understand how they coped with their illnesses and the stresses of homelessness and jail, because many of them had been jailed. I wanted to know what they thought about as they pushed their carts down the street. What they did was so much empty time. How they managed at night. And I guess I wanted to know why they made some of the choices they did. I began to approach people on the street, and I asked them whether they would be willing to talk to me about their lives. And I have to say before, before I talked to the first few people, I was really anxious that they would just blow me off and refused to talk to me because I was just some dude on the street, you know, with with a knapsack and none of the authority that I had in the hospital. I wasn’t some doctor with a, you know, with a white coat. But I found the opposite. They seemed genuinely pleased that I was interested in their lives. You know, most of these people had been neglected as children, and they continued to feel invisible as people on the street. So I guess seeing that I was very interested in their lives meant a lot to them.

Gabe Howard: During our pre-interview emails for this episode, you shared something that really struck me. Dr. Okin, you shared, we think of homelessness as being, quote, caused by mental illness, unquote. But we never really delve deeper than that. We tend to see the ways in which these people, which you put in quotes, are different from us, but not the things that we have in common with them, and that this is the first step in the process of dehumanization, that is ultimately ensures that more people are forced to the streets and stay there. Now, it really seems to me like you’re indicating that homelessness is not, in fact, caused by mental illness, but it’s rather caused by society and our policies.

Robert L. Okin, MD: Well, this is this is a complicated question. Homelessness. Well, first of all, there are different subgroups of homeless people and homeless mentally ill people, represent just one of those categories. So other categories of people, you know, are not at all mentally ill, and they fall off into the street largely for financial reasons. But the people that I interviewed were largely mentally ill and homeless, and most of them had been, as I said before, neglected or abused as children. They entered adulthood with no employable skills, and those who somehow managed to get a usually a very low paying job were often, often found themselves on the street after they suffered some, often minor reverse that most of us would be able to endure. You know, either the loss of an important relationship or the loss of their job. And bang, they were they were on the streets. About 40% of the women that I interviewed had been sexually abused in their childhoods. So there’s a huge there’s a huge amount of this that predisposed them to homelessness. But I have to say that there were some people I interviewed who clearly had been supported by their families, loved by their families, anything but abuse and neglect. But they developed mental illness, often in their late adolescence or early 20s, and they slipped off into the street and there was nothing that their families could do to prevent this. So. These are some of the individual factors.

Gabe Howard: It really sounds like you’re saying that there are factors at play here that may be outside of an individual person’s control, factors that are maybe created by society or the government. Is that true?

Robert L. Okin, MD: You know, it began in the 50s and 60s when state governments de-institutionalized people. In the United States, state governments dumped 600,000 mentally ill people onto the street with nothing. No support, no housing, no treatment. And to this day, 70 years after this, governments have still failed to create the kind of mental health and substance abuse service system that can help treat these people with serious mental illness and drug abuse. And the result is that 40% of the homeless population has serious and untreated psychiatric disorders. But more fundamentally, and I think people don’t really recognize this when they pass someone who’s mentally ill and and homeless. Fundamentally, the federal government contributed to this problem in a major way, largely by supporting the huge disparities of wealth that exist in this society through our taxation policies, largely. And the result of this is that 10% of the population has amassed a huge amount of wealth, more than 50% of the bottom half of the population combined. And this set the stage for a huge increase in the homeless population for the people at the very bottom of the income ladder were left with almost nothing. You know, you could put it this way. Government basically stuffed the richest segment of the population, which inevitably meant that it starved the poorest segment and the homeless population are the true casualties of this huge disparity in wealth. But instead of instead of helping to soften their poverty, the federal government aggravated it further.

Robert L. Okin, MD: By keeping welfare payments on which these people depend so low as to keep them impoverished forever. Well, you know, when you think about it, you realize that the federal government could have offset the impact of its own policies by creating a robust safety net so that the casualties of these policies wouldn’t flow off into the streets with one little financial reverse. But it didn’t do this. Instead, in the days of Reagan and subsequently, it slashed the already limited federal support for low-income housing and justified this by promoting a completely phony trickle-down economic theory which pushed still more people into the streets. I have to say that aggravating the federal contribution to homelessness was the fact that city and state governments enacted policies that diminished the amount of low-income housing. For example, city governments often created incentives that encouraged real estate developers to convert low-cost housing into condominiums that poor people couldn’t possibly afford. City governments often gave tax breaks and other incentives to big companies, wooing them to settle within their borders and then failing to adequately tax them for gobbling up the housing supply with their high paid employees. And then , you know, we find political leaders wringing their hands about what they created as though it had just happened by itself as part of the natural order of things, but there’s nothing natural about it. It didn’t just happen. Governments contributed to creating and maintaining the problem, and if we don’t see this, we will fail to hold them responsible to solve the problem.

Gabe Howard: That’s that’s. What can we do about this, Dr. Okin? Where can we possibly, as a society, go from here? How can we make this better?

Robert L. Okin, MD: Well. We need to start by recognizing that these people are not homeless because they want to be. You’ve got to recognize that most of them are on the street because disadvantages in their childhood and their adulthood have pushed them onto the street given government policies that have created homelessness in the first place. So the first thing we need to do is really examine our own beliefs about these people because unless we see them more realistically, unless we see that beyond their rags and their carts and their other stigmata of poverty, that beyond these are people who are much more like us than they are different, and that they have the right to a decent life, not because they have to earn it, but just because they’re human and they have rights as human beings.

Gabe Howard: Dr. Okin, in your experience, what is the most common misconception about mentally ill people on the streets that society holds this fact?

Robert L. Okin, MD: Well. Largely, I think society blames people who are homeless, including people who are homeless and mentally ill, for being on the street, you know, there there are myths that may be comforting to the public, but they’re largely untrue. For example, by and large, people are not on the street because they want to be. So the idea that they’re there, you know, is as an act of their free will is just, it’s just untrue. And then there’s a myth that if people really wanted to get off the street, if they really had the willpower to do so, they would get a job and, you know, make, make, a salary and be able to get off the street and to, to people who say to me, well, why don’t these people just get a job? I say to them, okay, imagine you’re on the street, you’re pushing a cart around with all your possessions in it. You’re largely dressed in rags. You haven’t showered in weeks, so you smell and you walk into a prospective employers and you say, can you can you give me a job? I mean, they would look at you as though you’re out of your mind. And even if some rare employer were to be sympathetic and say, okay, I’ll, I’ll try to find a job for you, you know, give me a give me an address where I can contact you. Well, I mean, these people have no address, and most of them have no phone. So how is the employer going to get in touch with them? I mean, the whole proposition that they could get a job if they wanted to is just so absurd, that it’s beyond words.

Gabe Howard: Of all the people who you met on the street, is there any one in particular that left a lasting impression? And would you like to share that story here?

Robert L. Okin, MD: Yes, Jeff was a person who left a lasting impression.

Sponsor Break

Gabe Howard: And we’re back with Dr. Robert L. Okin, author of “Silent Voices: People with Mental Disorders on the Street.”

Robert L. Okin, MD: Jeff was a guy who I met, actually, in his in his apartment because he had just he had just gotten off the street. And, as a child, he had, endured life with a schizophrenic mother who, who on occasion would take a knife from the kitchen and threaten his father that she would knife him, and he went to bed. Jeff went to bed, you know, terrified that his mother would come in in the middle of the night and kill him. He. Somehow he managed to get through school and got a job as a garbage collector because his dad had been a garbage collector. But he, there were there were, routine blood tests, and urine tests and, some pot was found in his urine, and he was fired. And that began a cascade of events that led him to the street. He became very depressed, barely get out of bed, and then began to use drugs, to try to treat his depression really. And the result was that he lost all of his money, his apartment and his fiancée. And. He lived for the next ten years on the streets. Well, taking drugs and sleeping on heating grates. At one point, he lost all of his teeth, as many people do who have lived on the street for years because, you know, they have terrible dental care. The grime on the streets, often creates infections and abscesses in their mouths, and they, they lose their teeth.

Robert L. Okin, MD: And Jeff told me once that he never smiles because he was so ashamed of his, of his toothless gums that he just didn’t want anyone to see them. And he said, though he longed for a romantic relationship, he said there’s no way that he would even try to meet a woman because he was so certain that she would be disgusted when she kissed him. Because he had no teeth. And he said to me once, you know, if you I think he said, if you have a big nose, well, no one could blame you. But if you have no teeth, everyone can see that you’re a real screw up, because that’s the only way that you would have lost your teeth. At some point his gums became abscessed and the infection traveled to his heart. He was hospitalized for a huge cost to the taxpayer for over 100 days. And during that time, one of the case managers approached him and developed a relationship with him, helped him, really begin to think about stopping his drug habit. I. I guess I’m trying to remember the sequence here, but he ultimately did stop his drugs, but only after he got into an apartment. Well, the end of the story is that he ultimately, became employed and he is now working, living in and living in housing and is off the street.

Gabe Howard: I think that’s great. I think that is wonderful. I never want. I work very, very hard as a host, not to be a distraction. I want to let the topic and guess shine. But. But just to share with you, I live with bipolar disorder. And listen, the reason that I am not homeless is because of the things that you said. I had a family, right? That that’s very, very lucky. I had health insurance. That’s very lucky. I had money and resources. That’s very lucky. I live in a big city and beds were available when I got sick. That’s that’s very, very lucky. If you remove those protective factors from me and you go back to when I was actively sick,

Robert L. Okin, MD: Yeah.

Gabe Howard: You know, I was, I was delusional, I thought, I thought demons were chasing me.

Robert L. Okin, MD: Yeah.

Gabe Howard: You know, that’s that’s and and I alienated a lot of people. But thankfully, I couldn’t alienate my mom. But if I was somebody who was, you know, maybe my parents passed away. Maybe I didn’t have siblings. Maybe I lived in a smaller town with significantly less resources. I it’s not hard for me to really see a direct link between, you know, serious and persistent mental illness, like bipolar disorder with, with, you know, with delusions and, you know, plus the mania, etc. and seeing myself get arrested. And then, of course, it’s much harder to get a job when you’ve been arrested.

Robert L. Okin, MD: Yes, right.

Gabe Howard: If nobody is looking out for me and I spend all of my money in a manic phase, I get evicted. Well, now I can’t rent another place because I’ve got an eviction on my record. I can’t get a job because I’ve got a felony on my record. I think that demons are chasing me and they can’t find me under the bridge. And before you know it, it’s insurmountable alone. Especially with a compromised brain. So I, I related to what you said when you were speaking. Just a couple decisions can lead so many people to homelessness. And I really feel like for me, it wasn’t even a couple decisions. It was the right people in my life, and I’m super thankful for them. But that means that there are many people who are homeless right now that because they didn’t have a mom or a dad, you know, who was in a position to help them, that’s why they’re homeless. And that just it’s so incredibly unfair. And frankly, it makes me feel very, very guilty and very, very lucky. But I just don’t want that for people. And I don’t think that any reasonable person should. So I really appreciate your work. Thank you.

Robert L. Okin, MD: What you, what you just said just is so true. That’s all I can say. It is so true. And you say it so well.

Gabe Howard: I really appreciate that, Dr. Okin. I do try very hard.

Robert L. Okin, MD: You know, Gabe, one of the things that’s wonderful about your interviewing is that it’s obvious that you really care about this. And it, you know, it makes someone like me feel like he has an ally, you know, because it’s it’s it often feels like one is kind of crying into the wilderness. And it’s very it’s just great to know that there’s an ally somewhere. But I think you’ve really gotten to the to the guts of it.

Gabe Howard: Well. Thank you, thank you. It. The, uh, sincerely, doctor. It’s such a. Some problems can only be resolved by government and that’s, you know, roads, roads cannot be built by,

Robert L. Okin, MD: Right individuals.

Gabe Howard: You know, by homeowners, right. Or,

Robert L. Okin, MD: Right, right.

Gabe Howard: You know, community members. You need an overarching. Bridges, you know, Hoover Dam. And I really see homelessness as one of those things that the difference is, is, you know, people want roads, people want dams, people want hydroelectric power. They certainly want water. They certainly want plumbing. You get to homelessness. And I see such a cavalier attitude.

Robert L. Okin, MD: Yeah.

Gabe Howard: They’re like, well, they’re lazy and they should get a job and they deserve it. This is a consequence,

Robert L. Okin, MD: Yeah, you know, I, it it, it really reminds me that that this is a problem that touches all of us, not just the homeless, that we as a society are poorer for having this problem. And if we could all wake up and recognize that none of us can escape the trauma of this problem, then we’d be more likely, no matter where we are on the political sides of the spectrum, to push governments into solving it. Because it’s not just the problem for people who are homeless, it’s also a problem for the whole society.

Gabe Howard: I like that a lot. And I agree with you, for what it’s worth,

Robert L. Okin, MD: Yeah.

Gabe Howard: It’s, uh, I struggle to enjoy my life knowing that other people in my position

Robert L. Okin, MD: Yeah.

Gabe Howard: Have fared significantly worse.

Robert L. Okin, MD: Yeah.

Gabe Howard: But there’s also another set of people who they actually celebrate their life. They’re like, look, the average person can’t overcome this and they become homeless. But I did, and

Robert L. Okin, MD: Yeah.

Gabe Howard: That makes me better, special, etc.. I, I’m not in that camp. I’m in the this

Robert L. Okin, MD: Yeah.

Gabe Howard: Actually ruins it for lack of a better word or diminish it diminishes is a better word.

Robert L. Okin, MD: Yeah.

Gabe Howard: This diminishes my recovery story.

Robert L. Okin, MD: Right, right.

Gabe Howard: It does not amplify it. And I wish more people thought that way.

Robert L. Okin, MD: Yeah I do too I it’s, it’s what I was trying to get at when I was talking about American values and, the, the celebration of one’s own. Really luck. Let’s face it.

Gabe Howard: Yeah.

Robert L. Okin, MD: The celebration of that as though it came from the fact that they’re, they’re they did something special. Well, they did something special because they had the luck of either their DNA or their parents or something. But they didn’t just create their success and earn their stake, you know, out of whole cloth, they were lucky. And they don’t look at that fact. They don’t look at the fact that people who are on the street just didn’t have any of the foundational luck that they had.

Gabe Howard: Exactly, exactly. And I, I wish that people would take a more holistic view of their own success and a more holistic view of other people’s challenges and or perceived failures. I think

Robert L. Okin, MD: Yeah.

Gabe Howard: That we’d get a lot further in society if we if we did so.

Robert L. Okin, MD: Yes, absolutely. And congratulations for what you had to get through to get to where you are. It’s really an inspiration. So, thank you.

Gabe Howard: Oh, thank you. Thank you so much again I, I would love to take all the credit, but I had an awful lot of help along the way.

Robert L. Okin, MD: Well, I’m glad you did.

Gabe Howard: Hey, nobody’s happier about it than my mom. But of course I am genuinely glad that I did it too. Now I, I want to let the listeners know, Dr. Okin, that your book “Silent Voices: People with Mental Disorders on the Street” is available right now. Once again, thank you so much for being here. I personally learned a lot.

Robert L. Okin, MD: Well, thank you so much for having me, Gabe. It means a lot.

Gabe Howard: You’re very welcome. And of course, a great big thank you to all of our listeners. We really loved speaking with Dr. Okin today, but we just couldn’t fit everything that he said into a single 30-minute podcast episode. So if you want to learn more and you enjoyed today’s episode, just head over to wherever you downloaded this podcast and look for the special bonus episode with Dr. Okin, which is available right now. My name is Gabe Howard, and I’m an award-winning public speaker who could be available for your next event. I also wrote the book “Mental Illness Is an Asshole and Other Observations,” which you can get on Amazon, but you can grab a signed copy with free show swag or learn more about me at my website, gabehoward.com. Wherever you downloaded this episode, please follow or subscribe to the show. It is 100% free and hey, can you do me a favor? Recommend the show because sharing the show is how we’re going to grow. I will see everybody next Thursday on Inside Mental Health.

Announcer: You’ve been listening to Inside Mental Health: A Psych Central Podcast from Healthline Media. Have a topic or guest suggestion? E-mail us at show@psychcentral.com. Previous episodes can be found at psychcentral.com/show or on your favorite podcast player. Thank you for listening.

Bonus Episode Transcript:

Producer’s Note: Please be mindful that this transcript has been computer generated

and therefore may contain inaccuracies and grammar errors. Thank you.

Announcer: You’re listening to Inside Mental Health: A Psych Central Podcast where experts share experiences and the latest thinking on mental health and psychology. Here’s your host, Gabe Howard.

Gabe Howard: Welcome to the show, everyone, and thank you for joining us for this bonus episode of the Inside Mental Health Podcast. My name is Gabe Howard. We recently spoke with Dr. Robert L. Okin about his work, his advocacy, and his book “Silent Voices: People with Mental Disorders on the Street.” Now, his information really taught me a lot and I was so enthralled the interview ran long. We just couldn’t fit all of it into a single podcast episode. But I really felt that some of what had to be cut deserved to be heard. I talked to the great folks at Healthline Media, and they agreed that our listeners, you, deserve to have an opportunity to hear what I heard as well. Now, please be mindful that this interview sort of begins in the middle, and some of what he references is contained in the primary episode, Untold Stories: Homelessness and Mental Illness, which is available right now on your favorite podcast player. Thank you so much for listening, and here is more from our interview with Dr. Robert L. Okin.

Gabe Howard: I think it’s incredible that when there’s multiple steps between, why don’t they just get a job and actually getting a job? The stories are like this one, right? We first we found stable housing. He got case management. He got a kitten. He got treatment for his physical, you know, illnesses. He got mental health treatment. And then suddenly, here’s a job. And as you just said, he. I don’t want to say he lived happily ever after, but he went from homeless to employed because there was all these steps in between. Society leaves those steps out a lot. It really seems like the solution to homelessness is just stop being homeless. Is this one of these things that society just really holds dear, that they believe that at any given moment, the entire homeless population can just wake up one morning and think, hey, I’m not going to do this anymore, and this problem is resolved.

Robert L. Okin, MD: Yeah. Well, I think that that myth is a convenient myth, because it takes the onus off of us to do anything and puts the onus totally on the people who are really kind of victims of government policy. Homelessness costs society a lot of money. You know, society may say, well, we don’t want to pay for this, but frankly, we are paying for it. But the reason we can’t see the full cost of homelessness is because the cost is buried in the budgets of many different city departments. So it’s in the, ambulance department, in the hospital department, in the, in the Department of Public Works, the police department, the courts. So it’s the cost is in these different departments, but it’s it’s hard to get our hands around it and see what the total cost is to society. And there have been several studies done on the cost of homelessness compared to the cost of giving people housing and treatment. And the cost of homelessness can be around $40,000 a year, and the cost to house and treat someone is about $20,000 a year. So it’s about twice as much to leave people homeless as it is to, as it is to help them get housing and treatment. And I while we’re talking about costs, I might say that it is it is much more expensive to get people off the street then to, prevent them from falling onto the street in the first place. So the cheapest thing for society to do is to prevent people from, from falling into homelessness in the first place. And the second cheapest thing to do is once they’re on the street, to get them housing and treatment. The most expensive thing for society is to let them slip onto the streets and leave them there.

Gabe Howard: I happen to know that you’re absolutely correct. Study after study after study after study shows that the cost of homelessness is being borne by the taxpayer, and it would be significantly cheaper if we prevented the problem rather than, how we’re handling it now, quite frankly. And yet, society is okay with this because they just feel like it’s a it’s a consequence of people’s actions. I, I, I can’t even begin to unpack why, as a nation, we’re okay with homelessness at all. But I really can’t begin to unpack why we’re okay with paying extra for a worse outcome. Do you have any thoughts on why society is is frankly kind of happy with the status quo, even though it’s not benefiting anyone?

Robert L. Okin, MD: Well, I, I think I understand it. Society despises these people. And that reaction to them is what is preeminent, even against society’s own economic interests. You know, mentally ill people have been despised and feared throughout history. You know, they were burned as witches. They were put in poor houses in jails. Then they were institutionalized and, you know, segregated from society with no treatment, basically allowed to languish in state hospitals. Then they were thrown out of state hospitals with nothing, no services, no housing. And so if you trace how society has always dealt with people with who have mental illness, it is usually that society despises and fears them.

Gabe Howard: It’s just such an incredible amount to unpack. And the reason that I say this is because all in the news, it’s it’s ethics, Christian values, taking care of one another, supporting each other, love. And then we get to the wealthiest nation in the world. We have we we have wealth beyond measure. And yet with all of that rhetoric that comes from this isn’t this isn’t rhetoric on the internet or rhetoric in the local bar or coffee shop. No, this is these are the conversations that our leaders have from from presidents to senators to, on down. I just I’m still just very shocked, given our nation’s motto of being an ethical, moral and Christian nation. God loves America and our boasting of being the wealthiest nation in the world, reporting pretty much all the billionaires, that that this is still a thing. I just it it’s just so incongruent to our public selves. Is there any movement at all to get this resolved? Or as a country, do we just have to accept that we’re hypocrites?

Robert L. Okin, MD: Well, just before I answer that question, I want to I want to reflect on on your comment about. About the fact that we. You know, we pretend certain things as a nation and we, you know, we like to believe certain things about ourselves, but. But the values of American society, have historically acted as powerful and pernicious forces in the cause of homelessness, and mentally ill people who fail to live up to these values are often pushed to the margins of society and abandoned. So let me give you a couple of examples of that. First although we celebrate the melting pot and diversity in theory, we’re clearly very ambivalent about it in practice. About the differences that exist among us. And differences are often negatively valued and deeply stigmatized. In the case of people who are, you know, who are different on the basis of race, religion, national origin, sexual orientation, disabilities of all kinds. You know, we we stigmatize them. So even though we we say that we believe in the melting pot, you know, our actions are, clearly, opposite of this.

Robert L. Okin, MD: Secondly, although we say we believe that all people should enjoy equal opportunity to thrive in the society, we totally ignore and actively oppose it in practice. And you can see that in all kinds of ways. The fact is that we tend to stack the deck of opportunity against those at the bottom right from the get go. So it’s it’s a myth that we believe in equal opportunity, economic opportunity. Then we say that we, you know, we should take care of people who are less fortunate than us. But, you know, just look at how we deal with this population who are homeless. And it’s obvious that that we that we don’t. And one of the reasons we don’t is that we have such an attachment to the idea and the value of self-reliance and productivity. You know, we we believe that people should be able to look after themselves. We believe in independence. We believe in productivity. But people who, for whatever reason, don’t have the capacity to meet their own needs and are forced to depend on others, are so often disparaged and devalued. You know, the personal characteristic of self-reliance has become idealized,

Robert L. Okin, MD: Also, an idealization of people being able to make it on their own. And, you know, many people who became successful, came to believe that they deserved what they had made of themselves and that others who couldn’t make it on their own, regardless of their personal, sometimes inborn, limitations or the social conditions in which they were raised, were deserving of nothing more than censure, contempt, and the impoverished life that they were forced to lead. And the result is that we’ve come to tolerate, accept and justify the misery of people who can’t make it on their own. Those who need society’s support for their survival are treated as, I guess you could say, that they’re treated as undeserving precisely because they need it. And the paltry level of government benefits that these people receive is, I would say, the economic expression of the contempt in which we hold them. You know, even children can’t escape this hostile and withholding stance. It can be seen from the fact that 15 million children we allow to go hungry. So there’s, you know, there’s the contribution of American values that, that really serve as the foundation of the way we view these people on the street.

Gabe Howard: Obviously, the average podcast listener is not going to be able to solve the systemic issues that lead to homelessness. We need massive government intervention and change. So

Robert L. Okin, MD: Yes.

Gabe Howard: As I asked this question, think about the the individual listening. What small changes can they make in their own lives to reduce the stigma against homeless people and to help make lives a little better for them in these moments when they when they come across them?

Sponsor Break

Gabe Howard: And we’re back with Dr. Robert L. Okin, author of “Silent Voices: People with Mental Disorders on the Street.”

Robert L. Okin, MD: I walk around the city with some extra pair of socks in my pocket, because I know that people who are homeless wear out their socks very fast because they’re always walking around. And so I, you know, I give people some pairs of socks when I pass them. And then also, you know, before I, before I go to an appointment, I give myself a little time because I know I’m going to pass people on the street and I want to have a little extra time to be able to get them a cup of coffee or a sandwich. And I don’t I don’t have any illusions about how trivial this kind of, you know, these kinds of actions are, but they. They have an effect beyond their beyond the concrete coffee or sandwich. You know that people said to me, the fact that some people are willing to do this makes them feel less invisible and less despised. And. That’s a big deal for people that are living on the street, because in addition to all the physical privations they endure, they have. They have the feeling that they’re kind of hated and. And these little gestures anyway. Tell them that at least some people don’t hate them.

Robert L. Okin, MD: But beyond these, you know, somewhat symbolic, gestures. The most important thing that people can do is, first of all. Try to remind themselves that people on the street didn’t just get their, you know, it wasn’t it wasn’t their fault that they’re there. And remember, some of the things that I’ve said about how this how homelessness develops. So remind themselves of that and then take action by calling and writing their political representatives, both in the cities, the states and the federal government. We’re lucky we live in a democracy. And in in a democracy, we we have the power to use our voice to push our political leaders to take action. And if we don’t use that power, then we’re going to be living with this humanitarian crisis, you know, for the next hundred years. So the most important thing that people can do is to just take ten minutes. It doesn’t take more than that to call or email their political leaders and insist that they stop wringing their hands and take action to really solve this problem.

Gabe Howard: You’ve indicated that the government needs to take action, and you’ve given some examples along the way of actions that government can take. But can you really drill this down, especially from the perspective of if we the people are going to advocate, what should we advocate for? Because obviously advocating to reduce homelessness is probably not going to get us anywhere. What specifically should we ask our political leaders and our government to do to help reduce the instances of homelessness?

Robert L. Okin, MD: Most fundamentally, government needs to shift its taxation policies to soften the huge disparity in wealth in this society and move some of it to the poorest part of the population so that governments can provide the housing and treatment that these people need to get off the streets. It’s not only the humane thing to do, but after an initial investment, it will also ultimately save the taxpayer money because, as I said before, the cost of leaving someone homeless is twice as expensive as giving them housing and treatment. Second, the government needs to stop adding to the problem of homelessness. It needs to stop encouraging the conversion of low cost housing to high cost condominiums, because this conversion decreases the supply of low cost housing stock. Governments also need to prevent very poor, fragile people from becoming homeless in the first place by providing housing vouchers, creating rent controls, prohibiting no fault evictions, giving them financial support to tide them over when they’re at risk of losing their apartments. Because, as I said before, it’s much more expensive and complicated to pull someone out of homelessness once they’ve slipped into the streets than to prevent it in the first place. Next, as I said before, we’ve got to reexamine our attitudes towards these people and recognize that had the deck of cards been dealt in another way, we could just as well be in their shoes and they in ours. And if we felt more connected to them, perhaps we’d be willing to speak out and hold our governments responsible for solving the problem.

Gabe Howard: Dr. Okin, is there anything that we as a society do that that just really, really, really drives stigma and makes the problem worse?

Robert L. Okin, MD: One of the most important things we can do is stop putting homeless people in jail for the consequences of their homelessness. For example, many cities have passed what are called sit-lie laws. That give the city the authority to put people in jail if they find them sleeping on the streets. Well, where else are homeless people going to sleep? I mean, to, you know, to jail them because they’re sleeping the only place they have to sleep. It just seems to it seems cruel. And all it does is contribute to another cycle of homelessness. Because when homeless mentally ill people are put in jail, by and large, they get no treatment. And jail is such a toxic place for them that if anything, their symptoms become worse. And then at the end of their sentences, they’re thrown out of jail with 25 bucks in their pocket with, you know, maybe a slip of paper, paper telling them to, you know, go to a mental health clinic. But no support, no housing, no nothing. It’s like a repetition of what happened to patients who were thrown out of state hospitals. Now, we put them in jail and we throw them out of jails. It’s it’s just a recapitulation of that same process. So one of the things that government can do is stop doing what makes things worse.

Gabe Howard: Obviously you’ve done a lot of research on this subject. I mean, you wrote a whole book on the subject. So can you share some examples of successes in addressing homelessness?

Robert L. Okin, MD: Yes, I can. We need to recognize that this is an eminently solvable problem, and that governments which created it in the first place should be on the hook for solving it. Unfortunately, some of the pessimism that’s developed over the years as to whether it’s solvable becomes a cause of homelessness or perpetuating homelessness in itself, because people think, well, there’s nothing that can be done. Well, that’s just not true. You know, there are good examples that when government does focus on the problem, it really can do something about it. For example, in the Obama administration, you know, faced with the embarrassment of the fact that the government had largely abandoned homeless veterans, the federal government began to create housing and services for this subgroup among the homeless, and the result was that it was able to reduce homelessness among vets by 41% in ten years. I mean 41% in ten years. That is a you know, that’s a substantial solution. And then another example, that comes to my mind is Houston, you know, the mayor of Houston decided and Houston’s, you know, in a city in a red state. So we’re not talking about some, you know, liberal city or liberal state. You know, like Massachusetts, for example, the mayor of Houston decided that he was going to make this a real priority of his administration, and he created housing and services for people. He pushed the, private nonprofit providers into alignment. So so they were all kind of working in the same direction. And the result was in a decade, Houston was able to reduce its homeless population by 63%. I mean that if that doesn’t show that this is a solvable problem, nothing does. And Houston is not some little city. Houston is one of the big cities in the United States and had all the problems that big cities have. So these are two examples that demonstrate that the problem is solvable.

Gabe Howard: Well, that’s all we have for you. Thank you so much for listening to this bonus episode of the Inside Mental Health podcast. We really appreciate you taking the time. If you would like to learn more about Dr. Okin’s work, please check out his book, “Silent Voices: People with Mental Disorders on the Street.” And if you happened to listen to this bonus episode first, please feel free to listen to Untold Stories: Homelessness and Mental Illness on your favorite podcast player right now. My name is Gabe Howard, and I’m an award-winning public speaker who could be available for your next event. I also wrote the book “Mental Illness Is an Asshole and Other Observations,” which you can get on Amazon, but you can grab a signed copy with free show swag or learn more about me at my website, gabehoward.com. Wherever you downloaded this episode, please follow or subscribe to the show. It is 100% free and hey, can you do me a favor? Recommend the show because sharing the show is how we’re going to grow. I will see everybody next Thursday on Inside Mental Health.

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