By Dr. Brian Dixon|May 8, 2019
No single person has the same story as another. Addressing homelessness in our city begins with understanding the inner motivations and outside forces at play in the lives of those without permanent housing.
I want to propose a framework for jumpstarting the conversation around responsible and highly effective social policy in Fort Worth. A responsible social policy that is based on what really works—not on limitless compassion.
What do I mean by limitless compassion? Americans are some of the most compassionate people on the planet. We give to charities at an incredibly high rate. Whether it’s because of guilt, goodness of heart, or tax incentives is beyond the scope of this discussion.
As the wealthiest country in the world, we tend to throw money at problems to make ourselves feel like the good guys. The hardest thing—and the most effective thing—we can do is think critically about how we’re using this money, diving deep to the core of social problems.
In places like Seattle, for instance, $1 billion is spent annually to serve the homeless population. With just over 11,000 people on the streets, that translates to about $100,000 per person experiencing homelessness. In 2017, Fort Worth spent over an estimated 7 million dollars. For an estimated 1,594 people suffering from homelessness, that’s approximately $4,390 per person. Seattle (with 148,000 fewer people) has proven that just throwing money on the table isn’t the best way.
In the past couple years, these policies have not helped to reduce Seattle’s homeless population. According to the city’s own data, more than half of those experiencing homelessness in Seattle are not from the city. People are coming to Seattle from other places because of the laissez-faire social climate around the issue of homelessness. It’s becoming an outsize problem there.
The effective policy in Seattle of limitless compassion has had some onerous unintended consequences: mainly enabling homelessness and cultivating a culture of permissiveness where anything goes. You do you.
Of course, compassion and money are not hindrances to solving homelessness.
Without responsible boundaries, compassion alone cannot address the systemic problems that contribute to homelessness. And yes, money undergirds every initiative.
My point: If money can be allocated to people experiencing homelessness, there are ways to solve the real problems faced by people on the streets. But critical thinking must come first.
Much has been written about homelessness in Fort Worth, but we do have a problem. As a local psychiatrist, I have noticed an alarming increase of people experiencing homelessness in our city.
As with all difficult conversations, it helps to start with some numbers:
Between 2010-2017, Fort Worth’s population increased at an average annual rate of 2.39%.
In comparison, from 2016 to 2017, people experiencing homelessness in Fort Worth skyrocketed by 12%. The next year, 2017-2018, the number increased by another 5%.
Let’s zoom in. What do these numbers actually mean to Fort Worthians? According to A Home With Hope, a local organization serving people experiencing homelessness, “On a given night in 2017, 1,924 persons experienced homelessness in Tarrant and Parker Counties.” In 2018, that number had risen to 2,015 people.
How do we send those numbers the opposite direction?
As we’ll discuss through this article, it starts with a change in the way we talk about people experiencing homelessness. It also takes political, financial, and interpersonal action to tackle the core issues of homelessness and its symptoms.
I’m far from the first person to suggest it, but reversing the problem of homelessness starts with changing how we talk about it.
In modern psychiatry, "crazy" is never used to discuss mental illness. Why?
Because it carries a huge stigma—one that prevents people from accessing help in the first place. Using pejorative terms doesn’t acknowledge the complexity of the way humans experience both mental health and mental illness.
Calling someone a “homeless person" does the same. It puts a stigmatized label on them that doesn’t take into account the nuances of the experience of homelessness.
Language informs the way we see the world. How we talk about one another determines how we perceive one another. Calling someone “homeless” vs. saying they are experiencing homelessness, for example, paints two very different pictures.
Using blanket terms doesn't account for the individual stories and circumstances of the people who make up this marginalized group.
As every physician knows, if you don't individualize the care, define the symptoms, and diagnose them correctly, you'll never get to an effective treatment plan.
The same thinking should apply to how we help those with impermanent housing.
First, let’s diagnose the problems. Every person’s story is indeed unique, but from my research, career, and personal experience, many of these stories have common underlying problems. These problems can be translated into solutions if we consider them differently.
Those experiencing homelessness are not a monolith. Thus, the often-overlapping problems that lead to impermanent housing should be named and categorized to help us determine the severity of each person and help define specific solutions.
To aid our understanding of this issue, here are seven common causes of homelessness:
*Denotes higher severity
The Substance Abuse and Mental Health Services Administration (SAMHSA) says, “People experiencing homelessness have lost the protection of a home and their community. They are often marginalized and isolated within the larger society… Social inclusion offers opportunities to re-engage with the community and form positive relationships.”
As Christopher F. Rufo pointed out in his article about Seattle, you can break homelessness down to one central problem. It’s a problem that many efforts fail to tackle: social inclusion. The resources to "fix" social inclusion should fit the concerns of the real people suffering from the lack of connection.
Solutions for homelessness come in three categories: soft solutions, hard solutions, and open-ended solutions.
"Soft" solutions: Credit, internet access, mentorship, guardianship, social connections, trauma focused/crisis counseling
"Hard" solutions: Cash, housing, clothes, hygiene items, nutrition, maintenance therapy, psychiatric services (including medications), transportation, home health, medical home
On the whole, eliminating the "open-ended" sides of the social net while keeping a rich tapestry of “soft” and “hard” services is key. To speak to Rufo’s charge that there are agencies that benefit from perpetuating the system (the homeless-industrial complex), yes, that happens. But I would redirect the conversation to spreading resources throughout a city. This gives neighborhoods more buy-in and derails potential hits to property values for surrounding homes.
I propose that any city (in this case Fort Worth) that wants to tackle a sensitive topic in a direct, solution-focused and thoughtful manner, will use this as a guidepost for an open and transparent conference with all relevant stakeholders.
By inviting experts in sociology, public health, psychology, psychiatry, city management, and social work, we can ensure an in-depth discussion that produces actionable results.
Take panhandling as an example. Seems straightforward, but the act can be dangerous to both drivers and those panhandling.
If panhandling is increasingly being identified by courts as protected free speech, so be it. But we should seek expertise about how to ensure panhandling is safe for drivers and people experiencing homelessness alike.
Basically, we should teach drivers the basics of how to safely give to those in need. Giving from your car window on an active street can be unsafe for both parties and the public (bicyclists, other cars, other panhandlers).
Instead, we need to get into the habit of donating to the groups (e.g. The Tarrant County Homeless Coalition) that can directly deliver support rather than giving to people in need directly. Creating new giving standards like this will reinforce safer behaviors at busy intersections and encourage people experiencing homelessness to approach groups that can best provide the help they need.
We have enough money and resources to tackle homelessness. We're living in a time when we can restore social inclusion and connection using a hybrid of technology and "boots on the ground."
What we need now is will: a will to innovate through new and creative means to connect us in more meaningful and transparent ways. Check out my infographic on addressing homelessness in Fort Worth!
I’d love to hear your thoughts. What’s your experience with homelessness in Fort Worth? Tweet me at @DrDixonFTW.
With accolades spanning my career as a child psychiatrist, entrepreneur, writer, and public speaker, I advocate for a more sensible U.S. healthcare solution that appeals across all party lines. I am a Texan, born and raised. My psychiatry practice, Progressive Psychiatry, is based in Fort Worth.Read Full Bio