This transcript has been edited for clarity.
Hi. I'm Art Caplan. I'm at the Division of Medical Ethics at the NYU Grossman School of Medicine.
If you walk around many of our major cities today, you see a tremendous problem with homelessness. I'm not talking about people who are camped out in a park or on a street and are making a mess or littering or having sanitation issues. I'm not even talking about those who are out there perhaps using drugs.
What I'm really focusing on today is the people who are out on our streets who are severely mentally ill. We don't have great numbers on what that population is, what percentage of persons who are homeless it is. Some people I know are out being homeless because they don't trust shelters. Some people are homeless because they choose to be that way.
There certainly is a significant number of people in places like Oakland, San Francisco, New York City, and many of our big cities where we have people who are obviously schizophrenic, screaming, running around half naked; getting preyed upon by thieves, rapists, and other people who take advantage of them; and sometimes getting into violent incidents with people. Some of the people who have pushed people off subway platforms in New York City clearly were violently mentally ill. I'm not saying all mentally ill people are a violence risk, but some of the people that are out on the streets definitely are and we know that they have committed crimes against others.
It is no favor, none, to keep severely mentally ill people out on the street. What are they doing there? Well, many decades ago, in an act of effort to try and be humane, we started to close our mental asylums and mental institutions. They were snake pits. They were warehousing people. They weren't getting care. They were often put in a corner, drugged to the point where they couldn't move around, and that was it.
In trying to solve that problem, reformers said, "Let's close these places down and give community housing and community care to many of the residents who are in these facilities." It didn't happen. Communities didn't want those facilities. We had a NIMBY problem: "not in my backyard." We had people who said, "I'm not putting mentally ill people near children. They can't be near a school."
Pretty soon, nothing happened. The institutions closed. The mentally ill went out on the streets. There they are, and there they remain. This is not ethical. This is not humane. The situation, in my view, is flat-out wrong.
There are some who will argue from a civil liberties perspective that says they have their rights. You can't just round them up and put them someplace. That's a violation of their dignity, of their civil liberties. I say that leaving the severely mentally ill out on the streets to rot with their rights on is a public policy mistake.
We have to reopen some institutions. Not snake pits or warehouses, but humane facilities where people can get reasonable care for their mental illnesses; get medications; be protected against the elements of the weather; get a blanket; not live under a box; not try to find a sewer grate to lie on top of; and not be running around frightening neighborhoods, scaring people out of going downtown, and starting to ruin the economies of many cities because people just say, "I can't deal with what I find if I go downtown in an American city."
It's good for the people with mental illness to reopen some of these institutions. It's good for their families who are deeply worried about what's happening to them. I'm not saying to round up all homeless people. We can talk another day about what to do about the homeless problem.
What I am saying is people with mental illness, severe disease, deserve better than to be told, "Stay where you are. We're not going to worry about you." Donald Trump has started to make this point. Ron DeSantis has started to make this point. There are other political leaders who are starting to say that it's time to reopen the asylums.
We have to do it with great care. There's no doubt about it. We abused and neglected people in the past. We harmed them by putting them into awful institutions. I'm not calling for that.
I'm calling for spending money to make our downtowns safe and to protect the welfare of mentally ill people who are out there and to get better treatments (which we now have), so that they may be able to regain more autonomy and self-control in settings that are humane, that get inspections, and that are willing to let any media outlet come in and see how these people are being taken care of.
That seems to be the right thing to do, and I think it's time that we start moving in that direction.
I'm Art Caplan. I'm at the Division of Medical Ethics at NYU's Grossman School of Medicine. Thanks for watching.
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Cite this: Time to Open Humane Facilities for People Who Are Homeless and Mentally Ill? - Medscape - Nov 27, 2023.
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