Homelessness has been the attention-grabbing headline these days, especially with the recent surge during the pandemic. We are quick to blame substance abusers, the seriously mentally ill or the homeless themselves. Most who become homeless have neither a serious mental illness or a substance use disorder (SUD). We need to look upstream for those factors that contribute to poverty and the policy decisions that set the stage.
The cost of prevention is always less expensive than dealing with the consequences. This is true in medicine, climate change, international conflicts or any variety of issues. Unfortunately, as a society, we usually prefer to wait until a problem has emerged. Only then do we struggle to find “solutions.” Some prevention occurs at a personal level. For example, getting vaccinated is far less expensive than paying for two weeks in an intensive care unit. Many are policy decisions made at the local, state or national levels which tap into our fabricated cultural wars, which makes finding effective solutions difficult.
For the past 40 years, our policies fit nicely into creating poverty and national statistics bear this out. Unfortunately, unyielding poverty tends to create despair, dysfunctional families and drug abuse. Children raised in those conditions experience a high level of adverse childhood experiences, leading to another generation of school dropouts, dysfunction and poverty.
How do we dig ourselves out of this hole? The low-skilled manufacturing jobs that had lifted so many families into the middle class have largely disappeared. Our economy now needs skilled workers, such as electricians, plumbers and technicians of various types, but there are not enough skilled workers for those jobs. Many of those who are unemployed or underemployed lack the self-management skills needed to learn those needed job skills. This essay is too short to adequately address all the policies that contribute to the highest rate of poverty in the developed world. The best I can do is touch on some of the most important policies that may make a difference.
Let’s start with pay rates. Minimum wages have not kept pace with inflation. Certainly, the cost of living is less in rural communities, but that’s not where the jobs are. While increasing the national minimum wage is not on the horizon, we can increase it locally. This also has the ripple effect of increasing wages for people making more than the minimum. That would have the immediate effect of reducing the risk of homelessness today. Investing in job training programs, which we have done, is also very helpful for those who can take advantage of those programs.
A further policy change that would have an immediate effect is the reform of our judicial system, a process that is already underway. Keeping nonviolent offenders out of jail so that they can continue in their jobs makes more sense than the punitive approach that this country has embraced for at least 30 years. Expanding diversion programs for substance users should be part of that reform. An issue often overlooked in the reform movement is what to do about an offender with a serious mental illness. This population, for a variety of reasons, is 10 times more likely to be incarcerated than hospitalized. We have not developed a holding structure that can provide voluntary treatment while holding the individual securely.
Looking further upstream, we need policies to help students stay in school. Unplanned teenage pregnancies are an important contributor both to school dropouts and a lifetime of poverty. Age-appropriate sex education should begin in elementary school and continue through high school. The use of contraceptives should be normalized and readily available for both sexes. Hoping that teens will “just say no” is pure fiction. There should also be mentoring and tutoring services available for those who are falling behind and giving up. Expanding vocational hands-on training in high school makes sense for those not academically inclined.
Even further upstream are children in distressed families. Although many families may be distressed by domestic violence, SUDs, or child abuse, many others may be distressed by poverty with both parents working long hours who are too exhausted to provide much stimulation for their young children. Ideally, state-funded early childhood education programs would be the norm. Readily available and affordable child care helps very young children learn socialization, impulse control and self-management skills. Effective case management and parent training to assist these distressed families need to supplement the efforts focused on children.
Poverty is the dominant risk factor for homelessness. I have described only the most important policy changes and social investments we can make to reduce poverty. There is certainly more that can be done, ranging from early interventions for minor infractions during adolescence and early substance experimentation to industrial policy (see “Can We Prevent Homelessness,” CDN, Nov. 2). Poverty is not a problem that will yield either easily or quickly. It will take a sustained effort over decades but it can be done.
John Dunne is a retired child and adolescent psychiatrist. After closing his practice in the Seattle area, he held consulting positions at Seattle Children’s and Peace Health. He belongs to the Rotary Club of Bellingham, plays trombone with the North Cascades Community Orchestra and volunteers with the Bellingham School District.