In the early evening, a man wanders slowly along a downtown residential street in a mid-sized city in upstate New York. He is wearing layers of tattered clothes, despite the summer heat. As he shuffles along, he softly mumbles to himself, occasionally yelling out incoherently. Onlookers are uncomfortable, tightening their circles of friends to avoid the possibility of contact with him. They are afraid, grabbing the hands of their children to pull them away from him. Some are cruel, taunting the man. Of the dozens of people the man passes, only one acknowledges his obvious distress; an outreach worker slowly approaches the man, providing reassurance and offering assistance.
Hands Across America
The mid-1980's was a time when the “homeless crisis” forced communities to recognize homelessness as a societal problem. By the end of the decade, public awareness of homelessness had gained some traction. In 1986, Hands Across America, an attempt to create a human chain from coast to coast, was organized to raise funds to fight homelessness.
McKinney-Vento Homeless Assistance Act
The Stewart B. McKinney Homeless Assistance Act was passed in 1987. Later renamed the McKinney-Vento Homeless Assistance Act, it was the first major federal legislative response to homelessness. Title VI of the McKinney-Vento Act authorizes programs to provide mental health services for people experiencing homelessness. The need for such services is great. According to a SAMSHA fact sheet on the Current Statistics on Prevalence and Characteristics of People Experiencing Homelessness in the United States – 2011 (PDF | 237 KB), as many as 30% of people experiencing chronic homelessness have mental health conditions; however, lacking ties to supports that traditionally lead people to get help (families, friends, primary care physicians), people experiencing homelessness may not be receiving the care they need. Addressing heath disparities in care of mental illnesses is a topic recently championed by Chirlane McCray, First Lady of New York City. At a conference in January 2015, she candidly shared her own family’s experience with mental illness before describing plans for a comprehensive review of mental health issues in New York City that will help address disparities.
Campaign to Change Direction
The willingness to share, to stop looking the other way, is a key message of a major nationwide initiative encouraging everyone to be more open and honest about mental health. Emerging from the White House National Conference on Mental Health held in 2013, the Campaign to Change Direction encourages people to recognize the five signs as a first step in getting help for oneself or for loved ones and acquaintances. In the official launch of the campaign, First Lady of the United States Michelle Obama said, “It’s time to tell everyone dealing with a mental health issue that they are not alone.”
Mental Health First Aid (MHFA)
In her remarks, Mrs. Obama specifically mentions MHFA as a tool that can be used to help someone who might be experiencing a mental health issue. MHFA was developed in Australia in 2001 and piloted in the United States seven years later under the coordination of the National Council for Behavioral Health, the Maryland Department of Health and Mental Hygiene, and the Missouri Department of Mental Health.
MHFA is the help offered to people developing a mental health condition or experiencing a mental health crisis until appropriate treatment and support are received or until the crisis resolves. Participants of the training learn how to assess for risk, listen to and reassure the person in crisis, and encourage professional help and other support. The training is beneficial to everyone in a community: hospital staff, law enforcement, employers, professional associations, faith communities, friends and families, Neighborhood Watch participants, school personnel, etc. Anyone working with people who are experiencing homelessness—outreach workers, case managers, shelter staff, food pantry volunteers—can benefit from the enhanced understanding of mental health offered by this training.
The Mental Health First Aid Australia has demonstrated that the program is effective in a myriad of ways, not the least of which is reducing overall social distance toward people with mental illness. Making connections is particularly important for a population living with the double burden of both homelessness and mental illness.
Awareness and education can dispel the mistrust and fear that lead to people tightening their circles, grabbing their children’s hands, taunting—actions that should not have occurred 30 years ago and should not be occurring today. All of us, not just one person out of dozens, need to know when and how to offer assistance. Commenting on recent efforts to change the way mental health is viewed in this country, Mrs. Obama urges, “It’s up to us to show compassion, to reach out, to connect, to help folks find the hope and the support they need.”
For more information on MHFA, visit the Mental Health Association of Maryland.
This article was originally published as a Voices from the Field Blog post. Find the latest SAMHSA Blog posts about behavioral health and homelessness.
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