Shoelessness and Subway Violence

The ongoing saga of Jeffrey Hillman, who was given shoes by a kind cop, and the horrific story of the killing of Ki Suk Han by Naeem Davis reveal the inadequacies of the tools available to authorities for the treatment of schizophrenics and others with mental disorders.

Specifically, short of institutionalization, society has no mechanisms to assure that people with mental disorders are treated and take proper medications.

To be sure, we have not been told that Hillman and Davis fit that category, but their behaviors and histories follow closely the symptoms -- such as constant smoking, apathy, argumentativeness, racing thoughts, lack of concentration, pacing, inability to complete tasks, and the like -- of schizophrenia's multi-faceted and multi-level nature.

The disease is not easily diagnosed in all of its sufferers since it can come in forms mild to extreme, and its symptoms and behaviors are found also in people with various levels of depression or with bipolar or schizoaffective disorders.

As I wrote here:

... fifty years ago, many such individuals, in all likelihood, would have been in an institution and not on the street.  However ... "deinstitutionalization" would allow "individuals who suffer with mental illness [to] lead more normal lives in the community then [sic] they could confined to an institution."

A driving force behind this "program" was the development of psychotropic medications that were accidentally discovered when researchers realized that laboratory animals and institutionalized patients who took certain antibiotics experienced positive changes in their behaviors and mental conditions.

But thrusting large numbers of previously institutionalized persons on communities caused numerous problems.  Not the least of those problems was an increase in homeless, because society was ill-prepared to accept, properly treat -- like assuring that medications are properly prescribed and taken -- and provide care for those persons when they suddenly appeared.

Many if not most of the deinstitutionalized persons went into halfway houses, flop houses, transient hotels, and a variety of newly established residential facilities.  Others went into the homes of family members or friends.  Not surprisingly, a majority of these people had great difficulty adjusting to their new circumstances and developing ways to care for themselves, including the taking of their psychotropics.

Additionally, not only do those psychotropic medications often produce unpleasant side-effects, but some people quit taking the medications "because they feel better or they may feel they don't need [them] anymore," or because they don't like to feel better (emphasis added):

... individuals often view taking medications ... as a sign of weakness, an admission that one can't handle things on their own, or that medications will change or alter who they are.

That is, to answer Rick Moran's question, yes, they do think they are "... better off, happier, blankly wandering the streets without shoes than subjecting [themselves] to the rules of a homeless shelter."

A thorough study of the problems with respect to side-effects can be found here.

Consequently, a sizeable portion of this population ended up either on the street or in and out of various facilities or homes.  Almost all of the released persons were unemployable or unable to hold jobs or manage their own affairs and finances.  This link offers interested readers an excellent synopsis of the situation.

And this brings us back to Mr. Hillman, who is not, in fact, homeless (emphasis added):

[He] ... has a sad history of refusing help from loved ones and the government[.] ... [He] has had an apartment ... paid for[,] ... rent vouchers and Social Security disability[,] and veterans benefits[.] ... [He] lived in city-operated ... "Safe Havens" ... geared toward "the chronic street homeless population."  Then, Hillman secured housing through a ... [VA] program[.] ... The program comes with a wide array of social services, including drug and alcohol counseling and mental health treatment.

CBS confirms that:

Hillman receives some benefits because he served in the military ... [like] a veteran-focused part of the housing voucher program[.] ... [And] the apartment comes with case management services, which Hillman doesn't use.  A Homeless Services official said on background that Hillman is also a recipient of disability benefits through Social Security.

Even though Hillman was not using the case management services, it is almost certain that whatever intake counseling/treatment he received included the prescribing of any one of a number of psychotropics, and it is almost equally probable that Hillman failed to follow the prescribed regimen for those drugs. 

Additionally, Hillman, like many schizophrenics, had little contact with his very normal and accomplished family after he was discharged from the Army, and, as noted here by Robert Tyrrell:

The more one looks into the case of this beneficiary of state and federal welfare the more curious his plight is[.] ... [H]e played basketball[,] ... smiling in ... [his] yearbook[,] horsing around[.] ... [This is] much different than [sic] the shambling vagrant seen ... without shoes[.] ... [He was] pretty middle class[.] ... What happened?

Well, what happened is what happens to most schizophrenics: the condition's "onset is typically between the ages of 15 and 25 ... [and] can come on over a period of years ... or be very rapid."

Davis's circumstances are less-well known.  However, ABC reports that Davis apparently does not have a "currently known mental illness history," but he was a homeless street person, had been for some time, and doesn't fit the profile of a schizophrenic other than disorderly conduct and a lack of empathy and close relationships:

Davis showed no remorse for causing Han's death[.] ... "He would walk down the street talking to himself. He was always alone." ... "He sleeps in a chair or milk crate or on cardboard on 49th Street[.] ... He looks shifty; he looks sick. But I've never seen him in a fight."

His history is spotty, but he somehow came here from Sierra Leone, showed fetal alcohol syndrome effects, and was raised in a foster home before seemingly drifting off to an aimless life culminating in keeping Mr. Han's "Appointment in Samara."

Of that event, the NY Post reports:

... Han approached the crazed man ... described as a panhandler ... [who] had been harassing and cursing at straphangers ... and tried to calm him down[.] ... "There was a confrontation ... the individual was talking to himself prior to pushing the victim[.]"

Like Hillman, Davis almost certainly went through an intake process that would have included some prescribing of medications.  A good summary of his early life, foster care situation, and arrests is provided here in the Beaver County Times.

In summary, then, these cases (and others such as James Holmes [the Batman shooter]; Jared Laughner, who wounded Congresswoman Giffords; and Andrew Goldstein, who pushed Kendra Webdale in front of a train in 1999) reveal that, as with the poor, we also will always have the mentally disturbed among us, and, short of the imposition of drastic measures for their control and treatment, there is very little that can prevent such ghastly occurrences from revisiting us all too regularly.

There simply is neither enough money nor sufficient will to change privacy and other laws in order to adequately follow and treat the mentally disturbed.  Full stop.

Forrest Stump is the pen name of the author, who has firsthand knowledge of mental health and other social welfare issues.