Ray Daniels* pays a visit to the local hospital emergency room a few times a month. Daniels is colloquially known throughout the neighborhood as the "Chairman" due to his long inhabitation of a wheelchair and has no permanent home. What happens when he disappears into the hospital is unknown, however, he returns each time to the streets quite unchanged. Permanently crippled, and leaning on a cane, he transforms at the beat of music into a surprisingly agile and graceful dancer, spinning and leaping about on his one good leg, with an obvious genius for rhythm. His shouting down of all of the people leaving a neighborhood church precipitated his last visit to the hospital. Though his rant was difficult to follow due to his slurred speech, it did not seem entirely devoid of good sense.
Daniels is among a growing number of mentally ill people who roam the streets, and for whom there is no help available except in the most dire emergency. A group of his friends waited one night for over two hours for the police to come and take him into the hospital, where at least he and others will be temporarily safe from his bouts of madness and violence. As the group waited for the police to arrive, attempting to cope with Daniels' increasingly erratic behavior, gun shots rung out down the street. Three squad cars shot down the streets with their sirens blaring just a few minutes later. Time and resources are precious in this neighborhood in North Philadelphia. Only the most vocal and violent outbursts are given any attention at all. There is no help at all to be had for those who suffer in silence. Those for whom psychiatric care is available have little hope of recovering when they are returned immediately to conditions of poverty and violence, with no coping skills for facing their circumstances.
There is a huge disconnect between the staff who work in these facilities and the conditions patients face when they leave.
Shane Byers*, who was hospitalized recently for severe depression and suicidal ideation, expressed extreme frustration with group sessions at the hospital, as well as the associated materials. They bore little relevance to the life Shane lives outside the hospital. She suggested that some of the coping exercises almost seemed almost like a cruel joke. "Take a walk in nature," she repeated, laughing. "Are you kidding me?"
It isn't impossible for those who live in these conditions to get well, but the treatment must be focused on the circumstances patients really face, including being homeless, facing food shortages and other lacks. By denying these realities, workers actually may be making people sicker.
"Poverty is shameful, and the details of it make people uncomfortable,” says street activist Annette Shield. "It is terrifically empowering when people affirm your reality. But when they deny it, they make it more difficult for people to cope. It forces people deeper into a fantasy, one they may never come out of."
*Names changed due to HIPAA and privacy statutes.