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Like the villages in the following tale, America’s first response to homelessness was to mobilize and confront the threat by targeting the immediate needs of the homeless:
Early one morning, in a village located on the banks of a river, a woman walked to the river’s edge and discovered, much to her horror, that the river was filled with baskets rushing downstream and that each basket held a baby. Aware of the danger the babies faced, she quickly ran back and mobilized the village’s inhabitants. Everyone rushed to the river and began fishing as many babies out as they could. Many more slipped by than they were able to save, but they toiled on anyway, so consumed by their task that it never occurred to them to send someone upstream in order to find out how the babies were getting into the river in the first place. (Anonymous)
We responded to the crisis with shelters and soup kitchens, spearheaded by private charitable organizations but frequently supported by public-sector dollars. We were like the villagers in the introductory tale, although our efforts were aimed not at fishing babies out of the water but at keeping them afloat. After a time, these efforts were accompanied by more tangible efforts to bring people to dry land. Outreach and case management programs were designed to reduce barriers to health and social services, for instance. Transitional housing pro-grams were developed to teach skills and provide support to people as they moved into their own apartments. Such efforts became increasingly sophisticated, reflecting a growing sensitivity to the continuum of care required to stabilize homeless people.
America’s walk to the river’s edge began in the early 1980s, when people of the United States awoke to find that masses of homeless people had appeared in their midst, seemingly overnight. Homelessness was not a new phenomenon, of course. Periods of pervasive homelessness had checkered our nation’s history, most recently in a post-World War II population consisting largely of single, older, white males who inhabited the skid row neighborhoods of our largest cities, where they drew upon a network of private sector resources, including missions, cubicle flophouses, and single-room occupancy (SRO) hotels. However, the new homelessness that we awoke to was a different, far more jarring phenomenon. Whereas homeless individuals during that prior period had remained safely ghettoized in the isolated urban niches ceded to them, these new homeless people were everywhere, occupying spaces throughout the city, spilling into the suburbs, and appearing even in rural areas. Moreover, they looked different from the homeless people we had become accustomed to. They were younger, more ethnically diverse, and more likely to include parents with dependent children. Even worse, whereas the vast majority of “homeless” individuals of decades past had been housed, albeit marginally, this new population was literally homeless, bedding down in large congregate shelters or on the streets and in other locations not meant for sleeping. More visible and far greater in number, they invaded our public consciousness and daily existences in a way that had not occurred since the Great Depression.
Yet, homelessness remained, perhaps even worsened. Although able to point to real success stories, service providers haven’t stemmed the tide of homelessness for reasons that go beyond the fact that their programs are underfunded and unable to meet demand. Many of the people who graduate from their programs become homeless again. Even more disturbingly, a seemingly inexhaustible supply of new faces joins the homeless ranks. Meanwhile, early optimism on the part of the public that a solution to this distressing social problem was at hand has given way to increasingly sharp frustration over the extent to which homelessness impinges on everyday life and a growing backlash against homeless people themselves.
Given the contemporary response to contemporary homelessness, it is hard to shake the feeling that our current quandary is not all that different from the one in which our allegorical villagers found themselves. Like the villagers, we have been toiling laboriously but ineffectively to end homelessness at least in part because our preoccupation with fishing people out of a bad situation has distracted us from the more fundamental issue of how they got there in the first place. Unless we understand and address the causes of homelessness, people will continue to fall into homelessness at a faster rate than we can pull them out.
Understanding the causes of homelessness, however, is not easy, in part because the factors that explain contemporary homelessness are so complex and intertwined, but also because the concept of “cause” itself, as researchers Wright, Rubin, and Devine point out, is so ambiguous. Wright and his colleagues present the hypothetical case of a man named Bill:
Bill is a high school dropout. Because of Bill’s inadequate education, he has never held a steady job; rather, he has spent his adult lifetime doing various odd jobs, picking up temporary or seasonal work when available, hustling at other times. Because of his irregular and discontinuous employment history, Bill’s routine weekly income is meager, and because his income is minimal, he is unable to afford his own apartment and lives instead with his older sister. Now, Bill drinks more than he should (this for a dozen different reasons) and because he drinks more than he should, he is frequently abusive and hard to get along with. Bill’s sister is usually pretty tolerant in such matters, but because she has been having some problems at work, she comes home one Friday in a foul, ungenerous mood only to find Bill passed out on the couch. She decides that Bill’s dependency and alcoholism are more than she can continue to take, and . . . Bill is asked to leave. Bill spends Saturday looking for an apartment that he can afford, but because his income is so low and because there are very few units available to someone with Bill’s income, he finds nothing and heads to the local shelter for homeless people instead, whereupon Bill effectively becomes a homeless person. (Wright, Rubin, and Devine 1998, 8)
Why is Bill homeless? Wright and colleagues point out that one can generate countless sentences that begin with “Bill is homeless because . . .” and that each would be true. Bill is homeless because he drinks too much. Bill is homeless because there are so few apartments available to people with his income. Bill is homeless because there are fewer stable jobs for people with poor educations. Bill is homeless because . . . . Moreover, we can see how pairing the question, “Why is Bill homeless?” with the question, “Why are there so many people who find themselves in situations similar to Bill’s?” might take us in entirely new, equally relevant directions. Talking about causes is difficult because “cause” can refer to many things—distal (more distant, though no less important) versus proximal (more immediate) conditions, for instance, or predisposing factors versus precipitating adverse events, or individual cases versus aggregate trends. In talking about causes, in other words, people can easily talk past each other by grabbing onto different pieces of the truth. This reality at least partially explains the sterile debate regarding the causes of homelessness that dominated much of the 1980s as people tried to come to terms with why homelessness was so evident. On one side of this debate were those people who attributed homelessness to the personal limitations of homeless people, particularly mental illness and substance abuse. Pitted against those people were those people who argued that pervasive homelessness is essentially a function of structural factors, particularly the failure of the housing market to meet the demands of a poverty population that had swelled due to a complex set of interrelated factors. Each group of people stridently rejected the claims of the other. The structuralists dismissed explanations of homelessness that cited high rates of serious mental illness and substance abuse as myths designed to medicalize a fundamentally social/economic problem. Those people espousing an individual limitations perspective, on the other hand, turned to the obvious presence of psychotic and substance-abusing homeless adults as proof that the structuralists were attempting to “normalize” homeless people as part of a bid to advance a policy agenda that had more to do with eliminating poverty than helping those who were literally homeless.
In fact, neither perspective was able to independently accommodate a growing body of evidence. Narrowly defined structuralist arguments could not satisfactorily explain the high rates of mental disorder, substance abuse, and personal problems increasingly documented among the homeless in carefully designed studies. By the same token, people who argued that individual limitations cause homelessness turned a blind eye toward a well-developed body of scholarship suggesting a close historical relationship between homelessness and broader economic conditions and ignored the changing social contexts in which poor people—including poor, non-institutionalized mentally ill and substance abusing adults—live their lives. Moreover, these people could not explain the distinctive demographics of contemporary homelessness, which did not resemble the demographics of the broader group of those troubled by mental health and substance abuse problems but instead the demographics of those groups at greatest disadvantage in our socioeconomic system. Although acknowledging the influences of structural events such as deinstitutionalization (without necessarily recognizing their structural character), such people continued to frame their explanations of homelessness largely in terms of the limitations of people. They ignored one of history’s clear lessons: that the lives of all people, disabled or not, are embedded in circumstances shaped as much by structural factors as personal and biographical ones and that in a permissive environment full of cheap flophouses and undemanding work, even outcasts largely remain housed.
Perhaps the biggest mistake that adherents of each of these perspectives made was thinking they were addressing the same question. In reality, they were addressing two related but different questions. The structuralists were answering the questions, “Why does pervasive homelessness exist now, and even further, why is it currently manifesting itself as ‘houselessness’?” Adherents of the individual limitations argument, despite their protestations that they were dealing with the fundamental causes of homelessness, were actually answering the question, “Who is at greatest risk for homelessness?” or, put slightly differently, “Who is most vulnerable to becoming homeless?” Identifying these two perspectives as addressing different questions makes it easier to see how they may not be mutually exclusive and how they might be reconciled to tell a fuller story.
In place of these opposing perspectives has emerged a widely held, more integrative framework—a structural explanation of homelessness that gives the individual limitations argument its due. Within this framework, the answer to the questions of why homelessness exists now and why it manifests itself as houselessness draws on the structural context in which contemporary homelessness emerged. This context was defined by a complex set of interwoven demographic, social, economic, and policy trends that increasingly left poor people—particularly the impaired among them—facing a growing set of pressures that included a dearth of affordable housing, a disappearance of the housing on which the most unstable had relied, and a diminished ability to support themselves either through entitlements or conventional or makeshift labor. Households and individuals barely making do increasingly found themselves under financial and interpersonal stresses that made a bad situation worse, culminating, by the early 1980s, in the pervasive homelessness that now seems to be an enduring part of our social lives.
Who actually becomes homeless in such a structural environment is not random, of course. Given that by the early 1980s, low-cost housing had become a scarce resource, it stands to reason that the first group to fall off the housing ladder would disproportionately include those people least able to compete for housing, especially those vulnerable individuals who had traditionally relied on a type of housing that was at extremely high risk of demolition and conversion. Viewed in this context, it is not surprising to find high numbers of people with mental illness and substance abuse among contemporary homeless populations—not just any mentally ill and substance-abusing individuals, it should be noted, but rather disproportionate numbers of those who came from backgrounds of poverty and/or who had diminished support resources to fall back on. For the same reason, it is hardly surprising to find high numbers of individuals with other sorts of personal vulnerabilities and problems among the homeless. This is not to say that mental illness, substance abuse, and other individual limitations in and of themselves cause homelessness, as witnessed in the fact that such individuals had remained housed in prior periods when low-cost housing and day labor suited to their occasionally chaotic lives were widely available. It is to say, rather, that such factors impaired the ability of people to compete with less vulnerable individuals for the scarce resource that affordable housing had become and thus left them at much greater risk for homelessness. People with problems are disproportionately numerous among the homeless, it becomes clear, because in a housing arena characterized by fierce competition, they are more vulnerable and, as a result, less likely to prevail.
We should spell out these structural trends and personal vulnerabilities in greater detail. First, let’s look at the salient factors that have created and defined the context in which pervasive homelessness has emerged and is sustained.
The Structural Context
Those researchers who have examined the structural underpinnings of homelessness have concentrated primarily on two sets of factors and their ultimate collision: a growing pool of vulnerable poor people and a concomitant decline in the availability of lowcost housing. As poverty rates fluctuated between the early 1970s and the late 1980s, the absolute number of poor individuals grew substantially, and their poverty deepened. Several factors contributed to these developments. For one, this period coincided exactly with a potent demographic trend—the coming of age of those people born during the “baby boom,” the post-World War II birth explosion that lasted through 1964. Unfortunately, this boom coincided with a marked transformation and a restructuring of global and local economies that severely restricted opportunities for the growing numbers of unskilled laborers preparing to enter the workforce.
Referred to, in its different aspects, as “globalization,” “post-Fordism,” and “deindustrialization,” these changes involved a shift from a predominance of relatively high-paying manufacturing jobs to lower-paying, often part-time, service jobs that lacked the same level of benefits and security and to a general slowing of wage growth rates.
Ultimately, these trends created a growing pool of young workers, particularly ill-educated individuals of minority status, who were either marginally employed or chronically unemployed. Simultaneously, a series of policy changes with regard to federal entitlements steadily eroded the real dollar value of both Social Security and Aid to Families with Dependent Children (AFDC) payments and, through tightened eligibility criteria, reduced the number of people who were able to rely on the government for support. Finally, changes in policies regarding the management of two economically and socially marginal populations—deinstitutionalization in the case of the severely mentally ill and decriminalization in the case of chronic public inebriates—meant that new groups of previously institutionalized people were swelling the ranks of the very poor. Because these latter people primarily relied on zones of tolerance characterized by SRO housing and intermittent day labor—zones of tolerance that were rapidly disappearing in response to pressures related, respectively, to gentrification and immigration—they were at particularly high risk. Gone were the safety valves that allowed this population to adapt to life on the margins, without an alternative set of mechanisms to take their place.
At the same time that the absolute number of poor people was growing, the nation’s supply of low-cost rental housing was shrinking for a variety of complex reasons and was thus increasingly unable to meet burgeoning demand. This occurred not only in the stock of multi-room units typically inhabited by poor families but also and even more precipitously in the stock of SRO hotels that served as the housing of last resort for single people—including the severely mentally ill and down-and-out substance abusers—on society’s margins. Thus, whereas in 1970 a substantial surplus of housing units affordable to households in the bottom quartile of income was available, by 1989, there was a deficit of 5 million units—2.8 million units for 7.8 million bottom-quartile renter households. In response, poor households began to spend more of their income on rent and to double up (move in with family or friends), leaving them more and more vulnerable to economic crisis and domestic stress and increasingly less able to support unproductive household members. The result was pervasive homelessness.
Although researchers have mobilized an enormous amount of convincing evidence to document these structural trends, researchers have had difficulty “proving” the structural argument by relating these trends directly (i.e., through mathematical modeling) to variation in homelessness over time and over region, despite necessarily crude attempts to do so. This is mostly due to the fact that precise and reliable estimates of the outcome variable—numbers of homeless people in a representative set of places at different time points—simply do not exist. Although advances in the science of enumerating homeless populations may allow more reliable estimates in the future and thus more precise modeling efforts, the absence of such data for the critical time period spanning the late 1970s to mid-1980s means that the data on observed trends and the persuasiveness of the structural argument must remain the basis on which the structural perspective’s merit rests.
Individual Vulnerabilities
Who is most vulnerable to homelessness in this context defined by housing scarcity? Efforts to identify the individual-level factors that place people at risk for homelessness have focused primarily on discrete and readily identifiable disorders, particularly severe mental illness and substance abuse. Such disorders are disproportionately present among the homeless, although perhaps not to the extent that a number of early, methodologically flawed studies first suggested. More rigorous studies have indicated that as many as one-fifth to one-quarter of the homeless have experienced severe and extremely disabling mental illnesses such as schizophrenia and the major affective disorders (clinical depression or bipolar disorder) at some point in their lives and that one-half have experienced either alcohol- or drug-use disorders. Current prevalence rates (symptoms present within a recent time frame) are substantially lower but are still disproportionately high relative to domiciled comparison groups.
As high as they are, these numbers almost certainly overestimate the prevalence of alcohol, drug, and serious mental disorders among the total population of persons who experience homelessness for a number of reasons. First, most estimates are derived from cross-sectional samples of homeless adults— that is, from samples drawn at one point in time. Such samples tend to overrepresent the chronically homeless and to underrepresent the much larger group of individuals who are homeless for much shorter periods of time. To the extent that these latter individuals are less likely to suffer from these disorders, rates of disorder among the population of different people who have experienced homelessness within longer spans of time—a year, for instance— will be lower. Second, most estimates are derived
from studies consisting largely of unattached homeless adults (i.e., those who are unmarried and without children in their care). Although this group still predominates among the homeless, to the extent that these studies underrepresent adults in homeless families—whose mental health and substance abuse profiles are far less severe—they overrepresent the prevalence of these disorders among the total homeless population. Third, these estimates are based on the prevalence of disorders among homeless adults.
If the children currently in the care of these adults—a large number in many cities—were added to the denominator, rates would change substantially.
Even so, mental illness and substance abuse, alone or together, are undoubtedly much more common among homeless adults than domiciled adults, suggesting that these disorders do indeed contribute to vulnerability to homelessness. However, not every severely mentally ill or substance-abusing adult becomes homeless. Nor are those people who do become homeless representative of the larger population of severely mentally ill and substance-abusing adults who remain housed, as we would expect if only mental illness and substance abuse were operating. In fact, severely mentally ill and substance-abusing adults who eventually experience homelessness instead more closely resemble the profile of homeless adults who are not mentally ill or substance abusing. Certainly this is true demographically. Like their non-disabled homeless counterparts, they are disproportionately African-American and poor. However, other factors—factors related to biography and situational circumstances—are also at work here, sometimes singly, often in complex combinations. Some of these factors may be as, or even more, important in understanding who is vulnerable to homelessness in an environment characterized by housing scarcity.
One such set of factors pertains to the childhood experiences of homeless adults. The picture that emerges when one delves more deeply into the backgrounds of homeless adults—particularly single homeless adults—is that homeless people are no strangers to poverty, housing instability, or the host of personal problems that disproportionately besets them as adults. As children, they disproportionately experienced significant disruptions in their residential stability, for example. In Los Angeles, fully two-fifths of a probability sample of homeless adults—the Course of Homelessness baseline sample (Sullivan, Burnam, Koegel, and Hollenberg 2000)—experienced housing problems while living with their families between the ages of six and eighteen (this at a time when the low-income housing market was far more forgiving). They doubled up with other households because of difficulty paying their rent, experienced evictions, and (in much smaller numbers) experienced literal homelessness with their families before such a phenomenon became common.
The backgrounds of homeless adults also suggest serious disruptions in family stability. Surprising numbers experienced out-of-home placement as children (in foster care, juvenile hall, orphanages, and treatment facilities); estimates cluster around 20 percent but reach as high as 40 percent in some reports. These extraordinarily high rates may be tied to other indicators that suggest early family disruption in the lives of homeless adults as well—high rates of mental health, substance abuse, and physical health problems among their parents and/or other adult members of their households; physical or sexual abuse in the household; and jail time among adult household members. This is not to say, of course, that every homeless individual comes from a background in which each set of problems—residential instability, out-of-home placement, and family trouble—was apparent. However, the vast majority of the Course of Homelessness baseline sample had experienced at least one of these problems as children, and many had experienced more. Such problems, not surprisingly, are often bundled together. These childhood experiences, in turn, may be related to the longstanding observation that many homeless individuals either do not have the family and friendship ties that people rely on to buffer them from the consequences of hard times or have ties to people who are similarly stretched and are thus in no position to provide substantial support. More immediate situational factors appear to increase an individual’s vulnerability to homelessness as well. The impact of such factors was apparent in the Course of Homelessness study, which included detailed questions on events that occurred in the year before the members first became homeless. Some of these events had clear structural or policy connections. In the year before becoming homeless, for instance, half of the individuals in this sample experienced a drop in income, either because they lost a job or lost the benefits on which they had been relying. Moreover, approximately one-third experienced a major increase in expenses during that period, such as rent or health care. Other events spoke more pointedly to changing interpersonal relationships. More than two-fifths reported that they had become separated or divorced or that they had experienced a break in a relationship with someone with whom they had been close. Somewhat more than one-third had faced a situation in which someone on whom they had depended for housing, food, or money was no longer willing or able to help them. (Although not asked about in this study, an association between being pregnant or giving birth within the last year and homelessness was found in a study of homeless versus housed families on public assistance in New York City.) Still other events spoke more directly to individual disorders and their impacts. Almost half of these adults admitted that they were frequently using alcohol and drugs during the year prior to first becoming homeless. One-quarter had spent time in a hospital, jail or prison, group care, or treatment facility during that year. One-fifth acknowledged that they had experienced serious physical or mental health problems during that period. Nearly 90 percent of the sample reported at least one of these various experiences, but multiple experiences were the rule. On average, sample members reported three such experiences.
In the absence of good comparative data on people who are “vulnerable” but for the time being housed, it is impossible to say with certainty whether and how these situational precipitants—or indeed the other background factors that may make them more likely to occur—combine to put people over the edge. Identifying the real basis for vulnerability is not always straightforward. Homeless families, to take one example, have certain characteristics that would intuitively appear to confer risk—such families are almost uniformly female-headed, single parent households, for instance—but the fact that their housed poor counterparts are equally likely to be headed by single mothers suggests otherwise.
More complex statistical analyses of who ends up in family shelters in New York City, in fact, show that factors such as race, pregnancy or recent birth of a child, childhood poverty and childhood disruptions, domestic violence, and particularly housing conditions (that is, whether one is in one’s own apartment, whether it is subsidized, and how crowded it is) are primary, not factors related to education, work history, or disorder. Similarly, multivariate analyses (i.e., analyses that examine the impact of variables while controlling for the impact of other variables) of data on homeless and vulnerable meal program users in Chicago suggest that social institutional factors such as whether people are receiving income maintenance grants when domiciled, whether they are living with others, and how high their rent is explain who is homeless—not factors related to disability. Careful comparative studies such as these add to our knowledge of the factors that actually confer vulnerability. More work along these lines is needed. Also needed are empirical studies that pinpoint the precise mechanisms through which earlier antecedents translate into later vulnerability.
When we look more deeply into the backgrounds of homeless adults—particularly single homeless adults—we see multiple events and conditions emerging at different points in their life span that potentially increase their risk for homelessness. Conceptual models designed to explain who is at highest risk for homelessness and the data on which they are based increasingly take into account these myriad factors, including those factors related to demography, diagnosis, life experiences, and current circumstances, and highlight the complex ways in which these factors are interrelated. These models emphasize that single pathways to homelessness, in which a solitary source of vulnerability acts in isolation from others to leave one at risk for homelessness, are comparatively rare. Far more frequently, characteristics, life experiences, and their consequences interact to create a particular trajectory. The cumulative burden of these problems and experiences leaves certain individuals at particularly high risk.
Structure plays a role here as well because structure creates and perpetuates vulnerability—it both directly and indirectly fosters the conditions and events that leave some people at greater risk for homelessness at the same time as it establishes the context in which pervasive homelessness is inevitable. As researchers Koegel, Burnam, and Baumohl noted, risk factors “are almost invariably bundled; very rarely does one alone cause homelessness. And the chances that one will acquire such bundles are not evenly distributed at the outset of the game. Nor do they even out over time” (Koegel, Burnam, and Baumohl 1996, 33).
An Integrated Perspective
To explain the presence and face of homelessness, then, one must consider two sets of factors: structural factors, which set the context for pervasive homelessness; and individual vulnerabilities, which earmark those people at highest risk for homelessness within tight housing and job markets. With regard to structural factors, a complex set of changes in the
housing market, in income distribution, in social policy regarding marginal populations, and in the availability of urban zones of tolerance all coalesced to set the stage for homelessness. In the case of individual vulnerabilities, a bundled set of risk factors emerging at critical points during an individual’s life span compounds itself to create the kinds of problems that leave a given person less able to compete for scarce social and economic resources and thus at elevated risk for homelessness in a structural context that makes homelessness inevitable.
References:
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