How funding to house #MentallyIll, #Homeless is a financial gain, not drain

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A director of a supportive housing center in Bronx, New York, talks with a resident and case worker in December 2015.
Bebeto Matthews/AP

Carol Caton, Columbia University Medical Center

As Congress considers the federal budget proposal for fiscal year 2018 to reduce funding for services to poor and homeless Americans, programs with proven cost-effectiveness should not be on the chopping block. One such program is supportive housing for homeless people with severe mental illness. The Conversation

Supportive housing, funded and coordinated by several different federal agencies and nonprofits, provides homeless people who have severe mental illness with housing coupled with treatment and support services. There is no increase in net public cost compared to street and shelter living.

While it may appear that paying for supportive housing is a drain on the federal budget, research has shown that ending homelessness for the severely mentally ill saves taxpayers money.

Because funding comes from several different agencies, it is hard to know specifically from the president’s budget plan how deep the cuts to supportive housing could be. Yet we do know that the president has proposed cuts in funding to Housing and Urban Development by 13 percent and to Health and Human Services by 19 percent. Both these agencies provide significant funding for supportive housing.

I research mental illness and homelessness. Cutting funds to house the homeless would cost us more money than it would save.

Supportive housing and the homeless mentally ill

Since the 1980s, homelessness has plagued cities and towns across the country. Today, more than a half-million people in the U.S. are homeless. One in every three homeless people suffers from a mental illness, which is often compounded by multiple health problems and substance abuse.

The homeless mentally ill are likely to remain undomiciled and without treatment for long periods of time. This brings a high social and economic cost to society. Disabled by mental illness and unable to work, these individuals have little hope of exiting homelessness without public assistance.

From www.shutterstock.com

Beset with extreme poverty and disability, their inability to work renders them heavily dependent on the largesse of government agencies for disability income, housing support and health care.

The challenges facing homeless people in general are daunting. Security, privacy and creature comforts are in short supply. The daily burden of being homeless involves finding ways to assuage exhaustion and hunger, and to sidestep the violence and victimization that regularly occurs in life on the streets. An estimated 14 to 21 percent of homeless people are victims of crimes, compared to about 2 percent of the general population.

Supportive housing, started in the early 1980s, has shown to make a big difference. Unlike the temporary respite provided by crisis shelters, it provides access to permanent housing, mental health treatment and support from mental health professionals to guide the adjustment from homelessness to stable residence in the community.

Supportive housing tenants must have a behavioral health condition that qualifies them for a federal disability income. Residents pay one-third of the cost of rent and utilities with their disability income (about US$733 per month). The balance is covered by a housing subsidy provided through private or governmental sources. In some cases, eligibility for a housing subsidy is based on duration of street and shelter living.

The numbers tell the story

In concert with the federal plan to “End Chronic Homelessness in Ten Years,” supportive housing has helped to reduce chronic homelessness by 35 percent between 2007 and 2016.

At an annual cost ranging from $12,000 to nearly $20,000 per unit, permanent supportive housing is expensive, but it is substantially less than the annual cost of a stay in a homeless shelter, jail or prison, or psychiatric hospital.

Some of the funding comes from the federal government, including from the Department of Housing and Urban Development’s Continuum of Care and from Section 8 housing subsidies. The Department of Health and Human Services and the Department of Veterans Affairs also provide funding.

States including New York, California, Washington and Connecticut have helped to fund housing for people with mental illness, as have some city and county governments.

Other sources of funding include low-income housing tax credits, private foundations and charitable donations to nonprofit housing providers. The Affordable Care Act Medicaid expansion program provides Medicaid reimbursement for services provided to individuals in supportive housing.

And the winner is…everyone

Controlled trials conducted in the United States and Canada have found the majority of people who have had access to supportive housing remain housed for a year or more, showing greater housing stability than that among comparison subjects. In addition, individuals in supportive housing not only stayed longer but also had a reduction in subsequent homelessness and decreased use of emergency departments and hospitals.

Cost offset studies show that supportive housing leads to less use of costly public services.

A landmark analysis of administrative data from multiple public service systems examined the impact of supportive housing placement on 4,679 individuals and their use of the public shelter system, public and private hospitals, and correctional facilities. The study found that persons placed in supportive housing experienced significant reductions in use of homeless shelters, hospitals and time incarcerated. In fact, public service cost reductions following housing placement nearly offset the cost of the housing itself.

Significantly, supportive housing is nearly half the average cost per year of $35,578 for a chronically homeless person. Part of the reason is that stable housing resulted in a shift in service use from expensive crisis services to less costly community-based care.

Strong and compelling evidence indicates that supportive housing is a “win-win” for both the homeless mentally ill and the holders of the public purse. It offers people with mental illness safe and adequate housing and greater access to treatment, essential elements in their recovery. And it can lead to greater cost-efficient use of public services.

Currently there are not nearly enough supportive housing units to house the thousands of individuals with severe mental illness who are currently unstably housed or are at risk of falling into homelessness.

It would not make economic sense to cut funding for a cost-effective intervention that provides a solution to homelessness. Rather, what we need now is the public will to bring supportive housing to scale so that the most fragile among us might achieve stable residence in the community. They, too, deserve the opportunity for personal fulfillment and involvement in mainstream society.

Carol Caton, Professor of Sociomedical Sciences (Psychiatry and Public Health), Columbia University Medical Center

This article was originally published on The Conversation. Read the original article.

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Four ways to stay mentally fit if you’re struggling with the political climate

A protest in New York’s Washington Square Park days after Donald Trump’s election. Muhammed Muheisen/AP
A protest in New York’s Washington Square Park days after Donald Trump’s election. Muhammed Muheisen/AP

Roxanne Donovan, Kennesaw State University

“This can’t be happening.”
“I feel like throwing up.”
“I don’t want to get out of bed in the morning.”
“Life is going to get a lot worse for people like me.”
“I’m so sad I can’t even think about it anymore.”
“Things are never going to be the same again.”

I’ve actually heard these statements from people pained by Donald Trump’s election. Such sentiments convey a mix of disbelief, despondency, powerlessness and fear.

That said, there are many people who are thrilled with the new administration. As a psychologist who researches the ways discrimination experiences impact well-being, however, I am particularly sensitive to those in distress.

My research, and that of other social scientists, helps explain why a Trump presidency is difficult for so many people – and particularly acute for those who have already experienced trauma based on some of the issues identified with Trump.

For example, many women who have been sexually abused were deeply affected because of recorded statements he had made about grabbing women in their crotches. Additionally, many African-Americans who felt empowered and validated by an Obama presidency felt deep sorrow and fear at Trump’s election, due in part to published accounts of his father’s company not renting to African-Americans. There is some good news among all this; there are strategies for coping.

Repeated stress wears the body down

It has proven hard for those opposed to Trump to adjust to his election. Many have felt like they are in the middle of an ongoing stress storm. Immigrants, for example, are stressed over concerns about being deported and separated from their families.

Making matters worse, some are more vulnerable to this storm’s impact than others. The more storms a person has endured, the greater the damage this new storm can inflict.

The reason why this happens is called allostatic load – the wear and tear on the body caused by ongoing stress. This deterioration is cumulative and can lead to physical, psychological and cognitive declines, including early death.

Along with genetics, environment and behavior, social demographics like race, gender and age also influence the weight of the load. University of Michigan public health professor Arline Geronimus and her colleagues captured this phenomenon when they examined allostatic load in black and white women and men.

They found that black participants, particularly black women, were more likely to have higher allostatic loads than white women and white men, above and beyond the effects of poverty. In other words, black people generally carried more stress in their daily lives.

Age matters too. Allostatic loads were similarly distributed across race and gender prior to age 30. From there, however, the loads disproportionately increased with age, revealing racial and gender gaps that widened over time (white men consistently had the lowest scores, followed closely by white women).

It’s not easy being different

Some psychologists believe the stress of otherness – being viewed and treated negatively due to group membership – is one reason for the unequal “weathering” effect. Mounting evidence gives credence to this belief.

My research group, for example, found black, Latino and Asian undergraduates report significantly more individual and ethnic-group discrimination than white undergraduates. Similarly, almost 100 percent of the black college women my collaborators and I sampled reported experiencing racial discrimination. In both studies, incidences of discrimination were associated with depressive symptoms and, in some cases, anxiety.

So the interplay between high allostatic load and low social position increases vulnerability. This is not good news for the many people of color, women, undocumented immigrants, sexual minorities and Muslims who are stressed out about a Trump presidency.

Strategies that can help

Before giving in to despair, there are reasons for cautious optimism. Psychological research points to promising coping techniques shown to lighten allostatic load and mitigate negative stress outcomes, even among those exposed to prolonged high-stress situations.

  1. Avoid avoidance. As tempting as it might be to address negative feelings through avoidance – think excessive shopping, working, drinking, eating, gaming, online surfing – doing so can be detrimental in the long run. Instead, choose behaviors shown to improve mood over time, like exercise and meditation. Mindfulness-Based Stress Reduction (MBSR), a standardized eight-week program that teaches mindful meditation, shows great promise at reducing stress and improving mood in a wide variety of populations.
  2. Problem-solve. Taking action to address a perceived stressor can be therapeutic. Called problem-focused coping in the psychological literature, this technique has been shown in my research and that of other social scientists to buffer the negative health effects of stress. Donating time or money to a preferred political candidate, party or cause or participating in a protest or letter-writing campaign are examples of problem-focused actions.
  3. Seek support. An aspect of problem-focused coping worthy of individual attention is social support. Connecting with empathetic others has the interrelated benefits of reduced stress, lower allostatic load and improved health and well-being. A solid support network doesn’t have to be large. It can contain just a few people you perceive as reliable. Need to build your network? Start by reaching out to those already in your life that you’d like to know better. Joining civic organizations or neighborhood groups are also good options. If you go this route, facilitate connections by volunteering to help the organizers.
  4. Get help. Sometimes our coping efforts don’t yield desired results, or we can’t bring ourselves to try anything. In these situations, professional help might be warranted. The American Psychological Association is a great resource for information about the benefits of psychotherapy and how to go about finding a therapist.

If you plan to endure the social changes under way with gritted teeth and clenched fists, I invite you to experiment with the above techniques to find what combination might work for you. Four years is a long time to be battered by a storm; preparation could mean a lot less damage, especially if previous storms have worn you down.

The Conversation

Roxanne Donovan, Professor of Psychology and Interdisciplinary Studies, Kennesaw State University

This article was originally published on The Conversation. Read the original article.

Why children believe (or not) that Santa Claus exists

Parents go to great lengths to make their kids believe the Santa myth. Boglarka Bodnar/MTI via AP
Parents go to great lengths to make their kids believe the Santa myth. Boglarka Bodnar/MTI via AP

Jacqueline D. Woolley, University of Texas at Austin

The holiday season is upon us, and so are its attendant myths, most prominent of which is the Santa Claus story. This is the time that many children are told about a man who lives forever, resides at the North Pole, knows what every child in the world desires, drives a sleigh pulled by flying reindeer and enters one’s house through a chimney, which most children don’t even have.

Given the many absurdities and contradictions in this story, it’s surprising that even young children would believe it. Yet research from my lab shows that 83 percent of five-year-olds think that Santa Claus is real.

Why?

An evolutionary advantage?

At the root of this paradox is a very basic question regarding the nature of the young child as an inherently credulous being – that is, believing everything he or she is told – versus a rational one.

The noted author and ethologist Richard Dawkins, in a 1995 essay, proposed that children are inherently credulous, and prone to believing in just about anything. He even suggested that it was an evolutionary advantage for children to believe.

He illustrated that quite convincingly with an example of a young child living near an alligator-infested swamp. His point was that the child who is skeptical, and prone to critically evaluating his parents’ advice not to go swimming in that swamp, has much less chance of surviving than does the child who unthinkingly heeds his parents’ advice.

This view of young children who believe easily is shared by many, including 18th-century philosopher Thomas Reid, and developmental psychologists, who argue that children are strongly biased to trust what people tell them.

Not very different from adults?

Yet research from my lab shows that children actually are rational, thoughtful consumers of information. In fact, they use many of the same tools as adults to decide what to believe.

So, what are some of the tools that adults use to decide what to believe, and what evidence is there that children possess them?

I’ll focus on three: One is attention to the context in which new information is embedded. A second is the tendency to measure new information against one’s existing knowledge base. And the third is the ability to evaluate the expertise of other people.

Let’s look first at context.

Imagine reading an article about a new species of fish – let’s call them “surnits.” Then imagine you’re reading this article in two very different contexts – one in which your doctor is late and you’re in the waiting room reading the article in a copy of National Geographic, the official magazine of a scientific society.

Adults usually trust information based on the context.
Nicolas Alejandro, CC BY

In another context, you encounter a report of this discovery while waiting in line at the grocery store and perusing the National Enquirer, an American supermarket tabloid. My guess is that the context surrounding your introduction to this new information would guide your judgment about the reality status of this new fish.

We essentially did this with children. We told them about animals they’d never heard of, like surnits. Some children heard about them in a fantastical context, in which they were told that dragons or ghosts collect them. Other children learned about surnits in a scientific context, in which they were told that doctors or scientists use them.

Children as young as four were more likely to claim that surnits really existed when they heard about them in the scientific context versus in the fantastical context.

How children use knowledge and expertise

One of the primary ways we, as adults, learn about new things is by hearing about them from others. Imagine hearing about a new kind of fish from a marine biologist versus from your next-door neighbor who often regales you with reports of his alien abductions. Your evaluation of the expertise and trustworthiness of these sources presumably will guide your beliefs about the true existence of this fish.

In another research project, we presented young children with novel animals that were either possible (e.g., a fish that lives in the ocean), impossible (e.g., a fish that lives on the moon) or improbable (e.g., a fish as big as a car). Then we gave them the choice to figure out on their own whether the entity really existed or to ask someone. They also heard reports from either a zookeeper (an expert) or a chef (a nonexpert).

We found that children believed in the possible entities and rejected the impossible ones. Children made these decisions by comparing the new information to their existing knowledge. For the improbable animals – ones that could possibly exist but were rare or odd – children were significantly more likely to believe in them when the zookeeper claimed they were real than when the chef did.

In other words, children use expertise, just as adults do.

It’s the adults

If children are so smart, why do they believe in Santa?

The reason is simple: Parents and others go to great lengths to support the Santa myth. In a recent study we found that 84 percent of parents reported taking their child to visit more than two Santa impersonators during the Christmas season.

The Elf on the Shelf, originally a children’s picture book about elves who inform Santa about children’s behavior around Christmastime, is now a multi-million-dollar franchise. And the United States Postal Service now promotes a “Letters from Santa” program in which it provides personal replies to children’s letters to Santa.

Why do children believe the myth? It’s the parents.
Steven Falconer, CC BY-SA

Why do we feel compelled to go to such great lengths? Why does Uncle Jack insist on climbing onto the roof on Christmas Eve to stomp around and shake jingle bells?

The answer is simply this: Children are not unthinkingly credulous and do not believe everything we tell them. So, we adults must overwhelm them with evidence – the bells on the roof, the live Santas at the mall, the half-eaten carrot on Christmas morning.

How children evaluate

Given this effort, it essentially would be irrational for children not to believe. In believing in Santa Claus, children, in fact, exercise their scientific thinking skills.

First, they evaluate sources of information. As ongoing research in my lab indicates, they’re more likely to believe an adult than a child about what’s real.

Second, they use evidence (e.g., the empty glass of milk and half-eaten cookies on Christmas morning) to come to a conclusion about existence. Other research from my lab shows that children use similar evidence to guide their beliefs about a fantastical being, the Candy Witch, who visits children on Halloween night and leaves new toys in exchange for candy.

Third, research shows that, as children’s understanding becomes more sophisticated, they tend to engage more with the absurdities in the Santa Claus myth, like how a fat man can fit through a small chimney, or how animals could possibly fly.

Wondering what to tell your child?

Some parents wonder whether they are harming their children by engaging in the Santa myth. Philosophers and bloggers alike have mounted arguments against perpetuating the “Santa-lie,” some even claiming that it could lead to permanent distrust of parents and other authorities.

So, what should parents do?

There is no evidence that belief, and eventual disbelief in Santa, affects parental trust in any significant way. Furthermore, not only do children have the tools to ferret out the truth; but engaging with the Santa story may give them a chance to exercise these abilities.

So, if you think it would be fun for you and your family to invite Santa Claus into your home at Christmas time, you should do so. Your children will be fine. And they might even learn something.

The Conversation

Jacqueline D. Woolley, Professor and Department of Psychology Chair, University of Texas at Austin

This article was originally published on The Conversation. Read the original article.

How Family, Neighborhood Affect A Person’s Mental Health #MentalHealth #UniteBlue #LibCrib

How Family, Neighborhood Affect A Person’s Mental Health

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Children’s mental health is strongly affected by their family and neighborhood, according to a new study published in the Journal of Psychiatric Research. Researchers from the Lund University in Sweden, Stanford University School of Medicine in California, and Virginia Commonwealth University followed 542,195 children for 11 years in an effort to learn more about the “potential

associations between individual-, family-, and neighborhood-level factors and psychiatric disorders in children and adolescents.” Children were specifically measured for internalizing psychiatric disorders, which refer to anxiety and mood, and externalizing disorders, which refer to ADHD and other conduct disorders. And as researchers predicated, family and neighborhood did impact mental health.

More than 26,000 children developed a psychiatric disorder; 29 percent of these cases were attributed to the child’s family and 5 percent were attributed to their neighborhood deprivation. Neighborhood deprivation refers to the relation between certain neighborhoods and health-related resources, like fresh fruits and vegetables at a supermarket — and it in particular was associated with a 2-fold risk of externalizing disorders, though not specifically ADHD. Prior research from the Robert Wood Johnson Foundation based in Princeton, N.J., found this type of deprivation can increase incident cases of type 2 diabetes and major depression.

“However, we also found that familial random effects, including both genetic and family environmental factors, accounted for six to eight times as much of the total variation in psychiatric disorders, compared with neighborhood random effects,” Jan Sundquist, lead researcher, said in a press release. “The estimated risks and random effects indicate that children are strongly affected by both their family and neighborhood environments and that the former seems to be more important at a population level.”

Sundquist added the study’s “rich amount of data” results in a comprehensive look at children and adolescent mental heath, answering the many questions people have when it comes to young people. However, more research needs to be done in order to identify means of intervention, as well as the mental health policies needed in order to properly address and manage these risk factors.

As is, researchers concluded, “these findings call for policies to promote mental health that consider potential influences from children’s family and neighborhood environments.”

Source: Sundquist J, et al. Familial and neighborhood effects on psychiatric disorders in childhood and adolescence. Journal of Psychiatric Research, 2015.

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