ALWAYS WITH US

Substance abuse and mental illness have plagued us throughout history. Public attitudes and efforts to mitigate them have varied over the ages. Last week’s column spotlighted the recent “homeless encampment” at the Portland, Maine City Hall with concentrations of people plagued by these issues and such is the case with nearly all homeless in cities across America. During my lifetime I’ve witnessed widely different societal strategies for these chronic, human problems.

Tewksbury State Hospital in Massachusetts was mysterious to me as a young boy growing up a mile away in the then-rural town by that name. When my mother allowed me to ride my bike to the Red Roof variety store to spend the quarter my grandmother gave me each week, twenty-five cents purchased  two Superman comic books and a Hershey bar with almonds. I’d sit on a well cover outside the store eating my chocolate bar and gaze at the fortress-like, 19th-century complex across a broad field.

It was surrounded by high, brick walls behind which taller, red-brick, administrative buildings loomed near the main gate. Behind those were various wards in smaller, separate brick buildings sprawling over many acres and housing individuals who had themselves become wards of the state. All the wards were connected by tunnels allowing traffic between them without traipsing through winter snow. Surrounding the walls was a working farm of over 800 acres including a piggery, a dairy farm, greenhouses, barns, and vast cornfields.

Established in 1852 as an “alms house,” its mission changed as the state took on more societal burdens. It morphed into an insane asylum; it treated alcoholism, unwed mothers, paupers, patients with congenital birth defects, quadriplegics, and many others. Annie Sullivan, better known as “The Miracle Worker” as Helen Keller’s teacher, spend several years there as a child. Her brother, Jimmi, died there and is buried in an unmarked grave.

Later, as an undergraduate at nearby University of Lowell, I’d work inside those walls on every men’s ward for more than two years as a full-time orderly on the 3-11:30 shift. The alcoholic ward treated street people from Greater Boston. After discharge, some made it with the help of churches and private charities but most relapsed and returned again and again. Many, if not most, had co-occurring mental illnesses — but they weren’t on the streets. They weren’t in jails. They were provided with food, clothing, shelter, healthcare, guidance, and vocational training if they were inclined to take it.

Just prior to my employment there in the 1970s, Massachusetts had begun to implement a different strategy. It would provide halfway houses with trained staff to counsel, administer psychoactive drugs, and help reintegrate patients into communities. The mentally ill were released from the hospitals, but the above-described services were never provided to the extent needed. Many former patients refused to take their meds and there was no way to make them.

Fifty years hence, our jails are filled with untreated, mentally-ill substance abusers. Others live on the streets, eat in soup kitchens, sleep in homeless shelters, doorways, under bridges, and in parks. They are used to push a political agenda as we witnessed this summer at Portland City Hall. Institutionalization had been the practice during most of the 20th century and it had flaws. Defects with the subsequent, de-institutionalization model, however, are before us every day in cities across the country. In Portland, people are camped out in parks, panhandling on street corners, and crashed out in downtown doorways.

My wife did her undergraduate internship for social work through the University of Southern Maine and worked with the homeless at the now-closed Preble Street Resource Center under its founder, Joe Kreisler, for a year. We both agree that neither of the above, historical approaches work well and there is no perfect model. “The poor you will always with you,” said Jesus Christ, posing a challenge to our humanity. We can measure ourselves by how we deal with them.

My suggestion is a modified institutional approach. Round up the homeless and care for them institutionally even when it’s against their will, then offer them a step-by-step strategy to earn re-entry into society. Play out their tethers gradually and pull them back quickly when they relapse — much the way probation officers do for jail inmates when they’re adequately funded. Most importantly, allow them to keep trying. Such an approach would be more expensive, but more humane than releasing them into our streets to fend for themselves.

As an old selectman told me decades ago when appointing me General Assistance Administrator for my town: “We have the poor, and the poor have us.” And so it goes.