Homeless by Choice

The choices we made are what put my son with schizophrenia on the streets.

Posted Mar 12, 2015

My son Tim has schizophrenia.  Most of the time, he is homeless on the streets of San Francisco.

When he is not on the streets, he is frequently incarcerated.  I’ve written about his life in a recent policy memoir. 

I don’t intend to use this blog column to explain how we lost Tim to homelessness, but to write about how we might find a way back home for Tim and thousands more like him.  But first, I think we need to understand something.  Tim is homeless by choice—not his, but ours.

This might confuse you a little, because if you were to ask Tim if he is content with his life, he would probably say yes.  And if you asked him if he wanted services, he’d probably say no.  So it might seem that he leads this life by choice.

But to understand how his life today was influenced not by his choice but by choices that were made for him, we have to row upstream.

Tim was just a child when he first showed signs of mental illness twenty-five years ago.  That makes him pretty typical.  Mental illnesses are diseases of childhood.  Half of all mental illnesses begin by the age of fourteen. 

It took eleven years from the time Tim first clearly showed signs of mental illness to get his final diagnosis.  That’s also pretty typical.  It frequently takes a decade or more after symptoms emerge to get the right diagnosis and treatment.

When Tim was in school, the most frequent response to his disruptive symptoms was to suspend or expel him, isolating him from his peers.  That’s also pretty typical today—children like Tim are twice as likely to be suspended from school as students without mental illnesses.

Removing children from the mainstream like this is a choice we make, not them.  And we do the same thing with adults.

Adults with mental illnesses are far more likely to be incarcerated than are adults without mental illness.  They make up only 6 percent of the general population, but 15 percent of the male prison population and 31 percent of the female prison population.  When we remove people from society this way, we’re doing pretty much what we did when we locked them away in asylums.  And when they are released, they are frequently excluded from housing because of their “criminal” past.

These are more choices we make, not them.

No one thinks that we should ignore people who are dangerous.  But when we confuse “danger” and “mental illness,” we make the wrong choices about how to respond to nothing more than a serious health condition.  We isolate them from society, instead of integrating them into it.

This makes mental illnesses the only chronic conditions we wait until Stage 4 to treat, and then often only through incarceration.  We can do better than this.  In future blogs, I’ll write about how we can intervene before stage four, and make different choices that will change the trajectories of lives like Tim’s.