Recovery From Schizophrenia: Psychiatry And Political Economy

174 THE POLITICAL ECONOMY OF SCHIZOPHRENIAbuses “the mentally disabled people who had found a home on the Ride (the bussystem) hit the streets again.” 15Since the early 1980s the reported frequency of mental illness among theAmerican homeless has decreased. The studies of the homeless listed in Table 8.1 16reveal that the average proportion of homeless men suffering from psychosis hasdropped to about 25 per cent since 1982, half of the earlier rate; and theproportion with schizophrenia has fallen to less than 10 per cent. A 1996 sourcereported that 20–25 per cent of the adult homeless population suffered from along-term severe mental illness, 17 but only five to seven per cent of the mentallyill homeless, it argued, were disturbed enough to be hospitalized. 18 The numberof homeless Americans appears to have held fairly constant at about 500,000–600,000 people over the past 20 years. Advocates for the homeless populationemphasize the economic factors that inflate the proportion of disabled among thepopulation. The National Coalition for the Homeless points out that the low levelof disability benefits forces many Americans into poverty and homelessness. 19 Inmost states the monthly pension amount barely covers rent; in 14 states and 69 citiesthe pension is actually less than the fair market rent for a one-bedroomapartment. 20 If we accept the recent estimates that around 10 per cent of thispopulation are suffering from schizophrenia, it is still clear that lives such asMary’s (p. 103) are to be counted in the tens of thousands (see Table 8.3).The dimensions of the problem have also varied over time in Britain. A surveyof the Camberwell Reception Centre in London on a night in the 1960s found22 per cent of the longer-term residents to be mentally ill, mostly withschizophrenia. It was apparent that their destitution was a consequence of theirillness—90 per cent had been living in settled homes before they fell ill. 21 In twoSalvation Army hostels in Central London in the late 1960s, 15 per cent of asample of residents were “gross and unequivocal cases” of schizophrenia. 22Robert Priest found that 32 per cent of the men in his random sample ofresidents of Edinburgh doss houses in the late 1960s were definitely or probablysuffering from schizophrenia. 23 The situation worsened as the economy declined.A tenth of all the people with schizophrenia seen at the emergency psychiatricclinic of the Maudsley Hospital in south London during six months in 1978 and1979 were homeless; few were offered any ongoing treatment. 24 The number ofhomeless in Britain doubled during the 1980s but the proportion of mentally illamong them did not decrease. Observers complained that the expansion ofcommunity services had failed to keep pace with hospital closures. Hospital unitsappeared to have given up on the task of finding housing for patients withpsychotic illness. A 1990 study of homeless mentally ill people in Britain revealedthat a large majority had been discharged from hospital without any discussion oftheir housing needs. 25 Some improvement in the proportion of mentally illamong homeless men was noted in the 1990s, 26 though the proportion amonghomeless women remained very high. 27 It seems that the problem ofhomelessness for the mentally ill is as great in Britain as it is in the US.