I used to walk the halls of power, at the Capitol and the Pentagon, when I spoke on PTSD among Soldiers, as an active duty Army psychiatrist. Now, I take care of those in the public mental health system in the nation’s capital. Those halls are much murkier, even as we celebrate Thanksgiving.
Every day I take the Metro and walk through Union Station. Right outside, depending on my route, I see the homeless, including veterans. It is only about four blocks from the Capitol to Union Station, but the gap is immense. And it is not just due to the construction and the tourist buses.
Walk along 1st St NE, along the side of Union Station, and you pass under the tunnel sheltering the homeless stretched out underneath, with their gray blankets and square plastic weaved bags. Other streets downtown are also festered with the homeless. Nobody really knows how many are veterans. About 25%, according to some estimates.
How can we stop our Soldiers and other service members from descending from their proud uniforms to the homeless with their plastic bags outside the Greyhound Bus Station? Remember, only about half of recent vets go to the VA. This number is higher than ever before. But it still means that at least half get there care through other means. Or get no care. Or end up on the streets.
It is not for lack of trying. In Washington DC, my department, the Department of Mental Health, has a very active homeless outreach program. The VA has homeless outreach. The Department of Health and Human Services has homeless outreach, as do various business districts. We try to coordinate through local meetings. But still the people stretched out on sidewalks persist.
As I have switched from the military to public mental health, I have attended a number of meetings on community psychiatry. I have learned that Washington DC’s lack of coordination between the military hospitals, the VA, and the public mental health system is far from unique. In fact, because we have small and well-defined borders—the Federal City—we are better off than most of the States.
So, what to do? There is a deep-seated desire among the American people to take care of our veterans. Less so, but still there, to care for the marginalized mentally ill, including the homeless. One best practice; Dade County in Florida has a tax for the homeless. Through that tax, and providing homes, medical services and mental health care, they have dramatically reduced their homeless population.
Another way is to turn the desire among the American public to take care of veterans toward improving the entire public mental health system. There are veterans of Afghanistan and Iraq, celebrating Thanksgiving today on the streets. As you prepare to feast, don’t forget to thank them. And don’t forget to help, if you can.