Thank you to Michael D. McGee, MD, President, WellMind, Inc; MedCentral Editor-at-Large for Clinical Excellence & Physician Wellbeing who published the article Perspective: Touching the Trauma of Homelessness, from which this series is shared.
Looking ahead, I see two vexing challenges that remain unaddressed by our society – and by our medical community. First, people with severe psychotic disorders such as schizophrenia lack insight into their illness; they likely do not know they have a mental illness, and thus, do not think they need treatment. Second, severe addiction can rob people of sound reasoning and free will, sending them into a spiral of compulsive destruction. Unfortunately, only about 10% of people with addictions seek treatment, in large part because the disease has co-opted their willingness to ask for help.
Letting people who lack the capacity to rationally choose the treatment they desperately need undergo the suffering of homelessness is not a solution either.
Ethically, I might be more prone to prioritize beneficence as a higher value than autonomy, especially when considering how traumatizing and life-threatening homelessness is, and the lack of sound reasoning with psychotic and severe addictive disorders that result in so much harm to this vulnerable population.
How do we help people who desperately need help but refuse help because of the nature of their illness?
To start, we need to support efforts to minimize homelessness and its cross-sectional impact on healthcare, crime, the economy (eg, the costs for incarceration), and overall moral injury.
Advocating with our legislators to develop more enlightened laws and fund the resources needed to reduce homelessness may be a step in the right direction. Read more about NAMI’s position on Medicaid: IMD Exclusion.
