Engaging the disengaged: proposals on madness and vagrancy

Reprinted from SOCIAL WORK. Vol. 25. No. S. September 1980 ngaging the disengaged: proposals on madness and Vagrancy Steven P. Segal and Jim Baumohl Urban areas have become host to young chronic ex-mental patients who often live on the street or in single-room occupancy hotels. The authors analyze obstacles to humane community care and sug- gest future policies and programs. Steven P. Segal. Ph.D.. is Associate Professor and Director. and Jim Baumohl. MS W. is Field Research Specialist. Mental Health and Social Welfare Research Group, Scltool of Social Welfare. University of Califor- nia. Berkeley. The research on which this paper is based was supported in part by Grant No. SROI MI! 254 I 7-05 from the Center for Epidemiologic Studies. National In- stitute ofMental Health, ttnda Faculty Research Grant from the Committee on Research. University of C altfornia. Ber/reley. This paper is a revised ver- sion of one prepared for the President&#39;s Commission on Mental Health. Winter I977. The authors express appreciation to Howard Levy, Kathryn Komatsu. Satinder Cheema. Lynn Everett-Dille. and Elsie ./ohnsonfor their comments. 358 YOUNG ADULT males will be the most difficult mental patients of the 19805. Although the rate of residence in men- tal hospitals for the overall population has declined markedly since I955. the‘ rate for young adult males has changed little in this time. Moreover. the size of this population has grown enormously and is projected to grow further during the 19805.‘ As elderly patients are removed to nursing homes and similar institutions, state and county hospitals will contend with a growing population of young patients. many of whom will become familiar, periodic guests. In this era of commu- nity care. most will receive only “re- volving-doorq treatment: they will be brieﬂy hospitalized. treated with major tranquilizers. and discharged. After discharge, some of these young people will “return to parents or spouses; others will find congenial halfway houses or board-and-care set- tings. Some will gravitate to cults or other communities of believers and. in retrospect. may view their madness as a necessary religious awakening.’ A signiﬁcant number. who have lost or exhausted their kin or who place au- tonomy before the refuge of home. will pursue independent lives. Perhaps they will never again need treatment. Unfortunately. many of these young. primarily male ex-patients will simply disappear into the tenderloins. youth ghettos. and -skid rows of America. Between hospitalizations. they will live on the street and. in time, become qcareerq mental patients and middle- aged urban nomads. Most probably. they will drift through rundown welfare hotels and be repeatedly involved with the police and mental health agencies as a result of public complaints.’ This article is concerned with the di- lemmas of this group of ex-mental patients—the so—cal|ed space cases. The authors discuss six major obstacles to their humane care in the community and describe approaches to social sup- port that might prevent the worst con- sequences of madness and disatTiIia- tion. in this article the authors use the terms qex-mental patient“ (or “ex- puticntq). qstreet person.q and qspace case“ to describe the subjects of their inquiry. These terms are not synony- mous. and the authors will be remiss in their obligation to those who partici- pated in the research if the distinctions are not clear. The term qstreet peopleq is a gross. imprecise term that is applied to a het- erogeneous population with only a few characteristics in common. Street people hang out on the street, using the sidewalks and parks of the city as the living rooms that most cannot afford: they participate in the various social and economic activities associated with street life the world over. However. there is no widely accepted “code of the streetsq in this country. If there is an encompassing tradition among street people in predominantly white. univer- sity-dominated Berkeley. California. rather than sets of expectations adher- ing to speciﬁc roles (such as that of the drug dealer). it is a vague legacy of the “psychedelic leftq that is. today. more veheer than substance.‘ The term “space case.q however. is specific and grounded in the authors‘ field research on social boundaries among street people. Space cases are those judged by other street people to be delusionary. unpredictable. and unreliable—in the lexicon of the street “burned out.q qfried.q or qspaced.“ Space cases have invariably been hos- pitalized. but not all street people who have been hospitalized are space cases.’ The term “ex-mental patientq refers to all individuals of such status. space cases included. Since the space case is a particular son of street person. he or she is also a special kind of ex-mental patient. PRESENTING PROBLEM In addition to psychiatric status. two dimensions of the ex-mental patient‘s life are of primary importance to caretakers: social functioning and propensity to violence. Kears. although referring to the whole population of young male ex-patients -in his area. provides a description that fairly repre- sents the mental health professional‘: view of space cases. He finds that space cases are “chronically dysfunc- tionalq or “violent and destructive.q‘ 0037-8046/803505-0358 $0.50 © I980. National Association of Social Workers. lnc.