Citizenship and Mental Health
Oxford University Press, 2015
Jim? I couldn’t see him young. He seemed gray. Not his hair, that was more sandy than gray. No, Jim seemed gray after the manner of some of the survivors in Kai Erikson’s books, who lift off the page before you real as your hand but separate, too. Ghosts with dirt under their fingernails.
Of course Jim was young once, like all of us are, or were. It was a failure of imagination on my part that made him gray . . . Jim was living on the streets of New Haven in 1994 when outreach workers found him one fall morning asleep on a ledge under the Water Street highway bridge for Interstate 95. Or they found someone who likely was a man, since few women who were homeless slept under highway bridges at the time. What they saw was a pair of neon yellow sneakers sticking out from one end of half a dozen blankets covering the form of a body. They didn’t want to wake this person at five-thirty in the morning and so, came back at the end of their early morning outreach run. He was gone, along with the others. They asked around at the soup kitchens and drop-in centers about a man who wore neon yellow sneakers. Finally someone said, “That’s Jim. Try the library.” They went to the main branch facing the New Haven Green where people who were homeless were allowed to sleep with a book propped open in front of them and walked around, bent over, looking at feet under tables. They found the sneakers, and Jim.
*******
Jim was not looking to be found, not by us. He didn’t deserve any help, he told the outreach workers, and made it clear that he wasn’t buying what we had to sell, anyway. Set apart and isolated as he seemed, though, Jim had social relationships on the street. He managed to share a ledge with others under the Water Street highway bridge. And somebody had to carry his dinner up to him at the Downtown Evening Soup Kitchen where I first met him, since he refused to go down into it.
But it was different with Ed, one of the outreach workers. It wasn’t just his persistence when Jim kept walking away from him. The other outreach workers were persistent, too. But Ed, who was a ‘peer’ outreach worker, meaning that he had personal experience of mental illness or substance abuse and had been homeless himself, found a way to connect with Jim.
*******
Ed had learned two things about Jim, he told me. The first was that you shouldn’t try to talk to him before he eats. “He’ll just be grouchy.” The second was that out on the street, people were always asking him for things from him. ‘Got a dollar, Jim?’ ‘Got a cigarette, Jim?’ ‘Got an extra blanket, Jim?’ So Ed decided he was going to bring things to him, a cup of coffee, a sandwich, socks. And it worked. “I got my hook in him,” he said.
Ed was a good listener, and Jim, after running through his list of ‘too old to be helped’, ‘don’t deserve help’, and ‘leave me alone’s,’ began to dole out bits and pieces of his story. He came from a large, poor family. When he was seventeen a younger female cousin told her parents of Jim’s romantic interest in her. He was drummed out of the family, nuclear and extended. He joined the army. Given his age when we met him I calculated this must have been around the time of the Korean War. He earned an honorable discharge and drifted south. Eventually Jim came back north, roaming the Eastern Seaboard for years and drinking himself out of one menial job after another, then wandered north to Connecticut, having by this time renewed contact with at least one family member, his sister in Meriden twenty miles northeast of New Haven. She took him in, but a couple of months later asked him to leave because of his drinking.
Jim came to New Haven. He slept under various highway bridges and other outdoor sites and ate in soup kitchens. It appeared that, like many others, he wasn’t sleeping on the streets because he’d been refused shelter due to his drinking or other behaviors but deliberately avoided them because of their noise, their rules, and the lack of security they offered for his few possessions. He continued to resist the services that Ed began to float in his company. The blankets and sandwiches were enough, he said. But Ed persisted. Eventually, Jim agreed to let Ed help him apply for SSI. He got it. Then Ed persuaded him to come to our office a mile away from the mental health center to see Dr. Laub, whom he’d met a few months before in the soup kitchen. Finally, after several more months of persuasion, Jim went apartment hunting with Ed, found a place, and agreed to try it out.
Getting Jim off the streets was a tall marker point for the outreach team. We’d come of age, had proved ourselves and proved wrong the naysayers at the mental health center who thought we’d never get this or that one who’d been ‘in the system’ years before to accept mental health care or housing. Not long after this watershed moment, though, a couple of weeks at most, Ed came into our weekly team meeting looking troubled. When his turn came he said Jim had told him he wanted to move back to his spot under the Water Street highway bridge. There, he said, he had friends. He knew what to do. He didn’t look and feel out of place. It would be better for him there.
*******
As we talked in the team meeting we realized that two big changes had happened in Jim’s life at precisely the same time. One was moving into his apartment. The other was that with Jim safely ensconced in his new apartment, Ed had been spending much of his time out on the street making contact with new people, and little of it with Jim. Thus at the moment when Jim may have needed Ed’s support the most, Ed, and we, had taken our foot off the gas. We agreed that Ed should spend more time with Jim, which he did, stopping by his apartment, showing him how to use his appliances, taking walks with him around the neighborhood, and accompanying him to a social club for people with mental illnesses.
It worked. But for me, Ed’s announcement at the team meeting reverberated after the blast of it. Outreach work was not the answer to the community inclusion of people like Jim. In pushing the work as far as it would take our clients and us we had simultaneously pulled back the curtain on it. Outreach workers could do many things. They could leave their offices to look for people who didn’t want to be found. They could make contact and build relationships with people that affirmed their human worth and right to be part of society rather than merely to survive, if they could, at its margins. They could offer tangible services including housing, which ends physical homelessness. What they couldn’t do were three things. First of all, they couldn’t make their clients neighbors of the building they moved into. Housing alone didn’t come with that status. Second, if we couldn’t ‘make’ our clients neighbors, then we couldn’t offer them status of community members, either. Now, using the terms ‘neighbor’ and ‘community member,’ with the sentimental connotations that cling to both, begs the question of what kind of neighborhood people are living in and whether or not they feel safe, let alone socially connected, in it. This is not to say that they don’t or can’t feel safe, but that these are open questions for residents of any neighborhood. And third, we couldn’t offer our clients full citizenship in our democratic society.
In American society, the mentally ill population has been marginalized by incarceration, high rates of homelessness, not being registered to vote, and being victims of trauma, poverty, and abuse. In a compassionate and well-researched book, Michael Rowe presents to students, social work clients, educators, and practitioners a model of inclusion and citizenship for the mental ill population to be members of American Society.
— Steven Granich, The New Social Worker
Medical sociologist Michael Rowe uses multicolored threads—values and ethics, concepts and theories, stories and lessons—to weave an intriguing tapestry. He presents the citizenship model as an adaptable framework for those working within the mental health system. The author begins the narrative with homeless outreach and concludes with genuine citizenship, as distinguished from community placement and abandonment. Rowe challenges readers to look at the realities of the community integration process through the lens of those who have lived it.
— M.M. Slusser, Choice. “Outstanding Academic Title” (American Library Association)
Citizenship and Mental Health provides an in-depth look at how citizenship theory can benefit the mental health field. Using a model and validated instrument, Rowe introduces a replicable approach to integrating citizenship theory and mental health practice. The book is accessible and [its] use of personal vignettes, introductory-level theory, and key research findings makes mental health care relevant to the general reader.
— Margaret McGrath Holland, Social Work
This book introduces and explicates the concept of citizenship and then demonstrates its practical applicability to the field of mental health . . . The novelty and creativity here are in the effort to apply citizenship to thinking about the care of individuals suffering from mental disorders. The current wave sweeping the field is known as “recovery,” but Rowe’s text represents a clear advancement on that notion.”
— Ezra Griffith, author of I’m Your Father, Boy: A Family Memoir of Barbados and Race and Excellence: My Dialogue with Chester Pierce
Not just a place to live: From homelessness to citizenship
Michael Rowe & Charles Barber
This article on homelessness and full (more than legal) citizenship was recently published in THE CONVERSATION. It has since been republished in SALON.COM, US NEW, the CHICAGO TRIBUNE, and the LOS ANGELES TIMES, among other publications.
How We Can Promote “Citizenship” in Communities
Here is another article on citizenship, from the Community Psychology website of the Society for Community Research and Action, reviewing Ponce & Rowe’s 2018 article, Citizenship and Community Mental Health Care in the American Journal of Community Psychology [61(1-2), 22-31. doi:10.1002/ajcp.12218]