This article describes a program called the “community living room” after one of its principal functions, which is to provide a place for the easy socializing from which help often derives. To the authors’ knowledge, no program exactly like it exists anywhere; the community living room is a composite of programs that have been visited and studied by the authors and those in which they have worked. It is also the product of imagination, informed by years of research and practice with the chronically mentally ill, street people, and the homeless and poor in general. The existing program that is perhaps closest to this ideal is Berkeley Support Services, in Berkeley, California, but there are doubtless others of a similar nature. Indeed, the term community living room was suggested ten years ago by a staff member of an agency in Richmond, Virginia, called The Daily Planet.
The goal here is to be useful rather than original. The program envisioned is one that serves as an effective link between society’s byzantine system of formal aid and those individuals who are in serious need of assistance but whose tolerance of protocol is severely limited. That this program owes much to settlement houses, runaway centers, hotel outposts, streetwork agencies, and other programs should be obvious and is gratefully acknowledged.
The Clients and the Context
The community living room is for all comers, but it is designed with the homeless poor and the chronically mentally ill foremost in mind because it is a program intended to address the basics of survival and to foster connection and trust where there is often isolation and suspicion.
The term homeless poor is used in a broad sense. It does not refer merely to those undomiciled individuals who, without regular abode, take up residence in transient shelters, box cars, well-concealed shrubbery, or under bridges. The lack of a domicile is an important indicator of homelessness,1 useful mainly because it permits some estimate of magnitude. For instance, Ellen Baxter and Kim Hopper, summarizing the reports of social welfare and mental health agencies in five Eastern cities, estimated that the undomiciled run to thirty-six thousand in New York, five to ten thousand in the District of Columbia, four to eight thousand in Boston, eight to nine thousand in Baltimore, and over three thousand in Philadelphia.1 Still, if a house is not a home, neither is a home merely a house. A home is a representation of important relationships with family, friends, even institutions. In the most important sense, a home is a place that represents desirable and highly valued attachments.2
In pursuing this broader notion of homelessness we are led to the rooming houses and residential hotels which afford and compound the social isolation which is at the core of homelessness. Indeed, there are sections of the city—skid rows, tenderloins, and the like—where family ties are minimal, friendships brittle and short-lived, and secure living space hard to come by. Although there is scant quantitative evidence, numerous field studies strongly suggest that a great deal of urban poverty is characterized by transience and isolation.3
Some unknown but presumably high percentage of the homeless poor consists of chronically treated mental patients. A recent study of Manhattan shelter residents found that 34 percent had been hospitalized for psychiatric problems.4 A one-month survey of young lodgers in a forty-five-bed Berkeley shelter found that more than 40 percent had been hospitalized for psychiatric problems at some time,5 and a week-long survey of 295 patrons of a Berkeley emergency food dispensary found that 22 percent had been psychiatric inpatients at some point.6 Stuart R. Schwartz and Stephen M. Goldfinger, summarizing an unpublished study by Chafetz conducted in 1979, reported that:
“In a study of 420 randomly selected patients seen in the same emergency services and similarly diagnosed, 20.9 percent were found to have no local residence. An additional 53.5 percent claimed residence in a district of San Francisco noted to have no single-family residential homes, with 89 percent of the residences hotel rooms or “studio apartments.”7
In the absence of adequate community care, this result was predictable. For better or worse, the mental hospital no longer provides long-term, life-sustaining services for the mentally ill. Today’s chronic patients face a different set of social and economic contingencies than did their counterparts twenty years ago. The reorientation of mental health services to the provision of community-based care has recast the nature of chronicity. Whereas autonomous adaptation to chronic mental disorder was atypical until the mid-1960s, it is now an established fact of life to which the mentally ill and their potential benefactors must adjust. Unfortunately, the adjustment of the human service community has been slow and ineffective; the social and material support of chronic patients, previously provided by mental hospitals, has been neglected. Thus, today’s chronic patients are not only chronically disordered but chronically poor. This is a direct result of changes in the United States’s system of mental health care.8
Today’s chronic patients also represent a generation of mental health clients who are young (average age about thirty-five years) and whose relationships with institutions have been formed in an era of civil rights and consumerism. Few have experienced long-term hospitalization, and few exhibit the apathy, lack of initiative, or the resignation that numerous studies found to characterize the long-term mental hospital resident. These “new” chronic patients have not been socialized to docility, to the role of acquiescent mental patient; they do not use services in the tractable fashion of their predecessors but rather as wary, often angry consumers demanding response to their broad needs for social and economic support. Furthermore, numerous clinicians and researchers have observed that today’s chronic patients, especially in the younger age range (eighteen to thirty-five years), tend to resist the contention that they are mentally ill.9 They often define their distress as derivative from their poverty or their isolation or, in some cases, their denial is incorporated into an elaborate system of delusions. Thus they approach services with mistrust and fear of confrontation about their psychiatric status.
Of this new chronic population, and the homeless poor in general, the younger members especially have the vices of their age-mates, in particular their use of illegal drugs and alcohol. Their sometimes prodigious consumption of drugs complicates their psychiatric status, erodes their social functioning, and contributes mightily to their difficult relations with human services.10 In addition, heavy drinking, illicit drug taking, and sexual activity are difficult to accommodate in community-based sheltered care.11
The community living room is designed with these issues and conflicts in mind. Moreover, it is conceived with full awareness that a typical pattern of service utilization among the poor and among impoverished, free-living chronic mental patients is their selective use of “therapeutic stations” for purposes that differ from the stated mission of the institution. The hospital, for example, is not viewed as a site of treatment but as a site of temporary refuge; nor is the mental health clinic perceived as a site of treatment but rather as a safe place to make contact; the caseworker is not seen as a therapist but as an advisor, mailman, safe deposit box, moneylender, or source of access to a telephone.12 This modest manipulation of the system enables people to fulfill dependency needs or needs for economic resources and sociability without sacrificing control of their circumstances and without necessarily accepting themselves as mentally ill or as subjects of charity. By preserving their own definitions of their plight and circumstances, they get what they need without obligating themselves to the institution’s purposes.
This description provides a background for considering the community living room.
The Community Living Room
There are four primary functions of the community living room. First, it provides a place to be; second, it offers survival services; third, it is a point for case finding and case management; and fourth, it offers food and shelter. In most communities it is probably not desirable to combine the shelter element on the same site as the others. It may also be useful to spread one function over several sites. Much will depend on available facilities and management problems pertaining to certain spaces. The community living room should be thought of as a constellation of related activities rather than as one program operating from an imposing building in which all is combined.
A Place to Be
The simple object here is to provide a place to do things or to “hang out,” people with whom to do things or with whom to “hang out,” and the material resources necessary to such activity. In some respects, then, this suggests a simple recreational element with some useful amenities. Typically, this is a storefront or church or synagogue basement with couches, a pool table, a pingpong table, card and game tables, a television set, and an area for reading or small talk with a pot of coffee brewing. It would also be useful if there were a shower, perhaps a washing machine and dryer, and a kitchen with a small dining area. The important idea is to provide a gathering place where life can be less boring and can be made easier by access to practical necessities. Clearly, the furnishings should not suggest the sort of elegant living room forbidden to small children.
Unlike an office, this element of the program does not require or imply that a visitor have a particular purpose in mind. Nonetheless, the staff of this component should have more in mind than shooting pool or keeping order. In the authors’ experience, it is in this sort of nondirected setting that the worker gains the most intimate knowledge of his “clients” by listening to them describe their circumstances and their triumphs, failures, or daily indignities. It is also in such settings that worker-client relationships can be formed gradually and candidly with minimal role distance interfering. Here, unencumbered by intake and assessment protocols that ritually confirm clienthood, worker and client may become known to each other through a process of gradual disclosure.13
There is a further value to working with people in such a setting. To the extent that people have friends who provide them with support or to the extent that they can develop such relationships during the course of “hanging out” in the community living room, the worker can support these ties by helping to resolve inevitable disputes and by being alert to ways in which cooperative action can solve problems. This is particularly important in circumstances where the law fails those without the desire or the resources to use it.14
Survival Services
Whether or not combined on a common site with the recreational component, the core of the community living room consists of a multiservice center that provides one-stop shopping for human service needs. This does not mean that all human services need to be represented on site but that any client ought to be able to sit down with a worker and, based upon a thorough appraisal of present needs, work out a detailed plan for using existing systems of aid to provide for those needs. In sum, it is a place where a client may sit with a worker and develop a detailed plan in aid of survival. The multiservice center should offer the following sorts of services:
First, the center should provide a safe place to receive mail (including checks) and messages, store belongings, and use the phone.
Second, the multiservice center should provide public assistance advocacy. Stephen Crystal and his colleagues observed that “dealing with public assistance is perceived as extremely difficult and troublesome by a significant number of these [shelter] clients, [thus] the advisability of stronger encouragement and assistance in following through with public assistance applications. …”15 Workers should be able to assess a client’s prospective eligibility for various sorts of programs (for example, general assistance or home relief, Aid to Families with Dependent Children, Social Security, food stamps, Medicare, unemployment insurance), work out a detailed plan for securing the necessary documentation, provide assistance in filling out the necessary forms, and serve as an advocate in the event of hearings or appeals.
Third, the multiservice center should offer money management (including representative payee) and check-cashing services. Where appropriate, client and worker should develop a money management plan that assures that the client’s basic needs are met, that the client is being trained to manage his or her own money, and that a savings system is devised.
Fourth, the center should offer a mental health brokerage service which provides referral and follow-up for psychotherapy and monitors and acts upon the availability of board and care beds, space in sheltered workshop programs, and the like. It will be useful for the center to organize a referral network of therapists who are adept at cases involving loneliness, depression, and drug and alcohol abuse.
Fifth, the center should offer paralegal services (or have a staff attorney) to help clients deal with small-claims court cases, matters of debts and bankruptcy, tenants’ rights, name changes, and uncontested divorce proceedings. Similarly, voter registration and tax preparation are matters for attention.
Finally, the center should provide a casual labor service and monitor the available space in public employment and training programs or supported work projects.
Emergency Shelter
This is an extremely important component of the community living room, and it is probably the most difficult to manage properly. Not since the municipal lodging houses of the Depression era have there been so many ill-conceived shelters for the homeless poor. Only political and financial expedience recommend the warehousing currently in vogue. The conversion of armories and hospital wards to shelters is not desirable, especially if residence in such a shelter replaces cash grants for public assistance, thereby creating a new sort of poorhouse,16 or if conditions are such as to warrant comparison with prison.17
An emergency shelter should provide safe, clean shelter and food for as short a period of time as possible to as few people as possible. Lengthy stays in large shelters that are most often spatially and socially isolated from the wider community provoke the despondency, apathy, and dependency called “shelterization” by Edwin H. Sutherland and Harvey J. Locke,18 and “institutional dependency” by many observers of mental hospitals and other large-scale residential institutions.19 In the authors’ view, emergency shelters should be small, located within the mainstream of community life whenever possible, and their activities should be closely coordinated with those of the multiservice center described above.
Emergency shelters of relatively small size are important for several reasons. First, small size mitigates the need for regimentation and police presence that often creates a captive/captor relationship between residents and staff. Second, small size facilitates the use of groupwork techniques to promote mutual aid among residents and to resolve the disputes that inevitably arise when people live cheek by jowl for any period of time. Third, small size facilitates the participation of residents in the maintenance and operation of the shelter, thus allowing them to feel less like subjects of charity and more like responsible participants in the solution of their dilemmas. Only incidentally does resident work reduce the operating cost of a shelter or serve as a quid pro quo for free lodging.
Shelters must also be designed with families and couples in mind. Currently, very few shelters can provide private rooms for parents and children or rooms where couples may sleep together. Crowding families and couples into dormitories or separating their members are serious disorganizing influences on lives already at loose ends.
Clearly, short stays in emergency shelters can be accomplished only if one function of shelter or multiservice center staff is to monitor the availability of other sorts of housing and housing assistance programs. In many cases, residents of emergency shelters resolve their immediate problems of income only to be relegated to a shelter because they can find no affordable permanent housing or because they cannot piece together the last month’s rent and security deposits required. While the authors agree with Thomas J. Main that “the purpose of the shelters should be to act as a safety net for … people until they can be reintegrated into a … social service program,”20 it is bewildering that he fails to recognize structural sources of homelessness, preferring instead to treat it as the outcome of individual pathology. Like unemployment, “unhousing” is a problem of political economy not amenable to simple tinkering with the victims. Society must build vastly more low-income housing and must put significant resources into saving what remains of a dwindling supply of residential hotel units.21 Without such efforts, shelters will become long-term encampments of the poorest citizens regardless of social work intervention. Condemned to long stretches of abject impoverishment, many of the homeless poor will develop precisely those characteristics deplored by Main and will play out their strings in the badlands between the criminal justice and mental health systems, whose representatives will manage their own helplessness by denouncing their clients.
A Commonsense Approach
The allied services that comprise the community living room represent a practical, commonsense approach to the intertwined problems of poverty and mental illness. There is nothing about the community living room which is particularly innovative or daring; its components are social work staples and reflect a commitment to organizing and providing services in a manner that suits the problems of consumers rather than the needs of a labyrinthine system of social and mental health services. It is a form of help that “begins with the client” and resists the divorce of mental health problems from the duress of everyday life. It relies upon patience, rapport, and support rather than on expedience and coercion, the hallmarks of a declining charity.
Contributor Information
Steven P. Segal, Mental Health and Social Welfare Research Group, School of Social Welfare, University of California, Berkeley, California..
Jim Baumohl, Board of Directors, Berkeley Support Services, Berkeley, California..
References
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