Lessons in care: a doctor’s take on Seattle’s homeless

AS a physician and volunteer at the Mary’s Place day center in downtown Seattle, I see homeless, single adult women and families every week. I attend to their medical problems and hear the personal stories behind them, which never cease to amaze me. In any four-hour period of attending to patients in the clinic, I will see:

• Women who grew up in the Seattle area, endured physical, sexual and emotional abuse as children, escaped to the streets, self-medicated their anxiety and PTSD with street drugs instead of properly prescribed medications, and ended up chronically homeless, drug-addicted and mentally ill.

• Immigrant women with young children who were first welcomed to the U.S. as refugees from war-torn countries. Who, after receiving three months of support from a local resettlement agency and eight months of federal financial support, were expected to be fully functioning U.S. residents with English proficiency, full-time jobs to pay the high cost of living in the area and the ability to navigate our woefully inadequate public-transit system. Illness, or loss of job or housing brings these women from their original resettlement locations to Seattle, where they hope to find a better life for their children.

• U.S.-born mothers (with children) escaping horrific domestic violence and searching for a friend who might take them in, only to end up on the streets before finding Mary’s Place Family Shelter Program.

• Intact families who were just one illness or tragedy away from losing a job, housing, and any support they might have had, ending up sleeping in old cars, praying that no one assaults them or steals the few belongings they have salvaged.

I realize there are complex social constructs causing individuals or families to become homeless, but I believe we can address the root causes of homelessness in our area in these ways:

• Mental health: Many of the families I see have family members struggling with mental-health issues — everything from simple anxiety and depression to schizophrenia. Access to quality mental-health services (including psychiatrists or psychiatric nurse practitioners) is essential for parents struggling with their own mental illness and for their children suffering the consequences of that struggle.

• Early childhood and parent education: Many studies demonstrate that investment in quality early childhood education and parent-child bonding not only prevents incarceration later in life, but also leads to more successful and mentally healthy children and parents.

• Affordable housing: We have shifted our social priorities from creating healthy and supportive communities to developing more commercial property and high-income residential units in the city, leading to economic prosperity for the wealthy but chasing low-income people away or onto our streets.

• Domestic violence education and advocacy: Many women and children on our streets could be in safe housing if domestic violence was recognized as the major public-health issue that it is and pursued it as passionately as contaminated food at a major restaurant.

• Jobs: After attending to acute medical conditions, I often consider what should come next. Does the job come before the housing, or the housing before the job? I’ve realized that until they have safe housing and food for their children, homeless parents can’t think straight enough to look for a job. With a roof over their heads, food and proper treatment for mental illness and addiction, they can find jobs — which then lead to housing retention.

I know none of this is new to most people living around here. But when I see the results of our society’s failures up close and personal in my clinic exam room, I realize my patients really aren’t very different from my own family members — and they certainly deserve the same opportunities in life.