The social and financial determinants of health

Societal stressors have triggered a mental health crisis! Incapacity to cope with the  stressors of everyday life , is the root cause of homelessness and substance abuse addiction

The pandemic -induced " great resignation" ( the " great resigntion"  was an act of. rebellion/resistance against the greed-fueled (profit-driven) basis of our market society) . did not abate with the end of the pandemic, but rather became amplified with inflation and the "cost-of,,-living crisis".                    The pandemic compelled a reassessment of personal values and goals. People with meaningless jobs chose to get off the treadmill and opted to drop out of the " rat race".

Overall inflation has increased the cost of food and shelter ,and made the cost of living unaffordable...many people are feeling disillusioned,alienated, excluded ,and defeated...and nihilistic! What is one to do if one can't afford the cost of living?  You do what you have to, to provide for yourself ---to survive.

Increasing homelesness, increased drug addiction, increased crime,and increased food bank use are -symptomatic of a systemic breakdown in society. Shopliftiing, looting , violence,vandalism -- these are the first signs of a breakdown in the social order.

Too wide an income disparity between the rich and the poor destabilizes the social. order.           It is the responsibility of the govt. to reestablish balance through legislation. 

We have enough wealth....;., its just not being fairly distributed.

The challenge is not increasing  economic growth, but one of distribution-- of  redistributing the abundance acrued by the economy more equitably .(univerval basic minimum income) reinvesting in /re-enforcing the social safety net.  

Instead of addressing the root cause of the alienation, (poverty,(denial of access to resources),society chooses the punitive option(ostracism/incarceration)Criminallization of poverty

You can provide a person with the resources to flourish and live with dignity (guaranteed basic income),, or you can cage them at the cost of $115,000./person/year

See "Mincome" --- "the town with no poverty , :  www.utpjournals.press/doi/full/10.3138/cpp.37.3.283

We already have.  the data that shows that a basic income ,(mincome) improves outcomes.((mental and physical health  improved and crime went down)

Oppression,injustice,disenfranchisement is achieved through the legal /court system. The legal institution is designed to maintaining the hierarchy, to favour the interests of the elite by criminalizing the impoverished.

Impoverished persons cannot pursue/access justice through the courts

When people realize the system is rigged, they opt out of it (,refuse to comply with the rules of the system) ,and resort to other options for settling their grievances such as illegal,antisocial behavior and the use of force .The social contract is no longer binding.   .They are no longer a stakeholder. The destitute/excluded do what they have to to provide for themself ---to access the basic resources they need to survive.

When people are denied access to education,employment opportunities, housing, food, basic income ...they become nihilistic. Denied a share in any of it...they just want to burn it all down!

Failure to respect and comply with the law undermines the social order.

Thus poverty results in a destabilization and  breakdown of the social  order.

The restoration of social order is contingent upon the restoration of equity and justice!

If the GDP is growing , why then is poverty not diminishing?.!      Who is benefiting from the growth in the GDP?

Clearly The wealth generated by the economy is not trickling down to the poorest. in society

Increasing the size of the economic pie does not increase prosperity for all!!

Where then is the fairness in the current distribution of the benefits of the economy?

People cannot afford shelter and basic  survival resources.This is causing homelessness and a mental health crisis

The existing social safety net is not enough!

Society has a moral obligation to provide for the poor/destitute so. they can  live a secure and dignified life..

Camping is a way of getting away from things...and especially  now we have a lot to get away friom.

Camping becomes a permanent lifestyle. Homeless encampments become a universal phenomenon.Excluded people (those excluded from mainstream society )find a sense of community/belonging in these encampments.        But these campsites are full of. pain and despair! ....for these are the common experiences thst. have brought their occupants together..                              They are invariably restricted to the outskirts of cities where they are less visible (out of sight,out of mind --like leper colonies) ,and do not inconvenience businesses and middle-class neighbourhoods.

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UBC study busts biases against homeless people’s spending habits

BY ERIK ROLFSEN, BA’92 | 3 MIN | AUGUST 30, 2023

James was among the people experiencing homelessness who received a cash transfer as part of a UBC study. Photo by Foundations for Social Change.

The public has the wrong idea about what homeless people would do after coming into a large amount of money.

A newly published University of British Columbia study in Proceedings of the National Academy of Sciences unveils this stark contrast between public perception and reality when it comes to how homeless people manage their finances.

Participants in a US survey of more than 1,100 people predicted that recipients of an unconditional $7,500 cash transfer would spend 81 per cent more on “temptation goods” such as alcohol, drugs, and tobacco if they were homeless than if they were not.

The UBC research team, in partnership with Vancouver's Foundations for Social Change, actually gave this amount of money to 50 people who were homeless in Vancouver, then compared their spending and outcomes over the following year with a control group of 65 homeless people who did not receive any cash.

Cash recipients spent 99 fewer days homeless, increased their savings, and saved society an average of $777 each by spending less time in shelters. They did not spend more money on temptation goods than the control group did.

The cash transfer worked, but public biases persist.

“The impact of these biases is detrimental,” said Dr. Jiaying Zhao (she/her), an associate professor of psychology at UBC who led the study. “When people received the cash transfer, they actually spent it on things that you or I would spend it on — housing, clothing, food, transit — and not on drugs and alcohol.”

The study did not include participants with severe levels of substance use, alcohol use or mental health symptoms, but Dr. Zhao pointed out that most homeless people do not fit these common stereotypes. Rather, they are largely invisible. They sleep in cars or on friends’ couches, and do not abuse substances or alcohol.

The researchers also tried to determine how public perception about cash transfers to homeless people could be changed. They found that the most effective messaging would counter stereotypes by explaining how homeless people actually spend money, or emphasize the utility of cash transfers and the net savings they bring to society.

Canadian lawmakers are considering a bill that would create a national framework for a guaranteed basic income to cover essential living expenses for people in Canada over age 17, including temporary workers, permanent residents, and refugee claimants.

Supporters of basic income policies argue that cash transfers help reduce poverty and give people more financial stability during tough times, but critics say they’re too expensive, and the money could be misused or discourage people from working.

“We know that people tend to dehumanize those experiencing homelessness. What’s surprising to me was how large this bias was,” Dr. Zhao said. “Homelessness is such a big problem in North America right now. It’s extremely costly in terms of GDP as well as human lives, and the current approaches to homelessness reduction are not working. That’s why I think it’s important to explore a different approach.”

Dr. Zhao’s Behavioral Sustainability Lab will now turn its attention to replicating this study with a much larger sample of people, and expanding it to other cities in Canada and the U.S.

ERIK ROLFSEN, BA’92

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JOHN TALBOTT OBIT

Guest: Allen Frances

SS: As a psychiatrist and an advocate, Dr. John A. Talbott pushed to de-institutionalize mental illness in the United States. And then, after it happened, he became one of the movement's biggest critics. Dr. Talbott died late last month. He was 88. Over some 60 years, Dr. Talbott built a career advocating for individuals experiencing homelessness and mental illness. In posts at universities, mental hospitals and prominent journals, dr. Talbott pushed for a model of community care -- one that failed to thrive after the mass closures of American mental hospitals. Dr. Allen Frances was a friend and former colleague of Dr. Talbott. We reached him in Carmel, California.

NK: Dr. Frances, when you first met John Talbott as a resident, what struck you about him?

ALLEN FRANCES: Well, John was the sort of person who lit up every room. He had tremendous energy. He was a lively, interested pairing. Never gave up, optimistic kind of person who really cared about people and understood them.

NK: He was a pioneer in many ways, a champion of this idea of community psychiatry at a time where that was not prevalent. People with mental illnesses were institutionalized and very different institutions than even the ones we know today. What was his dream or his, his ideal for how people dealing with mental illness should be cared for?

AF: When we began work, people with severe mental illness were housed in a horrible dungeon-like, snake-pit mental hospitals and with very few doctors to care for them. John was, began his psychiatric career just as deinstitutionalization was becoming a popular theme. And he was one of the leaders in encouraging deinstitutionalization. That people could live in the community with dignity as citizens rather than being stuck away in these horrible hospitals. John then quickly became discouraged about the way deinstitutionalization was being done. The patients were just dumped in the community without any assistance, social services, psychiatric care. And luckily, a community psychiatry bill was passed by the Kennedy administration in 1963, and John was one of the leaders in helping to understand how we could best treat people in the community with medication and with a place to live. And the tragedy was that starting with President Reagan in 1980, the funding for these programs was killed. The states had saved a fortune in closing their state hospitals, which usually were the most expensive line item in their budget. But they didn't spend the money on the community care. And John spent the rest of his career fighting against this.

NK: You wrote, quote, few people have ever had so distinguished a career as Dr. Talbott, but perhaps none has ever had a more frustrating and disappointing one, end quote. What did he tell you about that disappointment?

AF: Well, John never gave up. As the funding died in the United States. Luckily for people in other countries, governments began to realize that it was a much better model to take care of the patients in the community than to stick them in these expensive and horrible hospitals. And John had a very successful career internationally in promoting community psychiatry. But sadly, tragically, horribly, he, I and other people interested in this watched as the patients who previously were in these horrible hospitals became homeless and in prison. There are now about 600,000 psychiatric patients who are either in jail or living on the streets. And ironically, the situation has become so bad now that the public is taking notice that there is actually increased funding for community programs, largely pushed by the fact that there are so many homeless people living in so many different cities under horrible conditions. And people beginning to realize once they're living on their street corner that this is intolerable. The prisons are terribly overcrowded, with perhaps a fifth to a third of prisoners being mentally ill people who really need treatment in the community, not to be in jails. And I think that the prison associations, the sheriffs have become more and more aware of the need and advocate strongly in the direction that John did.

NK: Our listeners have just heard earlier in tonight's program two conversations I've had with, with people who have lost loved ones. And mental illness was, is certainly at the heart of their stories. But the inability of officials or institutions to deal effectively and properly with people who are, who are struggling with mental illness is at the heart of those stories as well. So, when you, when you did speak to him last, how was he reflecting on things?

AF: Well, I think that John was not the sort of person to ever accept a defeat. And I think he saw the situation in America realistically but optimistically. And I think that he felt, as I do, that things are so bad now. There's no, the way I put it, there's no place in the world where it's worse to be a severely mentally ill person than the United States. It's a disgrace. And other countries have done so much better than we have. I think John felt that the pendulum was swinging back towards the realization, if not for goodness of society, the necessity. Because people are no longer willing to tolerate having homeless people on the street and not house all of the mentally ill in prisons. So, I think he was optimistic that the message which had been ignored for all the wrong reasons during these last 40 years, was suddenly now being heard. And I think all of us have an obligation to carry on his work.

NK: It's interesting that you say that because when you brought up the example of homelessness earlier in the conversation as well, it struck me that it's because it's become a nuisance to people that, that others are living in their neighbourhoods or there are encampments rather than necessarily concern that people need help. That's a sad thing.

AF: It used to be considered a public responsibility to take care of our most disadvantaged people, the people with the most severe mental illness. And now, there's a complete non-system. No one's responsible. There's not nearly enough money. And in the vacuum, prisons and the street have become the default position. And I guess it's only when you hit bottom -- and we as a country in so many ways have hit bottom -- that you can begin to look upward and hope that things will get better.

NK: Could you share a bit of the last things you spoke about when you were able to speak to your friend?

AF: Yeah, no, we were talking about this to the very end. And, and he worked. He was editing his journal. Having terrific arthritis, pounding with one finger, he worked on his journal until a week before he died.

NK: He sounds like a remarkable person.

AF: Yeah.

NK: I'm sorry for your loss, Dr. Frances, but --

AF: Well, he was my friend for 55 years. And he was my boss 15 years. And he was a person I admired and tried to model myself on throughout my career.

NK: Thank you, Dr. Frances.

AF: Thank you.

SS: Dr. Allen Frances -- who was in Carmel

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