Are we unintentionally making things worse for the homeless?

Editor’s note: This is part one of a five-part series addressing homelessness originally published in the Deseret News.

At the conclusion of World War II, the British government commissioned Dr. Ludwig Guttmann to lead the first ever medical facility dedicated to the care of paraplegics. At the time, conventional medical practices held that keeping disabled soldiers lying horizontal and heavily sedated to minimize pain was the most humane approach. Life expectancy for these individuals was less than two years. 

Guttmann surmised that, though motivated by kindness, the outcomes fostered by this practice were not consistent with the intent behind them. He believed better lives for these disabled soldiers were possible. So, he designed a new, rehabilitative approach to treatment. He reduced sedatives by half. He asked the injured to sit up in their beds. Then he started throwing balls at them so that they were forced to play catch.  

For the patient, each of these approaches initially hurt. Other doctors and nurses, accustomed to methods rooted in immediate accommodation rather than progress and improvement, accused him of cruelty and summoned him to a medical tribunal. But Guttmann, intent on better outcomes for these disabled soldiers, persevered, and myriad patients made remarkable recoveries as a result. His reforms and vision were the genesis of the modern-day Paralympics. Thousands of lives were substantially improved! 

Today, chronic homelessness is a crisis analogous to the societal dilemma Guttmann navigated in the 1940s. Those experiencing chronic homelessness all too often navigate disabling conditions originating from extraordinary trauma, such as mental illness and substance use disorder. Regardless of their cause, these injuries are at least as crippling as the loss of physical limbs.

And much like the environment in which Guttmann began his work, today’s conventional approach to caring for those experiencing chronic homelessness stems from genuine concern. But these well-intentioned practices inadvertently exacerbate the root difficulties this population struggles to traverse. One result is that despite spending billions in aid, chronic homelessness in the United States increased 45% from 2017–2022.

How does this happen? While COVID-19 certainly played a role, the broader issue is a failure to understand and address chronic homelessness as a condition distinct from that experienced by the “situationally homeless” — those whose experience with homelessness is relatively temporary and infrequent. Situational homelessness is often precipitated by sudden, significant life setbacks. And it can largely be ameliorated by interventions that center on affordable or rapid (re)housing as well as other traditional social services.  

In contrast, for those experiencing chronic homelessness — simultaneously less numerous but much more visible than the situationally homeless segment — the persistent lack of shelter is a symptom, not a root cause. When we primarily focus on the “homelessness” issue rather than accurately diagnosing and naming the root problems as “debilitating trauma and their accompanying disabilities,” the result is a persistent set of well-intentioned perceptions, policies and practices that are harmful for these individuals and for society.  

Consider a specific, pressing example. Allowing camping in places not intended for habitation initially seems merciful by respecting their need for shelter wherever they can create it.

But in fact, this approach may be one of the very worst things society can do for this vulnerable population. Rather than enabling healing, living on the street exposes individuals to significant exploitation by malignant actors and activities that exploit and exacerbate preexisting trauma and disabilities. Time and time again, I have personally witnessed individuals enveloped by the streets, where they are repeatedly assaulted — sexually and physically — and poisoned with such toxic substances that their root challenge of debilitating trauma is so severely worsened, making recovery exponentially more difficult.  

So how does society more effectively rescue those in greatest pain? We start by defining improved human dignity, not shelter, as the true objective. We then invest in wraparound services that propel lasting recovery — from mental and behavioral health, to overcoming substance use addictions, to improved education and employment. We provide safe, long-term environments where people can heal, protected from criminal exploitation. Finally, we align systems to incentivize increased responsibility and accountability, rather than obstructing rehabilitation.  

Like the paraplegics under Guttmann’s visionary care, we must rethink the approaches that will best help individuals heal. Leaving them on the streets, sedated and preyed upon, is not the answer. Investing in the right systems and providing individuals the tools to help them realize their true potential is! 

Please go to www.utah-impact.org to engage with other Utahns committed to helping those experiencing homelessness.

Randy Shumway is the founder and chairman of the Cicero Group, the treasurer of the Utah Impact Partnership and the co-chair of the Utah Homeless Council.