The plastic hospital bracelet Mary Wiley still wears on her wrist could be a key, at least symbolically, to understanding the growing problem of homelessness in America.
Tall, with a mass of brown curls and a husky voice, Ms. Wiley has been on and off the streets for years.
Diagnosed with manic depression, her health weakened, she's just spent six weeks in the hospital. Now, though, she suddenly finds herself discharged - and spending her holidays at a drop-in center for the homeless in midtown Manhattan.
"They changed my doctor, and all of the sudden, he told me I had to leave," she says, visibly upset. "They told me the only place I could go was a city shelter."
This is life on the edge in America, where the first stop out of many social-service agencies - from mental-health facilities to hospitals to prisons - is the local homeless shelter, or the streets.
Indeed, the homeless system has now become something of an unofficial back-up safety net for America's mainstream social-service programs.
At the same time, the nation's stock of affordable and subsidized housing has plummeted - a problem the booming economy has only exacerbated. As a result, in the past 25 years homelessness has grown from a fairly rare phenomenon to a national problem, with more than 40,000 shelters and agencies springing up around the country to deal with the millions of Mary Wileys in America.
"If we keep letting this go on, we're going to be paying for this forever. We're going to totally institutionalize this problem - a problem we didn't have 25 years ago," says Nan Roman of the National Alliance to End Homelessness in Washington. "It's really a choice, and if it doesn't get made in the short term, soon, we're going to pass the point when we can turn it around."
Over the weekend, the Clinton administration announced more than $1 billion in new grants to help more than 200,000 people find a home. He said the goal was to "create new opportunities for the homeless, for hard-pressed working families, and for those struggling to buy their first home." Homeless advocates applauded the move as essential to help an overburdened system.
But many also believe it's time for a new approach to address the root causes of the problem. It's estimated that on any given night in America, anywhere from 700,000 to 2 million people are homeless.
The alliance has developed a plan to cut those numbers dramatically over 10 years. It's a combination of creating more affordable housing and rebuilding mainstream social-service programs to include the transitional programs they once provided - from comprehensive discharge planning to halfway houses to permanent affordable housing for the mentally ill.
From their perspective, the shelter system has become an expensive, national halfway house that isn't properly equipped to provide the training, treatment, or transition services people need to put their lives back together. That has helped create a core population of chronically homeless.
"We have done a terrible job in this country since we de-institutionalized [the mentally ill] in the '70s," says Dean Wright, a homeless expert at Drake University in Des Moines, Iowa. "We just did not provide care to the people that needed care - whether it be medical-care, mental-health, or substance-abuse treatment - and without it people end up right back in prison or out on the streets."
Now homeless advocates hope the new Republican administration - with its emphasis on compassionate conservatism - will be receptive to addressing that failure. And they're looking to Massachusetts, where conservative Gov. Paul Cellucci has embraced the concept, to help make their case. In a speech earlier this month, Governor Cellucci noted that, in 1997, almost 60 percent of the people in the state's homeless shelters had been released from some sort of institutional setting in the past 12 months.
He then announced that all state agencies - and private ones with state funding - will be required to develop "consistent and effective protocols" for discharging their clients that include "life-skills training and housing search assistance."
"The new ... initiative does not require new resources, but is a proven method for homeless prevention, which state agencies can implement quickly and effectively with dramatic results," he says.
That was a victory for Philip Mangano, executive director of the Massachusetts Housing and Shelter Alliance. For the past decade, he's been studying the growing homelessness problem and advocating a different approach from simply building more shelters.
He describes the current situation as analogous to a house where, every time five people go out the back door, seven more are waiting to get in the front. And many of them, like Wiley, are repeat visitors who need more than a place to put their head for the night.
"What you've got is gridlock at the back door because there isn't access to enough affordable housing, and we've got overflow and overcrowding at the front door because these mainstream systems keep dumping people into the shelters," says Mr. Mangano.
Even as the economy slows, housing prices are expected to remain high for some time, pushing more low-income families into the shelter system, as well. So along with proper discharge planning, homeless advocates are continuing to fight to increase tax incentives and subsidies to build more affordable housing.
"For homeless families, the problem continues to be an inability to pay market rent and a lack of access to capital to buy a place to live," says Gail Nayowith, executive director of the Citizens' Committee for Children of New York. "At the same time, there's been a complete shutdown in the development of affordable housing."
That shutdown has affected Wiley, as well. She has some income from Social Security, but only enough to pay a few hundred dollars a month. And in Manhattan, where it can take that much to rent a parking space, she has little chance of finding an apartment. In the meantime, she's been sleeping, sitting upright in the chairs of the drop-in center. "I was in a [single-room-occupancy hotel] before, but I lost that room," she says. "I'm willing to go back, I want to, I need a place to stay."
(c) Copyright 2000. The Christian Science Publishing Society