I ran over a woman on Hwy. 101 — a horrific accident that lays bare the trauma of homelessness

It was 6:11 a.m. Thursday morning, Dec. 3. I was driving north to work on Highway 101 through the predawn darkness, listening to the audiobook “Who Not How.”

Suddenly, my car hit something. I almost lost control as the car swerved. There was a loud “BANG!” as my car ran over … a body — though I didn’t know this at the time.

Shaken, I drove to Atascadero State Hospital where I called the California Highway Patrol. When Officer Willoughby came to look at my car, he told me I ran over the body of a homeless person. Officer Willoughby told me many cars has also driven over his body.

When he told me what I had done, I felt unreal. A feeling of horror and profound sadness flushed through me. Once again, I felt shaken.

What was this woman doing out on the highway?

Knowing the homeless population as I do, I wondered if this was a suicide attempt. Or perhaps she was psychotic due to untreated mental illness.

This got me to thinking about the seemingly intractable problem of homeless people. How do we help them, especially in the time of COVID-19, so that tragedies like this don’t happen? If we can put a man on the moon, why can’t we help our fellow citizens who have no place to live?

I don’t have all the answers; I don’t claim to be an expert on this. If there were an easy answer, I’m sure homelessness would have been eliminated by now.

Factors leading to homelessness

On any given night, about a half a million people are homeless. About 200,000 live on the streets without shelter. To me, it is a shame that a country as rich as ours could allow this to happen.

The main cause of homelessness is lack of affordable housing. But this is not the only factor. People living in poverty and those with mental illness are at much higher risk of homelessness because of a lack of economic, social, and functional reserves needed to cope with adversity. Homelessness disproportionately affects people of color. Some sources suggest that nearly 50% of homeless people are Black, even though they make up only about 13% of the US population.

Trauma is almost universal among homeless people. Trauma increases the risk of homelessness and homelessness increases the risk of trauma. In one study, all the woman and over 90% of the men reported at least one traumatic event. Over 50% had witnessed someone being badly injured or killed; 50% of the women and 10% of the men had been raped. Homelessness is traumatizing — both becoming homeless and being homeless.

Surveys suggest about 25% to 50% of homeless people have severe mental illnesses like schizophrenia, bipolar disorder and more suffer from addiction. Homeless people have three to six times higher rates of physical illnesses. In one study, 50% of unsheltered people suffered from a physical health condition, a mental health issue, and a substance use disorder. When you have all three, this is called “trimorbidity.”

Given the above, it is no wonder that the average age of death of homeless persons is about 50 years as compared to 78 years for non-homeless Americans. This is often because homeless people die from illnesses that often could have been treated or prevented.

What’s been shown to work

When it comes to the mentally ill homeless, I do know that supportive housing works when paired with social and clinical services. When you give people safe housing and caring support, they will sometimes accept help for their mental health issues, including addiction.

I recently read an article in one of my psychiatry trade journals advocating for reopening state hospitals for those with severe mental illness. This is a type of intensive “supportive housing” with integrated comprehensive clinical and social services that would benefit some of the homeless who are very mentally ill.

Unfortunately, this would require an investment in resources and perhaps a revisiting of commitment laws that favor allowing severely mentally ill people to refuse treatments they desperately need. It is a difficult ethical dilemma. How much do we passively allow people to suffer from severe mental illness — including addiction — often at a tremendous cost to themselves and to society? If they go to prison, they are often further traumatized. Some of them eventually end up at a forensic hospital like Atascadero State Hospital. What if we had an ethical and proactive way of intervening before it is too late?

There are two vexing dilemmas that remain unaddressed by our society. One is that some people with severe psychotic disorders such as schizophrenia lack insight into their illness; they don’t know they have a mental illness, so they don’t think they need treatment. The other dilemma is the problem of severe addiction, which robs people of sound reasoning and free will, sending them into a spiral of compulsive destruction. Unfortunately, only about 10% of people with addictions seek treatment, in large part because the disease has co-opted their willingness to ask for help. How do we help these people who desperately need our help but refuse help because of the nature of their illnesses?

Fortunately, there are wonderful people and organizations, like Transitions-Mental Health Association, CAPSLO (Community Action Partnership of San Luis Obispo), ECHO (El Camino Homeless organization) Five Cities Homeless Coalition and the county of San Luis Obispo attempting to address this traumatic problem. But they need our help.

We need to support efforts to minimize homelessness for the sake of everyone, as homelessness hurts all of us in many ways — both direct and indirect — in the forms of crime, violence, societal costs for incarceration and moral injury.

Blaming the homeless for their trauma, their addictions, their mental illnesses and their lack of social supports or vocational skills will not solve the problem. Looking the other way will not work either.

I personally don’t believe that letting people who lack the capacity to rationally choose treatment they desperately need to undergo the suffering of homelessness is a solution either. Ethically, I might be more prone to prioritize beneficence as a higher value than autonomy, especially when we see how traumatizing and life-threatening homelessness is.

I pray we can all come together to support those who are addressing this problem. Let’s all advocate with our legislators to develop more enlightened laws and fund the resources needed to reduce homelessness. If we do this, we all will benefit.

Dr. Michael McGee is a board certified general adult and addiction psychiatrist practicing in Avila Beach and at Atascadero State Hospital. He is the author of the award-winning book “The Joy of Recovery.”

This story was originally published December 8, 2020 at 11:49 AM.