 And welcome to another episode of Likeable Science here on ThinkTek Hawaii. I'm your host Ethan Allen, and Likeable Science is all about how science is a vital and interesting part of everyone's life, your life, my life, everyone's. We're all connected to science. Science impacts our lives every day. And today, here in the ThinkTek studios, I have Jack Burrill. Welcome, Jack. Thank you. I'm in the Department of Psychology at UH in the College of Social Sciences and studies the social determinants of health, sort of the bigger picture, the bigger context of what helps keep people healthy, happy, prosperous, growing, all these things that we don't tend to think about. They're a little bit outside of sort of medicine per se in general, huge slew of factors only really recently being recognized now, right? Oh, yeah. Yeah. In the last 25 years, you've seen like a steady increase and more of a focus or understanding of kind of social environments and built environments and how culture intersect and really make a difference in who succeeds, who fails, who lives healthy and who doesn't. Yeah. It's a classic example of systems thinking, right, where we aren't just individuals living our own lives, you know, where a doctor can just look at you and say, you know, do this, do that, he or she has to take into account the locale, your zip code, your friends, your occupation and all these different kinds of things, your activity levels, your diet, all these things will greatly impact how healthy you are or are not, right? Yeah. It's, so how did you get sort of started in this business and it's kind of studying it? It's sort of an odd field in a way. Yeah. Yeah. We've kind of grown with the field in a lot of ways. So in no new grad, I was a health science major and at the time, actually, I was thinking, oh, maybe I could go to the med school or, you know, do a classic health and I graduated and I wasn't quite sure what I wanted to do. So I took a job actually at a psychiatric hospital and that was, I worked there for a few years. It was really interesting. An eye-opening. I mean, it is. It's eye-opening. I guess I would say everyone, I recommend everyone do it because working there, what I found was that was, you know, people came in and the people I worked with largely had pretty profound psychopathology, really active psychosis and things like that. They weren't just in their sort of, you know, get rest or relaxation, they were people who had been pushed to their home. Oh, yeah. Yeah. So the people there, it's a locked unit. So they did not want to be there. So generally they're brought in by the cops, police usually and sometimes they're kind of, kind of, almost always get a little bit out of their mind. But, you know, sometimes they're very peaceful and police were very nice and treated them well. At times it was a little more brand-bunctious. But you know, it was kind of shocking because, you know, there is the seclusion rooms and literally like the leather straps and all the kind of classic nightmares that you hear of. But I was always surprised at how well people would do once they got in there. So within a couple weeks, you know, you really see these transformations with people. And I was like, wow, okay, this medicine stuff works. I was like, this is amazing. And then I realized after about a couple more weeks, sometimes a month would go by, they come right back. I was going to say they disappear, but you see them again. And I'd see them again and they looked just like they did before. And I'm like, I thought we fixed it, you know? And then, like, it cycles like that constantly in the hospital. So I was like, there's got to be more to this. There must be more out there. So I took a job as a case manager working on the streets with people with serious mental illness that were experiencing homelessness. And I'll say I quickly realized, I was like, oh, I figured it out. There is a lot going on out there. There's a lot of reasons why people struggle. What I quickly realized is at the hospital, we were kind of packaging them up, like propping them up, and kind of moving them on their way without any sort of supports available to them at all. It was just putting them right back in the same environment that brought them there. Exactly. So it was shocking to see the conditions and the daily lives that people live on the streets and the backgrounds and the histories. It's just really something that touches your soul in a lot of ways. Yeah, that's interesting. I like your idea that everyone should probably do this. It'd be a great form of sort of community service to have everyone do it. We tend to, when we hope, sort of engender empathy, right? We much more understand like, hey, they're, you know, but for the luck of the draw, go I, right? Yeah. Because a lot of these people that just random things happen to them, right? It's not a character flaw. It's not a defect in their personality, necessarily at all, right? No, no. I mean, I guess, you know, I grew up in a kind of middle class family and kind of suburbs of Washington, D.C. And I really, I mean, I didn't really have the same exposure to some of the events that people had. But when I got in the hospital, I'd read through people's charts and read their backgrounds and it was jaw dropping. And then I, when I was living on the streets, I really got to know the kind of really incredible traumatic experiences people had in their lives, ongoing trauma, just really difficulties on just daily day activities that everyone else takes to work or hand in. Right, right. We often don't realize how sort of smoothly our lives are progressing and how so many things aren't automatic and we don't worry about them. You know, most of us don't worry about where we're going that night to sleep, right? We're just, you know, we've got a place, you know, it may be good, it may not be so good, but it's a place and we can go there. And yeah, but you see there are communities where that's not at all true and there are kids who don't know where they're going to be after school. They don't know where they're going to sit and do their homework if they're going to be able to find a place, right? So we sit quietly and read or study or write whatever they have to do, right? Yeah. Yeah, and you can only imagine, like, if you're in those circumstances that you have this level of stress that's just ongoing, you know, it's kind of like I'll actually teach health science or health psychology and I tell people, you know, that if you have this chronic stressor, so there's almost no chronic stressor worse than living on the street, that it's almost like you're trying to run from a tiger all the time, but if it never goes away, it really does a number on your body physically, but of course, also mentally. So a lot of the mental health problems that people experience are really largely contributing to the overwhelming stress that they're experiencing in these circumstances. Little episodes of stress are fine and probably actually healthy, but chronic stress like that, particularly for young people, really literally changes their brains and makes them less able to cope with stress as an adult, right? I mean, they literally react quite differently than otherwise normal adult would. Yes, absolutely. You literally even metabolize your food differently. I mean, like, your body is reacting in just a way that's not adapted for what you're coping with. Yeah, so that's, so, okay, so you've got, then, this is a big problem, right? We understand, we see that every day on the streets and here around Honolulu, right? We see a lot of people. So, I mean, what kinds of programs are you working with that are trying to help these people out? Yeah, so I work on a kind of, I'll say, a large portfolio of interventions and programs that are designed to address needs of what I consider generally marginalized communities. So, I work with IHS here with Housing First and we're now in our fourth year, finishing up, I guess, in a couple of months, we'll be in our fourth year and then hopefully we'll be starting up our fifth year. And Housing First is a program, if you're not familiar with it, is one where the ideas that you move people that have been with a long history of living on the streets, oftentimes with profound mental health and substance abuse issues, into a home without kind of having to go through any middle ground. So, they don't have to go through substance abuse treatment, they don't have to go through mental health treatment to get into a place. Now, it's a problem here because there's not enough places to find people, but if that system works well, it's that, once you get into shelter now, and then you get a number of these stressors reduced, you see that a lot of people with kind of issues around substance abuse and mental health issues that kind of start to dissipate. And if you can put in wraparound services and case management around that, you see that people can really improve pretty quickly. Yeah, I'm sure it's not a silver bullet exactly, giving them a home, a place that they can call it their own, a place they know, they go to each night. But it's a huge first step, right? If they have that, suddenly, as you say, it's sort of one big tiger is now not chasing you, so there may still be others, but... Yeah, there is, there is, but yeah. So it's funny because, yeah, so that's just kind of what people will consider a basic need that you get met, but there is a whole other, I mean, it's not like you can remove the 20 years that people lived on the streets or 20 years of trauma. So there's still not a lot of assistance that's necessary, but it does get you through that door. Yeah, and then you can begin to look at that, some of the other issues. So you talk a little bit about the sort of the individual factors versus societal factors and somehow sometimes that we sort of confuse these two, right? Oh, yes, yeah, absolutely. Maybe you can say a little more about sort of, because I don't know that our audience necessarily will understand that distinction here about some definitions here. Yeah, okay, so, I mean, my area is in marginalized communities. So usually though, I focus on health and quality of life that people experience. So I usually use the example of homelessness as that, that when people think of homelessness, they usually think of individual factors, individual causes, you know, oh, someone has a substance abuse issue, someone has a mental health issue, oh, they lost their job. And these are concerns, I mean, don't get me wrong, they are factors, but they are not the determinants of who experiences homelessness, right? So these are things that can hurt somebody, but what really causes somebody to not have a home is just not enough homes to go to, right? So if you look at places that have, you know, that are affordable, where there's plenty of homes, it doesn't matter what the individual factors are or the people that live there, everyone ends up still in a home. So would someplace like Detroit right now actually have a relatively low rate of homelessness because it's much bigger city with lots and lots of homes built and now it's got a much smaller population? Yep, yeah, so I usually say the city's like, no offense Cleveland and stuff like that, that are not like booming economies. They actually do pretty well on metrics of homelessness, right? They don't do well on other economic metrics and they don't necessarily do well on health metrics, but when it comes to homelessness, it's a clear if there's not enough places for people to go, then someone's not done that. I think you sent a graphic here, I think a first graphic actually talks a little bit about this, right? So this shows essentially the sort of the cost of living, if I understand it, basically along the horizontal axis with higher ones being up there where San Francisco and Honolulu are shown and lower costs of living at the other end and basically the homelessness rates, right? Yeah, so this is just one snapshot of one year. Actually, so some people in my lab have been working on putting this together. So we have actually a series of these that we've looked at. And it clearly just depicts this linear trend of as rental rates increase, the rates of homelessness increase. It's very clear. So when you look at areas like San Francisco is really economically booming, there's a lot of tech and brains, a lot of wealth, but there's also a lot of costs, right? So we think our rental rates are high. They're much higher in the Bay Area. So you see that where places of high rent end up having much higher homelessness rates. And in some ways, I actually think like if you can kind of fall in the bottom half of the graph, you're kind of doing better than you should predictably where a city like where I'm from, Washington, DC generally does a little bit worse than would be predictably. But there's also, because there's a lot of other factors that go into DC's circumstances. Yeah, so that's intriguing that all these different factors and all what really spurs it. But then your point sort of the individual versus social societal factors, right? Where all those individual factors are indeed important and can be causative, if you will, for people becoming homeless. Homelessness itself ends up sort of triggering or causing almost more of those same things, right? Absolutely. So when people are kind of marginalized, whether that is because, well, you can kind of walk it back in the idea of if you live in a place where I have enough affordable homes, that's kind of the baseline. And you are marginalized by society for some reason. So you don't have a lot of strong support networks that are people. When one thing goes wrong in your life, you have no outlet, right? So if you lose your job and you have no one you can call, you have no one that can support you, you'll clearly fall to the bottom and you'll experience homelessness. And but then once you do that, then all the other stressors that we were just talking about come in, right? Come rushing down like that. And as when that happens, then people start to be much more likely to develop substance abuse issues, mental health issues and that sort of thing. And it goes both ways, but it's certainly then once you're marginalized there, then of course people marginalized for your experience in homelessness. And then once you do that, you develop a substance abuse issue and then people look and you go, no wonder you're living on the street. You're abused the drugs and then so you can never get back. So we're gonna follow this vicious circle more deeply here, but right now we're gonna take a one minute break here. I'll be back here with Jack Bril to talk more about homelessness, marginalized populations and what we can do about them right after this short break. And Aloha, my name is Calvin Griffin, the host of Hawaii in Uniform. And every Friday at 11 o'clock here on Think Tech Hawaii, we bring in the latest in what's happening within the military community. And we also invite all your response to things that's happening here. For those of you who haven't seen the program before, again, we invite your participation. We're here to give information, not disinformation, and we always enjoy response from the public. But join us here, Hawaii in Uniform, Fridays, 11 a.m. here on Think Tech Hawaii. Aloha. Hello, I'm Yukari Kunisue. I'm your host of New Japanese Language Show on Think Tech Hawaii called Konnichiwa, Hawaii, broadcasting live every other Monday at 2 p.m. Please join us where we discuss important and useful information for the Japanese language community in Hawaii. The show will be all in Japanese. Hope you can join us every other Monday at 2 p.m. Aloha. And you're back here on likable science with me, Ethan Allen, your host here on Think Tech Hawaii and Jack Burrill. Welcome again, Jack. Jack's a professor in the psychology department at UH and we've been talking about marginalized populations, homelessness and some of the issues that have caused this. And right before the break, we were talking about sort of this almost this feedback loop where there are factors like loss of a job, no money, poverty, substance abuse, mental illness that can trigger homelessness, but that equally and probably as often if not more often, homelessness itself, a condition of being homeless sort of triggers one or more of those same conditions, right? So when one gets into a rather a vicious circle, right? Because it's one thing if you've lost your job and you've still got your clothes in your car and things and you can sort of make do for a little bit. But as it goes downhill, you lose your car, you don't have clean clothes anymore, you can't get a job, you can't keep a job, your kids aren't in school, nobody likes you, people avoid you on the street. And you start drinking more heavily. Yes, absolutely. It goes down rapidly, I'm sure. Yeah, absolutely. And I'm sure you've seen this. Yeah, so if you have conditions of where you're living in a place that does not have enough affordable housing, I usually say like really affordable, like low income affordable rentals, not even just like things you can purchase, there's a lot of issues around that. If those conditions are in place, then someone's not going to get in a home and that usually happens for a couple of reasons. It's either people that have no support system or sometimes you do have people that have, and sometimes they have no support system because maybe they have developed a mental health issue. There is kind of genetic links to that and some people are more predisposed to that. And so these kind of classic factors that people consider as being related to homelessness due to some extent relate to who ends up without a home. Right, so that's shown in the second graph, I believe, that we have here. Right, all these factors that these various things aren't shown on left employment type, substance abuse, physical and mental health issues, and life-transition. Life-transition, which is one of my favorite categories that I just made up. I didn't make it up. I actually published paper that kind of considers that. So those things are actually unfortunately way too common, but there are things like being released from jail divorced, yeah, sometimes it can be related to evictions and other forced moves for some reason. Yeah, so the spouse, death of a loved one. Yeah, all those things, and they're actually quite causes. But what those sort of situations usually lead to is what, and I didn't make this up, is the metaphor of musical chairs where you have 10 chairs, if you have 12 people, two people aren't gonna get a chair. Now who's gonna be the people that don't get the chair? It's gonna be the people who want or more of those problems, right? Because people don't have those problems, they're looking for the chairs. Yeah, they're ready to grab them. Right, so anytime you marginalize certain people against who can get into a unit, who can get a rental, then also they're the ones that get left. But then the third graphic shows sort of that flip side of that, right, that once you are homeless, then you've got even more problems. It's harder to get a job and harder to stay employed because you can't get dressed up, you can't get cleaned up, you may not have transportation, you're gonna probably be around a lot more people doing a lot more substance abuse and who have more substance abuse problems and some of it, you're in an environment of that. Likewise, again, you've got sleeping on the streets, you run into violence, you run into trouble and may have more physical mental health issues. Yeah, and also the issue is that like the issue of homelessness or houselessness is a state, right? So unfortunately, a lot of people, not think tech Hawaii, but some people describe homelessness as like an identity or they are homeless people, you know? Where it's really just a state that people end up in and it can happen to anyone, but the problem with it is that once people fall into that houseless situation, now all of a sudden they're experiencing homelessness and now all of a sudden they are to be much more likely to develop all these other issues and continue with that cycle. It's then becomes a bigger and bigger jump to get back into housing. And it's pretty complicated, right? Because the state of being homeless really encompasses a lot of people with a lot of different issues. There are people who actively choose to be homeless, right? They don't want that responsibility of having a place that ties them down, that they choose to be living fast and loose on the streets, you know that? There are people who have just lost their job and lost their housing because there aren't enough affordable homes. There are people whose mental issues have basically driven them from their families and their friends, you know? So yeah, I mean, and those categories, it's not a one-size-fits-all solution, right? I mean, your idea of- No, it's very complicated. Making truly affordable housing will help a whole bunch will probably help almost all those people, maybe not the ones who wish to be homeless, but anyone else basically. Yeah, and generally I would say that people that you could say wish to be homeless it's usually that they're hopeless in the sense that they have lost their hope in getting into a home. There's not many people that just grow up and they go, you know what I'm thinking? I've really done grow up and live without a home, right? So it usually ends up people that have been kicked around quite a bit for a long time and maybe they don't trust people anymore, they develop mental health issues, they've developed a lot of circumstances where they are no longer kind of invested in society and that's because people mistreat them and there's a lot of reasons why people end up like without hope or feel that they can't come back from their situation. Yeah, and then again it gets to be a very self-reinforcing thing, it's they've given up hope and they sort of abrogate certain parts of the social contract about their appearance and how they treat other people and it all reciprocally feeds back onto them too. And yeah, so okay, so this is a huge problem. So other than going out and like building a gazillion new homes, what do we do about it? Well, I think that's a good start. You know, so I think just the way we navigate housing in general is kind of a very important first step. So building places where we don't have people that are marginalized within a building, I'd say a community way I'll say sometimes, building a community and not buildings, right? So you have people that have social networks and have people to reach out to in times of trouble and those sort of situations also help support and create a bubble around people so that they don't fall all the way to the bottom. I think part of the problem is we get, there's a vicious cycle of criminalization that leads to people who are picked up and there's a lot of reasons why people get picked up for a lot of things, but what happens is if you fill the jails with kind of really low level crimes, things that are just crimes of poverty, whatever that is. Sometimes that's even just stealing something from a store if you're hungry. But when you, they're in jail because of that, it backs up that jail. So now that's costing a lot of money. Now people have a, they can't make bail, they get charged, they get fines and things like that and they'll never get out of that cycle because then once they get used, there's no discharge planning from that. It's a serve your time, go back out there. So there's this program, I think it's called LEAP. LEAP. LEAP, sorry, not LEAP, LEAP. Law Enforcement Assisted Diversion, right? Yeah. Yeah, and so this is how to sort of break that part of the cycle, right? To take these people and not treat this as a legal problem but treat it as sort of a social support problem. Right? Yeah, so LEAP is a new program. It's being piloted in Chinatown though they've kind of been working with the boundaries a little bit and hopefully they grow it in some other areas of the state. But what happens is if they, there's somebody that is kind of where they're not supposed to be, which could be in a park after hours or we're working with some of the low, low drug crimes and other things that are not violent crimes, even some felonies personally I think should actually account for LEAP. But what happens if they get picked up by a police officer instead of actually arresting him they go, you know what? I really think social services would be a better fit for you. So an officer is empowered to say, let me call social worker, social worker will come out on the scene, talk to that person and if they're willing to then meet up with that social worker within the next month then they aren't charged with anything. So it cuts away some of this backlog they see particularly at OCCC and gives people a chance to then get integrated back into the system and have developed some of the supports to help them. Sure, it sort of stops that first step on that slide down or maybe the second step in some cases where they do get, it actually is providing some support they get put in touch with organizations and systems that can actually step in and raise them and either give them a place to stay for at least a while or help them find a job or get them some clean clothes in a place to shower or what they may need, perhaps get them one medications because again, there are a lot of people who have medication problems, right? And if you're homeless, it's very hard to get your prescriptions filled. It's hard to keep track of your prescription needs sometimes. You're right on what I am. The other projects I work with. Yeah, so when you live on the street that's actually one of the biggest problems is that you can't keep up with your medications, it rains, they get wet. And then it's hard to even keep track of other things because you oftentimes lose your identification, people steal your identification. So actually for that point, one of the groups actually I work with are some of the people that the medical school is doing and Health and H3RC, Hawaii Health and Harm Reduction Center, they've also worked with this. So we try to get people that have been diagnosed with HIV, they're living with HIV, they're not taking their medications consistently, but they're not taking their medications consistently because they're largely experiencing housing issues, subspecies issues, all these things that are like life issues. And for them, keeping up with their medication, getting their appointments is the last thing on their mind and the last thing they're really capable of doing. Hey, Jack, this is wonderful. This is so wishful. I feel like we could go on for hours a year. But unfortunately I'm told that we are now actually out of time. I want to thank you so much for coming in, Jack Brill, from the Psychology Department at UH, College of Social Sciences, yay. And I hope maybe I'll get you back here some other time when we can talk some more about this. I hope that you'll come back next week for another episode of Likeable Science here on Think Tech Hawaii.