Elissa Ely

Homeless, depressed, and done in by bureaucracy

By Elissa Ely
August 31, 2010

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A NUMBER of years ago, a piece of mail arrived in the shelter that put homelessness into perspective as no rational explanation could.

It was an official document from the Commonwealth, with the correct spelling of the recipient’s complicated name, and his birth date. The shelter was listed in the upper corner as his current address. In large font near the top of the page, as if enlargement would improve concentration, there was advice to read carefully: an Important Notice followed.

The reader had been discharged from a psychiatric hospital with diagnoses of mild dementia and severe depression. He had been living in the shelter for months, and was using it, as people do, for a home address and all his correspondence. If he wasn’t depressed before his admission, with less of everything since then — money, support, housing — he certainly had become depressed.

Someone in social services had filled out an application for him to receive emergency funding and public health insurance. This covered medical care and the antidepressant and dementia-slowing drugs he had begun. These forms of state assistance are customary, and, in this case, they were also appropriate.

Following the instructions, he read the letter carefully to himself. Then he read carefully out loud to us:

“Dear _____ ______. The Division will stop your assistance on March 4 because we do not know where you are living. The regulations used in reaching these decisions are 13O CMR: 503.002, 517.002.”

He looked up, confused. “I’m going to lose my assistance?” he said.

“Well,” said the case manager, temporizing (it’s not good to receive these kind of documents, and it’s also not so good to be asked to interpret them), “maybe we can call tomorrow and straighten it out. They probably don’t know you live here.”

He looked more confused. “If they don’t know where I live, how did they send me the letter?”

This koan was too deep, too taxing, and too maddening for anyone in the room to answer. In a couple of days, after many calls, the case manager might be able to unwind it. But none of us would be able to understand it.

Elissa Ely is a psychiatrist.

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