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And if they wind up getting admitted to a psych ward (super common for the homeless, but I'll get to that) depending on the acuity level of the unit as a whole sometimes they wind up losing the shirt. I work high high acuity psych which is meant for people experiencing acute psychosis who are a risk of immediate harm to themselves or others. So my unit isn't supposed to have any clothing with hoods, strings, belts, or metal zippers, among other things. The problem is that the wider system lacks everything from affordable housing, to cold weather / storm shelters, or even lower acuity psych facilities.

So you wind up having homeless people who fake or exaggerate suicidality or psychosis to get off the street for the night, but they're rolling the dice on whether a crisis stabilization or other low acuity unit is available or whether they're gonna get admitted to acute and wind up in paper scrubs with a neighbor in the next room screaming at the voices all night. Like they barely get to choose what clothes they have to begin with so there's decent odds they're wearing a t-shirt they can keep but about 60% of the time their pants need either a belt or drawstring to stay up.

And the sad part is you can tell so many of them are just... used to that. They're some of my favorite patients because they're just chillin' cracking jokes and eating shitty ice cream cups and Graham crackers waiting for the weather to dry out or warm up and they're 100% fine with all the unit rules but like. They don't actually need those rules but their neighbor very much needs everybody on the unit to not have those things (split between people not realizing they can't give other patients things and just outright theft). And they're just... used to that. That's just their life. They just perpetually drift between various institutions between hospitals, shelters, and jails.

And we store their stuff for them but shit gets misplaced all the fucking time even if all the employees are honest and doing their best. If they brought literally everything they own with them and it's still several bags worth we often don't have space allotted for it in the belongings room (most places I work set aside about a 15-30gal bin or a cubby / locker of similar size for each patient), so their bags just get stacked in a corner of the room and one gets stuck behind the shelf or whatever when they get discharged and we find it a month later after the social worker discharged them with a greyhound ticket to two states away. I suspect those are the newer homeless too. They probably steadily lose things a little bit at a time while they're doing that institution hopping I mentioned.

Sometimes I'm lucky just to have enough time in their admission to make sure their allergies and health history are in the system right, so there's been times I get home at the end of the night and wonder FUCK did I log their belongings? Did one of my coworkers do it??? SHIT. Logging belongings and checking what can come on the unit and what can't and making sure everything is written down to make sure they can get it back on discharge is just part of a several hour admission process and one time I was doing an entire admission on my own between checking another patient's restraints every fifteen minutes after they'd assaulted another patient. I didn't eat or piss for eight hours and as I was walking out the door over an hour after my shift was supposed to end I was thinking about what things I probably forgot to do. And on top of the honest people accidentally misplacing things I guarantee there's shady people somewhere out there in the system straight up stealing shit sometimes.

(oh and most clothing appropriate for cold weather is at least gonna have a hood, and probably also a possibly metal zipper and often drawstrings as well. What happens if you came in to get out of the cold and you can't have your coat on the unit and somewhere in the storage process we lose it? Where are you gonna get another coat? You're fucking homeless!)

I had a friend ask how I feel about my part in this system and like. I am looking forward to and even working myself on ways to help progress the field beyond where we're at but honestly my main gripe that we could fix right now is that what I do should be considered exclusively ICU level psych care. I should not be putting homeless people in paper scrubs (and honestly we need better psych safe clothing overall but that's still taking people's street clothes). I shouldn't have to be taking random homeless people's stuff and putting it in storage for it to get misplaced when they don't actually need their things taken for them personally to be safe. They should just be going to an environment where it's safe for them to have their things. I should be caring pretty much exclusively for people who are either genuinely too psychotic to not accidentally choke themselves on their clothing or who are actively hell bent on it. And even those people who need the level of care I'm providing should have actual homes somewhere to leave their things so I'm not responsible for them between making sure people don't shiv each other.

We need more truly affordable housing, more transient halfway houses to ease people back into them, and more low acuity psych facilities for people who really do just need a little extra monitoring for a second. Because right now we're just shoving people into levels of care that are wildly inappropriate to the type and level of crisis they're actually experiencing. Oh and also don't get me started on the fact that filling those beds with homeless people is delaying care for the genuinely mentally ill (not that I'm blaming the homeless people trying not to freeze) because that is a whole other essay on how this issue is also overloading the mental health system. Sorry for the essay I just think about this a lot there have actually been a lot of times I've logged obviously sentimental items that I just really really hope got back to people on discharge.

"I'll have the shirt, too. Fork it over."