On Panhandling–To Give Or Not To Give?

Last weekend I was driving around and walking around Chicago quite a bit, and noticed with the nicer weather, there are significantly more panhandlers out than usual. They’re not just on the sidewalk, but also at intersections and highway exits. Personally, I’m not comfortable with someone walking up to my car and asking for money. I’ve also noticed a number of these people (both men and women), have signs up that mention they are homeless, perhaps veterans, and need any help you can spare. God bless you.

This is just my personal experience from working as a psychiatrist in an urban setting. But about 99% of those who are panhandling for money are putting most of that that money towards alcohol or drugs. Perhaps a little money may be going towards food and other daily needs. But none of it is going towards saving for a place to stay. I can guarantee that.

The reason I know that is that I see these people in the emergency room, on the medical floors, and on the locked inpatient psychiatry unit. I’ve seen them for detox, intoxication, when they say they’re suicidal, and when they’re looking for a place to stay. Some of them have places to stay, and some of them don’t. Some of them have income which includes odd jobs usually with cash under the table, state disability payments, a veteran’s pension, or veteran disability payments. When they run out of that money (and it’s not going to rent and bills)–what do they do? Beg, borrow and steal. I’m serious. I know it’s true because when I am direct and ask where they get their money, they usually tell me.

The reasons behind why someone is homeless, using drugs, panhandling, and on the streets are many. I can’t change someone’s socioeconomic background, their history of abuse, their limited education, or their limited support system. But as a doctor, I treat these patients everyday, and I try to help in the best way I can. Sometimes it’s addressing mental health issues, or addressing their social and housing issues. I know for a fact, though, that the resources available to people in this situation, are numerous. In particular when I see a veteran begging on the street, I know that he has access to a homeless program, multiple types of drug rehab programs, vocational programs, free health care, and the list goes on. The thing is, when I see these patients in the hospital, they often reject these resources.

Why would someone reject free resources that could provide housing, medical care, job training, and a more “normal” life? Well, it’s not an easy question to answer. Sometimes there is mental illness that accompanies the drug use, and there is a lack of understanding, or a limited ability to work through the system (even though there are case workers, social workers and patient advocates to help). But most of the time, it’s because sadly, this person has not hit their “rock bottom.” It might be rock bottom for most, but for them, their life is still kind of working. They are able to feed their drug addiction because people around them support them in such a way that they don’t have to get help. That’s the family and friends who let them stay at their house, and people who give them money, whether family, friends, or strangers on the street.

To me this is a sad, complex topic. But at least for me, despite the twinge of guilt I have when I encounter the homeless who are asking for money, I feel the wrong thing to do would be to contribute to a situation that’s not working. Instead I try to do my job with compassion and understanding, and hope that the interactions and encounters I have with patients encourages them to accept the help that’s being offered.

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