Rough Sleepers: Dr. Jim O'Connell’s Urgent Mission to Bring Healing to Homeless People

Kidder analyzes the systemic components of houselessness. He explores the ways failures in private, state, and federal programs contribute to the outsized scope of the problem in the United States. A large portion of the population Jim treats throughout the narrative struggles with severe trauma, mental illness, and substance abuse disorders. Kidder reflects that the rise of houselessness in the 1980s

was driven and sustained by many long-brewing problems: the shabby treatment of Vietnam veterans; the grossly inadequate provisions that had been made for mentally ill people since the nation began to close its psychiatric hospitals; the decline in jobs and wages for unskilled workers; the continuation of racist housing policies such as redlining and racially disproportionate evictions; the AIDS epidemic and the drugs epidemic that fed it (52).

Kidder writes that the challenging process of applying for disability is also a contributing factor. These and other barriers keep rough sleepers on the streets. The programs meant to support people in need are inaccessible, either due to opaque regulations and difficult-to-navigate policies or to cuts in funding, like the cuts made by the Reagan administration. Multiple people end up on the street with very little resources to reobtain housing or health care.

Kidder also examines the role the criminal justice system and prison industrial complex play in houselessness. Kidder details the complex court processes Tony must go through to register as a sex offender and stay out of jail. Tony’s public defender is often overburdened with other cases, the judges change each time Tony must appear for court, and Tony’s status as a sex offender makes obtaining housing extremely difficult, even with the help of specialists. Kidder reports, “To Jim, the days spent with Tony in court felt like the bad old days of health care for homeless people in Boston—when the patients most in need of care rarely saw the same doctor twice”; in the meantime, Tony might rack up new charges for trespassing or public urination, charges that are difficult to avoid when living outside (248-49). Even though Tony gets his warrants dropped for not registering as a sex offender, he’ll always be a sex offender and required to register, “never be[ing] permitted to forget” (251). These facts continually contribute to Tony’s lack of well-being and inability to move forward in society.

Kidder examines the range of policies and cultural circumstances that contribute to houselessness in the United States. He catalogues these through lived narratives of the people who’ve experienced cracks in institutions like education, family, religion, government, and physical and mental health. He argues, “Given the [houselessness] complex etiology, no single group can be blamed for all its constituent parts” (53). He suggests that houselessness is a systemic failure—that the systems meant to protect society are, instead, perpetuating the harm they’re meant to protect.