Humane Exposures Blog

Photo by Susan Madden Lankford

A study of feminist therapy and incarcerated women advised that feminist psychotherapy is essential to the well-being of women of marginalized women, especially incarcerated women. Although some feminist principles have been applied to programming for women in prison, major feminist inroads have yet to be made into correctional systems.

Study author Susan Marcus-Mendoza writes:

We need to work towards a fully feminist paradigm of corrections that empowers incarcerated women and transforms women’s correctional facilities into rehabilitative environments.

Women in prison are among the most marginalized members of our society. Their lives behind bars are not within their control. Every hour of their day is scheduled for them, and access to everything inside and outside of the prison is strictly regulated. Such important aspects of life as food, medical care, reading materials, psychological treatment, exercise, educational opportunities and family contact are dictated by the prison policies and staff. Most of them are trauma survivors and victims of violent crimes who come from economically deprived, oppressive backgrounds.

Studies have shown abuse rates among female inmates as high as 85%, and therefore these women are likely to experience Complex Trauma and Post-Traumatic Stress Disorder. Additionally, most women in prison have been victims of one or more types of violence both as children and adults. One study found higher reported rates of homelessness, abuse, living in foster care or other agencies, having parents with substance abuse problems, having family members in prison and receiving public aid, as well as lower rates of living with both parents and being employed prior to incarceration.

A study by Kinsler and Saxon summed up the problem thusly:

We are incarcerating people who cope with their own prior abuse through three common pathways: depression, anger and violence, and substance abuse. In many ways, we are incarcerating last generation’s abuse survivors, rather than treating them.

Our corrections system is more focused on punishment and containment than treatment and rehabilitation, even though women’s prisons are full of those in serious need of treatment.

What is currently required is a gender-responsive model, which involves creating an environment and offering programs that reflect an understanding of incarcerated women’s lives and recognizes women’s unique pathways to crime. Such social and cultural factors as race, socio-economic status, gender disparities and ethnicity are taken into account in developing interventions for abuse, domestic violence, substance abuse, and other issues pertinent to incarcerated women. The emphasis in these interventions is on self-efficacy and skill-building.

Feminist therapy is informed by feminist political philosophies and analysis and grounded in multicultural scholarship on the psychology of women and gender, which leads therapist and client toward strategies and solutions advancing feminist resistance, transformation and social change in daily personal life, and in relationships with the social, emotional and political environments.

Feminist therapy is a subversive project that promotes growth and healing for women in distress. Working together, therapist and client strive to undermine oppressive patriarchal structures that serve as sources of distress and hinder women’s growth. This is accomplished by analyzing gender, power, and social locations/multiple identities as strategies for comprehending how and why a person feels distress or behaves in dysfunctional ways.

Feminist therapists in prisons must focus on issues of power and oppression, empowering women to take responsibility for their choices, as well as helping incarcerated women to deal with the oppressive setting of the prison, and to see the patriarchal structure of society. Feminist therapists in prisons must also make sure that they assist women in dealing with such issues as racism and homophobia, as experienced both inside and outside the prison. On an institutional and societal level, feminist therapists should actively question and work to change policies and practices that support oppression. They can do this by educating the prison staff about the issues faced by women in prison and advocating for feminist therapeutic interventions that are both effective and non-punitive. Therapists can advocate for development and implementation of gender-specific programming, and the hiring of women of color and  bilingual therapists and correctional staff.

Marcus-Mendoza concludes:

I believe that feminist therapy in women’s prisons is a crucial undertaking, and that feminist therapists should and can play a central role in transforming women’s prisons. I believe feminist therapists also need to do advocacy inside and outside of the prison to change policy and laws. The feminist therapist, should therefore not only work in the therapy room but should examine every aspect of the prison experience and work with staff and administration to bring about positive transformation. This feminist therapist is an advocate and an activist, giving voice to the oppressed women who may be punished for speaking for themselves.

Photo by Susan Madden Lankford

A study released in July 2014 from the Office of Juvenile Justice and Detention Prevention revealed that incarcerated youth die by suicide at a rate two to three times higher than that of youth in the general population, that 10.3% of juvenile detainees thought about suicide in the past six months and that 11% had attempted suicide.

The study, conducted with 1,829 Illinois Juvenile detainees, also found that: a) more than one-third of male juvenile detainees and nearly half of female juvenile detainees felt hopeless or thought a lot about death or dying in the six months prior to detention, b) recent suicide attempts were most prevalent in female detainees and youth with anxiety disorders and c) fewer than half of detainees with recent thoughts of suicide had told anyone about those thoughts.

In 2013 the Centers for Disease Control and Prevention reported that at a rate of 10.5 per 100,000 adolescents, measured in 2010, suicide was the third-leading cause of death in youth between 15 and 24. Youth suicide has nearly doubled since 1950, increasing at a faster rate than among adults age 25 and older.

Incarcerated youth frequently have characteristics commonly associated with increased risk for suicide, such as high rates of psychiatric disorders and trauma, as well as separation from loved ones, crowding, sleeping in locked rooms  and solitary confinement.

Youth detention centers should and could easily screen new inmates for suicide risk, which is critical for prevention.  A 2004 national study of 79 suicides among incarcerated and detained youth found that more than two-thirds of the victims had made prior attempts, reported suicidal thoughts, made suicidal threats or physically harmed themselves. So corrections staff may be able to significantly reduce the rates of suicide in detention if they can identify youth at risk for suicide.

The 2010  study refealed that 44.2% of juvenile female inmates sometimes felt life was hopeless, 31.5% thought a lot about death or dying in the past half-year, 10.5% had a specific suicide plan in the past six months and 27.1% had attempted suicide at some time (and this was 42.8% among non-Hispanic whites).

Within their lifetimes, 283 of the 1,829 participants in the study had attempted suicide: 26.9% by cutting (50.7% of white females), 23.8% via drug overdose (43.1%  of Hispanic females), 20.7% by jumping (39.9 of Hispanic and 22.7% of African-American males), 9.5% by hanging (11.6% of black males) and 3.7% by firearms (5.2% of white females).

Psychiatric disorders significantly associated with a recent suicide attempts included generalized anxiety disorder, overanxious disorder, major depression, oppositional defiant disorder, panic disorder, obsessive-compulsive disorder, psychotic disorder, separation-anxiety disorder, alcohol use disorder, conduct disorder, dysthymia and other substance use disorder. In an analysis that included gender, age, and race/ethnicity along with all of the disorders that were individually associated with the suicide attempt, generalized anxiety disorder and overanxious disorder significantly increased the odds of having made a recent suicide attempt.

The study also found that suicidal thoughts and behavior appear to be most prevalent in U.S.-born Hispanic females from traditional Hispanic families, who may find it difficult to cope with contrasting social role expectations at home and among peers.

A striking finding of this study was that:

Hispanic males who attempted suicide were more likely to use a firearm than African American or non-Hispanic white males. This finding is of particular concern because half of all completed suicides of young men in the general population involve firearms.

Juvenile detention centers often provide the first opportunity to screen youth for suicide risk and to provide interventions, yet most facilities do not currently perform adequate screening for emergent risk. A 2005 study found that facilities that screen all juveniles within 24 hours of arrival had lower prevalence rates of serious suicide attempts than those that screen only juveniles considered at risk for suicide.

The study urges that psychiatric services in detention facilities must be increased. The Office of Juvenile Justice and Delinquency Prevention’s biennial Juvenile Residential Facility Census reported that 43% of juvenile residential facilities do not assess all youth for mental health needs.

The study declares:

But youth with psychiatric disorders, especially anxiety, may be at particular risk for suicide attempts. Detention center staff should be trained to recognize anxiety disorders in detainees and should refer affected youth for psychiatric services. By competently assessing and treating psychiatric disorders in detained youth, facilities will prevent untimely deaths.

The brilliant new TV series, LAST WEEK ON SUNDAY WITH JOHN OLIVER, had a terrific July 20 episode explaining why American prisons are so awful–and how they can be fixed:

Photo by Susan Madden Lankford

A Central Florida Campaign, “Rethink Homelessness,” seeks to change public misconceptions that the homeless are just lazy people who don’t want to work.

The campaign’s centerpiece was a series of YouTube videos, including one that asked local homeless people what the rest of the population might be surprised to learn about them. They held their answers up to the camera on cardboard signs. The video got 100,000 Facebook views the first day alone.

Joshua Johnson, a main advocate for Rethink Homelessness recalls:

If I was approached, I’d hand a homeless person a business card for a local labor pool. Essentially the message was, ‘Here — I work for mine. You can work for yours.’

Once I met people on the streets and really talked to them, it changed my thinking about who they are. I came to understand that stereotypes suck.

In the most popular video, “Cardboard Stories,” set to the tune of “Royals” by Lorde, homeless people hold up signs revealing the details of their lives few would guess: They are battling lung cancer, for instance, or speak four languages. They are currently employed, are escaping domestic violence or once built robots. One, a 24-year-old whom many assume is on drugs or crazy, says: “I have Huntington’s.” Another woman’s sign reads: “I was a figure skater.”

Andrae Bailey, CEO of the homeless commission, which created the campaign, says:

We found out through our research that the homeless are people with disabilities and mental illness and mothers escaping domestic violence and veterans who panhandle because they have post-traumatic stress and they’re living on our streets after serving our country. Without understanding that, the community will never do anything to solve the problem.

A “tease and reveal” billboard campaign that began with various people holding cardboard signs reading: “I never thought this would happen to my family” or “I never thought it would be my kid.” After two weeks came the “reveal” stage: the tag line “Rethink Homelessness.”

The need for changing attitudes about homelessness in the area is genuine, since Central Florida now ranks No. 1 in the nation on the issue of long-term, chronic homelessness for regions of its size.

The campaign also has attracted attention from other communities, including Jacksonville and Atlanta.

Shannon Nazworth, executive director of the nonprofit Ability Housing of Northeast Florida, which helps the homeless and people with disabilities, says:

It’s a phenomenal campaign. Frankly, it blows you away. We’re actually in the beginning stages of discussing how we can do something like this ourselves.

Photo by Susan Madden Lankford

Reports on eating disorders in prison are surprisingly scarce. But these reports do suggest an unreported high rate of eating disorders in a women’s prison in the US, with a disturbing number developing for the first time during incarceration.

One reason that prisoners may under-report their symptoms is that inducing vomiting and possession of diet pills, laxatives and diuretics would subject them to disciplinary action. A critical factor seems to be that the American penal system appears to be more brutal, controlling and punitive than other penal systems in the developed world. The Texas heat , for example, can be brutal; 12 inmates died of heat-related causes in Texas prisons since 2007, and of 111 prisons in the system, only 21 are fully air-conditioned.

A major reason US prisons are so terrible has been the the privatization of the penal system.  Douglas Stephenson, Licensed Clinical Social Worker and former mental health consultant to a local county jail, said that the jail he worked with had been previously run by the county sheriff’s department, which employed graduates of the police academy with additional training and experience in corrections. The sheriff’s department protested greatly when the county commissioners decided to turn it over to the Corrections Corporation of America, which hired poorly trained, young, inexperienced personnel who were poorly paid and received few job benefits.

Stephensen wrote:

As I directly observed the way the guards dealt with the inmates, screaming, yelling at them, sometimes pushing them around, it seemed that they didn’t know the difference between a ‘jail’ and a ‘concentration camp’. In contrast, graduates of the police academy learned the difference early on over at the sheriff’s dept.

“The one thing the companies that make up the prison-industrial complex  –  companies such as Community Education or the private-prison giant Corrections Corporation of America  –  are definitely not doing is competing in a free market. They are, instead, living off government contracts. To the extent that private prison operators do manage to save money, they do so by employing fewer guards and other workers and by paying them badly. And then we get horror stories about how these prisons are run.

Photo by Susan Madden Lankford

Florida recently enacted legislation that will help prevent the state from locking children up and throwing away the key when they are tried and convicted as adults. Currently, Florida sends more children into the adult criminal justice system than any other state.

HB 7035 makes Florida comply with recent Supreme Court rulings that bar mandatory life sentences without parole for children tried and convicted as adults for the most serious offenses. It also allows most arrested children the opportunity to show a court that they have been successfully rehabilitated and should have the chance to be released.

Specifically, the new law, which went into effect on July 1, 2014: 1) provides criminal penalties applicable for certain serious felonies by juveniles; 2) requires judges to consider specified factors before determining if life imprisonment is appropriate; 3) provides review of sentences for specified offenders; 4) provides for proceedings for determining if life imprisonment is appropriate for offenders convicted of certain offenses; 5) provides sentence review proceedings after a specified period by the original sentencing court for certain offenders; 6) provides for subsequent reviews; 7) requires the department of corrections to notify offenders of eligibility for sentence review; 8) entitles offenders access to counsel; 9) enumerates factors to be considered in sentence review; 10) requires courts to modify sentences if certain factors found; 11) requires courts to impose probation if sentence is modified and 12) requires written findings if court declines to modify sentence.

Tania Galloni, director of the Southern Poverty Law Center’s Florida legal office, said:

This was long overdue, especially after the hysteria of the 1990s that led so many states to buy into the mantra of ‘adult time for adult crime.’

But much more remains to be done. For example, the overwhelming majority of children funneled into Florida’s adult criminal justice system are not charged with the most serious offenses. They are not criminal super-predators.

Prosecutors’ discretion, which a judge cannot overrule, has resulted in wild disparities in how a child is treated from one jurisdiction to another. Sometimes the difference between a child facing juvenile court and adult prison can be as simple as what side of a county line the child was standing on when the offense occurred.

Once these youngsters are charged as adults, many languish in adult county jails as they await trial. They’re often isolated and don’t have much opportunity to receive an adequate education as they wait. This occurs before a court has even determined whether these children are guilty of any offense.

Galloni added:

If convicted, these children face a lifelong battle against being treated as a ‘convicted felons.’ This isn’t a recipe for better public safety. Pushing these children into the adult system only alienates them once they are released and struggling to get their lives back on track.

Public safety is enhanced only when we rehabilitate young people through evidence-based treatment in the juvenile justice system. We don’t benefit from a system that needlessly destroys young lives in a misguided and ineffective effort to protect the public. Our state has certainly taken an important step, but it is clear more work remains.

Photo by Susan Madden Lankford

As of this writing, June 25, 2014, the Mayors or top local officals of 91 American cities have accepted the recent challenge by First Lady Michelle Obama, on behalf of her, the Veterans’ Administration and Housing and Urban Development to end Veterans’ homelessness by 2015. Also agreeing to work to end homelessness by former members of the US Armed forces are the governors of Colorado, Connecticut, Minnesota, Virginia and Puerto Rico.

These socially concerned mayors include those of 38 of the 50 most populous US municipalities. Unfortunately, 22 of the other biggest 50 cities have not yet committed to getting their vets off the streets and into housing. The laggards are: Los Angeles, San Jose, Austin, San Francisco, Charlotte, Ft. Worth, El Paso, Washington DC, Oklahoma City, Louisville, Portland, Albuquerque, Long Beach, Mesa, Virginia Beach, Colorado Springs, Omaha, Raleigh, Tulsa, Cleveland, Wichita and Arlington, TX. If you live in one of these burgs, feel free to urge your mayor to get on board.

The Mayors Challenge to End Veteran Homelessness is a fine way to solidify partnerships and secure commitments to end Veteran homelessness from mayors across the country.

Ending homelessness among Veterans cannot be accomplished by federal partners alone but will require the partnership and commitment of each community’s homeless response and housing system, including Veteran Service Organizations, community-based providers, faith-based organizations, public housing agencies, affordable housing operators and many more. Corporate and philanthropic partners can play an important role in rounding out the array of housing, services and jobs available to Veterans experiencing homelessness.

HUD offers mayors a “webinar” (online seminar) on housing placement and retention strategies for programs that serve Veterans who experience homelessness, as well as a webinar that shares advice from successful efforts on how to develop a comprehensive approach that effectively brings the resources available to Veterans in need, to improve housing and life outcomes.

Key strategies communities should implement to achieve the goals of ending homelessness among all Veterans include: Housing First, targeting of permanent supportive housing, providing rapid re-housing opportunities and using other community and mainstream resources.

A key strategy for ending chronic homelessness among Veterans is ensuring that your community is using Housing First approaches and effectively targeting permanent supportive housing opportunities, including those provided through the HUD–VA Supportive Housing (HUD-VASH) Program, to chronically homeless and vulnerable Veterans.

Housing First is a proven method of ending all types of homelessness and is the most effective approach to ending chronic homelessness. Housing First offers individuals and families experiencing homelessness immediate access to permanent affordable or supportive housing. With no clinical prerequisites like completion of a course of treatment or evidence of sobriety and with a low-threshold for entry, Housing First yields higher housing retention rates, lower returns to homelessness and significant reductions in the use of crisis service and institutions than other approches.

Due to its high degree of success, Housing First is identified as a core strategy for ending homelessness in Opening Doors: the Federal Strategic Plan to End Homelessness and has become widely adopted by national and community-based organizations as a best practice for solving homelessness.

Phoenix has already made progress toward ending vet homelessness. Its Project H3 Vets Initiative was launched as a collaborative strategy to quickly house 150 of the most vulnerable veterans who were experiencing chronic homeless in Phoenix, using assistance provided through the HUD-VASH program and other resources. The Project H3 Vets Initiative is an extension of the Phoenix 100,000 Homes Campaign, Project H3: Home, Health, Hope. This public-private collaboration involved multiple government agencies and community partners. Based on the success of this initiative, an additional 100 HUD-VASH vouchers have been allocated.

Photo by Susan Madden Lankford

After successfully creating one in Maine, architects in New Hampshire are working with the Department of Corrections to design a new $38 million state prison for 224 women, and unlike most women’s prisons around the country, these two facilities are designed for the particular needs of women inmates. Twelve years ago, the architect planning the New Hampshire facility designed the women’s unit at the Maine Correctional Center in Windham, Maine. That unit, which houses minimum- and medium-security inmates, is considered a national model for gender-responsive prison design.

For more than 20 years, feminist researchers and activists have been re-thinking treatment programs at women’s prisons, which too often merely replicated what was offered in larger men’s prisons.  Unlike male inmates, 90 percent of women who end up behind bars have histories of sexual and domestic abuse.  They’re also more likely to suffer from mental illness and addiction. So researchers began advocating a “gender responsive” approach to female incarceration: programs and officer training that take into account women inmates’ histories of trauma.

Fully 66 percent of women in the New Hampshire prison system are receiving mental health treatment, versus only 35 percent of the men. Nationally, 25 to 50 percent of female prisoners report childhood abuse. Last year 108 NH male prisoners struck staffers or injured other inmates–vs. zero female prisoners.

According to New Hampshire Deputy Commissioner of Corrections, Bill McGonagle:

Our new women’s prison’s housing units will look out over a large outdoor area with security fences concealed, so as you look around the courtyard, it won’t be obvious that’s where you are.

Women will have keys to their rooms, and in an open lounge area they can watch TV on upholstered couches with wood coffee tables. It is believed that soft materials and natural light are important aspects of making this a natural environment, so as opposed to the clanging metal doors in most prisons, this facility will have quiet wood doors, avoiding stress for trauma survivors.

The new environment will make it easier for prisoners to focus on anger management, personal healing and community college classes. Getting equal access to those kinds of educational opportunities brought about the building of this new women’s prison in New Hampshire in the first place.  The current women’s prison in Goffstown doesn’t have space for vocational or educational classes.

McGonagle believes that strengthening relationships among the inmates is one of the goals of the gender-responsive approach.  He hopes open spaces inside the building will encourage interaction. While routines at men’s prisons usually discourage inmates from interacting with each other, “women want to be more relational,” McGonagle says, “and their connections with other women  is one of their strengths.”

Alyssa Benedict, who consults with prisons on gender-responsive programming, warns:

A prison with more open spaces requires more and better-trained officers. You have to train your staff to understand female development, how they relate to each other, and how to as a staff member insert yourself in a skillful way to create safety.

The NH corrections department has requested increased personnel for the new prison, but that will be subject to future legislative budget debates. New Hampshire lawmakers funded the new women’s prison after decades of debate over parity for women inmates.  Previously, incarcerated women had lacked access to vocational classrooms, science classrooms, regular education classrooms and recreation.

Construction crews break ground on August 18, 2014, and the prison is slated to open in October 2016.

A jump in serious juvenile crime in the late 1980s and early 1990s led to state laws that moved away from the traditional emphasis on rehabilitation in the juvenile justice system toward tougher, more punitive treatment of youth. During the past decade, however, juvenile crime rates have declined, and state legislatures are rebalancing to yield better results for kids at lower cost.

Today, there is more and better information available to policymakers on the causes of juvenile crime and what can be done to prevent it. This includes im­portant information about neurobiological and psychosocial factors and the effects these factors have on development and competency of adolescents. The research has contributed to recent legislative trends to distin­guish juvenile from adult offenders, restore the jurisdiction of the juvenile court, and adopt sci­entific screening and assessment tools to structure decision-making and identify needs of juvenile of­fenders. Competency statutes and policies have be­come more research-based, and youth interventions are evidence-based across a range of programs and services. Other legislative actions have increased due process protections for juveniles, reformed de­tention and addressed racial disparities in juvenile justice systems.

The National Conference of State Legislatures has produced the report “Juvenile Justice Trends in State Legislation, 2001-2011” illustrating the trends in juvenile justice enactments over the past decade.

The report states:

Research shows that adolescent brains do not fully develop until about age 25, and the immature, emotional and impul­sive nature characteristic of adolescents makes them more susceptible to committing crimes. Studies also have shown that juveniles who commit crimes or engage in socially deviant behavior are not neces­sarily destined to be adult criminals. This research has provided the basis for widespread state legisla­tive policy reforms in juvenile justice systems.

Currently, 47% of states have outlawed execution of juveniles (and 53% have not!). In 2010, the US Supreme Court abolished life sentences without parole for youth convicted of crimes other than homicide. Twelve states currently forbid life sentences without parole or have no youths serving such sentences.

One trend over the past decade is raising the age of jurisdiction for juvenile courts. Thirty-eight states set the maximum age at 17, but 10 states still treat 16-year-olds as adults and New York and North Carolina can try youths of only age 15 as adults. Seven years ago Connecticut moved more than 10,000 cases a year from adult court to juvenile court by raising the age of jurisdiction from 16 to 18.

Ten states now address mental competency and insanity in their juvenile statutes. In 2005 Oregon allowed juvenile insanity defense. Georgia requires a youth be represented by a lawyer when being evaluated for competency. In 2010, Iowa required a legal proceeding be suspended if the child was ordered treatment in a mental facility.

In Michigan a juvenile court must appoint an attorney to represent an indigent youngster, and most states will appoint counsel for an indigent youth, but the way that is done, the fees and the application process vary from state to state.

A major trend over the past decade is prevention statutes that divert non-violent offenders away from prison. These tend to be evidence-based practices that clearly demonstrate the effectiveness of treating and rehabilitating a juvenile in the community rather than in the pokey. Multi-systemic therapy, family functional therapy and aggression replacement training are evidence-based interven­tions in place of incarceration today in Connecticut, Florida, Hawaii, Mississippi, Oklahoma, Pennsylvania, Tennessee and Washington.

Pre-trial diversion programs, such as Redeploy Illinois have also proved effective. Savings from fewer commitments are returned to the communities for treatment programs. In 2011, Ohio law ruled that 45% of the savings from closing corrections facilities be invested in community services, and Texas tasked its Youth Commission with increasing community-based juvenile offender programs statewide.

More than 65% of the two million youngsters arrested each year suffer from some mental disorder, so state policies have begun to focus on proper screening, assessment and treatment of young offenders. Washington State set a small sales tax to fund therapeutic courts. Colorado now allows a 90-day sentence suspension for mental treatment. Minnesota and Nevada require statewide mental health screening for all in the juvenile justice system, and Texas now insists that probation departments do mental health and substance abuse screening.

State legislatures are now trying to deal with the over-representation of minorities in the juvenile justice system. And many states are making fresh efforts to deal with the 100,000 kids released from confinement each year. California and Washington have eased healthcare accessibility for re-entering youth.

In addition, 10 states increased the confidentiality of juvenile records. Delaware, North Carolina and Vermont established automatic destruction of non-violent juvenile records, and Colorado, Illinois, Ohio and Washington created procedures for requesting juvenile records be expunged.

Because young females are the fastest-growing part of the juvenile justice system, representing as much as 34% of the incarcerated population in some states, Hawaii, Minnesota, Connecticut, Florida and Oregon now require gender-specific juvenile programs.

Photo by Susan Madden Lankford

According to the United Nations Commission on Human Rights, there are an estimated 100 million homeless people worldwide, which is startling when you consider how affluent some parts of the world are. A recent article titled 25 Cities with Extremely High Homeless Populations listed 14 foreign and 11 US cities with way too many homeless people. Worst was Manila, where 70,000 children live by begging or peddling. The next worst foreign cities on the list in order are Moscow, Mexico City, Jakarta, Mumbai, Buenos Aires, Budapest, Sao Paulo, Athens, Rome, Tokyo, Rio de Janeiro, Dublin and Lisbon. That list may be faulty, because it includes no African cities.  The worst American City is New York, followed by Los Angeles, San Francisco, Seattle, San Diego, Tampa, Washington D.C., Chicago, Baltimore, Indianapolis and Denver.

 
As of 2013, the number of homeless people sleeping each night in the New York City shelter system was already over 60,000, 22,000 of whom were children. Currently 53,615 homeless men, women, and children bed down each night in the NYC municipal shelter system. Additionally, more than 5,000 homeless adults and children sleep each night in other public and private shelters, and thousands more sleep rough on the streets or in other public spaces. During the course of each year, more than 111,000 different homeless New Yorkers, including more than 40,000 children, sleep in the municipal shelter system. The number of homeless New Yorkers in shelters has risen by 73% since 2002. The homelessness crisis in New York is exacerbated by the lack of housing assistance initiatives provided by local authorities.

 
Los Angeles has one of the largest concentrations of homeless people in the United States: currently about 58,423 homeless people—a 16% increase from the 50,214 counted in 2011. Fortunately, these totals are way down from the 88,345 homeless counted in 2005.  Between 6,500 and 10,000 people in San Francisco are homeless at various times. And 3,000 to 5,000 of them refuse to live in temporary shelters provided by the government. Although San Francisco spends $165 million a year on services for the homeless, all that money hasn’t made a dent in the homeless population in at least nine years. In addition to the 6,436 homeless adults counted during one night last year, a separate daytime count found 914 homeless youth.

 
According to the 2013 Annual Homeless Assessment Report to Congress, Seattle has a homeless population of 9,106. Among many health problems, diabetes is a common ailment among the homeless. Common causes of death among homeless individuals in the Seattle area include intoxication, cardiovascular disease and homicide—with the average age at death being 47. In 2007 there were 160 violent attacks against Seattle homeless people, with the most common reasons being race, religion or sexual orientation.

 
San Diego, with a population of 1,345,895 contains 8,520 homeless people in 2014—down 11.6% from 9,638 in 2012.  The opening of a transitional Connections Housing facility, as well as ex-Mayor Bob Filner’s push to increase funding for homeless shelters and encourage cooperation between various groups that aid the homeless, have all helped. The Serial Inebriate Program, a multi-agency effort intended to help homeless people deal with alcohol and substance abuse issues, placed 720 people in treatment and housing programs last year— an 84% increase from the arrangements made in 2012.

 
Lack of affordable housing and homeless shelters has contributed to the alarming number of 16,000 homeless people in the Tampa area. When Republicans held their 2012 convention in the city, CBS News reported that the Tampa-St.Petersburg area had the highest homelessness rate in the nation, according to the National Alliance to End Homelessness: 57 homeless for every 10,000 residents.

 
The Metropolitan Washington Council of Government’s 2014 Point-in-Time Count of the homeless in the metropolitan Washington D.C. area (seven counties and the district) found 11,946 homeless individuals, up 3.5% from the previous year’s count. Last year, the city government began to provide shelter to its homeless population whenever temperature levels dropped below freezing. Those people who do not want to stay in temporary shelters are provided with a budget to stay in hotels.

 
The Chicago Coalition for the Homeless recently found that 21,000 Chicagoans lacked residences in the course of a year, and a 2005 University of Illinois report funded by the Illinois Department of Human Services found that as many as 25,000 Illinois youth are homeless. Research has shown that the “Housing First,” approach best remedies the factors that contribute to a household’s homelessness. Research also reveals that for some, lifelong support may be required to prevent the reoccurrence of homelessness, but that placing these people in housing is the most socially productive and cost-effective approach to the problem.

 
According to a 2011 study, there are about 4,088 homeless in Baltimore, many of whom are families with children. Today, the “Charm City” local government is making strides toward putting an end to this problem by creating projects aimed at providing affordable housing and health care.  There are as many as 2,200 homeless people every night in Indianapolis, which is equivalent to around 15,000 over the course of a year. Thought this city is known for its faith-based shelters, there are just not enough of them to provide a place for the entire homeless population. According to the 2012 Point in Time report from Metro Denver Homeless Initiative, Denver saw an increase in its homeless population from 411 to 964 between the years of 2011 and 2012.