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A National Shame: The Mentally Ill Homeless

by Mike on October 15, 2008 · 89 comments

homeless veteran sm A National Shame: The Mentally Ill HomelessOne of our nation’s greatest shames is the number of homeless people adrift in the streets and parks of our cities.

And of the estimated 744,000 people who are homeless on any given night, 40 to 45 percent of them have a serious mental illness. Most of these mentally ill people go untreated, and unable to work, live a hand-to-mouth existence out on the streets.

Senator Pete Domenici says,

No vision haunts America’s conscience more than the sight of the street people… The irrationality and anguish that grip so many of these individuals leap out during any encounter, whether in Washington or Albuquerque.”

This post, in response to Blog Action Day’s call to write about poverty on October 15th, gives an overview of the crisis of the homeless mentally ill. This post covers the following topics:

  • How many homeless Americans are there?
  • How many of the homeless are mentally ill?
  • Why are there so many mentally ill homeless people?
  • Most mentally ill homeless people are not being treated
  • What’s to be done?

blog action day 350x90 A National Shame: The Mentally Ill Homeless

How many homeless Americans are there?

3.5 million are homeless in a year

The number of homeless Americans is hard to pin down, since homelessness is often a transient state, and due to the conflicting definitions of “homeless.” The best approximation is from a study done by the National Law Center on Homelessness and Poverty in 2007, which states that approximately 3.5 million people, 1.35 million of them children, are likely to experience homelessness in a given year. This translates to approximately one percent of the U.S. population experiencing homelessness each year, almost 40 percent of them being children, according to the Urban Institute.

In early 2007, the National Alliance to End Homelessness reported a point-in-time estimate of 744,313 people experiencing homelessness in January 2005. This is the figure most often quoted in homelessness studies.

How many of the homeless are mentally ill?

Homeless people suffer from high rates of mental health problems exacerbated by living on the streets and in shelters. 

40 to 50 percent of the homeless are mentally ill

An estimated 40 to 45 percent of homeless persons suffer from Axis I mental disorders in a given year, which include Anxiety Disorders, bipolar disorder, clinical depression, and schizophrenia, schizoaffective disorders, and severe personality disorders. Between 150,000 and 200,000 of the homeless have schizophrenia or bipolar disorder. This is the equivalent to the population of any of these cities:

  • Dayton, Ohio
  • Des Moines, Iowa
  • Fort Lauderdale, Florida
  • Grand Rapids, Michigan
  • Providence, Rhode Island
  • Richmond, Virginia
  • Salt Lake City, Utah

At any given time, there are many more people with untreated severe psychiatric illnesses living on America’s streets than are receiving care in hospitals. Approximately 90,000 individuals with schizophrenia or manic-depressive illness are in all hospitals receiving treatment for their disease.

Substance use is also prevalent among homeless populations. In a 1996 survey, 46 percent of the homeless respondents had an alcohol use problem during the past year, and 62 percent had an alcohol use problem at some point in their lifetime. Thirty-eight percent had a problem with drug use during the past year, and 58 percent had a drug use problem during their lifetime.

Why are there so many mentally ill homeless people?

The plan to transition from mental institution to outpatient care failed

There was a movement in the 1960′s and 1970′s to deinstitutionalize many of those being held in state and other mental institutions. The plan was to create community health centers where the mentally ill could receive outpatient treatment, along with residential facilities for those unable to make it on their own. Needless to say, the plan failed miserably.

Since the early 1970′s there have been harbingers of an impending crisis for people with untreated mental illnesses. Large numbers of mentally ill people began forming “psychiatric ghettos” around mental health facilities in cities across America. Following on this:

  • As large, often run-down, boarding homes filled with discharged psychiatric patients from the nearby hospitals, the intended policy of deinstitutionalization increasingly looked rather like trans-institutionalization — the exchange of one impersonal institution for another. 
  • At the same time, the availability of single-room occupancy hotels and other low-rent housing was declining precipitously in urban areas as redevelopment and gentrification shifted into high gear.
  • As early as 1972, a study commissioned by the National Institute of Mental Health reported, “Relationships between community mental health centers and public mental hospitals serving the same catchment area exist only at a relatively minimal level between the majority of the two types of organizations.”
  • By 1979, the Inspector General of the U.S. Department of Health, Education and Welfare was more blunt, saying, “The relationship between the CMHCs [community mental health centers] and public psychiatric hospital is difficult at best, adversarial at worst.”
  • By the early 1980s some unintended consequences of deinstitutionalization were becoming manifest. More and more very sick people were living on the streets and in public shelters.

Living on the streets and in shelters is bound to trigger mental illnesses in those susceptible to them. However, the core of the mentally ill homeless are those whose mental state makes them unable to hold jobs, and for whom the social safety net of residential facilities and community health centers has failed.

Most mentally ill homeless people are not being treated

Community mental health centers are inadequate

Community mental health centers, where the homeless might receive help, are chronically underfunded, and are often on the budget-cutting chopping block. Mentally ill homeless people present special problems for health care workers. 

  • They may not be as cooperative and motivated as other patients. 
  • Because of their limited resources, they may have difficulty getting transportation to treatment centers. 
  • They frequently forget to show up for appointments or take medications. 
  • The addition of drug or alcohol abuse can make them unruly or unresponsive. 
  • Among people with severe mental disorders, those at greatest risk of homelessness are both the most severely ill and the most difficult to help.

Many of the homeless mentally ill have anosognosia, and neither realize they are sick nor how dependent they are on regular treatment. Others have given up, no longer believing the system can or will help them. 

When researchers asked homeless people what their greatest needs were, respondents listed affordable housing, safety, education, transportation, medical/dental treatment, and job training/placement. Formal mental health and substance abuse services were rated as unimportant by comparison, not very easy to obtain, and not very satisfactory to people who had used them.

What’s to be done?

We must solve the problem of homelessness first

Solving the problem of the mentally ill homeless cannot be done without solving the entire problem of homelessness. State institutions for the mentally ill are no longer available by law to accommodate them. When the basic needs of life — food and shelter — are weighed against mental health needs, both the homeless and those trying to care for them choose those basic needs.

Many cities have responded to the homeless crisis by trying to shoo them away or by criminalizing homelessness, which only shunts the problem off onto the country’s over-filled jails. Religious and private concerns try to provide shelter and food, but that is only a stop-gap measure.

Without an all-out national effort to eliminate homelessness, I can see the problem only getting worse, particularly in these precarious economic times. The least able to fend for themselves, the mentally ill homeless, have no place to go, no way to provide for themselves and have little hope in the present situation.

What can you and I do? At the moment, the most effective work is being done locally through religious and private entities providing services for the homeless. Volunteering your time or donating to these efforts seems the best that can be done until the nation turns its eye on the least fortunate among us.

There are a number of associations advocating for the homeless. Among the best of them is the National Alliance to End Homelessness

What do you think?

  • Have you ever been homeless? What was your experience?
  • What is your attitude toward the mentally ill homeless?
  • Do you have any experience with helping the homeless?

What can you do now?

Your comments are always welcome, and are important to this blog’s community! Leave a comment now.

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©2008 Anxiety, Panic & Health. All rights reserved.

Resources used in this post:

LibraryIndex.com. (2008). The Mental Health of Homeless People. Retrieved October 14, 2008 from LibraryIndex.com Web site: http://www.libraryindex.com/pages/2321/Health-Homeless-MENTAL-HEALTH-HOMELESS-PEOPLE.html

Meharry Medical College. (2005) Homeless Mentally Ill. Retrieved October 14, 2008 from Meharry Medical College Web site: http://www.mmc.edu/www.meharry.org/Fl/Mental_Health/Homeless_Mentally_Ill.html

National Alliance to End Homelessness. (2008). Mental Health and Physical Health. Retrieved October 14, 2008 from National Alliance to End Homelessness Web site: http://www.endhomelessness.org/section/policy/focusareas/health

National Coalition for the Homeless. (2008). How Many People Experience Homelessness? Retrieved October 15, 2008 from National Coalition for the Homeless Web site (PDF): http://www.nationalhomeless.org/publications/facts/How_Many.pdf 

Treatment Advocacy Center. (2007). Fact Sheet: Homelessness, Tragic side effect of non-treatment. Retrieved October 14, 2008 from Treatment Advocacy Center Web site: http://www.psychlaws.org/GeneralResources/fact11.htm

{ 69 comments… read them below or add one }

Susay A Shafer December 8, 2011 at 4:04 pm

Volunteering is not enough! Please do not get me wrong. I know how much volunteers are appreciated by those individuals they help. Its the laws that need to be changed! Allowing mentally ill people to wander the streets should be the real crime! These people do not have a chance (even with volunteers) to pull themselves out of the gutter they have been thrown in. I have three mentally ill siblings living on the streets today. They are living half in this world and half in a fantasy world of thier minds creation. 90% of the time they are scared do death. Imagine living in “Nightmare on Elm Street” and you will only visualize what they are actually feeling. My heart is broken for them and everyone in thier situation. I know there are people that hate me when I give them my answer… I believe there should be a three strike law for those who refuse to take thier medications. If only they would take thier medications they could be higher functioning and possibly get off the streets. But thier mental illness impares thier ability to actually recognize they are sick. Today I will be dealing with a Gym that I pay for a membership so that my youngest brother can take a shower and use a toilett. I am sure they are calling to cancel his membership…. he has probably had another outburst (which he cannot control). He had open heart surgery last year.. a quadrupal bypass. He was in the hospital all of December and half of January. The rehab center released him onto the streets with no place to go. They said thier responsiblity to him ended when he could walk with a walker 200 feet! He refuses to take medication for his illness and therefor he cannot live with me. Back to the issue at hand is how to end homelessness. There is not a “cure” for this epidemic that does not involve changing some very “stupid” laws.

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57nomad December 22, 2011 at 4:22 pm

The article mentions the real reason for the amount of mentally ill homeless. It began in the early ’70′s along with many other ‘liberation’ movements. With the introduction of anti-psychotic drugs well-meaning but ignorant people concluded that forced institutionalization was equivalent to the incarceration of the innocent. Because, they reasoned, that the medication available alleviated the psychosis and hence the institutionalization was unjustified and it was they who forced the closure of the institutions.

What they did not take into account was that the medications only work for a few hours at a time and require the patient to take them on a regular schedule. Once released, these patients, because of the very symptoms that led to their original diagnosis, extreme paranoia, for example, simply refused to take their medication and we promptly seized by their psychosis soon after they were released. But, there were no longer any legal means of or reinstitutionalizing them and the centers themselves were closed. Bad move all around.

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Skye March 8, 2012 at 10:42 pm

I first saw him about a year ago in the library. A nice looking young man in his mid twenties, he told me my backpack was unzipped. He was sitting in one of the chairs as I was making my way through the stacks searching for a book. I had it open to easily drop books in as I found them, but I thanked him for trying to alert and try to help me. After that, I’d see him around town now and again, and I realized he must be one of the many homeless people who congregated nearby the library downtown. Then one morning last year, I saw him wonder out into a downtown street, he didn’t have a shirt on and he was muttering to himself. He almost walked out into a car which laid on it’s horn. He seemed disoriented. It frightened me for him; I knew he needed help. I called 911 to see if someone would locate him and check on what was wrong before he got hurt in that state. I worried about him and didn’t see him for a long time. Was he okay? Would he ever be okay? Later that summer in the sweltering heat of 100 degree days, I saw him again downtown. He was muttering and walking aimlessly on the sidewalk. He actually circled and passed me twice as I made my way to my car. At one point he leaned against a street pole and wiped the sweat away from his head. It was so hot outside! How would anyone cope when they had no home to escape to out of that heat. I was so sad for him and all of the homeless people in that situation.
A few days ago, I saw him again, sitting downtown on a street curb. He was muttering and visibly twitching. My heart broke for him. I don’t have a clue what I could do to help his situation. He doesn’t have a clue that anyone in the world he doesn’t know cares about his plight. I am sure he is one of the homeless, and perhaps has an addiction problem, perhaps he has schizophrenia. I can see that he has a life of distress. He is an attractive young man who could have a life of meaning instead of one on the streets, but for some reason he has ended up in this very bad situation. I worry what will ultimately become of him, can he be saved? What can we do, what can I do to help? I am in a quandry as to how to help? I know this society has become hardened and cold toward helping anyone in need and as the article states, often it is hard to help those who obviously need help. We have politicians who want to put an end to any humane services, whether healthcare, education or the lot, so I don’t see how these very vulnerable people can receive needed care unless they do have loving relatives who are willing to go the extra mile for them. I wish I had an answer. I wish I knew how I could help make changes to help this one young man and the very many others who need strangers to make some kind of difference to help. But I do not have a clue how I can.

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Lisa March 9, 2012 at 1:30 pm

I was reading Skye’s post and wanted to comment. I have a very early comment (like 2 years ago) and have some experience with mental illness as my brother became sick in his teens and is now in his 50′s.

The sad truth is that you cannot force treatment on anyone with a mental illness and many times the person who has the illness isn’t aware (fully) of what’s wrong because they are in the grip of it: the sad consequence of a brain illness. Also, many times they will self-medicate with drugs or alcohol which can aggravate their situation and state of mind. I tried over and over and over but could not get my brother treatment and in fact the laws favor him and not loving relatives. (See my previous comment and you’ll understand)

Skye, my suggestion is to offer kindness. So many people turn away from the mentally ill. They have lots of compassion for cancer suffers or someone with a broken leg but for some reason very little for someone suffering a brain illness. It’s almost like every part of the body can fail but not the brain. If you have Alzheimer’s then yes, there is compassion but if you’re schizophrenic no way!

I will say, however, that when someone is ill with a brain illness they can be temperamental and unpredictable – that is my direct experience, so I wouldn’t exactly invite him home with me but I would offer kindness. Kindness first, always and last. It can be as simple as a smile or saying hello. Seeing the person as a person.

Skye, the fact that you even care enough to post your thoughtful story shows me you’re ahead of many, many people. Many blessings to you on your journey and many blessings to that young man; after all he is some mother’s son who got sick and lost his way. I’m so glad that you have awareness and compassion for him and others.

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Ed March 25, 2012 at 4:16 am

As I read this I am volunteering as an overnight host at a homeless shelter. I am surfing on my iPad as the homeless guests are sleeping in the other room. My wife and I have been volunteering here for many years (our church is used for a shelter during the winter months). My concern is that my heart is growing hardened. I see many of the same people that have been here for years. They don’t want help…or they don’t accept it. My estimation is that at least 80% of the people here tonight have mental illness. They need to be in an institution. They need consistent structure, medicine, nutrition, healthcare and safety. There used to be a 3000 bed mental hospital a few miles from here. It closed 20 years ago…why? I can’t help these people the way they need it. Sure, I’ll make them breakfast in a few hours and give them clean socks and a toothbrush. I treat them with respect and dignity…it’s not enough. We need to reopen the mental institutions and give these people a chance at recovery.

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Tammy April 3, 2012 at 11:00 pm

I am a manager of a large apartment complex, and also happen to have a master’s in counseling-psychology; today a 21 year-old man was sleeping outside of my apartment door in shorts (this is Minnesota) in early April. I threw my schedule out the window when I discovered he was homeless… and obviously mentally ill. He told of leaving a treatment program… and that he was thrown out of the Salvation Army because he “wrecked the toilets”. He was calm with me… and I was determined to get him help. I called the police… they would do nothing…. not even a ride to a different church-run program. I called the county and talked to a social worker. He brushed me off, saying there was no program in place to help someone like this… because of budget cuts. They would not come and get him either. My husband and I decided to give him a ride to the church-run program. I went through hoops to get in to talk to the pastor who runs it (the doors were all locked)… he wouldn’t take him either because he wasn’t on medication… and he would need to apply to have housing there. There was a meal at 5 pm, however. It was only 9 am. He advised me to bring him to the emergency room to see if they would admit him. However… he warned me they would probably just release him back to the streets. He could then walk back at 5 for a meal. Nice. We took him to the emergency room… I gave him a pep talk, and watched him be sent to the waiting area with over 20 other patients. I felt like I was leaving a child at a daycare for the first time… and wasn’t so sure about the place. His face will haunt me always. I am angry. I am sad. I am sick that our society has nothing in place for people with mental illness who need a hand to get off the streets.

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Jean Grimm May 3, 2012 at 1:04 am

We can blame the national trageady on failed policy of President Jimmy Carter on emptying out the patients in State Mental hospitals into the streets.The idea of Outpatient Care is ridiculous for the severely mentally ill-they cannot even get themselves to the treatment centers. My uncle was schizophrenic and bipolar. Family rented him an apt., get him medications, after he was dumped out ofa state mental hospital. He would not take meds, would not stay in his home, and would take off and be homeless. He obviously needed to be in a safe institution in which he was receiving consisitent medication and care.

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emil berlendy June 4, 2013 at 3:45 pm

The reason I think their are so many mentally ill in the street is because when it happens the family is expected to make a call to 911 or where ever and it is not taken seriously enough but if a qualified professtional did it,it would but they don’t they leave it to the family to take care of who would the police be more likely to take seriously,the reason they don’t is that I really don’t think they care it,s about the money like always

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Cory May 27, 2012 at 2:01 pm

Actually Jean G., it was Reagan who is still to blame for the massive closings of mental institutions, definitely not Carter . His ignorant belief in the completely “free market,” laissez faire capitalism, and the idea that money is more important than the welfare of human beings (with the exception of the massively wealthy, of course) led to the closing of most state and federal mental institutions. However, he did not provide any community safety net for the mentally ill after displacing them from their institution, which directly led to a drastic increase in the homeless population with a SMI diagnosis (as if it wouldn’t lead to anything else). His ill thought out cuts in a wide range of social programs led to high unemployment rates (higher than the present), and increased debt of 2.5 trillion, and increased the gap between the rich and the poor (i.e. the rich got richer, the poor got poorer).

Indeed, his social cuts–especially his long run of mental health cuts starting when he was Governor of California in the 70′s–were draconian in nature and certainly in consequence. He did not even attempt to provide them with a community safety net upon displacement (he vetoed Ted Kennedy’s community mental health systems act in 1981). In essence, he was communicating to the mentally ill and now homeless population that he did not value their lives as sentient beings who share a common ancestry. I believe that in Reagan’s mind they were the cur of the earth who deserved to rot in the streets for not being able to buckle down and work 12+ hours a day for minimum wage like a good American. If that was not running through his mind, how could these policies have ever been produced? Perhaps, he didn’t even think mental illness was real and he thought they were malingering to procure the benefits of social programs. Those damn lazy cretins..

It is only fitting that Reagan was diagnosed with a neurological disorder which rendered him senile. A small taste of his own medicine? Not so easy to take care of yourself now is it buddy? Oh wait, that’s right, he amassed a fortune throughout his life (partially due to his own economic policies) and could afford the best treatment known to science. I think it is possible that many of his policies were the product of disordered thought characteristic of Alzheimer disease. At any rate, Reagan can be considered the start of the mentally ill and homeless trend, not Carter.

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julie berryman August 19, 2012 at 3:54 am

I have cared for the mentally ill resident most of my adult life. I house and provide services. My problem is with our municipality. WE ARE ALLOWED ONLY 8 EMERGENCY CALLS PER YEAR. AFTER THAT WE ARE CHARGED 500.00 PER CALL We have 32 residents and by law we have to call in a missing person after 24hrs. or sooner if mandated by guardians, case managers,etc. But still we are charged. This putting a few of the smaller homes in jeopardy of closing some very good homes.We are tryi9ng to thrash out this problem as I write. most of us want to do the right thing for our residents but, we are finding we have to turn away some of the most ill do to this ordinance.

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charles Hice
Twitter:
December 29, 2012 at 10:28 am

We should be ashamed. Many efforts should be to help children/adults to connect with families/support system. And, help families who need Mental Health aid–Mental Health should be monitored by citizens/ Are MH residents eating healthy? Are they sick? Apartments taken care of? How can we help?
937 545 6798 charlie hice………………why doesn’t everyone become involved in homelessness, especially helping mental health. We give food (and shelters), but we do not give our caring/love. Do not give money, teach them how to survive……….

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57nomad December 29, 2012 at 1:55 pm

Cory said:

“Actually Jean G., it was Reagan who is still to blame for the massive closings of mental institutions”

Cory is repeating ridiculous anti-Reagan slander. Neither Carter nor Reagan closed the institutions. The reasons should be clear to anyone who passed 7th grade civics. First of all Reagan was elected president in 1980, ten years after the institutions had been closed.

Secondly there was no national policy on closing the institutions not could there have been because the federal government had nothing to do with it. They were, and remain to this day, state laws.

Consequently, it is the state legislatures that closed the institutions, no governor had the power to do so, they do not make laws. What is important to note is that the laws that freed the inmates were based on a catastrophic misunderstanding of medicine. Until the laws are changes so that psychotic young men can be involuntarily institutionalized, none of us will be safe.

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A. Kennedy January 10, 2013 at 10:23 am

When I was in college in the early to mid 70s, I studied Human Services, and did practicums in psychotherapy, guidance counseling, and corrections. At the time, there was considerable coverage in the news all over the country about the state of our mental institutions. It must be said that many of them were deplorable. One of them in my state was actually not far from the city where my university was. In one of our classes, our professor, who was also the head of the department, used to discuss current trends in the profession – this was one area we discussed exhaustively. The thinking of the well-intentioned at the time was that it would be better to close these institutions, and place the mentally ill on medications in their homes or halfway houses. All we young late-teenagers and early-twenty year olds thought this was a fine idea. But our wise professor immediately began asking us the pertinent question – what do you do when the mentally ill individual won’t accept that they have a problem, or won’t take meds (for whatever reason, including the paranoia than can exist), or is not sufficiently in touch with reality to function in these milieu?
But the die was cast – mostly because of budgetary and judicial reasons (states, institutions and people were getting sued by patients and their families). And, I will add, the press was also responsible for running sensationalized stories about the conditions, without reasonable solutions. Everyone was looking for the easy way out. And most of these institutions were closed instead of reformed. Result – we now have many mentally ill people who are not properly cared for or supervised. Many of them are homeless. Many of them commit crimes. And sometimes these crimes are horrendous, as we have seen in the past year. And I would question whether, when we weigh the costs we are bearing in dealing with homelessness and crime with the costs of running institutions which are properly run, I’d say we got the raw end of the deal when we closed the institutions. I am not saying the mentally ill should be warehoused – I am saying they need to be properly provided and cared for, in an appropriate environment, depending on type and degree of their condition. Both they and society would reap the benefits.

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Deb Ellis April 15, 2013 at 11:55 pm

I feel more info should be accessible on ways to get involved to end the chronic homelessness of the mentally ill. Respect, kindness, caring and a united fight to help the helpless! What can I personally do to get involved? Managing this inhumane existence must not be our priority, but ending it should haunt us till resolved!

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Susay May 30, 2013 at 3:59 am

Send letters to your congressmen and local government agency’s. Let them know what you want your government to do. If you have a family member that is mentally ill, I highly suggest you join a NAMI group and take the Family to Family class. They can help point you in the direction of where you can get more involved with your local communities needs.
Good Luck and thank you for picking up the call!

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hannah jones December 2, 2013 at 3:56 pm

why are they closing mental hospitals when the rate of mental illness is increasing It;s a well known fact that mental ill health is linked to poverty and if they end up homeless they are very vulnerable

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