One 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?
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
Related Posts:
- Mental Illness Awareness Week: A Cause We Can All Support!
- Scapegoating and the Stigma of Mental Illness, Part 1
- Stigma of Mental Illness: Shocking Survey from Canada — US Likely the Same!
- Shameful Report Card: US Gets a “D” in Mental Health
- Quarter of All Hospital Stays Are for Mental Health Reasons
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Hi Mike,
You are right that this is a national shame. You have also correctly pegged deinstitutionalization as one of the primary causes.
I live in NYC. Just by the subway entrance my wife and I use sits an older man who looks like he could be someone’s grandfather. Most days he sits on an empty milk crate. If I give him money, he says, “Thank you, thank you very much.”
When we first moved to the neighborhood and saw him, we were quite disturbed. My wife spoke with some of the local police who told her, “Those old guys. They’re vets. Boozers. His name is Thomas. We round them up and they just come back. It’s easier just to leave them.”
It still breaks my heart. How much good can 50cents do? He never seems to be drunk, just very sad. Well, if he is buying booze, God bless him. As the good book says, “Give wine and strong drink to him who is perishing.” If only there was a place for these guys to go.
Sad post, Mike.
Alec
I intended to have information about homeless veterans in the post, but I had so much material, I decided to make it a second post. It is distressing how many veterans end up homeless and mentally ill on the streets, and all the more distressing how many of the Persian Gulf, Iraq and Afghanistan veterans are homeless.
That there are any homeless is a shame. That there are homeless veterans is a disgrace.
It is a sad post. I like to emphasize hope and possibility in my posts on mental health, but on this post I was almost at a loss. There are things we can do locally, but, despite the several national associations for the homeless, there is little effective help for the homeless on a national scale.
The homeless are forgotten, and pushed to the margins of society, as are all of the poorest of the poor. To eliminate homelessness it will be necessary to better the lot of the poorest of our citizens, to give them a decent place to live and food to eat, to give them jobs where they can earn a living wage, to give them hope of a better life. This will take more than local effort — it will take the national will to eliminate poverty, which I don’t see right now.
I hate to sound so bleak, but I just cannot see anything being done on a large scale to effectively help the homeless at this point.
Hi Mike,
Thank you for this post. It was really sobering.
I work in Philadelphia and am shocked by the number of homeless people I see day to day. It’s tough because I could give them spare money I have in my pocket and it will help them in the short term to get a cup of hot coffee or a little something to eat or alcohol to help kill the pain but it doesn’t do anything to address the bigger problem of homelessness in America.
I’ve found myself more recently aware of the problem too because of my friend Kim who also comments here. She will send me articles and she herself is really conscious of the problem. I’m trying to make a concerted effort to try to do more. Even if its contributing to food and clothing drives or donating money where I can. I figure, maybe naively, that if everyone contributes a little more then we might be able to make a dent.
I agree that the national efforts are not in place to stop and reverse this problem either. And none of the presidential candidates except for John Edwards really addressed the issue of poverty in their campaigns with more than a passing mention. The focus always seemed to be on the middle class. And when John Edwards spoke of the problem of homeless veterans, there were some in the media that dismissed it out of hand.
I look forward to the post on homeless veterans and have a story to share in the comments for it.
Jim
Jim’s last blog post..3 Fake Game Shows Cooler Than ‘Deal Or No Deal’
I was a homeless Female Veteran for eight years, I am now living at U.S. VETS, I have found out since I have been here that I have a diagnosis of Chronic Depression Dystimia, and Post Traumatic Stress.
Thank you for visiting, Delrae Lynn, and thanks for your comment!
Eight years on the streets must have been really tough. I’m glad you’ve found shelter now. I haven’t heard of U.S. VETS, though I will probably run across it when I write an article on homeless veterans soon. Could you tell me a little more about it?
The chronic dysthymia is something I have, and it’s no joke. You always feel a little down, no matter what’s happening, or how good you otherwise might be feeling.
I hope you are getting some treatment for your PTSD. It can make life horrible, but with treatment you can learn to control the symptoms and get your life back.
Thanks again for commenting. I’d like to hear from you to see how you are doing. You can email me rather than comment if you like. Just click the “Contact” tab at the top of the page.
Hey Mike,
Wanted to say thanks for writing this post. Believe it or not I found you via the Thesis forum.
Mike, my brother is schizophrenic. He got sick when he was about 17 years old – is now 52 and lives on the street. I can’t even begin to share the trail of tears and frustration in trying to get him help. It is nearly impossible for caring family members to help the mentally ill. There are limited services and quite frankly the law stands in your way (not to mention the sick person). People simply do not understand that the vast majority of homeless are victims of an illness. I remember meeting with the local DA in an attempt to get my brother treatment and he said to me “…Lisa, I went to court recently to help a homeless man who had been eating human waste and the court simply said he was no threat.”
People are uneducated, uninformed and unenlightened when it comes to understanding mental illness and its connection to homelessness.
The average person simply doesn’t accept that the brain, like any other organ of the body can become ill. And, of course, because mental illness can have varying symptoms (like anger, weird behaviors or odd thinking etc.) people don’t want to be around it or deal with it.
As a nation and people we should be ashamed of how we treat the mentally ill.
On behalf of myself and every other family member who has experienced the pain of mental illness (directly or indirectly) I want to thank you for making a positive contribution.
The last taboo – mental illness.
Peace and blessings to you….Lisa
Lisa, thank you for your kind compliments.
It breaks my heart to hear your brother’s story. The laws are structured now so that, unless a person is in danger of harming themselves or others, there is no way to force them to undergo treatment. While I’m as much an advocate for constitutional rights as anyone, I think that human compassion should enter into the cold calculus of the law. It’s not being loving or compassionate or kind to leave a person to suffer out on the streets.
And yes, there is the stigma of mental illness to deal with. It’s bad enough when the person is not out on the streets, but doubly bad when that person is homeless. People are afraid, and turn their heads trying to ignore the obvious suffering of the homeless, and especially the mentally ill homeless.
I feel so frustrated that there is no united push to get the homeless off the streets and into decent living conditions with the mental and physical care they need. What’s worse, the state of the economy is driving more and more of our citizens into homelessness. There are several private organizations that are working to alleviate homelessness, but let’s face it, until there is a push from the government to end this problem once and for all, their efforts are but drops in the ocean.
I just wanted to place a comment on the article, which was extremely enlightening although it is something, which I am personally acquainted as an individual who has a mentally ill family member living in his van. I have tried repeatedly to try and reason with him about obtaining a new place to live and made suggestions relating to NAMI, which led him to become agitated. Apparently, my relative is aware of the organization and views as a negative institution and a threat to all individuals, just not the mentally ill. Unfortunately, my relative is a paranoid schizophrenic and being familiar with this mental illness, it is apparent that he is exhibiting these symptoms when he talks to me about the US government poisioning his food, (last telephone conversation entailed McDonald food servers being a part of “the plot”) bugging his calls, and systematically shooting him remotely with ultra violet rays. I am terrified because trying to reason with him has proven fruitless and the last conversation entailed conversations relating to his being murdered by the government. I do not know where to turn being a single person without the resources and support system to offer him shelter although he walked away from his apartment and a house, he claimed to have as well. I was aware of his apartment as I visited him there several times. I also contacted him on the landline at the same address as well. Sadly, it seems as if far too many homeless are stricken with a mental illness and the fact that there is little being done to address this tragic circumstance is even more devastating in my humble opinion. I hope that someone out there can assist with any resource information they may have to share. How does anyone begin to help an individual who is in complete denial about having a serious mental illness even though they have been formally diagnosed and treated as a teenager particularly when they are now an adult and homeless, so that one cannot even attempt to stage an intervention and get them the help that they so desperately require?
Frustrated and Afraid!
that vet looks like dr house
I live in Chicago and there isn’t a day that goes by that I don’t see homeless people. It’s sad and frustrating to see the same people day in and day out- women and women, old and young. There is a feeling of guilt inside of me every time I see it. It’s not right that these people are just tossed aside when they really need HELP. Whether it’s a drug or alcohol problem, an unfortunate life occurrence (I met a women who was homeless because her house burnt down. She had no homeowners insurance and she had no family or friends to fall back on), or a mental illness, we should be helping these people.
It should be mentioned, mentally ill individuals qualify for Social Security and disability benefits. Problem is getting them through the red tape and government bureaucracy. They need good family members to help, unfortunately the nature of the illness pushes people away.
Its a sad and challenging (but not hopeless) reality.
I am plannning an informitive speach in my public speaking class on the Mentally Ill and Homless. I would apreciate any good receant information and publications or references. .
Mike,
I cannot thank you enough for your indepth post. I am a doctorial student researching how the federal government provide protection and support to the mentally ill during crisis or emergency response, in particular when the National Incident Management System (NIMS) is implemented. My dissertation is a study in policy research, with the hopes of improving our national policy and care of the mentally ill and disable people. I would love to contact you in the future as my research matures. Thank you again for your insight and wisdom.
Sincerely,
GC
my sister was paranoid schyzophrenic,she was in a mental unit,they knew her very well.she died in that place when they knew of her illnesses.second to her mental sadness,she had gallblader problems.she told them she was in pain.they did nothing to help her but give her a soft blanket.within two hours or so she was gone.i spoke with our county attorney about the problem of not helping our people with mental problems.he simply said,our system is broken.
I suffer from a severe mental illness and am afraid I will end up homeless every single day. It’s so hard to function. I was homeless after coming out of a city psychiatric hospital for a month. I cannot begin to explain how painful it is to have a mental illness. I cannot work in the medical state that I am in. I keep having rapid cycling even on medication with extreme agitation and depression. Instead of support there is such a stigma about mental illness that much of my family has shunned me and I tend to isolate myself because of the illness. I feel myself decompensating and I have no support. I fear that I will end up homeless. 15% of people with mental illness end up committing suicide. This is such a bad illness that it’s better being dead or not being born than suffering with such a bad and painful illness. It’s impossible to work with such a bad illness. I feel so alone.
It’s sad, but there is not much you can do to force someone into trreatment if they don’t want to go, no matter what. Do we really have a right to? Considering the limited resources is it really a bad idea to use preference as a reason for exclution when we dont’have enough time and money to help all the homeless mentally ill? A bit cold, but it is a reality of the situation.
In response to Joshua Beadle and to the issue of homelessness and stigma I say this:
We treat the mentally ill like they have a choice to go to therapy and take their meds. Most of the meds that exist only put a bandaid on the problem. They don’t heal. We drug our mentally ill so they can be less of a nuisance to us as they suffer. Guess what my friend, mental illness can strike anyone at anytime, because it is a physical disease, not a made up one and certainly not a choice. So I pray that you don’t suffer with Alzheimers or have a child with autism, because they are illnesses of the brain as well. Should we allow your child or you to become homeless for lack of funding?
I am ashamed of my mental illnesses. It’s so hard to get beyond dealing with myself. I fear being homeless, which I have experienced. I wanted to write brief.
i was homeless at the park this honolulu. hawaii lasted years 2009 october pick out at the ihs homeless sheltered i sleeped at the park in the street i living at the care home at the ewa beach area .this is years 2010 aloha to mahalo .i was getting feed at the raver of the life mission.
the jesus is lord he is was homeless at the kingdom freedom park and the build up the house to living at the house toeat a food with for the jesus .
the jesus is love you the jesus he is help you your homeless no fun be a homelessing
i am have a cerebral palsy is a disability i am wheel chair hood this ewa beach hawaii .
i from at the at the city of the worcester i was beened all my life this worcester what is you state down is born at .? i like you good life man . aloha to mahalo happy nice day smile to you.
Where do I begin…I was homeless or transient for what has to be more than 90% of my life. I was pretty much born homeless, I guess you can say.
I have done it all–when I was between 8-10, I lived in flophouse motels, of the sleaziest quality in bad areas. then we had a house for a good year or two, and then we lost that, so I ended up in motels again, only for my parents to lose the financing on that (they always argued, lots of physical abuse, emotional blackmail) so I ended up living in a car with exactly 5 others.
Most depressing moment of my life was that year and a half I lived like that. god, what made it worse and unbearable is that, for god knows what reason, my parents chose a wealthy community to settle in, so I went to school with a bunch of wealthy kids who made comments relentlessly that left me with insecurity issues and a complex towards people that lasts to this day.
these days, I’m sure I’m going to end up on the streets again because I have no real skills, no real plan, no real motive for anything.
I guess that’s the way life goes. who cares anyways? no one. oh sure, they can say they care, but do they actually do anything? no. yes, alot of this is my fault, but I don’t know how to solve these problems on my own. homelessness, abuse, desperation, and lack of motivation are the only things I know and know well.
Stephen,
Patterns are meant to be broken. I could tell you my story, but if I didn’t have one, I wouldn’t be here would I? I don’t know where you live, but I think you are wonderfully articulate and are able to spell out your own challenges, where most go there whole life thinking their challenges come from so evil force beyond their control. Re-read your own post. You will find your answers there. Remember the definition of insanity is doing the same thing over and expecting different results.
My son is 19 and schizoaffective and is suspected to have a personality disorder. He’s been mentally ill for 6 years. He is also sufficiently rebellious and continues to choose wrong ways. I am right now struggling in making the decision to make him live at the city shelter or come home (he has no friends and his dad rejects him), and drive me to a nervous breakdown. It’s seems that it’s me or him. I’m guessing that’s why a lot of mentally ill people are on the streets.