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A National Shame: The Mentally Ill Homeless

by Mike on October 15, 2008 · 91 comments

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.

You can find several related articles in the “Related Posts” list below. Click on the Categories tab at the top of the page for a complete list of all articles. And don’t forget the Google Custom Search field in the right sidebar, too!

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

Resources used in this post: (2008). The Mental Health of Homeless People. Retrieved October 14, 2008 from Web site:

Meharry Medical College. (2005) Homeless Mentally Ill. Retrieved October 14, 2008 from Meharry Medical College Web site:

National Alliance to End Homelessness. (2008). Mental Health and Physical Health. Retrieved October 14, 2008 from National Alliance to End Homelessness Web site:

National Coalition for the Homeless. (2008). How Many People Experience Homelessness? Retrieved October 15, 2008 from National Coalition for the Homeless Web site (PDF): 

Treatment Advocacy Center. (2007). Fact Sheet: Homelessness, Tragic side effect of non-treatment. Retrieved October 14, 2008 from Treatment Advocacy Center Web site:

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