Homelessness and Mental Illness
This morning, on my way to Peet’s for a decaf iced mocha, I saw two young women taking pictures of what at first glance might look like two bundles of clothes on the sidewalk. Since I frequent that particular Peet’s, and because I’ve worked in Berkeley, California, for over a year, I knew that the bundles were two people sleeping on the sidewalk. I’m not sure why that spot is a favorite, but I’m sure I’d know if I had the misfortune to be homeless in Berkeley.
I would like to think that the two young women were taking pictures because they were doing a photographic expose of homelessness, but I was clued into the fact that it wasn’t likely by their giggling as they scooted away. It was a little strange to see the homeless being treated as a kind of tourist attraction, but maybe they were visiting from somewhere that doesn’t have people sleeping on its streets.
I spent a lot of time in New York City, so by the time that I went to college in Boston, I was accustomed to seeing people living on the street. Both cities have a fairly large homeless population. So I certainly wouldn’t have taken pictures of them to show the folks back home, but neither was I overly sympathetic. My awareness of the myriad reasons that cause people to end up on the street was non-existent, and at that point I was pretty clueless about mental illness, also, unaware that I was suffering from it.
According to a fact sheet from the National Coalition for the Homeless, approximately 20-25% of the single adult homeless population suffers from some form of mental illness. The homeless who are mentally ill face barriers that even the homeless without mental illness are not dealing with: barriers to employment, an inability to maintain social relationships and appropriate attention to personal care and household management.
Part of the reason that a high proportion of the homeless population is mentally ill stems from the closure over 40 years ago of many psychiatric institutions. The idea was that community based outpatient facilities and supportive housing would take over. While this seems to have initially been implemented, cuts in public assistance over the last two decades have eliminated many of the support options for mentally ill people. In addition, a decrease in public housing and a rise in poverty has contributed to the problem.
So a certain portion of mentally ill people cannot receive care, and end up either in prison or on the street, even in a city as progressive as Berkeley. Not only do they not have a home, but the mentally ill homeless are subject to violence and abuse in greater numbers than non-mentally ill homeless.
Unfortunately, things are definitely not going to improve any time soon. States, counties and city budgets are taking a hit due to the housing crisis, and one of the first things that tends to be cut when the economy suffers is funding for mental health programs. And the number of mentally ill homeless will grow as more veterans come back from Iraq and Afghanistan with post-traumatic stress disorder and traumatic brain injuries. Many of them are not getting the treatment they need from the military administration, and have to turn to the community services that no longer have the funding to support them. This is a grim situation that’s going to only get worse.
Deborah Gray wrote about depression as a Patient Expert for HealthCentral. She lived with undiagnosed clinical depression, both major episodes and dysthymia, from childhood through young adulthood. She was finally diagnosed at age 27, and since that time, her depression has been successfully managed with medication and psychotherapy.