Mental illness plays a complex role in homelessness

Advocates will quickly tell you that the main cause of homelessness is the affordable housing…

Mental illness plays a complex role in homelessness
Mental illness plays a complex role in homelessness

Advocates will quickly tell you that the main cause of homelessness is the affordable housing shortage. But mental illness can also play a role. More than 20% of unhoused people have a serious mental health condition, according to the National Alliance on Mental Illness. That’s compared to 5.5% for the general population.

“People who have certain disabling conditions — mental health disability, substance use problems — are at higher risk of losing out in tight housing markets, so they are more likely to become homeless,” said Dr. Margot Kushel, who runs the Benioff Homelessness and Housing Initiative at the University of California, San Francisco.

Without stable housing, Kushel said, managing mental illness becomes almost impossible.

“Homelessness is devastating to one’s mental health,” she said. “The constant violence that people are exposed to … the lack of sleep, the stress and uncertainty, the humiliation — all of these worsen people’s mental health. And homelessness really limits people’s access to treatment.”

That’s something Grace Lee sees while walking the streets of Washington, D.C., doing outreach for the nonprofit Pathways to Housing.

Grace Lee sits on the corner of a low indoor fountain. She is a Black woman with locks wearing jeans, white sneakers, and a blue t-shirt that says "Pathways to Housing DC". She has a big smile and black lanyard around her neck with her ID.
Grace Lee provides outreach services for Pathways to Housing DC. The group says a large portion of their homeless clients are also struggling with some kind of mental illness. (Kimberly Adams/Marketplace)

“Unfortunately, a lot of our clients do have mental health issues,” Lee said. “So it’s one thing if you and I have depression or bipolar or whatever. We just go to the doctor. When you’re homeless, where do you go? What do you do?”

Lee helps the people she encounters get signed up for Medicaid, food assistance and free phones, all while working to transition them into stable housing.

“When you’re homeless, [mental illness] kind of takes the back burner,” she said. “All they’re concerned about is their next meal, how they’re going to pay for that phone or whatever is the issue of the day.”

One of Lee’s clients, Charles Gregg, has been homeless in D.C. for about two years. He said treating his post-traumatic stress disorder and depression isn’t as much a priority for him as trying to get housing.

But Gregg said the stress of being homeless doesn’t help his conditions.

“Nobody is the same way all the time, even though you try to be. But sometimes things happen that cause you to act other than you normally would. And so sometimes, that’s attributed to my PTSD,” Gregg said. “Because sometimes people say something or do something, and … when I get excited, sometimes I talk real loud. … And I don’t do it on purpose, but it’s just the way it comes out.”

Charles Gregg stands outside the glass-walled entrance to the First Congregational United Church of Christ. Gregg has a short white beard and a blue surgical mask under his chin. He's wearing a blue jacket and tan pants, and is standing in front of a 12-pack of toilet paper and a 3-pack of paper towels plus some other supplies he has on the ground next to him.
Charles Gregg is working with the group Pathways to Housing DC to get signed up for Medicaid and put a roof over his head. He says he’s struggled with depression and PTSD but stopped treatment since becoming homeless. (Kimberly Adams/Marketplace)

Pathways to Housing CEO Christy Respress said getting people into housing not only provides a foundation for treating mental illness, but it can reduce other costs for the broader community.

“Once people move into housing with the right support services,” Respress said, “their interaction with the legal systems go down. Their interactions with the ERs and hospital emergency rooms, the psychiatric emergency rooms, goes down.”

And using those services, Kushel of the Benioff initiative said, is much more costly over time than providing people with a place to live and the services to keep them there.

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