Homelessness and Mental Health

According to the Treatment Advocacy Center, one in 30 American adults experiences a chronic mental health diagnosis. This includes but is not limited to: schizophrenia, bipolar disorder and depression. “A Bed Instead” is an initiative currently being undertaken by the Treatment Advocacy Center, which seeks to support greater access to inpatient mental health beds for those struggling with serious mental illness. Follow this link to view an educational video highlighting the effect cutting funds to mental health has had on people in need of treatment.

Numerous factors can contribute to individuals losing their homes such as natural disaster, unemployment, domestic violence, substance abuse, major medical illness, etc. However, one of the most under addressed reasons contributing to homelessness is inadequate recognition and treatment of mental health disorders.

It is not difficult to imagine how people with chronic mental illness end up homeless, especially if these individuals are without family support or access to resources like addiction treatment for patients with co-morbid substance use. It becomes easy to see that once these patients fall through the cracks of our health care system, it is extremely difficult to get them back on track.

Further complicating treatment is a symptom called “anosognosia,” or lack of insight, that is common in the seriously mentally ill population. This means that many patients do not have insight into the severity of their condition, and as a result often do not know they are ill. This makes it very difficult to convince them to come to the hospital for evaluation, let alone be willing to partake in treatment. Anosognosia not only affects treatment of mental health, but physical health as well. Those with untreated mental illness are much less likely to see a physician for preventative health screening and health maintenance. Thus, they are at a much higher risk of dying from preventable health conditions such as hypertension, high cholesterol, type II diabetes, obesity, etc.

This becomes very important when we hear lawmakers and politicians discuss lack of engagement in mental health treatment and subsequent homelessness as a “choice.” It most certainly is not.

Having involuntarily hospitalized and treated many patients with serious mental illness myself, to date none of them have stabilized and said they were upset that they were hospitalized and treated against their will when they were floridly psychotic, detached from reality, and being tormented by debilitating auditory and visual hallucinations. The overwhelming majority of my patients came into the hospital severely mentally ill and left with a sense of gratitude that treatment had restored them to the highest functioning version of themselves. Some of them have even become advocates for others who are unable to speak for themselves.

One of my patients described his experience with an exacerbation of schizophrenia in the context of not having been able to refill his medication due to financial hardship as feeling “trapped.” Without his medication, he was experiencing terrifying auditory hallucinations of tormenting voices telling him that he was worthless, unworthy, and that he should kill himself. Thankfully, he was brought to the hospital by law enforcement who recognized that he was suffering from a mental health disorder. He was hospitalized and treated before he could do anything to harm himself. Not everyone is so fortunate.

So, what happens to people who are in need of mental health treatment but cannot get it?

The graphic below is important because it illustrates where seriously mentally ill patients end up. This also explains why individuals with mental health disorders are over-represented in the homeless and jail/prison population, and why suicide rates in the mentally ill are higher than that in the general population.

Image via https://www.usatoday.com/story/news/nation/2014/05/12/mental-health-system-crisis/7746535/

Having a mental health disorder is not a choice, and as a society, we should be recognizing mental health disorders as equally important to medical diagnoses like cancer. We call those who receive treatment for cancer “brave” and “strong.” When they are in remission, we say they “beat” cancer and we call them “survivors.”

One of the greatest tragedies in our society is that we do not use these powerful and meaningful words to describe those who have triumphed over depression, anxiety, schizophrenia, bipolar disorder and other mental health disorders.

Mental health diagnoses deserve the same amount of respect, care and attention that medical illnesses garner. No one wakes up in the morning and asks to be diagnosed with breast cancer, in the same way nobody with schizophrenia wakes up and asks to be homeless.

Medical and mental illness are non-discriminatory. They do not answer to gender, race, religion, or socioeconomic status, which means none of us are immune. All of us and the people we love are susceptible to medical and mental illness. It is not a question of “if” but a question of “when.”

It is easy to deflect and say “it doesn’t matter because that won’t happen to me” … until it does.

So, ask yourself: when it is you or someone you love, how would you want society to talk about them? How would you want them to be treated? Would you tell them that being homeless and mentally ill is a choice? Or would you fight for them advocate for them, and treat them with the compassion and care that every human being deserves?




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