Homelessness is real. It affects real people who are without shelter. As we explore this serious social issue, one cannot ignore the mental health issues associated with homelessness. It begs the question…does homelessness cause mental health issues or do mental health issues cause homelessness? Let us search its causes, possible solutions and hope for some answers.  

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The Department of Housing and Urban Development (HUD) collects data nationwide every January, called Point In Time (POT). January 2023 data was just issued on December 17, 2023.  653,104 is the number of people who have experienced homelessness nationwide in 2023. This number represents a record high since this data collection began in 2007. It is estimated that about 30% of all homeless have mental illness. 

Bringing it closer to home, of that count, 8393 people in Minnesota experienced homelessness in 2023. 

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As I try to fathom those numbers of people without homes, I am reminded of the disastrous Red Lake River flood of 1997 that forced the evacuation of 50,000 people from their homes.  Thousands came to Crookston where just hours earlier the same river crested fractions of an inch from overflowing our banks.  I still believe we were miraculously spared so we could open our arms and shelters to our neighbors from the North.  I was just one of hundreds helping at the triage center that was set up at our Crookston High School.  As each person or family came in, it occurred to me…at that moment… it didn’t matter what they did for a living, how much money they made, or what kind of house they lived in…at that moment… they were all homeless.  I will never forget the looks of devastation, desperation, and exhaustion on their faces. They had tried so hard to save their homes. 

This leads me to the fact that homelessness can happen as a result of any number of circumstances:    

• Disasters - like that flood or a fire 

• Mental health issues that are not treated properly  

• Insufficient access to mental health services 

• Abusive family situation 

• Addictions 

• Losing a job 

• Growing unaffordability of housing 

• Housing discrimination  

• Racial inequality 

All of these causes can be the result of, or contribute to, mental health issues.  Unhoused people with mental illness have often experienced tremendous adversity, trauma, and challenging life experiences, making it difficult to trust others. Homelessness also makes it difficult to plan beyond meeting basic needs. Mental illness itself can also rob people of their ability to reason and know they need help. For all these reasons, people with homelessness and mental illness are understandably often reluctant to seek care and resources. 

  

How can systems be more intentionally designed with/for unhoused neighbors living with mental illnesses?  

• First, the cornerstone of any system of care must include a plan to prevent homelessness — an area not given enough attention — among people with mental illness. It is not mental illness itself, but a lack of systems of care for people with mental illness that leads to homelessness. 

• For those who become homeless, the healthcare system must offer flexible, proactive community-based models of mental health care, such as Street outreach teams and clinics embedded in shelters, which facilitate accessing care for people who may not receive it otherwise. Traditional medical centers need to allow for walk-in appointments, screening for unhoused people, optimizing clinical care, and medication prescribing for this population.  Facilitating discharge planning from corrections facilities and mental health/addiction treatment centers helps to minimize people returning to the street. 

• For those on the pathway to housing, it is critically important to guide and support the person with mental illness so that they can thrive in housing. Housing First, which provides immediate access to subsidized, independent housing without pre-conditions, is an important and effective model but will only work if the support offered is tailored to each individual.  People with mental illness have unique challenges and goals in housing that should be addressed proactively through individualized housing plans, just like there are individualized psychiatric treatment plans.                                                        

• Evidence-based models include assertive community teams, which provide treatment, rehabilitation, and support services specifically for people with severe and persistent mental illness through multidisciplinary professionals. Evidence suggests that unhoused people are more likely to engage in mental health care when paired with housing and medical services, so interdisciplinary teams are important to create connections with mental health services. Having a case manager to help navigate the tremendously complex worlds of social services, health care, and housing is also valuable to connect people to IDs, shelter, food, clothing, appointments, housing, and other needs.   

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It is important to keep in mind that unhoused people are often very capable and creative individuals who have already found ways to navigate the incredible challenges that come with the experience of homelessness. Having a caring individual to remind them of these strengths can help empower them to navigate the resources available to meet their needs that will lead them to the life they desire and deserve. 

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We are complex human beings, intricately connected physically, emotionally, mentally, spiritually.  We cannot separate the effect one has on the other.  To help those who suffer homelessness and mental health issues, the whole person needs to be cared for.   

The most important things any individual can do is to: Become informed. Be compassionate. Donate to local shelters with time, things or money. 

 

Joan Morlan RN 

 

 

 

 

Resources: 

Center of Excellence on Public Health & Homelessness 

MN Dept of Health 

Dept. Housing & Urban Development HUD Point In Time 2023 

Homeless Hub- MN Interagency Council on Homelessness 

National Alliance to End Homelessness 

Katherine Koh, MD, MSc, Street Psychiatrist, Boston Health Care for the Homeless Program and Massachusetts General Hospital 

Dr. Deborah Padgett PH.D., MPA, MA, BA, Professor, Silver School of Social Work