The People on the Streets: Mental Health and Addiction among Unhoused Individuals

Walking along Tremont Street in Boston, you will probably see an elderly man among trash bags, huddled in a corner between the stairs of the Park Street Church and the wall of the Granary Burying Ground. He is bundled in dirty, ratty clothes and a coat. You might see the cup for spare change that he keeps a few feet in front of him. He does not speak or interact with pedestrians on his own accord. If you do engage him in conversation, you will notice that he has immense difficulty interacting with people. He stutters, pauses, interrupts himself, and even yells angrily in frustration at his ineloquent speech. This homeless, impoverished man, ignored by the hundreds of people who squeeze by him on the narrow sidewalk, suffers from a mental illness.

I am not a psychologist, and therefore lack the authority to diagnose someone with a mental disease. While I cannot be absolutely certain, I can confidently guess from my interaction with this man that he struggles with some form of disease, whether it be addiction, schizophrenia, bipolar disorder, or a host of other psychological conditions.  He is not alone; of the hundreds of thousands of people on any given night and the millions over the course of the year who do not have a place to sleep in the United States, approximately a quarter to a third of them suffer from a serious mental illness (Harvard). Because addiction and other mental illnesses are intimately connected to homelessness, the key to solving this social problem is not merely providing housing but treating mental illness. Therefore, federal and state governments should enact policies to integrate mental healthcare into homelessness solutions by providing more resources, allocating funding for integrating care and housing, decriminalizing and treating addiction, and giving courts power to mandate treatment.

A focus on mental health can provide relief for the currently homeless and prevent people who suffer from mental disease from becoming homeless in the future. Mental disease is a possible cause of homelessness, with one-third of homeless adults in the United States “having a prior history of psychiatric hospitalization” (Martens 82). Mental illness can impede individuals from getting jobs and keeping up with expenses, resulting in homelessness. There are some programs in place to assist homeless people afflicted with mental illness, such as community mental health centers that serve over eight million low-income people every year (Mantel 427). However, these programs, including housing, are complicated, difficult to access, and do not focus on treatment for addiction. The people in need of assistance are “often too depressed or disorganized to seek help for themselves” (Harvard). Because of the lack of effective mental healthcare, thousands of homeless people are unable to receive the care they need to improve their quality of life, and therefore continue to suffer in poverty.

The prevalence of addiction in the homeless population contributes to this social problem. Most people will not give money to panhandlers on the street out of fear of fueling their drug or alcohol habit. Addiction is a mental disorder, and one that is common among the homeless population. Some estimates in the United States for the rate of homeless people who suffer from substance abuse range from 29% to 51% (Martens 85). This poses several serious problems. First, while landlords cannot discriminate against people with mental illness, they can deny housing to drug addicts and alcoholics (Harvard). Therefore, people who suffer from addiction are less likely to receive housing. Also, approximately 72 percent of the homeless in the United States suffer from drug problems, especially heroin and cocaine (Martens 85). Homeless drug addicts may be convicted and sent to prison for the possession of illicit drugs, which jeopardizes their future ability to benefit from government programs. Addiction is a dangerous disease that keeps thousands of people trapped in poverty.

Since mental illness and addiction are closely connected to homelessness, incorporation of mental treatment is necessary. For this reason, only providing more housing is not sufficient because it does not take into account all the causes of homelessness. Between psychological disease and substance abuse, mental problems affect a large portion of the homeless population. Sam Tsemberis, the founder of a nonprofit organization, Pathways to Housing, is fighting homelessness. However, his methods are too simplistic, as he says in an interview with Mother Jones: “All you need to solve homelessness in the country is $10 billion; you would solve homelessness permanently in the country. About 80% of it would go to housing and then 20% would go to services and support that some people would need” (Tsemberis). He recognizes that integrated resources are required, but does not provide enough funding for adequate mental healthcare or elaborate on treatment for addiction.

Mental healthcare, the key to ending homelessness, requires government action to treat addiction as well as other mental diseases. The United States has struggled to provide its citizens access to adequate care. Following the recession of 2007, states severely cut funding for mental healthcare (Mantel 433-434). Since then, it has not been reinstated. Because of this, reform is necessary. First, the government should subsidize mental healthcare and increase access to prevent people with mental disease from falling into poverty. It should also allocate funds to provide housing integrated with care. Supportive housing programs take the homeless off the streets and provide them with necessary services as well as treatment for illness and addiction. Professional assistance, access to crisis centers, and agents ensure that the residents of the housing program follow their treatment plan. While these programs are expensive and require funding from the government, they do not raise costs because money is saved in other areas, as the people in supportive housing spend less time in psychiatric centers and prison (Harvard). In addition, to further decrease the costs of imprisonment, the government should decriminalize addiction to allow for a greater allocation of funds to treatment programs. Rather than arresting homeless people who are found to have illicit substances, states should focus on helping them recover. Finally, states can make it easier for courts to mandate outpatient treatment. This is different from institutionalization: the people who are mandated to receive care do not stay in the hospital. Rather, they have a legal obligation to attend their appointments and receive care. This ensures treatment without taking away civil liberties. These three mental health improvements have the potential to end homelessness.

Homelessness is a serious social issue closely connected to mental illness, but it does not receive enough attention or support. This complex social problem requires a comprehensive, sweeping solution. The government can enact several policies to ease the pain of the homeless and work toward justice. Expanding resources, integrating care with housing, providing help for addiction instead of imprisonment, and enabling states to mandate outpatient care for people who suffer from mental illness are possible answers that can alleviate suffering for the human beings who are degraded every day. There are many like the man who sits outside the Park Street Church. It is our responsibility as a society to recognize this social injustice and work to remedy it.

Works Cited

Harvard Mental Health Letter. “The Mentally Ill Are Vulnerable to Homelessness.” The 

Homeless. Ed. Louise Gerdes. Detroit: Greenhaven Press, 2007. Opposing Viewpoints. Opposing Viewpoints in Context. Web. 8 Nov. 2016.

Mantel, Barbara. “Mental Health Policy.” CQ Researcher 10 May 2013: 425-48. Web. 8 Nov.

Martens, Willem H.J. “Homelessness And Mental Disorders.” International Journal Of Mental  

Health 30.4 (2001): 79. Academic Search Complete. Web. 8 Nov. 2016.

Tsemberis, Sam. “Providing Housing Is the Key to Ending Homelessness.” Poverty and 

Homelessness. Ed. Noël Merino. Detroit: Greenhaven Press, 2009. Current Controversies. Rpt. from “Give Me a Home.” Mother Jones (20 Dec. 2004). Opposing Viewpoints in Context. Web. 8 Nov. 2016.