A National Shame: The Mentally Ill Homeless.

One of our nation’s greatest shames is the number of homeless people adrift in the streets and parks of our cities.

And of the estimated 944,000 people who are homeless on any given night, 40 to 45 percent of them have a serious mental illness. Most of these mentally ill people go untreated, and unable to work, live a hand-to-mouth existence out on the streets.

Senator Pete Domenici says,

No vision haunts America’s conscience more than the sight of the street people… The irrationality and anguish that grip so many of these individuals leap out during any encounter, whether in Washington or Albuquerque.”

This post, in response to Blog Action Day’s call to write about poverty on October 15th, gives an overview of the crisis of the homeless mentally ill. This post covers the following topics:

How many homeless Americans are there?
How many of the homeless are mentally ill?
Why are there so many mentally ill homeless people?
Most mentally ill homeless people are not being treated
What’s to be done?

How many homeless Americans are there?
3.8 million are homeless in a year
The number of homeless Americans is hard to pin down, since homelessness is often a transient state, and due to the conflicting definitions of “homeless.” The best approximation is from a study done by the National Law Center on Homelessness and Poverty in 2009, which states that approximately 3.8 million people, 1.9 million of them children, are likely to experience homelessness in a given year and by the end of 2011 many perdict these numbers to double. This translates to approximately one percent of the U.S. population experiencing homelessness each year, almost 46 percent of them being children, according to the Urban Institute.

In early 2009, the National Alliance to End Homelessness reported a point-in-time estimate of 944,313 people experiencing homelessness in January 2008. This is the figure most often quoted in homelessness studies.

How many of the homeless are mentally ill?
Homeless people suffer from high rates of mental health problems exacerbated by living on the streets and in shelters.

40 to 50 percent of the homeless are mentally ill
An estimated 40 to 45 percent of homeless persons suffer from Axis I mental disorders in a given year, which include Anxiety Disorders, bipolar disorder, clinical depression, and schizophrenia, schizoaffective disorders, and severe personality disorders. Between 150,000 and 200,000 of the homeless have schizophrenia or bipolar disorder. This is the equivalent to the population of any of these cities:

Dayton, Ohio
Des Moines, Iowa
Fort Lauderdale, Florida
Grand Rapids, Michigan
Providence, Rhode Island
Richmond, Virginia
Salt Lake City, Utah
At any given time, there are many more people with untreated severe psychiatric illnesses living on America’s streets than are receiving care in hospitals. Approximately 90,000 individuals with schizophrenia or manic-depressive illness are in all hospitals receiving treatment for their disease.

Substance use is also prevalent among homeless populations. In a 1999 survey, 46 percent of the homeless respondents had an alcohol use problem during the past year, and 62 percent had an alcohol use problem at some point in their lifetime. Thirty-eight percent had a problem with drug use during the past year, and 58 percent had a drug use problem during their lifetime.

Why are there so many mentally ill homeless people?
The plan to transition from mental institution to outpatient care failed
There was a movement in the 1960′s and 1970′s to deinstitutionalize many of those being held in state and other mental institutions. The plan was to create community health centers where the mentally ill could receive outpatient treatment, along with residential facilities for those unable to make it on their own. Needless to say, the plan failed miserably.