At the core of the policy debate about chronic homelessness is our broken mental health system. Chronic homelessness is usually coupled with mental illness. Often the person you may see inebriated on the street is “dual-diagnosed,” that is someone with mental illness who is self-medicating with drugs or alcohol.

As the recent Sacramento Bee article “Genny’s World” by Cynthia Hubert illustrated, every person without a home has a unique story. Some common elements emerge.

1. They are loved by family, friends and kind strangers who eventually exhaust attempts to get the person help. Mental health and supportive housing is not plentiful enough to make access easy. Especially at early onset of the illness when it will make the most difference.  My friend Noel is a smart, capable and resourceful person who became completely frazzled seeking help for a close friend who had a mental breakdown in her 50s. By the time she was able to secure a spot in affordable supportive housing the woman had been victimized by others so that she had no condo, no car, no computers and no other possessions of value. And most tragically no dignity. Noel had succeeded in saving her friend from a death on the street but little else.
2. Mentally ill people sometimes do not believe they are impaired and need treatment or help. They have a condition called anosognosia and results from damage to the part of the brain that determines self-awareness. As Hubert explains, “It is, according to studies, the second-most common reason that people with schizophrenia decline treatment. The first is the negative side effects of the drugs designed to treat the condition.” One of the most frustrating aspects of advocating for people experiencing homelessness is the countering the common misperception that they want to be homeless.
3. Mental illness is still shrouded in stigma and ignorance. Some people do not believe in mental illness, characterizing the symptoms as demons. Others choose denial over seeking help because they see it as a character failing or might expose their family to judgement. Many families choose isolation over seeking help. Sometimes people underestimate the seriousness of conditions such as depression.

There are other challenges.When help is sought it is often very difficult to find and pay for it. Often insurance companies dodge providing needed services.  Or as someone once told me, “Do not use Kaiser’s psychiatric services–they are more harmful than doing nothing.”  Or as a social worker told a friend about a mental health facility: “I would never let anyone I love go to that place.”

Therapies need to improve! As the earlier quote stated, for some people dealing with schizophrenia the side effects from the meds are worse than the symptoms of the illness. And we need to exponentially increase the supply of supportive housing where people can have an apartment home with the social support they need to stay healthy.

As citizens and leaders, what is to be done? And why are we tolerating doing so little? I am going to continue to pursue these questions. Stay tuned.