Homelessness and Mental Illness: A Stigma Double-Whammy


By Yvonne M. Perret & Ann Hackman, Members of the Anti-Stigma Project | July, 2017

Joe, not his real name, stayed on the same street corner in Baltimore for 15 years. He is a gentle, quiet man who was experiencing symptoms of his psychotic mental illness for all this time. Each day, he went to the emergency shelter across the street and returned, early in the morning, to his same corner—each hot summer day and freezing cold winter day. No one assisted him until, one day, an outreach worker from the Baltimore Department of Social Services (DSS) walked by and started to talk with Joe. For weeks afterward, this worker stopped to see Joe—to learn his name and to do his best to find out what Joe needed. He then referred Joe to an outreach program in Baltimore that helped adults who were homeless with accessing expedited Social Security Income (SSI) benefits. The staff went out to see Joe. At first, he would say very little. Gradually, they learned that Joe had been working for years, began having problems, lost his job, and was evicted when the sheriff came to put him out of his apartment and put all Joe’s belongings on the street.

They determined that Joe’s eviction left him feeling that he had to wait for the police to tell him it was ok for him to get a place to live and go back inside. This was not because anyone had told him this was the case, but rather was his own thinking. So, for 15 years, he had quietly waited on the stoop of a closed hardware store, on his corner, waiting for the police to send him a letter granting him permission to live back inside. No letter was forthcoming. Dr. Hackman accompanied the staff to see Joe, provided a diagnosis, and he received SSI quickly. Her team then helped Joe get a place to live and all the other essentials he needed. He has improved his life greatly, to his own satisfaction and definition. He has his own apartment, is now receiving treatment in a traditional clinic, is managing his diabetes well and attends a program where he is working on computer skills. He has a friend with whom he spent Thanksgiving. He remains, as he was from the moment we all met him sweet, gentle, and lovely. He now has a safe, meaningful and much happier life.

It took one person ‒ the worker from DSS ‒ to recognize the humanity of Joe. He was unseen and forgotten by most of the people who walked by that area except, interestingly, for some Baltimore City public works staff who would bring Joe sandwiches from time to time. Otherwise, he was invisible.

According to a Penn State posting, the essence of stigma is the negative labeling of an individual so as to set them apart from the fabric of society and a sense of community. Poverty, in and of itself, is stigmatized as individuals who are financially poor are viewed in our culture as being responsible for their poverty. Homelessness takes this attitude to an extreme; not only are people who experience homelessness financially poor but they also have other conditions that are stigmatized as well, including inhabiting public places, struggling with grooming and hygiene, having mental illness and/or substance use disorders and simply, being in need.

From the National Coalition for the Homeless, we learn of several truths about being homeless that our society, in general, doesn’t understand.

  1. We live in a system that makes it extremely difficult to end one’s homelessness. The Coalition notes that many people assume that homelessness arises from a person’s lack of interest in employment. In fact, about 44% of people who are homeless are employed. Clearly, the challenge of maintaining employment is huge if one is homeless and includes such essential work-related assets as transportation, food, ability to do laundry, etc.

  2. Hunger is a small part of the problem. People who are homeless clearly need food. However, much of the food they can access is not very healthy. In addition, unlike those of us who have resources and housing, the choice of what they can eat is nonexistent as it depends on the kindness of strangers and food programs. And, hunger is simply a part of meeting daily needs.

  3. Homelessness can happen to anyone. Housing costs, illness, poor health insurance, and/or financial struggles in general can lead to homelessness. Currently, for example, we know that since 2007, according to the NAEH, “severe housing cost burden,” defined as paying 50% or more of one’s salary for housing, has increased roughly 28%.

So, comparable to the misunderstandings, stigma, and discrimination surrounding mental health problems are the same myths, discrimination and stigma regarding homelessness. Just as we only have estimates on the number of individuals managing serious mental health challenges, so too, do we only have estimates on the number of individuals who are homeless and who have serious mental health problems. From the research, we do know that roughly 90% or more of the women who have a diagnosis of a mental illness and are homeless have experienced sexual abuse as young children. In addition, we know that roughly half of the men in comparable circumstances have experienced sexual abuse as young children. Traumatic histories are the hallmark of adults who are homeless and have serious mental health problems. In addition, homelessness subjects individuals to further trauma in the form of sexual assault, physical assault, and robbery. We have only rough estimates of these experiences partly because many people who have mental health problems have limited access to services that they find useful and welcoming. People who are homeless are identified, generally, through what is called a point-in-time count, required by HUD and completed on a winter’s day each year by staff and volunteers who visit shelters and other places where homeless people are visible. However, clearly, this count misses many people who are hidden—under bridges, in the woods, in abandoned buildings and other uninhabitable locations. So, we know that the identification of people who are homeless and who have serious mental health problems and/or problems with mental health challenges and substance use are under-counted and underserved. In addition, the experience of living homeless and managing a mental health problem is fraught with many dangers, and their corresponding fears and challenges. People are routinely assaulted; they feel unsafe and therefore, unable to sleep. Hiding from others is reasonable. Others walk around people who are homeless, cross the street, and routinely send the message that people who are homeless are less than the rest of us. Services essential to survival—food, shelter, clothing, health care—are organized so that individuals must walk, carrying all their belongings simply to access what they need to live. Judgments are made routinely about motivation when people experiencing homelessness miss appointments, can’t follow through, or are mistrustful—all lessons learned from living as a person who is homeless. We all need to think about what our own lives would be like if we had no place to live, no choice, no caring, and no hope. This is inherent in the experience of homelessness.

In our culture, it is easier to judge than to understand. The compounding of stigma against people with mental illness and those who are homeless and have these illnesses is truly a double-whammy. Trying to exit homelessness in a system that often is not welcoming, is overcrowded, is uninformed and poorly resourced leaves individuals with few, if any options. This sounds all too familiar to the experiences of individuals who are managing serious mental health problems on their own and have limited access to and understanding of all the challenges that they face. And, despite all this, people’s resilience, courage, sense of humor, persistence, and fortitude push them forward toward better lives and recovery.

Joe is now living a life much more of his choosing. As with all our lives, it’s not perfect but it’s much richer in experience, hope, warmth, and care. He is an example for us all of knowing when others are genuine, are interested, are curious and want to know who Joe is—not what his diagnosis is but who he, the person, is. It is incumbent on all of us to banish the stigma of homelessness from the lives of people experiencing it, in conjunction with understanding that, often, mental illness either results from or is a precursor to people losing their homes. Blaming them is much too simple. We can do better, and we must.