I opened my e-mail and read the words “Shadow Count”. As a first year social work student, I was asked to volunteer as a “decoy” on January 28-29 when the Department of Homeless Services (DHS) conducts their Homeless Outreach Population Estimate (HOPE) Count. As a decoy, I would assess the accuracy of the official DHS HOPE Count. Past data has shown their report astronomically underestimates the numbers. No surprise there.

I became increasingly interested in housing policies in NYC and after a ten second google search found how correlated homelessness was with serious mental illness. Housing First is an approach to quickly and effectively find permanent housing for individuals and families experiencing homelessness. This approach has been applicable for homeless persons with serious mental illness and emphasizes the need for holistic and multisectoral approaches to mental health policy. We must push for more policies like these!  

Housing First goes against the idea that an individual need to prove their “readiness” for housing by completing a residential and/or treatment program before being linked to permanent housing. It emphasizes the need to place these individuals in stable housing first and underscores their right to self-determination, dignity, and respect. This type of approach can be extremely useful in other public health arenas, particularly treatment for individuals with serious mental illness.

According to the National Alliance of Mental Illness (NAMI),  26% of homeless adults residing in shelters live with a serious mental illness, whereas 4% of adults in the general population live with a serious mental illness. Considering the rate of mental illness in the homeless population is astronomically higher as compared to the rate of mental illness in the general population, Housing First is a step in the right direction for mental health. How do we expect to combat the increasing rates of serious mental illness in the US, if we do not address the increasing rates of homelessness and the clear correlation between the two?

Lack of treatment for most individuals living with a serious mental illness can cause kinds of delusions and bizarre behavior that makes holding a job as well as living alone or at home with families much more difficult. In fact, mental illness is the third leading cause of homelessness in the US. Further, the risk for individuals experiencing homelessness and living with a serious mental illness is high; 33% of homeless individuals with serious mental illnesses are untreated and individuals with psychotic disorders are much more likely to get assaulted or threatened while homeless. It seems like a no-brainer here—these issues must be dealt with together, not treated as separate entities.

Not only are these issues deeply intertwined, but looking closely at the financial burden of each helps draw attention to the increasing need to address these issues in conjunction with one another. Homelessness costs the US $10.95 billion per year and it is estimated that if individuals were found permanent housing, this expense would drop to about $7.88 billion. Serious mental illness costs the US $193.2 billion in lost earnings per year. We cannot afford to ignore these issues anymore and must address them together.

Some may think that policies around mental health should focus on providing adequate treatment and not worry about including other issues, such as housing, into the mix, but this would be ignoring the clear correlation between the two and would simply fall short as a solution. We must begin to think differently about policy change and recognize how each sphere interacts with the other. Focusing on ensuring individuals experiencing homelessness are provided with stable housing, allows subsequent focus on long-term and effective treatment programs.

The more we can understand the relationship between homelessness and serious mental illness the more we see the need for policies like Housing First that truly look at the social determinants of health and understand the cyclical nature of these interrelated issues. We must advocate for more policies to take this type of holistic and multisectoral approach that looks at and addresses the individual in his or her environment.

Adina Heckelman (MPH, MSW candidate ‘2020, Columbia University) is a contributing writer to YMFMH.

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