Mental Health and Homelessness

This month we have looked at the barriers to receiving supports for those struggling with mental health, which affects even those who are housed and employed. It might go without saying then that someone who is unhoused faces even higher barriers to getting the services they need, and the fact is, there is a higher prevalence of mental health concerns among those who are struggling with homelessness.

What is to be done about this dilemma? If someone is struggling with homelessness, mental illness, and addictions, each challenge aggravating the other, how do we begin to untangle the compounding problems they face?

The establishment of those who study and work towards ending homelessness tend towards the Housing First model, which posits simply that the way to end homelessness is to give people homes. Institutions on the international and national stages recognize the right to housing, with the Canadian government endorsing the guarantee of “an adequate standard of living… including adequate food, clothing and housing.” Famously in housing policy circles, Medicine Hat, Alberta has followed a consistent application of Housing First principles to achieve the functional defeat of homelessness. Where there is the will, there is the way, as long as the communities are ready to devote the requisite resources.

Yet detractors remain. Prior to Housing First, the most common approach was to make the provision of housing conditional on a number of factors, like demonstrating sobriety or adhering to other criteria showing one’s virtue; the thought was that the homeless need to earn the right to dignity and safety, and if they didn’t want to live a virtuous life, then they weren’t worth the effort.

The libertarian Cicero Institute argues that Housing First has failed, citing how homelessness continues in many jurisdictions across the United States despite Housing First-like programs being attempted. One of the central arguments is that the homeless aren’t homeless because of a lack of housing, but rather due to other factors like mental illness and addictions issues. The thinking behind this argument is that these afflicted individuals are so challenged by these conditions that giving them housing will fail to make a change in their lives. The Cicero Institute and other fellow-travelers like the Heritage Foundation point to examples where mental health and addictions issues continue for participants in Housing First programs, ultimately suggesting that these people are homeless due to their own faults, and that giving such a person free housing won’t help those issues. They exhort all governments to “refocus their homelessness strategies on short-term shelter, moving people off the streets, and more mental health and substance-use treatment. While we can’t hope to end homelessness, we can hope to ameliorate it.”

We respectfully disagree. We can hope to end homelessness if we devote enough resources towards that goal.

The detractors of Housing First say that the idea doesn’t work because those struggling with mental health and addictions are homeless because of those factors, and so giving them a home will do nothing to solve that core problem. But homeless can “cause a level of disability and impaired social functioning in some people that, in the absence of adequate treatment and support, may lead to homelessness, which will then exacerbate these conditions.”

Indeed, “homelessness can cause trauma and emotional distress” which can be the catalyst for mental health struggles and addictions. The point we’re trying to emphasize as clearly as possible is that the homeless are not always homeless due to mental illness and addictions, but that mental illness and addictions are often exacerbated by the experience of homelessness. Homelessness can often begin due to factors like losing one’s job, divorce, or a death in the family, and only after experiencing the stress of homelessness do mental health and addictions struggles begin. The opponents of Housing First say that it’s pointless to help the homeless without first forcing them to go into mental illness or addictions treatment, but if it’s homelessness itself that’s exacerbating the problems, of course nothing’s going to get better!

We believe in Housing First. We believe that homelessness can be ended. The way to do that is by putting unhoused persons into housing. If they also need other mental health, addictions, and social supports, then they should be provided those things too. Besides being a moral perversity, the enormous costs associated with allowing homelessness to go unchecked mean that the costs of just giving people homes and health services are often offset in the end. Sure, it costs us money to end homelessness, but it costs us money to allow homelessness to continue, too.

A person can become homeless due to mental illness and addiction. A person can develop mental illness and addiction due to homelessness. At the end of the day, the solution is the same: Give people homes and give people treatment.