I recently found myself disagreeing with one of GMC’s doctors. She talked about the impact of poverty in homelessness. “Wait a minute” I stammered, “homelessness is all about mental illness and disability” and I began talking in circles. Although I feel strongly that most of the people I see on the street are homeless because of faulty mental processes and therefore are unable to fit successfully into society, I didn’t have much evidence other than the anecdotes of my work over the last 30 years.

It is important to remember that we work with a unique subset of people who are homeless: people who live on the street. And many of the people we work with have been on the street for years. We almost never see families.

There is a shortage of good literature on the prevalence of mental illness among people who are homeless. Good data and good research involving mental illness starts with definition. What is mental illness? Do you include personality disorders? Traumatic brain injuries and developmental disabilities such as autism? These are all realities for the people we see.

The second problem is diagnosis. Even well-trained professionals disagree on diagnoses. It takes a long time to do an effective evaluation and even then many people don’t want to share their behavioral flaws for many different and complicated reasons. Additionally, while much of psychiatry has been systematized in a way that gives good guidance to diagnosticians, it is still very complicated.

Often people have more than one set of symptoms or have symptoms that change from day to day – as in borderline personality disorder. Also symptoms of bipolar disorder can mimic the psychosis of depression or schizophrenia.

The third problem is that half of all people with serious mental illness don’t think they have a brain disorder. They have a condition known as anosognosia which blocks insight into their own dysfunction. They deny symptoms and avoid mental health practitioners.

In the end, it is my observation that most of the people I see on the street have conditions that limit their ability to function in society. Sometimes the symptoms are obvious such as yelling at nobody in particular as they walk down the middle of the street. For most it is not so evident, even to the trained observer. It might take months of interactions before the observer notices an unusual preoccupation with “the Church,” for instance, or an unwillingness to enter buildings of any type.

We also hear about substance abuse as a leading cause of homelessness, but again from my observations over the years (except during the crack epidemic), I rarely meet a substance abuser in which I don’t find an underlying brain disorder. In fact, research has shown that people with certain disorders of the brain are much more likely to abuse substances.

Many people experience substance abuse and brain disorders without becoming homeless. However, most homeless people are on the street because of an untreated or poorly treated (sometimes untreatable) disorder of thought and a lack of supportive services. We can do better. I have no doubt that poverty contributes to homelessness, but I don’t think that poverty, in itself, is a significant cause of urban homelessness as we know it in the United States.

―Gunther Stern

$50/month provides 10 GMC guests with access to our two psychiatrists and general practitioner each year. By serving clients who do not have access to basic medical care and psychiatric treatment, we help them address the underlying issues that may cause their homelessness. Find out more about how you can help!