Too Little, Too Late, for too Many Homeless, Mentally Ill People

In late March 2020, Dennis Culhane, Ph.D., who is one of, if not the nation’s most trusted researcher into homelessness of individuals unaccompanied by children, issued a terrifying, and for many of us, a heartbreaking report. According to his research, homeless individuals who are unaccompanied by children are 2 to 2.5 times more likely to be infected with the COVID-19 virus than non-homeless people. Even worse, they are two to three times more likely to die of the virus. Understandably, those who sleep unsheltered are more at risk than those who are sheltered.

How many homeless people are there? In January 2019, HUD reported that 567,715 people were reported to be literally homeless, e.g., in shelters, in transitional housing, on the streets, and in other places "not meant for human habitation." Of those, 371,916 were individuals unaccompanied by children and 180,487 of them were sleeping unsheltered. Tragically, of those who were sleeping unsheltered, 116,179 were severely mentally ill and 52,243 of them were sleeping unsheltered. By comparison, 88,873 were chronic substance abusers, and 43,069 of them were sleeping unsheltered. Sadly, I was not at all surprised by these statistics. Approximately half of adults, homeless or housed, who have schizophrenia or bipolar disorder also have anosognosia, a brain dysfunction that prevents them from being able to accept the reality that they have a serious mental illness.

Therefore, they refuse all medications and far too many "self-medicate" with alcohol or other drugs. As a result, they often need involuntary inpatient treatment for as long as needed in order for them to stabilize on their medications and be stable enough to make the decision to accept housing and services.

But some good can come of every tragedy. Since its beginning, The Kennedy Forum, a major advocacy group, has focused entirely on mental HEALTH, with little or no mention of serious mental illness. Not surprisingly, they have not been supportive of advocacy efforts to convince Congress to repeal the discriminatory Institutions of Mental Disease (IMD) Exclusion. For half a century, this exclusion has prevented people ages 22-64 from using their Medicaid to pay for treatment in an institution of mental disease (aka state psychiatric hospital). Due to the COVID19 virus and its effects on homeless people, the Kennedy Forum is now urging Congress to repeal the IMD Exclusion.

It stands to reason that most of us have a home where we may self-isolate during this crisis. We need to remember that there are thousands of homeless, mentally ill people who need others to serve as advocates for them as they have nowhere to self-isolate except outdoors.