The Homeless Man is Likely Also Mentally Ill

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In the streets of San Francisco, homelessness is a common sight. In the seven block distance on my way to work, I passed by 23 homeless individuals, men and women, old and young. In San Francisco, homelessness has become so pedestrian that I find myself almost numb, lacking any empathy towards their stories, but it is this ignorance that fuels the fire.

An article in the NY Times from 1998 reports that 1,000 to 1,200 homeless were sleeping in the streets of Berkeley every single night, half of whom, the author estimates, are mentally ill.

“It’s like a mental ward in the streets”

So why are so many mentally ill individuals homeless? The answer is in the shortage of psychiatric hospital beds. In 2006, Markowitz published a study showing the direct correlation between psychiatric capacity and homelessness. He reports that more than 30% of psychiatric discharges are homeless within six months.


With rising healthcare costs, hospitals and clinics are under pressure to free up beds. Nevertheless, when patients feel the effect of these rushed timelines, their chances for a full recovery tumble. The problem is exacerbated when in major cities, low-income housing capacity continues to decline as well, leaving discharged patients without any options. We never imagined that the deinstitutionalization efforts of the 1980s would create an even more dire situation.

The implications cause a vicious cycle: 63% of homeless fail to take medication on time, compared to 18% for their counterparts with homes (Drake, 1989). Failure to comply with medication drastically reduces chances of recovery. Unsurprisingly, the death rates for the mentally ill homeless are markedly higher, due to impaired thinking.

When approximately a third of the over 800,000 homeless today suffer from some time of mental illness, how can we continue to brush this topic under the rug?

This post was written by Cathy Liu. Please contact with any questions.