Mental Health and Homelessness: Understanding the Connection

The Numbers: How Common Is Mental Illness Among Homeless Populations?

According to SAMHSA (Substance Abuse and Mental Health Services Administration), approximately 30% of people experiencing chronic homelessness have a serious mental illness (SMI). This includes conditions like schizophrenia, bipolar disorder, and severe depression that substantially interfere with major life activities.

In Tulsa's 2025 Point-in-Time count, 28% of surveyed individuals reported mental health conditions as a contributing factor to their homelessness, up significantly from 19% the previous year. This increase may reflect both worsening conditions and improved willingness to disclose.

The rates vary significantly by type of homelessness:

Importantly, while mental illness is overrepresented among homeless populations, most homeless people do not have serious mental illness. Homelessness has many causes, and oversimplifying it as a "mental health problem" can lead to inadequate responses.

How Mental Illness Leads to Homelessness

Serious mental illness can set off a cascade of events that ultimately results in homelessness:

Job Loss and Income Collapse

Mental illness often first manifests in adulthood, disrupting established careers. A man developing schizophrenia in his late 20s may go from stable employment to unemployable within months. The symptoms themselves (paranoia, disorganization, inability to concentrate) make work impossible, and the stigma makes finding new employment even harder.

Depression is particularly insidious. It saps motivation, makes every task feel impossible, and often goes unrecognized by the person experiencing it. A man may lose his job due to declining performance without ever understanding why.

Relationship Breakdown

Untreated mental illness strains relationships to the breaking point. Spouses cannot cope with erratic behavior, paranoid accusations, or the emotional absence of severe depression. Family members burn out trying to help someone who refuses treatment or repeatedly relapses.

Eventually, the support network collapses. The person is asked to leave the family home. Friends stop answering calls. The informal safety net that prevents homelessness for most people simply disappears.

Treatment Avoidance and Anosognosia

One of the cruelest aspects of certain mental illnesses is anosognosia: the neurological inability to recognize that one is ill. Approximately 50% of people with schizophrenia and 40% with bipolar disorder have some degree of anosognosia.

From the outside, it looks like stubbornness or denial. But the person genuinely does not believe they are sick. They see medication as unnecessary or as a form of control. Treatment seems like persecution. This is not a character flaw; it is a symptom of the illness itself.

Self-Medication with Substances

Many people with untreated mental illness turn to alcohol or drugs to manage symptoms. Alcohol temporarily quiets anxiety. Stimulants counteract the fog of depression. Opioids numb emotional pain.

This self-medication creates a secondary problem that compounds the first. Now the person has both a mental illness and a substance use disorder. This co-occurring condition is extremely common among homeless populations and requires integrated treatment to address.

How Homelessness Causes and Worsens Mental Illness

The relationship is bidirectional. Homelessness itself is traumatic and can cause or worsen mental health conditions:

• • Constant stress: The hypervigilance required to survive on the streets creates chronic stress that damages mental health over time
• • Sleep deprivation: Without safe, stable housing, sleep is fragmented and inadequate, worsening all mental health conditions
• • Trauma exposure: Homeless people frequently experience violence, assault, robbery, and witness traumatic events
• • Loss of identity: The shame and stigma of homelessness erode self-worth and hope
• • Medication disruption: Without stable housing, maintaining medication schedules is nearly impossible

Someone who became homeless due to job loss may develop PTSD from experiences on the street. A man with mild depression may see it become severe depression after months of homelessness. The condition creates a spiral that makes recovery increasingly difficult.

Specific Conditions Common in Homeless Populations

Schizophrenia and Related Disorders

Schizophrenia is dramatically overrepresented among homeless populations. Symptoms including hallucinations, delusions, and disorganized thinking make independent living extremely difficult without treatment. The visible symptoms (talking to oneself, responding to internal stimuli) often result in exclusion from shelters and public spaces.

Bipolar Disorder

The cycling nature of bipolar disorder creates instability. During manic episodes, someone may quit jobs, destroy relationships, spend money recklessly, or engage in criminal behavior. During depressive episodes, they cannot function. The unpredictability makes maintaining housing and employment extremely difficult.

PTSD and Trauma Disorders

Veterans with combat trauma, survivors of abuse, and people who have experienced violence are overrepresented in homeless populations. PTSD symptoms including hypervigilance, avoidance, and emotional numbing interfere with work and relationships. Substance use to cope with symptoms is common.

Major Depression

Severe depression saps the energy and motivation needed to maintain employment, relationships, and housing. The hopelessness that accompanies depression makes it difficult to take steps toward recovery. Without treatment, depression tends to worsen over time.

Traumatic Brain Injury

Often overlooked, TBI is common among homeless populations. Head injuries from accidents, assaults, or falls can cause cognitive impairments, emotional dysregulation, and personality changes that make independent living difficult. Many homeless men have undiagnosed TBI from previous injuries.

What Works: Treatment Approaches

Treating mental illness in homeless populations requires approaches adapted to their unique circumstances:

Housing First with Intensive Services

The evidence is clear: stable housing is a precondition for effective mental health treatment. You cannot address psychiatric symptoms in someone who does not know where they will sleep tonight. Housing First programs provide immediate housing without requiring treatment compliance as a precondition, then wrap services around the housed individual.

Assertive Community Treatment (ACT)

ACT teams bring treatment to people rather than expecting them to come to clinics. Multidisciplinary teams including psychiatrists, nurses, social workers, and peer specialists visit people in their homes, shelters, or on the streets. They provide medication management, therapy, crisis intervention, and practical support.

Integrated Treatment for Co-occurring Disorders

When mental illness and substance use occur together, they must be treated together. Programs that address mental health in one silo and addiction in another often fail. Integrated treatment recognizes that the conditions interact and must be addressed simultaneously.

Peer Support

People who have lived with mental illness and experienced homelessness bring unique credibility. Peer specialists can build trust where professional providers cannot. They demonstrate that recovery is possible and provide practical guidance based on lived experience.

Long-term Commitment

Recovery from serious mental illness takes time, often years. Short-term interventions rarely work. Effective programs commit to supporting people through setbacks, relapses, and the slow process of stabilization. This requires patience, resources, and a long-term view.

The Steady Ground Approach

Mental health is central to our model at The Steady Ground. We recognize that many of the men we serve will have mental health conditions, diagnosed or undiagnosed, treated or untreated.

• • Comprehensive assessment: Every resident receives a thorough clinical evaluation that includes mental health screening, trauma history, and cognitive assessment
• • On-site mental health services: Counseling and psychiatric care available without requiring off-campus appointments
• • Medication management: Support for medication compliance with direct observation when needed
• • Trauma-informed environment: Staff trained to understand trauma responses and avoid retraumatization
• • Long-term residential program: Time for stabilization without pressure to "graduate" before ready
• • Community and purpose: Brotherhood, meaningful work, and spiritual support that aid mental health recovery

Mental illness is not a disqualifier. It is a condition that requires treatment. With the right support, men with serious mental illness can recover stability, purpose, and independence.