Root Causes: Mental Health, Addiction, and the Systems That Failed

The Myth of Personal Failure

Walk by a man sleeping on the street and most people make instant judgments: he made bad choices, he should get a job, he brought this on himself. The reality is more complicated and more tragic.

According to data from Tulsa's 2025 Point-in-Time count, 82% of respondents said their homelessness began in Oklahoma. 75% said it began in Tulsa. These are not drifters who came from somewhere else. They are our neighbors, our former coworkers, people who once lived in the same neighborhoods we do.

The number one reported cause across surveys? Lack of affordable housing. The number one reported need? Housing placement. Personal failure is a comforting narrative because it absolves us of responsibility. The data tells a different story.

Mental Illness: The Silent Driver

The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that approximately 30% of people experiencing chronic homelessness have a serious mental illness. In Tulsa's 2025 data, 28% reported that mental health conditions contributed to their homelessness, up from 19% the previous year.

These are conditions like schizophrenia, bipolar disorder, major depression, and PTSD. Untreated, they make it nearly impossible to maintain employment, relationships, or housing. The symptoms themselves, paranoia, disorganization, mood swings, isolation, push people away from support systems.

The deinstitutionalization movement of the 1960s and 70s closed state psychiatric hospitals without adequately funding community mental health services to replace them. The result was predictable: many people with serious mental illness ended up on the streets.

This is not a moral failing. This is a medical crisis without adequate treatment infrastructure. You would not tell a diabetic to just try harder. We should not tell someone with untreated schizophrenia to pull themselves up by their bootstraps.

Substance Use Disorders: Both Cause and Consequence

The relationship between substance abuse and homelessness runs both directions. For some, addiction leads to job loss, relationship breakdown, and eventual homelessness. For others, homelessness itself leads to substance use as a coping mechanism for trauma, exposure, and despair.

SAMHSA data indicates that approximately 38% of homeless people have alcohol use disorders and 26% have drug use disorders. Many have both. And many of those developed their addictions after becoming homeless, not before.

The opioid epidemic has accelerated this crisis. What begins as legitimate pain management for a workplace injury can progress to dependency, then to illicit drug use when prescriptions are cut off, then to homelessness when the addiction consumes everything else.

Treating addiction without addressing housing instability fails. Providing housing without addressing addiction fails. Effective intervention requires both, simultaneously, in a coordinated way.

Trauma: The Thread That Connects

Trauma underlies almost all chronic homelessness. Childhood abuse, combat exposure, domestic violence, sexual assault, witnessing violence, these experiences rewire the brain in ways that make stable functioning difficult.

Veterans are overrepresented in the homeless population because combat trauma is exceptionally severe. In Tulsa's data, 10% of those surveyed were veterans. In Oklahoma City, 7% were veterans. Many more have trauma that did not come from military service.

Trauma also intersects with both mental illness and addiction. PTSD often co-occurs with depression, anxiety, and substance use. The person self medicating combat nightmares with alcohol is not making a moral choice. He is trying to survive the only way he knows how.

Trauma informed care is not optional. Any program that fails to address underlying trauma will cycle people back to the street, no matter how many other services it provides.

Systemic Factors: The Triggers

Individual vulnerabilities only become homelessness when triggered by systemic factors. The person with mental illness might function adequately in affordable housing but cannot survive when rent exceeds income. The veteran with PTSD might hold it together until a job loss removes structure.

Each of these triggers is survivable with adequate resources and support. They become catastrophic when someone is already vulnerable due to mental illness, addiction, or trauma, and lacks family, savings, or community connections to cushion the fall.

The Men's Crisis: Why Men Fall Harder

Men make up 60% of the homeless population and 70% of homeless individuals. They are more likely to be unsheltered (39% vs 28% for women), more likely to be chronically homeless, and less likely to seek or receive help.

Why? Several factors converge:

• • Men are socialized to be self reliant and avoid seeking help
• • Fewer shelter beds and programs exist for single adult men compared to families
• • Men are more likely to have criminal records that bar them from housing
• • Men are more likely to work in industries (construction, manufacturing) where injuries lead to disability
• • Men are less likely to maintain family connections that provide safety nets
• • Men are more likely to be veterans with combat related trauma

The cultural expectation that men should handle things on their own becomes a death sentence when they cannot. This is why The Steady Ground focuses specifically on men: they are the majority of the problem and the minority of the targeted solutions.

What Actually Works

Understanding root causes points toward solutions. Effective intervention must address:

• • Mental health: On site psychiatric services, medication management, ongoing therapy
• • Addiction: Medical detox, recovery programming, long term sobriety support
• • Trauma: Trauma informed care throughout, specialized therapies like EMDR and CPT
• • Housing: Stable housing as foundation, not reward for completing programs
• • Employment: Job training, placement, and ongoing support for retention
• • Community: Peer support, mentorship, belonging to something beyond survival
• • Assessment: Comprehensive clinical evaluation to identify the specific combination of factors at play

This is the model The Steady Ground is built on. Not a shelter that manages symptoms, but a restoration community that addresses causes. Every resident and their family will receive the Stronghold Assessment, a 200+ question clinical evaluation developed by Dr. Hines that covers personality, empathy, trauma patterns, manipulation detection, and mental health screening. Most shelters hand you a bed. We hand you a clinical roadmap.

We know this approach works because we have seen it work with veterans. Now it is time to apply those lessons broadly.