Gunther Stern: Homelessness is often a symptom of untreated mental illness

More than 3 million Americans — 1.1 percent of the U.S. population — have schizophrenia, according to the National Institute of Mental Health. But within the homeless population, between a fifth and a third are believed to suffer from schizophrenia.

Schizophrenia is just one of the disabling disorders of the brain that are overrepresented in the homeless population. Depression, bipolar disorder and personality disorders, as well as developmental disabilities like autism, severe learning disorders and intellectual impairments, are all present within the homeless population. Anything that impacts thinking, judging and perceiving too often leads to homelessness.

In all likelihood the influence of mental illness on homelessness is severely understated. Even the doctors I walked with on the streets of DC while I served as executive director of the Georgetown Ministry Center were not able to diagnose mental illness in many cases without repeated visits, so how can anyone conducting a survey be expected to get this in a 30-minute interview unless it is divulged? It is often not.

Anosognosia — a lack of awareness of one’s mental health condition — affects about half of all people with serious mental illness. People with anosognosia have no idea their thoughts are impaired. One man I used to work with went on and on about his identity being stolen by someone who applied for Social Security disability benefits using his name. What had really happened was at some point earlier in his illness he applied for and received Social Security disability benefits; as the disease progressed, he refused to accept the disability payments because they were for a brain disorder that he no longer believed he had.

Anosognosia is real. It is something that can be seen on brain scans. Obviously, if you don’t think you have a mental illness, you will deny it to a surveyor and you won’t want treatment for it. If you don’t get treatment for your mental illness, you will not get better, which leads many to social isolation and homelessness.

Among the homeless people I served on the streets here in Georgetown until I retired this year, just about all of them could be diagnosed with a significant disorder of the brain. These disorders often come with co-occurring substance-abuse disorders. People with disorders of the brain are far more susceptible to the lure of drugs and alcohol.

We talk about a lack of affordable housing as the primary reason for homelessness, but many of the people I have served express no interested in housing. We go back week after week, year after year. “Can I please help you get into housing?” we ask. The answer is often “No, not today,” or “I don’t have time. Maybe someday.”

Mental illness bends the mind in ways that we can’t understand, rendering people unable to manage their lives. Anosognosia makes it all the worse by blocking avenues to treatment. The only way to bring treatment to people who are highly resistant is through coercion.

You don’t allow your mother with dementia to wander off by herself. (By the way, anosognosia affects people with dementia, too.) If she disappears, the police will quickly jump into action. If, on the other hand, your adult child with schizophrenia wanders off and decides to live under a bridge, there is very little you can do. They must present a clear and present danger to self or others before we can legally intervene against their will — which means that the family of the woman living in squalor on a bench in a park can do nothing to help her because, even though she is there because of a delusion the CIA is secretly poisoning her food, she is doing nothing to immediately harm herself or others.

I cannot tell you how frustrating it is to watch, as I have, over the past 30 years, as people grow old and die on the street because we do not have the tools we need to intervene.  

Laws, policies and attitudes need to change in order to enable caring family members and treatment professionals to intervene before a son, daughter, mother or father becomes homeless — perhaps for life.

Gunther Stern is former executive director of the Georgetown Ministry Center.