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Many Homeless Have Mental Illness

Over the last year, I've been learning much as possible about homeless people with disabling mental illnesses, especially ones with psychotic disorders.

May is Mental Health Month, and I am a licensed professional counselor, so this might be a good venue and time to share some of what I found.

First, it's impossible for anyone to determine, with absolute certainty, the number of homeless Americans with schizophrenia or other psychotic disorders. These good people don't wear name tags letting you know they have a mental illness. It's a hidden disability. Most people with any form of schizophrenia, for example, can't hold a regular job.

Probably a little more than one percent of the general population has a form of schizophrenia, whereas the rate among chronically homeless people is probably just above ten percent, which amounts to a rate about ten times that of the general population.

A person with schizophrenia, in general, may have bizarre delusions, hallucinations, show grossly disorganized or inappropriate behavior, disorganized speech, emotional unresponsiveness, say few words, and be unable to initiate activities. Men usually acquire schizophrenia between ages 18-25 and women ages 25-35. Genetics play a role. A person right before onset usually experiences severe stress.

What makes the homeless population more of a concern, given their financial limitations and often their lack of healthcare insurance, is their strong likelihood of not having access to psychiatric care and medication, which is absolutely essential to managing these disorders.

People with schizophrenia tend to have poor insight into having it, leading many of them who aren't seeing a psychiatrist to not see a need for going, and the ones seeing a psychiatrist often to not comply with treatment. Many times the medication prescribed has almost intolerable side effects. Also, in some cases, the disorder itself tends to move people toward social isolation and away from seeking treatment.

For instance, one person I met preferred homelessness because being so enabled him to stay away from people he thought were persecuting him. His thoughts were a manifestation of a delusional disorder, akin to schizophrenia. This particular person likely never would apply for healthcare insurance (he didn't have any then) or see a psychiatrist due to deep-seated fears of what "they" would do to him.

There are other serious and persistent mental illnesses besides schizophrenia, including borderline personality disorder, bipolar disorder, and recurrent major depression. Other homeless people have these potentially disabling conditions, too. and Palmer Bus Service make this column possible.


Daniel J. Vance may be reached at