The homeless mentally ill

Hundreds of thousands of Americans spend the night in shelters or on the streets, and a high proportion of them have serious mental illnesses. How this situation has come about and how to change it are questions that concern the general public as well as mental health professionals. There are signs that the beginning of a solution may be emerging.

About 600,000 people are homeless on any given night, and 2 million at some time in any given year. Over a five-year period, 2%–3% of the population, as many as 8 million people, will be homeless for at least one night. Of these, 80% find a home within a few weeks, but about 10% remain homeless for a year or more. The United States Department of Health and Human Services estimates the number of chronically homeless at 100,000–200,000.

About a quarter to a third of the homeless have a serious mental illness — usually schizophrenia, bipolar disorder, or severe depression — and the proportion is growing. A study published in 2004 showed a 20-year rise in the rate of psychiatric illness among the homeless in St. Louis. In the year 2000, 30% had a combination of mental health and drug or alcohol problems (dual diagnosis) and another 15% had mental health problems alone. A survey of more than 10,000 patients treated for serious mental illness in San Diego County found that 15% had been homeless during the previous year.

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