[timbray]

I'm highly unconvinced of the proposition that most homeless are severely mentally ill; the data I've seen doesn't support it. That's some of it, and also addiction. But a lot of them just can't make the rent.

Agree on the underbuilding.

[xboxnolifes]

As an anecdote, two people in my family have been or are homeless (don't know their current situation) entirely because they are incapable of continually making basic, smart financial decisions. At the level of "I decided to just not show up to work today" or "I spent my entire week's pay on a new toy". They both received enormous financial and social support from various people in the family, but always eventually just end up spending all their money somehow, or they get fired, or even just quit their job(!). Both eventually ran away from the responsibilities they built up into a different state.

I don't know if we should call this inability to make basic, smart financial decisions a mental illness or not, but it's something. And these 2 people aren't/weren't even what I would consider visibly homeless. At least as long as you didn't see them living in their car behind a convenience store.

Starting with the framing that housing is just too expensive makes the problem simple. You build more housing, or you subsidize housing for these people, or somehow just inject money into services for them so they can get back on their feet. But if that's not the core issue for some or many of these people, how do you actually help these people? How does a society help people who are incapable of handling their own finances? That's where the hard questions begin.

[amanaplanacanal]

I doubt we will get to the end cause of all the issues in a conversation here, but my understanding is that getting people whatever kind of help they need is vastly easier if they have a roof over their head and a permanent address.

[xboxnolifes]

I agree. But one of these 2 people had subsidized housing through the state. It was incredibly cheap rent for the area. Cheaper than any housing can be just from building more. But they still lost the place after a few months because they did not pay rent and instead bought toys and quit their job. They were receiving money from the family, work opportunities from the family, the family walked them through all of their legal and bureaucratic needs, and the family took care of their children. But it was not enough.

For this subset of people, I don't see how you can help them without managing their finances for them. Even if you completely manage their finances, how do you help them if they just quit every job they get?

I never really thought about it much before them, but I think pretty often about the problem. How do you help someone who can't be helped? Even if you gave them free housing and a weekly allowance, they would still find a way to not have money for food before the next week.

[anon84873628]

It is a type of executive dysfunction or mental illness. They need to be in a conservatorship.

[slibhb]

Most homeless people aren't mentally ill. But those "huddling in the rain" mostly are, or are at least addicts.

Non-mentally I'll homeless people are rarely "street people". They live in a car or with friends or in a shelter. Plenty of them have jobs.

[pstuart]

A lot of the young ones are either escaping sexual abuse, thrown out by their family for their sexuality or rejection of religion, or aged out of foster care.

There is indeed a spectrum of homelessness from temporarily distressed to broken beyond repair. There's different actions for the different factions.

I live in the Portland OR metro and believe that the issue has spawned the Homeless Industrial Complex that thrives on extracting money to "help" but are incentivized to keep the problem going for their livelihood.

I'm not unsympathetic to their plight (I had been effectively homeless a couple times in my life). It bothers me to no end how this problem is mismanaged.

[tbrownaw]

There is a difference between "most homeless" (your comment) and "most visibly homeless" (comment you're replying to).

IIRC, most people who obtain "homeless" status only keep it for a short time, and don't live on the streets during that time.

You'll get very different statistics if you count transitions into (or out of) homelessness over some window, vs systematic point-in-time counts of current homeless status, vs point-in-time counts of people camping on the street, vs trying to measure QALYs.

[FireBeyond]

One of the challenges here as an ex-paramedic in the PNW who has certainly seen their fair share of homeless is that several of the more prominent studies use HUD's definition of "severe mental illness" that is far more conservative than you or I would expect...

"Requiring hospitalization more than once a month, on multiple occasions in a year".

And that number, per HUD, is 22%.

If you want to look at "untreated mental illness" in the homeless, now you're above 50%.

[jakefromstatecs]

> If you want to look at "untreated mental illness" in the homeless, now you're above 50%.

But "untreated mental illness" isn't the same as "mental illness that requires institutionalization" which is what the OP is saying.

Additionally, a lot of mental illnesses can be reasonably managed with proper medication, and in my mind very, very few actually require institutionalization. But we as a country can't even get behind the idea of universal healthcare for non-homeless let alone homeless people. Somehow institutionalizing them seems more feasible or reasonable than just covering their medical care?.. I don't get it.

[FireBeyond]

That's true, and it blows my mind that that's the first or even high on the list of "ways we can help with this".

I do think there's a Venn diagram around severely mentally ill and untreated mentally ill that might require more intensive care. There's also the complexity that drug use and abuse is a method to cope with the emotional pain of homelessness (as one of my instructors said, "if my existence was reduced to fishing rained-on food out of trash, brushing cigarette ash off of it, sleeping and shitting in alleyways, often without something to effectively wipe with, you better believe I'd be on a fast path to taking some drugs to numb that"), or for "self-medication" of said untreated mental illness.

[Uhhrrr]

This meta-analysis puts it at 67%: https://jamanetwork.com/journals/jamapsychiatry/fullarticle/...

What data have you seen which doesn't support it?

[aidenn0]

Good thing that GP didn't say that most homeless are severely mentally ill.