People are afraid of the homeless in part because they fear that homeless individuals suffer from mental health disorders. This means they cannot be trusted, their behaviors cannot be predicted, and they could lash out irrationally at people passing by. This perception of mental health disorders is fueled by real observations, such as depressed homeless individuals, homeless people talking to themselves, or homeless people acting and behaving in strange ways. It is also used as an excuse to explain why people are homeless, how useless it is to try to help them, and why we don’t really need to help them (because they have mental problems and we can’t help them even if we wanted).
However, Elliot Liebow’s book Tell Them Who I Am suggests that this perception is at least partially wrong. According to Liebow, some of the homeless women he met did have real mental health issues and concerns, but those concerns and problems did not necessarily cause their homelessness. For many of the women he met, the causal arrow flowed in the opposite direction. He writes, “some women explained that their mental health problems were caused (not merely aggravated) by homelessness and shelter living, and there was nothing to do about them so long as one remained homeless. For these women, the remedy lay in housing rather than treatment.”
Homelessness and the loss of autonomy that comes from living within shelters was the cause of mental health issues for many women. The stress of homelessness, the unpredictability of shelter living, and insufficient nutrition created mental health crises for some of the women. Social isolation and the feeling of failure and worthlessness further contributed to mental health problems. Mental health problems didn’t always drive women into homelessness and poverty, but often homelessness and poverty did drive women into mental health problems.
One solution would be to try to treat the homeless with medications or therapy to solve their mental health challenges and open a pathway to a job and stable housing. Liebow suggests that this would not work for many of the homeless. Their mental health challenges in part stem from being homeless (something Matthew Desmond wrote about in Evicted) and what they need more than treatment is a stable place to live. A stable place to live can open a pathway to improved mental health, reintegration with society, and ultimately a job and all the things we want for homeless men and women. For mental health concerns, Liebow argues, housing must come first, not as a reward for getting things back on track.
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