The complicated connection between mental illness and homelessness. Image by: Getty Images
When Phillip first found himself on the streets, he was sleeping in the bushes outside a hospital. After finding ways to make a bit of money, he was able to begin paying strangers to stay on their couches, but many nights, he feels safer in shelters or even in the protective bushes outside. "People take advantage of you," says Phillip. "You lose your property. You lose everything." Everything, for Phillip, consists of a heavy black bag of clothes, the Simon and Garfunkel T-shirt on his back and the dirty black ball cap he wears to shade his weathered face and tired eyes from the sun.
Around the time Phillip became homeless—he can't quite remember when—his mental health began to decline and his memory became confused. He started to see a therapist for help, but he admits his mind is not the same as it used to be. "I have pills because I cannot sleep," he says. "I hear voices, and they wake me up and I start to think someone's going to kill me."
In the more than 10 years that Phillip has been on the streets, he's been attacked three times, resulting in broken ribs, a head injury and a dislocated shoulder. Now 57, he fears that he won't ever escape the situation he's in. "I'm scared to be here," he says, "and I don't know what to do."
Mental illness doesn't cause homelessness
Phillip is part of the majority of homeless Canadians who struggle with mental illness. According to the 2010 report Housing Vulnerability and Health, more than half of the homeless and vulnerably housed individuals in Toronto, Vancouver and Ottawa reported a past diagnosis of a mental health problem. But, while mental illness is certainly prevalent among the homeless population, it doesn't cause homelessness as many believe.
Experts point out that the harsh realities of street life are actually conducive to poor mental health. Louise Bradley, president and CEO of the Mental Health Commission of Canada, calls it a chicken-and-egg situation. "In some cases, a chronic and severe mental illness might have contributed to homelessness, but in other cases, being homeless may trigger mental illness." Stress, problems sleeping and financial worries are issues that can impact mental health in the general population; for people sleeping on the street, these problems are often far more desperate. In some cases, the hardships of street life can also lead to addiction. "We all use different coping mechanisms," says Bradley. "Trying to find some kind of escape is understandable."
Paula Goering, affiliate scientist at the Centre for Addiction and Mental Health and professor in the departments of psychiatry and nursing at the University of Toronto, says unequivocally that, despite the prevalence of mental illness among homeless populations, mental illness is not driving people into homelessness. "Too often, people want to say it's something that's going on with the individual and their background and their health that's created this problem, and that ignores the social context," she says. Goering explains that a lack of social supports has created a trap that many individuals with mental health issues are falling into. "If there's not enough income and there's not enough affordable housing, then people who are the most disadvantaged are the most at risk."
Goering lists histories of physical and sexual abuse, unstable childhoods and family histories of substance abuse as examples of disadvantage that are common among homeless individuals. Interestingly, these factors are also more common among people with mental illness. "The fact that mental illness and homelessness coexist does not necessarily mean that one causes the other," she says.
While programs are available to help individuals like Phillip access care for mental illness and other issues, sometimes, finding the next meal can be prioritized over making an appointment. And, in the end, these programs, when used with other emergency responses, are simply a way of managing homelessness, not solving it. "People are homeless," says Goering. "Part of the solution has to be housing."
*Name has been changed.
Read more about the state of homelessness in Canada and what we can do to help.