The Vicious Cycle — How Homelessness Causes and Is Caused by Mental Illness
An 8-part series on the intersection of homelessness and mental health with input from Dr. Katrina Amber-Monta, a third-year psychiatry resident at Lehigh Valley Health Network (PA). Dr. Amber-Monta completed her undergraduate degree at Bennington College (VT) in 2003 where she studied music, and in 2022, graduated from Cooper Medical School of Rowan University (NJ).
We like clean categories—stories that move neatly from cause to effect. But homelessness and mental illness defy that logic. This isn't a one-way street. It's a loop. A feedback cycle. A system that wears people down until even the strongest begin to break.
Imagine sleeping outside for three nights. Then imagine three months. Or three years. Now add constant stress, exposure to violence, hunger, and isolation. This isn't just hardship—it’s trauma.
Dr. Amber-Monta explains, "Research shows that Post-Traumatic Stress Disorder (PTSD) physically alters the brain and body. When our bodies are constantly in 'fight, flight, or freeze' mode, the systems that regulate our biological functions become imbalanced. In the brain of a person who suffers from PTSD, the structures and circuits related to fear, survival, memories, perception, and executive functioning become abnormal. PTSD can alter gene expression and has been linked to chronic physical problems such as high blood pressure, high cholesterol, obesity, heart disease, chronic pain, fatigue, and decreased life expectancy. So it isn't any wonder how or why trauma, untreated, not only leads to mental illness but becomes a self-perpetuating feedback loop."
Study after study shows elevated rates of depression, anxiety, PTSD, and suicidality among people who had no mental illness before becoming unhoused. The longer someone is homeless, the greater the psychological toll.
At the same time, untreated mental illness can push people into homelessness. It can interfere with work, relationships, and housing stability. But it's often the lack of support that causes the fall, not the diagnosis.
I've been working in the streets long enough to see homelessness worsen a man's mental illness right before my eyes. I know a street artist who used to be a light hearted host to any volunteer that I introduced to him. Fast forward five years and now he is paranoid and explosive.
In order to break the cycle, I would argue the following steps would be a great a place to start:
1. We need to invest in more permanent supportive housing with on-site mental health care support. While not everyone experiencing homelessness suffers from mental illness, the intersectionality of this crisis requires a more comprehensive solution that includes permanent supportive housing.
2. We need specialized outreach teams, like City Relief's, that go directly to people in need with tangible help like food, water and clothing to build rapport as well as connections to services that understand and support people struggling with mental health challenges.
3. Anyone who works in an industry that engages people with a high percentage of mental health challenges should be required to go through mental health first aid training. This includes but is not limited to, police, EMS, firefighters, ER personnel, clergy, and direct service providers. And even if you don't work in these fields, it would go a long way for you to volunteer with an organization like City Relief in order to engage directly with people who might not fit into the stereotypical box of "mentally ill" or "homeless."
Overall, we need to shift how we think. Mental health is a housing issue. And housing is a mental health intervention. We can't solve one without the other.
Thanks for reading,
Josiah Haken
City Relief, CEO
