Unhoused, Not Unwell: Rethinking Mental Illness and Homelessness
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).
Dear %firstName%,
"Steve" is smart, articulate, and kind. But years of surviving on the street had aged him well beyond his years. His beard, tattered clothes, and slouched shoulders reflected what his quiet voice confirmed—he was struggling.
Steve earned a master's degree from a world-renowned university, but no amount of education could protect him from a genetic predisposition to schizophrenia. The voices began in his twenties, a few years before we met him and he started volunteering with City Relief.
After several months of consistent service, Steve disappeared. We held onto a few of his belongings in the hopes that he’d return. Then a hospital social worker called. Steve had been involuntarily hospitalized by the NYPD. Though “stable,” they were preparing to discharge him back to the street. Thankfully, we were able to intervene and help transition him into supportive housing.
Not everyone who experiences homelessness is mentally ill, and not everyone with mental health challenges ends up homeless. While almost 50 million Americans struggle with some form of mental illness, there were just under 700,000 people counted on a single night in January of 2024 without a reliable place to sleep. This tells me that there are more variables that impact homelessness than mental health issues.
And yet, the myth persists—that people are homeless because they're "crazy" or "addicts." I believe this narrative lets us off the hook. If homelessness is "simply" a result of mental health challenges, we don’t have to fix broken systems—we can just medicate people and move on.
But the truth is far more complex. As Dr. Katrina Amber-Monta explains, "Our mental health is determined by a plurality of factors: our physical biology and genetics, the social structures and systems we are born into and participate in (family, friends, culture, society), and the psychological factors such as our emotions, beliefs, and self-esteem. When one of the legs (the social structures and systems) is faulty, we are at higher risk for mental illness."
That's not to say mental health challenges don’t impact homelessness at all. They obviously do. Living unhoused—exposed to violence, sleep deprivation, and constant stress—can erode anyone's mental well-being, while at the same time, maintaining economic stability is extremely difficult for those who are navigating a mental health crisis.
Over the next 8 weeks, with Dr. Amber-Monta's help, I will explore how mental illness and homelessness intersect—and how we can approach both with honesty, compassion, and practical action.
Until next week,
Josiah Haken
City Relief, CEO
