Week 4: Mental Healthcare on the Streets
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).
I met Maria in Harlem on a brisk April day in 2020. The city had come to a standstill. The world was telling everyone to "stay home," but Maria didn't have one. We were standing under the Metro-North tracks on Park Avenue, handing out meals in a city that had shuttered itself. As an organization, we didn't know what the consequences would be if we kept showing up. But we knew what would happen if we didn't.
Maria told me her psychiatrist had fled the city without notice. No follow-up, no transfer of care. Without a provider, she couldn't get her prescriptions filled—her antidepressants, antipsychotics, or sleep medication. She was forced to turn to the local underground pharmaceutical industry to buy what she could and hopefully avoid getting locked up in the process.
While I listened, I realized something uncomfortable. It would be inconvenient for me if my doctor stopped prescribing my meds. I'd adapt. I have options. Maria didn't. And she's far from alone.
Even with stable housing, navigating the mental healthcare system in the U.S. is hard. But when you're unhoused, the barriers don't just slow people down, they stop them in their tracks.
Let me put that in perspective:
Nearly 1 in 5 U.S. adults lives with a mental illness, yet over 55% receive no treatment in a given year.
Among people experiencing homelessness, 20–25% live with serious mental illness—more than four times the national rate.
And fewer than one-third of those individuals receive adequate care.
This isn't about people not wanting help. It's about a healthcare system that is built for profit instead of progress.
Cost is the first wall. Therapy can run $100 to $300 per session. Psychiatry is even higher. Many providers don’t accept Medicaid—or only accept a few patients with it.
Then there's availability. Waitlists often stretch for weeks or months. That kind of timeline doesn't work when you're living outside or moving between shelters. Crisis doesn’t wait for an opening.
Then comes logistics. Accessing care often requires a photo ID, a mailing address, a phone number, transportation—all of which are out of reach for many people living on the street.
And layered over all of this is stigma. People with mental illness are frequently criminalized instead of cared for. Add homelessness, and you're not just invisible—you're seen as a threat.
The U.S. mental healthcare system was built around certain assumptions: that people have stability, privacy, money, and trust in institutions. The people who need care most are the ones it was never designed to serve.
We have to stop asking why people aren't seeking care and start asking why care doesn’t reach them.
So What Do We Do?
Fund street-based and mobile care teams that go where people are.
Invest in trauma-informed, low-barrier clinics that don't require insurance, ID, or proof of address.
Design systems with people who've lived this experience.
Mental health care isn't a bonus. It's a basic need. And until it's accessible to those navigating the trauma of poverty and displacement, we're not offering care—we're just offering a myth.
Thanks for reading,
Josiah Haken
City Relief, CEO
