Week 6: An Invisible Crisis that Requires a Visible Response
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).
Mental health is something I don't fully understand. Serious mental illness runs in my family, and chances are, it touches yours too. Maybe you've lived through a difficult season—depression, anxiety, or something harder—or walked with someone else through it. Mental illness is more common than we admit, and more complex than it appears.
Part of the challenge is that it often isn't visible. There's no cast or scan that confirms it, and treatment doesn’t look the same for everyone. What works for one person may not work for another. Even professionals sometimes have to try, wait, and adjust.
Now imagine navigating that complexity without housing. Sleep deprivation can lead to hallucinations. Hunger and exposure can destabilize even the most resilient person. Add trauma to the mix—something nearly every unhoused person carries—and the line between environmental stress and psychiatric illness gets blurry fast.
And yet, instead of mental health professionals, the first response many people get is from law enforcement. In cities across the U.S., police are the default for crisis intervention. Officers are often doing their best, but they're not clinicians—and shouldn't be expected to act like them. According to the Treatment Advocacy Center, people with untreated serious mental illness are 16 times more likely to be killed during a police encounter than other civilians. That's not a policing problem alone—it's a systems problem.
We need more compassionate, coordinated responses. Here are three steps that are already working in some cities:
1. Invest in Mobile Crisis Teams
Programs like CAHOOTS in Eugene, Oregon and B-HEARD in New York City send trained mental health workers instead of police to respond to nonviolent crises. B-HEARD resolved 95% of calls without police backup, connecting people to care—not cuffs.
2. Expand Supportive Housing with Services
Housing-first programs that pair stable housing with onsite mental health support improve outcomes significantly. One study found a 50% reduction in psychiatric hospitalizations and over 80% housing retention over several years. Housing gives people a foundation for healing.
3. Meet People Where They Are
Outreach teams in cities like Houston and Denver are showing the power of street-based mental health care and peer support. Building trust over time increases engagement and reduces the need for involuntary treatment or hospitalization.
These aren't silver bullets, but they're steps toward a system that sees people as human beings—not case numbers or code violations. When care is flexible, mobile, and rooted in dignity, fewer people fall through the cracks.
Thanks for reading and for staying engaged. Next week, we'll talk about the role of community and peer support in helping people recover—not just from illness, but from isolation.
With Gratitude,
Josiah Haken
City Relief, CEO
