May is recognized as Mental Health Month. It is estimated that 1/3 of the homeless population is suffering from some form of mental illness, though popular mythology will tell us that most, if not all, homeless people are “crazy.”
Former President Ronald Reagan is sometimes referred to as the father of modern homelessness, not just because he oversaw drastic budget cuts to Federal affordable housing programs, but also because he repealed the Mental Health Systems Act, which had the effect of closing most institutional mental health service centers.
From a Salon article from 2013:
President Reagan never understood mental illness. Like Richard Nixon, he was a product of the Southern California culture that associated psychiatry with Communism. Two months after taking office, Reagan was shot by John Hinckley, a young man with untreated schizophrenia. Two years later, Reagan called Dr. Roger Peele, then director of St. Elizabeths Hospital, where Hinckley was being treated, and tried to arrange to meet with Hinckley, so that Reagan could forgive him. Peele tactfully told the president that this was not a good idea. Reagan was also exposed to the consequences of untreated mental illness through the two sons of Roy Miller, his personal tax advisor. Both sons developed schizophrenia; one committed suicide in 1981, and the other killed his mother in 1983. Despite such personal exposure, Reagan never exhibited any interest in the need for research or better treatment for serious mental illness.
Much of the rhetoric in the 1980’s was about how patients at mental hospitals should have the agency to get the care they need. However, neither the housing nor support services needed to fully integrate former patients into their communities were provided. The result was that many suffering from mental illness were left to fend for themselves on the streets.
Luckily, today, most of the country understands that mental illness is a disease and that those suffering from a mental illness need and deserve treatment. The popularity of Housing First homeless assistance models rests on the understanding that folks who are chronically homeless, often with a mental illness, need ongoing access to appropriate treatment and care.
In 1996, the Mental Health Parity Act (MHPA) was signed into law, requiring that group health plans provide mental health treatment. Additionally, the Mental Health Parity and Addiction Equity Act of 2008, and the Affordable Care Act in 2010, extended the scope of mental health services insurers were required to cover.
Despite these legislative advancements, it remains difficult to access adequate mental health care. The expansion of Medicaid under the Affordable Care Act has been able to connect many homeless folks to care, but not all states have expanded their Medicaid offerings. Further, current attempts to add bureaucratic and counter-productive work requirements to Medicaid could decrease the number of poor folks who can access adequate mental health care.
Today, 40 years after de-institutionalization of mental illness patients, we still have not fully addressed the mental health needs of our residents, housed or not. See the below links for more: