Mental illness and homelessness intersect to form a wicked problem. So wicked that contemporary solutions are little better than they were 300 years ago when towns relied on jails to provide meals and a bed to those whose behavior was “strange” and their families would not or could not care for them. Current estimates are that two-thirds of those who are unhoused need supportive living facilities and mental health care. From reliance on jails, to the establishment of state-operated psychiatric hospitals, to deinstitutionalization, to reliance on jails and camping on the street, the problem has come full circle.
BaranyiG.FazelS.LangerfeldtS. D.MundtA. P. (2022). The prevalence of comorbid serious mental illnesses and substance use disorders in prison populations: A systematic review and meta-analysis. Lancet Public Health, 7(6), e557–e568. https://doi.org/10.1016/S2468-2667(22)00093-7
2.
BelenkoS.HillerM.HamiltonL. (2013). Treating substance use disorders in the criminal justice system. Current Psychiatry Reports, 15(11), Article 414. https://doi.org/10.1007/s11920-013-0414-z
3.
BuchheitW. (2020). The South Carolina State Hospital. History Press.
4.
CallahanR. F.RedburnS.LarsonL.RileyB. (2025). Reducing homelessness: An intergovernmental challenge. Public Administration Review, 85(5), 1288–1301. https://doi.org/10.1111/puar.13918
5.
DeeseA. W.FayeC. (Eds). (2016). Nineteenth century American asylums. University of Akron Press.
DurantR. F. (2020). Building the compensatory state: An intellectual history and theory of American administrative reform. Routledge.
8.
HarrisE. (2024). Two-thirds of unhoused people have mental health disorders. Journal of the American Medical Association, 331(21), 1795. https://doi.org/10.1001/jama.2024.7725
9.
KeseyK. (1962). One flew over the cuckoo’s nest. Viking Press.
MartinE. J. (2015). Affordable housing, homelessness, and mental health: What heath care policy needs to address. Journal of Health and Human Services Administration, 38(1), 67–89. https://doi.org/10.1177/107937391503800103
12.
MoselS.SharpA.FullerK. (2025, April1). Substance abuse and homelessness: Statistics and rehab treatment. American Addiction Centers.
13.
National Alliance on Mental Illness. (2025). Mental health by the numbers. NAMI.
14.
ParryM. S. (2006). Dorothea Dix (1802–1887). American Journal of Public Health, 96(4), 624–625.
15.
PolgarM. F.JohnsenM. C.StarrettB. E.FriedB. J.MorrisseyJ. P. (2000). New patterns of community care: Coordinated services for dually diagnosed adults in North Carolina. Journal of Health and Human Services Administration, 23(1), 50–64. https://doi.org/10.1177/107937390002300104
16.
RochefortD. A. (1984). Origins of the “third psychiatric revolution”: The Community Mental Health Centers Act of 1963. Journal of Health Politics, Policy, and Law, 9(1), 1–30. https://doi.org/10.1215/03616878-9-1-1
17.
SmithH. P.SitrenA. H.KingS. (2019). “A call to action” - Mental illness and self-injurious behavior occurring in jails & prisons. Journal of Health and Human Services Administration, 41(4), 16–44. https://doi.org/10.1177/107937391904100402
18.
SzaszT. S. (2010). The myth of mental illness: Foundations of a theory of personal conduct. Harper Perennial. (Original work published 1961)
19.
U.S. National Institute of Mental Health. (2024, September). Mental illness. National Institute of Mental Health (NIMH).
