For people in mental health crisis, the effects of coronavirus are particularly severe
As governments across the United States are requesting, or mandating, their residents to “shelter in place” to help prevent the further spread of the novel coronavirus, acute anxiety grows exponentially one group in particular: our neighbors without housing.
Many U.S. residents have already lost their jobs, or risk future job loss, due to closures in the food, entertainment, and travel industries, as well as instability in the gig economy, which augures future financial hardship for millions. But, at very least, those of us with stable housing can follow guidelines to avoid crowds and public spaces for the duration of the outbreak to keep ourselves and the most vulnerable safe. For the nearly 900,000 homeless individuals across the United States, “just stay home” isn’t possible.
These disparities in who can afford to shelter in place aren’t just about who physically owns a home. They also point to deep inequalities in the American healthcare system. The COVID-19 pandemic has painfully highlighted and intensified the stark inequalities that already underlie Americans’ abilities to access basics like housing and healthcare. The high rates of homelessness threaten the country’s most vulnerable people with COVID-19 infection. But they also reveal the complex links between homelessness, overall wellbeing, and a third problem: the United States’ lack of a mental health safety net.
A Crisis for Vulnerable People
Homeless shelters are already overburdened, and even when there are available beds (though there’s no guarantee of this in many cities), most shelters can’t comply with recommendations that individuals remain at a safe six-foot distance. What’s more, homeless shelters themselves are often unsafe for vulnerable people, especially women and LGBTQ people, who experience a heightened risk of assault and abuse.
The crisis is particularly severe for individuals living in Washington State and California, epicenters of the coronavirus outbreak, and home to more than a third of the country’s homeless population. There are more than 150,000 homeless people in California, and more than 11,000 homeless people in the Seattle region alone. The crisis is also sure to have a severe effect in New York City, the city with the most cases in the U.S. as of March 19, and with a population of 80,000 people who lack housing.
High Rents Worsen Public Health
There are many complex reasons folks experience housing instability. Primary among them, of course, is a truth most of us would readily acknowledge: the rent is too damn high.
With rents and home prices across the U.S. rapidly outstripping inflation and wages, the cost of housing is simply unsustainable for most Americans. At the same time, rapid gentrification in places like the Bay Area, where the influx of high-paid tech jobs, and the accompanying, dramatic increase in rents, has rendered the regions’ low-income inhabitants increasingly vulnerable to housing instability.
Homelessness is a Mental Health Health Issue
Not everyone living in rapidly gentrifying areas, or suffering under- or unemployment, becomes homeless, however. One major determining factor in who becomes homeless: mental illness, and the inability to access affordable, supportive mental healthcare.
A host of inequalities undergirds this relationship. About 81% of people who experience mental illness report social discrimination, while 56% report employment discrimination. This contributes to high rates of unemployment among people with mental illnesses: around 80% of people receiving public mental health services are unemployed.
At the same time, homeless individuals are also disproportionately likely to have histories of sexual trauma or domestic violence. For example, 80% of homeless mothers with children have experienced domestic violence.
The interplay between all of these factors and other inequalities — like racial injustice and the effects of mass incarceration — often lead to chronic housing instability.
Inequality Harms Public Health
Homelessness and its connection to untreated mental illness were public health crises before the COVID-19 pandemic. Now, however, the pandemic is revealing the fault lines that develop from a lack of sustainable, affordable healthcare in the United States — including mental healthcare.
Despite Obama-era guidelines mandating that individuals receive or purchase healthcare coverage, in 2018, 27.9 million Americans lacked health insurance. At the same time, one in four Americans are unable to access medical care because of the high cost. In 2019, 137 million Americans faced financial hardship because of medical debt, which poses a burden so severe, many have had to put off life milestones like purchasing homes or having children.
Mental healthcare access is even more challenging. The United Nations has listed mental healthcare access as an important development goal, yet most Americans don’t receive the care they need. Obama-era insurance regulations stipulate that most insurance plans cover some forms of mental healthcare.
Still, every year, half of the 60 million American adults with mental health conditions go without care. What’s more, many people with mental health conditions don’t seek care at all, because of the deep stigma that still accompanies mental illness.
This creates a vicious cycle. When people can’t access affordable mental healthcare, the effects of their mental illness are exacerbated. This can lead to disruptions in employment, housing instability, and homelessness — which still further exacerbate mental and physical illness.
Crises Can Reveal Resilience
The COVID-19 crisis is a trying and frankly frightening time for most of us. But it also illustrates the possibility for our societies to react to hardship with collective strength, and with care toward the most vulnerable people.
The willingness of millions of people to put their daily lives on hold in order to protect more vulnerable community members is awe-inspiring. Meanwhile, forms of mutual aid — including restaurants repurposing to feed school children, and neighbors arranging funds for people who have lost employment — reaffirms the power of communities to care for one another.
State and local politicians make unprecedented efforts to house people without adequate shelter. California Governor Gavin Newsom announced that the state will allocate $150 million in emergency funding to helping the state’s homeless populations receive adequate shelter and care. Meanwhile, the federal government has passed provisions for free coronavirus testing and for paid sick leave and unemployment for some workers.
We Need Mental Healthcare for All
While we should embrace such emergency measures, they will not be enough to prevent society’s most vulnerable people from falling victim to the coronavirus or another such virus in the future. To do that, we need to invest in the long-term health of our communities.
This means free, universal healthcare for all, including mental healthcare. That also includes continuing the fight to destigmatize mental illness, and provide supportive housing and employment for those who need it.
Everybody deserves to have shelter, and everybody’s health is important, regardless of circumstances. Now, during a period when so much is being disrupted, is the time to decide what kind of society we want when we return to normalcy, and to recognize that it was never “normal” to allow such suffering in our own communities.
Experts predict the unprecedented crisis we are facing now will strain our healthcare systems beyond their capacity. But they also challenge us to envision a future society which is truly inclusive, and in which care — physical, mental, and social — is a right for all.