Homelessness and Mental Illness

Whenever I answer the “what do you do for work?” question, one of the follow-up questions I almost always get is: “How many people are homeless because of mental illness?” It’s a logical question. Walking around downtown San Diego, or nearly any city in America, it won’t take long before you come across someone with noticeably poor hygiene who appears to be talking, often angrily, to the air. Seeing that same snapshot over and over again creates a certain impression.

Statistically, there’s a big correlation between mental illness and homelessness. Nearly a third of homeless people in San Diego last year were willing to admit to strangers (volunteer interviewers) that their mental issues were a significant factor in their continued homelessness. And that’s just self-reporting; plenty of others would be embarrassed to admit something like that, or are in denial.

The problem is that, behind the “homelessness and mental illness” question, there are often some underlying assumptions being made. Assumptions about who is worth helping, who is capable of change, who is worth the investment–and who isn’t.

Nothing has the power to change someone’s perspective like personal experience: getting to know mentally ill homeless folks on a personal level, hearing their stories, learning to love their idiosyncrasies, and yes, being driven crazy by their unreasonableness. You start to see that the snapshot of someone talking to the air downtown is just that: a snapshot. You see people on their good days, not just their bad days. You start to see that the fears, loves, and hates going on beneath the surface of the delusions are a lot more relateable–more normal–than they first appeared. And you slowly begin to realize how street life itself is a cause, not just an effect, of mental problems.

Consider our dear friend, Don. Don has schizophrenia and was homeless for four decades on the streets of San Diego. On the streets, Don had an unkempt beard, gnarly fingernails, a quick temper, and a tendency to growl and bite his own fist when he got upset. At first glance, it was hard to know how to help someone like him. Today, Don is being taken care of in a nursing home. His needs are met and he has a safe and stable place to live, perhaps for the first time in his adult life. Although his physical health is declining, his mental health is better than we’ve ever seen it. He still has some symptoms of schizophrenia and anxiety disorder, but he is calm, easy to talk to, clean-shaven, and content. Best of all, he has a clear and unwavering faith in Jesus.

Mental illness is a contributing factor in many people’s homelessness. But it is not the totality of who someone is, and it does not have to be the end of their story.

Coffee Time

One of our Ladle regulars is an older gentleman in his early seventies. He’s originally from the East Coast but has lived in California for decades. He tells me often about his time studying for the Catholic priesthood as a young man, his job as a schoolteacher, his beloved parents, and the time he met Katherine Hepburn when he was working at SeaWorld. Some weeks he stops by the church almost every day for a cup of coffee in the morning and some conversation.

He has good days and bad days. I wonder at what point in his life the symptoms of schizophrenia and bipolar began to set in and disrupt his life. I wonder what kinds of traumatic experiences he may have had that contributed to his mental disorders. I admire how he tries to maintain a semblance of normalcy and personal dignity; he always pays attention to his appearance and is proud of his academic vocabulary. And yet, I’m frustrated by how impossible it is to reason with him on his bad days.

He has no living parents or siblings. Never married, never had children. He’s alone in world, continually cycling through the revolving doors of hospitals, jail, psychiatric crisis centers…and First Presbyterian Church.

Despite his sometimes fragile grasp on reality, one thing he knows for certain is that he loves the Lord, and that the Lord loves him.

This church is a haven for him, and the closest thing he has to family. I haven’t seen him here for a few days now…and I’m missing coffee time.

Remembering Lloyd


Yesterday was the Rescue Mission’s annual candlelight vigil for the homeless who died on the streets last year. We grieved the lives lost, all 116 of them, certain that at least a few were known to us — including a family member of John, our director.

During the vigil, I couldn’t stop thinking about Lloyd. Lloyd was a middle-aged homeless man and a regular at our Ladle meals, where he came both for the food and for the kindness. His unrelenting alcoholism had kept him languishing on the streets for many years. He vacillated between apologetic despair and a simple faith in God that edged toward hope. He always expressed his gratitude to us for serving him and often seemed ashamed by his inability to repay the favor. On his good days, he had smiling eyes and a compliment for everyone. On other days, he kept to himself and just emanated sadness.

Last fall, Lloyd let me know privately that he had just been diagnosed with pancreatic cancer — stage four. He told me he was ready to die and that he hoped God would accept him. I saw Lloyd for another month or two after that, and then he stopped appearing at the Ladle. It’s now been almost a year since I’ve seen him.

At the vigil yesterday, John reminded us that our God is a God of the homeless and lonely. Even Jesus had “no place to lay his head.” Lloyd’s life and death mattered. I wish I could tell him how much he has been missed.

The Role of the Church

Even though the Christian Church has fallen out of fashion in many modern circles, we see every week (and sometimes every day) that people in crisis still turn to the Church for solace, banking on the kindness of God’s people. Especially because our church building is so iconic and so “churchy,” people frequently knock on our doors seeking everything from a bathroom, to a borrowed phone, to a word of encouragement or a shoulder to cry on. It’s striking to think that people still know that we as Christians are commanded by God to help the poor and show mercy to the hurting. In desperate moments, they depend on us to fulfill that commandment – and so, they show up at church.

Jesus’s greatest gift to the world is the gift of himself. Likewise, the greatest gift his people can give is the gift of themselves as Jesus makes himself known through them. When it comes to the plight of homelessness, the funding and services provided by government agencies are highly needed. And yet, the role of the Church – of people giving of themselves to others with the love of Christ – is invaluable and irreplaceable. Anyone can throw money at homelessness. It’s the Church that throws people.

For Christians, this means we ought to remember our sacred obligation to personally engage with the homeless and get to know them as fellow human beings, rather than outsourcing them as a “problem” for the government to deal with. It’s not the job of social services to love people. That’s our job as imitators of Christ.

For policy makers and service providers, this means that the Church’s role in the homeless community should not be overlooked. Many of the people we serve don’t trust anyone; and yet they trust us, as the only people who see them as people and love them with God’s love. This gives us a level of access into people’s lives that professional agencies need, and yet often miss.

I saw this happen today. One of our Ladle guests is enrolled in a local program for mentally ill homeless seniors. This morning, I was texting with his nurse about tracking him down and changing his medication. By building collaboration between the social service agency and our church, we are both able to serve and care for him so much better than either of us could do alone.

Being Family

One of the hardest realities about life on the streets, especially for the chronically homeless who have been out there for years, is isolation. You get the flu and no one takes care of you. Or, worse, you end up in the ER and no one goes with you. Many of our friends from the Ladle have no family, or they haven’t spoken to their families in decades. Many have become accustomed to highly solitary lives. Sometimes it’s painfully obvious: someone will be visibly jarred just by being spoken to, or being called by their name, or being touched.

The isolation of many homeless folks is especially highlighted when people go through medical crises. Hepatitis A is currently ravaging many of the homeless in San Diego, including some of our Ladle guests. This week we had to admit one of our most faithful attendees to the hospital for this disease. This individual has no living family members, and he has been isolated on the streets for a long time, suffering from episodic anxiety and schizophrenia. Yet he is truly a brother in Christ. His faith in God and his humble heart, despite everything he has gone through, is something remarkable.

John sat with him in the ER for half the night on Wednesday. Otherwise, he would have been there alone, physically ill and mentally troubled, with no one to speak up for him or make him feel safe in the uncomfortable and scary environment of a hospital waiting room. Our goal at the Ladle is to break into the isolation of our guests and become family to those who have no family; that’s exactly what happened in that waiting room.

I got to go visit him today, and another friend of his from church is going to see him tonight (despite this whole get-up the nurses make us wear). He is not alone. He is deeply loved, and he has a family.

“I feel like they’ll strap me down”

That’s what one of our guests said to me on Sunday when talking about why he doesn’t want to go to a traditional clinic for medical care. He’s usually referred to only with nicknames, although over the past six months he has shared his real name with a couple of us. As a young black man growing up in the South in the 1960s, he experienced a lot of abuse from “the system.” In high school, a gym teacher racially insulted him and he grabbed the man’s lanyard in defiance. That landed him in prison, since the judge counted it as “assault with a deadly weapon.” It’s not surprising that he distrusts institutions.

He loves the Ladle though. We’ve gotten to know him well. He makes money by washing and detailing cars, and he’s gradually growing his client base. We think he’s really got the potential to turn it into a legitimized business someday.

By giving him an opportunity to speak with doctors in a setting where he already feels comfortable and cared for, with people he already trusts, we’re able to give him access to medical care that he might not otherwise receive. That’s the whole point of Street Corner Care. He summed it up well when he said, “I don’t like going to clinics. But I like your doctors. You guys are the only doctors I’ll talk to.”