While Harris County is spending millions of dollars on mental health services and service-providing agencies to reduce the number of mentally ill people entering its county jails, activists on the ground are tackling the problem from another angle—by providing direct support to the county’s homeless population.
“We don’t have the best safety nets in Texas, and from the mental health standpoint, there really aren’t the mental health services available that people need,” Catherine Villarreal, director of communications at the Coalition for the Homeless, told TRNN. But Villarreal also stressed that, for people experiencing homelessness and/or mental health crises, the lack of healthcare resources and social support is a crisis unto itself: “when someone ends up homeless, often that didn’t happen overnight.”
In mid-April, the Houston City Council voted to fund $21 million in mental health resources, which include a service that would divert nonviolent 911 calls to healthcare professionals. The spending package also includes funds for iPads and HIPAA-certified software that will enable police officers to facilitate on-site telehealth appointments with mental health professionals for people experiencing an active mental health crisis. Houston-area groups such as the Coalition for the Homeless also collectively received $45 million in federal funds to combat homelessness in March, with the US Department of Housing and Urban Development allocating over $125 million for more than 200 organizations across the state of Texas.
Housing and mental health advocates like Villarreal, who have been calling for more funding for years, see the move as a step in the right direction. But some think more is still needed, especially to substantively help unhoused people in the state.
There are more than 3,000 people in Harris County and the counties surrounding it who are currently experiencing homelessness, according to a 2021 survey by Coalition for the Homeless. More than half of the homeless population in the surveyed area come from Harris County.
Mental illness affects a large number of unhoused people throughout the nation. Nearly 1 in 3 Americans who experience chronic homelessness have mental health disabilities, according to a 2018 report by the Center for American Progress.
Regardless of the damaging stigmas and stereotypes about the connection between mental illness and homelessness, there is no determinative relationship between the two. However, homelessness certainly exacerbates the effects of living with mental illness, and when other necessary supports are unavailable, mentally ill people can experience a heightened risk of becoming homeless. As Lilanthi Balasuriya, MD, MMS, Eliza Built, MD, and Jack Tsai, PhD, wrote in May 2020 for Psychiatric Times,
There is clearly a link between psychiatric disorders and homelessness; disentangling the nature of this relationship is complicated. Regardless of mental health status, people who are homeless generally have a history marked by poverty and social disadvantage, including considerable poverty in childhood and lower levels of education, and they are likely to belong to an ethnic minority. Mental illness had preceded homelessness in about two-thirds of the cases. Homelessness in turn has been associated with poorer mental health outcomes and may trigger or exacerbate certain types of disorders. For example, findings indicate that homelessness is related to higher levels of psychiatric distress and lower perceived levels of recovery from serious mental illness.
The overlapping experiences of struggling with mental illness and homelessness—and the effects that inadequate social support and inaccessible healthcare resources can have on people experiencing one or both—are especially pronounced in the criminal justice system, according to Nadine Scamp, CEO at Santa Maria Hostel in Houston. Santa Maria is Texas’ largest outpatient substance treatment and residential center, one that provides proper care for pregnant and parenting women.
“What we see is with homelessness… it is very easy to run into law enforcement, so you can get a ticket for being on the sidewalk,” Scamp said. “So when somebody has a mental illness and they are on the streets, it’s then compounded as it’s very difficult to be able to be stable, have access to your medications, access to a therapist, and be able to take care of everything you need.”
People who are homeless are much more likely to get arrested for nonviolent crimes like trespassing, panhandling, sleeping in a vehicle, etc. These arrests often lead to incarceration. It’s a cycle of instability that is exacerbated by a law enforcement-led social policy focused on criminalizing unhoused people for existing in public, rather than addressing the conditions that leave millions with few or no other options to avoid homelessness.
When police officers are the ones making initial contact with unhoused people, especially if it is in response to a person experiencing a mental health crisis, those interactions are often contentious and can be dangerous, Gabriela Barahona, a program associate with Texas Jail Project, told TRNN. The criminalization of mental health disabilities occurs when someone is arrested and incarcerated for experiencing a mental health crisis, rather than connecting that person to sustainable treatment. People who are experiencing homelessness and mental health crises are in need of resources and care so they can build back their life, not further criminalization that increasingly shuts them off from the rest of the world, forcing them into the invisible margins of society or into a prison. This is why activists like Barahona stress the need for more resources.
“Generational investments and permanent supportive housing is absolutely an answer that has been very effective in reducing the criminalization of people with disabilities,” said Barahona. “Just reducing the size and scope of police in general” is an essential step, but “as long as police budgets [remain] so dominant, [resources for] crisis intervention responses will still be given to those departments.”
The Harris County jail, a detention facility, is infamously known as one of the largest mental health facilities in Texas. The jail was treating more mental health cases than all of the county’s mental health facilities combined, POLITICO reported in 2018. Nearly 2,000 formerly incarcerated people in the county jail who were picked up for trespassing had previously sought mental health treatment with the county’s diversion program, according to The Harris Center for Mental Health and IDD.
“There were a lot of things and a lot of places where homelessness could have been prevented, and ideally there would be all these other safety nets in place to prevent somebody from falling into homelessness,” Villarreal said. “What they need is a financial safety net or a mental health safety net.”
Harris County has started creating those safety nets. The county, which includes Houston, created five diversion programs starting in 2018. The programs feature diversion courts, mental health deputies, and civilian outreach teams. The guiding idea for such diversion programs is to have options for responding to people who need help during a mental health crisis besides calling the police, who aren’t trained to handle or de-escalate those types of situations.
Becky Landes, CEO at The Beacon, a nonprofit organization serving Houston’s homeless population, thinks the problem stems from a lack of funds. The Beacon helps people by providing care and a range of services for individuals who are living on the streets, including hot lunches, laundry services, civil legal aid, counseling and mentoring, and more. They are a part of a broader homeless response network operating in the greater Houston area.
“The burden to provide an adequate level of funding lies largely with the state,” Landes told TRNN. “More funding for behavioral health services is needed to provide access to care to individuals experiencing homelessness as well as other community members.”
Texas has in many ways defunded public healthcare, but mental healthcare programs were never adequately funded to begin with. In 2003, state lawmakers cut the funding for community mental health programs by $101 million. The pandemic added an extra layer of complication—now the state has more demand than it has the capacity to fulfill. In 2021 Houston’s fiscal-year budget increased the police’s budget to $964 million, a significant jump from $836 million in 2020.
Until more lasting and substantial investments in community care and social safety resources besides police are made, organizers are determined to fill the gap. The alternative—i.e., leaving human beings in dire need to fend for themselves—is not an option.
“If folks need a place to stay, and they can’t be with their family because they’re in crisis, they should absolutely not be taken to jail,” Barahona said. “That is the absolute worst environment for a person in [a] psychiatric crisis.”
The Texas Jail Project, a grassroots organization based in Tyler, works with county jails to provide support for mentally ill people incarcerated in those facilities; organizers also do advocacy and enforcement work, like ensuring that the Sandra Bland Act is being followed and those in crisis receive proper resources.
The Act, which passed in June 2017, enacted new jail reforms that established better standards for mental health and substance abuse treatment; it also mandated the investigation of jail deaths. The final version of the bill, the passage of which was motivated by Sandra Bland’s so-called suicide in a Texas jail in 2015 after a contentious traffic stop, was stripped of many of the police reforms in the original draft.
Scamp, who helps run the Santa Maria Hostel, also notes that substance abuse often complicates the situation for many unhoused people in the county. Drug-related deaths in Harris County rose between 2010 and 2016, according to a 2019 report by the county health department.
“I think sometimes when we talk about mental health, we forget the substance use disorder component of that,” Scamp said. “So a lot of times I talk about behavioral health, which includes both the substance use needs [that] have to be addressed, as well as the mental health needs.”
Advocates on the ground are adamant that local policymakers and police departments need to stop criminalizing mental health and homelessness and start investing in community programs that will get them help instead.
“Before crisis, Harris County residents deserve more secure housing,” Barahona said. “Investing in more permanent supportive housing, investing [in] radical new ideas like universal basic income and guaranteed health insurance for all, I think, are critical.”
This article was produced in partnership with Just Media, a national hub supporting young writers covering justice issues.