New findings show majority of LA's homeless population has mental illness
Mental illness, substance abuse and physical disabilities are much more pervasive in Los Angeles County's homeless population than officials have previously reported, a Times analysis has found.
The Times examined more than 4,000 questionnaires taken as part of this year's point-in-time count and found that about 76% of individuals living outside on the streets reported being, or were observed to be, affected by mental illness, substance abuse, poor health or a physical disability.
The Los Angeles Homeless Services Authority, which conducts the annual count, narrowly interpreted the data to produce much lower numbers. In its presentation of the results to elected officials earlier this year, the agency said only 29% of the homeless population had either a mental illness or substance abuse disorder and, therefore, 71% “did not have a serious mental illness and/or report substance use disorder.”
The Times, however, found that about 67% had either a mental illness or a substance abuse disorder. Individually, substance abuse affects 46% of those living on the streets - more than three times the rate previously reported - and mental illness, including post-traumatic stress disorder, affects 51% of those living on the streets, according to the analysis.
The homeless services authority did not dispute what The Times found. Rather, Heidi Marston, the agency's acting executive director, explained that its report was in a format required by federal guidelines, leading to a different interpretation of the statistics.
“We're acknowledging that there are more layers to the story,” Marston said.
The Times analysis aligns with a national study released Sunday by the California Policy Lab at UCLA, which found even higher rates in most categories. It also found that a mental health “concern” affected 78% of the unsheltered population and a substance abuse “concern,” 75%.
The findings lend statistical support to the public's frequent association of mental illness, physical disabilities and substance abuse with homelessness. But neither the UCLA study nor the Times analysis suggests that these disabilities and health conditions alone cause people to end up on the streets. Elected officials and researchers largely agree that California's affordable housing crisis and poverty are the primary drivers of homelessness.
Rather, both the analysis and the study illuminate a population struggling with complex mental health conditions and physical disabilities that interact and grow worse as people remain outside. Both data sets found mental and physical impairments to be far more prevalent among those living on the streets than in shelters.
The Times found that 50% of unsheltered people had two disabilities at the same time and 26% had three all at once - a condition known as tri-morbidity. UCLA researchers found tri-morbidity in half the population they studied.
The UCLA study also found that, among those who had been homeless for more than three years, 92% had a physical health condition - anything from cancer to an abscess.
In Los Angeles County, 75% of homeless people are unsheltered and, in 2018, the statewide rate of unsheltered homelessness was about the same.
Californians living in poverty and on the edge of homelessness have been crushed by soaring rents and sky-high home prices in recent years. A 2017 study by real estate firm Zillow found that a 5% rent jump in L.A. County would leave 2,000 more residents homeless.
The research at UCLA, conducted by Janey Rountree, Nathan Hess and Austin Lyke, sought to offer empirical insight into a poorly understood community, Rountree said. The findings show a need for more attention to the physical and emotional distress of those on the street who are waiting for scarce housing opportunities.
She added that housing is crucial, but it won't alone solve “these very deep medical, mental health and substance abuse issues.”
“There really needs to be an examination of the inflow of the unsheltered population, and are there issues of access to medical care, mental health care and to substance abuse treatment that are just as important as thinking about how to house them immediately when they do become homeless,” Rountree said.
Los Angeles County's homeless initiatives - along with most initiatives across the state and the nation - emphasize what's known as a “housing first” strategy. The primary focus is on getting chronically homeless individuals off the streets and into permanent housing, where they can access services to address mental and physical problems.
But the number of chronically homeless people in L.A. County - at nearly 17,000 as of January and growing - far exceeds the housing and shelters currently available. Even the thousands of new units being built with help from the $1.2-billion Proposition HHH homeless housing bond won't be enough to close the gap.
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