Tag: homeless mentally ill

It Takes a Village to Tackle Homelessness: What’s Iowa Doing?

After I read Dr. Dawson’s post today “More on homelessness and violence as a public health problem,” it got me thinking about what the situation on homelessness of people with mental illness and substance use disorder is here in Iowa.

First, I looked at the 2024 Iowa Homelessness Needs Assessment, which is a thorough report you can download if you need it. It’s a 23-page pdf document which doesn’t mention the intersection with the homeless mentally ill until almost the very last page. It gets mentioned in the section subtitled “Improve Coordination With Adjacent Systems”:

To end or substantially reduce homelessness, a coordinated response is needed that aligns the resources in adjacent systems with CoC resources and housing. Homelessness is often caused by and/or exacerbated by the inability of public support systems to address the complex needs of people in extreme poverty experiencing housing crises. These systems include education, hospitals, behavioral health, criminal justice, and child welfare. Engagement and service delivery approaches need to be responsive to the particular needs of people at imminent risk or experiencing literal homelessness. More responsive adjacent systems will provide specialized engagement, enrollment supports, discharge planning, and coordination with CoCs in each region.

Typically, this kind of document makes me thirsty for a more granular, human connected account of what kind of person actually becomes homeless. Are they always dangerous? The answer is “no.”

Actually, there’s this human-interest Iowa’s News Now story published December 27, 2024, “A Closer Look: U.S. and Iowa homelessness reach record highs” (accessed July 28, 2025). It’s about a real person who became homeless despite being a University of Iowa graduate.

People become homeless for many reasons. I just want to mention resources that are available in Iowa that could be helpful. The website Homeless or At-Risk of Homelessness presents the idea that “Sometimes, life takes an unexpected turn. People face hardships and turn toward their communities for support.”

There are some people who struggle with mental illness and substance abuse and as a consequence of those challenges become homeless, as the Iowa Homelessness Needs Assessment above points out.

One resource I think is important is The University of Iowa’s Integrated Multidisciplinary Program of Assertive Community Treatment or PACT program. It’s an evidence-based treatment model that’s been around for decades in many locations in the U.S.

There’s also an Iowa Health and Human Services program called PATH (Projects for Assistance in Transition from Homelessness) to help homeless adults with mental illness, substance abuse and trauma.

This was just a quick and admittedly superficial summary of what Iowans have been doing about the homelessness crisis. It really takes a village.

Shout Out to Dr. George Dawson for Post “The Autocratic Approach to Homelessness”

I want to give a shout out to Dr. George Dawson for his post today “The Autocratic Approach to Homelessness” in reference to President Trump’s most recent executive order, “Ending Crime and Disorder on America’s Streets.” As a retired psychiatrist, I look back and remember seeing the problem of the homeless mentally ill a lot. You can read my take on it from last summer’s posts:

What About Bob?

Thoughts on the Homeless Mentally Ill

Thoughts on Hobos and Homelessness

I spend a lot of time joking around on my blog, but this is no joking matter. I think the President gets it wrong.

Thoughts on the Homeless Mentally Ill

The homeless man who lives on the sidewalk outside our hotel reminds me of a couple of things. One is Dr. Gerard Clancy, MD who is University of Iowa Health Care Professor of Psychiatry, Professor of Emergency Medicine, and Senior Associate Dean of External Affairs.

I remember Gerry, who was in the department of psychiatry when I was a resident. I saw his picture in the newspaper and hearing about him riding a bicycle around Iowa City doing a sort of outreach to the homeless mentally ill.

I found an archived article mentioning him published in 1995 in the Daily Iowan. The story starts on the bottom of the front page, entitled “I.C. opens new doors for area’s mentally ill.” It continues on page 9A.

The story mentions Dr. Clancy and what was called then the Clinical Outreach Services and the Emergency Housing Program (EHP). The challenges then sound a lot like what they are now: long waiting lists for psychiatric evaluation and treatment, a lack of funding for the treatment of mental illness, and a lack of preventive care. The most common mental illnesses in the homeless mentally ill are chronic schizophrenia, schizoaffective disorder, and bipolar disorder. The idea of reaching out to them “on their own turf” as Clancy was quoted, was to help them feel more comfortable talking about their mental illness.

The housing situation for this population of those struggling with mental illness was dismal then and it’s still dismal.

The homeless guy I’ve been calling Bob lives on the sidewalk next to a busy street. It’s just my opinion that he’s mentally ill based on my observations of his behavior. I’ve never tried to talk to him. However, Bob gets visits from people who obviously have differing views about the way he lives.

Some of them do talk to him and, although I can’t hear their conversations, the actions tell me important things. Some bring him what I call “care packages,” often food, water, and other items. They may start by acting kind, although may get impatient with him. Others try to clean up his sidewalk, and may criticize him. The police occasionally visit and have so far not taken him into custody.

It looks like things have not changed much since 1995 regarding the homeless mentally ill based on what I write here about my observations. In fact, it’s easy to find current news stories that say things are getting worse.

At the beginning of this post, I said I found a couple of things. The other thing was a very thorough teaching presentation about the current state of formal outreach to this population. It’s available on the web as a power point presentation by another University of Iowa faculty, Dr. Victoria Tann, MD, entitled “Assertive Community Treatment 101.”

Dr. Tann is currently an IMPACT Team psychiatrist. It’s an excellent source of background on the history of this effort at outreach to the homeless mentally ill. It also summarizes what’s happening with the program now.