Mental illness and violence among people experiencing homelessness: An evidence-based review

Abstract

The US media is saturated with coverage of perceived threats to public safety by people experiencing homelessness (PEH) with purported “mental illness.”

In a prescient 2017 article in the Journal of the American Medical Association (JAMA), then-Los Angeles health commissioner, Mitchell Katz, noted a sense of public “frustration with some of the behaviors of some homeless people,” ranging from “sidewalks being blocked by shopping carts, aggressive panhandling, and urination and defecation in public.” Such sentiments have intensified in recent years, as the number of PEH has surged, with frustration increasingly turning into fear.

With regards to media coverage, a series of articles suggested that nearly half of commercial sidewalks in San Francisco were “covered in feces,” leading to widespread public outrage. Meanwhile, a content analysis of 6,400 tweets regarding PEH collected over three months showed widespread generalizations that PEH posed a high risk of violence and that homelessness was caused by untreated mental illness.

Against this backdrop, this review seeks to harness our expertise in forensic psychiatry, addiction science, health policy research, social work, and adult psychiatry to highlight potential misinformation and provide an evidence-based update for clinical generalists. We will also discuss evidence-based solutions for PEH, describing why long-term custodial psychiatric care and involuntary psychiatric hospitalization is unlikely to solve the ongoing crisis.