May is Mental Health Awareness Month, and I had hoped to be writing a blog post about stories of hope, resilience, and recovery from mental illness. Instead, the murder of Jordan Neely on May 3, 2022, recorded on video in a New York subway, is another graphic reminder of how urgently we must address the failures of behavioral health and social policy for some of our most vulnerable and disenfranchised community members.

Mental illness. Homelessness. Racism. Poverty. Jordan Neely did not deserve to die. Yet our collective failure to address these intersectional oppressions continues to result in preventable tragedies for people who experience them. The data is staggering, and reveals a landscape of both human indifference and government inability to meet the fundamental public health and public safety needs of people with mental illness who are homeless.

Public and institutional stigma, as well as racism, experienced by people with mental illness who are homeless results in unwarranted assumptions and reactions by the general public. Police often arrest people who are homeless for crimes of poverty — but homeless people are also significantly more likely than others to be victims of crime. Mental illness, too, is a risk factor: According to the National Alliance on Mental Illness, studies have shown that people with mental illness are 23 times more likely to be victims of a violent crime than others. And finally, people with black or brown skin — who are disproportionately homeless — are also at an elevated risk of being victims of crime and police brutality. The risk of simple existence in public is much greater for those with serious mental illness who are homeless, particularly those of color, yet it is they who are regarded as an inherent public safety threat. Nothing illustrates this backwards reasoning more clearly than the murder of Jordan Neely and the apparent lack of accountability for his assailant.

Real Solutions

Our nation’s current approaches to both mental illness and homelessness are built on fail-first policies and funding. Over half (54.7%) of adults with a mental illness and 94% of people with a substance use disorder are receiving no treatment for their condition. The consequences of this gap are undeniable. It is estimated that 37% of people in prison, 44% of those in jail, and over half of people experiencing homelessness have a diagnosable mental illness.

Yet it doesn’t have to be this way. Policymakers across the country are giving unprecedented attention to mental illness and homelessness, implementing evidence-based interventions that can meet the needs of most people. These efforts are improving access to intensive, community-based services like Assertive Community Treatment, permanent supportive housing, and peer supports. Unfortunately, our efforts have so far been insufficient to meet the level of crisis that exists for far too many individuals, families, and communities.

We must demand that proven policy solutions be implemented at scale, with the goal that it will become universally unacceptable for a person experiencing homelessness, mental illness, and a substance use disorder not to receive needed treatment services and affordable housing — let alone for them to be killed as a result of their circumstances. Some of our nation’s systems to support health and stability have been neglected, and urgently need to be supported with sufficient resources to accomplish their mandates. Others have never been just or adequate, and must be rebuilt from the ground up with a new vision. In all cases, people with their own lived experience of the many challenges faced by Jordan Neely must be fully involved in charting the course toward a safer world for all of us.

As a leading voice in behavioral health, homelessness, racial equity, and social justice, TAC recommends the following framework:

1. Mental health and addiction are public health issues. Rather than exacerbating the problem with reactionary measures, elected officials and policymakers must enact policy, allocate funding, and develop upstream programs based on prevention, early intervention, treatment, and recovery supports. This is the only way to reduce dependence on a law enforcement response that frequently results in preventable injury and costly incarceration or institutional services.
2. Policy, financing, and program leaders must use a racial equity and social justice lens. All professionals who engage people who are homeless and/or have a mental illness or substance use disorder must be trained in racial equity in order to engage and serve people who face systemic barriers, including people of color, members of the LGTBQ+ community, and people with disabilities.
3. Social determinants of health are essential in addressing behavioral health needs and homelessness. For instance, access to safe, decent, affordable housing is associated with improved health outcomes and quality of life, but nowhere in the United States can a person with serious mental illness who is on Supplemental Security Income afford housing at the federally established fair market rent.
4. A trained, culturally competent behavioral health workforce is needed to meet this crisis. Federal, state, and local government agencies must exercise all of their authority to establish a workforce, inclusive of people with lived experience, that is sufficient in number and expertise, culturally competent, and adequately compensated, to meet the needs of people living with serious mental illness who are homeless.
5. Public education and awareness are essential. Stigma is real. Collectively, we must incorporate awareness about mental illness and substance use disorders, as well as homelessness, racism, and poverty, throughout our public health, educational, and other systems. Mental Health First Aid and other programs can provide critical basic understanding about mental health conditions so that the general public has a sense of how to respond.

Jordan Neely’s life ended tragically because it was undervalued on so many levels. In trying to understand who he was, I came across a video of him on a subway impersonating Michael Jackson. In the video, I watched him as a street performer using his artistic talent to bring joy to onlookers while trying to make a living. Many people tried to help Jordan Neely, but those efforts weren’t enough. We can and must do better.

Acknowledgment: These issues may trigger significant emotional and race-based traumatic stress, especially for readers living with mental illness and who are Black, Brown, and Indigenous. Please prioritize self-care and reach out to trusted sources for support if needed.