Something is very broken for many of us who most need mental health care. We have only to look in our streets, in our jails, in once hidden corners of our parks, under bridges and overpasses, alongside our roadways..

What we are seeing today is a tragedy for millions of Americans. A tragedy that touches our own families. Our neighbors. Our friends. Ourselves.

It is the apocalyptic landscape we have created for too many people with serious mental illness in the decades following deinstitutionalization.

Serious mental illness, whether schizophrenia or bipolar illness, besets young people at the cusp of adulthood. Without early and intense intervention, many will experience challenges accessing care and enter a pipeline that moves into a revolving door of emergency and police intervention on its way to jail and the street. There ARE evidence-based practices. There CAN be hope. Yet such hope is often allocated unevenly across communities and service arrays have become a patchwork quilt, threadbare at best in the face of successive waves of retrenchment in budgetary support as military spending grows.

While there are those who manage in community settings – whether with family, shared residential settings, or on their own – this broken landscape is the chasm that beckons for those unable to gain a footing.

While the majority of the homeless are not seriously mentally ill, the homeless mentally ill are among the most vulnerable. They make up a third or more of this population, with substance and alcohol abuse overlapping and often initiated to self-medicate. And these conditions - alone or combined - make up 50-70% of the homeless population overall. What we too often fail to see is the enormity of pain and impact of these conditions on those who suffer and on their families.

• a woeful shortage of permanent affordable housing with meaningful work built around community

• adequate hospital beds and financial coverage for adequate inpatient or residential stays

• without widely available early identification, intervention and support, they and their families move into extreme duress

• treatment for most people with SMI has been confined to medication and some navigation with little attention to community, permanent housing, and work

• laws that make it harder to get people into treatment who may have no insight into their needing care - reducing rather than improving access and letting people ‘die with their rights on’. There should be a right to Rx
  
  The result?
  
  A cycle of destabilization that feeds on itself and creates an ongoing barrier to meaningful engagement in school and work, and to the sense of purpose and community that that conveys.