Chronic Homeless Need Help, But Lived Experience Counters Incarceration

gate to mental hospital
A personal reflection on the experience of inpatient mental health treatment followed by years of homelessness.

The latest fad(?) in solving homeless problems has been dominated by fed-up citizens endlessly encountering dangerous(?) chronic homeless people on the streets. Responding to the concerns of their citizens, politicians in a number of American jurisdictions have dusted off theories that are a century old at least. They are exploring involuntary institutionalization in mental hospitals. There, those with mental health problems and/or drug problems, supposedly can be effectively be treated and eventually released to become civilized, productive members of society1.

Does the theory work? The last half of the 20th century has seen a dramatic drop in the number of mental hospitals. Why? One possibility is that the treatment indeed works, but is too expensive. If so, budget conscious politicians climbing onto incarceration bandwagons should take note of past experience.

Another possibility: mental institutions don’t work all that well. This was the premise underlying a much viewed film ‘One Flew Over the Cuckoos Nest.’ That Hollywood vision of incarceration and ineffective mental health treatment undoubtedly had an influence on an international public audience. It no doubt contributed to the gradual emptying and closure of mental health institutions both in North America and elsewhere.

Chronic homelessness solutions involving those with mental health or drug abuse issues currently lean towards Housing First, which emphasizes assisting homeless people to access permanent housing. There they can participate in programs providing mental health and social support, which a hospital might refer to as ‘outpatient’ treatment. This approach, focused on a personal privacy and security, has proven to be effective as well as cost effective2.

Back to a nagging question: is involuntary incarceration/treatment effective? Let’s query someone with lived experience. Leif Gregersen, who lives in Edmonton Alberta, is not a big fan. Not homeless, but suffering from mental illness, Leif spent time in a mental institution. If his mental problems were diminished by the time of his release, his homeless problems were just beginning. Gregersen spent the next 12 years either marginally housed or homeless — pretty much the opposite opposite of the results that jurisdictions currently considering involuntary incarceration are setting out to achieve.

Should we take Leif’s experience into account? It turns out that Gregerson is a person of some influence in Edmonton’s war against homelessness. The city police employ him to help educate new recruits about homelessness and mental health.

He also has some tips on how an average member of the public can help people who are chronically homeless. His idea of what counts as effective help for a homeless person is not necessarily what comes to mind.

Read more about Leif Gregersen’s lived experience of both institutional mental health treatment as well as homelessness in The Edmonton Journal: Opinion: How to help the mentally ill homeless


  1. Try: U.S. East & West Coasts Flirt With Incarceration Programs For Chronic Homeless
  2. Current costs in Toronto indicate that supportive housing (at $2,800/month) has a lower cost than an emergency shelter bed (at $7,000/month) or a hospital bed (at $30,000/month). Read more about supportive housing in Toronto at NPR: This doctor wants to prescribe a cure for homelessness