Serious Mental Illness among People who are Unsheltered in Los Angeles — Colin Caprara, Dean Obermark, Janey Rountree, Robert Santillano, May 2022

This policy brief examines the prevalence of serious mental illness among unsheltered individuals in Los Angeles, showing how mental health conditions, especially psychotic disorders, shape homelessness duration, service needs, and housing outcomes, while highlighting gaps in care and system capacity.

0. What serious mental illness (SMI) is and how it relates to homelessness

1. Mental illness is present but not the primary driver

2. Psychotic disorders create the most severe barriers

3. People with SMI are deeply embedded in service systems

4. Housing systems are limited and insufficient

5. Inequality and measurement limits shape how we understand the crisis

⭐ Star Facts

• 45,021 unsheltered individuals were enrolled in street outreach programs in LA (2019–2020).
• Only 17% had a recorded serious mental illness (SMI) within 5 years → 83% did not.
• Within that, 10% had psychotic spectrum disorders (PSD)—the most severe category.
• ~60% of people with PSD were not placed into housing within a year, despite system contact.
• Overall, only 20% of all participants entered any housing program within a year → ~80% remained unhoused.
• Most placements were temporary:
  • 17% interim housing
  • 2.4% rapid re-housing
  • 1.5% permanent supportive housing
• People with PSD are highly system-connected:
  • 80% had prior homeless service contact vs. 31% without SMI
• Black individuals = 45% of those with PSD, vs. 30% of those without SMI → major disparity.
• Average time to housing is long:
  • ~107 days to interim housing
  • ~175 days to rapid re-housing
  • ~199 days to permanent housing
• Housing capacity is constrained:
  • Rapid re-housing was at ~100% occupancy
  • Permanent supportive housing at ~88% occupancy
• SMI is likely undercounted because data excludes undiagnosed individuals and those treated outside county systems.