“It’s the saddest sound in the world,” said Joey, a homeless veteran who was begging on the street. “The sound of footsteps speeding up as they hurry to get by me. For most people, it would be better if I didn’t exist.”1

According to the most recently published official count, in January 2023, there were more than 650,000 homeless people in the United States, the highest number since annual surveys began in 2007. Some, particularly families with children, were dealing with transient life crises, but more than one-third of homeless individuals had a chronic pattern of living without shelter.2 Many in this group suffer from severe and persistent mental illness, addictions, or both. Whatever their health conditions had been before they became homeless, life on the streets is guaranteed to make them worse. As one shelter director put it, “The longer they stay here, the crazier they become.”3 A recent study found that the mortality rate for unsheltered homeless people in Massachusetts was 10 times that of the general population.4

It wasn’t always this way. Homelessness as we know it began in the 1980s, during the presidency of Ronald Reagan. Reagan himself opined that many such people were “homeless by choice.”5 In fact, the main contributors to this complex problem, which has become endemic in America, were his administration’s austerity policies, with deep budget cuts to disability benefits and social services and to the Department of Housing and Urban Development. These drastic cuts in the social safety net were implemented just as people with chronic mental illness were being discharged from state hospitals in record numbers.

Deinstitutionalization was adopted as a national mental health initiative........

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