While estimates vary, Catholic Charities’ John Sexton believes that at least a third of chronically homeless individuals suffer from mental illness.  

“People’s instability due to mental illness and not taking their medications can lead to them not being able to maintain relationships, hold a job, take care of themselves and many other things,” Sexton, who has worked with homeless people for 25 of the last 27 years, told Angelus News. “And people get very alienated from their families because families get exasperated dealing with their ongoing issues. So I think at times families just kind of bail because they can’t handle it anymore. And there’s nowhere for these folks to go.”

He described the stressful scenario homeless people face, even without mental illness, being deliberately ignored on the street day after day. “Just imagine how that feels. They don’t talk to anybody. Nobody talks to them. I think people go out of their way to avoid them,” he said. “I know it would affect me. So what do you start doing interior-wise to deal with that, to defend against whatever thoughts or feelings that come with that?”

And the longer people are homeless, according to Sexton, the worse their mental health is likely to get. “If you’re not crazy when you get out there, certainly it’s got to take its toll,” he pointed out. “I think myself and most people I know don’t like prolonged isolation. We might like periods of solitude. But that’s very different than just being shunned and alienated. So it has to take a toll.”

But the seasoned counselor, who is retiring at 64 next month, doesn’t blame people for not approaching homeless individuals trying to survive on the streets of Los Angeles, Santa Monica, Pasadena and other SoCal cities. If a guy is standing talking to himself in the middle of Wilshire Boulevard, or a woman is screaming profanities in a park, both might be in the midst of psychotic episodes and potentially dangerous. These episodes can be drug induced or not, he said, but they are “pretty scary.”

So what are the major forms of mental illness people on the street can be suffering from?

“A lot of depression,” he said. “A lot of issues with alienation or isolation. If we’re doing any kind of counseling, one of the things we look for is what kind of support network a person has. Because recent studies talk about that being one of the factors that predicts how well people will do in general. The more support they have, the more love they have, the more connections they have, it helps them.”

Sexton reported, as many other practitioners and researchers have noted, the problem of substance abuse among the hardcore homeless is rampant. The difficulty, he observes, comes in determining which came first or what led to what.

Helping individuals with serious mental problems can be hard when they come from stable environments and show up regularly for therapy or counseling sessions. What can professionals hope to accomplish with the homeless?

“I think I’ve learned over the years, and I’ve been at this a long time, to really scale back my expectation for what I can do,” he acknowledged with a quick chuckle. “I read a quote from Maya Angelou that says something to the effect that people might forget what you said to them. People might forget what you did for them. But people will never forget how you treated them.

“I’ve seen hundreds and hundreds of people over the years, but I don’t know if their coming to see me ever made a long-term impact, because I don’t see them again. So I try not to get too caught up in thinking about that because I’d probably get discouraged.

“But when they come, we have the opportunity to treat them with respect,” he said. “We have the opportunity to take them seriously. And I think a lot of people that we deal with, they feel like life or their family or people in relationship with them don’t take them too seriously — don’t take their pain very seriously. And I think we have the opportunity to do that.