A recent investigative report highlights how psychiatric patients in the United States can spiral into homelessness and fragmented care. Centered on a Missoula, Montana case and told through a daughter’s voice, the piece shows how limited mental health services, unstable housing, and bureaucratic gaps push vulnerable people to the margins. As Thailand confronts rising numbers of unhoused individuals with mental illness, these findings offer urgent lessons for Thai policymakers, health workers, and communities.
K, 65, has lived without stable shelter in Missoula for eight years while managing schizoaffective disorder. An under-recognized symptom, anosognosia, makes self-awareness of illness difficult, leading to refusal of care even when it is available. Her daughter’s determined efforts to connect her with support illuminate a broader system failure. Underfunded psychiatric services, facility closures during the COVID-19 era, and budget cuts have strained Montana’s care network, resulting in cycles of crisis that land people in jail, ERs, or the state’s sole psychiatric hospital without lasting progress.
Data from research links these local stories to broader patterns. Studies show that homelessness is linked to higher rates of psychiatric disorders in both the United States and Thailand. In Bangkok, a systematic survey found that three-quarters of unhoused individuals meet criteria for a diagnosable mental illness, with depression, psychosis, and substance use much more common than in the general population. Suicidal risk among Bangkok’s homeless was alarmingly high, and alcohol dependence was prevalent. These insights underscore how substance use and mental health intersect to shape homelessness.
The Montana case demonstrates that short-term interventions—like brief hospital stays or temporary shelters—do not resolve the underlying cycle without stable housing and integrated supports. L’s experience reflects gaps in continuity of care and housing: loss of case management due to funding cuts, inconsistent shelter access due to medication side effects, and, in one instance, an adverse hospital medication error that set progress back. This personal narrative echoes findings from Thai research, where many people become homeless due to poverty, trauma, and untreated mental illness, and where lack of documents and transportation barriers compound barriers to care.
In Thailand, researchers have identified similar bottlenecks. A 2024 scoping review of 19 studies found that structural factors—poverty, family disruption, trauma, and mental health issues—drive homelessness. Once on the street, individuals face document shortages for health insurance, transport barriers, stigma, and a perception that the system is not built to help. Among psychiatric patients admitted from the street to Bangkok hospitals, many were diagnosed with schizophrenia and faced lengthy stays, often followed by discharge back to shelters or street life.
The overarching message from both the NPR piece and Thai research is that emergency, short-term responses do not break the cycle. In Montana, a proposed US$300 million mental health reform aims to expand group homes, create step-down facilities, and strengthen mobile crisis teams. Yet experts warn that housing support must accompany these reforms to be effective. Securing such housing remains a central challenge in both contexts.
Thailand faces parallel pressures. While universal health coverage exists on paper, people without stable housing or identification can be excluded from care. Local studies emphasize a shortage of on-the-ground mental health resources, and case management remains under-resourced. Cultural attitudes toward mental illness—stigma and family caregiving burdens—further complicate reintegration efforts. Community involvement, including religious and neighborhood networks, could be mobilized to support recovery and inclusion.
What next? Both international and local research point to clear priorities. First, stable, supported housing is essential for recovery. Combined with community-based psychiatric services and employment support, housing helps people regain independence. Second, training for shelter staff, police, healthcare workers, and social service staff is critical to prevent retraumatization and improve care continuity. Third, practical barriers—like missing identity documents or bureaucratic hurdles—must be addressed through outreach and community-based service models.
Thai society also needs to address stigma at institutions and within communities. Change will come not only from health ministries but from neighborhoods, temples, and local organizations willing to support rehabilitation and reintegration. Collaborative programs that draw on Thailand’s communal traditions—engaging monks, community leaders, and volunteers—could offer culturally resonant approaches to care.
The stories of K and L offer a cautionary but actionable message. As urbanization and inequality strain safety nets, Thailand and many countries will see more people like K unless comprehensive, integrated action is taken. The takeaway for policymakers, health workers, and citizens is simple: address homelessness and mental health together with compassion and coordinated strategies.
Practical steps for Thai readers include supporting community organizations that provide case management and outreach, urging officials for integrated mental health services, volunteering with shelters, and promoting social inclusion for people living with mental illness. As a Thai proverb reminds us, mutual support sustains us all.
Informed by research from leading health and social institutions, these recommendations emphasize long-term housing stability, continuous community-based care, professional training, streamlined access to services, and culturally grounded reintegration efforts.