Silent Voices: People with Mental Disorders on the Street

The Second Edition contains an expanded discussion of the Causes and Solutions to the crisis of chronic homelessness.

We avert our eyes when we meet them on the street: homeless mentally ill people with their hand-scrawled signs, shopping carts, and cardboard boxes. Because of the fear and revulsion they arouse in us, or the guilty relief we feel at our own relative good fortune, we fail to see—no, insistently deny—any human connection with them.

Still, we’re curious: How do these people end up on the street and how do they survive the stress and privations of such a life? How do they brace themselves against the elements day after day? How do they cope with their frightening symptoms, their drug addictions, the paradoxical mix of extreme danger and mind-numbing boredom that characterizes their existence? What combination of biological vulnerabilities, traumatic childhoods, drugs, mental disorders, and financial devastation brought them down? And how do some manage, against all odds, to climb out of this desperate situation?

Practicing psychiatrist, professor, and former commissioner of mental health Robert Okin spent two years on the street, meeting and photographing homeless individuals with mental illness to find answers to these questions. Using his ability to connect with the people he met, Okin masterfully brings them to life through stories and images that are intimate and gritty. These accounts are not only intrinsically interesting, they help us reflect on why these troubled souls living on the periphery of society should matter to the rest of us: Because we share their humanity. Had things gone differently in our lives, their plight could have been our own.

How often have we looked back in history at instances of great human suffering and asked with outrage how they could have been allowed to happen? We are living in such a moment today. The phenomenon of homelessness is taking place in our time, on our streets, on our watch.

In this second edition, Dr. Okin has written expanded sections on the causes and solutions to homelessness of people with mental disorders.  The first expanded section covers material on the lack of affordable housing, deficits in community mental health services, criminalization of the mentally ill, the values of American society, and other causes of homelessness among people with mental disorders.  The second section covers interventions that increase the quantity of affordable housing, the lessons taught to us by COVID, expansion of involuntary outpatient treatment, the creation of enlightened community services, creation of linkages of general hospitals and jails with supportive housing, and other crucial initiatives.

Both editions of the book are about hope, not just grief and despair. It challenges us to face the situation and do something about it, rather than simply look away.

Second edition

All profits from the sales of Silent Voices will be donated to homeless advocacy organizations.