In January 2025, New York City Mayor Eric Adams announced a $650 million plan to “address homelessness and mental illness,” touting it as the largest investment in the fight against street homelessness in the city’s history.
“When we came into office,” Adams said, “we said the days of ignoring people in need—on our streets and in our subways—were over.”
Adams is far from the only major officeholder to link homelessness with the prevalence of serious mental illness. In the past several years, both Democratic and Republican elected officials throughout the country have made similar moves in support of leveraging coercive treatment and criminalization against the unhoused population in an attempt to address record rates of homelessness. Adams, a Democrat running for re-election as an independent, and Democratic New York Governor Kathy Hochul have succeeded in forcing more unhoused people into mental health and substance use treatment. Similarly, California Governor Gavin Newsom, another Democrat, helped implement a state-wide court system in 2022 to compel people experiencing mental illness into psychiatric treatment under the threat of being placed in court-appointed guardianships. States such as Washington, Oregon, Georgia, and Louisiana have also passed legislation to broaden the criteria for involuntary hospitalization for mental illness or substance use disorders.
In advancing this agenda, these elected officials and the coalition of policy advocates behind them argue that untreated mental illness and substance use are a core cause—if not the core cause—of skyrocketing homelessness in the United States. Unhoused people, the narrative goes, are primarily homeless because they have failed to accept treatment and can no longer be easily forced into it. In fact, the primary cause of homelessness is a nationwide shortage of affordable housing. Millions of units of government-subsidized housing from decades past have been lost even as market-rate housing grows astronomically more expensive.
In casting the problem as an epidemic of individual pathology rather than one of political economy, these leaders have ignored the obvious economic reality: The rise of homelessness has resulted primarily from the hyper commodification of housing. In New York City and much of the United States, urban studies scholars Peter Marcuse and David Madden write in their book In Defense of Housing, “housing is becoming ever less an infrastructure for living and ever more an instrument for financial accumulation.”
The truth is that Adams’s and others’ rhetoric surrounding mental illness and homelessness stems from a decades-old misleading narrative that has fundamentally distorted the public discourse around both housing and mental illness alike. As private equity firms have purchased hundreds of thousands of rent-stabilized apartments in New York City over the past twenty-five years, this false narrative has served the interests of a political class beholden to the entire real estate industry. In doing so, it has caused real harm to some of the most vulnerable New Yorkers by attempting to decouple their material conditions from the economic and political forces that shape them.
Between the late 1930s and the mid-1970s, homelessness was relatively rare in New York City, even as the population grew by nearly one million. The rate of U.S. homelessness ballooned from 1929 to 1933 during the Great Depression. In response, significant New Deal-era investments in public and affordable housing on the federal, state, and city levels allowed working-class and low-income people to access new housing options in the city. In his famous “Second Bill of Rights” speech at the 1944 State of the Union, President Franklin D. Roosevelt called for the right to “a decent home” for every American.
But over the following decades, the federal government mostly retreated from its New Deal commitments to public and affordable housing, and instead largely turned the sector over to the private market and the real estate industry. In 1973, the Nixon Administration put a moratorium on the construction of new units of public housing and replaced federal housing assistance with a private housing voucher system known as Section 8—a system that the Reagan Administration then cut by nearly half, while also slashing funds for mental health care services.
The speed of the decline in subsidized housing was staggering. The total nationwide number of low-cost rental units in 1970 actually exceeded the number of low-income rental households. By 1985, the number of low-cost units had fallen by nearly one million, while the number of low-income renter households had grown by 2.7 million—creating a total shortage of 3.3 million units in the span of just fifteen years.
These policy choices were driven by an ideological shift around homelessness amid the transition from the New Deal era into the rise of neoliberalism. Under Ronald Reagan, homelessness was increasingly seen as a problem of individual behavior. Government-funded research focused on the prevalence of mental illness and substance use among the homeless population while failing, in historian Marian Moser Jones’s words, to examine “the relationship between homelessness and structural factors such as housing, employment, and social services.”
Even New York City, which spent much of the twentieth century building and maintaining public and affordable housing units for poor and working-class people, has now allowed the majority of its housing stock to become a commodity whose price is dictated by the real estate market. Between 1996 and 2017, the city lost 1.1 million units of affordable housing, while wages stagnated and both rents and home prices surged. A 2025 National Low Income Housing Coalition report found there were only thirty-four “affordable and available homes” for every 100 extremely low-income households in New York City; vacancy rates for units costing $2,400 or more a month were 3.39 percent, while vacancy rates for units costing less than $1,100 a month were 0.39 percent. The math is clear: In New York City, like most major metropolitan areas where homelessness is surging, there is simply not enough affordable housing to meet the growing demand.
Hochul and Adams have acknowledged the lack of housing and advocated for private development to fill the gap. They have pushed for the state and city to relax zoning laws and bring back tax breaks for private developers, to allow them to build hundreds of thousands of new private housing units. But they refuse to acknowledge that the primary driver of homelessness in New York City is the hyper-commodification of housing and the lack of government regulation of the private market—not just a lack of overall supply, but a specific lack of affordable or decommodified units.
Simultaneously, Hochul and Adams are advocating for a small amount of reinvestment in New York’s withered mental health care system: Hochul has introduced a plan to increase inpatient psychiatric treatment capacity by 1,000 beds, as well as create 3,500 new housing units geared toward people with mental illness statewide.
But an integral component to these proposals is their push for broadly expanding the use of involuntary psychiatric intervention. Their proposals would see both the expansion of court-ordered outpatient treatment, known as Assisted Outpatient Treatment or Kendra’s Law, and lowering the legal threshold for involuntarily hospitalizing people deemed unable to meet their basic needs. Involuntary treatment, they claim, must be a central pillar of any initiative to combat homelessness.
The data simply does not support this assertion. The vast majority of unhoused New Yorkers—almost 70 percent—are families with children, while only about 17 percent of all unhoused New Yorkers are living with a serious mental illness. The explicit aim of Hochul’s and Adams’s coercive approach is to remove unhoused people from public space, without doing anything to change the structures of power that have made so many New Yorkers homeless in the first place.
Conservatives have long pointed to the visibility of unhoused people with signs of serious mental illness as evidence that much of the current homeless population would have been institutionalized in generations past—a narrative that moderate Democrats have also embraced in recent years. But the vast majority of unhoused people are less visible to the public, living in shelters, temporary arrangements with friends or family, their vehicles, or encampments outside high-traffic areas. As a result of the 1979 class action lawsuit Callahan v. Carey, which created a right to shelter for all unhoused New Yorkers, 95 percent of unhoused people in New York City are living in city-run shelters.
Kim Hopper, a medical anthropologist and professor at Columbia University who was among the first to document modern homelessness in the 1970s in New York City, tells a different story about the relationship between homelessness and mental illness. As a graduate student at Columbia University in 1979, Hopper and fellow graduate student Ellen Baxter were commissioned by the Community Service Society (CSS), one of the city’s oldest charities, to conduct an ethnographic study of “mentally disabled persons” living on New York City’s streets. The dominant narrative about homelessness at the time, Hopper tells The Progressive, was that those living on the streets and in the subway system were primarily mentally ill individuals who had been discharged from asylums that had closed throughout the 1970s. Rising rates of homelessness in New York City were seen as the result of deinstitutionalization.
But while Hopper says that he and Baxter encountered some people that met the criteria for mental health conditions, there were many others who did not. Many of the unhoused people they met were young people without mental illness, some of whom were working, and nearly all of whom were living in the streets or subways as a result of job loss or displacement from affordable housing. Many did not have family or a social support network to fall back on and as a result ended up on the street.
Hopper and Baxter had expected to find mostly former inpatient psychiatric patients—“we had a strong psychiatric bias,” he admits. But instead, he says, “what we found was that many of these folks were not psychiatrically disabled. We found that this was a crisis of housing and affordability.”
The published report in 1981 caused a stir in New York City, with city officials arguing that Hopper and Baxter had used inflated figures for the number of homeless New Yorkers. What was undeniable, though, was that the report forcefully pushed back against the narrative that homelessness was the result of individual failure or pathology. As Moser Jones wrote in 2015, Hopper and Baxter “sought to reframe the core problem as one centered on the lack of housing more than one of mental illness, personal choice, or individual social failure.”
As part of their report, Hopper and Baxter also visited a former hotel that had been purchased by the Franciscans in 1978 and turned into low-income housing with supportive services for seniors and people with disabilities. At the hotel, Hopper and Baxter met many individuals living with serious mental illness who were given housing and supportive services, and found that these individuals were able to live stable and dignified lives without coercion. This directly contradicted the idea that serious mental illness and psychiatric disability were the root cause of homelessness.
The experience reaffirmed their research findings that the primary driver of homelessness was a lack of decommodified housing, rather than the inherent nature of mental illness—a theory that has since been borne out time and time again.
The federal government has not expanded the stock of public housing since 1999. Rates of homelessness have risen to their highest level since the Great Depression—132,000 New Yorkers slept in NYC Department of Homeless Services shelters in 2024, with thousands more sleeping on the streets or in the subways and parks. Meanwhile, the standard bearers of both parties, cowed by their real estate industry donors, offer no viable path foward.
“We’ve seen this before,” Hopper says. “This focus on involuntary treatment of those with mental health problems is not new, and it really is an insult to the public, who has seen this approach fail already in the past. The solution—the only solution—to homelessness is decommodified housing: housing that exists outside of the market and is available to anyone who needs it, regardless of ability to pay.”
A few weeks after Hopper’s interview with The Progressive, State Assemblymember Zohran Mamdani won the Democratic Party nomination for New York City mayor in a shocking upset victory. Mamdani, a democratic socialist, has put access to affordable housing and mental health services—without the expansion of involuntary treatment—at the center of his policy platform. Mamdani has promised to freeze the rent for all 1.5 million rent stabilized tenants in New York City in addition to building 200,000 new units of truly affordable housing.
Mainstream media outlets and establishment politicians across the country have been quick to paint Mamdani’s proposals as ill-conceived and unserious. It remains to be seen how fully Mamdani’s plan, if he secures office, can be realized in the face of stiff political resistance from a political establishment which has a clear material interest in maintaining the status quo. But history suggests that the only sensible path to ending homelessness is through massive public investment in truly affordable housing and non-coercive services for the most vulnerable.
“We can’t talk only about mental illness and housing and involuntary treatment,” Hopper says. “We need to roll all of that into a conversation around economic inequality and redistribution, a working-class politics that centers working people and their material conditions. That is the only way I see the change we need happening.”