Diagnosed to Be Deserving: How Mental Health Labels Are the Price of Surviving Homelessness

In many cities across the U.S., there’s a hidden cost to getting help when you’re homeless — a psychiatric diagnosis. This is happening now with an agency I work with,

and I find it repulsive.

If you're sleeping in your car, couch-surfing, or lining up at a shelter, chances are you’ll have to prove you're mentally ill to access services like housing, food, or support. Not hungry. Not broke. Not a victim of rising rent and vanishing jobs. No — you need to be “sick.”

This practice has become so normalized that few even question it. But let’s be clear: requiring a mental health diagnosis to receive basic human needs is not just bureaucratic — it’s coercive.

The System’s Unspoken Message: “Broken People Get Help”.

Service providers often frame this as “trauma-informed” or “needs-based” care. In reality, it serves as a gatekeeping tool. Funders want data. Agencies need to justify expenses. Diagnoses become the currency of legitimacy.

Here’s what that means for people on the ground:

• If you want help, you have to admit you're mentally ill.

• If you don’t fit a diagnostic box, you're labeled as “non-compliant” or “not ready for services.”

• If you refuse to take meds, you may lose your place on a housing list.

So the message becomes painfully clear: If you want shelter, say you're broken.

Diagnosis as a Weapon

This isn’t just unethical — it’s dehumanizing. Diagnoses that should be voluntary and therapeutic become transactional. It’s not about healing. It’s about survival.

People are often encouraged to overstate symptoms to qualify. Others are misdiagnosed just to check a box. And once you’ve been labeled, that label sticks — in your records, in future services, in the way people treat you. Try shaking it later.

Why This Is Harmful

• It pathologizes poverty. Not everyone who's unhoused has a mental illness. But when services are only available to the “mentally ill,” poverty gets recoded as pathology.

• It strips autonomy. Forced diagnosis means you don’t control your own story. A stranger writes it for you — often inaccurately — and you’re stuck with it.

• It creates dependency. When your housing, food, and medical care hinge on a diagnosis, there’s a built-in incentive to remain “sick.”

• It makes recovery risky. Get better, and you might lose services. What kind of system punishes healing?

We Can Do Better

People don’t need to be labeled mentally ill to deserve safety. They need homes, jobs, and respect — not psychiatric labels slapped on as tickets to eligibility.

It’s time we stop forcing people to trade dignity for support.

Because no one should have to prove they’re broken just to sleep indoors.

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References:

Hopper, K. (2003). Reckoning with homelessness. Cornell University Press.

Padgett, D. K., Henwood, B. F., & Tsemberis, S. J. (2016). Housing First: Ending homelessness, transforming systems, and changing lives. Oxford University Press.

Whitley, R., & Campbell, R. D. (2014). Stigmatization, mental illness, and homelessness: A cross-cultural review. Current Psychiatry Reports, 16(10), 1–9. https://doi.org/10.1007/s11920-014-0508-7

SAMHSA. (2014). Behavioral Health Services for People Who Are Homeless: A Treatment Improvement Protocol (TIP) Series 55. https://store.samhsa.gov/sites/default/files/d7/priv/sma14-4811.pdf

National Coalition for the Homeless. (2009). Mental Illness and Homelessness. https://www.nationalhomeless.org/factsheets/Mental_Illness.pdf