Mental Illness for Sale: How Buffalo Profits from Pathologizing the Poor

In Buffalo, NY, you can’t just be homeless. You have to be diagnosed.

If you’re cold, hungry, jobless, and living on the street, that’s not enough to get you help. You need a mental health label. Not food stamps. Not a shelter bed. Not housing. Not job training. Not even socks or a bus pass. Not unless someone with a clipboard decides you’re clinically unwell.

Somewhere along the line, homelessness stopped being treated as a social issue—and started being monetized as a mental health condition.

Buffalo’s Mental Illness Requirement for Help

In Western New York, especially in Buffalo proper, many homeless service providers will not accept someone into a program—whether it’s transitional housing, shelter, or recovery—without a formal mental health diagnosis.

It’s not policy printed on public websites. It’s what actually happens on the ground. Shelter workers are trained to screen people into the system through “assessments” provided by the umbrella agency of the homeless center - yeah, no conflict of interest there! These assessments frequently result in a diagnosis, as that’s the only way the agency can obtain reimbursement.

Medicaid. OMH. HUD. It’s all tied to coding. And codes mean cash.

Diagnose to Be Deserving

No diagnosis? No help.

It’s not enough to be suffering and OBVIOUSLY dealing with mental health issues like anxiety if you are living on the street. You have to be diagnosed as mentally ill to be seen as worthy of compassion.

This creates a sick equation: poverty + label = services. poverty without label = nothing.

Agencies in Buffalo claim it’s about tailoring support. But talk to people on the street, and they’ll tell you: they’re told they must get diagnosed to get indoors. That they won’t be considered “chronically homeless” unless they’ve got a “serious and persistent mental illness” stamped on file. Appalling.

Who Profits in Buffalo?

The mental health system. Local nonprofits like Endeavor Health Services. Contractors running supportive housing. Behavioral health agencies billing Medicaid. Case managers with quota pressure.

Buffalo has a robust network of service providers, but many are financially dependent on labeling their clients. They need a diagnosis to justify their funding. And the more diagnoses, the more billing/money.

This is not care. It’s business.

And the people stuck in it? They know the game. They often play along. Because pretending to be sick is sometimes the only way to get off the street.

The Human Cost of Systemic Profit

Requiring a diagnosis does more than open doors—it shuts others permanently:

• Lifelong medical records follow people.

• Forced psychiatric treatment becomes part of the deal.

• Self-perception warps—many begin to believe the labels.

• Opportunities vanish: housing applications, employment, education.

People are being pathologized not because they’re mentally ill—but because poverty doesn’t pay. But a mental illness diagnosis? That unlocks funding streams.

A Buffalo Built on Billing Codes

Let’s call it what it is: We are not treating homelessness. We are monetizing it.

And Buffalo is no exception.

Local providers, city officials, and state-funded agencies must be held accountable for creating a system where the only way to survive is to become a patient.

There Is a Better Way

Buffalo doesn’t need more diagnosis-driven shelters. It needs:

• Housing First programs without strings.

• Services based on need, not billing.

• Respect for autonomy, not coercive “support.”

• Funding models that prioritize housing over healthcare codes.

Because until then, every warm bed comes with a price:Your identity.Your records.Your freedom.

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References:

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

2. Draine, J., Salzer, M. S., Culhane, D. P., & Hadley, T. R. (2002). Role of social disadvantage in crime, joblessness, and homelessness among persons with serious mental illness. Psychiatric Services, 53(5), 565–573.

3. Rosenheck, R., & Lam, J. A. (1997). Client and program characteristics as predictors of outcome in supported housing. Psychiatric Services, 48(4), 489–495.

4. New York State Office of Mental Health (OMH). (2023). Behavioral Health Medicaid Program Guidance.

5. United States Interagency Council on Homelessness (USICH). (2023). Fact Sheet: Housing First and Mental Health.