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Mental health issues not only contribute to homelessness but also may be consequences of it, says Keith Armstrong, LCSW, a clinical professor in the department of psychiatry  at the University of California, San Francisco (UCSF) and coauthor of Courage After Fire: Coping Strategies for Troops Returning From Iraq and Afghanistan and Their Families.  Some veterans, he notes, have no significant mental health issues until, and as a result of, becoming homeless. Sometimes, it is both.    

He poses, for example, a scenario of a veteran with psychological problems consistent with a diagnosis of PTSD who may not be able to take care of the basics in life, such as  paying bills. He may use what money he has on gambling, drugs, or alcohol—avoidant coping strategies to protect himself from the memories of his war experience. The combination  of substance abuse and trauma exposure, Armstrong says, can lead to homelessness, and once homeless, the vet may become depressed, and a cascade of psychological problems can occur.    

The mental illness piece of this tangled puzzle may be treated with medication, Shaheen notes. “That can be important, especially for removing the pain and suffering that comes  with the symptoms,” particularly those exacerbated by trauma and loss of friends and fellow vets during combat. But, he says, “We need other nonclinical and personal wellness-based strategies to treat the root causes and engage individuals back into a program of recovery and rehabilitation.”