The SCOTUS Decision on Homelessness May Increase Suicides

When the United States Supreme Court rendered its opinion in City of Grants Pass v. Johnson last month, it laid a foundation that could make the mental health of persons experiencing homelessness worse across the country. The Court’s 6-3 opinion reversed a lower opinion that the small Oregon city of approximately 40,000 people did not violate the Eighth Amendment’s cruel and unusual punishment clause when it established laws banning camping on public property, including local parks. Proponents, including Governor Gavin Newsom of California, assert the decision empowers state and local municipalities to protect their communities and the public. Homelessness advocates insist that the Court has made matters worse.

According to the Department of Housing and Urban Development, approximately 650,000 individuals experienced homelessness on a single night in January 2023, a 12 percent increase from the year prior. In Colorado, where I practice as an emergency department psychiatrist, statewide homelessness rates increased 39 percent in 2023. On a daily basis, many of these individuals arrive in emotional crisis for mental health evaluation, and the Grants Pass opinion stands to exacerbate an already overburdened mental health system.

Mental Illness and Homelessness Often Co-Occur

Mental health disorders and psychiatric illness are common among those without permanent shelter. Chronically unhoused adults are more likely to suffer from mental illness and substance use disorders (with alcohol being the most frequently used substance) than those with stable housing. Suicidal ideation is a common finding among persons experiencing homelessness, especially among children and adolescents. A 2024 meta-analysis of “runaway and homeless youth” demonstrated a 38 percent lifetime prevalence of suicidal ideation and a 27 percent lifetime prevalence of active suicide attempts.

The detrimental effects of involuntary displacement of persons experiencing homelessness are perhaps most evident for individuals with substance use disorders. Overdose deaths deserve special mention in this regard. A 2023 JAMA study showed that involuntary displacement and relocation of unsheltered individuals who inject drugs was associated with decreased 10-year life expectancy and increased chances of overdose. Displacement also resulted in less opportunity to deploy evidence-based interventions such as medication-assisted therapy for opioid use disorders (i.e., buprenorphine).

Suicide Rates are Higher After Incarceration

The Grants Pass opinion notes that “initial violations [of municipal code precluding encampments] can trigger a fine, while multiple violations can result in imprisonment.” Jailing of individuals experiencing homelessness incurs further risk of self-harm, compounding the elevated suicide risk many already face. A May 2024 study of 7.1 million adults released from incarceration in 2019 revealed that nearly one in five suicides occurred among adults who were incarcerated within the prior year. The authors also noted that 0.8 percent of suicides occurred during jail stays.

The Covid Pandemic Expanded the Demographic Facing Homelessness

The designation of “experiencing homelessness” has sometimes been cast as a product of mental illness or substance use. But the Covid-19 pandemic has toppled this mischaracterization. One in five adults with Covid-19 symptoms lasting three months or longer struggled with housing insecurity between September 2022 and April 2023, including difficulty with household expenses, being behind on rent or mortgage payments, or at risk for eviction. For many Americans who previously had stable housing, Covid made the possibility of homelessness more conceivable than ever before. The Supreme Court’s decision green-lights a governmental response against these and other individuals whose only apparent mistake was to fall ill to an unforeseen viral pandemic.

Some may point out that the opinion offered in Grants Pass v. Johnson should be more narrowly received. Writing for the majority, Justice Gorsuch noted that the impression that state and local governments have uninterrupted authority to dismantle homeless encampments is “gravely mistaken...we hold nothing of the sort.” Instead, the court held that “the only question we face is whether one specific provision of the Constitution—the Cruel and Unusual Punishments Clause of the Eighth Amendment—prohibits the enforcement of public-camping laws.”

Nevertheless, the court’s needle-like perspective cannot eschew the prodigious importance the decision likely has on policy and American public consciousness. Amicus briefs filed by several state attorneys-general in Grants Pass reflect the standing of these stakeholders, and there is cause to think that state governments may now redouble their legislative efforts in support of the supreme court’s decision.

“Homelessness is complex. Its causes are many.” On this point, the court’s opinion is hard to dispute. However, any effort to criminalize an individual for the shortcomings of faulty social systems is misguided. Los Angeles Mayor Karen Bass recently noted that cities cannot “arrest their way out of this problem." The lives—and humanity—of those affected demand a different solution.