31/01/2026
Don’t know about you but I rarely scroll past social media posts where someone rescues a stray and malnourished animal. We hit a ❤️ emoji and scroll on. But I was reminded recently how we don’t always stop and see when the homeless need our equal attention.
Yesterday, here in New York, the temperature was -10 C. A homeless man outside a coffee shop asked for change. His jacket was thin cotton. Nothing close to what you need, specially when wind chill feels even lower. I asked if he had a winter coat; he didn’t. He told me how the hospital had discharged him the day before and that he’d been outside since.
I rushed back to my hotel. Gave him my spare winter coat, bought him coffee and breakfast.
The graph attached says enough. We didn’t close mental health institutions, we only moved them. Closing hospital beds looks like fiscal savings; immediate and visible. But these costs didn’t just vanish. They were just relocated to places that cost more yet help less.
Emergency departments became holding areas. Jails often became long-term care. In the US, about one in five people in jail live with serious mental illness. Streets become the gap between discharge and nowhere. Someone moves through emergency, gets released with minimal follow-up, ends up back in crisis. Then it happens again and the bill grows. A false economy. In some places, nearly three dollars are spent on prisons for every dollar spent on mental health treatment. Families stretch trying to fill gaps the system left open. Treatment becomes less likely.
Some countries have made different choices. Australia hasn’t always. We’ve found our own shallow savings by cutting back on mental health spending too. Places that funded community mental health early, and kept services accessible, see measurable returns. Research suggests spending on treatment brings value back through productivity and health. Some studies show four dollars returned for every dollar invested. People stay in work more often. Treating mental health as a utility instead of an expense changes what gets funded and when.
That man I met yesterday walked out of a hospital into freezing weather with no coat and nowhere to go. He’ll hopefully find somewhere tonight. Tomorrow the same question returns.
Society pays for mental health either way. Fund care earlier, when it still works and ultimately costs less. Leave it late and the bill expands through emergency services or incarceration. Calling it “savings” by shifting expense from treatment to criminal justice won’t reduce the total. It only moves the line item and decides who bears the weight.
Mental health isn’t an expense problem, it’s a social utility. Until we treat it that way, the cycle keeps turning and people keep falling through the gaps we pretend aren’t there.
If this piece has brought up difficult emotions for you, please know that support is available. You can call Lifeline at 13 11 14 for 24/7 confidential crisis support.