The apartment came up on the city’s alert system: a studio on a leafy street, one block from Prospect Park in Brooklyn.The location is extremely desirable – it would be a score for any single person hunting for their first New York rental, let alone someone who had spent years in the shelter system.But Diane, my client, rejects it outright.“As I’ve told you,” she says, “the prophecy apartment is on 40th and Amsterdam.”I remind her again that the intersection of 40th Street and Amsterdam Avenue does not exist in New York City.

I suggest, gently, that this might still be worth seeing.“Maybe just give it a look?” I say.We’re seated close together in my tiny airless office in the basement of a church, a space so small it once served as a clothing closet.Diane starts doing the thing where her eyes shift an inch above my head to address the voices and spirits that follow her throughout her days.This morning it’s Dionne Warwick, who reliably serves as the harbinger of any news that will jeopardize Diane’s fulfillment of “the prophecy”, which she has chased across seven states and seven shelter systems.

She begins to shout so forcefully the veins pop in her neck,She rebukes demons and even Neil Diamond, who sometimes conspires against Warwick,I sit there calmly, waiting for her to finish, then she drops her eyes and re-enters my world,“I’m sorry, but we cannot accept the apartment,” she says,It’s the fourth one she’s turned down.

Diane is one of many people I try to help each day who are caught between homelessness and serious mental illness.After a career in journalism covering war and poverty, I entered seminary and trained as a chaplain at New York’s Bellevue Hospital.I now serve as a mental health chaplain and clinical director at Broadway Community in Manhattan.We’re a small interfaith non-profit that runs a 19-bed shelter and a bustling soup kitchen in the basement of Broadway Presbyterian church, where I was ordained.We place no requirements on belief or affiliation; some people come for communion or spirituality groups, others simply for a meal and a place to sit.

New York City has the largest unhoused population in the country, and one of the tightest housing markets in the world.The vacancy rate for affordable apartments is under 1%.Outreach teams try to funnel people into roughly 40,000 supportive housing units across the city.Once people are housed, they tend to stay housed – and the cost is far lower than alternatives such as hospitalization or jail.But for neighbors living with delusions, paranoia and trauma, the path can be wildly complicated and mostly hidden from public view.

Often it’s interrupted by the very symptoms that already isolate them and keep them on the streets.Our job is to guide clients through a maze of bureaucracy that can overwhelm even an organized mind.We help replace lost IDs, apply for benefits, submit dense housing paperwork and connect people with doctors, medication and caseworkers while they wait months for interviews.In the meantime, we buy them a cell phone so they can reconnect with family and keep their appointments.Our free shower and laundry program helps them maintain dignity and social acceptance.

We encourage them to join us for meals in the soup kitchen and to make new friends,Eventually, if we’re lucky, we escort them to apartment viewings,One day, Jerry walked into my office covered head to toe in pink glitter,Jerry’s stories were always grandiose,He said he was investing in a cattle ranch in Montana where he would employ everyone in the soup kitchen.

A European prince, he told me, owed him $5bn,I had first met Jerry at our soup kitchen,He was middle-aged and well educated, and before landing on the streets had worked in the music industry, traveling all over the world,By the time he came to us he was living with bipolar disorder and prone to using drugs during manic swings,Jerry’s history of mental illness and years on the streets should have made him a clear candidate for supportive housing – buildings where staff help residents manage medications, benefits and medical care.

But in the rush to get people housed, a caseworker at a Bronx shelter instead secured Jerry a city voucher typically reserved for clients without serious mental illness or substance use histories,His long record of psychosis and hospitalizations went largely unheeded,Jerry moved into a studio apartment in a brand-new building, and the problems began right away,He was too ill to work, but the Social Security Administration had denied him Supplemental Security Income (SSI), which assists folks with proven mental illnesses,As part of his voucher, the city had agreed to cover Jerry’s “share” of the monthly rent, which amounted to about $220 of the overall sum.

But a year into his lease, the city still hadn’t paid his share and arrears began to pile up.Around this time Jerry entered one of his manic phases, typically punctuated by a signature flamboyance.One rainy afternoon he stood on the church steps and told Isaac Adlerstein, our executive director: “Send everyone in the kitchen home, I’ve cooked enough for everyone.” In his hands was an empty soup pot.Another day, he showed up in an orange jumpsuit from a correctional facility in a neighboring state.

Had he just escaped? We didn’t ask, just gave him a change of clothes and quickly pointed him to the restroom.Around this time, Jerry also became convinced that people in his apartment building were trying to kill him.He began looking haggard and said he was sleeping outside.We accompanied him to Bellevue hospital, where he was admitted to the psych unit for several weeks.Upon discharge, Isaac took him home only to be greeted at the door by a woman wielding a screwdriver.

She was a known crack user who lived on the streets and somehow found her way in Jerry’s apartment.She wouldn’t unlatch the chain so the super called the police to kick in the door.Once inside, Jerry discovered the woman had sold nearly all of his belongings to buy drugs: his mattress and furniture, clothing, even his can opener.Later, we learned that during his time outside, a police officer had picked him up and taken him to the city’s main men’s shelter on 30th Street.Jerry had filled out the intake papers and walked right out, never even spending the night.

Nonetheless, the intake was recorded in the city records and flagged by the agency that paid his rent.As a rule, you can’t live in city housing and a shelter at the same time, so they cut his voucher.I discovered this months later, when Jerry brought me a letter his landlord had slipped under his door saying he owed more than $15,000 in both rent and his individual share and was now facing eviction.He was quite fragile at the time: his hands trembled and he was having trouble walking.I accompanied him to New York City’s main housing office on 16th Street, where the clerk confirmed that he had lost his voucher.

She pointed us to another agency that could reinstate it, saying it shouldn’t take long,The next week, we trudged up to the Bronx and waited for an appointment with a case manager who said their caseload was so backlogged they couldn’t even look at his file,They gave him an appointment for October – three months away,When the appointment finally came, another worker assured us it was just a matter of getting his address re-entered into the city’s computers,Not to worry.

Meanwhile, Jerry went back into the hospital, this time for chronic insomnia that caused him to go weeks without sleeping.The sleeplessness was a symptom of his bipolar disorder, or perhaps a side-effect of the meds he was taking or the cocaine he sometimes snorted.Whatever the case, not sleeping seemed to awaken his mania and bring it on faster.The hospital stays grew longer, some up to six weeks.There were other fallouts.

In addition to losing his voucher, he had also been arrested several times for petty theft (hence the jumpsuit).During one incident at a deli, a security guard beat him with a golf club and left him with a concussion.Court notices began arriving in the mail.Our team scrambled to keep up – contacting legal aid lawyers, coordinating with an intensive mobile treatment team, and trying to stabilize Jerry’s medication.At one point, I counted a dozen different mental health professionals who were tasked at keeping him housed and out of jails and hospitals.

The eviction letters kept coming.Elsewhere, the ground was giving way.While Jerry was surrounded by doctors who managed his care, getting my other clients treatment was a constant challenge.In particular, we were worried about Diane, who had begun to decompensate.That is when someone can no longer cope with their symptoms, leading to the deterioration of their mental or physical health.

Our staff is careful to distinguish between what might be a momentary mental episode and full-on decompensation, which requires professional intervention and perhaps hospitalization,Calling 911 is always our last resort as these incidents can constitute additional trauma for our clients, but Diane was leaving us with no choice,She had verbally assaulted several other shelter guests, convinced they were possessed by demons,Then security called one night: Diane was standing on a table, yelling and refusing to get down,Once I arrived, I was more alarmed to learn she hadn’t eaten in over a week (“I will not eat the canine food you serve in this establishment!”) and was barely drinking water.

She looked thin and smelled of urine due to incontinence we suspected was caused by a urinary tract infection, which also needed treatment,The decision was easy,Isaac called 911 and four female officers arrived – despite him specifically asking for EMS – who despite her refusal and slight resistance carried Diane into a waiting ambulance and took her to a nearby hospital,But when the attending psychiatrist called me an hour later, she said Diane seemed “fine” and wondered what had prompted us to hospitalize her,I’d already played this game many times and lost, but still I made the case.

I explained Diane’s history of delusions and the “prophecy” that was keeping her from being housed and meeting her basic needs; I explained the recent assaults and erratic behavior and lastly, the hunger strike which was also tied to her paranoia,Harm to self and others, Diane checked both boxes for admission,The doctor shared that Diane had shown the triage nurse the scars on her back from where her “angel wings” used to be “but in speaking with her myself I see no reason to keep her”,Sensing I was getting nowhere, I pleaded they at least hold her overnight to test for the UTI, which in extreme cases can cause symptoms of psychosis,She agreed.

The infection was in fact confirmed and Diane was given a regimen of antibiotics.Two days later however she was back in our care, a bit more subdued but as delusional as ever.I believe that if Diane had gotten the psychiatric care she needed, if the hospital had admitted her for six weeks or more, like Bellevue had done for Jerry, and if she was willing to try medication, she would eventually stabilize to a point where she could be housed.I’ll never know the exact reasons the doctor discharged Diane (although in my cynicism I could list a few), but I do know that a lot of our clients with extensive psychiatric histories are savvy (or “clinically trained”) and know what language to use when speaking with doctors and others who potentially stand between them and their freedom.And who can blame them?As a clinician, I don’t make diagnoses and don’t put much credence in their overall usefulness.

However we needed one for housing, and I wanted a psychiatrist to accurately diagnose Diane so she could qualify for the categories best suited for her.A few months earlier, I had scheduled an evaluation with a doctor who worked with one of our partner organizations.In the biopsychosocial assessment that I’d prepared beforehand, I had indicated that Diane exhibited what appeared to be auditory hallucinations.I detailed the spiritual delusions, and shared a story about the time Diane found me in the soup kitchen and whispered, “Pastor, there’s a demon attached to my leg and it’s moving toward you, so beware.” (I had thanked her for the heads up and rebuked the demon just as casually, which seemed to satisfy her).

In the assessment, I had also detailed the heartbreaking story of a woman whose parents had abandoned her as a child but who had nonetheless managed to thrive, graduated with honors, completed a masters degree, and enjoyed a professional career until mental illness derailed everything.She had been in and out of hospitals for over a decade and homeless most of that time.As a chaplain and pastor, my job is to facilitate a language of faith that perhaps other clinicians cannot.For this reason, I assume Diane felt at ease expressing to me what was happening in her mind.In that way, our soup kitchen doubles as a kind of mental health day-program for folks whose behavior would otherwise isolate them from the rest of the world.

One of our regulars, Franklin, paces his own labyrinth through the tables while wrestling with the voices in his head.One woman sits with her face inches from the wall and eats her meals, a floppy hat pulled low over her eyes.Some find relief from their voices in our computer lab where we lend them headphones to watch endless YouTube videos and stream music.A sign on our wall declares our core values, which we try to embody and announce each day before lunch: “In this room: you belong here.You matter