By Danielle Butchee
He had not stepped into a shower in weeks, his unkempt hair and unwashed clothes telling a story of neglect. She gripped a crumpled plastic bag brimming with outdated medication, mumbling fragments of a conversation that echoed only in her mind. This is the hidden crisis of Portland—not just the visible struggle of homelessness, but the quiet, relentless suffering of untreated mental illness that plays out each day on our sidewalks, in bleak underpasses, and throughout public parks. It lurks in every corner, weaving a complex tapestry of despair and isolation that often goes unnoticed by those who pass by. As of 2023, Oregon has the highest rate of mental illness in the nation and ranks worst for access to treatment (OPB, 2023). On any given night, thousands of Portlanders sleep outside. For many, their homelessness is not a cause but a symptom—a direct result of untreated trauma, post-traumatic stress disorder, bipolar disorder, and substance dependency. The city of Portland openly acknowledges the urgency, referring to homelessness as a “humanitarian crisis” that requires “coordinated, compassionate action” (Portland.gov, 2024).
But when it comes to mental health, compassion alone isn't enough—we need infrastructure, access, and accountability.
Where the System Breaks
Unhoused individuals who are dealing with mental illness and addiction often find themselves in survival mode. A 2020 national study revealed that co-occurring conditions, such as schizophrenia combined with opioid use disorder or trauma along with alcohol dependency, are common among unhoused people (Santa Maria et al., 2020).
Despite this reality, Portland's response has remained fragmented. Some shelters continue to enforce abstinence-only policies, denying beds to those who have not yet detoxed. Additionally, many shelters lack trauma-informed staff or onsite medical care. Consequently, individuals with the greatest needs are often the most excluded, leading them to cycle through emergency rooms, county jails, and street sweeps, all of which fail to provide sustainable pathways to recovery.
Even when assistance is available, it is often hidden behind lengthy waitlists. Caseworkers are overwhelmed, and long-term psychiatric care has become increasingly rare. In some discussions, Oregon leaders have even contemplated compulsory treatment, which would require individuals to undergo care as a last resort. While this approach may stabilize some lives, it raises ethical concerns about autonomy and consent within a system that has consistently failed to provide real options beforehand (OPB, 2023).
What Could Compassion Look Like?
Compassion means meeting people where they are. That starts with:
Harm reduction shelters that allow substance use but provide overdose prevention, clean supplies, and recovery services without judgment.
Housing First programs prioritize stable housing as the foundation for health.
Mobile crisis teams that dispatch social workers and clinicians, rather than police officers.
Permanent supportive housing that includes wraparound services for trauma, mental health, and addiction treatment.
We know these models work. Cities like Houston, Salt Lake City, and even Vancouver, WA, have all made measurable strides using coordinated Housing First approaches. In Portland, we need more of them—and more investment in making them sustainable.
Why Should You Care?
Because ignoring this crisis doesn’t make it disappear, it just drives it deeper into the margins.
Because it’s not just about someone else’s brother, mother, daughter, or friend—it could be yours. Healing cannot begin until people are off the streets, supported, and seen as worthy of care.
Every person deserves a chance to heal, to feel safe, and to be seen—not as a problem, but as a person with potential. By donating to New Narrative, you help transform isolation into support, trauma into resilience, and survival into recovery. Your gift powers mental health care, housing, and hope for those who need it most.
👉 Click HERE to give now and be part of someone’s turning point.
Refrences
Menza, T. W., Lipira, L., Bhattarai, A., Cali-De Leon, V., & Orellana, E. R. (2020). Prevalence and correlates of transactional sex among women of low socioeconomic status in Portland, OR. BMC Women's Health, 20(1), 219. https://doi.org/10.1186/s12905-020-01088-1
New Narrative. (n.d.). Donate. https://newnarrativepdx.org/donate/
Oregon Public Broadcasting. (2023, April 1). When homelessness and mental illness overlap, is compulsory treatment compassionate? https://www.opb.org/article/2023/04/01/oregon-california-when-homelessness-and-mental-illness-overlap-is-compulsory-treatment-compassionate/
Portland.gov. (2024). Homelessness response and action. City of Portland. https://www.portland.gov/wheeler/homelessness
Menza, T. W., Lipira, L., Bhattarai, A., Cali-De Leon, V., & Orellana, E. R. (2020). Prevalence and correlates of transactional sex among women of low socioeconomic status in Portland, OR. BMC Women's Health, 20(1), 219. https://doi.org/10.1186/s12905-020-01088-1
New Narrative. (n.d.). Donate. https://newnarrativepdx.org/donate/
Oregon Public Broadcasting. (2023, April 1). When homelessness and mental illness overlap, is compulsory treatment compassionate? https://www.opb.org/article/2023/04/01/oregon-california-when-homelessness-and-mental-illness-overlap-is-compulsory-treatment-compassionate/
Portland.gov. (2024). Homelessness response and action. City of Portland. https://www.portland.gov/wheeler/homelessness
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