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At dawn, the shelters send them back to the streets. Or they wake up beside the river, another day to wander downtown among the workers and tourists. Two-thirds of them, the chronically homeless of Denver, have this in common: mental illness. Just one-third of those with mental illnesses are receiving treatment, based on national estimates.

The causes of homelessness job loss, family breakups, alcohol and drug abuse often are rooted in mental illness, and treatment of mental health problems becomes even more difficult without a stable home.

Housing is health care, the best form of treatment for those with mental illness living on the streets. Yet Denver has a shortage of affordable housing, leaving nonprofits and government agencies to offer a patchwork of psychiatric services to the homeless that barely reaches beyond the most severe cases.

"All of these things work together to create a feeder system into homelessness," said John Parvensky, president of the Colorado Coalition for the Homeless. "Once people are on the streets, their mental health issues intensify. What might be mild anxiety becomes more significant anxiety. Depression certainly intensifies as well."

The need is far greater than nonprofits and government clinics can handle.

The coalition's mental health clinic kept a waiting list for new patients until a few years ago. The staff threw it out when it reached 2,000 names.

It was not "kind, useful or ethical" to tell people what number they were, and by the time someone on the wait list was up for an appointment, it usually was impossible to find them again, said psychiatric director Dr. Elizabeth Cookson. Now the psychiatric team accepts patients mostly through referrals from the coalition's primary care staff. An unknown number are turned away when the clinic is full.

The coalition has capped its waiting list for housing at 100 names, a dent in the thousands of homeless in the Denver area. There are now hundreds of people waiting, for months or years.

Homeless for a year

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For Colorado homeless with mental illnesses, housing is health care