Michelle Turner was already grappling with post-traumatic stress related to childhood abuse when a death in the family, the loss of her nursing job and an eviction nearly sent her over the edge.

"You can be a strong person, but when three or four things combine, sometimes it’s a little overwhelming. I became homeless about a year and a half after losing my job. I never had to go on the street; if I had, I would have lost my mind," said the 61-year-old Turner, who received medical care and housing assistance from the Waikiki Health Center.

She said health center providers helped her transition from the Next Step Shelter to her own apartment, which since January has helped her healing.

"When you are living in an open area, things get stolen, people fight, and there are just a lot of personalities in one spot. There were 200 people at the shelter, so I would guess that makes about 500 personalities and about five of them were mine," Turner joked.

Turner is part of a population with highly specialized needs that saw much of their support cut over the past several years. Homeless service providers and advocates say coming health care improvements will help the state’s homeless people who suffer from mental illness. But, they say, the community won’t see real progress until stable housing is part of the mix.

"Being homeless is one of the most destabilizing events anyone can experience," said state Homeless Coordinator Colin Kippen. "Placing a person or family into housing as soon as possible reduces costs and increases measures of health, well-being and economic stability. This is the conversation that we need to be having at every level."

Kippen said he’s stepping up Housing First, which seeks to house and provide care to the most vulnerable homeless, many of whom have mental health or substance abuse issues. Through June, the program had housed 71 Oahu residents.

State legislators approved $1.5 million this year to expand the supportive-housing program to the neighbor islands.

Next year, Kippen said he will ask legislators to permanently fund the program, which is expected to cost up to $1.5 million annually. By the end of 2015, Mayor Kirk Caldwell’s Housing First pilot plan to help 100 of Oahu’s chronically homeless should supplement state efforts.

Institute for Human Services Executive Director Connie Mitchell said Housing First is most appropriate for homeless people who are severely impaired, mentally ill or have medical conditions. She said other programs such as transitional shelters, halfway homes, adult foster care and rent subsidies should also be bolstered to keep people who require less care from becoming homeless.

While many people with mental illness eventually wind up homeless, living in that condition manifests symptoms, said Marya Grambs, executive director of Mental Health America of Hawaii.

"We know there are an awful lot of sick people living on our streets," she said. "When you see homeless people and think they are mentally ill, it’s probably true."

IHS did a survey of the chronically homeless and found that 60 percent had mental illness and 45 percent had mental illness and substance abuse issues, Mitchell said.

She said despite some restoration of state programs, the number of homeless with mental illness is growing.

"In the last several months, we’ve had about a 50 percent increase in referrals from (the) Queen’s (Medical Center’s) inpatient psychiatric unit to our emergency shelter," she said.

There’s still some carryover from when Gov. Linda Lingle’s administration cut back on community health services, said Louis Erteschick, executive director of the Hawaii Disability Rights Center. He said the worst cuts eliminated the Assertive Community Treatment teams, reduced case management hours, and trimmed eligibility from about two pages of covered diagnoses to about two paragraphs.

"Some of Hawaii’s mentally ill homeless individuals became ineligible for case-management and housing services," he said. "If they had depression, PTSD or drug-induced problems, it wasn’t covered. Only the most severely impaired got help."

Scott Wall, vice president for the Community Alliance For Mental Health, said that’s when Hawaii went from running one of the nation’s best behavioral health systems to one of the worst.

"Up until 2008, Hawaii had the best system that I’d seen, including California, New York, Connecticut and Florida," said Wall, who is bipolar, was homeless and has navigated five different state systems, including Hawaii’s, over the past 45 years.

After the cuts, Wall estimates that Hawaii’s behavioral health services declined 45 percent.

"It wasn’t just penny-wise and pound-foolish; people died," he said "We also lost providers because with fewer clients they couldn’t get as much funding."