Challenges in the provision, accessibility and corresponding treatment gaps in mental health services in India and other low- and middle-income countries have been the subject of considerable discussion in recent times. Moving away from frequently acknowledged macro concerns, a few recurring, persistent problems remain insufficiently analysed. This article aims to capture the complexity and distress caused by the co-occurrence and interrelatedness of poverty, mental ill health and homelessness. It examines the ramifications of this nexus in domains including health systems and access to healthcare, productive living and full participation, social attitudes and responsiveness, and the development of human resources and leadership in the social sector. It also discusses the failure to engage with these issues which results in greater vulnerability, distress and social defeat among the affected populations.