Homelessness impacts communities large and small, resulting in over 500,000 individuals in the U.S. alone who live without permanent housing, on any given night.
Among its many detrimental effects, homelessness causes mental health issues to worsen, with untreated mental health conditions increasing the risk of poverty and, eventually, the lack of secure housing. These individuals have fewer resources to address such significant issues, creating a highly vulnerable population.
Read on to understand more about homelessness, mental health conditions, and several risk factors for both issues. Then learn about identifying barriers and some proposed solutions to improve outcomes.
Though accurate mental health and homelessness statistics are challenging to compile, these figures paint a broad picture of the greatest areas of concern facing individuals without secure housing.
Estimates of homeless individuals with mental health conditions vary widely. In high-income countries, such as the U.S. and the United Kingdom, one comprehensive research study review reported that approximately 76-80% of individuals without secure housing have a current mental health condition. While this is an alarming number, less is known about the prevalence in low- to middle-income countries, where trauma symptoms and severe housing shortages likely play a more significant role.
And due to the transitory nature of homelessness, some individuals are among the “hidden homeless.” Individuals and families migrating between countries, refugees, and those staying temporarily with friends or family are often not included in these statistics.
The most common mental conditions among homeless individuals are listed below, with the prevalence in the general population for comparison.
Substance Use Disorders: Individuals have difficulty or are unable to control their substance use even when faced with significant and repeated negative consequences such as not fulfilling major life responsibilities or maintaining good health.
Alcohol Use:
Drug Use (methamphetamine, marijuana, opioids, cocaine, etc.):
Major Depression: Individuals experience a persistently low mood and a diminished ability to feel pleasure, and may also feel a lack of confidence, have disturbed sleep and appetite, and have low energy.
Schizophrenia Spectrum Disorders: Individuals experience psychotic symptoms, including hallucinations (false perceptions of sights and sounds) and delusions (a firmly held belief or suspicion despite evidence to the contrary). Other symptoms of schizophrenia may include low energy, lack of pleasure, and disorganized speech and behavior.
Each disorder is in excess for those faced with homelessness, although the difference for major depression is not as stark. Still, the overwhelming presence of mental health conditions in this population adds a significant burden and interference with their ability to maintain stable housing.
Several risk factors increase the chances that some individuals may experience both poor mental health and homelessness.
Bidirectional Risk: Homelessness and psychological health carry bidirectional risk, meaning that both situations can increase the likelihood of the other developing or worsening.
Poverty and Inadequate Low-Income Housing: Those with mental health disorders are often homeless due to poverty or lack of low-income housing. This is most often due to symptoms that disrupt their ability to maintain a job and earn reliable income for housing.
Severe Mental Illness: The risk is highest with severe mental illness (SMI), encompassing disorders with severe symptoms that can become significantly disruptive to daily functioning, such as major depression, psychosis, and bipolar disorder. Mental health and homelessness research results vary, but estimates indicate that 20-50% of homeless adults also have a severe mental illness.
Individuals with SMIs are also more likely to come in contact with the justice system, causing additional disruption, potential trauma, and negative life experiences. They also tend to have more difficulties with interpersonal relationships, creating more barriers to transitioning out of homelessness than individuals without these disorders.
More Persistent Impairment: Individuals who are homeless are more likely to remain impaired for longer due to worse overall health and poorer access to care than the general population.
While the interaction between homelessness and mental health is complex, individuals with these issues can improve their lives. A comprehensive approach that addresses each problem can be challenging to implement but can ultimately result in better overall health and stability.
Before addressing solutions, it is essential to understand some of the fundamental barriers the homeless population faces when contending with mental health conditions.
Transportation: Homeless individuals lack access to reliable transportation, such as owning a car, riding a bike, or using public transportation. These methods may be cost-prohibitive, unreliable, or non-existent for some individuals, limiting their ability to obtain training, maintain a job, access support services, get food, or seek medical care.
Communication and Information Barriers: Much like transportation challenges, communication barriers can contribute to the disruptions associated with homelessness, such as little or no access to a cell phone or internet service. Scheduling appointments for medical or mental health care can be difficult without the ability to make contact or follow up between sessions. Poor access to the internet can also limit communication as well as access to essential information.
Cost of Care: Since most homeless individuals are unemployed and without insurance-based health care, mental health expenses are often left to government support programs, such as Medicaid. Rising costs threaten the sustainability of these programs, a significant problem given the complex care needed for some conditions. Also, some homeless individuals may not know about these programs at all, resulting in months or years of unmet mental health needs and chronically poor mental health.
Physical Needs Take Priority: Because homelessness is a direct threat to fundamental needs, such as food, shelter, and security, many individuals without secure housing understandably prioritize these issues. Even though mental health may be the primary driver of homelessness for some individuals, these basic needs are more tangible and may not stabilize long enough for psychiatric needs to be adequately evaluated.
Stigma: As challenging as it may be for homeless individuals to access mental health care, stigma can be yet another hidden barrier. While many have compassion for homeless individuals and want to provide support and care, homelessness still carries a social label of being an outcast or a failure. For individuals who are homeless, mental health services may be necessary but also expose individuals to potential rejection. They may understandably choose to avoid care instead of risk feeling shame and embarrassment.
Multiple strategies are being explored to address both homelessness and its damaging interaction with untreated mental health conditions. Treating homelessness as a public health crisis taps into a solution-oriented approach that can hit complex health and safety problems from many angles. Among these strategies are two critical efforts: creating a pathway for more stabilized housing and improving access to comprehensive health care.
Steady Employment Leads to Stable Housing: To improve the odds of acquiring and maintaining housing, individuals need the skills to gain meaningful employment and step out of poverty. Training and support programs can help individuals get jobs that pay well enough to meet their basic needs and secure housing.
Access to Comprehensive Health Care: To maintain steady employment, individuals must be able to adequately treat and address significant health issues, including mental health conditions. Improved access to comprehensive health care helps individuals have a better quality of life and reduces the financial burden on communities and government programs. Some solutions include:
Integrated care models, where physical and mental health needs are addressed simultaneously.
Street psychiatry, extending mental health programs for homeless individuals into their natural environment to reduce barriers to access.
A trauma-informed approach, recognizing the chronic distress associated with homelessness.
Homelessness impacts an estimated half million individuals nationwide, and most contend with mental health issues. When these conditions occur together, the risk of remaining homeless with untreated mental health conditions is high. Solutions that include pathways to better employment, housing, and health care offer homeless individuals with mental health conditions the greatest chance for stability.
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