Mental Health and Homelessness

The traditional definition of homelessness applies to as a state of being unhoused/unsheltered and/or lacking safe, stable, and adequate housing.

However, the concept of homelessness is changing, Recently, The United States’ Substance Abuse and Mental Health Administration (SAMHSA) has redefined the definition of homelessness to include a link to poverty, and this definition considers a homeless individual to be one who may “lack shelter, resources, and/or community ties.” With this definition of homelessness, both incarcerated and hospitalized individuals are also included.

In this guide

Who is at risk?
Intersections
Intervention examples
Additional resources

SAMHSA’s definition of homelessness makes us aware of the fact that being homeless doesn’t solely mean that someone is without an adequate place to live. Homelessness opens the doors for other issues, such as limited access to food and water, an increased risk of abuse and trauma, behavioral health issues, physical and cognitive impairments and delays, and complex, untreated medical problems.

In addition to this, persons who find themselves to be homeless may be unable to access adequate healthcare, may face detrimental barriers related to disability, culture, language, finances, literacy, and transportation, will often find themselves under excess amounts of stress, lack adequate social supports, and may even find themselves facing the wrath of the criminal justice system, simply for their attempts to survive.

The National Alliance to End Homelessness is a nonpartisan, nonprofit organization, whose aim is to end homelessness within the United States. They have been tracking the prevalence of homelessness in this country and they identified that in January of 2020, approximately 580,000 individuals within the United States were facing homelessness, with about 30 percent of these individuals being families with children. Unaccompanied minors (classified as being under the age of twenty-five) and veterans made up 12 percent of that total number.

Who is at risk of homelessness?

Some subpopulations may be more at risk for homelessness than others. Individuals who are of lower socioeconomic statuses, those who experience adverse childhood experiences or other traumas, those who suffer from mental health illnesses and/or substance abuse, and those who are ethnic, gender, and/or sexual minorities are at an increased risk for experiencing homelessness during at least one point in their lives. Many individuals who are homeless do suffer from at least one mental health disorder- with some of the common disorders being psychotic disorders such as schizophrenia, mood disorders, substance abuse disorders, personality disorders, and cognitive/intellectual disorders.

According to the United States’ Substance Abuse and Mental Health Administration, approximately 30 percent of individuals who experience chronic homelessness, also have mental health conditions. However, much research is still needed surrounding the specific lived experiences of some of these individuals as they navigate homelessness.

For example, we are aware that many mothers who are victims of domestic violence or who experience a breakdown of their familial relationships, often experience chronic homelessness, however, little is known about their exact experiences.

Homelessness, in itself, can be a form of trauma, which then exacerbates individuals’ levels of distress, and can contribute to the development of mental illnesses all on its own. Much research is still needed to determine what can be done to support those encountering homelessness.

We are, however, aware that about half of individuals experiencing chronic or long-term homelessness, are African American middle-aged males. Between 60 and 80 percent of these males will suffer from lifetime mental health and substance abuse problems.

Youth experiencing homelessness are often victims of physical and sexual abuse, and become even more at risk for re-traumatization as they endure homelessness. Approximately 20 percent of homeless youth identify as being a part of the LGBTQ+ population, and these youth are more likely to be victims of violent acts and to attempt suicide than their heterosexual peers who also experience homelessness.

There is a considerable portion of the homeless population that is elderly. These individuals endure many untreated medical problems, such as vision and dental issues, hypertension, arthritis, diabetes, heart problems, and strokes.

Approximately 100,000 veterans experience homelessness on any given night. Substance abuse, traumatic brain injuries, post-traumatic stress disorder, and depression are common among this homeless subpopulation. In addition, many incarcerated individuals will either find themselves homeless prior to their offense or find themselves homeless following release. For homeless individuals who are temporarily hospitalized, their experience appears to be very similar. Little to no support is often available and/or provided to these individuals.

The intersection of homelessness and mental health

The American Psychological Association (APA), which is the leading scientific and professional organization that governs and represents the field of psychology within the United States, acknowledges that homelessness in the US is a major public problem.

This organization asserts that mental health professionals have a role in the mitigation of homelessness and its effects upon American individuals. As mental health professionals consider what their role might be and how to support homeless individuals, homelessness appears to be on the rise. Coupled with the unforeseen impacts of the Coronavirus pandemic, current economic crises’ and a lack of effective social policies, there has been an increase of the homeless population as a whole. In fact, between 2019 and 2020, homelessness increased by 2% nationwide, according to the National Alliance to End Homelessness.

As we wonder what the best solution is for combatting homelessness, many cite that it is creating and offering more low income housing opportunities. While mental health professionals might not be capable of increasing the amount of low-income housing that is available, per say, there are some things that mental health professionals can do to support the homeless population.

Examples of mental health professionals and social worker interventions

Conduct screenings: Conducting both large and small-scale mental health screenings helps to identify individuals who might be most at-risk for homelessness. Mental health professionals should always be asking their own clients about their capability to meet their basic needs. Providing individuals with the tools and resources to best support themselves is a great preventative measure. Remember that early intervention is always preferred.
Increase access: Mental health professionals can offer low-cost or pro bono services to increase and improve treatment access to the homeless population. Work closely with advocates in the community, donors, institutions which provide practitioners with grants, and insurance companies to make your services more widely accessible.
Assist clients in accessing some form of housing: Work with individuals experiencing housing instability or those who are at risk for losing their housing, to secure some type of safe housing that might be available. Some agencies may be dedicated to providing safe housing for those without, and in many cases there may be other options such as transitional/permanent housing, Section 8 offerings, or other government-funded housing options, group homes, and shared accommodations. Network and make connections with these kinds of institutions so that you have resources available when someone you encounter is in need.
Offer case management services: Sometimes mental health services will need to go above and beyond talk therapy, especially for our homeless population. Remember that in Maslow’s hierarchy of needs, it is indicated that people must have access to shelter, food, and other basic necessities prior to working on higher-order goals. Mental health professionals may need to check in with their clients routinely about basic needs to ensure that they are being adequately met. And, in cases in which they are not, providing resources, teaching life skills, supporting clients’ job/house hunting efforts, and offering support in navigating said resources can be beneficial. Check out our guide on obtaining a case manager certification, for more information. Often there are case managers or advocates in the community, in which mental health professionals can connect their clients with and work alongside to ensure that clients get all of their needs met in a timely and efficient manner. For example, at-risk youth may benefit from being connected with a school social worker or a child social worker. Veterans may benefit from being connected with a military social worker. And, immigrants experiencing homelessness may benefit from being connected with an immigration social worker.
Connect clients directly to supportive resources: Because of the co-occurring nature of mental health illnesses, substance abuse, and homelessness, some resources will be imperative to connect at-risk or presently homeless individuals to. These resources may include, but are not limited to the following: supportive/transitional housing, emergency and specialty shelters, detox centers, inpatient units, and spaces which offer emergency medical care. In some cases, mental health professionals will want to take their work a step further and bridge the gap between their clients and these resources. They can do so by initiating contact or contacting the resources alongside their clients. Individuals at-risk for homelessness or those who are already experiencing homelessness may not know how to navigate supportive resources, have difficulties advocating for themselves, and/or may not know what questions to ask and how to get their own questions answered. Mental health professionals can be a big help in this area.
Help patients to apply for health Insurance such as medicaid/medicare, supplemental security income (SSI), social security disability insurance (SSDI), the supplemental nutrition assistance program (SNAP), emergency solutions grants, and other available mainstream benefits: Mental health professionals can offer specified support with applications for health insurance, benefits, grants, and other supportive resources to ensure that individuals gain access to what is needed to get them back on their feet. In many cases, mental health professionals can write letters of support in regards to a patient’s disability status, need for services, or for other necessities. https://www.benefits.gov and https://www.ssa.gov/ are always a great place to start when an individual is in need of benefits, but is unsure of what’s available and what they might qualify for.
Safety plan: Patients who may be at risk for homelessness can benefit from identifying a safety plan in the event of an emergency. Mental health professionals can assist these persons in creating a safety plan that works for them. Identifying emergency resources, personnel, social supports, and creative measures to acquire income, food and/or shelter are some things you’ll want to include on a safety plan.
Enhance community resources: Taking a community-oriented approach to homelessness has been shown to be widely effective. Equipping the community with recovery-oriented treatment for mental health and substance abuse disorders can help to prevent and support the populations of people who are most at risk for homelessness. Talk to your community leaders and agencies/organizations about how you can collaborate to equip your community with supports for the homeless. For example, given that there tends to be a lot of homeless youth across the nation, can your community establish a safe center for youth who may have ran away from home or lost access to their housing?
Participate with mobile crisis response services: Individuals experiencing homelessness, mental health or substance-related difficulties may sometimes find themselves in crisis situations. By initiating or joining a mobile crisis response team in your area, as a mental health professional, you can help to provide imminent support, short-term counseling, and relief to those in need. These services prevent law enforcement members, whom often have little to no mental health training, from contributing to the traumatization or re-traumatization of these individuals. You can make a huge difference just by dedicating a few hours a week to responding to crises in your community.
Implement therapeutic interventions which target homelessness: Some mental health approaches, interventions, and techniques are especially supportive of the homeless population. Trauma-informed support, relapse prevention, stress-management, assertiveness training, psycho education, and motivational interviewing are some great examples! Patients may also benefit from learning coping skills which aid them in navigating time periods which include homelessness. When in doubt, you can always simply listen. Persons facing homelessness may have already experienced an excess amount of helplessness and a lack of control over what occurs in their lives. The last thing a mental health professional wants to do in this case, is to push or coerce these individuals to take certain actions. Be supportive, empathic, understanding, prioritize the therapeutic relationship, and offer a kind ear and a safe space. Sometimes, this is what’s needed the most!
Advocate: Mental health professionals have the opportunity and professional/ethical duty to advocate for those who are underserved and cannot advocate for themselves. By reaching out to governing personnel and agencies/resources in the community and beyond, to effectively communicate and advocate for the needs of the homeless population, change can ensue and access to resources can increase! Reach out to your local senator or governor, write a letter, and get other professionals to join your efforts.

Mental health and social work homelessness resources

Patient Resources

Clinician Resources