# data[].attributes.headline
poor standards for affordable housing and their correlation to mental health and local environments

# data[].attributes.subject
poor standards for affordable housing and their correlation to mental health and local environments

# data[].attributes.body
“California cities also need to enforce laws to address the homeless crisis. Typhus, tuberculosis, and hepatitis are widespread in some areas of Los Angeles, San Francisco, and San Diego. City streets are littered with human waste and 2 million used hypodermic needles annually in San Francisco, where one out of every 38 residents has a substance-abuse problem.”Ohanian, Lee. “The Economics of Why Homelessness Worsens as Governments Spend Even More on the Problem.” Hoover Institution, 18 June 2019, www.hoover.org/research/economics-why-homelessness-worsens-governments-spend-even-more-problem.

# data[].attributes.headline
“I saw so many things that a human should never see. I had never seen someone get killed before…. I’d never seen someone starving…. Things like that shake you to your core.”

# data[].attributes.subject
“I saw so many things that a human should never see. I had never seen someone get killed before…. I’d never seen someone starving…. Things like that shake you to your core.”

# data[].attributes.body
Gibson, Lydialyle. “The Homelessness Public Health Crisis: Addressing a Problem Undermining the Very Fabric of Our Society.” Harvard Magazine, May-June 2024.https://www.hsph.harvard.edu/news/hsph-in-the-news/homelessness-undermining-the-very-fabric-of-our-society/

# data[].attributes.attachment_link.title
Homelessness ‘undermining the very fabric of our society’

# data[].attributes.attachment_link.description
A sharp uptick in homelessness in the U.S.—driven by high rents, shrinking public assistance, a lack of affordable housing, and fallout from the COVID pandemic—represents “a hard and complicated pu…

# data[].attributes.body
Two-thirds reported current mental health symptoms and more than a third experienced physical or sexual violence during this episode of homelessness. More than a third had visited an Emergency Department in the prior six months. One in five who used substances reported that they wanted substance use treatment – but couldn’t get it.Colliver, Victoria. “California Statewide Study Investigates Causes and Impacts of Homelessness | UC San Francisco.” Www.ucsf.edu, 20 June 2023, www.ucsf.edu/news/2023/06/425646/california-statewide-study-investigates-causes-and-impacts-homelessness.

# data[].attributes.body
“positive price impact on peer buildings and reduces the risk of investment in affordable housing.” Jeddi Yeganeh, A., McCoy, A. P., & Hankey, S. (2019). Green Affordable Housing: Cost-Benefit Analysis for Zoning Incentives. Sustainability, 11(22), 6269. https://doi.org/10.3390/su11226269

# data[].attributes.body
Persistent homelessness reveals deep flaws in the social safety net, which often fails to protect vulnerable families and individuals.

"Families with children, mostly women caring for children alone, were 'the fastest growing segment of the homeless," facing "fighting, fear, depression (acute or chronic), feelings of failure, and lack of stability" due to the "lack of space" in shelters.

The Homeless Crisis. (2001). In J. S. Baughman, V. Bondi, R. Layman, T. McConnell, & V. Tompkins (Eds.), American Decades (Vol. 9). Gale. https://link.gale.com/apps/doc/CX3468303123/SUIC?u=mcps&sid=bookmark-SUIC&xid=1bf093ea

# data[].attributes.body
The lack of adequate federal funding for housing programs directly threatens the effectiveness of local initiatives aimed at reducing homelessness.

"HUD and independent sources such as the Government Accountability Office (GAO) have long acknowledged that community efforts to address homelessness depend on federal assistance beyond that provided by the McKinney-Vento homeless assistance programs."

CUTS IN FEDERAL HOUSING ASSISTANCE ARE UNDERMINING COMMUNITY PLANS TO END HOMELESSNESS 1. (2007). Rice, D., & Sard, B. https://cbpp.org/sites/default/files/atoms/files/2-1-07hous.pdf

# data[].attributes.headline
“According to Healthy People 2030, 35 percent of renter households are cost-burdened in the United States, meaning that families spend more than 30 percent of their income on housing costs and utilities.”

# data[].attributes.subject
“According to Healthy People 2030, 35 percent of renter households are cost-burdened in the United States, meaning that families spend more than 30 percent of their income on housing costs and utilities.”

# data[].attributes.body
Saldua, Mark. “Addressing Social Determinants of Health Among Individuals Experiencing Homelessness.” Center for Behavioral Health Statistics and Quality, 15 Nov. 2023. https://www.samhsa.gov/blog/addressing-social-determinants-health-among-individuals-experiencing-homelessness

# data[].attributes.attachment_link.readable_text
Over 582,000 individuals across the country were experiencing homelessness on a single night in 2022. The Point-in-Time (PIT) census is a count of sheltered and unsheltered individuals experiencing homelessness on a single night in January. The PIT count is valuable in quantifying homelessness, identifying year-over-year trends, and supporting policy development. Key additional findings from the 2022 Annual Homelessness Assessment Report (AHAR) to Congress (14.8 MB) and Continuum of Care Homeless Populations and Subpopulations Report (178 KB) include:

21 percent of individuals experiencing homelessness reported having a serious mental illness, and 16 percent reported having a substance use disorder.

A 16 percent increase among individuals experiencing chronic homelessness between 2020 and 2022.

The homeless population comprised 37 percent of individuals who identified as Black and 24 percent identifying as Hispanic.

Homelessness is associated with a higher prevalence of mental and substance use disorders when compared to stably housed individuals. Individuals experiencing homelessness continue to face health disparities, including increased mortality due to suicide (PDF | 192 KB). Homelessness is a complex problem, and the social determinants of health serve as a key factor in addressing and developing comprehensive solutions to prevent and end homelessness. SAMHSA's 2023-2026 Strategic Plan recognizes the importance of social determinants of health as a lever to achieve its goal of promoting whole-person care, advancing policies and programs, and improving health outcomes to meet the needs of individuals experiencing homelessness.
Economic Stability
A prominent risk factor for homelessness is the lack of affordable or stable housing. According to Healthy People 2030, 35 percent of renter households are cost-burdened in the United States, meaning that families spend more than 30 percent of their income on housing costs and utilities. Rental home costs continue to increase while household renter incomes stagnate. Additionally, unemployment and underemployment disproportionately impact individuals experiencing homelessness (PDF | 1.1 MB). While many express the desire to work, individuals experiencing homelessness encounter obstacles that make finding and maintaining employment challenging. Without affordable housing and stable employment, families face adversity and expend a significant portion of their income on shelter without having enough funds for necessities, such as food, transportation, and healthcare. Economic instability can create chronic stress for individuals and may lead to illegal drug use and mental health issues, such as anxiety or depression.
Education Access and Quality
Individuals with lower educational attainment are at greater risk of unemployment and poverty compared to their more educated counterparts. Lack of income due to unemployment is a direct cause of homelessness. Youth with less than a high school diploma or General Educational Development (GED) are especially vulnerable. Compared to youth with at least a high school degree, youth without a high school diploma or GED have a 346 percent higher risk of experiencing homelessness (PDF | 191 KB). Furthermore, the lack of education on mental health is associated with increased mental health challenges. A 2020 study found that K-12 students who participated in school-based mental health treatment were over 15 times more likely to attain improved mental health status. Increasing high school graduation rates for students and prioritizing the need for school-based mental health services are critical to preventing homelessness and improving mental health.
Healthcare Access and Quality
Barriers that prevent individuals who are experiencing homelessness from accessing health care may contribute to the increase in individuals experiencing chronic homelessness and can lead to increased risks of adverse health outcomes. Sixty percent of individuals experiencing homelessness lack health insurance, which restricts them from obtaining preventive and primary care services. Research has shown that health insurance coverage is associated with improved health monitoring and lower mortality rates. Additionally, participants with mental and substance use disorders experiencing homelessness in a 2020 study felt that they received poor quality care due to clinician bias. Increasing healthcare access and culturally competent care can ensure that concerns are adequately addressed for individuals experiencing homelessness.
Social and Community Context
Stigma involves negative stereotypes that lead to discrimination against individuals experiencing homelessness. Individuals experiencing homelessness are erroneously stereotyped as lazy, dangerous, and solely responsible for their homelessness. However, research has shown that experiencing domestic violence can precipitate homelessness. Moreover, homelessness disproportionately impacts LGBTQ+ youth due to discrimination and increased risks for mental and substance use disorders. In the United States, 10 percent of the general youth population identifies as LGBTQ+; however, nearly 40 percent of LGBTQ+ youth comprise the homeless youth population. The intersectional stigma surrounding homelessness and mental and substance use disorders worsens health and well-being by creating barriers that prevent recovery. Addressing stigma within healthcare and the general public is vital to ending discrimination and supporting individuals experiencing homelessness.
What SAMHSA is Doing to Address Homelessness Among People with Mental and Substance Use Disorders
Expanding Access to and Use of Behavioral Health Services for People Experiencing Homelessness offers evidence-based practices for behavioral health providers to directly support and maintain relationships with people experiencing homelessness, provide mental health and substance use treatments, and boost retention in treatment services. The Projects for Assistance in Transition from Homelessness (PATH) supports outreach and engagement, case management, and housing assistance for individuals. Grants for the Benefit of Homeless Individuals (GBHI) supports treatment and recovery services, housing services, and health insurance enrollment guidance. Treatment for Individuals Experiencing Homelessness (TIEH) promotes access to treatment services, peer support, and resources for permanent housing. Supplemental Security Income/Social Security Disability Insurance Outreach, Access, and Recovery (SOAR) aims to increase Social Security disability benefits for eligible children and adults with medical impairments and co-occurring disorders.

The Certified Community Behavioral Health Clinic (CCBHC) program addresses disparities in the behavioral health care system by increasing access to high-quality, coordinated comprehensive behavioral health care to individuals regardless of their age, ability to pay, or place of residence - including individuals experiencing homelessness. CCBHCs also provide housing assistance and 24/7 crisis intervention services for individuals experiencing a mental health or substance use crisis. The Assertive Community Treatment (ACT) and Assisted Outpatient Treatment (AOT) grant programs aim to reduce homelessness, hospitalization, and mental and substance use disorders. Lastly, the Homeless and Housing Resource Center (HHRC) provides accessible, no-cost training for health and housing professionals in evidence-based practices on housing stability, recovery, and homelessness to effectively meet the needs of individuals experiencing homelessness.
Conclusion
Homelessness and behavioral health are inextricably linked and recognizing the social determinants of health is crucial to ending homelessness. Homelessness is an intricate and multifaceted issue with systemic issues related to housing affordability, economic opportunities, healthcare access, and stigma. SAMHSA utilizes its national surveys and grantee data to create effective programs and services to prevent and end homelessness among people with mental and substance use disorders. Efforts to increase accessibility to stable housing and treatment services while simultaneously addressing the social determinants of health can be an effective strategy to reduce health disparities for individuals experiencing homelessness.

# data[].attributes.attachment_link.title
Addressing Social Determinants of Health Among Individuals Experiencing Homelessness

# data[].attributes.attachment_link.description
Over 582,000 individuals across the country were experiencing homelessness on a single night in 2022. The Point-in-Time (PIT) census is a count of sheltered and unsheltered individuals experiencing homelessness on a single night in January. The PIT count is valuable in quantifying homelessness, identifying year-over-year trends, and supporting policy development.

# data[].attributes.body
“the supply shortage and affordability crisis also have significant effects on labor markets, with implications in markets across the country and to the country’s overall productivity.” Klurfield, Kristen. “Exploring the Affordable Housing Shortage’s Impact On ...” Bipartisan Policy Center, bipartisanpolicy.org/wp-content/uploads/2024/03/Exploring-the-Aff-Housing-Shortage-Impact-on-American-Workers-Jobs-and-the-Economy_BPC-3.2024.pdf. Accessed 23 Oct. 2024.

# data[].attributes.body
Helping families have a safe, stable place to call home should not be controversial. It’s not red state versus blue state, not urban versus rural” Whitehouse, Sheldon. “Whitehouse: Expanding Housing Affordability Drives Economic Growth: U.S. Senate Committee on the Budget.” Chairman Press | Chairman’s Newsroom | Chairman | U.S. Senate Committee On The Budget, 31 Jan. 2024, www.budget.senate.gov/chairman/newsroom/press/whitehouse-expanding-housing-affordability-drives-economic-growth.

# data[].attributes.body
“seek to limit the destruction of the environment in neighborhood design and mitigate challenges such as increasing heat islands in cities and poor walkability, among others, through climate-sensitive design strategies,” Tetteh, Nathan, and Masa Noguchi. “Re-Conceptualizing Vertical Subdivision Development for Sustainable, Affordable Housing Delivery.” Encyclopedia, vol. 4, no. 1, Mar. 2024, pp. 256–72. EBSCOhost, https://doi.org/10.3390/encyclopedia4010020.

# data[].attributes.headline
“According to the 2022 Annual Homelessness Assessment Report to Congress, the homeless population comprised 37 percent of individuals who identified as Black and 24 percent identifying as Hispanic.”

# data[].attributes.subject
“According to the 2022 Annual Homelessness Assessment Report to Congress, the homeless population comprised 37 percent of individuals who identified as Black and 24 percent identifying as Hispanic.”

# data[].attributes.body
Saldua, Mark. “Addressing Social Determinants of Health Among Individuals Experiencing Homelessness.” Center for Behavioral Health Statistics and Quality, 15 Nov. 2023. https://www.samhsa.gov/blog/addressing-social-determinants-health-among-individuals-experiencing-homelessness

# data[].attributes.attachment_link.readable_text
Over 582,000 individuals across the country were experiencing homelessness on a single night in 2022. The Point-in-Time (PIT) census is a count of sheltered and unsheltered individuals experiencing homelessness on a single night in January. The PIT count is valuable in quantifying homelessness, identifying year-over-year trends, and supporting policy development. Key additional findings from the 2022 Annual Homelessness Assessment Report (AHAR) to Congress (14.8 MB) and Continuum of Care Homeless Populations and Subpopulations Report (178 KB) include:

21 percent of individuals experiencing homelessness reported having a serious mental illness, and 16 percent reported having a substance use disorder.

A 16 percent increase among individuals experiencing chronic homelessness between 2020 and 2022.

The homeless population comprised 37 percent of individuals who identified as Black and 24 percent identifying as Hispanic.

Homelessness is associated with a higher prevalence of mental and substance use disorders when compared to stably housed individuals. Individuals experiencing homelessness continue to face health disparities, including increased mortality due to suicide (PDF | 192 KB). Homelessness is a complex problem, and the social determinants of health serve as a key factor in addressing and developing comprehensive solutions to prevent and end homelessness. SAMHSA's 2023-2026 Strategic Plan recognizes the importance of social determinants of health as a lever to achieve its goal of promoting whole-person care, advancing policies and programs, and improving health outcomes to meet the needs of individuals experiencing homelessness.
Economic Stability
A prominent risk factor for homelessness is the lack of affordable or stable housing. According to Healthy People 2030, 35 percent of renter households are cost-burdened in the United States, meaning that families spend more than 30 percent of their income on housing costs and utilities. Rental home costs continue to increase while household renter incomes stagnate. Additionally, unemployment and underemployment disproportionately impact individuals experiencing homelessness (PDF | 1.1 MB). While many express the desire to work, individuals experiencing homelessness encounter obstacles that make finding and maintaining employment challenging. Without affordable housing and stable employment, families face adversity and expend a significant portion of their income on shelter without having enough funds for necessities, such as food, transportation, and healthcare. Economic instability can create chronic stress for individuals and may lead to illegal drug use and mental health issues, such as anxiety or depression.
Education Access and Quality
Individuals with lower educational attainment are at greater risk of unemployment and poverty compared to their more educated counterparts. Lack of income due to unemployment is a direct cause of homelessness. Youth with less than a high school diploma or General Educational Development (GED) are especially vulnerable. Compared to youth with at least a high school degree, youth without a high school diploma or GED have a 346 percent higher risk of experiencing homelessness (PDF | 191 KB). Furthermore, the lack of education on mental health is associated with increased mental health challenges. A 2020 study found that K-12 students who participated in school-based mental health treatment were over 15 times more likely to attain improved mental health status. Increasing high school graduation rates for students and prioritizing the need for school-based mental health services are critical to preventing homelessness and improving mental health.
Healthcare Access and Quality
Barriers that prevent individuals who are experiencing homelessness from accessing health care may contribute to the increase in individuals experiencing chronic homelessness and can lead to increased risks of adverse health outcomes. Sixty percent of individuals experiencing homelessness lack health insurance, which restricts them from obtaining preventive and primary care services. Research has shown that health insurance coverage is associated with improved health monitoring and lower mortality rates. Additionally, participants with mental and substance use disorders experiencing homelessness in a 2020 study felt that they received poor quality care due to clinician bias. Increasing healthcare access and culturally competent care can ensure that concerns are adequately addressed for individuals experiencing homelessness.
Social and Community Context
Stigma involves negative stereotypes that lead to discrimination against individuals experiencing homelessness. Individuals experiencing homelessness are erroneously stereotyped as lazy, dangerous, and solely responsible for their homelessness. However, research has shown that experiencing domestic violence can precipitate homelessness. Moreover, homelessness disproportionately impacts LGBTQ+ youth due to discrimination and increased risks for mental and substance use disorders. In the United States, 10 percent of the general youth population identifies as LGBTQ+; however, nearly 40 percent of LGBTQ+ youth comprise the homeless youth population. The intersectional stigma surrounding homelessness and mental and substance use disorders worsens health and well-being by creating barriers that prevent recovery. Addressing stigma within healthcare and the general public is vital to ending discrimination and supporting individuals experiencing homelessness.
What SAMHSA is Doing to Address Homelessness Among People with Mental and Substance Use Disorders
Expanding Access to and Use of Behavioral Health Services for People Experiencing Homelessness offers evidence-based practices for behavioral health providers to directly support and maintain relationships with people experiencing homelessness, provide mental health and substance use treatments, and boost retention in treatment services. The Projects for Assistance in Transition from Homelessness (PATH) supports outreach and engagement, case management, and housing assistance for individuals. Grants for the Benefit of Homeless Individuals (GBHI) supports treatment and recovery services, housing services, and health insurance enrollment guidance. Treatment for Individuals Experiencing Homelessness (TIEH) promotes access to treatment services, peer support, and resources for permanent housing. Supplemental Security Income/Social Security Disability Insurance Outreach, Access, and Recovery (SOAR) aims to increase Social Security disability benefits for eligible children and adults with medical impairments and co-occurring disorders.

The Certified Community Behavioral Health Clinic (CCBHC) program addresses disparities in the behavioral health care system by increasing access to high-quality, coordinated comprehensive behavioral health care to individuals regardless of their age, ability to pay, or place of residence - including individuals experiencing homelessness. CCBHCs also provide housing assistance and 24/7 crisis intervention services for individuals experiencing a mental health or substance use crisis. The Assertive Community Treatment (ACT) and Assisted Outpatient Treatment (AOT) grant programs aim to reduce homelessness, hospitalization, and mental and substance use disorders. Lastly, the Homeless and Housing Resource Center (HHRC) provides accessible, no-cost training for health and housing professionals in evidence-based practices on housing stability, recovery, and homelessness to effectively meet the needs of individuals experiencing homelessness.
Conclusion
Homelessness and behavioral health are inextricably linked and recognizing the social determinants of health is crucial to ending homelessness. Homelessness is an intricate and multifaceted issue with systemic issues related to housing affordability, economic opportunities, healthcare access, and stigma. SAMHSA utilizes its national surveys and grantee data to create effective programs and services to prevent and end homelessness among people with mental and substance use disorders. Efforts to increase accessibility to stable housing and treatment services while simultaneously addressing the social determinants of health can be an effective strategy to reduce health disparities for individuals experiencing homelessness.

# data[].attributes.attachment_link.title
Addressing Social Determinants of Health Among Individuals Experiencing Homelessness

# data[].attributes.attachment_link.description
Over 582,000 individuals across the country were experiencing homelessness on a single night in 2022. The Point-in-Time (PIT) census is a count of sheltered and unsheltered individuals experiencing homelessness on a single night in January. The PIT count is valuable in quantifying homelessness, identifying year-over-year trends, and supporting policy development.

# data[].attributes.body
Reliable federal funding is essential for local homelessness initiatives to succeed

"most state and local plans underscore that, if they are to succeed, the federal government must be a reliable and strong partner in this regard."

CUTS IN FEDERAL HOUSING ASSISTANCE ARE UNDERMINING COMMUNITY PLANS TO END HOMELESSNESS 1. (2007). Rice, D., & Sard, B. https://cbpp.org/sites/default/files/atoms/files/2-1-07hous.pdf

# data[].attributes.body
:“revealing a shift in families moving from the nation’s largest cities to smaller metro and nonmetro areas, which often have more affordable housing options.” Klurfield, Kristen. “Exploring the Affordable Housing Shortage’s Impact On ...” Bipartisan Policy Center, bipartisanpolicy.org/wp-content/uploads/2024/03/Exploring-the-Aff-Housing-Shortage-Impact-on-American-Workers-Jobs-and-the-Economy_BPC-3.2024.pdf. Accessed 23 Oct. 2024.

# data[].attributes.body
“Nationwide, the shortage of affordable housing opportunities costs the American economy an estimated $2 trillion each year. High housing costs reduce disposable income and economic mobility, stifling economic opportunities.” Whitehouse, Sheldon. “Whitehouse: Expanding Housing Affordability Drives Economic Growth: U.S. Senate Committee on the Budget.” Chairman Press | Chairman’s Newsroom | Chairman | U.S. Senate Committee On The Budget, 31 Jan. 2024, www.budget.senate.gov/chairman/newsroom/press/whitehouse-expanding-housing-affordability-drives-economic-growth.

# data[].attributes.headline
“In a 2020 study, participants with mental and substance use disorders experiencing homelessness felt that they received poor quality care due to clinician bias.”

# data[].attributes.subject
“In a 2020 study, participants with mental and substance use disorders experiencing homelessness felt that they received poor quality care due to clinician bias.”

# data[].attributes.body
Saldua, Mark. “Addressing Social Determinants of Health Among Individuals Experiencing Homelessness.” Center for Behavioral Health Statistics and Quality, 15 Nov. 2023. https://www.samhsa.gov/blog/addressing-social-determinants-health-among-individuals-experiencing-homelessness

# data[].attributes.attachment_link.readable_text
Over 582,000 individuals across the country were experiencing homelessness on a single night in 2022. The Point-in-Time (PIT) census is a count of sheltered and unsheltered individuals experiencing homelessness on a single night in January. The PIT count is valuable in quantifying homelessness, identifying year-over-year trends, and supporting policy development. Key additional findings from the 2022 Annual Homelessness Assessment Report (AHAR) to Congress (14.8 MB) and Continuum of Care Homeless Populations and Subpopulations Report (178 KB) include:

21 percent of individuals experiencing homelessness reported having a serious mental illness, and 16 percent reported having a substance use disorder.

A 16 percent increase among individuals experiencing chronic homelessness between 2020 and 2022.

The homeless population comprised 37 percent of individuals who identified as Black and 24 percent identifying as Hispanic.

Homelessness is associated with a higher prevalence of mental and substance use disorders when compared to stably housed individuals. Individuals experiencing homelessness continue to face health disparities, including increased mortality due to suicide (PDF | 192 KB). Homelessness is a complex problem, and the social determinants of health serve as a key factor in addressing and developing comprehensive solutions to prevent and end homelessness. SAMHSA's 2023-2026 Strategic Plan recognizes the importance of social determinants of health as a lever to achieve its goal of promoting whole-person care, advancing policies and programs, and improving health outcomes to meet the needs of individuals experiencing homelessness.
Economic Stability
A prominent risk factor for homelessness is the lack of affordable or stable housing. According to Healthy People 2030, 35 percent of renter households are cost-burdened in the United States, meaning that families spend more than 30 percent of their income on housing costs and utilities. Rental home costs continue to increase while household renter incomes stagnate. Additionally, unemployment and underemployment disproportionately impact individuals experiencing homelessness (PDF | 1.1 MB). While many express the desire to work, individuals experiencing homelessness encounter obstacles that make finding and maintaining employment challenging. Without affordable housing and stable employment, families face adversity and expend a significant portion of their income on shelter without having enough funds for necessities, such as food, transportation, and healthcare. Economic instability can create chronic stress for individuals and may lead to illegal drug use and mental health issues, such as anxiety or depression.
Education Access and Quality
Individuals with lower educational attainment are at greater risk of unemployment and poverty compared to their more educated counterparts. Lack of income due to unemployment is a direct cause of homelessness. Youth with less than a high school diploma or General Educational Development (GED) are especially vulnerable. Compared to youth with at least a high school degree, youth without a high school diploma or GED have a 346 percent higher risk of experiencing homelessness (PDF | 191 KB). Furthermore, the lack of education on mental health is associated with increased mental health challenges. A 2020 study found that K-12 students who participated in school-based mental health treatment were over 15 times more likely to attain improved mental health status. Increasing high school graduation rates for students and prioritizing the need for school-based mental health services are critical to preventing homelessness and improving mental health.
Healthcare Access and Quality
Barriers that prevent individuals who are experiencing homelessness from accessing health care may contribute to the increase in individuals experiencing chronic homelessness and can lead to increased risks of adverse health outcomes. Sixty percent of individuals experiencing homelessness lack health insurance, which restricts them from obtaining preventive and primary care services. Research has shown that health insurance coverage is associated with improved health monitoring and lower mortality rates. Additionally, participants with mental and substance use disorders experiencing homelessness in a 2020 study felt that they received poor quality care due to clinician bias. Increasing healthcare access and culturally competent care can ensure that concerns are adequately addressed for individuals experiencing homelessness.
Social and Community Context
Stigma involves negative stereotypes that lead to discrimination against individuals experiencing homelessness. Individuals experiencing homelessness are erroneously stereotyped as lazy, dangerous, and solely responsible for their homelessness. However, research has shown that experiencing domestic violence can precipitate homelessness. Moreover, homelessness disproportionately impacts LGBTQ+ youth due to discrimination and increased risks for mental and substance use disorders. In the United States, 10 percent of the general youth population identifies as LGBTQ+; however, nearly 40 percent of LGBTQ+ youth comprise the homeless youth population. The intersectional stigma surrounding homelessness and mental and substance use disorders worsens health and well-being by creating barriers that prevent recovery. Addressing stigma within healthcare and the general public is vital to ending discrimination and supporting individuals experiencing homelessness.
What SAMHSA is Doing to Address Homelessness Among People with Mental and Substance Use Disorders
Expanding Access to and Use of Behavioral Health Services for People Experiencing Homelessness offers evidence-based practices for behavioral health providers to directly support and maintain relationships with people experiencing homelessness, provide mental health and substance use treatments, and boost retention in treatment services. The Projects for Assistance in Transition from Homelessness (PATH) supports outreach and engagement, case management, and housing assistance for individuals. Grants for the Benefit of Homeless Individuals (GBHI) supports treatment and recovery services, housing services, and health insurance enrollment guidance. Treatment for Individuals Experiencing Homelessness (TIEH) promotes access to treatment services, peer support, and resources for permanent housing. Supplemental Security Income/Social Security Disability Insurance Outreach, Access, and Recovery (SOAR) aims to increase Social Security disability benefits for eligible children and adults with medical impairments and co-occurring disorders.

The Certified Community Behavioral Health Clinic (CCBHC) program addresses disparities in the behavioral health care system by increasing access to high-quality, coordinated comprehensive behavioral health care to individuals regardless of their age, ability to pay, or place of residence - including individuals experiencing homelessness. CCBHCs also provide housing assistance and 24/7 crisis intervention services for individuals experiencing a mental health or substance use crisis. The Assertive Community Treatment (ACT) and Assisted Outpatient Treatment (AOT) grant programs aim to reduce homelessness, hospitalization, and mental and substance use disorders. Lastly, the Homeless and Housing Resource Center (HHRC) provides accessible, no-cost training for health and housing professionals in evidence-based practices on housing stability, recovery, and homelessness to effectively meet the needs of individuals experiencing homelessness.
Conclusion
Homelessness and behavioral health are inextricably linked and recognizing the social determinants of health is crucial to ending homelessness. Homelessness is an intricate and multifaceted issue with systemic issues related to housing affordability, economic opportunities, healthcare access, and stigma. SAMHSA utilizes its national surveys and grantee data to create effective programs and services to prevent and end homelessness among people with mental and substance use disorders. Efforts to increase accessibility to stable housing and treatment services while simultaneously addressing the social determinants of health can be an effective strategy to reduce health disparities for individuals experiencing homelessness.

# data[].attributes.attachment_link.title
Addressing Social Determinants of Health Among Individuals Experiencing Homelessness

# data[].attributes.attachment_link.description
Over 582,000 individuals across the country were experiencing homelessness on a single night in 2022. The Point-in-Time (PIT) census is a count of sheltered and unsheltered individuals experiencing homelessness on a single night in January. The PIT count is valuable in quantifying homelessness, identifying year-over-year trends, and supporting policy development.

# data[].attributes.body
“Green infrastructure design, installation, and maintenance activities support jobs and career opportunities.” United States Environmental Protection Agency. (2024, August 27). Economic benefits of green infrastructure. Economic Benefits of Green Infrastructure. Retrieved October 29, 2024, from https://www.epa.gov/green-infrastructure/economic-benefits-green-infrastructure

# data[].attributes.headline
"In the USA, healthcare professionals were among the first responders to the homelessness ‘epidemic’ of the 1980s. The Robert Wood Johnson Foundation Health Care for the Homeless initiative funded 19 health clinics around the nation, beginning in 1985.”

# data[].attributes.subject
"In the USA, healthcare professionals were among the first responders to the homelessness ‘epidemic’ of the 1980s. The Robert Wood Johnson Foundation Health Care for the Homeless initiative funded 19 health clinics around the nation, beginning in 1985.”

# data[].attributes.body
Padgett, Deborah K. “Homelessness, Housing Instability, and Mental Health: Making the Connections.” British Journal of Psychiatry, vol. 217, no. 1, 2020, pp. 3-5. PMC7525583.https://pmc.ncbi.nlm.nih.gov/articles/PMC7525583/

# data[].attributes.attachment_link.authors[].name
✉Correspondence to Deborah K. Padgett (dkp1nyu.edu)

# data[].attributes.attachment_link.title
Homelessness, housing instability and mental health: making the connections

# data[].attributes.attachment_link.description
Research on the bi-directional relationship between mental health and homelessness is reviewed and extended to consider a broader global perspective, highlighting structural factors that contribute to housing instability and its mental ill health…

# data[].attributes.body
“politicians who are trying to deal with roughly 135,000 homeless people within the state can thank previous generations of politicians who presided over decades of badly designed public policies that created this problem in the first place.” Ohanian, Lee. “The Economics of Why Homelessness Worsens as Governments Spend Even More on the Problem.” Hoover Institution, 18 June 2019, www.hoover.org/research/economics-why-homelessness-worsens-governments-spend-even-more-problem.

# data[].attributes.body
“D.C. 's ambitious carbon reduction goals will deliver the benefits of climate-friendly homes to residents in D.C.’s underserved communities… upgrade more than 750 affordable multifamily housing units through electrification and energy efficiency upgrades.” National Housing Trust. (n.d.). D.C. healthy, green and affordable housing program [Fact sheet]. National Housing Trust. Retrieved October 29, 2024, from https://nationalhousingtrust.org/sites/default/files/documents/nht-healthy-green-affordable-factsheet-po-8.23.23_0_0.pdf

# data[].attributes.headline
	“The recent report by the prestigious US National Academy of Science, Engineering, and Medicine (NASEM) on the health benefits of permanent supportive housing…argued for the need to identify ‘housing-sensitive’ health conditions.”

# data[].attributes.subject
	“The recent report by the prestigious US National Academy of Science, Engineering, and Medicine (NASEM) on the health benefits of permanent supportive housing…argued for the need to identify ‘housing-sensitive’ health conditions.”

# data[].attributes.body
Padgett, Deborah K. “Homelessness, Housing Instability, and Mental Health: Making the Connections.” British Journal of Psychiatry, vol. 217, no. 1, 2020, pp. 3-5. PMC7525583.https://pmc.ncbi.nlm.nih.gov/articles/PMC7525583/

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✉Correspondence to Deborah K. Padgett (dkp1nyu.edu)

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Homelessness, housing instability and mental health: making the connections

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Research on the bi-directional relationship between mental health and homelessness is reviewed and extended to consider a broader global perspective, highlighting structural factors that contribute to housing instability and its mental ill health…

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"Financial benefits of green buildings and features (e.g., solar panels, green roofs, etc.) increase where more energy savings can be achieved due to the scarcity of water reserves (i.e., higher water costs) or frequency of heating or cooling degree days" Jeddi Yeganeh, A., McCoy, A. P., & Hankey, S. (2019). Green Affordable Housing: Cost-Benefit Analysis for Zoning Incentives. Sustainability, 11(22), 6269. https://doi.org/10.3390/su11226269

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"maximize the conservation of urban green spaces and their subsequent effects on air and environmental quality to promote wellness" Tetteh, N., & Noguchi, M. (2024). Re-Conceptualizing Vertical Subdivision Development for Sustainable, Affordable Housing Delivery. Encyclopedia, 4(1), 256–272. https://doi.org/10.3390/encyclopedia4010020

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The growing visibility of homelessness has underscored the social and economic gaps that leave countless individuals without stable housing.

"Starting in the early 1980s homeless people often called 'street people' -became an increasingly frequent sight in New York; Los Angeles; Chicago; Washington, D.C; Saint Louis; and most other major cities, as well as many smaller cities."

The Homeless Crisis. (2001). In J. S. Baughman, V. Bondi, R. Layman, T. McConnell, & V. Tompkins (Eds.), American Decades (Vol. 9). Gale. https://link.gale.com/apps/doc/CX3468303123/SUIC?u=mcps&sid=bookmark-SUIC&xid=1bf093ea

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Homelessness has transitioned from a perceived emergency to a routine social issue, indicating a need for long-term strategies rather than temporary fixes.

"homelessness is no longer considered an unusual circumstance; it has become a routine part of the political and social service landscape."

The Future of Homelessness. Society, (1998). Hambrick, R. S., & Johnson, G. T. https://explore.proquest.com/sirsissuesresearcher/document/2249946240?accountid=1151

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Communities need to shift from quick fixes for homelessness to develop lasting, sustainable solutions.

"homelessness is not simply a passing phenomenon requiring heroic volunteer efforts."

The Future of Homelessness. Society, (1998). Hambrick, R. S., & Johnson, G. T. https://explore.proquest.com/sirsissuesresearcher/document/2249946240?accountid=1151

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Record numbers of homeless adults slept in New York City shelters during the pandemic, and locations including Los Angeles, California, and the Portland, Oregon. “Housing Supply Is Key.

Cato.org, Cato, 8 May 2023,

www.cato.org/briefing-paper/hous

Ing-markets-first-housing-supply-

Affordability-are-key-reducing-ho

melessness. Accessed 23 Oct.

2024.

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Record numbers of homeless adults slept in New York City shelters during the pandemic, and locations including Los Angeles, California, and the Portland, Oregon. “Housing Supply Is Key.

Cato.org, Cato, 8 May 2023,

www.cato.org/briefing-paper/hous

Ing-markets-first-housing-supply-

Affordability-are-key-reducing-ho

melessness. Accessed 23 Oct.

2024.

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Eleven years ago, I met a person experiencing homelessness named Adam who first attuned me to the concept of relational poverty. I’ll never forget his words: “I never realized I was homeless when I lost my housing, only when I lost my family and friends.” “What’s the Real Reason People Become Homeless?” Greater Good, 2024, greatergood.berkeley.edu/article/item/Whats_the_Real_Reason_People_Become_Homeless.

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A 2019 Council of Economic Advisors paper titled The State of Homelessness in America found that “if the 11 metropolitan areas with significantly supply-constrained housing markets were deregulated, overall homelessness would fall … by 31 percent in these 11 metropolitan areas, which currently make up 42 percent of the United States homeless population.”“Housing Supply Is Key.

Cato.org, Cato, 8 May 2023,

www.cato.org/briefing-paper/hous

Ing-markets-first-housing-supply-

Affordability-are-key-reducing-ho

melessness

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The California Statewide Study of People Experiencing Homelessness used surveys and in-depth interviews to develop a clear portrait of homelessness in California, where 30% of the nation’s homeless population and half of the unsheltered population live.

Increase access to housing affordable to extremely low-income households making less than 30% of the Area Median Income: produce more housing affordable to the lowest-income renters expand rental subsidies (e.g., Housing Choice Vouchers)

Colliver, Victoria. “California Statewide Study Investigates Causes and Impacts of Homelessness | UC San Francisco.” Www.ucsf.edu, 20 June 2023, www.ucsf.edu/news/2023/06/425646/california-statewide-study-investigates-causes-and-impacts-homelessness.

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California Statewide Study Investigates Causes and Impacts of Homelessness | UC San Francisco

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UCSF releases most comprehensive study of people experiencing homelessness.

By Victoria Colliver

UC San Francisco Benioff Homelessness and Housing Initiative has released the largest representative study of homelessness in the United States since the mid-1990s, providing a comprehensive look at the causes and consequences of homelessness in California and recommending policy changes to shape programs in response.

The California Statewide Study of People Experiencing Homelessness used surveys and in-depth interviews to develop a clear portrait of homelessness in California, where 30% of the nation's homeless population and half of the unsheltered population live.

The study found that for most of the participants, the cost of housing had simply become unsustainable. Participants reported a median monthly household income of $960 in the six months prior to their homelessness, and most believed that either rental subsidies or one-time financial help would have prevented their homelessness.

"The results of the study confirm that far too many Californians experience homelessness because they cannot afford housing," said Margot Kushel, MD, direct of the UCSF Benioff Homeless and Housing Initiative (BHHI) and principal investigator of the study. "Through thousands of survey responses and hundreds of in-depth interviews, the study's findings reflect the incalculable personal costs of homelessness. Our policy recommendations aim to inform solutions to the homelessness crisis."

Disparities in homeless populations

The study found that the state's homeless population is aging, with 47% of all adults aged 50 or older, and that Black and Native Americans are dramatically overrepresented. Contrary to myths of homeless migration, most were Californians: 90% of participants lost their last housing in California and 75% of participants live in the same county as where they were last housed. Nine out of ten spent time unsheltered since they became homeless. The median length of homelessness was 22 months.

One in five participants entered homelessness from an institution. Of those who hadn't been in an institution, 60% came from situations where they weren't leaseholders, such as doubling up with family or friends. Participants were disconnected from the job market and services, but almost half were looking for work.

The results of the study confirm that far too many Californians experience homelessness because they cannot afford housing.

Margot Kushel, MD

"As we drive toward addressing the health and housing needs of Californian's experiencing homelessness, this study reinforces the importance of comprehensive and integrated supports," said Dr. Mark Ghaly, Secretary of the California Health and Human Services Agency. "California is taking bold steps to address unmet needs for physical and behavioral health services, to create a range of housing options that are safe and stable, and to meet people where they are at. We are grateful for the voices of those who participated in this study, as they will help guide our approach."

Participants had experienced multiple forms of trauma throughout their life, increasing their vulnerability to homelessness and contributing to their mental health and substance use challenges. Two-thirds reported current mental health symptoms and more than a third experienced physical or sexual violence during this episode of homelessness. More than a third had visited an Emergency Department in the prior six months. One in five who used substances reported that they wanted substance use treatment - but couldn't get it.

"Having experienced homelessness firsthand, I vividly recall the relentless fight for survival, the pervasive shame that haunted me, and my unsuccessful endeavors to overcome homelessness on my own," said Claudine Sipili, a member of the study's Lived Expertise Board. "The study holds great significance for me because it aims to provide a more comprehensive understanding of homelessness. I hope it will inform the development of effective strategies, policies, and programs; address the issue in a dignifying way; and support individuals in their transition from homelessness to housing stability."

About the study
The California Statewide Study of People Experiencing Homelessness (CASPEH) was designed to be representative of all adults 18 years and older experiencing homelessness in California. It includes nearly 3,200 administered questionnaires and 365 in-depth interviews with adults experiencing homelessness in eight regions of the state, representing urban, rural, and suburban areas. Interviews were conducted in English and Spanish, with interpreters for other languages. In partnership with a wide array of community stakeholders, the UCSF BHHI team collected data between October 2021 and November 2022. See additional information, including the full report and executive summary, here.

Community advisory boards consisting of those with lived experiences of homelessness and those involved in policy and practice played a critical role at every stage of the study. CASPEH was funded by the UCSF Benioff Homelessness and Housing Initiative, the California Health Care Foundation, and Blue Shield of California Foundation.

A documentary project produced in support of CASPEH, which includes photographs and interviews with Californians experiencing homelessness, is available at www.unhousedca.com.

About UCSF BHHI
The UCSF Benioff Homelessness and Housing Initiative provides accurate, timely policy-oriented research about homelessness for local, state, and national policymakers and practitioners. Funded by a generous gift from Marc and Lynne Benioff and based at the UCSF Center for Vulnerable Populations, UCSF BHHI is a trusted source for evidence-based practice, policy, and scalable solutions - turning evidence into action to prevent and end homelessness.

About UCSF
The University of California, San Francisco (UCSF) is exclusively focused on the health sciences and is dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. It includes UCSF Health, which comprises three top-ranked hospitals, as well as affiliations throughout the Bay Area. Visit ucsf.edu, or see our Fact Sheet.

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California Statewide Study Investigates Causes and Impacts of Homelessness

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UCSF Benioff Homelessness and Housing Initiative has released the largest study of homelessness in the United States since the mid-1990s, providing a thorough look at the causes, consequences, and potential policy changes of homelessness in California.