Over 582,000 people across the country experienced homelessness on one night in 2022. The Point-in-Time (PIT) census is a count of sheltered and unsheltered people who experienced homelessness on one night in January. The PIT number is valuable for quantifying homelessness, identifying year-over-year trends, and supporting policy development. Key additional findings from the 2022 Annual Homeless Assessment Report (AHAR) to Congress (14.8 MB) and Homeless and Subpopulation Continuum of Care Report (178 KB) include:
- 21 percent of people experiencing homelessness reported having a serious mental illness and 16 percent reported having a substance use disorder.
- 16% increase among people experiencing chronic homelessness between 2020 and 2022.
- The homeless population comprised 37 percent of individuals who identified as Black and 24 percent as Hispanic.
Homelessness is associated with a higher prevalence of mental and substance use disorders compared to stably housed individuals. People experiencing homelessness continue to face health disparities, including; increased suicide mortality (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 the social determinants of health as a driver for achieving the goal of advancing care for the whole person, advancing policies and programs, and improving health outcomes to meet the needs of people experiencing homelessness.
Financial Stability
A major risk factor for homelessness is the lack of affordable or stable housing. According Healthy People 2030, 35 percent of renter households are cost-burdened in the United States, meaning families spend more than 30 percent of their income on housing and utilities. Housing rental costs continue rise while the incomes of household renters remain stagnant. In addition, unemployment and underemployment disproportionately affect people experiencing homelessness (PDF | 1.1 MB). While many express a desire to work, people experiencing homelessness face barriers that make finding and keeping work difficult. Without affordable housing and stable employment, families face adversity and spend a significant portion of their income on shelter without sufficient funds for essentials such as food, transportation, and health care. It can create financial instability chronic stress for individuals and can lead to illicit drug use and mental health issuessuch as anxiety or depression.
Access and quality in education
People with a lower level of education 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 particularly vulnerable. Compared to youth with at least a high school diploma, youth without a high school diploma or GED have a 346 percent higher risk of experiencing homelessness (PDF | 191 KB). Additionally, lack of mental health education is associated with increased mental health challenges. ONE study 2020 found that K-12 students who participated in school-based mental health treatment were more than 15 times more likely to achieve improved mental health status. Increasing high school graduation rates for students and prioritizing the need for school-based mental health services is critical to preventing homelessness and improving mental health.
Access and quality of health care
Barriers that prevent people experiencing homelessness from accessing health care may contribute to the increase in people experiencing chronic homelessness and may lead to increased risks of adverse health outcomes. 60% of people experiencing homelessness do not have health insurancewhich limits them from receiving preventive and primary care services. Research has shown that health insurance coverage is associated with improved health monitoring and lower mortality rates. In addition, participants with mental and substance use disorders who experience homelessness in a study 2020 they felt they received poor quality care due to physician bias. Increasing access to health care and culturally competent care can ensure that concerns are adequately addressed for people experiencing homelessness.
Social and community context
Stigma includes negative stereotypes that lead to discrimination against people experiencing homelessness. People experiencing homelessness are wrongly viewed as lazy, dangerous, and solely responsible for their homelessness. However, research has shown that Experiencing domestic violence can precipitate homelessness. Additionally, homelessness disproportionately affects 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 make up the homeless youth population. The intersecting stigma surrounding homelessness and mental and substance use disorders impairs health and well-being by creating barriers to recovery. Addressing stigma within healthcare and the wider public is vital to ending discrimination and supporting people 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 treatment, and enhance retention in services treatment. Homeless Transition Assistance (PATH) Projects support outreach and engagement, case management and housing assistance for individuals. Grants for the Benefit of Homeless Individuals (GBHI) supports treatment and rehabilitation 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 Outreach, Access and Recovery (SOAR) aims to increase Social Security disability benefits for eligible children and adults with medical disabilities 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 for people regardless of age, ability to pay, or place of residence – including people who faced by homeless people. CCBHCs also provide housing assistance and 24/7 crisis intervention services to people 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. Finally, the Homeless and Housing Resource Center (HHRC) provides accessible, no-cost training for health and housing professionals in evidence-based practices related to housing stability, recovery, and homelessness to effectively meet the needs of individuals who experiencing homelessness.
conclusion
Homelessness and behavioral health are inextricably linked, and recognizing the social determinants of health is critical to ending homelessness. Homelessness is a complex and multifaceted issue with systemic issues related to housing affordability, economic opportunity, access to health care, and stigma. SAMHSA uses its national surveys and beneficiary data to create effective programs and services to prevent and end homelessness for people with mental and substance use disorders. Efforts to increase access to stable housing and treatment services while simultaneously addressing the social determinants of health may be an effective strategy to reduce health disparities for individuals experiencing homelessness.
