December is a month of transition as many communities across our country make the transition from cool, bright fall days to longer, colder nights. As we busily prepare for upcoming meals and seasonal feasts with friends and family, it’s a good time to think about what home means to us. Protection from the elements, a place to store our treasures and the necessities of life, a place to belong and be with the people we love, somewhere soft to rest our heads each night and a place to return to to ourselves day in and day out – home can mean so much.
December 21st marks the winter solstice – the longest night of the year – and National Homeless Day of Remembrance. This is a somber time for reflection and action on the pervasive problem of homelessness that more than 1 million American adults and children experience each year. On this day, groups nationwide hold vigils and memorial services to remember the many people who lost their lives without a place to call home. There are many ways to become homeless – none of us are immune – but chief among them is lack of affordable housing and salaries that do not keep pace with mortgages, rents and the overall cost of living. By increasing access to behavioral health prevention, treatment and recovery support services, the Substance Abuse and Mental Health Services Administration (SAMHSA) plays a critical role in stabilizing and strengthening the resilience of those at risk of or currently experiencing homelessness. As Chair of the US Interagency Council on Homelessness, US Secretary of Health and Human Services Xavier Becerra emphasized how important stable housing is to the health — including behavioral health — of individuals and families.
About 1.4 million people, or one in 130 households in America (PDF | 3.1 MB)stay in a homeless housing program during one year, according to the US Department of Housing and Urban Development (HUD). An esteemed one 256,610 people were experiencing homelessness without shelter (PDF | 18.6 MB) as of HUD’s count at the end of January 2023. That’s the many Americans sleeping on sidewalks, in abandoned buildings, in bus stops and other places not intended for human habitation. This does not include the many other individuals and families who couch surf or double up with family or friends. Additionally, nearly 9 million renter households in America are at risk of homelessness (PDF | 3.1 MB) because they have very low incomes, do not receive housing assistance and live in extremely inadequate housing, paying more than half their income on rent, or both.
Although not the main drivers of homelessness, mental illness and substance use disorder they are commonly experienced among the unsheltered, and particularly those who do not live in any form of shelter. Injuries, diseases and premature death are all more likely to happen people who have nowhere to live. The experience of homelessness can also worsen mental illness and substance use disorder symptoms. Without a stable home, it is difficult for people to engage in health-promoting activities – such as storing and taking medications, cooking healthy meals, or getting enough sleep. Meeting basic survival needs such as eating, bathing, or finding a toilet can become persistent and painful daily obstacles.
Criminalization of the homeless by ticketing, arresting or jailing people for sleeping in public places can perpetuate a harmful cycle from prison to streetbecause having an incarceration history makes it harder to secure housing, and because fining people already living in deep poverty just makes housing more distant.
It doesn’t have to be that way
Homelessness is preventable. It requires a collaborative, integrated approach from a wide range of partners, including people with lived experience of homelessness and housing instability. Cross-sector partners may include government agencies, homelessness and housing service providers, charities, legal services organizations, medical and behavioral health providers, and a range of other organizations that address homelessness locally. Together these partners can use data to tailor specific housing resources to local needs, while also investing broadly in methods to help people stay in their homes or settle and stabilize in new ones.
For people already experiencing homelessness—including those with a mental illness or substance use disorder—a variety of approaches are known to be helpful. The first, of course, is housing. Successful recovery from any health condition is more likely when a person has a safe, stable place to live.
Supportive services such as case management, help applying for benefits (including Supplemental Security Income/Social Security Disability Insurance or SSI/SSDI), and supported employment all help one achieve stability. Specialized medical outreach teams or other mobile care teams go where people are, offering support for behavioral health needs. This may mean training someone overdose preventionconnecting them to treatment or psychiatry, starting them on medication for their substance use disorder, providing peer support, or a range of other services. The key is to build relationships with people over time and ensure that people have a voice and a choice about the services and support they receive.
When designing community services for people with mental illness, substance use disorder and/or homelessness, it is important that people who have experienced or lived experience are included in decision-making and as members of treatment teams. This involvement can help build trust and connection with those receiving services and promote more responsive behavioral health and housing services.
Taking action for those experiencing homelessness
As we prepare for winter, let us turn our collective attention to those who remain homeless. Here are some specific things you can do:
Resources for local governments and community organizations
If you work for an organization that serves people who are not housed, SAMHSA and other federal agencies have developed a wide range of resources that may help you as you plan and implement your programs. Some of these resources include:
SAMHSA grants focus on reaching people experiencing homelessness
Finding help in a crisis
Finally, if you or someone you care about is experiencing homelessness or the threat of homelessness, with or without co-occurring mental health needs or a substance use disorder, here are some specific resources to consider:
- HUD: Find your local Public Housing Agency or find others housing assistance.
- Other housing resourcesincluding information about eviction and foreclosure, help with home repairs, and filing complaints against landlords.
- FindTreatment.gov (Español), a confidential and anonymous online resource for people seeking treatment for mental and substance use disorders.
- FindSupport.gov (Español) is an online guide that helps people navigate common questions as they begin their journey to better behavioral health.
- SAMHSA’s National Helpline, 1-800-622-HELP (4357), a free, confidential, 24/7, 365 days a year referral and treatment information service (in English and Spanish) for individuals and families experiencing mental and/or substance use disorders.
- 988 Suicide and Crisis Lifeline: If you or someone you know is struggling or in crisis, help is available. Call or text 988 or chat on 988lifeline.org.
- If you are a veteran who is homeless or at immediate risk of becoming homeless, please call National Call Center for Homeless Veterans at (877) 4AID-VET (877-424-3838) for assistance.
- Disaster Helpline: 1-800-985-5990
