Homelessness and Housing

Overview

Stable housing provides the foundation upon which people build their lives. Without a safe, affordable place to live, it is almost impossible to achieve good health or to achieve one’s full potential. But, according to the Department of Housing and Urban Development (HUD), on a single night in 2014, more than 578,000 people, including 136,000 children, experienced homelessness. Of those people, more than 177,000 were unsheltered. While the number of people experiencing homelessness has declined since 2007, much work remains to be done to reach the goal of ending homelessness in the United States.

According to HUD’s 2013 Annual Homelessness Assessment Report, of those who experience homelessness, approximately 257,300 people have a severe mental illness or a chronic substance use disorder.

The circumstances of homelessness take different forms. People experiencing homelessness may find themselves in any one of the following groups:

• Unsheltered—living on the streets, camping outdoors, or living in cars or abandoned buildings
• Sheltered—staying in emergency shelters or transitional housing
• Doubled up—staying with friends or family temporarily

People with mental and/or substance use disorders can be precariously housed and particularly vulnerable for homelessness. In January 2014, one in five people experiencing homelessness had a serious mental illness, and a similar percentage had a chronic substance use disorder. However, efforts to combat homelessness are having an impact, particularly among veterans and people experiencing chronic homelessness.

SAMHSA works closely with the U.S. Interagency Council on Homelessness (USICH). Its mission is to coordinate the federal response to homelessness and to create a national partnership at every level of government and with the private sector to reduce and end homelessness in the nation while maximizing the effectiveness of the federal government in contributing to the end of homelessness. In June 2010, USICH published Opening Doors, the federal strategic plan to prevent and end homelessness. This plan outlines four goals:

• Finish the job of ending chronic homelessness in five years
• Prevent and end homelessness among veterans in five years
• Prevent and end homelessness for families, youth, and children in 10 years
• Set a path to ending all types of homelessness

USICH developed this strategic plan as a blueprint to aid in the coordination of the 19 federal members of USICH, and also for state and local partners to end homelessness. Opening Doors calls for Department of Health and Human Service (HHS) agencies to collaborate and review how SAMHSA, Medicaid, and Temporary Assistance to Needy Families (TANF) programs can be coordinated with housing resources to prevent and end homelessness. For SAMHSA, this means improving coordination and targeting of existing SAMHSA homelessness and recovery resources.

Chronic Homelessness

A person is considered to be experiencing chronic homelessness when he or she spends more than a year in a state of homelessness or has experienced a minimum of four episodes of homelessness over a three-year period. Of the 578,000 people experiencing homelessness on a single night of 2014, approximately 99,000 were considered to be experiencing chronic homelessness. Although chronic homelessness represents a small portion of the overall homeless population and the number of people experiencing chronic homelessness is decreasing across the United States, this population consumes more than half of services.

According to the Office of National Drug Control Policy, approximately 30% of people experiencing chronic homelessness have a serious mental illness, and around two-thirds have a primary substance use disorder or other chronic health condition. These health problems may create difficulties in accessing and maintaining stable, affordable, and appropriate housing.

Research from the Collaborative Initiative to Help End Chronic Homelessness (CICH), a joint effort of HUD and Veterans Affairs, sheds light on the prevalence of these issues. They indicate that, at program entry, 72% of participants had substance use disorders and 76% had mental illness problems.

SAMHSA’s goal is to increase access to permanent housing for individuals with mental and/or substance use disorders and their families. Learn more about SAMHSA’s involvement to help end homelessness:

• Poverty and Housing
• SAMHSA’s Efforts to Prevent Homelessness
• Trauma and Trauma-Informed Care
• Grants Related to Homelessness and Housing
• Publications and Resources on Homelessness and Housing

Specific Populations

Lesbian, Gay, Bisexual, and Transgender (LGBT) Youth

One group that is at high risk for homelessness is lesbian, gay, bisexual, and transgender (LGBT) youth. Among youth who are experiencing homelessness, LGBT youth are at higher risk for physical assaults, sexual exploitation, and mental and/or substance use disorders. To best serve this population, treatment and service providers need to be aware of the unique needs of these youth. For more information about the prevalence LGBT youth experiencing homelessness and interventions and services available, download the National Alliance to End Homelessness publication Incidence and Vulnerability of LGBTQ Homeless Youth – 2008 (PDF | 279 KB).

According to the report On the Streets: The Federal Response to Gay and Transgender Homeless Youth – 2010 (PDF | 524 KB), there are approximately 1.6 million to 2.8 million young people experiencing homelessness in the United States, and estimates suggest that disproportionate numbers of these youth are LGBT. Research indicates that between 240,000 and 400,000 lesbian, bisexual, gay, transgender, and questioning (LGBTQ) youth experience at least one episode of homelessness each year.

Rural Residents

Understanding homelessness among rural populations requires a more flexible definition of homelessness. There are far fewer shelters in rural areas, so people experiencing homelessness are more likely to live in a car or camper or with relatives in overcrowded or substandard housing. Defining homelessness to include only those who are literally homeless—living in a shelter or on the streets—does not fit with the rural reality.

Rural homelessness, like urban homelessness, is the result of poverty and lack of affordable housing. Studies have shown that people experiencing homelessness in rural areas are more likely to be white, female, married, and currently working. Homelessness among Native Americans and migrant workers is also more common in rural areas.

While research around behavioral health and homelessness among rural populations is limited, there is growing evidence indicating the likelihood of behavioral health problems among this population. In California, adults experiencing homelessness were screened for the probability of lifetime major mental and/or substance use disorders. Compared to the two urban counties in the test, the homeless populations in the rural county had higher rates of severe mental illness. In a similar study in Montana, 18% of the rural population experiencing homelessness admitted to having been diagnosed with mental illness and 15% admitted to alcohol or drug use disorder. About 26% of those who participated in the study reported that chronic drug or alcohol use was a cause of their homelessness.

Learn more about homelessness among rural populations and available federal resources.

Veterans

In 2014, almost 50,000 veterans experienced homelessness on a single night, down from more than 75,000 in 2009. Among veterans experiencing homelessness in 2013, 50% had a serious mental illness, 70% had a substance use disorder, and 74% experienced chronic homelessness. A large number of veterans who are experiencing homelessness or who are at-risk of experiencing homelessness live with lingering effects of post-traumatic stress disorder (PTSD). For many, their situation is further complicated by co-occurring substance use.

Learn more about homelessness and the other challenges faced by our veterans and military families. Find federal resources for veterans experiencing homelessness.

Outreach and Engagement

Meeting people where they are—geographically, philosophically, emotionally—is the essence of effective outreach to people experiencing homelessness and the beginning pathway to engaging them in treatment and services. Rather than expecting people to access services on their own, outreach workers across the country take services to where people are. These outreach workers are often the first and only point of contact for people who might otherwise be disconnected.

Find infromation about outreach to homeless populations and other behavioral health and homelessness resources.

Cultural Awareness and Competency

People experiencing homelessness come from a wide range of backgrounds. Providers should recognize that each person’s diverse experiences, values, and beliefs will impact how he or she accesses homeless services. Of equal importance is recognizing that the cultural values of treatment and service providers have an effect on how services are delivered and accessed.

The disproportionate impact of homelessness on minority populations is noted in the HUD 2013 Annual Homeless Assessment Report. Data show that minorities (i.e., Hispanics, African Americans, and other non-white races) are among the populations most vulnerable to fall into homelessness. One in 129 minorities and one in 69 African Americans in the United States experienced homelessness in shelters in 2012. While the number of minorities in the total U.S. population increased 13.1% between 2007 and 2012, the number in shelters actually decreased by 1%.

Furthermore, the proportion of adults who are disabled in shelters increased an estimated 37% between 2007 and 2012. Between 2007 and 2012, the number of sheltered people experiencing homelessness increased 20.4% in suburban and rural areas and declined 14.4% in cities, reflecting a similar geographic trend in the U.S. poverty population. Minorities were almost 2 times as likely to become homeless than to receive a cancer diagnosis (1 in 243).