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, per the Department of Housing and Urban Development (HUD), on a single night in 2016, more than 549,900 people, including 120,819 children, experienced homelessness. Of those people, more than 176,357 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.

The circumstances of homelessness take different forms. People experiencing homelessness may find themselves in 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 particularly vulnerable to becoming homeless or being precariously housed. According to HUD’s 2016 Annual Homelessness Assessment Report, of those who experience homelessness, approximately 202,297 people have a severe mental illness or a chronic substance use disorder. In January 2016, 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, creating 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 ending homelessness. In June 2010, USICH published Opening Doors, the federal strategic plan to prevent and end homelessness. Amended in 2012 and 2015 to reflect the latest data, this plan establishes four goals:

• Prevent and end homelessness among veterans in 2015
• Finish the job of ending chronic homelessness in 2017
• Prevent and end homelessness for families with children and youth in 2020
• Set a path to ending all types of homelessness

USICH developed this strategic plan as a blueprint for coordinating the 19 federal members of USICH and 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 has a disability and has been continuously homeless for 1 year or more or has experienced at least four episodes of homelessness in the last 3 years where the combined length of time homeless in those occasions is at least 12 months.. Of the 549,928 people experiencing homelessness on a single night of 2016, approximately 86,492 had chronic patterns of homelessness. Although chronic homelessness represents a small percentage (16%) 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.

SAMHSA seeks to support states and communities in delivering evidence-based mental and/or substance use disorders treatment and recovery supports and increase access to permanent housing. 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 at high risk for homelessness is lesbian, gay, bisexual, and transgender (LGBT) youth. According to the report Seeking Shelter: The Experiences and Unmet needs of LGBT Homeless Youth, up to 2 million young adults in the U.S. experience homelessness, and estimates suggest that a disproportionate number of these youth identify as LGBT. Findings from a national survey of homeless youth services providers report that as many as 40% of their clientele identify as LGBT. 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 resources on serving LGBT youth experiencing homelessness, go to the HUD Exchange, Youth.gov, or the National Center for Homeless Education.

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 American Indians and migrant workers is also more common in rural areas.

While research on 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 an 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 2016, approximately 39,500 veterans experienced homelessness on a single night, down from more than 75,000 in 2009. Many veterans who remain homeless or who are at risk of experiencing homelessness live with lingering effects of post-traumatic stress disorder. For many, their situation is further complicated by co-occurring substance use. Mental illness and substance use disorders have been identified as strong risk factors for veteran homelessness.

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. In 2015, SAMHSA lead an expert panel on the role of outreach and engagement in ending homelessness.

Find information 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. The disproportionate impact of homelessness on minority populations is noted in the HUD 2016 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. According to census numbers, African-Americans, for example, make up approximately 13 percent of the U.S. population, yet 39 percent of the U.S. population experiencing homelessness are African American. Other subpopulations experiencing homelessness also present with unique needs, including mitigation of trauma: over 68,000 are victims of domestic violence, and over 35,000 are unaccompanied youth.

Of equal importance is recognizing that the cultural values of treatment and service providers influence how services are delivered. Providers must be trained to identify underlying conditions associated with homelessness and address them in a judgment-free manner using evidence-based practices. For example, 20 percent of the population experiencing homelessness have serious mental illness and 17 percent live with chronic substance use. Regardless of personal feelings about these conditions, providers must meet those they are serving where they are at the time.