Debunking myths about homelessness and mental health

Last year, the U.S. Department of Housing and Urban Development reported that over half a million people were experiencing homelessness on a single night in January 2022. 

When people experience homelessness, it has a direct negative impact on their mental health. Studies show that people who are homeless experience more prevalent thoughts of suicide and depression and display more symptoms associated with trauma and substance use disorders. 

The strong relationship between mental health and homelessness makes it a relevant subject for mental health providers. Many of us approach the topic with preconceived ideas about homelessness, perpetuated by biases and misinformation. 

Myth 1: All homeless people have mental illness or substance use disorder.

SAMSHA found that 26.2% of all homeless people had a severe mental illness and that 34.7% of all sheltered adults who were homeless had chronic substance use issues. So while it is true that a greater percentage of homeless people have a mental health or substance use disorder relative to the general population, a majority of people who are homeless do not have mental health or substance use disorder.

Regardless, people should have access to support. The stigma around mental health and substance use disorders is often used to justify a lack of services for people experiencing homelessness. It’s interpreted as a character flaw for which homelessness is a consequence they deserve, instead of a societal issue that can be addressed.

Myth 2: It’s their fault they are homeless.

36% of people experiencing homelessness are children. As a whole, many people end up homeless due to causes that they don’t have much control over. These causes may include a mental health or physical health disorder or impairment, lack of affordable housing, displacement from gentrification, and income disparities. 

In fact, a review by The National Law Center on Homelessness & Poverty found that insufficient income and lack of affordable housing are the leading causes of homelessness. For example, in 2012, 10.3 million renters had extremely low incomes—but the amount of affordable rental units was only a little over half that number. There isn’t enough housing for low income people.  

Of course, people can apply for higher-paying jobs and obtain education that can increase their income—at least in theory. The reality is that for many, barriers make what seem like a simple solution extremely difficult. Mental or physical disabilities, limited access to transportation, educational barriers, lack of permanent housing, and criminal history often put financial mobility and therefore stability out of reach.

Myth 3: Homelessness cannot be solved.

Homelessness is such a pervasive global problem that it can seem like an overwhelming—and maybe impossible—problem to solve. Yet certain regions have shown that this isn’t the case as they make strides in eradicating homelessness. 

Finland, for example, recorded over 18,000 people and families as experiencing homelessness in 1987 but brought this number down to 5,000 by 2019, a decrease of about 70%. This decrease was partially attributed to the “housing first model,” which posits that a homeless individual should first obtain housing and then supportive services as opposed to the other way around. Because housing first requires additional housing units, Finland ended up reducing their shelter beds while increasing their supportive housing and independent rental apartments. 

Of course, the situation in the United States is much different from the one in Finland. The United States is a larger country, with greater regional, cultural, and political differences that require different approaches.  Yet significant progress has been made in the United States as well within certain communities: In Houston, more than 28,000 people have been housed since 2012, resulting in a 60% decreased homelessness rate. 

There are also innovative nonprofits in the space. Community Solutions, a nonprofit which won the $100 million MacArthur Foundation award, partners with cities and counties in an effort to bring homelessness in the community to what they call “functional zero.” Functional zero indicates that “a community has measurably solved homelessness for a population” and in that community, “homelessness is rare and brief.” Their innovative approach entails comprehensive and real-time monitoring, pushing for greater data sharing between involved parties, and breaking down silos. Through these efforts, 14 communities have achieved functional zero for at least one population, and 43 communities have achieved a measurable reduction in homelessness. 

What to know as a provider

Homelessness is a complex but solvable issue. Furthermore, although people who are homeless have higher rates of mental health and substance use disorders, most people experiencing homelessness don’t. And while people can fall into homelessness due to mental health and substance use difficulties, there are other, larger societal issues which play a key role in the rates of homelessness we experience today. 

In working with those who are homeless, we must be flexible as providers. We can utilize modalities such as motivational interviewing, Community-Based Intensive Case Management Services and Treatment, and Assertive community treatment. Many of these treatment modalities involve groups of providers, ranging from mental health therapists and psychiatrists to case managers and nurses. 

Additionally, it is important to be mindful of other clinical issues that may present themselves. For example, people who are homeless may have greater rates of dropping out of treatment due to various issues including lack of motivation, difficulty finding transportation, or a general dissatisfaction with services. Yet this can be addressed through actions such as elimination of wait times between enrollment and entry, increased contact with case managers, and access to more accessible services.

As trained mental health clinicians can better educate ourselves on clinical issues that help us to work with or support those who are homeless.