The U.S. Interagency Council on Homelessness (USICH) released guidance on September 12 summarizing ways that federal resources can be used to address the behavioral health needs of people experiencing or at risk of homelessness. The guidance offers information to state and local agencies, tribes, health and human services systems, and community-based organizations about how federal funding, technical assistance, policy and regulatory flexibilities, and other resources should be used to support the delivery and financing of behavioral health services. Additionally, the new guidance provides an overview of evidence-based interventions for addressing the mental health and substance use needs of people experiencing homelessness.
USICH emphasizes that the root causes of homelessness are lack or loss of affordable housing or income. The guidance notes that recent data show that some populations, such as Native American and Black communities, have experienced increasingly disproportionate risks of homelessness in recent years. USICH states that behavioral health conditions can exacerbate housing instability, but while there can be bidirectionality, it is more common for homelessness to trigger or exacerbate behavioral health disorders for individuals than the other way around.
Data also reveal that people experiencing homelessness are more likely to experience mental illness and substance use disorders than those who are housed, with 21% of people experiencing sheltered or unsheltered homelessness reporting a “serious mental illness” and 17% reporting “chronic substance abuse.” Furthermore, in a 2021-2022 California Statewide Study of People Experiencing Homelessness (CASPEH) survey, 66% of respondents self-reported a current mental health condition and approximately 40% reported either regular illicit substance use or heavy alcohol use. Housing instability and homelessness often lead to new or recurring behavioral health conditions due to factors that increase triggers, such as acute stress, uncertainty, and trauma, among others. Additionally, structural and social barriers like lack of insurance, absence of transportation, and discrimination make it significantly harder for people to access behavioral health treatment when they are unhoused.
Given the increasing prevalence of behavioral health disorders among people experiencing homelessness, stakeholders, policymakers, and providers should implement evidence-based and compassionate strategies that address these intersecting challenges. Most importantly, USICH finds that implementing a Housing First model is key to improving health, maximizing housing stability, and preventing a return to homelessness. This includes offering permanent supportive housing without preconditions or barriers and voluntary supportive services that successfully achieve these goals. In fact, research has consistently shown that Housing First leads to greater long-term housing stability, reduced costs across health-care systems, and better outcomes related to behavioral health disorders across all subpopulations of people experiencing homelessness. Lastly, it is important to note that requiring unhoused people to receive treatment while living without a home often prolongs homelessness and exacerbates health problems, and thus prioritizing a Housing First model is essential when it comes to helping individuals achieve housing stability and improve their health.
USICH highlights several additional evidence-based interventions, including behavioral health treatment, crisis stabilization, harm reduction, case management, and recovery support. These interventions operate among existing federal programs and are crucial in addressing behavioral health needs of people experiencing or at risk of homelessness. However, challenges surrounding these interventions include systemic barriers that hinder implementation, such as the insufficient supply of affordable housing and provider shortages, a lack of standardized guidelines, and the lack of fidelity, which need to be addressed accordingly.
Overall, policymakers at all levels of government should work to implement evidence-based strategies and interventions that address behavioral health needs disproportionately affecting people experiencing homelessness. In addition to prioritizing a Housing First model, providing additional services and support is crucial to ensure successful transitions into and the maintenance of housing and ultimately address behavioral health disorders and homelessness.
Find the USICH guidance at: https://tinyurl.com/4usc64fk.