The Intersection of Homelessness and Mental Illness

Author: Laura Pettigrew

May 13, 2026

[Image credit: Tyrone Madera via Wikimedia Commons]

Introduction

In the Universal Declaration of Human Rights (1948), the United Nations listed the right to housing as a basic human right, stating that “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services” (Article 25). The Office of the United Nations High Commissioner for Human Rights (n.d.) published a fact sheet focusing on the right to adequate housing. In this fact sheet, adequate housing is defined with the following criteria: security of tenure, availability of facilities and infrastructure, affordability, habitability, accessibility, location, and cultural adequacy.

In the United States, President Franklin Delano Roosevelt (1944) spoke of “the right of every family to a decent home” (para. 69) in his 1944 State of the Union Address. According to Roosevelt, “We cannot be content, no matter how high that general standard of living may be, if some fraction of our people—whether it be one-third or one-fifth or one-tenth- is ill-fed, ill-clothed, ill housed, and insecure” (para. 59). However, the right to housing was never officially made into law in the US. Instead, adequate housing has only become less affordable (Bratt, 2022; Montague, 2024). Because of this, the number of individuals experiencing homelessness has increased drastically. Researchers estimate that, at a single point of time in 2024, 771,480 individuals in the United States lacked a “fixed, regular, and adequate nighttime residence”, the highest homelessness rate out of any year (de Sousa & Henry, 2024).

People with mental illnesses are overrepresented among Americans experiencing homelessness. Only 5.5% of Americans have a serious mental illness, but over 20% of people in the US experiencing homelessness have a serious mental illness. People with a serious mental illness who are experiencing homelessness also face worse conditions and outcomes than people experiencing homelessness without a serious mental illness, being more likely to be victimized, arrested, and experience chronic homelessness (Parker & Silver, 2024). 

People experiencing unsheltered homelessness are more likely to have mental health illness and abuse substances than sheltered populations. Unsheltered populations have a higher mortality rate and rates of chronic conditions, trauma, and victimization than sheltered populations (Batko et al., 2020; Richards & Kuhn, 2023). A study by Lam and Rosenheck (1998) found that severity of psychotic symptoms and rate of alcohol use were associated with higher rates of victimization among people experiencing homelessness with a serious mental illness. In turn, victimization was associated with lower quality of life. Sullivan and colleagues (2000) also reported that individuals experiencing homelessness with a mental illness report poorer physical health and more instances of victimization than individuals experiencing homelessness without a mental illness. As a whole, people with a serious mental illness who are also experiencing homelessness face worse outcomes and worse conditions than people without a serious mental illness.

Causes

One of the main causes of homelessness is the lack of affordable housing (Bratt, 2022; Grabenstein, 2023; National Alliance of Mental Illness, n.d.; Parker & Silver, 2024). In the US, the price of housing has increased exponentially over time, but wages have not increased with it (Bratt, 2022). Even Americans who work full-time jobs are unable to afford housing, and individuals who cannot work need to rely on inadequate insurance. Mental illness can affect an individual’s ability to work, well as their cognitive functioning (Ridley et al., 2020), causing them to rely on disability insurance, which is often not enough to cover the cost of adequate housing (National Alliance of Mental Illness, n.d.; Parker & Silver, 2024). 

Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) are two government programs that provide financial support to people with disabilities. SSDI requires the recipient to have worked in the past, which excludes individuals with a serious mental illness who have never been able to work (Parker & Silver, 2024). SSI lacks this requirement but provides so little money that nowhere in the US can someone whose only income is SSI afford a decent apartment without rental assistance (National Alliance of Mental Illness, n.d.; Parker & Silver, 2024).

In addition to having difficulty functioning in the workplace, people with a mental illness face barriers to employment in the form of stigma. In a review of the existing literature, Voldby and colleagues (2022) found that people with mental illness were discriminated against by employers who were reluctant to hire them.

Stigma can also affect an individual’s ability to receive housing directly. Although fair housing laws in the US prohibit housing discrimination based on disability (Homeless and Housing Resource Center, 2022), a report by Hammel and Smith (2017) found that people with mental illnesses and intellectual/developmental disabilities faced “adverse differential treatment” (p. vii) regarding housing, including being less likely to be told a unit was available, being less likely to be invited to inspect an available unit, and being less likely to even receive a response to an initial inquiry about the available unit. 

A final reason people with mental illnesses struggle with money is the availability of mental health care. In the US, mental health care is in short supply (Padgett, 2020). A study by Mental Health America (Reinert et al., 2025) found that, in 2024, there were 320 people for every 1 mental health provider in the US. In 2023, 59.8% of adults with a mental illness who needed but did not receive treatment stated that the cost of the treatment is why they did not receive it. Mental health care is a financial burden that many Americans cannot afford.

Effects of Homelessness on Mental Health

As many reasons as there are that people with mental illnesses might be more likely to experience homelessness, homelessness can also lead to mental illness. Experiencing homelessness is frequently considered to be a traumatic event (Deck & Platt, 2015; Goodman et al.,1991; Thorndike et al., 2022). Trauma can result from losing one’s shelter and the conditions of experiencing homelessness (Goodman et al., 1991). In a survey of men experiencing homelessness, Deck and Platt (2015) found that 30% of their participants met the criteria for post-traumatic stress disorder (PTSD). In addition, those that met the criteria had been experiencing homelessness longer and were more likely to experience chronic homelessness. 

People experiencing homelessness also encounter stigma in various aspects of their lives. Constant exposure to stigma leads to worse mental and physical health. Stigma from and previous negative experiences with healthcare providers can lead to individuals being reluctant to seek the care that they need (Canham et al., 2024; Reilly et al., 2022; Thorndike et al., 2022). 

Even when people experiencing homelessness seek out healthcare providers, help can be difficult to find. Health and social services, such as treatment centers, can be spread out and a distance away from housing arrangements for people experiencing homelessness (Magwood et al., 2020). Other barriers to healthcare among individuals experiencing homelessness include lack of transportation, lack of phone access, competing priorities, provider turnover, and restricted hours (Thorndike et al., 2022; Wille et al., 2017). 

Solutions

A review by Roy and colleagues (2024) found that housing support, specifically Housing First efforts, assertive community treatment, critical time intervention, case management, and combinations of two or more of those approaches were the most effective for individuals with mental illness experiencing homelessness.

Housing First

The National Alliance to End Homelessness (2022) defines the Housing First approach as “a homeless assistance approach that prioritizes providing permanent housing to people experiencing homelessness, thus ending their homelessness and serving as a platform from which they can pursue personal goals and improve their quality of life” (“What is Housing First” section). Housing First, as opposed to a Treatment First approach, corresponds to Maslow’s Hierarchy of Needs, a model of human motivation and behavior first conceptualized in 1943 by psychologist Abraham Maslow (1943). The model takes the form of a pyramid with five layers of human needs. The five layers from bottom to top are physiological needs like food and sleep, safety needs like health and financial security, love and belongingness, esteem needs like recognition and social status, and self-actualization. To satisfy the needs at the top of the pyramid, needs at the bottom of the pyramid must be satisfied (McLeod, 2026). According to Maslow’s Hierarchy, individuals will be unable to work on treatment while they are unhoused, meaning treatment-first programs will be ineffective when compared to housing-first programs (Henwood et al., 2015). 

Housing First is an evidence-based practice with a successful track record. O’Campo and colleagues (2016) found that participants in a Housing First intervention had greater housing stability and quality of life than a control group at a 2-year follow-up. The Housing First group also had fewer psychiatric hospital stays and arrests than the control group. When compared to participants in Treatment First programs, participants in Housing First programs were also less likely to identify housing and employment as needs during a 12-month follow-up (Henwood et al., 2015). 

The effects of Housing First programs on substance use are inconclusive. A review by Saldanha and colleagues (2024) of the existing research found that some studies have found no change in substance use among Housing First participants, while others found a decrease. Individuals with higher rates of substance use were also more likely to drop out of Housing First programs.

Based on the evidence, Housing First programs are effective for individuals experiencing homelessness (National Alliance to End Homelessness, 2022). However, these programs face significant challenges in implementation, mostly because of underfunding and difficulty in accessing adequate housing (Carvalho & Furtado, 2022; National Alliance of Mental Illness, n.d).

Assertive Community Treatment

Assertive community treatment (ACT) refers to a specific and community-based type of treatment for individuals with serious mental health problems and a history of psychiatric hospitalizations, involvement with the criminal justice system, or substance abuse (“Assertive community treatment (ACT)”, n.d.; Mancini et al., 2009; Phillips et al., 2001). It was developed when researchers concluded that providing support within community settings to patients who had been discharged from a hospital was more effective than providing support in hospital programs to those patients before they were discharged (Bond & Drake, 2015). ACT involves a multidisciplinary team who work with patients in their community by providing them with training and support (Bond & Drake, 2015; Mancini et al., 2009). A core feature of ACT is the low staff-to-client ratio, allowing the patient to access support more easily (Bond & Drake, 2015; Mancini et al., 2009).

The evidence indicates that ACT is effective for individuals with serious mental illnesses. Research has found that ACT is associated with higher quality of life, housing stability, and fewer psychiatric hospital visits (Bond et al., 2001). An analysis by Coldwell and Bender (2007) found that, among studies that specifically used participants experiencing homelessness, ACT was related to reductions in homelessness and psychiatric symptoms.

One limitation of ACT is that it is ill-suited for sparsely-populated rural areas, as there are not enough individuals requiring intensive mental health services for ACT to be useful (Bond & Drake, 2015). Other barriers to implementation include cost concerns, gaps and limitations in research regarding the effectiveness of ACT (Rochefort, 2019), excessive documentation requirements, and staffing issues (Mancini et al., 2009).

Critical Time Intervention

Critical time intervention (CTI) is an evidence-based model for vulnerable populations to provide support during critical time periods (“CTI model”, n.d.; National Alliance to End Homelessness, 2021). Traditionally, CTI lasts for nine months (Dixon et al., 2009) and consists of three phases: transition, try out, and transfer of care (“CTI model”, n.d.; Herman et al., 2007). Herman and colleagues (2007) describe the main goal of CTI as “to prevent recurrent homelessness and other adverse outcomes during the period following placement into the community from shelters, hospitals, and other institutions” (pp. 297-298). During the critical transition period, CTI provides support and strengthens clients’ ties to services, family, and the community.

Research shows that CTI decreases homelessness among people with severe mental illnesses (Herman et al., 2007; Herman et al., 2011; Susser et al., 1997). CIT is also associated with less severe psychiatric symptoms (Herman et al., 2007) and a decreased risk of psychiatric re-hospitalizations (Tomita & Herman, 2012). Jones and colleagues (2003) argue that CTI is also more cost-effective than treatment as usual.

Conclusion

People with a serious mental illness have a higher risk of experiencing homelessness for a variety of reasons. Mental illnesses can impair an individual’s ability to work, which can require them to rely on government programs for income. People with mental illnesses are also discriminated against in the workplace and housing market. Homelessness itself can lead to mental illness through trauma and stigma, perpetuating a cycle.

Although there are programs that have proven to be effective in reducing homelessness among people with mental illnesses, implementation of these programs is hindered by their lack of resources. To help individuals experiencing homelessness with a mental illness, the government needs to set aside money and resources to evidence-based programs, such as case management, Housing First, Assertive Community Treatment, and Critical Time Intervention.

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Glossary

• Adequate housing: Housing where occupants are legally protected from forced evictions, services and facilities are readily available, the cost is affordable, occupants are physically protected from the elements, needs of specific disadvantaged groups are taken into consideration, the location is not cut off from social facilities, and the expression of cultural identity is respected.

• Assertive community treatment: Evidence-based programs for individuals with a serious mental illness focusing on community integration and recovery.

• Case management: A collaborative health care process where professionals plan, coordinate, and monitor services that patients need to reach their goals.

• Chronic homelessness: An individual with a disability who is currently experiencing homelessness and has experienced homelessness continuously for at least twelve months, or on at least four separate occasions in the past three years, as long as the occasions are at least twelve months long when combined.

• Critical time intervention: Evidence-based programs with a duration of 9 months focusing on community integration and continuity of care for vulnerable individuals who are in a period of transition, such as being discharged from a psychiatric hospital or released from jail.

• Cultural adequacy: A component of the right to adequate housing. Housing that respects the expression of cultural identity, such as religious requirements.

• Fair housing laws: Laws that prohibit discrimination in housing based on various protected characteristics.

• Habitability: A component of the right to adequate housing, the capacity of housing to provide physical safety, adequate space, and protection from adverse weather and structural hazards.

• Homelessness: The state of lacking permanent housing.

• Housing first: Homelessness programs that provide permanent housing and community-based treatment.

• Maslow's Hierarchy of Needs: A motivational theory of human behavior proposed by psychologist Abraham Maslow. Maslow's Hierarchy takes the shape of a triangle with physiological needs at the bottom and self-actualization needs at the top. According to Maslow, humans need to satisfy needs at the bottom of the triangle before they can satisfy the needs at the top.

• Mental illness: Mental health conditions affecting an individual's emotion, thinking, and/or behavior. Mental illnesses cause impairment in day-to-day functioning.

• Security of tenure: A central component of the right to adequate housing. Refers to the legal right to live in or use a building that is rented from the owner. 

• Self-actualization: The full realization of one's potential, involving personal growth.

• Serious mental illness: A mental, behavioral, or emotional disorder that significantly impairs an individual and/or significantly limits their major life activities. 

• Sheltered homelessness: Living in temporary accommodations, such as a homeless shelter or motel.

• Social Security Disability Insurance (SSDI): A taxpayer-funded government program that provides money to individuals who have work history but cannot currently work due to a disability.

• Stigma: Unfair negative beliefs held by society or a group of people about something.

• Supplemental Security Income (SSI): A government program that provides money to low-income individuals who have a disability and/or are 65 or older. People receiving SSI cannot have assets worth more than $2,000.

• Treatment first: Homelessness programs that require participants to address psychiatric symptoms, social skills, and/or substance abuse before accessing housing.

• Universal Declaration of Human Rights: A document written by United Nations representatives after World War II outlining basic rights every human should have. It is the basis for multiple human rights treaties.

• Unsheltered homelessness: Living in a place not meant for human habitation, such as in a park or a car.

• Victimize: To subject someone to unfair or cruel treatment; to make someone a victim.

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