Homelessness and Mental Health: Part 1

Homelessness has been defined as “lacking a fixed, regular and adequate nighttime residence.” Prior to the COVID-19 pandemic, over a half-million individuals were estimated to be experiencing homelessness in the United States. The number homeless may increase with the hardship of COVID-19, which has disproportionately affected already vulnerable populations. Over 60% of those who experience chronic homelessness also have a mental health condition. As mental health providers, we have an opportunity and responsibility to understand the relationship between homelessness and mental illness, address risk factors for homelessness, and provide evidence-based interventions for our patients experiencing homelessness and mental illness. In this collection, we highlight several studies and commentaries that explore unique challenges and solutions to addressing homelessness, particularly for people with mental illness. Articles in this collection describe the impacts of COVID-19, suicidality, childhood adverse experiences, and victimization on the mental health and psychosocial well-being of people experiencing homelessness. This collection also offers concrete solutions to these complex challenges, including housing-first models, which can lower shelter use; Medicaid demonstration waivers supporting housing; and peer navigation models that lead to improvements in general medical health and mental health. Now more than ever, our patients and communities experiencing these dual challenges deserve our attention and support.

COVID-19 and Homelessness

Social Determinants of Mental Health

Addressing the Urgent Housing Needs of Vulnerable Women in the Era of COVID-19: The Los Angeles County Experience

Goodsmith N, Ijadi-Maghsoodi R, Melendez RM, et al.

Psychiatric Services in Advance, Nov 10, 2020

Suicidality and Homelessness

Article

Suicide Attempts and Homelessness: Timing of Attempts Among Recently Homeless, Past Homeless, and Never Homeless Adults

Bommersbach TJ, Stefanovics EA, Rhee TG, et al.

Psychiatr Serv 2020; 71:1225–1231

https://doi.org/10.1176/appi.ps.202000073

Brief Report

Suicidality and the Onset of Homelessness: Evidence for a Temporal Association From VHA Treatment Records

Culhane D, Szymkowiak D, Schinka JA

Psychiatr Serv 2019; 70:1049–1052

https://doi.org/10.1176/appi.ps.201800415

Homelessness and Our Veterans

Open Forum

Addressing Veteran Homelessness to Prevent Veteran Suicides

Tsai J, Trevisan L, Huang M, et al.

Psychiatr Serv 2018; 69:935–937

https://doi.org/10.1176/appi.ps.201700482

Article

National Utilization Patterns of Veterans Affairs Homelessness Programs in the Era of Housing First

Tsai J, Byrne TH

Psychiatr Serv 2019; 70:309–315

https://doi.org/10.1176/appi.ps.201800393

Adverse Childhood Experiences and Homelessness

Article

Adverse Childhood Experiences and the Risk of Criminal Justice Involvement and Victimization Among Homeless Adults With Mental Illness

Edalati H, Nicholls TL, Crocker AG, et al.

Psychiatr Serv 2017; 68:1288–1295

https://doi.org/10.1176/appi.ps.201600330

Homelessness and Victimization

Review

Criminal Behavior and Victimization Among Homeless Individuals With Severe Mental Illness: A Systematic Review

Roy L, Crocker AG, Nicholls TL, et al.

Psychiatr Serv 2014; 65:739–750

https://doi.org/10.1176/appi.ps.201200515

Supporting Adults with Intellectual Disabilities Experiencing Homelessness

Research, Community, & Services Partnerships

Supporting Efforts by Intellectually Disabled Adults to Exit Homelessness: Key Ingredients of a Cross-Sector Partnership

Lamanna D, Lunsky Y, Wen S, et al.

Psychiatr Serv 2020; 71:96–99

https://doi.org/10.1176/appi.ps.201800590

Homelessness and Housing Programs

Article

Trajectories of Homeless Shelter Utilization in the At Home/Chez Soi Trial of Housing First

Chu CMT, Moodie EEM, Streiner DL, et al.

Psychiatr Serv 2020; 71:648–655

https://doi.org/10.1176/appi.ps.201900260

Article

A Multiple-City RCT of Housing First With Assertive Community Treatment for Homeless Canadians With Serious Mental Illness

Aubry T, Goering P, Veldhuizen S, et al.

Psychiatr Serv 2016; 67:275–281

https://doi.org/10.1176/appi.ps.201400587

Brief Reports

Sustaining Housing First After a Successful Research Demonstration Trial: Lessons Learned in a Large Urban Center

Kumar N, Plenert E, Hwang SW, et al.

Psychiatr Serv 2017; 68:739–742

https://doi.org/10.1176/appi.ps.201600220

Article

Housing Is Mental Health Care: A Call for Medicaid Demonstration Waivers Covering Housing

Mathis J

Psychiatric Services in Advance, Dec 18, 2020

DOI: 10.1176/appi.ps.202000252

Article

Identifying Social Skills That Support Housing Attainment and Retention Among Homeless Persons With Serious Mental Illness

Gabrielian S, Hamilton AB, Gelberg L, et al.

Psychiatr Serv 2019; 70:374–380

https://doi.org/10.1176/appi.ps.201800508

Homelessness and Access to Benefits

Article

An Evaluation of SOAR: Implementation and Outcomes of an Effort to Improve Access to SSI and SSDI

Kauff JF, Clary E, Lupfer KS, et al.

Psychiatr Serv 2016; 67:1098–1102

https://doi.org/10.1176/appi.ps.201500247

Use of Peer Navigation and Individuals Experiencing Homelessness

Integrated Care

Using Peer Navigators to Address the Integrated Health Care Needs of Homeless African Americans With Serious Mental Illness

Corrigan PW, Kraus DJ, Pickett SA, et al.

Psychiatr Serv 2017; 68:264–270

https://doi.org/10.1176/appi.ps.201600134