A common misconception about homelessness is that it primarily affects people with severe mental illness or substance use disorders. This oversimplification not only misrepresents the diverse population of people experiencing homelessness but also distorts our understanding of the primary causes of housing instability in America.
The Reality: A More Complex Picture
While mental health and substance use issues do occur among people experiencing homelessness, the prevalence is often exaggerated, and the relationship between these conditions and homelessness is frequently misunderstood.
What the Data Actually Shows
According to the most reliable research:
- Approximately 25-30% of people experiencing homelessness have a serious mental illness
- About 30-35% have substance use disorders
- Many people have neither condition
- The rates vary significantly depending on the subpopulation (youth, families, veterans, chronically homeless individuals)
Important Context
These statistics mean that a majority of people experiencing homelessness do not have severe mental illness, and a majority do not have substance use disorders. The perception that "most" homeless people have these conditions is simply not supported by evidence.
Cause or Consequence?
Perhaps more importantly, the relationship between mental health, substance use, and homelessness is not as straightforward as many assume.
Mental Health and Homelessness
For some individuals, untreated mental illness can contribute to homelessness through:
- Difficulty maintaining employment
- Challenges managing finances
- Strained relationships with family and support networks
- Barriers to accessing services and benefits
However, for many others, mental health conditions develop or worsen after becoming homeless due to:
- The extreme stress and trauma of homelessness itself
- Sleep deprivation
- Exposure to violence
- Social isolation
- Lack of privacy and constant hypervigilance
Research shows that housing instability can trigger or exacerbate mental health conditions, creating a vicious cycle that makes recovery more difficult.
Substance Use and Homelessness
Similarly, the relationship between substance use and homelessness is complex:
- For some, substance use contributes to housing loss through financial strain or behavioral issues
- For others, substance use begins or intensifies after becoming homeless as a coping mechanism for trauma, stress, or untreated physical/mental health conditions
- Many people use substances to stay awake at night (for safety) or to stay warm in cold weather
Studies have found that many people who develop substance use disorders while homeless did not have these issues before losing their housing.
The Primary Cause: Housing Affordability
Research consistently shows that the primary driver of homelessness in the United States is the lack of affordable housing, not individual health conditions:
- Cities with the highest housing costs tend to have the highest rates of homelessness, regardless of mental health or substance use rates
- When affordable housing is available, even people with severe mental illness or substance use disorders can maintain stable housing with appropriate supports
- Many people with serious mental illness or substance use disorders never become homeless because they have access to housing they can afford
Evidence from Other Countries
Countries with stronger social safety nets and more affordable housing have lower rates of homelessness despite similar rates of mental illness and substance use in their general populations. This demonstrates that these health conditions alone don't cause homelessness—they become risk factors primarily in the absence of affordable housing and adequate support systems.
The Visibility Factor
One reason this myth persists is the visibility factor. People with untreated mental illness or substance use disorders who are homeless are often more visible in public spaces, while those without these conditions may:
- Be more likely to access shelters
- Find temporary accommodations with friends or family
- Live in vehicles or other less visible locations
- Maintain appearances that don't conform to stereotypes about homelessness
This visibility bias creates a skewed perception of who experiences homelessness.
The Harm of This Myth
The misconception that homelessness is primarily a mental health or addiction issue causes several harms:
Policy Misdirection
When we misidentify the primary causes of homelessness, we develop ineffective solutions. While mental health and substance use services are important, they cannot solve homelessness without addressing the fundamental lack of affordable housing.
Stigmatization
This myth contributes to the stigmatization of people experiencing homelessness, portraying them as fundamentally different from the housed population rather than as people experiencing a housing crisis.
Overlooking Structural Factors
Focusing on individual health conditions diverts attention from the structural factors that create and perpetuate homelessness: housing unaffordability, inadequate wages, insufficient social safety nets, and systemic discrimination.
A More Accurate Understanding
A more accurate understanding recognizes that:
- Homelessness affects a diverse population with varying needs and circumstances
- Mental health and substance use issues affect some but not most people experiencing homelessness
- These health conditions are often consequences of homelessness rather than causes
- The primary driver of homelessness is the lack of affordable housing
- Even for people with serious mental illness or substance use disorders, stable housing is possible with appropriate supports
Evidence-Based Solutions
Understanding the true relationship between mental health, substance use, and homelessness points to more effective solutions:
Housing First
The Housing First approach provides permanent housing without preconditions of treatment or sobriety. Research shows this approach is effective even for people with serious mental illness or substance use disorders, with housing retention rates of 80-90% in many programs.
Supportive Housing
For those who do have mental health or substance use disorders, permanent supportive housing combines affordable housing with voluntary support services. This model has proven highly effective at ending homelessness for people with complex needs.
Expanded Affordable Housing
Increasing the overall supply of affordable housing prevents homelessness for people with and without health conditions.
Conclusion
The myth that most homeless people have mental illness or addiction oversimplifies a complex issue and misidentifies the primary causes of homelessness. While these health conditions affect some people experiencing homelessness, they are not the defining characteristic of the population nor the primary driver of housing instability.
By moving beyond this misconception, we can develop more effective, evidence-based approaches that address the true causes of homelessness and meet the diverse needs of people experiencing housing crises.
Key Takeaway
Mental health and substance use issues are present in the homeless population but are not as prevalent as commonly believed. Even when these conditions are present, they're often consequences rather than causes of homelessness. The primary solution to homelessness remains increasing access to affordable housing, with appropriate supports for those who need them.
References & Further Reading
- Substance Abuse and Mental Health Services Administration (SAMHSA). "Current Statistics on the Prevalence and Characteristics of People Experiencing Homelessness in the United States." SAMHSA, 2023. https://www.samhsa.gov/homelessness-programs-resources
- U.S. Department of Housing and Urban Development. "The 2023 Annual Homeless Assessment Report (AHAR) to Congress." HUD, 2023. https://www.huduser.gov/portal/sites/default/files/pdf/2023-AHAR-Part-1.pdf
- Fazel, S., Khosla, V., Doll, H., & Geddes, J. "The Prevalence of Mental Disorders among the Homeless in Western Countries: Systematic Review and Meta-Regression Analysis." PLOS Medicine, 5(12), 2008. https://doi.org/10.1371/journal.pmed.0050225
- National Low Income Housing Coalition. "The Gap: A Shortage of Affordable Homes." NLIHC, 2024. https://nlihc.org/gap
- Shinn, M. & Khadduri, J. "In the Midst of Plenty: Homelessness and What to Do About It." Wiley-Blackwell, 2020. https://doi.org/10.1002/9781119104841
- Tsemberis, S. "Housing First: The Pathways Model to End Homelessness for People with Mental Illness and Addiction." Hazelden Publishing, 2010. https://www.pathwayshousingfirst.org/
- Quigley, J. M. & Raphael, S. "The Economics of Homelessness: The Evidence from North America." European Journal of Housing Policy, 1(3), 2001. https://doi.org/10.1080/14616710110091525
- National Alliance on Mental Illness (NAMI). "Mental Health By the Numbers." NAMI, 2024. https://www.nami.org/mhstats
- Padgett, D. K., Henwood, B. F., & Tsemberis, S. J. "Housing First: Ending Homelessness, Transforming Systems, and Changing Lives." Oxford University Press, 2016. https://doi.org/10.1093/acprof:oso/9780199989805.001.0001