Homelessness and Mental Health: Part 1

March 2021

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 of homeless may increase with the hardships 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.

Lilanthi Balasuriya, M.D.
Lisa B. Dixon, M.D., M.P.H.

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COVID-19 and Homelessness

Addressing the Urgent Housing Needs of Vulnerable Women in the Era of COVID-19: The Los Angeles County Experience
Nichole Goodsmith, M.D., Ph.D., Roya Ijadi-Maghsoodi, M.D., M.S.H.P.M., Rebeca M. Melendez, M.A.Hum., Emily C. Dossett, M.D., M.T.S.
2021, Volume 72, Issue 3, pp. 349–352

Suicidality and Homelessness

Suicide Attempts and Homelessness: Timing of Attempts Among Recently Homeless, Past Homeless, and Never Homeless Adults
Tanner J. Bommersbach M.D., M.P.H., Elina A. Stefanovics, Ph.D., Taeho Greg Rhee, Ph.D., Jack Tsai, Ph.D., Robert A. Rosenheck, M.D.
2020, Volume 71, Issue 12, pp. 1225–1231


Suicidality and the Onset of Homelessness: Evidence for a Temporal Association From VHA Treatment Records
Dennis Culhane, Ph.D., Dorota Szymkowiak, Ph.D., John A. Schinka, Ph.D.
2019, Volume 70, Issue 11, pp. 1049–1052

Homelessness and Our Veterans

Addressing Veteran Homelessness to Prevent Veteran Suicides
Jack Tsai, Ph.D., Louis Trevisan, M.D., Minda Huang, M.A., Robert H. Pietrzak, Ph.D., M.P.H.
2018, Volume 69, Issue 8, pp. 935–937


National Utilization Patterns of Veterans Affairs Homelessness Programs in the Era of Housing First
Jack Tsai, Ph.D., Thomas H. Byrne, Ph.D.
2019, Volume 70, Issue 4, pp. 309–315

Also featured in the Asking for Change: Homelessness and Mental Health collection.

Adverse Childhood Experiences and Homelessness

Adverse Childhood Experiences and the Risk of Criminal Justice Involvement and Victimization Among Homeless Adults With Mental Illness
Hanie Edalati, Ph.D., Tonia L. Nicholls, Ph.D., Anne G. Crocker, Ph.D., Laurence Roy, Ph.D., Julian M. Somers, Ph.D., Michelle L. Patterson, Ph.D.
2017, Volume 68, Issue 12, pp. 1288–1295

Homelessness and Victimization

Criminal Behavior and Victimization Among Homeless Individuals With Severe Mental Illness: A Systematic Review
Laurence Roy, Ph.D., Anne G. Crocker, Ph.D., Tonia L. Nicholls, Ph.D., Eric A. Latimer, Ph.D., Andrea Reyes Ayllon, M.Sc.
2014, Volume 65, Issue 6, pp. 739–750

Also featured in the Asking for Change: Homelessness and Mental Health collection.

Supporting Adults With Intellectual Disabilities Experiencing Homelessness

Supporting Efforts by Intellectually Disabled Adults to Exit Homelessness: Key Ingredients of a Cross-Sector Partnership
Denise Lamanna, M.A., Yona Lunsky, Ph.D., C.Psych., Sophia Wen, B.Sc., Denise Dubois, M.Sc., O.T., Vicky Stergiopoulos, M.H.Sc., M.D.
2020, Volume 71, Issue 1, pp. 96–99

Homelessness and Housing Programs

Trajectories of Homeless Shelter Utilization in the At Home/Chez Soi Trial of Housing First
Cherry M. T. Chu, M.Sc., Erica E. M. Moodie, Ph.D., David L. Streiner, Ph.D., Eric A. Latimer, Ph.D.
2020, Volume 71, Issue 7, pp. 648–655

Also featured in the Homelessness and Mental Health: Part 2. The Impact of Housing Interventions collection.

A Multiple-City RCT of Housing First With Assertive Community Treatment for Homeless Canadians With Serious Mental Illness
Tim Aubry, M.A., Ph.D., Paula Goering, R.N., Ph.D., Scott Veldhuizen, M.A., Carol E. Adair, M.Sc., Ph.D., Jimmy Bourque, Ph.D., Jino Distasio, Ph.D., Eric Latimer, Ph.D., Vicky Stergiopoulos, M.D., M.H.Sc., Julian Somers, Ph.D., David L. Streiner, Ph.D., Sam Tsemberis, Ph.D.
2016, Volume 67, Issue 3, pp. 275–281

Also featured in the Asking for Change: Homelessness and Mental Health collection.

Sustaining Housing First After a Successful Research Demonstration Trial: Lessons Learned in a Large Urban Center
Nishi Kumar, M.P.H., Erin Plenert, M.P.H., Stephen W. Hwang, M.D., M.P.H., Patricia O'Campo, Ph.D., Vicky Stergiopoulos, M.D., M.S.Hc.
2017, Volume 68, Issue 7, pp. 739–742


Housing Is Mental Health Care: A Call for Medicaid Demonstration Waivers Covering Housing
Jennifer Mathis, J.D.
Ahead of Print


Identifying Social Skills That Support Housing Attainment and Retention Among Homeless Persons With Serious Mental Illness
Sonya Gabrielian, M.D., M.P.H., Alison B. Hamilton, Ph.D., M.P.H., Lillian Gelberg, M.D., M.S.P.H., Ella R. Koosis, M.P.H., Axeline Johnson, M.D., M.P.H., Alexander S. Young, M.D., M.S.H.S.
2019, Volume 70, Issue 5, pp. 374–380

Homelessness and Access To Benefits

An Evaluation of SOAR: Implementation and Outcomes of an Effort to Improve Access to SSI and SSDI
Jacqueline F. Kauff, M.S.W., Elizabeth Clary, M.A., Kristin Sue Lupfer, M.S.W., Pamela J. Fischer, Ph.D.
2016, Volume 67, Issue 10, pp. 1098–1102

Use of Peer Navigation and Individuals Experiencing Homelessness

Using Peer Navigators to Address the Integrated Health Care Needs of Homeless African Americans With Serious Mental Illness
Patrick W. Corrigan, Psy.D., Dana J. Kraus, M.S.W., Susan A. Pickett, Ph.D., Annie Schmidt, B.A., Ed Stellon, M.A., M.S., Erin Hantke, M.P.H., Juana Lorena Lara, B.A.
2017, Volume 68, Issue 3, pp. 264–270

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