Note: This piece delves into the intersection of mental health and homelessness.
As a mental health therapist, sitting with clients is a privilege I do not take for granted. Over the years, I have met individuals across the lifespan, from various cultural backgrounds, and across the spectrum of gender identity and sexual orientation. My clients have held assorted degrees and certifications, sweated in the Texas summers while working physically demanding blue-collar positions, and hustled through 60-80 hour work weeks between two (or even three) concurrent jobs. Engineers, food servers, teachers, retail workers, nurses, and college students have all sat on my office couch and graciously allowed me to enter their world and lived experiences. As unique as they have all been, my clients have shared one similarity when meeting with me: actively surviving homelessness.
At a basic level, we can break homelessness into two main categories: sheltered and unsheltered. Sheltered individuals include those residing in both emergency shelters and transitional housing facilities. Unsheltered individuals include those living in locations not meant for human habitation, such as parks and cars. Additionally, homelessness can be subcategorized into chronic homelessness and episodic homelessness. Those experiencing chronic homelessness have experienced homelessness for at least a year—or repeatedly—while struggling with a disabling condition such as a serious mental illness, substance use disorder, or physical disability, per the National Alliance to End Homelessness (NAEH). Episodic homelessness often occurs due to a traumatic or sudden event such as a loss of a job, disproportionate rent increases, death in the family, or divorce. The 2023 NAEH data reported homelessness has been on the rise since 2017, with an overall increase of 6% from 2017-2022. In addition, 2022 reached record highs in NAEH data collection history of individuals experiencing chronic homelessness (127,768) and episodic homelessness (421,392) in the United States.
The 2022 Annual Homeless Assessment Report to Congress (AHAR) reported that 40% of the homeless population was unsheltered. Unhoused individuals who are non-cisgender reported disproportionate rates of unsheltered homelessness. 56% of transgender, 66% of non-binary or gender non-conforming, and 78% of gender-questioning individuals were unsheltered. These rates are dramatically higher than their cisgender counterparts. Racial disparities also exist in homelessness trends. Per NAEH, in January of 2022, roughly 18 out of every 10,000 people in the US experienced some form of homelessness. Compared to the national rate, Native Hawaiian and Pacific Islanders experience homelessness at a rate of 121 out of every 10,000. While no data currently exists for older adults experiencing homelessness, data projections suggest that homelessness among older adults will nearly triple by 2030. The National Foster Youth Institute (NFYI) reported an estimated 20% of youth become homeless upon aging out of the foster care system at 18 years old.
Physical and mental health concerns also impact those living unsheltered. Per the NAEH, on any given night in 2022, 21% of those experiencing homelessness reported having a serious mental illness (such as schizophrenia, personality disorders, bipolar disorder, and post-traumatic stress disorder), 16% reported chronic substance use, and almost 10,000 individuals reported a diagnosis of HIV/AIDS. Severe mental illness, chronic substance use, and physical disabilities exacerbate the odds of an individual meeting the definition of chronic homelessness. Accessing health care services becomes increasingly difficult for unsheltered individuals to navigate. This inaccessibility is compounded by high costs/lack of insurance, lack of technological tools (cell phones, tablets, or reliable internet connectivity), childcare options, and lack of private or public transportation, to name a few.
While advocacy for this population is needed across all levels of government to increase the quantity and quality of care, combatting the stigma of homelessness begins on an individual level. In my specific role as a therapist, I predominately work with individuals experiencing sheltered, episodic homelessness. For many of these individuals, if you did not meet them in the context of our program, you would not realize they met the definition of homeless.
My clients may be the barista making your morning latte. They may be the daycare worker watching your children. They may be your ride-share driver. They may be the freshman sitting next to you in your economics class.
Many things housed individuals take for granted do not exist for those living unsheltered, and their ability to multitask and plan is commendable. How does one maintain a job if they do not have access to a shower regularly or cannot routinely wash their clothing? How does one consistently get to work without reliable transportation, and how do they protect their valuables and belongings if they cannot lock them behind a door for safekeeping while they are away? One’s self-worth often declines when they are unable to shower or wear clean clothes. Being unable to get adequate food, water, or sleep detrimentally affects one’s health. Without being able to work, many individuals are unable to afford the resources needed for mental health support. They cannot access services such as counseling or support groups, and often cannot afford any medications required to assist in managing mental (or physical) health diagnoses. The external and internal negative views associated with being unsheltered also negatively impact one’s levels of self-worth, leading to an exasperation of any mental health struggles.
The stigmas attached to homelessness are often a self-preservation method. For example: “They are homeless because they are lazy.” This phrase often translates to: “If I work hard, I will never be homeless.” In reality, my clients are often some of the hardest-working people I know. As current wages stagnate and inflation rises across the nation, many more people are experiencing episodic homelessness for the first time due to no fault of their own. Oftentimes we tie our intrinsic value with our “production value” to society. Under the umbrella of capitalism, “production value” often translates to our income and our work output. Those who struggle financially are labeled as lazy and are viewed as less than others, which serves to expand the stigmas of homelessness. These stigmas, rooted in capitalism, lead people to look down on unsheltered individuals. They create a lack of compassion, and people experiencing homelessness become viewed as subhuman. These people lose their humanity, both from others and within themselves.
I like to think of life as a giant game of Jenga. As we navigate through our day-to-day existence, we remove pieces and reposition them in various ways. Sometimes, other people pull blocks in your game that destabilize the tower. In life, maybe this is a new mental health diagnosis. Perhaps it’s inflation. Maybe it’s a divorce. The next move often determines whether your tower stands or falls as the blocks wobble. Sometimes, one single event can send life’s entire tower tumbling to the ground. A job loss during a time of inflation. A rent increase after a divorce. These things can topple life’s tower, leading someone into episodic homelessness. While we can’t rebuild the entire tower in one move when it starts to wobble, strategically placing one block may help stabilize the tower enough to keep it standing.
The topic of homelessness is complex. Kindness towards our neighbors, however, is simple.
People need other people. You are not weak for wanting or needing support. If you’re seeking professional help, we encourage you to use TWLOHA’s FIND HELP Tool. If you reside outside of the US, please browse our growing International Resources database. You can also text TWLOHA to 741741 to be connected for free, 24/7 to a trained Crisis Text Line counselor. If it’s encouragement or a listening ear that you need, email our team at [email protected].