Behavioral Health

Behavioral health includes the emotions and behaviors that affect the overall well-being of youth. It is sometimes referred to as mental health and often includes substance use. Behavioral health conditions put individuals at risk of experiencing homelessness and exacerbate behavioral health conditions for people experiencing homelessness. For example, untreated mental health and substance use conditions are potential risk factors for youth running away from home,¹ and runaway youth and youth experiencing homelessness also are linked to long term substance use and mental health conditions. Runaway youth were more likely to be dependent on drugs and show depressive symptoms at age 21 than youth who had not run away.²

Substance Use

• A study of youth experiencing homelessness found that almost 60 percent reported drug use, whereas almost 20 percent reported having an addiction to drugs and 13 percent an addiction to alcohol. The average age of first drug use was 13 (ranged between 6 and 22).³
• Interviews with 215 young people (ages 13–25) in five U.S. counties found that 21 percent mentioned substance use as a barrier to obtain or keep housing.⁴
• Previous substance abuse, self-harm behaviors, and suicide attempts were prevalent among youth experiencing homelessness who were later trafficked.⁵

Mental Health

• A study of young people experiencing homelessness (ages 18–24) in two U.S. cities found that, in both cities, more than 80 percent of youth experiencing homelessness met criteria for at least one psychiatric diagnosis, and the average number of diagnoses per person was four.⁶
• Homeless young people are more likely to struggle with depression compared with their housed peers (43 percent vs. 28 percent, respectively).⁷
• High school students who are experiencing homelessness consider suicide more often, and they are more than three times as likely to have attempted suicide in the last year.⁸
• Nearly half of youth experiencing homelessness reported participating in self-harming behavior (cutting, not eating for long periods, drinking alcohol excessively, and scarification).⁹
• A study in Chicago among predominately African American homeless youth found that without adequate psychological support, an estimated 50 percent of transition-age homeless youth continue experiencing housing instability and/or homelessness into adulthood.¹⁰

Because of the individualized and complex needs of runaway youth and youth experiencing homelessness, one way to help youth address their behavioral health needs may be through intensive case management. This can help youth navigate the health care system and understand how to fulfill their health care needs.¹¹ Providing youth experiencing homelessness with access to substance use and mental health treatment through federal programs and federally supported community-based programs also can help youth experiencing homelessness who are facing behavioral health challenges access treatment.

Resources

Homelessness Programs and Resources: SAMHSA
The Homeless and Housing Resource Center (HHRC), supported by the Substance Abuse and Mental Health Services Administration (SAMHSA), shares state-of-the-art knowledge and promising practices to prevent and end homelessness. HHRC has numerous toolkits and fact sheets related to substance use and serious mental illness. Free online training courses related to behavioral health include the following:

• Serious Mental Illness and Homelessness
• Introduction to Treatment Models and Engagement
• Whole-Person Care for Opioid Use Disorder
• Supporting People Who Use Methamphetamine

Runaway and Homeless Youth Training and Technical Assistance Center
This centralized national resource for Runaway and Homeless Youth (RHY) grantees is funded by the Family and Youth Services Bureau at the U.S. Department of Health and Human Services. Training and technical assistance services are directed at assisting RHY grantees to engage in continuous quality improvement of their services and to build their capacity to effectively serve runaway youth and youth experiencing homelessness.

Health Resources and Services Administration (HRSA) National Training and Technical Assistance Partners
HRSA funds two organizations—the National Health Care for the Homeless Council and the Corporation for Supportive Housing—to provide training and technical assistance to health professionals to improve awareness of, screening for, and interventions to reduce housing insecurity, to remove barriers to health care access, and to increase referrals to harm reduction services. The Health Center Program served more than 8.8 million youth aged 17 and younger in 2022, the most recent year that data are available. In 2022, nearly 1.4 million health center patients of all ages self-identified as experiencing homelessness.

Projects for Assistance in Transition from Homelessness (PATH)
The PATH program is administered by the Center for Mental Health Services, a component of SAMHSA. It provides formula grants to the 50 states, the District of Columbia, Puerto Rico, the Northern Mariana Islands, Guam, American Samoa, and the U.S. Virgin Islands for people with serious mental illness, including those with co-occurring substance use disorders, who are experiencing homelessness or are at risk of experiencing homelessness. PATH services include community-based outreach, mental health, substance abuse, case management, and other support services, as well as a limited set of housing services. Although some states provide services to youth under 18 years old, most do not.

Grants for the Benefit of Homeless Individuals (GBHI)
GBHI is a competitively awarded grant program from SAMHSA that enables communities to expand and strengthen their treatment services for people experiencing homelessness who have substance use disorders or co-occurring mental and substance use disorders. Grants are awarded for up to 5 years to community-based public or nonprofit entities. Funded programs and services include substance abuse treatment, mental health services, wraparound services, immediate entry into treatment, outreach services, screening and diagnostic services, staff training, case management, primary health services, job training, educational services, and relevant housing services.

Treatment for Individuals Experiencing Homelessness (TIEH)
TIEH is a competitively awarded grant program from SAMHSA that provides comprehensive, coordinated, and evidenced-based services for individuals, youth, and families with a serious mental illness, serious emotional disturbances, or a co-occurring disorder who are experiencing homelessness or at imminent risk of homelessness. Grants are awarded for up to 5 years to community-based public or nonprofit entities. Funded programs and services include engaging and connecting the population of focus to behavioral health treatment, case management, and recovery support services; assisting with identifying sustainable permanent housing by collaborating with homeless services organizations and housing providers, including public housing agencies; and providing case management that includes care coordination/service delivery planning and other strategies that support stability across services and housing transitions.

Supplemental Security Income/Social Security Disability Insurance (SSI/SSDI) Outreach, Access and Recovery (SOAR) Program
SOAR is a national program, sponsored by SAMHSA, designed to increase access to the disability income benefit programs administered by the Social Security Administration (SSA) for eligible adults and children who are experiencing or at risk of homelessness and have a serious mental illness, medical impairment, and/or a co-occurring substance use disorder. The SOAR Online Course: Child Curriculum trains case workers to assist eligible children (under age 18) to apply for SSI, the SSA’s disability program. The SOAR TA Center published an issue brief, Connecting Unaccompanied Youth Experiencing Homelessness to Social Security Disability Benefits, that explores how use of the SOAR model can increase access to income and health insurance, facilitate housing stability, and support unaccompanied youth pursing education and vocational goals. Additional resources for youth are available in the SOAR Works Library.

National Maternal Mental Health Hotline
The hotline (1-833-TLC-MAMA or 1-833-852-6262) provides 24/7, free, confidential emotional support, resources, and referrals to any pregnant and postpartum mothers facing mental health challenges and their loved ones, via telephone and text in English and Spanish. Interpreter services are available in 60 additional languages, and a relay service is also available. Please visit the hotline website to download or order promotional materials to share with clients, providers, birthing hospitals, community-based and faith-based organizations, and any other partners who serve new moms and young families.

References