Health Care

Stable housing and supportive services are critical to help people experiencing homelessness move toward recovery.

About half of people experiencing homelessness suffer from mental health issues. At any given point in time, 45 percent of homeless people report having had indicators of mental health problems during the past year. About 25 percent of the homeless population has serious mental illness, including chronic depression, bipolar disorder, and schizophrenia.

People experiencing homelessness also have a high rate of substance use. According a 1996 survey, 46 percent of homeless respondents reported having an alcohol use problem in the past year, and 38 percent reported a problem with drug use in the past year.

Mental and physical health problems are exacerbated by living on the streets and in shelters. Health conditions that require ongoing treatment — such as diabetes, HIV/AIDS, addiction, and mental illness — are difficult to treat when people are living in shelter or on the streets. Medication can require special steps, including refrigeration or special storage, that can be difficult to execute for people experiencing homelessness. Preventative care can also be difficult for this population to access due to its often prohibitive cost, so people experiencing homelessness may wait to seek medical care until a trip to the emergency room is necessary.

These mental and physical health conditions should be considered when designing effective, efficient strategies to end homelessness. Permanent supportive housing provides stable housing coupled with supportive services as needed – a cost-effective solution to homelessness for those with the most severe health, mental health, and substance use challenges.

Spotlight

Fact Sheets | March 26, 2013
This fact sheet highlights key information for beginning conversations with community leaders and partners about health care benefits enrollment, including where to go for more specific information. Under the Affordable Care Act 2010, new state programs and processes could affect how vulnerable homeless people receive medical services, behavioral health treatment and long-term supports; and how these services are funded in communities. In many topic areas, definitive answers to questions that may arise are not yet available, or may vary from state to state. The Alliance will continue to update this resource as new information becomes available.  
Federal Policy Brief | February 19, 2013
This resource provides the Alliance's comments on the Medicaid Proposed Rule of January 22, 2013. The Alliance's comments address several issues that affect vulnerable adults who are chronically homeless, at-risk of becoming chronically homeless, or recovering from chronic homelessness in permanent supportive housing.
Solutions Brief | October 17, 2012
Post-Traumatic Stress Disorder (PTSD) can be caused by the experience of homelessness. This brief includes an overview of PTSD, implications for providers, and principles of trauma-informed care.
Webinar | January 19, 2012
A video recording of the webinar entitled, "Putting the Pieces Together: Primary Care and Behavioral Health Services in Permanent Supportive Housing."
Federal Policy Brief | August 9, 2011
Policymakers seeking strategies to manage health care costs often look at ways to reduce unnecessary emergency room visits and hospital stays. Frequently overlooked in this approach are community-based solutions that offset health care costs associated with homelessness.
Federal Policy Brief | February 28, 2011
\| As parts of the Affordable Care Act are phased in, state leaders are facing complex decisions on issues. This issues - as well as possible solutions - are discussed in this brief about applying the ACA to benefit at-risk and homelessness populations.

Library Resources

Icon
Solutions Brief | March 25, 2011
Clearly health care reform creates opportunities to improve assistance to chronically homeless people. Those concerned to combine housing and services should get involved early to ensure that the interests of people they care about are protected.
Icon
Report | December 3, 2009
This is an issue brief presenting the ways state mental health agencies can work cooperatively with community members and lawmakers to prevent and end homelessness for those afflicted with severe mental illness. Key strategies are examined in this brief, as well as case studies of states that have successfully implemented some of these strategies.
Icon
Video | August 31, 2009
Peggy Bailey, program and policy analyst at the National Alliance to End Homelessness, explains how health care fits into discussions about homelessness, and outlines the Alliance's priorities in the health care reform debate.
Icon
Other | April 29, 2009
Click here for additional resources on how mental health and substance use issues affect homelessness. Materials include "Chronic Homelessness," "Christian Community Health Center in Chicago, Illinois: Providing Supportive Housing and Health Care," and "Amethyst Inc. in Columbus, Ohio: Helping Addicted Women to Gain and Maintain Sobriety."
Icon
Other | April 29, 2009
Click here to access additional resources related to health care and Medicaid. Materials include "New Targeted Case Management Rule and Homelessness," "Medicaid Coverage for Rehabilitation Services," "Medicaid Proof of Citizenship," and "Protecting Health Care for the Homeless Programs."
Icon
Fact Sheets | August 10, 2006
This fact sheet examines issues facing homeless people who have HIV/AIDS.