Mental Health and Physical Health

Homeless people suffer from high rates of mental and physical health problems exacerbated by living on the streets and in shelters. Health conditions that require ongoing treatment—such as diabetes, cardiovascular diseases, tuberculosis, HIV/AIDS, addition, and mental illness—are difficult to treat when people are living in shelter or on the streets. Medication needs to be taken at regular intervals and often have other instructions such as needing refrigeration which are difficult for people experiencing homelessness to carry out and make it difficult to manage their illness. People experiencing homelessness also often lack access to preventative care, waiting until a trip to the emergency room is a matter of life or death. These emergency room visits are costly. Finally, hospitals far to often discharge people without ensuring they have housing which increases the odds that the condition being treated will return or worsen.

In addition, approximately half of people experiencing homelessness suffer from mental health issues. At a given point in time, 45 percent of homeless report indicators of mental health problems during the past year, and 57 percent report having had a mental health problem during their lifetime. About 25 percent of the homelessness population has serious mental illness, including such diagnoses as chronic depression, bipolar disorder, schizophrenia, schizoaffective disorders, and severe personality disorders.

Substance use is also prevalent among homeless populations. In a 1996 survey, 46 percent of the homeless respondents had an alcohol use problem during the past year, and 62 percent had an alcohol use problem at some point in their lifetime. Thirty-eight percent had a problem with drug use during the past year, and 58 percent had a drug use problem during their lifetime.

These statistics illustrate the need to connect housing with treatment services. The Alliance and our partners are working to ensure that mental health and substance use treatment agencies understand their role in ending homelessness.

Summary of S. 1781, the REDUCE Act

The REDUCE Act, S. 1781, would create a demonstration program that would allow service providers to reimburse Medicaid for coordinated care management and community support services. The program targets Medicaid beneficiaries with complex medical and behavior health conditions who frequently rely on emergency health care services. Read More >

Legislative Text of REDUCE Act, S. 1781

This is a copy of the legislative text of S. 1781, the Reduce Emergency Department Utilization through Coordination and Empowerment (REDUCE) Act. Read More >

Medicaid Reform: Organizational Sign-On Letter

The Alliance and the National Council for Community Behavioral Healthcare sent a letter, which was endorsed by over 200 local, state, and national organizations, to U.S. House and Senate members of leadership to ensure final health reform legislation includes provisions to improve access and quality of health care for people experiencing homelessness. Read More >

Health Care and the Homeless


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. Read More >

Strategies of State Mental Health Agencies to Prevent and End Homelessness

For this paper, mental health officials in 10 states shared innovative approaches to building political will and creating affordable housing for clients who need mental health services. The paper provides examples of how states: engaged governors and mayors, created housing positions within the mental health agency, partnered with other state agencies and organizations, participated in plans to end homelessness, provided housing technical assistance throughout the state, leveraged state resources and used data to promote programs. Read More >

Health Care Reform Recommendations

Given the debate in Congress over health care reform, the Alliance has prepared two recommendations for inclusion in health care reform. First, that at least every American living below the federal poverty level must be eligible for Medicaid; second, that Medicaid eligible populations must have access to integrated health services that include mental health and substance use treatment. Read More >

Health Care and Medicaid Resources

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." Read More >

Mental Health and Substance Use Resources

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." Read More >

Related Health Care Links

Click here to access links to our partner organizations that serve as strong resources on the intersection of health care and homelessness. Read More >

Related Substance Use and Mental Health Links

Click here to access links to our partner organizations that serve as strong resources on the intersection of substance use, mental health, and homelessness. Read More >

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