Life on the Streets Intersects with Mental Illness, Substance Abuse and Physical Illness
A new report published by the California Policy Lab, “Health Conditions Among Unsheltered Adults in the U.S.,” found that unsheltered individuals experiencing homelessness face even more challenging lives than those experiencing homelessness and living in shelters.
These increased challenges include more severe health problems, higher rates of experiences of violence and trauma, and longer periods of homelessness than people staying in shelters. And one could add to this list, depending on where one lives, an increased chance of being arrested on grounds related to living unsheltered. None of these severe challenges are surprising given how tough it is to live unsheltered.
The U.S. Dept. of Housing and Urban Development (HUD) defines “unsheltered homeless” as any individual or family “with a primary nighttime residence that is a public or private place not designed for or ordinarily used as a regular sleeping accommodation for human beings, including a car, park, abandoned building, bus or train station, airport, or camping ground.”
And as a comparison, although in not every way, a direct comparison, to the California Policy Lab report, NJCounts 2019 gives us a perspective on New Jersey’s unsheltered population and a one-time count of the state’s homeless population.
Unsheltered homeless individuals and families are among those with the most critical housing needs in a community. The unsheltered are especially vulnerable in the cold weather and the elements such a snow, ice and rain, which are in evidence at the end of January when the Count takes place. The Point-In-Time survey can play an important role in helping communities understand why some of the homeless remain unsheltered, and who is included in this group.
NJCounts found that on January 22, 2019, there were 8,864 individuals, living in 6,748 households, experiencing homelessness on a single night in New Jersey. Of that total number, 1,482 or almost 22% were living unsheltered. New Jersey’s unsheltered homeless population has increased overall by 57% since 2015 but did see a decrease of 95 from 2018 to 2019 decreasing from 1,623 households to 1,482 households.
And the majority of the indivdiuals experiencing homelessness and living unsheltered in New Jersey, 80.6%, indicated that they were chronically homeless. Of those experiencing unsheltered homelessness, 437 individuals were homeless for a period of one to three years and 360 individuals were homeless for over 3 years.
The authors of the California Policy lab report found significant differences in reported factors as to why they were homeless among unsheltered and sheltered homeless individuals. Compared to those living in shelters, people living unsheltered were four times more likely to report physical health conditions, three times more likely to report mental health conditions, and eight times more likely to report substance abuse.
About 46% of unsheltered people reported experiences of abuse or trauma as causes of housing loss, as did 34% of sheltered people. The data show greater vulnerability for unsheltered women. Whereas 38% of unsheltered men (and 34% of sheltered women) report emotional, physical, psychological, or sexual trauma as a cause of housing loss, 80% of unsheltered women report such trauma.
According to NJCounts 2019, 4,8% of those individuals living unsheltered self-reported that they are victims of domestic violence. As domestic violence can more often not be an invisible and unreported crime, this percentage is most likely an undercount and underreporting.
The California Policy lab report also finds disparities in the health conditions of sheltered and unsheltered individuals. Unsheltered individuals were more than four times more likely than sheltered individuals to report physical health problems. Unsheltered individuals were 25 times more likely to report they were concurrently dealing with physical health, mental health, and substance abuse conditions.
According to NJCounts 2019, seventy percent of those experiencing homelessness reported a disability with 600 indivdiuals each reporting that they have a mental health issue or a substance abuse disorder and 334 individuals reporting they that they have a physical disability and 319 individuals reporting having a chronic health condition (please note that disability categories are not mutually exclusive.)
According to the California Policy lab report, unsheltered people also reported twice as many visits to emergency rooms and ambulance rides as sheltered people. Regardless of shelter status, though, the health conditions of those experiencing homelessness appeared to worsen over time.
What strategies can we continue to employ and expand on to help those experiencing homelessness and living unsheltered move into their own apartments? The key to helping those experiencing homelessness and living unsheltered stabilize their lives is outreach services and permeant supportive housing with available support services including linkages to healthcare. Those who have been living unsheltered for long periods of time may need repeated attempts to connect to outreach services and more long term services and support.
If individuals living unsheltered are given the opportunity to move into permanent, affordable housing that offers a Housing First strategy, they may have greater success at stabilizing their lives. The first step would be helping them get their own roof over their head and then to help them build a relationship or strengthen an existing relationship with a service provider and access services for mental illness, physical health problems including chronic health conditions, and/or substance abuse or counseling to address the needs related to the experience of domestic violence.