For those who find themselves unhoused, the simple things in life that most take for granted have a massive impact on one’s mental and physical health: no quiet place to sleep, nowhere safe to store medication, no address or phone number to give a clinic, no way to keep a standing appointment. Mental health becomes very difficult to maintain in this situation, and if one was already experiencing a mental health issue before becoming unhoused, treating this issue while unhoused is an uphill battle. For those who are unhoused with a mental health issue, the only ‘care’ many receive is in a moment of crisis, and most likely in an emergency room where follow-ups are required but incredibly difficult to follow through with. This cycle repeats because these individuals lack stable housing. As we dig into this topic, we do want to make one point very clear: not all who are experiencing homelessness are experiencing mental health issues. According to a recent HUD study, 1 in 5 people experiencing homelessness has a serious mental health issue.
Why Care Falls Apart Without Housing
Being unhoused even in the best circumstances is traumatic. For those who are experiencing a mental health issue at the same time, the basic functions of life can become unmanageable. For those seeking mental health treatment, one key to success is consistency. This means following up with regular appointments, taking medication on a consistent schedule, and building trust over time with mental health providers. When someone is unhoused, all these needed consistencies to treat mental health become incredibly difficult. Transportation to appointments changes depending on where one is staying; keeping medications safe is incredibly challenging; and due to the transient nature of homelessness, sometimes it may not be possible to stay in the same place and return to the same care provider. Stability is incredibly lacking in the lives of those experiencing homelessness.
A Housing First approach changes all of this and brings much-needed stability. Housing shifts people from crisis care towards consistent care, and they are more likely to attend routine mental health visits once housed. The National Low Income Housing Coalition backs this up in a 2020 research study. Housing First provides a safe, stable place to begin healing consistently and adopt a healthy lifestyle.
What Housing First Changes
Housing First houses individuals first, bringing stability and consistency to life, and then offers support services. What matters is that this approach does not depend on mental health services. Services are available when a resident wants to use them.
For those who do utilize services in a Housing First setting, we see a shift from fewer psychiatric emergencies to routine visits. Those in permanent supportive housing had a 38% reduction in psychiatric emergency department visits, according to the National Low Income Housing Coalition Health Services Research on this topic. When a Housing First approach is taken, emergencies across the board decrease, from emergency shelter beds used to the need for emergency service interventions.
Housing First provides a stable setting where healing is set up for success. This setting allows for safe rest and sleep, an address, regular transportation from a common pick-up/drop-off spot, a safe place to store medication, and much more. The calm, privacy, and peace of having a bed of one’s own to rest and recuperate in a safe spot make a world of difference.
Housing First Was Built for This
Housing First isn’t a new or fringe idea; the model was designed for individuals with mental health issues. The original Housing First program was called Pathways and was created specifically for people experiencing chronic homelessness who were also experiencing serious mental illness or substance use disorder. The approach is simple yet profound: provide housing first, then support services. The standard approach has typically been to support mental health and substance use disorders first, and only when a benchmark of health is reached is housing offered. Essentially making housing something to be earned as a reward, not a basic human right.
When participants received a Housing First approach, support services were offered and used, and the retention rate of remaining housed was 80%. In Canada, Housing First participants spent 73% of their time in stable housing compared to 32% of those who received treatment as usual, according to HUD. These facts illustrate that stable housing plays a vital role in recovery. The VA puts it more succinctly: “It is much easier to manage one’s health, sobriety, and employment when you don’t have to worry about where you’ll sleep each night.”
In Conclusion
Treating mental illness without stable housing is a lot like treating an open wound in a driving rainstorm. When an unhoused individual is experiencing a mental health issue, there is little time or the ability to focus on mental health when survival sits at the forefront. Keeping appointments, finding a safe place to rest and heal, as well as storing medications safely, becomes incredibly difficult for those experiencing homelessness. However, a Housing First approach gives those who need access to mental healthcare a stable base. Trying to recover from a bout of mental illness while one’s life is in chaos is not only incredibly difficult but is cruel. Housing First was created specifically for those who are experiencing a mental health or substance use issue, and the statistics on success rates show that this method works. Housing is a human right and essential to health.
More in this series:
Housing Shouldn’t Be Conditional: The Common Sobriety-First Barrier
It’s Not Addiction, It’s Rent: The Real Cause of Homelessness
What The Research Actually Shows About Housing First
Housing First, Explained: The Simple Idea That Stability Starts With a Home
Sources:
Johns Hopkins Bloomberg School of Public Health. “How Stable Housing Supports Recovery from Substance Use Disorders.” Opioid Principles, https://opioidprinciples.jhsph.edu/how-stable-housing-supports-recovery-from-substance-use-disorders/.
National Low Income Housing Coalition. “Permanent Supportive Housing Associated with Less Emergency Psychiatric Care, Fewer Days in Shelters.” NLIHC, https://nlihc.org/resource/permanent-supportive-housing-associated-less-emergency-psychiatric-care-fewer-days.
Technical Assistance Collaborative. Homelessness and Serious Mental Illness: Research Summary, https://www.tac.org/wp-content/uploads/2016/09/TAC_ORPA_ResearchSummary_Homelessness.pdf.
Tsemberis, Sam, Leyla Gulcur, and Maria Nakae. “Housing First, Consumer Choice, and Harm Reduction for Homeless Individuals with a Dual Diagnosis.” American Journal of Public Health, vol. 94, no. 4, 2004, pp. 651–656, https://ajph.aphapublications.org/doi/10.2105/AJPH.94.4.651.
U.S. Department of Housing and Urban Development. “Housing First: A Review of the Evidence.” Evidence Matters, Spring/Summer 2023, https://www.huduser.gov/portal/periodicals/em/spring-summer-23/highlight2.html.
U.S. Department of Veterans Affairs. “What Is HUD-VASH, and How Does It Help Homeless Veterans?” VA Homeless Programs, 6 Apr. 2026, https://department.va.gov/homeless/what-is-hud-vash-and-how-does-it-help-homeless-veterans/.
