What should be considered in the care of homeless individuals with mental health issues?

Homelessness and Behavioral Health Problems

About one in four of homeless adults meet criteria for a serious mental illness. This is compared to one in seventeen for adults in the general US population. Two-thirds of people experiencing homelessness report a substance use and/or mental health issue with around 30% meeting criteria of a substance use disorder compared to 9% of the general population (see this tip from SMI Adviser).


Engagement refers to the process through which someone becomes active and involved in their recovery process by forming healthy connections with people who support their recovery and wellness. Barriers for engaging homeless individuals may include stigma, paranoia, trauma, disorganization, psychotic symptoms and negative prior experiences with providers and hospitals. To engage homeless individuals, provide nonjudgmental, supportive interactions with consistency. Engaging people who are homeless is as much about building relationships as it is about providing therapeutic interventions. Offering incentives such as food and drink, hygiene products and transportation vouchers can aide in this process as well.

Ongoing Care

Providing person-centered, trauma-informed and recovery-oriented care is essential. Normalize mental health issues and use the person’s own language, avoid overly clinical questions. Gather information about the person’s history including past treatment for mental health issues or substance use, psychiatric hospitalizations, medication history and risk history for suicide or violence. Assess medical issues such as past accidents, injuries and exposure related problems. Complete a mental status exam at every visit to assess for symptoms, appetite, sleep, concentration, mood, memory, risk, insight, judgment and memory. During this process, asses their ability to follow up with treatment, take routine medications and ability to make decisions. Routine discussion of treatment possibility without pressure should occur. A goal would be to provide ongoing mental health care, link to physical healthcare and provide resources.

For more information, see this resource: Adapting your Practice: General Recommendations for the Care of Homeless Patients

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