Homelessness

Center for Mental Health Services Division of Service and Systems Improvement Homeless Programs Branch Programs for Homeless People with Serious Mental Illnesses

Nearly every homeless person with serious mental illness has been involved with local mental health care. By current estimates, as many as 700,000 Americans are homeless on any given night (National Law Center on Homelessness and Poverty, 1999). An estimated one-fourth of these people have serious mental illnesses, and more than one-half have an alcohol and/or drug problem (National Resource Center on Homelessness and Mental Illness, 2001).

People who are homeless and have mental illnesses need a broad range of services. For many people in need of these services, the complexities of the "system," such as figuring out which agencies to contact, filling out numerous and complicated forms, making appointments, and arranging transportation, can prevent them from getting the help they need.

Fortunately, the situation is changing. CMHS is committed to furthering this change through a range of options that help communities tailor local solutions to the dilemma of homelessness in the 21st century.

Projects for Assistance in Transition from Homelessness

Projects for Assistance in Transition from Homelessness (PATH) was established in 1990 to address the multiple needs of people who are homeless and mentally ill. CMHS distributes formula grants to States and Territories, which are required to match funds with $1 for every $3 received in Federal funds. A local match of 25 percent of program funding is required; in recent years, State and local support was more than double the sums required by the match. After requesting their grants, States establish their own guidelines for making awards to grantees and have considerable flexibility in designing programs to meet the specific needs of their homeless population.

Outreach is the service most often selected by states for funding with the PATH program. Other CMHS research and knowledge development programs have shown that providing comprehensive, community-based outreach services can re-engage homeless individuals and help them to stabilize their lives and retain decent housing. Outreach is critical in assisting individuals who might not seek help on their own; it is often the first step in connecting someone to much-needed mental and physical health, social welfare, and housing services. In addition, program funds provide a variety of support services, including, screening and diagnosis, rehabilitation, community mental health treatment, alcohol and/or drug treatment, case management, limited housing assistance, and referrals to other services, job training, and education.

Programs to Address Homelessness and Co-occurring Disorders

Families make up the most rapidly growing segment of the homeless population. Typically, they are single-parent families headed by mothers with young children who are homeless due to circumstances such as domestic violence, poverty, and substance abuse. Many of these families are also plagued with mental health and/or substance use problems that can significantly impair their ability to break the homelessness cycle and to function as parents for their children.

In response to the growing needs of homeless families, CMHS works with its fellow center, the Center for Substance Abuse Treatment (CSAT), on the Homeless Families Program to improve service delivery for homeless mothers with mental health and/or substance use disorders who care for dependent children. The program documents and evaluates the effectiveness of short-term, multifaceted intervention strategies for providing treatment, trauma recovery, housing, support, and family preservation services. It is an effort designed to encourage movement out of homelessness, stability in housing placement, family preservation, decreased alcohol and drug use, and improvements in mental health and social functioning. Program results will be used to disseminate information on effective interventions to States, counties, and local communities to help them address the issues affecting homeless families.

Also in partnership with CSAT, CMHS recently completed the Homelessness Prevention Program, a 3-year, eight-site demonstration program to document and evaluate the effectiveness of interventions to prevent homelessness of high-risk adults with mental health and/or substance use disorders. The interventions included: strategies for housing placement and the prevention of housing loss, money management and representative payee programs, and family support and respite approaches. Cross-site findings indicate that consumers in the experimental sites had more stable housing and experienced fewer days of homelessness. Interventions that could guarantee access to housing demonstrated more significant results in reducing and preventing homelessness than their comparison groups.

SAMHSA collaborating with HRSA, HUD, VA, and the Interagency Council on Homelessness on a 3-year, $55 million joint initiative to help end chronic homelessness. The initiative promotes a collaborative and comprehensive approach to addressing chronic homelessness through the use of a consolidated application process that allowed simultaneous submissions for HUD housing, HHS services, and VA support. Eleven grants were awarded in 2003.

Funding provided by SAMHSA is directed toward substance abuse treatment, mental health and related supportive services; HRSA funds are used for primary health care services; funding provided by HUD is used to provide permanent housing; and additional resources from local VA facilities are available for addressing the specific needs of veterans experiencing chronic homelessness.

Cooperative Agreements to Evaluate Housing Approaches for Persons with Serious Mental Illness

CMHS has recently completed the Housing Initiative, a multi-site program designed to evaluate the effectiveness of different housing approaches for persons with serious mental illness. The program was implemented in two phases. During Phase I, study site grantees conducted a process evaluation of at least two distinctly different and fully operational housing approaches. Six sites were competitively selected to continue into Phase II, a cross-site evaluation using a common data collection protocol as well as site-specific evaluations to assess the effectiveness of supported housing relative to a variety of comparison housing approaches on residential tenure, level of functioning, quality of life, satisfaction, service utilization, consumer perception of service quality, independence, and cost.

The study demonstrated that provision of housing with services to people with serious mental illnesses, regardless of housing approach, resulted in major improvements in housing retention and housing stability, as well as decreases in homelessness and hospitalization. In addition, some improvements in quality of life, mental health functioning, and work were found as well as reductions in critical incidents, arrests, other treatment, and community integration.

Comprehensive Drug/Alcohol and Mental Health Systems for Persons Who are Homeless

The purpose of this 5-year program is to enable communities to expand and strengthen their treatment services for individuals who are homeless with substance abuse disorders, mental illness, or with co-occurring substance abuse disorders and mental illness. This program addresses the need to link substance abuse and mental health services with housing programs and other services for homeless persons, and to secure and maintain housing for homeless persons with these disorders.

Funds support implementation of mental health and substance abuse services that have a strong evidence-base for effectiveness and must be used primarily to support direct service delivery. Eligibility by statute is restricted to community-based public and private nonprofit entities. These entities include county governments, city or township governments, Federally recognized Native American tribal governments, tribal organizations, community-based nonprofit organizations (including faith-based organizations), and community-based State entities, such as State colleges, universities and hospitals, that propose to provide services under this announcement to the community. States are not eligible to apply under this program’s statute.

For free information about homelessness and mental health - including publications, references, and referrals to local and national resources and organizations - call 1.800.789.2647; (TDD) 1.866.889.2647.