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Homelessness is an extreme form of poverty characterized by the instability of housing and the inadequacy of income, health care supports and social supports. This definition includes people who are absolutely homeless (those living on the streets, sometimes referred to as “rough sleepers”); shelter dwellers (people staying temporarily in emergency shelters or hostels); the “hidden homeless” (people staying temporarily with friends or family), and others who are described as under housed or “at risk” of homelessness.

People with poor mental health are more susceptible to the three main factors that can lead to homelessness: poverty, disaffiliation, and personal vulnerability. Because they often lack the capacity to sustain employment, they have little income. Delusional thinking may lead them to withdraw from friends, family and other people. This loss of support leaves them fewer coping resources in times of trouble. Mental illness can also impair a person’s ability to be resilient and resourceful; it can cloud thinking and impair judgment. For all these reasons, people with mental illness are at greater risk of becoming homeless.

Homelessness, in turn, amplifies poor mental health. The stress of being homeless may exacerbate previous mental illness and encourage anxiety, fear, depression, sleeplessness and substance use. The needs of homeless people with mental illnesses are similar to those without mental illnesses: physical safety; education; transportation; affordable housing; and, affordable medical/dental treatment. When providing care to people who are homeless, it is essential to create a non-threatening and supportive atmosphere, address basic needs (e.g. food and shelter), and provide accessible care.

People with mental illness remain homeless for longer periods of time and have less contact with family and friends.