Behavioral health challenges for individuals experiencing housing insecurity
How housing insecurity affects individuals’ behavioral health
The number of people experiencing housing insecurity has been on the rise since the onset of the COVID-19 pandemic. One in ten young adults aged 18-25 and one in thirty youths aged 13-17 experience housing insecurity over a 12-month period.
Housing insecurity shortens an individual’s life by 30 years, as individuals who are unhoused typically live in challenging situations. They are more likely to experience substance use disorders, mental health diagnoses, chronic illnesses, and severe and persistent mental health diagnoses.
“People who experience housing insecurity also experience considerable instability,” says Krista Noam, PhD, AVP Analytics & Innovation, Carelon Behavioral Health. “Data from our Connecticut program shows that people who experienced housing insecurity in 2022 were twice as likely to have experienced a chronic mental health condition when compared to people with stable housing. They were also seven times more likely to have been diagnosed with a substance use disorder.”
According to Noam, due to their struggling with chronic mental health illnesses, people who experience housing insecurity may also fear using system supports. “Individuals experiencing schizophrenia disorder might be suspicious of institutions and medical or mental health providers. Those who experience housing insecurity may also struggle with medication adherence due to moving frequently, irregular meals, or a lack of safe storage spaces for medication. They may also incur higher expenditures from struggling with chronic medical conditions that are easily treatable with adequate care.”
Addressing the need for secure housing
Conversely, secure housing increases an individual’s quality of living, saving on Medicare and Medicaid costs in the long run. “People who experience housing insecurity are especially vulnerable. When they find secure housing, the housing can provide them a solid base from which they can focus on their long term behavioral and physical health,” says Noam.
The Housing First model has become an increasingly popular solution. The model prioritizes permanent housing for people experiencing housing insecurity, so that individuals can focus on improving their quality of life. “The Housing First approach stresses the importance in providing stable housing to an individual, regardless of the person’s substance use history or status. Traditional models emphasize providing housing to individuals only after they have been in recovery. Behavioral health providers now understand that individuals who experience housing insecurity first need a stable home environment in which to live. Only then can they begin to address other challenges in their lives,” says Noam.
How to best provide behavioral healthcare to individuals experiencing housing insecurity
Person-centered care is a vital approach that providers can use to treat individuals who experience housing insecurity. The care model prioritizes delivering integrated care in a setting in which the individual is most likely to be responsive, and is sensitive to the individual’s goals and values. Person-centered care also supports good provider–patient communication, empowering the individual receiving the care to work with the provider on an effective care plan.
“Providers need to recognize that when people do not have their basic needs met, they are often not in a place to work on treatment for serious and persistent mental illness. They are often more willing to seek treatment after their basic needs are met,” says Elizabeth Downing, VP, Director, Behavioral Health Services, Carelon Behavioral Health.
Individuals who experience housing insecurity struggle with addressing a variety of basic needs. “Shelters and soup kitchens often have timeframes that must be met, which can impact an individual’s ability to make it to appointments. If an individual needs to be at a soup kitchen by 11:00am to get lunch and line up for a shelter by 3:30pm, and they need to walk from place to place, that can be a barrier to filling their overall service needs. They may also have difficulty staying organized because they lack a regular, safe base in which to keep their belongings,” says Downing.
Because of the various challenges, individuals struggling with housing insecurity often need more help than solely receiving referrals or assistance with making an appointment. “People experiencing housing insecurity often need help planning each step they need to take to accomplish a goal,” says Downing.
“Providing stable housing and person-centered care allows a person to concentrate on addressing their behavioral and mental challenges,” says Noam. “These are the first steps on a person’s journey towards recovery.”
