Approximately 23 percent of adults in the United States experience mental illness, according to a 2024 report from Mental Health America. Despite its prevalence, access to care remains dismal. Nearly 10 percent of adults who reported a mental illness were uninsured, and 1 in 4 people reported unmet need for treatment.
The gaps are greater for people experiencing homelessness. Without a stable place to call home, challenges like finding a provider, accessing transportation to and from appointments, or even just storing medications can create major barriers to receiving care and adhering to treatment. Homeless service providers, including peer support specialists, can fill some of that gap, but ultimately the lack of community-based treatment services, peer support networks, clinicians, and treatment beds affects everyone in need of care – housed or unhoused.
That is why Mental Health Awareness Month provides a moment for reflection and a call to action for our field.
How Mental Health Care Gaps Make Homelessness Worse
One of the greatest barriers to care is the shortage of mental health providers. This is not unique to people experiencing homelessness; you may have experienced this too if you ever attempted to find a therapist or a healthcare specialist. Per the Health Resources and Services Administration (HRSA), 154 million people live in a Mental Health Professionals Shortage Area. This is greater than the gap in primary care and dental health service providers per population. They estimate that nationally, the United States needs an additional 7,680 health professional providers to meet the mental health needs.
We also know that these shortages may be greater depending on where you live.
New Jersey comes the closest to meeting the need for mental health providers, but it barely meets half (52.3 percent) of its population’s needs. Rural states like West Virginia, Alaska, Maine, South Dakota, and Kentucky have less than 20 percent of the needs met. Likewise, California barely scratches 24 percent of the provider needs met for the state.
For people experiencing homelessness, combatting stigma while trying to coordinate services can be challenging in this dearth of providers, even when there are population specific programs that exist. This task is made even more difficult because most people experiencing homelessness rely on Medicaid for coverage, which also limits their choices for providers.
What People Experiencing Homelessness Actually Need from the Healthcare System
These shortages are happening at the same time as lawmakers are increasingly calling for outdated and poorly-conceived strategies for addressing the mental health needs of unhoused individuals. Whether it comes in the form of Executive Orders calling for forced institutionalization, reshaping guardianship models and directing them at people experiencing homelessness with limited results, or the “campus model” that was recently dismissed by the state of Utah for being exorbitantly expensive and ineffective, we are seeing a troubling assumption that our nation has more mental health resources than it has, and that people experiencing homelessness require a vastly different level of care than other people with mental health needs have.
People experiencing homelessness do not need healthcare systems to reinvent the wheel to create accessible pathways to treatment and care. While individuals experiencing homelessness may require additional and creative outreach that meets them where they are, providers who build trust, and of course, access to housing solutions, they also need the same things that everyone in the nation needs: more investment in community based care, more investment in psychiatric professionals, and easier access to the help that they want and need.
Executive Orders, expanding guardianship, and state “campus” plans that redirect funding from evidence-based community care will not solve the provider shortage, nor will they help everyone achieve their mental wellbeing goals. Innovations and programs being piloted by Healthcare for the Homeless programs, provider outreach teams, psychiatric and substance use providers, federally qualified health centers, and certified community behavioral health centers should be funded to scale when the evidence shows that they work. This Mental Health Awareness month, we can all focus on proven solutions to achieve accessible care.
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