Homelessness is more than just a housing issue—it’s a public health crisis affecting communities across North America and around the world. Mental health struggles and substance use can put people at greater risk of losing their homes, and once someone becomes homeless, the stress and trauma of that experience often make these challenges even worse. To truly help people, we need solutions that connect safe housing with access to mental health and addiction care—because the two are deeply connected.
The Link Between Behavioral Health and Homelessness
Studies show that people experiencing homelessness are far more likely to struggle with mental health issues or substance use disorders. In fact, nearly half of all people experiencing homelessness in Atlanta have a serious mental illness, and 40% are battling substance use disorders, according to the 2024 Point-in-Time Count from Partners for Home.
Nationwide data reflects a similar pattern: one study found that 77% of people experiencing homelessness have had a mental health disorder at some point in their lives. It’s not hard to see why—mental health issues can make it harder to maintain a job, secure housing, or navigate complex support systems. And for those without a strong safety net, it often results in homelessness.
Back in the 1960s and 70s, there was a major shift to move people with mental health conditions out of large institutions and into community settings. While the idea was to improve quality of life, many communities didn’t have the resources or support systems in place. As a result, too many people were left without the help they needed—and often ended up in poverty or homeless.
Even today, people with mental health conditions often face major barriers to getting help, like long waitlists, confusing systems, or being denied benefits. And if someone has both mental health and substance use challenges, those barriers only grow. On top of that, many have experienced deep trauma, isolation, or discrimination, which can make it even harder to access care or find a stable place to live.
Unsafe, Unseen, and Overwhelmed: The Mental Health Costs of Homelessness
Being homeless doesn’t just affect where you sleep at night—it takes a serious toll on your mental health. Even if someone had challenges before becoming homeless, the experience itself can make things much worse. Living on the streets or bouncing between shelters can lead to constant stress, fear, and trauma. People in these situations often face violence, feel unsafe, and carry the heavy weight of stigma and uncertainty. It’s no surprise that depression, anxiety, and even thoughts of suicide are much more common among those without stable housing.
Lack of sleep, exposure to bad weather, and untreated health problems only add to the struggle. For many, using drugs or alcohol becomes a way to cope, which can lead to a deeper cycle of addiction and isolation.
This creates a harmful cycle. Many people end up bouncing between hospitals, shelters, and even jail—not because they’re unwilling to get help, but because our systems are too disconnected. Mental health services, addiction treatment, and housing support are often offered separately, making it hard for people to stay on track.
Even when someone gets treatment, it’s tough to stay well without a safe place to live. That’s why we need more programs that bring care and housing together. Services should be trauma-informed, flexible, and designed to meet people where they are—without making them jump through hoops just to get help. Breaking the cycle starts with understanding the whole person and giving them the support they need, all in one place.
The impact isn’t limited to adults. Children experiencing homelessness are especially vulnerable. Growing up without a stable home can lead to emotional trauma, developmental delays, and challenges in school—issues that can follow them for the rest of their lives.
What’s Not Working—and What Can
For too long, homelessness, mental health, and addiction have been treated as separate problems, handled by different systems that rarely work together. But this fragmented approach just doesn’t work. People need stable housing and access to healthcare—at the same time, in the same place, without jumping through hoops.
Community members need to understand that housing isn’t just about having a roof over your head—it’s a key part of staying healthy. You can’t treat someone’s mental health or help them recover from addiction if they don’t have a safe place to live.
That’s why we need to move away from disconnected systems that treat housing, mental health, and substance use separately. Instead, we should build a more connected and coordinated approach—one that sees the full picture of what people are going through and provides the support they need, all in one place.
That’s where the “Housing First” model comes in. Instead of requiring people to be sober or in treatment before getting housing, this approach gives them a permanent place to live first—because it’s nearly impossible to heal or make progress without a safe place to call home.
And it works. People in Housing First programs are more likely to stay connected to behavioral health services and are less likely to end up in the emergency room. In fact, one study found that clients in Housing First saw a 28% increase in behavioral health care and a 37% drop in emergency room visits (National Alliance to End Homelessness).
Still, housing is just one piece of the puzzle. Long-term stability also requires wraparound support—mental health care, substance use treatment, peer support, and case management—to help people rebuild their lives and thrive.
Hope Atlanta’s Response: Integrated Behavioral Health Services
At Hope Atlanta, we’ve seen firsthand how behavioral health challenges and homelessness reinforce each other. With over 125 years of experience serving Atlanta’s most vulnerable populations, we’re expanded our work to meet this crisis head-on.
Our comprehensive behavioral health program—not as a separate service, is fully integrated into our housing and outreach work. Our approach combines trusted relationships, flexible care, and trauma-informed support to reach those who are often left out of traditional systems.
Here’s how we’re doing it:
- On-site Behavioral Health Services at place-based housing like The Melody, our newest permanent supportive housing community, where we serve 40 formerly chronically homeless clients.
- Street Outreach Integration, where trained clinicians and peer specialists engage people where they are, reducing the chances that they’ll fall through the cracks.
- Hiring and Training of experienced clinical staff—including licensed social workers, a psychiatrist, and Certified Peer Specialists—to ensure high-quality, culturally competent care.
- Investment in Infrastructure, including an electronic health records system, insurance billing systems, and compliance tools that allow us to scale services sustainably.
Why It Matters
Georgia ranks third in the U.S. in the prevalence of mental illness—but 47th in access to care. That gap puts our most vulnerable neighbors at continued risk. Without investment in accessible, community-based care, especially for those experiencing homelessness, the cycle continues.
At Hope Atlanta, we believe housing is healthcare. And we believe mental health care should meet people where they are—not require them to jump through hoops or wait for weeks for an appointment they might never get to.
Since launching our integrative behavioral health program a year ago, we’ve seen some incredible results:
- Every single person in the program (100%) has shared that they feel more supported and connected to others than they did before.
- 9 out of 10 participants (90%) have built stronger coping skills and resilience to handle life’s challenges.
- 80% have been able to stay in permanent housing for at least a full year—an important milestone for stability and healing.
- Nearly 9 in 10 (87%) now have a primary care provider, helping them take care of both physical and mental health.
- And 90% have been able to increase their income, which supports long-term independence and well-being.
These numbers show that when people have the right support, they can make real progress in their lives. This is a model of care that works. It restores dignity, breaks cycles of crisis and recidivism, and builds stronger, more resilient communities.
References
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