In our recent article November is Homeless Youth Awareness Month, we offered basic information everyone should know about youth and adolescent homelessness. We covered the overall numbers, identified the primary reasons youth and teens become homeless or experience homelessness, and listed a series of evidence-based recommendations made by private and public entities that can help prevent or reduce the number of homeless families, youth, and adolescents in the U.S.

Here’s a quick recap of that article, in case you don’t want to go back and read the whole thing.

Homeless Stats:

• At least 2.5 million young people experience homelessness each year.
• Between 1 million and 1.7 million young people have either run away from or been asked to leave their homes.
• Over 500,000 young people each year are homeless for over a week

How Youth and Teens Become Homeless:

1. Family problems. These can range from physical, emotional, or sexual abuse, to a parent having an alcohol or substance use disorder, to the youth or teen themselves having mental health issues their family is unable to handle.
2. Discharge from Government or Foster Care. When youth or teens are released from government care, either from juvenile detention, temporary state care, or foster care, they’re often without any type of support. This can quickly lead to both food and housing insecurity.
3. Financial Issues. Families may become homeless when parents lose employment, become incarcerated or otherwise involved in the criminal justice system. Parents may also experience and unforeseen and temporarily insurmountable economic hardship.

Evidence-Based Remedies for Youth and Adolescent Homelessness:

• Rental and housing subsidies for at-risk families
• Eviction Prevention Policies
• Proactive screening for vulnerable populations, including veterans, youth in foster care, youth with alcohol/substance use disorders, youth in juvenile detention.

We repeat all those facts for good reasons: people need to know the scope of the problem, how and why it happens, and what they can do to help.

This article builds on that information and discusses an aspect of youth and teen homelessness that also needs attention. The high prevalence and increased risk of mental health, alcohol, and substance use disorders among homeless youth and adolescents.

Homeless Youth: Common Mental Health Issues

Homeless youth and adolescents are at increased risk of a number of mood, behavioral, and mental health disorders. A study published in August 2019 by the Homelessness Policy Research Institute at the University of Southern California (USC) indicates that homeless youth and adolescents are at increased risk of developing several types of psychiatric disorders and/or risky behaviors. There is no expert consensus on whether the presence of mental health disorders is the result or cause of homelessness.

In any case, they are present in homeless youth at numbers far above national averages. Studies show:

• Lifetime prevalence of mental health disorders in homeless youth is almost double that of youth who are not homeless.
• Youth and adolescents who experience homelessness are six times more likely to have two or more mental health disorders than youth and adolescents who are not homeless.

The USC study mentioned above includes specific prevalence rates among homeless adolescents, by type of disorder. We’ll present those rates, as well as national diagnosis rates for the same disorders, as reported by the Centers for Disease Control (CDC) and the National Alliance on Mental Illness (NAMI)

Mental Health Disorder Prevalence: Homeless and Non-Homeless Adolescents

• Conduct Disorder: 53%
  • National: 7.4%
• Any Substance Use Disorder: 28% – 81% (estimates vary)
  • National: 4.0%
• ADHD: 32%
  • National: 9.4%
• Depression: 21%
  • National: 6.1%
• Anxiety: 22%
  • National: 10.5%
• Mania or hypomania: 21%
  • National: 3.1%
• PTSD: 12%
  • National: 5.3%
• Schizophrenia: 10%
  • National: 0.23%

These figures make clear the fact that homeless youth are at significantly increased risk of experiencing a range of mental health disorders. The differences are, in a word, huge. In every category, rates for homeless adolescents are more than double than for those who are not homeless. In most cases they’re triple. And in some, homeless youth are close to ten times more likely to have a particular disorder than youth who are not homeless.

Obstacles to Treatment for Homeless Adolescents

Let’s start this section by acknowledging one fact: virtually everything is challenging when you’re living on the street or in shelters. From the very basics, such as personal hygiene, staying warm, and eating, to the more complex, like finding and keeping a job, staying in school, or staying healthy, the things most of us take for granted cannot be taken for granted by a homeless person. These challenges are even greater for adolescents. That’s a fundamental understanding everyone needs to have: housing instability creates so many problems and challenges it’s hard to know where to start naming them.

That’s why seeking treatment for mental health issues is so difficult for homeless teens. They’re preoccupied with finding a place to stay for the night, staying warm, and eating. Seeing a counselor for anxiety, depression, or substance use is typically not their primary concern – although treatment could remove some of the root causes of their homelessness, that’s not something easy to understand for someone who is under acute daily survival stress.

With all of that said, a 2015 report from the National Health Care for the Homeless Council identifies the following barriers to treatment for homeless youth and adolescents.

Homeless Teens and Mental Health: Ten Barriers to Treatment

1. Knowledge of available resources
2. Shame or embarrassment about asking for help
3. Negative history with mental health staff
4. Lack of transportation
5. Cost
6. Fear of being detained or reported/turned in to authorities
7. Inability to consent to their own care (teens under age 18)
8. Unaware of the presence of a mental health disorder that needs treatment
9. Stigma from others around mental health disorders
10. Minimal availability of harm-reduction resources

We look at this list in three ways. First, as valuable in that it comes from survey responses from homeless adolescents. Second, with a degree of sadness and frustration because every one of these obstacles can be overcome. Third, with a degree of optimism and hope – because with attention and effort, every single one of these obstacles can, indeed, be overcome.

Helping Homeless Teens with Mental Health Issues

There is very little research on the long-term effects of specific mental health interventions for homeless youth and adolescents with diagnosed mental health or alcohol/substance use disorders. There are, however, several types of initiatives, programs, and interventions already in place. When these interventions are implemented for homeless adolescents, they result in improvements in their physical, emotional, and mental health.

The University of California report, mentioned above, identifies the following evidence-based interventions for improving the mental health of homeless adolescents:

Stable Housing

Any local, state, federal, or private program that works to ensure housing stability for at-risk populations can improve every facet of life for homeless teens. By every facet, we mean every one. Physical health, mental health, emotional stability, self-esteem, academic achievement, and risky behavior all improve with stable housing.

Drop-In Centers

These centers are exactly what they sound like: locations where homeless or at-risk youth can drop in and access support they don’t have. Types of support offered by drop-in centers include basic needs such as food, clothing, and hygiene, as well as high-level needs such as STD screening, mental health and substance use disorder treatment, individual and group counseling, school dropout prevention, academic tutoring, and life skills classes. Evidence shows homeless youth are twice as likely to use drop-in centers than shelters, primarily because they have fewer rules, and most adopt a “come as you are” approach to supporting homeless youth.

Trauma-Informed Care

There’s a movement in the country to include all aspects of healthcare under the trauma-informed umbrella. This umbrella also extends to schools and other support services for teens. The idea is that if responsible adults in a position of authority realize the widespread impact of trauma and understand potential paths for recovery, recognize the signs and symptoms of trauma, and actively seek to actively resist re-traumatization, then they can mitigate some of the negative effects of trauma, which in some cases include homelessness. The six components of trauma-informed care, as identified by the Substance Abuse and Health Services Administration (SAMHSA), are: 1. Safety 2. Trustworthiness and Transparency, Safety 3. Peer Support, Collaboration, and Mutuality 4. Empowerment, Voice, and Choice, 4. Cultural, Historic, and Gender Issues.

Social Networks

Several studies show that social connectedness improves self-esteem and reduces depressive symptoms and instances of substance use disorder in homeless youth. Shelter workers warn that in most cases, social connectedness is a positive factor in the lives of homeless youth and adolescents. They offer a caveat, though. Some social connections result in “adverse substance use outcomes.” Therefore, the quality and type of connections made in shelters and drop-in centers should be closely monitored by staff.

Computer Access

A study on over a hundred homeless adolescents in the Los Angeles area found that teens who used email and social media to maintain connections with friends and family were more likely to use computers to search for and gain employment and stable housing.

Homeless teens need the same things all teens need: safety, stability, and support from responsible, caring adults. Upon close inspection, these interventions have something in common. They fill gaps in the lives of homeless teens that would not exist if they had secure housing and the consistent, positive attention of adults invested in their health and well-being.

Creating Safe Spaces for Homeless Adolescents

Homelessness during adolescence has repercussions that extend beyond the acute stress of finding daily food and shelter. If we stop and think about that for a moment, however, we realize that many U.S. citizens never experience daily stress on this level. We should never, therefore, minimize the impact this type of prolonged stress has on the life of any individual. Most of us experience ups and downs, and for many of us there are times when money is uncomfortably tight. But homeless teens experience basic survival stress every day they’re homeless. This acute, toxic stress increases their already elevated risk of developing mental health, alcohol, and/or substance use disorders. Their homelessness also impacts their academic achievement, their ability to finish high school, and their ability to seek and gain employment.

Initiatives to treat and improve the mental health of homeless teens need to address – or at least be informed by – all the factors at play in the teen’s life. A complete, integrated strategy to support these teens is the ultimate goal. The current ecosystem of shelters, drop-in centers, and food/clothing banks offer essential support, but homeless teens need more. They need stable housing and comprehensive support designed to meet their individual needs. When we, as a society, allow our teens to fall through the cracks, we are the lesser for it. However, when we support the transition of every child through adolescence and propel them toward a productive adulthood, we improve not only their lives, but our society as a whole.