Health Conditions Among Unsheltered Adults in the U.S.

POLICY BRIEF: Health Conditions Among Unsheltered Adults in the U.S. 

TECHNICAL APPENDIX: Technical Appendix: Health Conditions Among Unsheltered Adults in the U.S. 

PRESS RELEASE: Health Conditions Among Unsheltered Adults in the U.S.

The California Policy Lab analyzed responses from more than 64,000 adults in the United States experiencing both sheltered and unsheltered homelessness. Unsheltered adults are far more likely to report suffering from chronic health conditions, mental health issues, and experiences with trauma and substance abuse problems as compared to homeless people who are living in shelters. As policymakers design interventions for unsheltered individuals and balance investments in emergency housing and permanent housing, they will need to consider whether emergency housing is adequate or appropriate for a highly vulnerable population, half of whom are trimorbid.

November 2025: Important research note: Please read before reading or citing this study

There has been considerable interest in this analysis, however, there have also been mis-interpretations of the findings. While we had already posted a research note explaining some important caveats in interpreting this analysis, given recent events, we are updating this research note. Please reach out to press@capolicylab.org if you have additional questions.

This study does not describe the prevalence of health conditions among all people experiencing homelessness or explain the causes of homelessness. This study analyzes data from a non-representative sample of people in 15 states who were given a triage survey while they were experiencing homelessness and being prioritized for supportive housing. In many communities, this survey is typically given to a subset of people whom case managers believe are medically vulnerable or disabled enough to qualify for fully supportive housing or housing subsidies. The people in this sample are therefore on average much more medically vulnerable than the broader population of people experiencing homelessness. In other words this sample has selection bias. The purpose of this brief was to compare health conditions among people accessing shelter vs people not accessing shelter — among this already vulnerable group.

In addition, these triage surveys asked respondents about their lifetime prevalence of mental health and health conditions. However, those findings should be interpreted with caution because they are focused on lifetime prevalence and they are self-reported. In contrast, in more recent research, CPL analyzed clinical diagnoses of mental illness among people receiving homelessness services in Los Angeles. In a 2021 study, we showed that 20% of participants in Street Outreach services had a diagnosis of serious mental illness in the previous twelve years. In a follow-up study, looking at the previous 5 years (prior to enrolling in services), we showed that 10% of people had been diagnosed with a psychotic spectrum disorder, and an additional 7% had been diagnosed for other serious mental illness without psychotic spectrum disorder.

CPL is adding this additional context to this research note because we are deeply concerned about these survey results being misused to make broad claims about the causes of homelessness. Hundreds of studies — including our own — show economic pressures are the primary drivers of homelessness, that housing people ends homelessness, and that targeted financial assistance helps people at risk of homelessness stay stably housed.

Select media coverage about the Health Conditions Among Unsheltered Adults in the U.S.

Pittsburgh Post-Gazette: City Mission breaks ground on new Washington County women’s shelter (May 23, 2024)

Indiana Public Media: City Limits: Crawford Apartments’ housing-first approach leads to drop in arrest rates (March 30, 2023)

WFIU Public Radio: City Limits: Crawford Apartments’ housing-first approach leads to drop in arrest rates (March 30 2023)

NBC Los Angeles: UCLA Study Finds Health Problems, Trauma Rates High for Unsheltered Homeless October 7, 2019.

UCLA Daily Bruin:UCLA study shows health problems significantly contribute to homelessness October 8, 2019.

Suggested citation: Rountree, J., Hess, N., Lyke, A. (2019). Health Conditions Among Unsheltered Adults in the U.S. California Policy Lab, University of California. https://capolicylab.org/health-conditions-among-unsheltered-adults-in-the-u-s/[/vc_column_text][/vc_column][/vc_row]