Housing instability and homelessness are major determinants of poor mental health outcomes. Lack of stable housing increases the risk of psychiatric conditions such as depression, anxiety, and psychosis.1 Homelessness also correlates with substance use disorders and an increased incidence of self-harm.²

Clinical Relevance

• Research shows that people who are homeless are more likely to suffer from chronic mental health disorders, and housing stability (e.g., living without violence) can significantly reduce the severity of these conditions.³
• Homelessness and housing instability are major SDoMH relevant to clinical outcomes in patients with schizophrenia spectrum psychotic disorders (SSPD).⁴
• Addressing housing needs should be a priority in diagnosis and treatment planning.
• Among persons experiencing homelessness, the mean pooled prevalence rates of major depressive disorder (MDD) were 13% to 26%.⁵

Economic Impact

• In fact, more than half of low-income American households now allocate over 50% of their income to housing.²
• The costs of homelessness include an increase in emergency room visits, hospitalizations, and long-term mental healthcare, which strain public resources.⁶
• By investing in stable housing, society can significantly reduce long-term healthcare costs.

Policy and Programs

Programs like Housing First, which provide stable housing without preconditions for psychiatric treatment, show success in improving mental health outcomes.²

Avenues of Intervention

• For Psychiatrists: Work with social workers to help homeless patients secure housing resources and stable living conditions.³
• For Individuals: Educate and advocate for access to subsidized housing and rent support programs.⁷
• For Organizations: Partner with local governments and organizations to promote housing-first policies for individuals with severe mental health conditions.^1,8

References

1. American Psychiatric Association. (2022). Report of the Presidential Task Force on the Social Determinants of Mental Health (.pdf). In American Psychiatric Association.
2. Swope, C. B., & Hernández, D. (2019). Housing as a determinant of health equity: A conceptual model. Social Science & Medicine, 243, 112571. https://doi.org/10.1016/j.socscimed.2019.112571
3. Rotter, M., & Compton, M. (2021). Criminal Legal Involvement: A Cause and Consequence of Social Determinants of Health. Psychiatric Services, 73(1), 108–111. https://doi.org/10.1176/appi.ps.202000741
4. Jester, D. J., Thomas, M. L., Sturm, E. T., Harvey, P. D., Keshavan, M., Davis, B. J., Saxena, S., Tampi, R., Leutwyler, H., Compton, M. T., Palmer, B. W., & Jeste, D. V. (2023). Review of Major Social Determinants of Health in Schizophrenia-Spectrum Psychotic Disorders: I. Clinical Outcomes. Schizophrenia bulletin, 49(4), 837–850. https://doi.org/10.1093/schbul/sbad023
5. Alon, N., Macrynikola, N., Jester, D. J., Keshavan, M., Reynolds, C. F., 3rd, Saxena, S., Thomas, M. L., Torous, J., & Jeste, D. V. (2024). Social determinants of mental health in major depressive disorder: Umbrella review of 26 meta-analyses and systematic reviews. Psychiatry research, 335, 115854. https://doi.org/10.1016/j.psychres.2024.115854
6. Florence, A. C., & Susser, E. (2024). Centering Agency and Choice in Moving Toward Social Justice in Mental Health: Reflections on Childhood Maltreatment, Psychiatric Symptoms, and Homelessness. American Journal of Psychiatry, 181(12), 1039–1041. https://doi.org/10.1176/appi.ajp.20240956
7. Salzer, M. S. (2021). Community Inclusion and Social Determinants: From Opportunity to Health. Psychiatric Services, 72(7), 836–839. https://doi.org/10.1176/appi.ps.202000394
8. Moran, M. (2021). Incoming APA President Outlines Specific Plan to Address Social Determinants of Mental Health. Psychiatric News, 56(7). https://doi.org/10.1176/appi.pn.2021.7.27