essay on effects of homelessness

Featured Topics

Featured series.

A series of random questions answered by Harvard experts.

Explore the Gazette

Read the latest.

Roadmap to Gaza peace may run through Oslo

Why Democrats, Republicans, who appear at war these days, really need each other

Decline of golden age for American Jews

Why it’s so hard to end homelessness in america.

City of Boston workers clear encampments in the area known as Mass and Cass.

Craig F. Walker/The Boston Globe via Getty Images

Alvin Powell

Harvard Staff Writer

Experts cite complexity of problem, which is rooted in poverty, lack of affordable housing but includes medical, psychiatric, substance-use issues

It took seven years for Abigail Judge to see what success looked like for one Boston homeless woman.

The woman had been sex trafficked since she was young, was a drug user, and had been abused, neglected, or exploited in just about every relationship she’d had. If Judge was going to help her, trust had to come first. Everything else — recovery, healing, employment, rejoining society’s mainstream — might be impossible without it. That meant patience despite the daily urgency of the woman’s situation.

“It’s nonlinear. She gets better, stops, gets re-engaged with the trafficker and pulled back into the lifestyle. She does time because she was literally holding the bag of fentanyl for these guys,” said Judge, a psychology instructor at Harvard Medical School whose outreach program, Boston Human Exploitation and Sex Trafficking (HEAT), is supported by Massachusetts General Hospital and the Boston Police Department. “This is someone who’d been initially trafficked as a kid and when I met her was 23 or 24. She turned 30 last year, and now she’s housed, she’s abstinent, she’s on suboxone. And she’s super involved in her community.”

It’s a success story, but one that illustrates some of the difficulties of finding solutions to the nation’s homeless problem. And it’s not a small problem. A  December 2023 report  by the U.S. Department of Housing and Urban Development said 653,104 Americans experienced homelessness, tallied on a single night in January last year. That figure was the highest since HUD began reporting on the issue to Congress in 2007 .

Abigail Judge of the Medical School (from left) and Sandra Andrade of Massachusetts General Hospital run the outreach program Boston HEAT (Human Exploitation and Sex Trafficking).

Niles Singer/Harvard Staff Photographer

Scholars, healthcare workers, and homeless advocates agree that two major contributing factors are poverty and a lack of affordable housing, both stubbornly intractable societal challenges. But they add that hard-to-treat psychiatric issues and substance-use disorders also often underlie chronic homelessness. All of which explains why those who work with the unhoused refer to what they do as “the long game,” “the long walk,” or “the five-year-plan” as they seek to address the traumas underlying life on the street.

“As a society, we’re looking for a quick fix, but there’s no quick fix for this,” said Stephen Wood, a visiting fellow at Harvard Law School’s Petrie-Flom Center for Health Law Policy, Biotechnology and Bioethics and a nurse practitioner in the emergency room at Carney Hospital in the Dorchester neighborhood of Boston. “It takes a lot of time to fix this. There will be relapses; there’ll be problems. It requires an interdisciplinary effort for success.”

A recent study of 60,000 homeless people in Boston found the average age of death was decades earlier than the nation’s 2017 life expectancy of 78.8 years.

Illustration by Liz Zonarich/Harvard Staff

Katherine Koh, an assistant professor of psychiatry at HMS and psychiatrist at MGH on the street team for Boston Health Care for the Homeless Program, traced the rise of homelessness in recent decades to a combination of factors, including funding cuts for community-based care, affordable housing, and social services in the 1980s as well as deinstitutionalization of mental hospitals.

“Though we have grown anesthetized to seeing people living on the street in the U.S., homelessness is not inevitable,” said Koh, who sees patients where they feel most comfortable — on the street, in church basements, public libraries. “For most of U.S. history, it has not been nearly as visible as it is now. There are a number of countries with more robust social services but similar prevalence of mental illness, for example, where homelessness rates are significantly lower. We do not have to accept current rates of homelessness as the way it has to be.”

“As a society, we’re looking for a quick fix, but there’s no quick fix for this.” Stephen Wood, visiting fellow, Petrie-Flom Center for Health Law Policy, Biotechnology and Bioethics

Success stories exist and illustrate that strong leadership, multidisciplinary collaboration, and adequate resources can significantly reduce the problem. Prevention, meanwhile, in the form of interventions focused on transition periods like military discharge, aging out of foster care, and release from prison, has the potential to vastly reduce the numbers of the newly homeless.

Recognition is also growing — at Harvard and elsewhere — that homelessness is not merely a byproduct of other issues, like drug use or high housing costs, but is itself one of the most difficult problems facing the nation’s cities. Experts say that means interventions have to be multidisciplinary yet focused on the problem; funding for research has to rise; and education of the next generation of leaders on the issue must improve.

“This is an extremely complex problem that is really the physical and most visible embodiment of a lot of the public health challenges that have been happening in this country,” said Carmel Shachar, faculty director of Harvard Law School’s Center for Health Law and Policy Innovation. “The public health infrastructure has always been the poor Cinderella, compared to the healthcare system, in terms of funding. We need increased investment in public health services, in the public health workforce, such that, for people who are unhoused, are unsheltered, who are struggling with substance use, we have a meaningful answer for them.”

“You can either be admitted to a hospital with a substance-use disorder, or you can be admitted with a psychiatric disorder, but very, very rarely will you be admitted to what’s called a dual-diagnosis bed,” said Wood, a nurse practitioner in the emergency room at Carney Hospital.

Kris Snibbe/Harvard Staff Photographer

Experts say that the nation’s unhoused population not only experiences poverty and exposure to the elements, but also suffers from a lack of basic health care, and so tend to get hit earlier and harder than the general population by various ills — from the flu to opioid dependency to COVID-19.

A recent study of 60,000 homeless people in Boston recorded 7,130 deaths over the 14-year study period. The average age of death was 53.7, decades earlier than the nation’s 2017 life expectancy of 78.8 years. The leading cause of death was drug overdose, which increased 9.35 percent annually, reflecting the track of the nation’s opioid epidemic, though rising more quickly than in the general population.

A closer look at the data shows that impacts vary depending on age, sex, race, and ethnicity. All-cause mortality was highest among white men, age 65 to 79, while suicide was a particular problem among the young. HIV infection and homicide, meanwhile, disproportionately affected Black and Latinx individuals. Together, those results highlight the importance of tailoring interventions to background and circumstances, according to Danielle Fine, instructor in medicine at HMS and MGH and an author of two analyses of the study’s data.

“The takeaway is that the mortality gap between the homeless population and the general population is widening over time,” Fine said. “And this is likely driven in part by a disproportionate number of drug-related overdose deaths in the homeless population compared to the general population.”

Inadequate supplies of housing

Though homelessness has roots in poverty and a lack of affordable housing, it also can be traced to early life issues, Koh said. The journey to the streets often starts in childhood, when neglect and abuse leave their marks, interfering with education, acquisition of work skills, and the ability to maintain healthy relationships.

“A major unaddressed pathway to homelessness, from my vantage point, is childhood trauma. It can ravage people’s lives and minds, until old age,” Koh said. “For example, some of my patients in their 70s still talk about the trauma that their parents inflicted on them. The lack of affordable housing is a key factor, though there are other drivers of homelessness we must also tackle.”

The number was the highest since the U.S. Department of Housing and Urban Development began reporting on the issue to Congress in 2007 .

Most advocates embrace a “housing first” approach, prioritizing it as a first step to obtaining other vital services. But they say the type of housing also matters. Temporary shelters are a key part of the response, but many of the unhoused avoid them because of fears of theft, assault, and sexual assault. Instead, long-term beds, including those designated for people struggling with substance use and mental health issues, are needed.

“You can either be admitted to a hospital with a substance-use disorder, or you can be admitted with a psychiatric disorder, but very, very rarely will you be admitted to what’s called a dual-diagnosis bed,” said Petrie-Flom’s Wood. “The data is pretty solid on this issue: If you have a substance-use disorder there’s likely some underlying, severe trauma. Yet, when we go to treat them, we address one but not the other. You’re never going to find success in the system that we currently have if you don’t recognize that dual diagnosis.”

Services offered to those in housing should avoid what Koh describes as a “one-size-fits-none” approach. Some might need monthly visits from a caseworker to ensure they’re getting the support they need, she said. But others struggle once off the streets. They need weekly — even daily — support from counselors, caseworkers, and other service providers.

“I have seen, sadly, people who get housed and move very quickly back out on the streets or, even more tragically, lose their life from an unwitnessed overdose in housing,” Koh said. “There’s a community that’s formed on the street so if you overdose, somebody can give you Narcan or call 911. If you don’t have the safety of peers around, people can die. We had a patient who literally died just a few days after being housed, from an overdose. We really cannot just house people and expect their problems to be solved. We need to continue to provide the best care we can to help people succeed once in housing.”

“We really cannot just house people and expect their problems to be solved.”  Katherine Koh, Mass. General psychiatrist

Koh works on the street team for Boston Health Care for the Homeless Program.

Photo by Dylan Goodman

The nation’s failure to address the causes of homelessness has led to the rise of informal encampments from Portland, Maine, to the large cities of the West Coast. In Boston, an informal settlement of tents and tarps near the intersection of Massachusetts Avenue and Melnea Cass Boulevard was a point of controversy before it was cleared in November.

In the aftermath, more than 100 former “Mass and Cass” residents have been moved into housing, according to media reports. But experts were cautious in their assessment of the city’s plans. They gave positive marks for features such as a guaranteed place to sleep, “low threshold” shelters that don’t require sobriety, and increased outreach to connect people with services. But they also said it’s clear that unintended consequences have arisen. and the city’s homelessness problem is far from solved.

Examples abound. Judge, who leads Boston HEAT in collaboration with Sandra Andrade of MGH, said that a woman she’d been working with for two years, who had been making positive strides despite fragile health, ongoing sexual exploitation, and severe substance use disorder, disappeared after Mass and Cass was cleared.

Mike Jellison, a peer counselor who works on Boston Health Care for the Homeless Program’s street team, said dismantling the encampment dispersed people around the city and set his team scrambling to find and reconnect people who had been receiving medical care with providers. It’s also clear, he said, that Boston Police are taking a hard line to prevent new encampments from popping up in other neighborhoods, quickly clearing tents and other structures.

“We were out there Wednesday morning on our usual route in Charlesgate,” Jellison said in early December. “And there was a really young couple who had all their stuff packed. And [the police] just told them, ‘You’ve got to leave, you can’t stay here.’ She was crying, ‘Where am I going to go?’ This was a couple who works; they’re employed and work out of a tent. It was like 20 degrees out there. It was heartbreaking.”

Prevention as cure?

Successes in reducing homelessness in the U.S. are scarce, but not unknown. The U.S. Department of Veterans Affairs, for example, has reduced veteran homelessness nationally by more than 50 percent since 2010.

Experts point out, however, that the agency has advantages in dealing with the problem. It is a single, nationwide, administrative entity so medical records follow patients when they move, offering continuity of care often absent for those without insurance or dealing with multiple private providers. Another advantage is that the VA’s push, begun during the Obama administration, benefited from both political will on the part of the White House and Congress and received support and resources from other federal agencies.

The city of Houston is another example. In 2011, Houston had the nation’s fifth-largest homeless population. Then-Mayor Annise Parker began a program that coordinated 100 regional nonprofits to provide needed services and boost the construction of low-cost housing in the relatively inexpensive Houston market.

Neither the VA nor Houston was able to eliminate homelessness, however.

To Koh, that highlights the importance of prevention. In 2022, she published research in which she and a team used an artificial-intelligence-driven model to identify those who could benefit from early intervention before they wound up on the streets. The researchers examined a group of U.S. service members and found that self-reported histories of depression, trauma due to a loved one’s murder, and post-traumatic stress disorder were the three strongest predictors of homelessness after discharge.

In April 2023, Koh, with co-author Benjamin Land Gorman, suggested in the Journal of the American Medical Association that using “Critical Time Intervention,” where help is focused on key transitions, such as military discharge or release from prison or the hospital, has the potential to head off homelessness.

“So much of the clinical research and policy focus is on housing those who are already homeless,” Koh said. “But even if we were to house everybody who’s homeless today, there are many more people coming down the line. We need sustainable policies that address these upstream determinants of homelessness, in order to truly solve this problem.”

The education imperative

Despite the obvious presence of people living and sleeping on city sidewalks, the topic of homelessness has been largely absent from the nation’s colleges and universities. Howard Koh, former Massachusetts commissioner of public health and former U.S. assistant secretary for Health and Human Services, is working to change that.

In 2019, Koh, who is also the Harvey V. Fineberg Professor of the Practice of Public Health Leadership, founded the Harvard T.H Chan School of Public Health’s pilot Initiative on Health and Homelessness. The program seeks to educate tomorrow’s leaders about homelessness and support research and interdisciplinary collaboration to create new knowledge on the topic. The Chan School’s course “Homelessness and Health: Lessons from Health Care, Public Health, and Research” is one of just a handful focused on homelessness offered by schools of public health nationwide.

“The topic remains an orphan,” said Koh. The national public health leader (who also happens to be Katherine’s father) traced his interest in the topic to a bitter winter while he was Massachusetts public health commissioner when 13 homeless people froze to death on Boston’s streets. “I’ve been haunted by this issue for several decades as a public health professional. We now want to motivate courageous and compassionate young leaders to step up and address the crisis, educate students, motivate researchers, and better inform policymakers about evidence-based studies. We want every student who walks through Harvard Yard and sees vulnerable people lying in Harvard Square to not accept their suffering as normal.”

Share this article

You might like.

Former Palestinian Authority prime minister says strengthening execution of 1993 accords could lead to two-state solution 

Political philosopher Harvey C. Mansfield says it all goes back to Aristotle, balance of competing ideas about common good

Franklin Foer recounts receding antisemitism of past 100 years, recent signs of resurgence of hate, historical pattern of scapegoating 

College accepts 1,937 to Class of 2028

Students represent 94 countries, all 50 states

Pushing back on DEI ‘orthodoxy’

Panelists support diversity efforts but worry that current model is too narrow, denying institutions the benefit of other voices, ideas

Aspirin cuts liver fat in trial

10 percent reduction seen in small study of disease that affects up to a third of U.S. adults

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• HHS Author Manuscripts

Solving Homelessness from a Complex Systems Perspective: Insights for Prevention Responses

Patrick j. fowler.

1 The Brown School, Washington University in St. Louis, St. Louis, Missouri 63130, USA; ude.ltsuw@relwofjp , ude.ltsuw@dnamvohp , ude.ltsuw@lacramek

Peter S. Hovmand

Katherine e. marcal.

2 Department of Computer Science and Engineering, Washington University in St. Louis, St. Louis, Missouri 63130, USA; ude.ltsuw@yamnas

Homelessness represents an enduring public health threat facing communities across the developed world. Children, families, and marginalized adults face life course implications of housing insecurity, while communities struggle to address the extensive array of needs within heterogeneous homeless populations. Trends in homelessness remain stubbornly high despite policy initiatives to end homelessness. A complex systems perspective provides insights into the dynamics underlying coordinated responses to homelessness. A constant demand for housing assistance strains service delivery, while prevention efforts remain inconsistently implemented in most countries. Feedback processes challenge efficient service delivery. A system dynamics model tests assumptions of policy interventions for ending homelessness. Simulations suggest that prevention provides a leverage point within the system; small efficiencies in keeping people housed yield disproportionately large reductions in homelessness. A need exists for policies that ensure reliable delivery of coordinated prevention efforts. A complex systems approach identifies capacities and constraints for sustainably solving homelessness.

1. HOMELESSNESS AS A COMPLEX PUBLIC HEALTH THREAT

1.1. scope of homelessness.

Homelessness poses an enduring public health challenge throughout the developed world. Although the Universal Declaration of Human Rights declared housing a basic right in 1991, the United Nations continues to identify homelessness as an urgent human rights crisis ( 109 ). Definitions vary, but homelessness generally refers to the lack of safe accommodations necessary for respite and connection with people and places ( 11 , 47 , 110 ). Homelessness includes living on the streets or in shelters, as well as patterns of housing insecurity such as overcrowding or excessive cost burden. The most recent global survey of countries estimates that more than 1.5% of the world’s population lack basic shelter, while as many as one in five people experience housing insecurity ( 109 ).

Trends of homelessness suggest stubbornly stable or expanding rates. Most of Europe has seen large increases in rooflessness as well as housing instability in recent years ( 80 , 110 ). For instance, the homeless populations of Germany and Ireland have increased by approximately 150% from 2014 to 2016 and from 2014 to 2017, respectively ( 92 ). Point-in-time counts of homeless persons in Australia suggest increases in per capita (PC) rates from 2006 (45 per 10,000) to 2016 (50 PC) ( 3 ). The United States shows decreases in PC rates of homelessness based on annual point-in-time counts of sheltered and unsheltered persons ( 47 ); however, changes have leveled off despite substantial reorganization of homeless assistance.

Housing insecurity represents the much larger problem of hidden homelessness. On average, poor families (earning less than 60% of the median national income) in the European Union spent more than 40% of their income on rent in 2016 ( 92 ). More than 80% of US households below the federal poverty line spent at least 30% of their incomes on rent. Frequent moves and doubling up represent additional common indicators of inadequate housing ( 20 ). Foreclosure and evictions are endemic in certain communities; estimates suggest that nearly one million US households experienced eviction in 2016, while eviction represents a major challenge across Europe ( 23 , 53 ). Trends demonstrate the challenges of solving homelessness and the need for innovations.

1.2. Impact of Homelessness

Homelessness and associated poverty have life course implications for physical and mental health. Many adverse health and socioemotional outcomes are linked to homelessness in children ( 26 , 117 ). Homeless adults face increased mortality from all causes, and those with severe mental illness display significantly worse quality of life compared with nonhomeless individuals with mental illness ( 61 ). Education levels and employment rates among homeless adults are low compared with the general population ( 9 , 16 ). In Europe, average life expectancy of people who experience homelessness is 30 years less than nonhomeless populations ( 11 ).

In addition to human suffering, public expenditures associated with homelessness are substantial. In the United States, estimated costs (all adjusted to 2018 USD) of a homeless shelter can exceed $7,000 per month per family ( 19 , 45 , 98 ) with additional costs attributed to inpatient hospitalization, incarceration, and public assistance ( 36 , 99 ). Cost estimates in Europe are limited but suggest substantial expenditures associated with shelter and outside services such as emergency departments, psychiatric care, and jail or prison ( 78 ). In Australia, the government estimates spending at $30,000 per homeless person per year ( 4 ). Few rigorous studies quantify the additional social losses in productivity and well-being. Communities around the world struggle to manage the human and financial burdens of homelessness.

2. COMPLEXITY IN CAUSES AND RESPONSES TO HOMELESSNESS

2.1. complex causes of homelessness.

Experiences of homelessness depend on a complex interplay between individual, interpersonal, and socioeconomic factors. Research has long identified mental illness and addiction as risk factors for homelessness ( 37 , 47 , 48 ). Personal struggles also strain interpersonal relationships with family, friends, and romantic partners; in a vicious cycle, conflict undermines well-being as well as erodes potential housing supports ( 21 , 77 ). However, socioeconomic factors often dictate the likelihood of displacement.

Globally, marginalized communities disproportionately experience homelessness. Homelessness is much more common among the poor and minorities in terms of race/ethnicity, sexual orientation and identity, and institutionalization and among those with physical and mental disabilities compared with the general population ( 105 ). For instance, members of Aboriginal communities in Australia comprise a quarter of people receiving homeless services, while representing less than 3% of the total population ( 3 ). A similar disparity exists in Canada, with Indigenous people 10 times more likely to use homeless shelters than non-Indigenous ( 37 , 91 ). Due to structural inequalities associated with marginalization, the accessibility of jobs and affordable housing remains constrained; availability of appropriate accommodations is more or less random ( 11 , 74 ). Household-level shocks to housing stability such as job loss, termination of assistance, or eviction require a scramble for housing that may or may not be available, given market constraints. Homelessness results when other formal or informal housing supports remain inaccessible; lack of supports can reinforce vulnerability to crises that threaten stable housing. Thus, entries as well as exits into homelessness among vulnerable populations become a matter of bad timing and bad luck. The presence of personal and interpersonal barriers exacerbates vulnerabilities but fails to explain homelessness.

2.2. Implications of Complexity for Homeless Responses

Complexity underlying housing insecurity carries important implications for systematic responses to homelessness. First, extensive heterogeneity exists in homeless populations and in the types of services needed to address housing instability. Individuals with severe mental illness, for example, may require ongoing intensive supports to avoid falling back into homelessness, whereas pregnant teens with few connections to supportive adults have a different set of needs. This variation requires considerable flexibility and tailoring of resources to promote stability.

A related implication concerns variation in the timing and patterns of homelessness. Some households experience single episodes of homelessness, while chronic homelessness refers to instability for more than two years (one year for families with children) with ongoing barriers to stability [HEARTH Act of 2009 (Pub. L. 112–141)]. Research that investigates patterns of housing insecurity reveals distinct subpopulations based on housing trajectories ( 18 , 31 , 33 , 106 ). For instance, studies show that chronic patterns of homelessness affect a relatively small number of persons ( 33 , 34 ). Homeless assistance continuously interacts with households at different stages of different trajectories, which makes accurate prediction of risk as well as response to interventions exceedingly difficult ( 5 , 38 , 44 , 58 , 95 ).

The complex causes of homelessness require complex solutions. Homeless assistance typically requires the provision of multifaceted supports that adapt in response to shifting household demands and often includes unique combinations of residential and nonresidential supports. Recurrent constraints on the availability of supports often require further tailoring of homeless assistance on the basis of resource accessibility. The resulting combinatorial complexity of housing interventions challenges sustained, systematic responses to homelessness ( 35 ).

Finally, the complex causes of and responses to homelessness present substantial challenges for screening and resource allocation. Efficient service provision depends on accurate assessments of risk and potential responses to interventions ( 10 , 58 , 72 ). Tools, such as the Vulnerability Index—Service Prioritization Decision Assistance Tool (VI SPDAT), purport to categorize households seeking homeless assistance for appropriate interventions from responses to screening questions; high vulnerability requires supportive housing, moderate requires temporary housing with less intensive supports, and households with low risk are diverted from the system ( 22 ). VI SPDAT developers report item reliability and claim use in communities around the world ( 75 ). However, little evidence exists on the tool’s accuracy, and available research suggests poor sensitivity and specificity with common scoring procedures ( 7 , 15 ). The VI SPDAT intervention assignments poorly differentiate households, resulting in extensive false positives (false alarms) and false negatives (missed hits) ( 6 , 108 ). Other screening tools show similar challenges for targeting preventive services ( 13 , 28 , 44 , 94 ). The difficulty in prediction reflects the complexity that underlies homelessness ( 5 , 38 , 58 ).

2.3. Complex Systems and Coordinated Responses to Homelessness

Nations have adopted various strategies to address homelessness. Responsibility for serving homeless populations in European Union nations generally falls under common social welfare policies, while federal policies and funding structure local responses to homelessness in Australia, Canada, and the United States (11, 116; Pub. L. 112–141). Although communities differ in how supports are organized, a common structure connects the delivery of homeless assistance. Delivery of housing plus supports leverages interorganizational networks composed of governmental and nongovernmental agencies ( 10 , 41 , 81 , 87 ). Formal and informal partnerships work together to screen and respond to individuals and families experiencing housing crises.

Figure 1 illustrates the underlying framework for homeless services from a complex systems perspective. In the center, households experience countervailing supports and strains that influence stability, represented as virtuous and vicious cycles. When strains exceed supports, a need for housing triggers the demand for homeless assistance. Access to homeless services depends on local and national contexts; formal and informal policies determine eligibility, timing, and funding of resources, while socioeconomic conditions influence demand chains for services ( 27 , 74 ). The resulting dynamics allow homeless services to adapt and evolve over time.

Coordinated responses to homelessness as a complex system. Solid lines reflect a treatment first approach, whereas dashed lines represent housing first philosophy. Circular nodes represent examples of key supports in keeping people housed; ties between nodes generally refer to information exchanges, such as communications, service referrals, or funds. The + and − signs indicate the direction of correlation between variables.

The top layer in Figure 1 represents the general structure of homeless or residential services. Although heavily based on a North American perspective, the model captures a number of common elements in local and national responses to homelessness ( 10 , 11 , 25 ). Screening aims to identify need and allocate households to the most appropriate and available service. Emergency responses address immediate housing crises; in many countries, this represents homeless shelters that provide short-term accommodations. Temporary housing provides time-limited accommodations with case management and other nonresidential services. Supportive housing refers to permanent connection to housing plus case management to address substantial barriers to stability. Rapid rehousing and homelessness prevention represent efforts to provide immediate access to stable accommodations.

Movement through the system depends on organizing philosophies for solving homelessness. Screening attempts to forecast the level of need, ranging from low (prevention), moderate (rapid rehousing), and high (supportive housing) risk for ongoing homelessness ( 75 ). Treatment first assumes people need services to address the underlying barriers that led to homelessness ( 88 , 107 ). A staircase model structures services so that households progress from shelters to temporary housing in addition to the provision of services to permanent supportive housing. Transitions expose people to higher levels of supports that make them more prepared for stable housing. In contrast, housing first considers stable accommodations as a precondition for any treatment needed to reduce homelessness ( 107 ). The structure of residential services attempts to place people in stable housing as quickly as possible.

The bottom layer in Figure 1 illustrates the extensive networks of formal and informal supports engaged in addressing household instability. Conceptually, connections can be informal interpersonal communities or formalized through agreements and contracts. Homeless services at the hub denote efforts to weave a safety net of supports for households. Systems vary in the extent to which nonresidential supports are specific to the residential service or carry over with households as they transition into and out of homelessness ( 11 , 30 ). Regardless, homeless systems rely on extensive cross-systems collaboration to promote stability and remove barriers that prolong homelessness ( 10 , 19 , 90 ).

Use of interagency networks responds to the complexities of addressing homelessness. Foremost, referral networks allow for quicker access to a wide range of supports, which can handle the extensive heterogeneity of needs among homeless populations. Networks also provide flexibility to expand and contact with shifts in demand for services ( 10 , 19 , 73 , 87 ). A timely example concerns displacement due to conflict that triggers surges in refugee populations with various needs within a community or country; Germany, for example, saw a 150% increase in homelessness from 2014 to 2016 composed primarily of refugees ( 92 ). In times of greater need such as an influx of refugee families, interagency networks allow for sharing information and resources to respond more quickly. Likewise, collaborative organizations avoid hierarchal approval processes; instead, decision making on service delivery is distributed across providers within agencies that potentially speed up resource allocations ( 82 ). A network structure provides a dynamic and adaptive response to homelessness.

Collaborative networks introduce their own complexities for homeless service delivery. Actual efficiencies of the system depend on the mutually agreed upon rules that drive resource allocation ( 8 , 82 ). Partnerships must continuously devote time toward planning and monitoring mutually agreed upon goals, which shifts resources away from the core service missions of each agency ( 35 ). Given the constant pressure for social services, a dynamic emerges that threatens continued investment in collaboration ( 59 ). Instability can create oscillations in the quality of network performance toward ending homelessness ( 35 ). Virtuous cycles emerge within collaborations that have clear goals, strong leadership, and investments in backbone supports ( 62 ). Challenges exist for sustainable efforts.

Taken together, coordinated approaches to homelessness must consider the extensive heterogeneity in the population, as well as in the types and timing of services. Given the multiple pathways into homelessness and the diversity of the homeless population, a one-size-fits-all approach is inadequate. Collaborations represent a flexible strategy to address homelessness. However, system performance toward ending homelessness depends in large part on continuous investments in partnerships.

3. TRANSFORMING COORDINATED RESPONSES TO HOMELESSNESS

3.1. housing first as an organizing philosophy.

The complex systems delivering homeless assistance organize around key theories on ending homelessness. Formal and informal policies operationalize these theories, and structure emerges to coordinate resource allocation across intersecting networks ( 8 ). A paradigm shift has moved homeless systems toward a housing first philosophy ( 76 ). Although housing first also refers to a specific case management intervention, the philosophy more generally aligns services to stabilize accommodations quickly and without preconditions. This approach contrasts with the earlier treatment first, or staircase, approach that require homeless persons to demonstrate housing readiness or compliance with service plans as a condition of obtaining and maintaining housing supports. Fundamentally, the shift in philosophies moves toward a person-centered and recovery-oriented approach that assumes housing serves as a platform for reintegrating into communities.

Housing first interventions provide access to housing plus ongoing supports ranging in duration and intensity ( 11 , 107 ). Examples include assertive community treatment (ACT), critical time intervention (CTI), and Pathways to Housing. Early experimental studies in the 1980s and 1990s showed that homeless persons experiencing severe mental illness achieved stability more quickly and more consistently when randomly assigned to housing first instead of to treatment first services ( 87 , 102 ). Moreover, early studies suggested that the delivery of case management yielded savings from avoided costs for shelter, hospitalization, and criminalization ( 51 , 85 ). The initial evidence challenged assumptions of housing readiness to highlight cheaper and more effective options for homeless service delivery.

Well-designed studies subsequently tested the implementation and impact of housing first models with different homeless populations. Several large experiments in the United States and Canada randomly assigned homeless individuals and families to different housing interventions and carefully monitored the impacts of service delivery on a host of outcomes ( 2 , 45 , 87 ). Evidence from these and other studies generally support permanent housing approaches for improving stability ( 84 ). Benefits of permanent housing on well-being and quality-of-life improvements are more elusive; treatment effects are smaller and less consistent across outcomes and populations ( 32 , 45 ). Additionally, emerging evidence on rapid rehousing interventions providing time-limited rental assistance shows little impact on stability or well-being ( 14 , 45 , 58 ). As a whole, the body of evidence firmly dismisses housing readiness requirements for homeless assistance.

3.2. Dissemination and Implementation of Housing First

Numerous rigorous investigations into widespread dissemination and implementation of housing first provide important considerations for complex homeless systems. Studies show that fidelity to specific housing first models promotes household outcomes ( 2 , 40 , 87 ). Yet, model adherence requires substantial investment in training and technical assistance ( 2 , 40 , 69 ). Using the interactive systems framework ( 115 ), a national rollout of Pathways to Housing in Canada showed that fidelity diminished in communities with less initial buy-in and support ( 2 , 69 ).

Similar findings emerged from an initiative to provide housing first to 85,000 veterans across the United States ( 55 , 56 ). The organizational transformation model ( 63 ) directed substantial investment and technical assistance to deliver supportive housing as part of the health care system for veterans. Housing readiness requirements diminished through transformational efforts; however, model fidelity for client-centered supportive services remained inconsistent ( 54 ). Both studies emphasize the necessity of strong leadership and buy-in for achieving housing first model adherence ( 2 , 39 , 40 , 54 ). The studies show the difficulty in shifting cultures toward housing first principles even in well-resourced initiatives.

Systems integration of services for housing first also proves challenging. An innovative early experiment of supportive housing for homeless individuals experiencing severe mental illness also tested impacts on systems of care ( 43 ). The study randomly assigned individuals to receive supportive housing, as well as communities to receive technical assistance for systems transformation to integrate services. Community-level interagency networks were assessed over time to see if resources for supportive housing triggered new and stronger partnerships for nonresidential services. Findings suggested little change in systems of care, and technical assistance failed to integrate services ( 73 , 86 , 88 ).

3.3. Housing First Adoption and Adaptations

Despite implementation challenges, the housing first philosophy has been broadly adopted within homeless services around the world ( 11 , 76 ). This shift is most apparent in the integration of housing first principles into national strategies for addressing homelessness in Australia, Austria, Belgium, Canada, Denmark, France, Finland, Germany, Great Britain, Greece, Italy, the Netherlands, Portugal, Scotland, Spain, Sweden, and the United States ( 76 ). Policies focus on the provision of housing as a platform for connection to other services necessary for ending homelessness ( 79 , 112 ). However, considerable variation exists in adherence to evidence-based interventions as well as adaptations for system-wide implementation ( 11 , 76 ).

The United States provides an example of both broad adoption and adaptations of housing first philosophy. The Homeless Emergency Assistance and Rapid Transition to Housing (HEARTH) Act of 2009 (Pub. L. 112–141) introduced federal legislation that required every community across the country to develop and implement coordinated responses to homelessness. Guided by housing first principles, policies focus on procedures for community-wide screening and allocation of homeless assistance based on level of need; resources are prioritized for homeless persons deemed most vulnerable ( 62 , 113 ). The emphasis on vulnerability coincides with a shift in resources toward the literal homeless and away from the broader demand for supports to maintain housing ( 10 , 19 , 94 ). The housing first tenets were codified in a redefinition of homelessness and eligibility for services, as well as national agendas for ending homelessness ( 113 ; Pub. L. 112–141).

Figure 2 illustrates the implementation of housing first policies through shifts in new and reallocated resources. Plotting year-round beds available for homeless persons since 2007, the system has increasingly used housing first rapid rehousing and supportive housing, whereas use of shelters and temporary housing has declined. Trends in total federal funding for homeless assistance also demonstrate increases in capacities. Although annual budgets fail to disaggregate funds by service type, increases in funding correspond with shifts toward rapid rehousing and supportive housing. Decreases in the number of persons served through homeless assistance over the same period further suggest that the homeless systems provide more intensive services ( 46 ).

Capacity trends of homeless assistance in the United States. Bars indicate the number and type of year-round beds according to Continuum of Care Housing Inventory Counts; the red trend line represents overall federal funding of homeless services through the US Department of Housing and Urban Development (HUD), Veterans Affairs (VA), and Community Development Block Grants (CDBG). Other abbreviations: ES, emergency shelter; OPH, other permanent housing; PSH, permanent supportive housing; SH, safe haven.

3.4. Housing Insecurity and Coordinated Responses to Homelessness

Capacity shifts also signal the role of housing insecurity in the coordinated response to homelessness. Although US policy requires communities to include prevention in coordinated responses to homelessness, the availability and funding for such efforts are not tracked. Moreover, annual assessments of homeless system performance required by federal regulations do not consistently measure successful prevention efforts (Pub. L. 112–141). A similar pattern emerges in countries across the world; European countries that record funding show disproportionate spending on homeless interventions relative to prevention ( 66 , 78 ). Only Wales systematically monitors the total demand and response to prevention services ( 66 , 68 ). In the absence of metrics that track the implementation and outcomes of prevention, it is difficult to understand how well-coordinated responses address overall demand for homeless assistance.

Crises in affordable housing throughout the United States and globally suggest widespread unmet demand. Figure 3 , for instance, presents an indicator of housing insecurity in the United States. The figure plots the annual number of renting households paying more than 50% of income toward rent, referred to as severe rent burdened ( 111 ). A spike of 10 million households in 2012 has declined in recent years, and the trend line of severely burdened as a proportion of all renting households suggests some relief for the lowest-income households. Yet, reductions have yet to return to prehousing crises levels ( 52 ). Markets around the world face similar shortages in affordable housing that create a constant demand for homeless assistance ( 27 , 60 , 92 ).

Number ( blue bars ) and percent ( red line ) of households in the United States with severe rent burden 2007–2017. Data obtained from the American Community Survey 1-year estimates ( 111 ).

3.5. Prevention in Coordinated Responses to Homelessness

The lack of focus on housing insecurity reflects ambivalence in national policies regarding prevention ( 67 ). On one hand, most countries emphasize prevention as a key component of housing first strategies ( 11 , 37 , 66 , 113 ). Prevention frameworks are based on a public health conceptualization of homelessness and generally refer to policies and practices that promote connections to stable homes ( 37 , 67 , 94 ). As illustrated in Figure 4 , prevention efforts target populations at varying levels of risk for homelessness with evidence-based resources that increase in intensity ( 42 , 67 , 94 ). Universal prevention is broadly available to ensure access to housing, such as the right to housing legislation that guarantees access to housing supports, as well as duty to assist policies that require governments to respond to requests for housing supports ( 11 , 67 , 103 ). Selective prevention targets resources toward groups vulnerable for homelessness, for instance families under investigation for child maltreatment, youth aging out of foster care, and veterans returning from combat ( 14 , 32 , 33 ). Indicated prevention focuses on populations demonstrating vulnerability for homelessness, such as households facing evictions and foreclosures and low-income families screening high for housing instability ( 44 , 95 , 114 ). Coordinated prevention initiatives combine multiple intervention types to stem the inflow into homelessness. National policies aspire to avoid human and social costs through timely assistance that addresses housing insecurity.

Homelessness prevention targets based on population and intensity of housing supports.

On the other hand, policy agendas struggle to reconcile aspirations with the feasibility of meeting the broad demand posed by housing insecurity ( 11 , 19 , 67 ). Prevention proves challenging, given the difficulty in predicting whether timely assistance averts homelessness that would have occurred otherwise; inefficiencies in targeting create false alarms that diminish cost-effectiveness ( 12 , 94 , 95 ). Moreover, prevention efforts that fail to address societal determinants of homelessness—including structural poverty, violence, and marginalization—are perceived as misguided ( 12 , 94 ). In the context of scarcity, persuasive arguments suggest a responsibility to deliver services for households most likely to avoid homelessness and associated costs ( 12 , 19 , 94 ). Prevention efforts shift toward avoiding reentry into homelessness instead of promoting connections to housing ( 14 , 67 , 104 ).

Policy ambivalence results in inconsistent applications of prevention across countries ( 67 ). Debates over prevention-oriented approaches to homelessness have persisted over three decades ( 19 , 50 , 94 ). Few national strategies currently include structured processes for delivering and monitoring prevention activities, and instead, countries vary considerably in basic definitions on targeting of services ( 67 , 68 ). In the United States, coordinated responses allow allocation of homeless funds for prevention without guaranteeing access. Even most communities that recognize housing as a basic right ensure only connection with supports (regardless of appropriateness and legality) and not accommodations ( 12 , 67 ). Homeless assistance relies on diverting demand driven by housing insecurity toward community-based services and other social welfare resources outside of homeless systems ( 12 , 19 , 72 ). If the adage that what gets measured gets done is correct, the lack of accountability reveals the unsystematic role of prevention within coordinated responses to homelessness ( 67 , 68 ).

4. SOLVING HOMELESSNESS FROM A COMPLEX SYSTEMS PERSPECTIVE

4.1. homeless assistance from a complex systems perspective.

Complex systems provide a critical perspective on the delivery of coordinated responses to homelessness. Complex systems are composed of multiple interacting agents that produce nonlinear patterns of behaviors, and they continually adapt and evolve in response to conditions within the system ( 24 , 64 , 93 , 101 ). Dynamics emerge from feedback mechanisms, influencing future system behaviors. Reinforcing feedback generates patterns of growth (positive or negative), whereas balancing feedback limits unconstrained growth (homeostasis). Interactions between feedback processes often produce counterintuitive results when trying to change a system. Given the nature of homelessness, complex systems offer a unique tool for evaluating coordinated responses.

Complexity characterizes homelessness and systematic responses. At the household level, transitions between stable and unstable accommodations create oscillations over time that characterize homelessness ( 83 , 89 , 96 ). The patterns challenge accurate predictions and effective responses to homelessness ( 38 , 44 , 95 ). The elaborate ties across persons, agencies, and service systems enable extensive customization to unique and dynamic demands for services ( 1 , 57 , 81 ).

A complex systems perspective offers insights into sustainable solutions to homelessness. Framed as a dynamic problem ( 49 , 100 ), total homelessness is a function of the initial levels plus the ongoing movement of people in and out of homelessness. Mathematically, the dynamic is articulated in the differential equation:

where d represents change, homelessness represents total persons homeless, t represents time, entries represents persons entering homelessness at a given time, and exits represents persons exiting homelessness at a given time. Homelessness trends depend on the population size plus the rate of entries and exits over time. This stock-and-flow dynamic is analogous to water levels in a bathtub and produces counterintuitive results ( 100 , 101 ). For instance, to drain a tub, the volume of water from the tap must be less than the volume of outflow after pulling the stopper. Thus, water levels will continue to rise after opening the drain completely without also closing the tap. Likewise, closing the tap will raise water levels if the drain remains blocked. As anyone who has dealt with an overflowing toilet knows, the complexity can trigger poorly timed and counterproductive reactions.

Community-wide coordinated responses to homelessness attempt to manage stock-and-flow dynamics under conditions of far greater uncertainty. Efficient solutions likely address the net flow of homelessness, as opposed to one part of the system. However, the interacting processes that respond to the need for homeless assistance (see Figure 1 ) produce nonlinearities that obscure optimal choices for system-wide strategies ( 71 , 100 ). A number of common results from intervening in complex systems challenge decision making, such as delayed effects, tipping points, and worse-before-better scenarios ( 100 ). The dynamics make decisions about resource allocation toward housing first adaptations or prevention approaches difficult.

4.2. A System Dynamics Model of Coordinated Responses to Homelessness

A system dynamics model allows investigation into coordinated responses to homelessness. The systems science method uses informal and formal models to represent complex systems from a feedback perspective ( 49 , 64 , 100 ). Computer simulations test assumptions of the system, as well as help identify leverage points that represent places to intervene in the system for maximum benefit ( 70 ).

Figure 5 represents a dynamic hypothesis for solving homelessness. Historical trends present the annual number of persons receiving homeless services in the United States ( 97 ). Hoped and feared trajectories represent theorized responses to homelessness. The trajectories define the dynamic problem as a need for innovative policies that disrupt the status quo ( 49 , 67 , 100 ). Although the example uses annual national data on homeless persons served in the United States, similar hopes and fears likely emerge in many local and national contexts ( 35 ).

Dynamic hypothesis of coordinated responses to homeless in the United States. Historical trends ( black ) present the annual number of persons receiving homeless services. Hoped ( blue ) and feared ( red ) trajectories represent theorized responses to homelessness. Based on trends in the United States, the vertical axis reports the number of persons served by homeless assistance annually, whereas the horizontal axis represents time as 10 years in the past and future. The left half of the graph shows the observed linear decline in homeless, which is interpreted as progress ( 97 ). The right half of the graph articulates the hopes and fears of coordinated responses to homelessness.

Policy shifts toward housing first adaptations as well as prevention-oriented approaches hypothesize a sharp and sustainable downward trajectory of homelessness. However, the mechanisms underlying the dynamic differ on the basis of philosophy. Housing first adaptations assume moving more homeless persons into stable housing more quickly will drive down demand for homeless assistance, whereas prevention-oriented approaches hypothesize that supports provided before homelessness will reduce demand. A third hypothesis from a complex systems perspective suggests that a combination of approaches disrupt homeless trajectories. Articulating the theories of change allow researchers to model the dynamics.

Figure 6 presents an informal model of coordinated responses to homelessness. The structure elaborates on the previous formulation to capture stock-and-flow dynamics, and a formal computational model incorporates additional differential equations to capture dynamics ( 100 ). Using system dynamics conventions, stocks refer to accumulations of people, whereas flows represent transitions in and out of stocks. People exit stocks into stable housing defined as not needing housing assistance. In addition to homelessness, the model tracks individuals experiencing housing insecurity who are seeking assistance versus hidden homeless, which incorporates the different targets of prevention. Dynamics emerge as people transition in and out of stable housing. The model assumes that the average time in homeless assistance is 3.5 years, and housing insecurity represents a transitional state through which most exit within two years, loosely based on definitions of chronic homelessness ( 97 ).

System dynamics model of people receiving homeless assistance and those experiencing housing insecurity and hidden homelessness. Boxes represent accumulations of people, arrows represent transitions in and out of stocks, and clouds represent stable housing.

Computer simulations test a series of policy experiments for solving homelessness. The first experiment tests efforts to improve housing first by decreasing time spent in homeless assistance before exiting to stability. The second experiment expands universal, selective, and indicated prevention by reducing each inflow into homelessness assistance. The third experiment tests combined housing first and prevention strategies. Each experiment improves performance by 50%, and combined interventions do not exceed 50% effects. All analyses were conducted within Stella Architect Version 1.2.1. A web-interface provides access to the model and allows real-time experiments ( https://socialsystemdesignlab.wustl.edu/items/homelessness-and-complex-systems/ ).

4.3. Simulation Results

Initial analyses assessed confidence in the model. Simulations replicate observed trends in persons seeking homeless assistance ( Figure 3 ) and housing insecurity ( Figure 2 ) in the United States between 2007 and 2016. Moreover, exploratory analyses suggest that the model is insensitive to initial values; similar patterns emerge when increasing stocks and reducing transition times ( 100 ). Different indicators of homelessness and insecurity produce similar results, which further suggests that the model captures the population-level dynamics of homelessness.

Figure 7 displays results from policy experiments on trends of homeless assistance and total housing insecurity (seeking assistance plus not seeking assistance). Findings demonstrate support for the complex systems perspective. Optimizing housing first approaches results in incremental reductions in the number of persons in homeless assistance with no impact on the rates of housing insecurity; results suggest that the system is already optimized for reducing homelessness quickly, and it currently strains to keep up with the constant demand for homeless assistance. By reducing the demand for homeless assistance, prevention improvements qualitatively shift the trajectory of housing insecurity, while generating similar incremental improvements in homeless assistance trends as housing first optimization. The same shifts occur when experimenting with smaller improvements in efficiencies; prevention always outperforms housing first adaptations. For instance, a 5% improvement in prevention generates a similar decrease on total need for housing as a 5 0% improvement in housing first adaptations. Thus, prevention represents a leverage point to enhance coordinated responses to homelessness, and tests reveal that universal plus indicated preventions account for the greatest shifts. However, the optimal response to homelessness comes from a multipronged approach that incorporates prevention with housing first, which generates shifts in housing insecurity and homeless assistance. As hypothesized by the complex systems perspective, managing the net flow achieves desired outcomes of moving toward solving homelessness.

Policy experiments showing the impact of housing first and prevention efforts on the number of people in homeless assistance ( a ) and number of hidden homeless ( b ) with services as usual ( dark blue line ); housing first only ( light blue line ); universal, selective, and indicated prevention ( red line ); and housing first plus universal, selective, and indicated prevention ( yellow line ).

Results must be considered in context. Simulations use US national data to build confidence that the model replicates trends; however, the forecasts are not meant as point estimates for planning purposes. Likewise, national data aggregate across communities that may experience different outcomes from coordinated responses. Using local data and different indicators of system performance would improve confidence in the simulation, as well as in the dynamics of homeless assistance. Finally, the simulations fail to provide an oracle; malleability exists in how policy responds and adapts to trends in homelessness that may alter the system dynamics. The models also make no assumptions about the implementation of prevention. Reducing demand by 50% may exceed realistic expectations, and the simulations fail to consider policy resistance generated from current paradigms. Regardless, simulations suggest small improvements in prevention generates qualitative shifts in demand for assistance.

4.4. Implications for Coordinated Responses to Homelessness

Homeless systems across the world are optimizing policies toward solving chronic homelessness. Resource allocation increasingly prioritizes on the basis of vulnerability and moral preference (e.g., households with children, veterans, seniors). However, simulations warn of unintended consequences that arise from constant pressure for stable housing. Systems that focus on the most vulnerable risk ignoring the unseen needs of the many households unable to access timely supports. Effective responses need to manage both the inflows and outflows to produce intended declines in homelessness rates.

A complex systems perspective presents a number of implications for homeless policies and practices. First, prevention represents a necessary component for sustainable reductions in homelessness. Although declines are achievable and have been demonstrated through coordinated efforts ( 67 ), the dynamics of the system challenge population-level reductions in the absence of considerable ongoing investment of resources. Second, the efficiency of prevention questions the fairness of current policies that prioritize on the basis of vulnerability. Not only does accumulating evidence question the reliability of prioritization tools ( 6 , 108 ), but also simulations suggest that withholding prevention potentially harms a large population of individuals who are unable to access useful services. Policies must consider an equitable distribution of both benefits and harms in resource allocation strategies. Third, history warns of resistance to reorienting systems toward prevention ( 17 , 19 , 94 ). A shift requires longer-term investment and introduces delays in observing results, which proves challenging in the presence of human suffering associated with current homelessness, as demonstrated by the well-meaning appeal of prioritization on the basis of vulnerability. Policies, and especially system performance goals, need to create incentives for balancing crisis response with upstream interventions. Fourth, an immediate step toward a prevention framework requires communities to track and actively monitor broader demand for housing assistance beyond entry into homeless services. As communities increasingly move toward a coordinated entry into homeless services, existing policies typically emphasize or require a homelessness determination for access and, thus, fail to connect with the delivery of prevention services. The oversight results in limited information being provided to assess and improve prevention responses; for instance, communities may be unable to track demand for prevention beyond those who receive the limited services available. The lack of success of disorganized resources further undermines investments in prevention. System performance metrics contingent on homelessness reductions must also reward prevention successes. Finally, rights-based housing policies provide the most conducive framework for broad-scale prevention ( 29 , 66 ). Duty to assist legislation enacted in Wales ensures households seeking housing supports receive best effort responses, which include counseling plus short-term housing only if necessary ( 67 , 68 ). Households that still need assistance and those already homeless enter more intensive interventions. Policies structure services to capture demand for and effectiveness of prevention responses in ways that allow for ongoing system improvements.

Homelessness represents a global public health challenge. Coordinated responses leverage flexible networks to deliver a range of services tailored to complex needs. However, current policies that prioritize services on the basis of vulnerability miss opportunities for prevention, thus contributing to overwhelming pressure on the service system. To achieve broad and sustainable reductions in housing insecurity, homelessness prevention must be fully integrated into existing service networks. Prevention-oriented policies that ensure timely responses to housing insecurity extend the housing first philosophy and leverage the considerable capacity of homeless services.

ACKNOWLEDGMENTS

This project was supported by award number 90CA1815 (principal investigator: Fowler) from the Administration for Children and Families–Children’s Bureau. We acknowledge Kenneth Wright and Katie Chew for their research assistance and help with visuals. We are also very grateful for the many consumers and providers of homeless services who greatly informed our thinking.

DISCLOSURE STATEMENT

The authors are not aware of any affiliations, memberships, funding, or financial holdings that might be perceived as affecting the objectivity of this review. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Children’s Bureau.

LITERATURE CITED

5 Essays About Homelessness

Around the world, people experience homelessness. According to a 2005 survey by the United Nations, 1.6 billion people lack adequate housing. The causes vary depending on the place and person. Common reasons include a lack of affordable housing, poverty, a lack of mental health services, and more. Homelessness is rooted in systemic failures that fail to protect those who are most vulnerable. Here are five essays that shine a light on the issue of homelessness:

What Would ‘Housing as a Human Right’ Look Like in California? (2020) – Molly Solomon

For some time, activists and organizations have proclaimed that housing is a human right. This essay explores what that means and that it isn’t a new idea. Housing as a human right was part of federal policy following the Great Depression. In a 1944 speech introducing what he called the “Second Bill of Rights,” President Roosevelt attempted to address poverty and income equality. The right to have a “decent home” was included in his proposals. Article 25 of the Universal Declaration also recognizes housing as a human right. It describes the right to an “adequate standard of living.” Other countries such as France and Scotland include the right to housing in their constitutions. In the US, small local governments have adopted resolutions on housing. How would it work in California?

At KQED, Molly Solomon covers housing affordability. Her stories have aired on NPR’s All Things Considered, Morning Edition, and other places. She’s won three national Edward R. Murrow awards.

“What People Get Wrong When They Try To End Homelessness” – James Abro

In his essay, James Abro explains what led up to six weeks of homelessness and his experiences helping people through social services. Following the death of his mother and eviction, Abro found himself unhoused. He describes himself as “fortunate” and feeling motivated to teach people how social services worked. However, he learned that his experience was somewhat unique. The system is complicated and those involved don’t understand homelessness. Abro believes investing in affordable housing is critical to truly ending homelessness.

James Abro is the founder of Advocate for Economic Fairness and 32 Beach Productions. He works as an advocate for homeless rights locally and nationally. Besides TalkPoverty, he contributes to Rebelle Society and is an active member of the New Jersey Coalition to End Homelessness.

“No Shelter For Some: Street-Sleepers” (2019)

This piece (by an unknown author) introduces the reader to homelessness in urban China. In the past decades, a person wouldn’t see many homeless people. This was because of strict rules on internal migration and government-supplied housing. Now, the rules have changed. People from rural areas can travel more and most urban housing is privatized. People who are homeless – known as “street-sleepers” are more visible. This essay is a good summary of the system (which includes a shift from police management of homelessness to the Ministry of Civil Affairs) and how street-sleepers are treated.

“A Window Onto An American Nightmare” (2020) – Nathan Heller

This essay from the New Yorker focuses on San Francisco’s history with homelessness, the issue’s complexities, and various efforts to address it. It also touches on how the pandemic has affected homelessness. One of the most intriguing parts of this essay is Heller’s description of becoming homeless. He says people “slide” into it, as opposed to plunging. As an example, someone could be staying with friends while looking for a job, but then the friends decide to stop helping. Maybe someone is jumping in and out of Airbnbs, looking for an apartment. Heller’s point is that the line between only needing a place to stay for a night or two and true “homelessness” is very thin.

Nathan Heller joined the New Yorker’s writing staff in 2013. He writes about technology, higher education, the Bay Area, socioeconomics, and more. He’s also a contributing editor at Vogue, a former columnist for Slate, and contributor to other publications.

“Homelessness in Ireland is at crisis point, and the vitriol shown towards homeless people is just as shocking” (2020)#- Megan Nolan

In Ireland, the housing crisis has been a big issue for years. Recently, it’s come to a head in part due to a few high-profile incidents, such as the death of a young woman in emergency accommodation. The number of children experiencing homelessness (around 4,000) has also shone a light on the severity of the issue. In this essay, Megan Nolan explores homelessness in Ireland as well as the contempt that society has for those who are unhoused.

Megan Nolan writes a column for the New Statesman. She also writes essays, criticism, and fiction. She’s from Ireland but based in London.

You may also like

15 Quotes Exposing Injustice in Society

14 Trusted Charities Helping Civilians in Palestine

The Great Migration: History, Causes and Facts

Social Change 101: Meaning, Examples, Learning Opportunities

Rosa Parks: Biography, Quotes, Impact

Top 20 Issues Women Are Facing Today

Top 20 Issues Children Are Facing Today

15 Root Causes of Climate Change

15 Facts about Rosa Parks

Abolitionist Movement: History, Main Ideas, and Activism Today

The Biggest 15 NGOs in the UK

15 Biggest NGOs in Canada

About the author, emmaline soken-huberty.

Emmaline Soken-Huberty is a freelance writer based in Portland, Oregon. She started to become interested in human rights while attending college, eventually getting a concentration in human rights and humanitarianism. LGBTQ+ rights, women’s rights, and climate change are of special concern to her. In her spare time, she can be found reading or enjoying Oregon’s natural beauty with her husband and dog.

The Complex Link Between Homelessness and Mental Health

Many americans are at heightened risk of homelessness due to the pandemic..

Posted May 21, 2021 | Reviewed by Hara Estroff Marano

• An estimated 20 to 25 percent of the U.S. homeless population suffers from severe mental illness, compared to 6 percent of the general public.
• The combination of mental illness, substance abuse, and poor physical health makes it difficult to maintain employment and residential stability.
• Better mental health services would combat not only mental illness but homelessness as well.

This post was written by Lenni Marcus, Cameron Johnson, and Danna Ramirez.

For many Americans, the prospect of losing their homes and falling into uncertain housing situations became excruciatingly prescient during the economic downturn caused by the impact of the coronavirus outbreak. A 2019 study suggested that even at that time, 40 percent of Americans were already one missed paycheck away from poverty.

And though governmental policies have temporarily slowed or halted evictions in many places, many individuals and families are still at risk of homelessness, or have already fallen through the cracks. Few are on a path to financial recovery and the profound aftershocks of this crisis will be felt far beyond the upcoming months and may impact families and their mental health for years to come.

Many homeless people share similar experiences, but a substantial subgroup of the homeless population struggle with severe mental illness as well. Yet the resilience of this group is often understated. Some just need help accessing resources, including mental health services, to reach a stable housing and financial situation. To understand how to better provide resources to break the cycle of homelessness, it is important to understand the many factors that may contribute to their impoverished state.

Homelessness and Mental Health

The idea that mental illness alone causes homelessness is naive and inaccurate, for two major reasons. First, the overwhelming majority of those living with mental illness are not homeless (and studies have failed to demonstrate a causal relationship between the two).

These types of distortions can have dangerous implications, wrongly focusing the attention on the individual rather than on the institutions that perpetuate housing insecurity. As a result, the illusory division between the “mentally ill homeless” and the “non-mentally ill homeless” casts the former as more deserving of intervention and services and the latter as seemingly “unworthy” or “undeserving” of support.

Though there is no causal relationship between mental illness and homelessness, those who suffer from housing insecurity are struggling significantly, both psychologically and emotionally. The constellation of economics, subsistence living, family breakdown, psychological deprivation, and impoverished self-esteem all contribute to the downward cycle of poverty.

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), in 2010, 26.2 percent of all sheltered persons who were homeless had a severe mental illness, and 34.7 percent of all sheltered adults who were homeless had chronic substance use issues. Of those who experience chronic/long-term homelessness, approximately 30 percent have mental health conditions and 50 percent have co-occurring substance use problems. Also, they typically endure traumatic experiences that could potentially lead to mental health struggles, and certain environmental factors may increase the likelihood that they encounter future traumas.

Over 92 percent of mothers who are homeless have experienced severe physical and/or sexual abuse during their lifetime, and about two-thirds of homeless mothers have histories of domestic violence . Mothers who are homeless have three times the rate of PTSD and twice the rate of drug and alcohol dependence of their low-income housed counterparts. Left untreated, these stressors can further damage their mental health, potentially triggering maladaptive coping and putting them at risk for future traumatic events.

Breaking the Cycle of Homelessness

Homelessness is a social problem with complex and multifactorial origins. It underlies economic , social , and biographical risk factors such as poverty, lack of affordable housing, community and family breakdown, childhood adversity, neglect, and lack of social support, to name a few. These factors contribute to the onset, duration, frequency, and type of homelessness amongst individuals of all ages.

About 3 percent of Americans experience at least one episode of homelessness throughout their lives. Many enter an unbreakable cycle of homeless living due to the lack of access to adequate resources.

There are many components involved in the healthy exit of homelessness, with two of the most important being housing and social support . Meaningful and sustainable employment is fundamental to creating and maintaining housing stability. At the same time, individuals experiencing homelessness face many barriers to finding and maintaining employment . Most organizations that provide brief employment interventions assist individuals with only their most immediate employment needs (e.g., resume preparing); frequently these have little or no beneficial effects.

More intensive interventions that include an educational and/or training component are effective for those who participate regularly. Connecting people experiencing homelessness with job training and placement programs provides them with the necessary tools for long-term stability and success.

Access to housing and effective employment programs alone do not address other issues, such as loneliness , social exclusion, or any psychological problems that might have emerged. Promoting social connections as part of the transition out of homelessness plays a major role in improving outcomes.

Social support is a multidimensional concept that is measured by the size of a social network , received social support, and perceived social support. Received and perceived social support can each consist of different components: emotional support (the expression of positive affect and empathetic understanding), financial support (the provision of financial advice or aid), and instrumental support (tangible, material, or behavioral assistance). Therefore, programs providing training in job and life skills should also address how to navigate through social networking and how to maintain healthy social relations.

Breaking the cycle of homelessness requires institutions and policymakers to focus their efforts on multifaceted programs that are as complex as the social problem itself.

About the Authors

Lenni Marcus is a former social worker at the Compass program for young adults at The Menninger Clinic.

Cameron Johnson is a research assistant at The Menninger Clinic . Cameron collects and manages treatment outcomes survey data, which Menninger uses to help track the symptoms of patients.

Danna Ramirez is the Clinical Research Informatics Engineer at The Menninger Clinic . Her research interests include the neurobiology of psychiatric disorders, especially personality disorders and mood disorders

Mind Matters is a collaborative blog written by Menninger staff and an occasional invited guest to increase awareness about mental health. Launched in 2019, Mind Matters is curated and edited by an expert clinical team, which is led by Robyn Dotson Martin, LPC-S. Martin serves as an Outpatient Assessment team leader and staff therapist.

• Find a Therapist
• Find a Treatment Center
• Find a Psychiatrist
• Find a Support Group
• Find Teletherapy
• United States
• Brooklyn, NY
• Chicago, IL
• Houston, TX
• Los Angeles, CA
• New York, NY
• Portland, OR
• San Diego, CA
• San Francisco, CA
• Seattle, WA
• Washington, DC
• Asperger's
• Bipolar Disorder
• Chronic Pain
• Eating Disorders
• Passive Aggression
• Personality
• Goal Setting
• Positive Psychology
• Stopping Smoking
• Low Sexual Desire
• Relationships
• Child Development
• Therapy Center NEW
• Diagnosis Dictionary
• Types of Therapy

Understanding what emotional intelligence looks like and the steps needed to improve it could light a path to a more emotionally adept world.

• Coronavirus Disease 2019
• Affective Forecasting
• Neuroscience

• Open access
• Published: 22 August 2017

Social conditions of becoming homelessness: qualitative analysis of life stories of homeless peoples

• Mzwandile A. Mabhala   ORCID: orcid.org/0000-0003-1350-7065 1 , 3 ,
• Asmait Yohannes 2 &
• Mariska Griffith 1  

International Journal for Equity in Health volume  16 , Article number:  150 ( 2017 ) Cite this article

64k Accesses

49 Citations

23 Altmetric

Metrics details

It is increasingly acknowledged that homelessness is a more complex social and public health phenomenon than the absence of a place to live. This view signifies a paradigm shift, from the definition of homelessness in terms of the absence of permanent accommodation, with its focus on pathways out of homelessness through the acquisition and maintenance of permanent housing, to understanding the social context of homelessness and social interventions to prevent it.

However, despite evidence of the association between homelessness and social factors, there is very little research that examines the wider social context within which homelessness occurs from the perspective of homeless people themselves. This study aims to examine the stories of homeless people to gain understanding of the social conditions under which homelessness occurs, in order to propose a theoretical explanation for it.

Twenty-six semi-structured interviews were conducted with homeless people in three centres for homeless people in Cheshire North West of England.

The analysis revealed that becoming homeless is a process characterised by a progressive waning of resilience capacity to cope with life challenges created by series of adverse incidents in one’s life. The data show that final stage in the process of becoming homeless is complete collapse of relationships with those close to them. Most prominent pattern of behaviours participants often describe as main causes of breakdown of their relationships are:

engaging in maladaptive behavioural lifestyle including taking drugs and/or excessive alcohol drinking

Being in trouble with people in authorities.

Homeless people describe the immediate behavioural causes of homelessness, however, the analysis revealed the social and economic conditions within which homelessness occurred. The participants’ descriptions of the social conditions in which were raised and their references to maladaptive behaviours which led to them becoming homeless, led us to conclude that they believe that their social condition affected their life chances: that these conditions were responsible for their low quality of social connections, poor educational attainment, insecure employment and other reduced life opportunities available to them.

It is increasingly acknowledged that homelessness is a more complex social and public health phenomenon than the absence of a place to live. This view signifies a paradigm shift, from the definition of homelessness in terms of the absence of permanent accommodation [ 1 , 2 , 3 , 4 , 5 ], with its focus on pathways out of homelessness through the acquisition and maintenance of permanent housing [ 6 ], to understanding the social context of homelessness and social interventions to prevent it [ 6 ].

Several studies explain the link between social factors and homelessness [ 6 , 7 , 8 , 9 , 10 ]. The most common social explanations centre on seven distinct domains of deprivation: income; employment; health and disability; education, skills and training; crime; barriers to housing and social support services; and living environment [ 11 ]. Of all forms, income deprivation has been reported as having the highest risk factors associated with homelessness [ 7 , 12 , 13 , 14 ]: studies indicate that people from the most deprived backgrounds are disproportionately represented amongst the homeless [ 7 , 13 ]. This population group experiences clusters of multiple adverse health, economic and social conditions such as alcohol and drug misuse, lack of affordable housing and crime [ 10 , 12 , 15 ]. Studies consistently show an association between risk of homelessness and clusters of poverty, low levels of education, unemployment or poor employment, and lack of social and community support [ 7 , 10 , 13 , 16 ].

Studies in different countries throughout the world have found that while the visible form of homelessness becomes evident when people reach adulthood, a large proportion of homeless people have had extreme social disadvantage and traumatic experiences in childhood including poverty, shortage of social housing stocks, disrupted schooling, lack of social and psychological support, physical, sexual, and emotional abuse, neglect, dysfunctional family environments, and unstable family structures, all of which increase the likelihood of homelessness [ 10 , 13 , 14 ].

Furthermore, a large body of evidence suggests that people exposed to diverse social disadvantages at an early age are less likely to adapt successfully compared to people without such exposure [ 9 , 10 , 13 , 17 ], being more susceptible to adopting maladaptive coping behaviours such as theft, trading sex for money, and selling or using drugs and alcohol [ 7 , 9 , 18 , 19 ]. Studies show that these adverse childhood experiences tend to cluster together, and that the number of adverse experiences may be more predictive of negative adult outcomes than particular categories of events [ 17 , 20 ]. The evidence suggests that some clusters are more predictive of homelessness than others [ 7 , 12 ]: a cluster of childhood problems including mental health and behavioural disorders, poor school performance, a history of foster care, and disrupted family structure was most associated with adult criminal activities, adult substance use, unemployment and subsequent homelessness [ 12 , 17 , 21 ]. However, despite evidence of the association between homelessness and social factors, there is very little research that examines the wider social context within which homelessness occurs from the perspective of homeless people themselves.

This paper adopted Anderson and Christian’s [ 18 ] definition, which sees homelessness as a ‘function of gaining access to adequate, affordable housing, and any necessary social support needed to ensure the success of the tenancy’. Based on our synthesis of the evidence, this paper proposes that homelessness is a progressive process that begins at childhood and manifests itself at adulthood, one characterised by loss of the personal resources essential for successful adaptation. We adopted the definition of personal resources used by DeForge et al. ([ 7 ], p. 223), which is ‘those entities that either are centrally valued in their own right (e.g. self-esteem, close attachment, health and inner peace) or act as a means to obtain centrally valued ends (e.g. money, social support and credit)’. We propose that the new paradigm focusing on social explanations of homelessness has the potential to inform social interventions to reduce it.

In this study, we examine the stories of homeless people to gain understanding of the conditions under which homelessness occurs, in order to propose a theoretical explanation for it.

The design of this study was philosophically influenced by constructivist grounded theory (CGT). The aspect of CGT that made it appropriate for this study is its fundamental ontological belief in multiple realities constructed through the experience and understanding of different participants’ perspectives, and generated from their different demographic, social, cultural and political backgrounds [ 22 ]. The researchers’ resulting theoretical explanation constitutes their interpretation of the meanings that participants ascribe to their own situations and actions in their contexts [ 22 ].

The stages of data collection and analysis drew heavily on other variants of grounded theory, including those of Glaser [ 23 ] and Corbin and Strauss [ 24 ].

Setting and sampling strategy

The settings for this study were three centres for homeless people in two cities (Chester and Crewe) in Cheshire, UK. Two sampling strategies were used in this study: purposive and theoretical. The study started with purposive sampling and in-depth one-to-one semi-structured interviews with eight homeless people to generate themes for further exploration.

One of the main considerations for the recruitment strategy was to ensure that the process complies with the ethical principles of voluntary participation and equal opportunity to participate. To achieve this, an email was sent to all the known homeless centres in the Cheshire and Merseyside region, inviting them to participate. Three centres agreed to participate, all of them in Cheshire – two in Chester and one in Crewe.

Chester is the most affluent city in Cheshire and Merseyside, and therefore might not be expected to be considered for a homelessness project. The reasons for including it were: first, it was a natural choice, since the organisations that funded the project and the one that led the research project were based in Chester; second, despite its affluence, there is visible evidence of homelessness in the streets of Chester; and third, it has several local authority and charity-funded facilities for homeless people.

The principal investigator spent 1 day a week for 2 months in three participating centres, during that time oral presentation of study was given to all users of the centre and invited all the participants to participate and written participants information sheet was provided to those who wished to participate. During that time the principal investigator learned that the majority of homeless people that we were working with in Chester were not local. They told us that they came to Chester because there was no provision for homeless people in their former towns.

To help potential participants make a self-assessment of their suitability to participate without unfairly depriving others of the opportunity, participants information sheet outline criteria that potential participants had to meet: consistent with Economic and Social Research Council’s Research Ethics Guidebook [ 25 ], at the time of consenting to and commencing the interview, the participant must appear to be under no influence of alcohol or drugs, have a capacity to consent as stipulated in England and Wales Mental Capacity Act 2005 [ 26 ], be able to speak English, and be free from physical pain or discomfort.

As categories emerged from the data analysis, theoretical sampling was used to refine undeveloped categories in accordance with Strauss and Corbin’s [ 27 ] recommendations. In total 26 semi-structured interviews were carried out. Theoretical sampling involved review of memos or raw data, looking for data that might have been overlooked [ 27 , 28 ], and returning to key participants asking them to give more information on categories that seemed central to the emerging theory [ 27 , 28 ].

The sample comprised of 22 male and 4 female, the youndgest participant was 18 the eldest was 74 years, the mean age was 38.6 years. Table 1 illustrates participant’s education history, childhood living arrangements, brief participants family and social history, emotional and physical health, the onset of and trigger for homelessness.

Ethical approval

Ethical approval was obtained from the Research Ethics Committee of the University of Chester. The centre managers granted access once ethical approval had been obtained, and after their review of the study design and other research material, and of the participant information sheet which included a letter of invitation highlighting that participation was voluntary.

Data analysis

In this study data collection and analysis occurred simultaneously. Analysis drew on Glaser’s [ 23 ] grounded theory processes of open coding, use of the constant comparative method, and the iterative process of data collection and data analysis to develop theoretical explanation of homelessness.

The process began by reading the text line-by-line identifying and open coding the significant incidents in the data that required further investigation. The findings from the initial stage of analysis are published in Mabhala [ 29 ]. The the second stage the data were organised into three themes that were considered significant in becoming homeless (see Fig. 1 ):

Engaging in maladaptive behaviour

Being in trouble with the authorities.

Being in abusive environments.

Social explanation of becoming homeless. Legend: Fig. 1 illustrates the process of becoming homeless

The key questions that we asked as we continued to interrogate the data were: What category does this incident indicate? What is actually happening in the data? What is the main concern being faced by the participants? Interrogation of the data revealed that participants were describing the process of becoming homeless.

The comparative analysis involved three processes described by Glaser ([ 23 ], p. 58–60): each incident in the data was compared with incidents from both the same participant and other participants, looking for similarities and differences. Significant incidents were coded or given labels that represented what they stood for, and similarly coded or labeled when they were judged to be about the same topic, theme or concept.

After a period of interrogation of the data, it was decided that the two categories - destabilising behaviour, and waning ofcapacity for resilience were sufficiently conceptual to be used as theoretical categories around which subcategories could be grouped (Fig. 1 ).

Once the major categories had been developed, the next step consisted of a combination of theoretical comparison and theoretical sampling. The emerging categories were theoretically compared with the existing literature. Once this was achieved, the next step was filling in and refining the poorly defined categories. The process continued until theoretical sufficiency was achieved.

Figure 1 illustrates the process of becoming homeless. The analysis revealed that becoming homeless is a process characterised by a progressive waning of resilience created by a series of adverse incidents in one’s life. Amongst the frequently cited incidents were being in an abusive environment and losing a significant person in one’s life. However, being in an abusive environment emerged from this and previously published studies as a major theme; therefore, we decided to analyse it in more detail.

The data further show that the final stage in the process of becoming homeless is a complete collapse of relationships with those with whom they live. The most prominent behaviours described by the participants as being a main cause of breakdown are:

Engaging in maladaptive behaviour: substance misuse, alcoholism, self-harm and disruptive behaviours

Being in trouble with the authorities: theft, burglary, arson, criminal offenses and convictions

The interrogation of data in relation to the conditions within which these behaviours occurred revealed that participants believed that their social contexts influenced their life chance, their engagement with social institution such as education and social services and in turn their ability to acquire and maintain home. Our experiences have also shown that homeless people readily express the view that behavioural lifestyle factors such as substance misuse and engaging in criminal activities are the causes of becoming homeless. However, when we spent time talking about their lives within the context of their status as homeless people, we began to uncover incidents in their lives that appeared to have weakened their capacity to constructively engage in relationships, engage with social institutions to make use of social goods [ 29 , 30 , 31 ] and maturely deal with societal demands.

Being in abusive environments

Several participants explicitly stated that their childhood experiences and damage that occurred to them as children had major influences on their ability to negotiate their way through the education system, gain and sustain employment, make appropriate choices of social networks, and form and maintain healthy relationships as adults.

It appears that childhood experiences remain resonant in the minds of homeless participants, who perceive that these have had bearing on their homelessness. Their influence is best articulated in the extracts below. When participants were asked to tell their stories of what led to them becoming homeless, some of their opening lines were:

What basically happened, is that I had a childhood of so much persistent, consistent abuse from my mother and what was my stepfather. Literally consistent, we went around with my mother one Sunday where a friend had asked us to stay for dinner and mother took the invitation up because it saved her from getting off her ass basically and do anything. I came away from that dinner genuinely believing that the children in that house weren’t loved and cared for, because they were not being hit, there was no shouting, no door slamming. [Marco]

It appears that Marco internalised the incidents of abuse, characterised by shouting, door slamming and beating as normal behaviour. He goes on to intimate how the internalised abusive behaviour affected his interaction with his employers.

‘…but consistently being put down, consistently being told I was thick, I started taking jobs and having employers effing and blinding at me. One employer actually used a “c” word ending in “t” at me quite frequently and I thought it was acceptable, which obviously now I know it’s not. So I am taking on one job after another that, how can I put it? That no one else would do basically. I was so desperate to work and earn my own money. [Marco]

Similarly, David makes a connection between his childhood experience and his homelessness. When he was asked to tell his life story leading to becoming homeless, his opening line was:

I think it [homelessness] started off when I was a child. I was neglected by my mum. I was physically and mentally abused by my mum. I got put into foster care, when I left foster care I was put in the hostel, from there I turn into alcoholic. Then I was homeless all the time because I got kicked out of the hostels, because you are not allowed to drink in the hostel. [David]

David and Marco’s experiences are similar to those of many participants. The youngest participant in this study, Clarke, had fresh memories of his abusive environment under his stepdad:

I wouldn't want to go back home if I had a choice to, because before I got kicked out me stepdad was like hitting me. I wouldn't want to go back to put up with that again. [I didn't tell anyone] because I was scared of telling someone and that someone telling me stepdad that I've told other people. ‘[Be] cause he might have just started doing again because I told people. It might have gotten him into trouble. [Clarke]

In some cases, participants expressed the beliefs that their abusive experience not only deprived them life opportunities but also opportunities to have families of their own. As Tom and Marie explain:

We were getting done for child neglect because one of our child has a disorder that means she bruise very easily. They all our four kids into care, social workers said because we had a bad childhood ourselves because I was abused by my father as well, they felt that we will fail our children because we were failed by our parents. We weren’t given any chance [Tom and Marie]

Norma, described the removal of her child to care and her maladaptive behaviour of excessive alcohol use in the same context as her experience of sexual abuse by her father.

I had two little boys with me and got took off from me and put into care. I got sexually abused by my father when I was six. So we were put into care. He abused me when I was five and raped me when I was six. Then we went into care all of us I have four brothers and four sisters. My dad did eighteen months for sexually abusing me and my sister. I thought it was normal as well I thought that is what dads do [Norma]

The analysis of participants in this study appears to suggest that social condition one is raised influence the choice of social connections and life partner. Some participants who have had experience of abuse as children had partner who had similar experience as children Tom and Marie, Lee, David and his partners all had partners who experienced child abuse as children.

Tom and Marie is a couple we interviewed together. They met in hostel for homeless people they have got four children. All four children have been removed from them and placed into care. They sleep rough along the canal. They explained:

We have been together for seven years we had a house and children social services removed children from us, we fell within bedroom tax. …we received an eviction order …on the 26th and the eviction date was the 27th while we were in family court fighting for our children. …because of my mental health …they were refusing to help us.

Our children have been adopted now. The adoption was done without our permission we didn’t agree to it because we wanted our children home because we felt we were unfairly treated and I [Marie] was left out in all this and they pin it all on you [Tom] didn’t they yeah, my [Tom] history that I was in care didn’t help.

Tom went on to talk about the condition under which he was raised:

I was abandoned by my mother when I was 12 I was then put into care; I was placed with my dad when I was 13 who physically abused me then sent back to care. [Tom].

David’s story provides another example of how social condition one is raised influence the choice of social connections and life partner. David has two children from two different women, both women grew up in care. Lisa one of David’s child mother is a second generation of children in care, her mother was raised in care too.

I drink to deal with problems. As I say I’ve got two kids with my girlfriend Kyleigh, but I got another lad with Lisa, he was taken off me by social services and put on for adoption ten years ago and that really what started it; to deal with that. Basically, because I was young, and I had been in care and the way I had been treated by my mum. Basically laid on me in the same score as my mum and because his mum [Lisa] was in care as well. So they treated us like that, which was just wrong. [David]

In this study, most participants identified alcohol or drugs and crime as the cause of relationships breakdown. However, the language they used indicates that these were secondary reasons rather than primary reasons for their homelessness. The typical question that MA and MG asked the interview participants was “tell us how did you become homeless”? Typically, participants cited different maladaptive behaviours to explain how they became homeless.

Alvin’s story is typical of:

Basically I started off as a bricklayer, … when the recession hit, there was an abundance of bricklayers so the prices went down in the bricklaying so basically with me having two young children and the only breadwinner in the family... so I had to kinda look for factory work and so I managed to get a job… somewhere else…. It was shift work like four 12 hour days, four 12 hour nights and six [days] off and stuff like that, you know, real hard shifts. My shift was starting Friday night and I’ll do Friday night, Saturday night to Monday night and then I was off Tuesday, Wednesday and Thursday, but I’d treat that like me weekend you know because I’ve worked all weekend. Then… so I’d have a drink then and stuff like that, you know. 7 o’ clock on a Monday morning not really the time to be drinking, but I used to treat it like me weekend. So we argued, me and my ex-missus [wife], a little bit and in the end we split up so moved back to me mum's, but kept on with me job, I was at me mum’s for possibly about five years and but gradually the drinking got worse and worse, really bad. I was diagnosed with depression and anxiety. … I used to drink to get rid of the anxiety and also to numb the pain of the breakup of me marriage really, you know it wasn’t good, you know. One thing led to another and I just couldn’t stop me alcohol. I mean I’ve done drugs you know, I was into the rave scene and I’ve never done hard drugs like heroin or... I smoke cannabis and I use cocaine, and I used to go for a pint with me mates and that. It all came to a head about November/December time, you know it was like I either stop drinking or I had to move out of me mum's. I lost me job in the January through being over the limit in work from the night before uum so one thing led to another and I just had to leave. [Alvin]

Similarly, Gary identified alcohol as the main cause of his relationship breakdown. However, when one listens to the full story alcohol appears to be a manifestation of other issues, including financial insecurities and insecure attachment etc.

It [the process of becoming homeless] mainly started with the breakdown of the relationship with me partner. I was with her for 15 years and we always had somewhere to live but we didn't have kids till about 13 years into the relationship. The last two years when the kids come along, I had an injury to me ankle which stopped me from working. I was at home all day everyday. …I was drinking because I was bored. I started drinking a lot ‘cause I couldn't move bout the house. It was a really bad injury I had to me ankle. Um, and one day me and me partner were having this argument and I turned round and saw my little boy just stood there stiff as a board just staring, looking at us. And from that day on I just said to me partner that I'll move out, ‘cause I didn't want me little boy to be seeing this all the time. [Gary]

In both cases Gary and Alvin indicate that changes in their employment status created conditions that promoted alcohol dependency, though both explained that they drank alcohol before the changes in their employment status occurred and the breakdown of relationships. Both intimated that that their job commitment limited the amount of time available to drink alcohol. As Gary explained, it is the frequency and amount of alcohol drinking that changed as a result of change in their employment status:

I used to have a bit of a drink, but it wasn’t a problem because I used to get up in the morning and go out to work and enjoy a couple of beers every evening after a day’s work. Um, but then when I wasn't working I was drinking, and it just snowballed out, you know snowball effect, having four cans every evening and then it went from there. I was drinking more ‘cause I was depressed. I was very active before and then I became like non-active, not being able to do anything and in a lot of pain as well. [Gary]

Furthermore, although the participants claim that drinking alcohol was not a problem until their employment circumstances changed, one gets a sense that alcohol was partly responsible for creating conditions that resulted in the loss of their jobs. In Gary’s case, for example, alcohol increased his vulnerability to the assault and injuries that cost him his job:

I got assaulted, kicked down a flight of stairs. I landed on me back on the bottom of the stairs, but me heel hit the stairs as it was still going up if you know what I mean. Smashed me heel, fractured me heel… So, by the time I got to the hospital and they x-rayed it they wasn't even able to operate ‘cause it was in that many pieces, they weren't even able to pin it if you know what I mean. [Gary]

Alvin, of the other hand, explained that:

I lost my job in the January through being over the limit in work from the night before, uum so one thing led to another and I just had to leave. [Alvin]

In all cases participants appear to construct marriage breakdown as an exacerbating factor for their alcohol dependence. Danny, for example, constructed marriage breakdown as a condition that created his alcohol dependence and alcohol dependence as a cause of breakdown of his relationship with his parents. He explains:

I left school when I was 16. Straight away I got married, had children. I have three children and marriage was fine. Umm, I was married for 17 years. As the marriage broke up I turned to alcohol and it really, really got out of control. I moved in with my parents... It was unfair for them to put up with me; you know um in which I became... I ended up on the streets, this was about when I was 30, 31, something like that and ever since it's just been a real struggle to get some permanent accommodation. [Danny]

Danny goes on to explain:

Yes [I drank alcohol before marriage broke down but] not very heavily, just like a sociable drink after work. I'd call into like the local pub and have a few pints and it was controlled. My drinking habit was controlled then. I did go back to my parents after my marriage break up, yes. I was drinking quite heavily then. I suppose it was a form of release, you know, in terms of the alcohol which I wish I'd never had now. When I did start drinking heavy at me parents’ house, I was getting in trouble with the police being drunk and disorderly. That was unfair on them. [Danny]

The data in this study indicate that homelessness occurs when the relationships collapse, irrespective of the nature of the relationship. There were several cases where lifestyle behaviour led to a relationship collapse between child and parents or legal guardians.

In the next excerpt, Emily outlines the incidents: smoking weed, doing crack and heroin, and drinking alcohol. She also uses the words ‘because’, ‘when’ and ‘obviously’, which provide clues about the precipitating condition for her behaviours “spending long time with people who take drugs”.

I've got ADHD like, so obviously my mum kicked me out when I was 17 and then like I went to **Beswick** and stuff like that. My mum in the end just let me do what I wanted to do, ‘cause she couldn't cope anymore. …I mean I tried to run away from home before that, but she'd always like come after me in like her nightie and pyjamas and all that. But in the end she just washed her hands of me . [Emily]

Emily presented a complex factors that made it difficult for her mother to live with her. These included her mother struggle with raising four kids as a single parent, Emily’s mental health (ADHD], alcohol and drug use. She goes on to explain that:

Ummm, well the reason I got kicked out of my hostel was ‘cause of me drinking, so I'd get notice to quit every month, then I’d have a meeting with the main boss and then they'd overturn it and this went on every month for about six months. Also, it was me behaviour as well, but obviously drink makes you do stuff you don't normally do and all that shit. I lived here for six months, got kicked out because I jumped out the window and broke me foot. I was on the streets for six months and then they gave me a second chance and I've been here a year now. So that's it basically. [Emily]

There were several stories of being evicted from accommodation due to excessive use of alcohol. One of those is David:

I got put into foster care. When I left foster care I was put in the hostel, from there I turn into alcoholic. Then I was homeless all the time because I got kicked out of the hostels, because you are not allowed to drink in the hostel. It’s been going on now for about… I was thirty-one on Wednesday, so it’s been going on for about thirteen years, homeless on and off. Otherwise if not having shoplifted for food and then go to jail, and when I don’t drink I have lot of seizures and I end up in the hospital. Every time I end up on the street. I trained as a chef, I have not qualified yet, because of alcohol addiction, it didn’t go very well. I did couple of jobs in restaurants and diners, I got caught taking a drink. [David]

Contrary to the other incidents where alcohol was a factor that led to homelessness, Barry’s description of his story appears to suggest that the reason he had to leave his parents’ home was his parents’ perception that his sexuality brought shame to the family:

When I came out they I’m gay, my mum and dad said you can’t live here anymore. I lived in a wonderful place called Nordic... but fortunately, mum and dad ran a pub called […] [and] one of the next door neighbours lived in a mansion. His name was [….] [and] when I came out, he came out as in he said “I'm a gay guy”, but he took me into Liverpool and housed me because I had nowhere to live. My mum and dad said you can't live here anymore. And unfortunately, we get to the present day. I got attacked. I got mugged... only walked away with a £5 note, it’s all they could get off me. They nearly kicked me to death so I was in hospital for three weeks. By the time I came out, I got evicted from my flat. I was made homeless. [Barry]

We used the phrase “engaging in maladaptive behaviour” to conceptualise the behaviours that led to the loss of accommodation because our analysis appear to suggest that these behaviours were strategies to cope with the conditions they found themselves in. For example, all participants in this category explained that they drank alcohol to cope with multiple health (mental health) and social challenges.

In the UK adulthood homelessness is more visible than childhood homelessness. However, most participants in this research reveal that the process of becoming homeless begins at their childhood, but becomes visible after the legal age of consent (16). Participants described long history of trouble with people in authority including parents, legal guardians and teachers. However, at the age of 16 they gain legal powers to leave children homes, foster homes, parental homes and schools, and move outside some of the childhood legal protections. Their act of defiance becomes subject to interdiction by the criminal justice system. This is reflected in number of convictions for criminal offenses some of the participants in this study had.

Participants Ruddle, David, Lee, Emily, Pat, Marco, Henry and many other participants in this study (see Table 1 ) clearly traced the beginning of their troubles with authority back at school. They all expressed the belief that had their schooling experience been more supportive, their lives would have been different. Lee explains that being in trouble with the authorities began while he was at school:

‘The school I came from a rough school, it was a main school, it consisted of A, B, C, D and The school I came from [was] a rough school, it was a main school, it consisted of A, B, C, D and E. I was in the lowest set, I was in E because of my English and maths. I was not interested, I was more interested in going outside with big lads smoking weed, bunking school. I used to bunk school inside school. I used to bunk where all cameras can catch me. They caught me and reported me back to my parents. My mum had a phone call from school asking where your son is. My mum grounded me. While my mum grounded me I had a drain pipe outside my house, I climbed down the drain pipe outside my bedroom window. I used to climb back inside. [Lee]

Lee’s stories constructed his poor education experiences as a prime mover towards the process of becoming homeless. It could be noted in Table 1 that most participants who described poor education experiences came from institutions such as foster care, children home and special school for maladjusted children. These participants made a clear connection between their experiences of poor education characterised by defiance of authorities and poor life outcomes as manifested through homelessness.

Patrick made a distinct link between his school experience and his homelessness, for example, when asked to tell his story leading up to becoming homeless, Patrick’s response was:

I did not go to school because I kept on bunking. When I was fifteen I left school because I was caught robbing. The police took me home and my mum told me you’re not going back to school again, you are now off for good. Because if you go back to school you keep on thieving, she said I keep away from them lads. I said fair enough. When I was seventeen I got run over by a car. [Patrick]

Henry traces the beginning of his troubles with authorities back at school:

[My schooling experience]… was good, I got good, well average grades, until I got myself into [a] few fights mainly for self-defence. In primary schools, I had a pretty... I had a good report card. In the start of high school, it was good and then when the fights started that gave me sort of like a... bad reputation. I remember my principal one time made me cry. Actually made me cry, but eh... I don't know how, but I remember sitting there in the office and I was crying. My sister also stuck up for me when she found out what had happened, she was on my side; but I can’t remember exactly what happened at that time. [Henry]

Emily’s story provides some clues about the series of incidents - including, delay in diagnosing her health condition, being labelled as a naughty child at school, being regularly suspended from school and consequently poor educational attainment.

Obviously, I wasn't diagnosed with ADHD till I was like 13, so like in school they used to say that's just a naughty child. … So it was like always getting suspended, excluded and all that sort of stuff. And in the end [I] went to college and the same happened there. [Emily]

The excerpt above provides intimations of what she considers to be the underlying cause of her behaviour towards the authorities. Emily suggests that had the authorities taken appropriate intervention to address her condition, her life outcomes would have been different.

Although the next participant did not construct school as being a prime mover of their trouble with authorities, their serious encounters with the criminal justice system occurred shortly after leaving school:

Well I did a bit of time at a very early age, I was only 16… I did some remand there, but then when I went to court ‘cause I'd done enough remand, I got let out and went to YMCA in Runcorn. Well, that was when I was a kid. When I was a bit older, ‘cause it was the years 2000 that I was in jail, I was just trying to get by really. I wasn’t with Karen at the time. I was living in Crewe and at the time I was taking a lot of amphetamines and was selling amphetamines as well, and I got caught and got a custodial sentence for it. But I've never been back to jail since. I came out in the year 2000 so it's like 16 years I've kept meself away from jail and I don't have any intentions of going back. [Gary]

The move from school and children social care system to criminal justice was a common pathways for many participants in this study. Some including Lee, Crewe, David, Patrick spent multiple prison sentences (see Table 1 ). Although Crewe did not make connection between his schooling experiences and his trouble with law, it could be noted that his serious encounter with criminal justice system started shortly after leaving foster care and schooling systems. As he explains:

I was put into prison at age of 17 for arson that was a cry for help to get away from the family, I came out after nine months. I have been in prison four times in my life, its not very nice, when I came out I made a promise to myself that I’m never going to go back to prison again. [Crewe]

Lee recalls his education experience. He explained:

I left school when I was fifteen… then I went off the rails. I got kidnapped for three and half months. When I came back I was just more interested in crime. When I left school I was supposed to go to college, but I went with travellers. I was just more interested in getting arrested every weekend, until my mum say right I have enough of you. I was only seventeen. I went through the hostels when I was seventeen. [Lee]

None describe the educational experience with a similar profundity to Marco:

On few occasions I came out on the corridors I would be getting battered on to my hands and knees and teachers walk pass me. There was quite often blood on the floor from my nose, would be punched on my face and be thrown on the floor. …. It was hard school, pernicious. I would go as far as saying I never felt welcome in that school, I felt like a fish out of the water, being persistently bullied did my head in. Eventually I started striking back, when I started striking back suddenly I was a bad one. My mother decided to put me in … school for maladjusted boys, everyone who been there including myself have spent time in prison. [Marco]

The trouble with authorities that was observes in participants stories in this category appear to be part of the wider adverse social challenges that the participants in this study were facing. Crewe’s description of arson as a cry for help appears to be an appropriate summation of all participants in this category.

The participants’ description of the social conditions in which were raised and their references to maladaptive behaviours which led to them becoming homeless, led us to conclude that they believe that their social condition affected their life chances: that these conditions were responsible for their low quality of social connections, poor educational attainment, insecure employment and other reduced life opportunities available to them.

The key feature that distinguish this study from comparable previous studies is that it openly acknowledges that data collection and analysis were influenced by the principles of social justice [ 28 , 30 , 31 ]. The resulting theoretical explanation therefore constitutes our interpretation of the meanings that participants ascribe to their own situations and actions in their contexts. In this study, defining homelessness within the wider socioeconomic context seemed to fit the data, and offered one interpretation of the process of becoming homeless.

While the participants’ experiences leading to becoming homeless may sound trite. What is pertinent in this study is understanding the conditions within which their behaviours occurred. The data were examined through the lens of social justice and socio-economic inequalities: we analysed the social context within which these behaviours occurred. We listened to accounts of their schooling experiences, how they were raised and their social network. The intention was not to propose a cause-and-effect association, but to suggest that interventions to mitigate homelessness should consider the social conditions within which it occurred.

Participants in this study identified substance misuse and alcohol dependency as a main cause of their homelessness. These findings are consistent with several epidemiological studies that reported a prevalence of substance misuse amongst the homeless people [ 32 , 33 , 34 , 35 , 36 ]. However, most these studies are epidemiological; and by nature epidemiological studies are the ‘gold standard’ in determining causes and effects, but do not always examine the context within which the cause and effect occur. One qualitative study that explored homelessness was a Canadian study by Watson, Crawley and Cane [ 37 ]. Participants in the Watson, et al. described ‘lack of quality social interactions and pain of addition. However, Watson et al. focus on the experiences of being homeless, rather than the life experiences leading to becoming homeless. To our knowledge the current study is one of very few that specifically examine the conditions within which homelessness occurs, looking beyond the behavioural factors. Based on the synthesis of data from previous studies, it makes sense that many interventions to mitigate homelessness focus more on tackling behavioural causes of homelessness rather than fundamental determinants of it [ 38 ]. From the public health intervention’ point of view, however, understanding the conditions within which homelessness occurs is essential, as it will encourage policymakers and providers of the services for homelessness people to devote equal attention to tackling the fundamental determinants of homelessness as is granted in dealing behavioural causes.

Participants in this study reported that they have been defiant toward people in positions of authority. For most of them this trouble began when they were at school, and came to the attention of the criminal justice system as soon as they left school at the age of 16. These findings are similar to these in the survey conducted by Williams, Poyser, and Hopkins [ 39 ] which was commissioned by the UK Ministry of Justice. This survey found that 15 % of prisoners in the sample reported being homeless before custody [ 39 ]; while three and a half percent of the general population reported having ever been homeless [ 39 ]. As the current study reveals there are three possible explanations for the increased population of homeless young people in the criminal justice system: first, at the age of 16 they gain legal powers to leave their foster homes, parents homes, and schools and move beyond some of the childhood legal protections; second, prior to the age of 16 their defiant behaviours were controlled and contained by schools and parents/legal guardians; and third, after the age of 16 their acts of defiant behaviour become subject to interdiction by the criminal justice system.

The conditions in which they were born and raised were described by some participants in this study as ‘chaotic’, abusive’, ‘neglect’, ‘pernicious’ ‘familial instability’, ‘foster care’, ‘care home’, etc. Taking these conditions, and the fact that all but one participants in this left school at or before the age of 16 signifies the importance of living conditions in educational achievement. It has been reported in previous studies that children growing up in such conditions struggle to adjust in school and present with behavioural problems, and thus, poor academic performance [ 40 ]. It has also been reported that despite these families often being known to social services, criminal justice systems and education providers, the interventions in place do little to prevent homelessness [ 40 ].

Analysis of the conditions within which participants’ homelessness occurred reveals the adverse social conditions within which they were born and raised. The conditions they described included being in an abusive environment, poor education, poor employment or unemployment, poor social connections and low social cohesion. These conditions are consistent with high index of poverty [ 37 , 41 , 42 ]. And several other studies found similar associations between poverty and homelessness [ 42 ]. For example, the study by Watson, Crowley et al. [ 37 ] found that there were extreme levels of poverty and social exclusion amongst homeless people. Contrary to previous studies that appear to construct homelessness as a major form of social exclusion, the analysis of participants’ stories in this current study revealed that the conditions they were raised under limited their capacity to engage in meaningful social interactions, thus creating social exclusion.

Homeless people describe the immediate behavioural causes of homelessness; however, this analysis revealed the social and economic conditions within which homelessness occurred. The participants’ descriptions of the social conditions in which were raised and their references to maladaptive behaviours which led to them becoming homeless, led us to conclude that they believe that their social condition affected their life chances: that these conditions were responsible for their low quality of social connections, poor educational attainment, insecure employment and other reduced life opportunities available to them.

Limitations

The conclusions drawn relate only to the social and economic context of the participants in this study, and therefore may not be generalised to the wider population; nor can they be immediately applied in a different context. It has to be acknowledged that the method of recruitment of the 26 participants generates a bias in favour of those willing to talk. The methodology used in this study (constructivist grounded theory) advocates mutual construction of knowledge, which means that the researchers’ understanding and interpretations may have had some influence on the research process as the researchers are an integral part of the data collection and analysis

Department for Communities and Local Government. Statutory homelessness: October to December quarter 2015, in 26 homelessness statistical release 2016. London: Stationery Office; 2015.

Google Scholar  

HM Government. Homelessness act 2002. London: UK Government; 2002.

HM Government. Homelessness reduction act 2017. London: UK government; 2017.

MH Government. Housing (Homeless Persons) act 1977. London: UK Government; 1977.

Department for Communities and Local Government. Statutory homelessness: October to December quarter 2015, in 26 homelessness statistical release 2016. London: Stationery Office; 2016.

Christian J, Abrams D, Clapham D, Nayyar D, Cotler J. Intentions to move from homelessness to social inclusion: the role of participation beliefs, attitudes and prior behaviour. Soc Incl. 2016;4643(4):16–27.

Article   Google Scholar  

Deforge BR, Belcher J, O’rourke M, Lindsey MA. Personal resources and homelessness in early life: predictors of depression in consumers of homeless multiservice centres. J Loss Trauma. 2008;13:222–42.

Barman-Adhikari A, Petering R, Lengnick-Hall R, Rice E, Rhoades H, McCune S. Social context of service use among homeless youth in Los Angeles, California. J Soc Serv Res. 2016;42(4):501–15.

Barman-Adhikari A, Bowen E, Bender K, Brown S, Rice E. A social capital approach to identifying correlates of perceived social support among homeless youth. Child Youth Care Forum. 2016;45(5):691–708.

Keane CA, Magee CA, Kelly PJ. Is there a complex trauma experience typology for Australians experiencing extreme social disadvantage and low housing stability? Child Abuse Negl. 2016;61:43–54.

Article   PubMed   Google Scholar  

Department for Communities and Local Government. The English indices of deprivation 2015. London: Stationery Office; 2016.

Patterson ML, Moniruzzaman A, Somers JM. History of foster care among homeless adults with mental illness in Vancouver, British Columbia: a precursor to trajectories of risk. BMC Psychiatry. 2015;15(1):32.

Article   PubMed   PubMed Central   Google Scholar  

Fry C, Langley K, Shelton K. A systematic review of cognitive functioning among young people who have experienced homelessness, foster care and of poverty. Child Neuropsychol. 2016; doi.10.1080/09297049.2016.1207758 .

Reeve K. Welfare conditionality, benefit sanctions and homelessness in the UK: ending the ‘something for nothing culture’ or punishing the poor? J Poverty Soc Justice. 2017;25(1):65–78.

Somers J, Patterson M, Moniruzzaman A, Currie L, Rezansoff S, Palepu A. Vancouver at home: pragmatic randomized trials investigating housing first for homeless and mentally ill adults. Trials. 2013. doi: 10.1186/1745-6215-14-365 .

Watson J, Crawley J, Kane D. Social exclusion, health and hidden homelessness. Public Health. 2016;139:96–102.

Article   CAS   PubMed   Google Scholar  

Roos LE, Distasio J, Bolton S-L, Katz LY, Afifi TO, Isaak C, Goering P, Bruce L, Sareen J. A history in-care predicts unique characteristics in a homeless population with mental illness. Child Abuse Negl. 2014;38(10):1618–27.

Anderson I, Christian J. Causes of homelessness in the UK: a dynamic analysis. J Community Appl Soc Psychol. 2003;13:105–18.

Anderson I. Synthesizing homelessness research: trends, lessons and prospects. J Community Appl Soc Psychol. 2003;13:197–205.

Tsai J, Edens EL, Rosenheck RA. A typology of childhood problems among chronically homeless adults and its association with housing and clinical outcomes. J Health Care Poor Underserved. 2011;22(3):853–70.

Haskett ME, Armstrong MJ, Tinsdale J. Developmental status and social-emotional functioning of young children experiencing homelessness. Early Childhood Educ J. 2016;44:119–25.

Charmaz K. Constructing grounded theory: a practical guide through qualitative analysis. London: SAGE Publications; 2006.

Glaser BG. Remodelling grounded theory. Hist Soc Res. 2007;Supplement 19:47–68.

Corbin J, Strauss A. Basics of qualitative research: techniques and procedures for developing grounded theory. Los Angeles: Sage Publications; 2008.

Book   Google Scholar  

Economic and Social Research Council: The research ethics guidebook a resource for social scientists. 2017. http://www.ethicsguidebook.ac.uk/ . Accessed 6 June 2017.

HM Government: Mental capacity act 2005.2005. http://www.legislation.gov.uk/ukpga/2005/9/pdfs/ukpga_20050009_en.pdf . Accessed 5 June 2017.

Strauss A, Corbin J. Basics of qualitative research: techniques and procedures for developing grounded theory. 2nd ed. London: Sage Publication; 1998.

Mabhala M. Public health nurse educators’ conceptualisation of public health as a strategy to reduce health inequalities: a qualitative study. Int J Equity Health. 2015;14:14.

Mabhala MA, Massey A, Ellahi B, Kingston P. Understanding the determinants of homelessness through examining the life stories of homeless people and those who work with them: a qualitative research protocol. Diversity Equality Health Care. 2016;13(4):284–9.

Mabhala M. Social justice and global perspectives on health improvement in health improvement and wellbeing strategies and actions. Maidenhead: McGrow Hill and Open University Press; 2014.

Mabhala MA. Health inequalities as a foundation for embodying knowledge within public health teaching: a qualitative study. Int J Equity Health. 2013;12:46.

North CS, Eyrich-Garg KM, Pollio DE, Thirthalli J. A prospective study of substance use and housing stability in a homeless population. Soc Psychiatric Epidemiol. 2010;45:1055–62.

Kushel M, Vittinghoff E, Haas J. Factors associated with the health care utilization of homeless persons. J Am Med Assoc. 2001;285:200–6.

Article   CAS   Google Scholar  

Orwin RG, Scott CK, Arieira C. Transitions through homelessness and factors that predict them: three-year treatment outcomes. J Subst Abus Treat. 2005;28:S23–39.

Grinman MN, Chiu S, Redelmeier DA, Levinson W, Kiss A, Tolomiczenko G, Cowan L, Hwang SW. Drug problems among homeless individuals in Toronto, Canada: prevalence, drugs of choice, and relation to health status. BMC Public Health. 2010;10:94.

Linton SL, Celentano DD, Kirk GD, Mehta SH. The longitudinal association between homelessness, injection drug use, and injection-related risk behaviour among persons with a history of injection drug use in Baltimore, MD. Drug Alcohol Depend. 2013;132:457–65.

Crawley J, Kane D, Atkinson-Plato L, Hamilton M, Dobson K, Watson J. Needs of the hidden homeless – no longer hidden: a pilot study. Public Health. 2013;27(7): 674–80.

Office of the Deputy Prime Minister: Housing, planning, and local government and the regions committee: homelessness: third report of session 2004–05. 2005. https://www.publications.parliament.uk/pa/cm200405/cmselect/cmodpm/61/61i.pdf . Accessed 24 Oct 2016.

Williams K, Poyser J, Hopkins K. Accommodation, homelessness and reoffending of prisoners: results from the surveying prisoner crime reduction (SPCR) survey. London: Ministry of Justice; 2012.

Kennedy S. It should not be a pit stop: voices and perspectives of homeless youth on labeling and placement in special education. J Ment Health Res Intellect Disabil. 2017;10:1–19.

Lugo MA. Oxford Poverty & Human Development Initiative (OPHI): employment, in Oxford Poverty & Human Development Initiative (OPHI). Oxford: Oxford University; 2007.

Shinn M. Homelessness, poverty and social exclusion in the United States and Europe. Eur J Homelessness. 2010;4:19–43.

Download references

Acknowledgements

The authors wish to thank all participants in this study; without their contribution it would not have been possible to undertake the research. The authors acknowledge the contribution of Professor Paul Kingston and Professor Basma Ellahi at the proposal stage of this project. A very special thanks to Robert Whitehall, John and all the staff at the centres for homeless people for their help in creating a conducive environment for this study to take place; and to Roger Whiteley for editorial support. A very special gratitude goes to the reviewers of this paper, who will have expended considerable effort on our behalf. 

This research was funded by quality-related research (QR) funding allocation for the University of Chester.

Availability of data and materials

The datasets generated during and/or analysed during the current study are not publicly available due to ethical restriction and privacy of participant data but are available from the corresponding author on reasonable request.

Author information

Authors and affiliations.

Faculty of Health and Social Care, Department of Public Health and Wellbeing, University of Chester, Riverside Campus, Chester, CH1 1SL, UK

Mzwandile A. Mabhala & Mariska Griffith

Mount Sinai, Department of Surgery, Ambulatory Surgery Centre, 5 East 98th Street, 14th Floor, Box 1259, New York, NY, 10029-6574, USA

Asmait Yohannes

Department of Public health and Wellbeing, University of Chester, Riverside Campus, Chester, CH1 1SF, UK

Mzwandile A. Mabhala

You can also search for this author in PubMed   Google Scholar

Contributions

MM wrote the entire manuscript, designed the study, collected data, analysed and interpreted data, and presented the findings. AY contributed to transcribing data and manuscript editing. MG contributed to data collection, and transcribed the majority of data. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Mzwandile A. Mabhala .

Ethics declarations

Ethics approval and consent to participate.

Ethical approval to conduct the study was provided by the Faculty of Health and Social Care Research Ethics Subcommittee of the University of Chester.

Consent for publication

All participants have given consent to publish.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated.

Reprints and permissions

About this article

Cite this article.

Mabhala, M.A., Yohannes, A. & Griffith, M. Social conditions of becoming homelessness: qualitative analysis of life stories of homeless peoples. Int J Equity Health 16 , 150 (2017). https://doi.org/10.1186/s12939-017-0646-3

Download citation

Received : 24 March 2017

Accepted : 10 August 2017

Published : 22 August 2017

DOI : https://doi.org/10.1186/s12939-017-0646-3

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Homeless People
• Poor Educational Attainment
• Public Health Phenomenon
• Permanent Accommodation
• Behavioral Causes

International Journal for Equity in Health

ISSN: 1475-9276

• General enquiries: [email protected]

Homelessness and its Solutions Essay

The shelter is one of the basic wants of man. Sadly, several people live without shelter. The state of homelessness is caused by factors such as the effects of war, poverty and the occurrence of natural phenomena such as earthquakes and landslides. In order to know exactly what is meant by being homeless, it is necessary to establish what should be counted as a home. We shall define home as a place of residence or refuge (Davis, 2004). This definition draws the slight distinction between a shelter and a home. It can be observed that one can have shelter without a home but not a home without shelter. A homeless person is bound to face other challenges that come with lacking a place to call his or her home. Among the many problems faced by these people is the problem of lack of proper healthcare. This problem is caused by either inability to afford the costs of proper medication or as a result of the congestion within the concentration camps of the homeless.

Homelessness is a major cause of serious health problems. Most of the health problems are associated with poverty. The homeless population is devastated by diseases such as AIDS, malnutrition, tuberculosis, several dental problems among others. These diseases have claimed the lives of thousands of homeless people across the world (Glasser, 1994). They normally die after a short period due to the poor conditions that they are obliged to live in. In some cases, a homeless person can be suffering from a series of ailments and to make matters worse, he or she may be unaware of his or her pathetic condition.

There are other health problems faced by the homeless population that exists quietly especially along the streets. Some of them are mental illnesses, diabetes, alcoholism, physical disabilities and hypertension (Kusmer, 2002). These deadly diseases are prone to the homeless population because they are easily exposed to frostbite, parasites, infections and violence. These are some of the ways through which they contract the above diseases.

Even though they are desperately in need of good medication, the homeless population does not have any sort of health insurance or worse still, cannot afford to pay for medical care. This leaves these miserable people with no option other than to sit and let come what may. To make matters worse, most of them stay far away from the medical facilities they are in need of (Ogilvie, 2004). The homeless population focuses mainly on their immediate needs such as food and safety and tends to ignore minor symptoms of diseases until they become urgent medical emergencies.

One of the ways in which the homeless population can be helped to achieve better health can be through the establishment of clinics that are specifically designed to get over the access problems faced by the homeless population (Ward, 1989). The clinics can provide comprehensive care which helps to reduce the effects of homelessness. Medical vans can then visit the clinics or the encampments, underpasses and parks to give free medicinal drugs to the homeless population.

Another way of providing better health services to the homeless can be through the formation of projects of healthcare for them. These can be initiatives set up by the community to address the healthcare problems of their locality (Wallace & Wolf, 1999). The community can be well organized in that each project can secure providers of different services such as substance abuse, mental services and hospital services. These projects if well managed can go a long way in reversing the healthcare problems that are faced by the homeless population.

In conclusion, the homeless population faces a number of healthcare problems that affect their health and even cause death. It is upon the community and the government as a whole to find an appropriate way of helping the homeless population out of their pitiful situation.

Reference list

Davis, S. (2004). Design for the homeless: Architecture that works . Berkeley: University of California Press.

Glasser, I. (1994 ). Homelessness in a global perspective . New York: Maxwell.

Kusmer, K.L. (2002). Down & out, on the road: The homeless in American History . New York: Oxford University Press.

Ogilvie, R. S. (2004). Voluntarism, community life, and the American ethic. Bloomington: University press.

Wallace, R. A., & Wolf, A. (1999 ). Contemporary sociological theory . New Jersey: Prentice-hall.

Ward, J. (1989). Organizing for the Homeless . Ottawa: Canadian Council on Social Development.

• Chicago (A-D)
• Chicago (N-B)

IvyPanda. (2022, March 22). Homelessness and its Solutions. https://ivypanda.com/essays/homelessness-and-its-solutions/

"Homelessness and its Solutions." IvyPanda , 22 Mar. 2022, ivypanda.com/essays/homelessness-and-its-solutions/.

IvyPanda . (2022) 'Homelessness and its Solutions'. 22 March.

IvyPanda . 2022. "Homelessness and its Solutions." March 22, 2022. https://ivypanda.com/essays/homelessness-and-its-solutions/.

1. IvyPanda . "Homelessness and its Solutions." March 22, 2022. https://ivypanda.com/essays/homelessness-and-its-solutions/.

Bibliography

IvyPanda . "Homelessness and its Solutions." March 22, 2022. https://ivypanda.com/essays/homelessness-and-its-solutions/.

• On How to Eradicate Homelessness
• Homelessness in the United States
• Approaching Homelessness in America
• The Causes and Impacts of Homelessness
• The Homeless in Our Community
• Mumbai Great Problem: Homelessness Problem in Cities
• Homelessness in the US
• The Effects of Homelessness in Ohio
• Homelessness: Its Causes, Effects, and Prevention
• Homelessness as the Social Phenomenon
• Homeless Women and Healthcare: Access to Health Care, Medication, and Health Facilities
• Reflective Analysis of Poverty
• Poverty: A Sociological Imagination Perspective
• Microeconomic Perspective on Poverty Evolution in Pakistan
• The Impact of Poverty on Children Under the Age of 11

Home — Essay Samples — Social Issues — Homelessness — Causes and Solutions to Homelessness

The Problems Caused by Homelessness and Ways to Solve Them

• Categories: Homelessness Poverty in America

About this sample

Words: 1386 |

Published: Jan 28, 2021

Words: 1386 | Pages: 3 | 7 min read

Table of contents

Introduction, problems related to homelessness, homelessness solutions.

Homelessness,Health care,Poverty,Homelessness in the United States,Health insurance,Healthcare reform

Works Cited

• Caton, C. L. M., Wilkins, C., & Anderson, J. (2007). People who experience long-term homelessness: Characteristics and interventions. In D. Levinson (Ed.), Encyclopedia of Homelessness (Vol. 2, pp. 609-617). Sage Publications.
• Culhane, D. P., Metraux, S., Byrne, T., Stino, M., & Bainbridge, J. (2013). The age structure of contemporary homelessness: Evidence and implications for public policy. Analyses of Social Issues and Public Policy, 13(1), 228-244.
• D’Amore, J., Hung, O., Chiang, W., Goldfrank, L., & Adams, J. G. (2016). The epidemiology of the homeless population and its impact on an urban emergency department. Academic Emergency Medicine, 23(6), 655-657.
• Fazel, S., Geddes, J. R., & Kushel, M. (2014). The health of homeless people in high-income countries: Descriptive epidemiology, health consequences, and clinical and policy recommendations. The Lancet, 384(9953), 1529-1540.
• Hwang, S. W., & Burns, T. (2014). Health interventions for people who are homeless. The Lancet, 384(9953), 1541-1547.
• Kertesz, S. G., Baggett, T. P., O’Connell, J. J., & Buck, D. S. (2017). Permanent supportive housing for homeless people—Refining the concept. Journal of General Internal Medicine, 32(9), 1016-1017.
• National Alliance to End Homelessness. (n.d.). Health care and homelessness. Retrieved from https://endhomelessness.org/homelessness-in-america/what-causes-homelessness/health-care/
• National Coalition for the Homeless. (2021). Factsheet: Healthcare and homelessness. Retrieved from https://nationalhomeless.org/issues/healthcare/
• O’Connell, J. J., & Sledge, W. H. (2005). Substance abuse among the homeless: Epidemiology and treatment. Psychiatric Clinics, 28(4), 1023-1034.
• Tsemberis, S., & Eisenberg, R. F. (2000). Pathways to housing: Supported housing for street-dwelling homeless individuals with psychiatric disabilities. Psychiatric Services, 51(4), 487-493.

Cite this Essay

Let us write you an essay from scratch

• 450+ experts on 30 subjects ready to help
• Custom essay delivered in as few as 3 hours

Get high-quality help

Prof Ernest (PhD)

Verified writer

• Expert in: Social Issues

+ 120 experts online

By clicking “Check Writers’ Offers”, you agree to our terms of service and privacy policy . We’ll occasionally send you promo and account related email

No need to pay just yet!

Related Essays

4 pages / 1819 words

1 pages / 570 words

4 pages / 1781 words

4 pages / 2001 words

Remember! This is just a sample.

You can get your custom paper by one of our expert writers.

121 writers online

Still can’t find what you need?

Browse our vast selection of original essay samples, each expertly formatted and styled

Related Essays on Homelessness

Homelessness is a pressing issue that affects individuals across all walks of life, including college students. In Eleanor's essay "Homeless On Campus," this important topic is explored in depth, shedding light on the challenges [...]

In his essay "On Dumpster Diving," Lars Eighner explores the art of scavenging through dumpsters to find food, clothing, and other essentials. Eighner provides a firsthand account of his experiences as a dumpster diver and [...]

Homelessness is a pressing issue that continues to plague societies around the world, prompting debates on how best to address the needs of those without stable housing. From individuals living on the streets to families [...]

Homelessness is a complex and pervasive problem that affects individuals, families, and communities across the United States. While the issue of homelessness has been present for decades, it has only recently garnered public [...]

Canfield, J. (2014). The effects of homelessness on children. Journal of Family Issues, 36(2), 165-178.Chavkin, W., Kristal, A. R., Seabron, F., & Guigli, L. (1987). Reproductive experience of homeless women in welfare hotels in [...]

Throughout history, societies have grappled with the issue of homelessness. The United States, often considered a land of opportunity, is no exception. In this essay, we will delve into the complex issue of homelessness in [...]

Related Topics

By clicking “Send”, you agree to our Terms of service and Privacy statement . We will occasionally send you account related emails.

Where do you want us to send this sample?

By clicking “Continue”, you agree to our terms of service and privacy policy.

Be careful. This essay is not unique

This essay was donated by a student and is likely to have been used and submitted before

Download this Sample

Free samples may contain mistakes and not unique parts

Sorry, we could not paraphrase this essay. Our professional writers can rewrite it and get you a unique paper.

Please check your inbox.

We can write you a custom essay that will follow your exact instructions and meet the deadlines. Let's fix your grades together!

Get Your Personalized Essay in 3 Hours or Less!

We use cookies to personalyze your web-site experience. By continuing we’ll assume you board with our cookie policy .

• Instructions Followed To The Letter
• Deadlines Met At Every Stage
• Unique And Plagiarism Free

• Share full article

Advertisement

Supported by

California Today

How Los Angeles Is Approaching Homelessness

A conversation with the Times reporter who wrote about Mayor Karen Bass’s flagship program to solve homelessness.

By Soumya Karlamangla

About 171,000 people living in California are homeless, a total that has grown significantly over the past decade. If you live here, this has surely not gone without notice, as encampments have popped up on sidewalks and in public parks across the state in recent years.

Though California accounts for 12 percent of the nation’s population, the state is home to 30 percent of all homeless people in the United States.

My colleague Jill Cowan recently wrote about a new program spearheaded by Mayor Karen Bass of Los Angeles that’s aimed at eliminating the most visible encampments in the city. Bass took office in late 2022, and the program, Inside Safe, is at the core of her efforts to solve homelessness.

The program provides motel rooms for homeless residents who agree to leave encampments, a shift from sweeps in which officials clear encampments and force people to leave. But while Inside Safe has moved more than 2,100 people into shelters, only 400 of them have since moved into permanent housing. That’s drawn criticism that the program is only a short-term fix and perhaps more for optics than helping Angelenos most in need.

You can read Jill’s full article here.

I spoke to Jill about her article and her reporting, which spanned more than a year. Here’s our conversation, lightly edited:

Why did you decide to focus on Inside Safe?

Because it was the mayor’s focus — it was the program she touted the most and it was meant to address some of the people who need it most.

You reported that through Inside Safe and other programs, L.A. moved 21,000 people off the street and into temporary housing in 2023, about 4,000 more than it did in the prior year. How are Bass’s efforts seemingly more effective than her predecessors’?

There were a few things that Bass has done differently and not all of them are related to Inside Safe, but it’s a useful place to start. The level of coordination and focus on a specific encampment were new for Inside Safe: It was important to follow through on promises of shelter, and for that shelter to be individual rooms, as opposed to big congregate shelters, which make a lot of homeless people feel unsafe or like they don’t have privacy. Bass has also emphasized her relationships across government agencies, like with members of the Los Angeles County Board of Supervisors and with leaders in the federal government, to help get everybody rowing in the same direction, which experts say is a bigger change than you might think.

You live in L.A. When you drive or walk around the city, does it feel as if the reduction in encampments is noticeable?

I think so. It certainly isn’t true to say that there are no encampments anywhere. But there are also a lot of public spaces where there were wall-to-wall tent encampments covering sidewalks or in parks, and many of those are no longer there. Venice is an example that many of the mayor’s allies point to, and the difference there is really striking. I live near Echo Park Lake, and during the pandemic there were a lot of encampments around that area, but I have seen very few tents in the last year or so.

What’s the pushback to the program been?

A longtime criticism of Los Angeles’s — and many cities’ — approach to homelessness is that it prioritizes the experience of housed residents at the expense of stably getting people experiencing homelessness into homes. To be clear, a lot of progressives and homeless advocates say they prefer Bass’s general approach to sweeps, where people are forced to leave encampments.

But they say that Inside Safe still essentially closes off large parts of public space to people who may not have homes but still have a right to be in public. Because once an encampment is gone, the city or other agencies often put up barriers or, in some cases, enforce the city’s anti-camping ordinance to ensure people don’t come back to that area.

What has Bass said in response to this criticism?

She has been open about the fact that making visible progress for the benefit of voters is a top priority and she says that Inside Safe, for all its imperfections, is getting people in need off the street quickly. Leaving them there while they’re on a waiting list for temporary or permanent housing is not an option, in her view. She sees her work now as almost like triaging the situation in the time it takes to get more housing built.

Wait, she’s been open about the fact that Inside Safe is somewhat for image? Or is she casting it in some other less cynical way?

She has been open about the fact that it’s designed in part to satisfy voters.

Fascinating. OK, anything else about the story you want to share?

Just that this is an ongoing issue. Experts on housing and homelessness told me they were optimistic about Bass’s work and approach, but she needs time.

The rest of the news

A Los Angeles Times analysis of data from the Bureau of Labor Statistics shows that California has the lowest job growth in the United States , particularly in rural counties.

Researchers with U.C. Santa Barbara and the NASA Jet Propulsion Laboratory report that water consumption in the U.S. could be cut by about 93 percent if California farmers planted less thirsty crops, CalMatters reports.

Southern California

A bill introduced in the California Legislature will seek reparations for the families of people who were displaced from their homes in Los Angeles in the 1950s on land that became the site of Dodger Stadium.

The Murrieta Police Department, which has been using Lego heads and emojis to cover suspects’ faces in social posts, has been asked by the Lego company to stop , The Associated Press reports.

Nancy Valverde, an L.G.B.T.Q. activist, died on Monday at her home in Hollywood, ABC News reports. She was 92 .

Northern California

Berkeley will stop enforcing a ban on natural gas piping in new homes and buildings in response to opposition in court by the California Restaurant Association, NBC Bay Area reports.

San Francisco’s 4/20 festivities in Golden Gate Park, a celebration of cannabis and cannabis culture, will not take place this year, The San Francisco Chronicle reports.

Amid all the upheaval of the pandemic, there have been moments of hope and positive change. What have been your pandemic silver linings? Tell us at [email protected] .

And before you go, some good news

Stacey Terterian grew up in Fresno, but during a recent visit to Armenia she discovered a deep connection to the country she says feels like home.

Terterian, whose family has roots in Armenia, decided to join a service program called the Armenian Volunteer Corp in August 2023 after a challenging period in her personal life. The trip brought her to Armenia for the second time in her life.

Terterian’s volunteering involved assisting Armenians who were affected by the ongoing conflict in Nagorno-Karabakh, an ethnic enclave of Armenians in Azerbaijan. Then, in September 2023, Azerbaijan attacked Nagorno-Karabakh, taking control of the region and causing more than 100,000 Armenians to flee. Suddenly, Terterian found herself on the front lines of the crisis, providing aid to the refugees and, through that experience, locating a deep connection to Armenia and its people.

Terterian describes the course-changing visit in a recent essay in The Fresno Bee . “A picturesque land, rich in both beauty and history. Armenians know despair; they know resilience as well. My journey embodies that spirit,” she wrote.

Thanks for reading. I’ll be back tomorrow. — Soumya

P.S. Here’s today’s Mini Crossword .

Maia Coleman and Briana Scalia contributed to California Today. You can reach the team at [email protected] .

Sign up here to get this newsletter in your inbox .

Soumya Karlamangla reports on California news and culture and is based in San Francisco. She writes the California Today newsletter. More about Soumya Karlamangla

Why Easter brings me back to church

Even though i don’t practice in earnest anymore, memories and community give me a reason to return every spring, by gabriella ferrigine.

“Please — come join us in the cafeteria after Mass has concluded!”

Father Ariel’s jaunty voice echoed from where he was standing at the slabbed marble pulpit, as he smiled out at the congregation. His family, who had arrived from the Philippines in droves to celebrate his 50th birthday, beamed from the first several rows of glossy, varnished pews. 

I’m not an atheist per se, but trying to find an equilibrium with faith has undoubtedly become a game of mental Tetris.

Mid-morning light filtered through stained glass depicting saints and the Stations of the Cross, casting soft pinks and blues and greens across the church: our local parish, St. James. Sun illuminated the top of Father Ariel’s head, and behind him, a domed mural of the stages of Jesus’ life — his birth in a manger, his crucifixion atop Calvary, and his resurrection after emerging from a stone sepulchre — seemed to swell higher with every slow, measured note of music from the raftered choir.

It was a Sunday morning in April, not exactly Easter but right around the time. The smell of incense — a combination of frankincense and myrrh — leached from every corner of the space, creating a somewhat soporific effect. I pictured my family, friends and neighbors gently falling asleep to its bitter, powdery aroma, like Dorothy  did in the poppy field. Everything felt buoyant and peaceful.

My family and many other parishioners — mainly gentle, geriatric hordes — joined Father Ariel with his multitude of relatives in my middle-school cafeteria for an authentic Filipino feast. Side dishes of pearly quail eggs, roasted fish and meats, bright salads and an array of desserts adorned every inch of table space, the very same where I ate many peanut butter and jelly sandwiches in my youth. At the center of it all was a huge roast pig, or lechón, with delicate, crisped skin. I looked at the pig’s face, then at the people ambling around the dingy, linoleum floors, and immediately felt love. 

This was nearly 10 years ago, back during a time when I went to Church every Sunday and consistently prayed to God. I don’t consider myself a particularly religious person anymore. I’m not an atheist per se, but trying to find an equilibrium with faith has undoubtedly become a game of mental Tetris. Sure, Jesus seemed like a pretty cool guy — to me, his message has always unequivocally been "love,” in a broader sense. I’m on board with that. 

But I still remain immensely put off by how Catholicism’s sordid underbelly has blended into sociopolitical life, underpinning the dismantling of women’s reproductive rights and enabling sexual abusers. I find myself still clinging to it largely because it’s woven tightly into many people I love. It’s a perturbing relationship; I feel as though my continued shunning of organized religion has in a sense estranged me from the memory of some very important people. 

And yet, Easter and springtime always bring me back to church. I find myself craving, not exactly the scriptures and the teachings embedded in them, but how the space evokes the memories of people I love — chiefly my maternal grandmother and my mom — and an inclusive sense of community. 

A deeply spiritual person, my grandma — born in a small Bolivian jungle village called Riberalta — spent her teenage years living in a convent with a U.S.-based congregation of nuns performing foreign missionary work. She was readying to enter the sisterhood when she met my grandfather, a Sicilian and civil engineer volunteering with a Catholic mission group to help build new infrastructure in Riberalta. They returned to America together and settled in Bayonne, New Jersey, joined in a union forged out of a shared devotion to God and each other.

Though my mom didn’t pray a daily rosary or make pilgrimages to Lourdes like my grandma, she was deeply affected by her religious upbringing, a heritage she inculcated her five children with through weekly mass, and offering up nightly intentions along with prayers before dinner: family and friends who were sick or had died, poverty and homelessness, wartime conflict, our cat Sweet Pea’s hypothyroidism. 

In my grandmother’s house and my own, the iconography of Jesus and other religious figures was everywhere, peppering walls and mantelpieces alongside family photos and wedding albums. Each time one of my more than 25 cousins or I received a sacrament — Baptism, First Holy Eucharist, Confirmation — a sprawling, family-wide party followed, usually at an Italian restaurant with a generically benevolent, pot-bellied owner who would toddle around and ask, “How yous all likin’ the food?” And of course, there was always a large white sheet cake, piped in bubbled fonts: “God Bless ____!” 

Seeing as my mom’s eight siblings were spread out across central New Jersey, I essentially ran the gauntlet of various Catholic parishes in our area for different holidays and events. I had my favorite churches. St. James retained the top position. Then came St. Michael’s, a red-bricked church that was famous for its live-animal manger display during the Christmas season. Holy Cross — located in one of the more affluent towns in my county — had a stunning interior, but its reputation had always been somewhat sullied in my mind from a 2006 embezzlement incident . 

While I was able to evade formal liturgical participation, my three younger sisters were all urged to be altar servers, helping St. James’ priests — mostly middle-aged men from the Phillippines and India — prepare and proceed with weekly Sunday mass. One sister recalled a time when she and another altar server accidentally spilled open a bag of already-consecrated Eucharist wafers as they were preparing for mass in the wood-paneled sacristy. 

“Oh! Uh, don’t worry girls — I’ll consume these later,” the priest said when he walked in and saw them scooping the body of Christ off the floor and into Ziploc bags. 

Another time several years ago, my family was running late for Easter Sunday mass, half of us with our hair still wet. “Overflow,” an usher posted outside the church doors said as we approached, jerking his thumb toward the rear parking lot where the grammar school was located. Given that creasters (Catholics who only attend church on Christmas and Easter) come out of the woodwork every winter and spring, tardy worshippers are forced to attend the secondary service, held in the gymnasium or auditorium. 

From my seat in a metal folding chair, nostalgia washed over me as the priest carried a gold crucifix across the same floor where I’d once played dodgeball, toward the makeshift altar where I’d watched classmates act out a rendition of “The Little Mermaid.”

I feel as though my continued shunning of organized religion has in a sense estranged me from the memory of some very important people.

I spent last Easter in Newport, Rhode Island with my family for a short holiday vacation. The weekend was oceanic cliffs and Gilded Age mansions and a kaleidoscopic assortment of saltwater taffy. On Easter Sunday, we walked from our quaint bed and breakfast to St. Mary’s, Our Lady of the Isle, where JFK and Jackie O wed in September of 1953. We took turns waiting outside with our two Great Pyrenees, who had reaped the benefits of Newport’s reputation for being dog-friendly.

Ahead of the homily, the part of the service when the priest explains the Gospel reading in further detail, I elected to relieve my mom of dog duty, knowing she wouldn’t want to miss the crux of the mass. 

As I turned toward the door to trade off with her, the sharp New England morning air — and an emotional pang — made me bristle. I didn’t want to leave. Mashed tightly in hard-backed pews alongside other Catholics, loyalists and creasters alike, I felt a distinct sense of calm. The very same that came to me years ago as I gazed at a pig’s snout.

This Easter, we’ll be going back to St. James. Father Ariel is no longer at the parish — I don’t know many of the priests there anymore, my connection to the parish steadily eroded by distance, time and sheer obstinance on my part. It’s an elegiac relationship, compounded by the recent passing of my grandmother, who embodied holiness and unadulterated love in every sense. 

And while I may not take the time to philosophize about my salvation on Sunday, I’m certain I’ll think of her and what my being there would mean to her. For me, that’s enough to return every spring. 

about this topic

• Do Christians believe Jesus was resurrected from the dead? Well, it's complicated
• The history of the Easter butter lamb, an enduring Polish tradition in the states
• Best Easter pageant ever? Half a century of "Jesus Christ Superstar"

Gabriella Ferrigine is a staff writer at Salon. Originally from the Jersey Shore, she moved to New York City in 2016 to attend Columbia University, where she received her B.A. in English and M.A. in American Studies. Formerly a staff writer at NowThis News, she has an M.A. in Magazine Journalism from NYU and was previously a news fellow at Salon.

Related Topics ------------------------------------------

Related articles.