The Negative Health Impacts of Unsheltered Homelessness - VA Homeless Programs
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VA Homeless Programs


The Negative Health Impacts of Unsheltered Homelessness

By Monica Diaz, executive director, VHA Homeless Programs Office
Posted April 12, 2023

There are infinite pathways that can lead a person to struggle to keep a roof over their head: Being included in the latest round of layoffs. Taking a leave of absence from work to serve as the caretaker for an ill family member. Facing unexpected but exorbitant medical costs. Being told your landlord is selling their house.

These circumstances can happen to anyone, at any time—often with little warning. And without a backup plan or strong social safety network, these unfortunate twists of fate can result in something previously unimaginable.

Such scenarios happen every day in America, including to the heroic individuals who once wore this nation’s uniform. Veterans may find themselves unsure of how to get help or hesitant to ask, which can lead to them experiencing unsheltered homelessness.

Unsheltered homelessness in America

Though the number of Veterans experiencing homelessness has declined by 11% since 2020—and by more than 55% since 2010—communities across the country are seeing an increase in the rates of unsheltered homelessness among Veterans and individuals.

A person experiencing unsheltered homelessness has a primary nighttime location in a place where individuals don’t typically sleep, such as streets, vehicles, or parks. In 2022, 41% of all Veterans experiencing homelessness were unsheltered, and between 2021 and 2022, unsheltered homelessness rose among all Americans by 7%.

Short and long-term health impacts

While it’s no surprise that people experiencing unsheltered homelessness have more significant health issues than those who are sheltered, many don’t consider that they also struggle to consistently access essential medical supplies, including health records, documents, and medications. Moreover, many also lack basic hygiene resources, causing them to face a greater risk of contracting infectious diseases.

Veterans experiencing unsheltered homelessness may also struggle with mental health issues such as anxiety, depression, substance abuse, and traumatic stress disorders, putting them at a higher risk for drug and alcohol abuse.

Health challenges and unsheltered homelessness can be a mutually reinforcing cycle. Studies have shown that health challenges are strong and consistent risk factors for homelessness. The longer a Veteran remains unsheltered, the greater the likelihood that the issues will be exacerbated.

Barriers to care

There is a myth that people experiencing unsheltered homelessness simply choose not to engage in available services. As Dr. Jack Tsai, research director for the National Center on Homelessness Among Veterans points out, no Veteran chooses to be homeless and some unsheltered Veterans currently receive care.

“Many Veterans face both legitimate and perceived barriers that can prevent them from engaging in certain types of care,” Dr. Tsai explains. “Previous negative interactions with VA or other social service organizations may keep some Veterans from seeking support.”

It is, however, important to note that VA homeless programs have expanded significantly in recent years—even if Veterans may not have been eligible for services in the past, there are now more people and programs than ever before to help Veterans.

VA is committed to showing all Veterans that no matter what they are going through, we are here to help. VA homeless programs staff strive to meet Veterans where they are, listen to what they need, and help connect them with the services and programs that align with their housing goals.

“A lot of it comes back to trust and building those relationships, which often takes multiple visits,” says Dr. Jillian Weber, national program manager of VA’s Homeless Patient Aligned Care Teams (HPACTs).

VA is also listening to Veterans by expanding low-barrier models to housing that have proved popular, including the West Los Angeles VA’s Care, Treatment and Rehabilitative Services’ (CTRS) Tiny Shelters, which strive to maintain Veteran autonomy and support Veterans with family members. Additionally, VA’s Grant and Per Diem (GPD) program reduces long-term homelessness among Veterans by empowering Veterans to choose their own path, trusting that Veterans are the best experts on the programs and approaches that will best fit their needs.

Fighting for unsheltered Veterans

VA Medical Centers engage with unsheltered Veterans through street or community-based outreach services that meet Veterans where they are—including at encampments or congregate meal sites—as well as with Community Resource and Referral Centers (CRRCs) and through strong community partnerships.

VA currently has more than 30 CRRCs where Veterans can meet with VA staff to obtain support services. In addition, VA secured more than 18,000 shelter beds for homeless and at-risk Veterans and hosted 153 Stand Down events reaching over 30,000 homeless Veterans in 2021.

In 2022, VA exceeded Secretary McDonough’s challenge to place 38,000 Veterans in permanent housing by housing 40,401 Veterans in under 10 months. But there is still work to do.

VA’s 2023 goals for preventing and ending Veteran homelessness also include placing at least 38,000 Veterans in permanent housing. In addition, VA will strive to engage with at least 28,000 unsheltered Veterans to help them obtain housing and other wraparound services. This goal represents a more than 10% increase in the number of unsheltered Veterans reached during 2022.

To reach as many unsheltered Veterans as possible, VA will continue conducting outreach through innovative methods, such as with the 25 new Mobile Medical Units that will help VA staff reach Veterans and provide essential health care resources through the HPACT program wherever they are. Mobile Medical Units will be critical, especially in reaching rural Veterans who may live far from VA Medical Centers, community housing, and medical resources.

VA’s National Center on Homelessness among Veterans and its partners are also leading new research projects to examine which housing models best serve unsheltered Veterans, and how these findings can inform future VA programming to connect all Veterans to the safe, stable, and permanent housing they need and deserve.

Resources for Veterans

  • If you are a Veteran who is homeless or at risk for homelessness, call the National Call Center for Homeless Veterans at 877-4AID-VET (877-424-3838).
  • Visit the VA Homeless Programs website to learn about housing initiatives and other programs for Veterans exiting homelessness.
  • If you are a Veteran experiencing suicidal thoughts, dial 988, then press 1.
  • To find a medical center near you, visit our directory.