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The daily lives of people experiencing homelessness are stressful, dangerous, traumatic, and often take a toll on their mental health.

The trauma of homelessness may exacerbate previous mental illness and encourage anxiety, fear, depression, sleeplessness, and substance use.

The purpose of this article is to share key statistics on mental health care and homelessness, highlight the inequities in access, and advocate for the importance of trauma-informed, integrated behavioral health care for people experiencing homelessness. 


Debunking Mental Health Myths:

    Contrary to the stereotype of the person experiencing homelessness due to a psychotic disorder, in a report from SAMHSA, the Substance Abuse and Mental Health Services Administration, depression and suicidal behaviors are more commonly reported among people experiencing homelessness, followed by traumatic stress disorders and substance use disorders.
    Although the prevalence for mental illnesses is higher for populations experiencing homelessness, it does not imply causation of homelessness. The assumption that homelessness is caused by mental illnesses is a dangerous one, implying a burden of responsibility upon the individual rather than the systems and institutions that perpetuate the housing insecurity and health inequities that result in homelessness. 

Mental Health Burden among People Experiencing Homelessness

On a single night in 2023, 653,104 people were experiencing homelessness nationwide. 143,105 individuals experience chronic homelessness, repeated or extended episodes of homelessness, on any given night.

According to the SAMHSA Report on the Results from the 2022 National Survey on Drug Use and Health, 23.1% of people in the United States experienced any mental illness, and 6.0% had serious mental illness (SMI). It is important to note that this survey was voluntary and excluded individuals with no fixed address, such as unsheltered people experiencing homelessness.

In contrast, in 2023, 31.4% of people experiencing homelessness had SMI, according to the HUD 2023 Continuum of Care Report. Serious Mental illnesses are defined as a mental, behavioral, or emotional disorder resulting in serious functional impairment or disability.

These numbers are typically regarded as a minimum, since mental health and homelessness data is historically difficult to gather due to a variety of factors such as stigma, poor access to mental health care and screening, and the transient nature of people experiencing homelessness.

Mental Health Care Access Inequities in New Mexico

New Mexico ranks in the top ten of states with the worst mental health provider access. According to the Kaiser Family Foundation, as of 2023, only 14.4% of the state’s mental health needs are met, with a gap of 401 mental health providers needed to meet needs.

1 in 10 New Mexicans do not have health insurance, and even those who do, hesitate to use it because their current coverage options are too expensive. Today, nearly 60% of New Mexicans have been forced to endure health issues, including mental health issues, rather than seek medical services due to cost.


How the AHCH Model is meeting this need

With philosophies of care rooted in evidence-based models informed by personal choice, dignity, and respect, AHCH's Patient Centered Medical Home provides high-quality integrated health services that are trauma-informed and healing-focused, with an emphasis on harm reduction and housing first. AHCH continues to provide a distinctive array of programs and integrated care teams to address the health-related causes and consequences of homelessness.

Psychiatry: 

Our program provides support, medication, and problem solving for individuals experiencing homelessness and mental health disorders. They also play a key role in AHCH’s medication assisted treatment (MAT) program. Traditional MAT programs require certain criteria to be seen, such as a referral from a specialist visit or contracted rules for care which can be a huge barrier to care and ultimately result in individuals continuing unsafe substance use and dying from overdose. In contrast, AHCH's MAT program is uniquely low-barrier and integrated as part of primary care--reducing stigma by treating substance use disorders similar to other chronic conditions such as high blood pressure, diabetes etc. Our psych team, as a part of our medical team, closely integrates with our behavioral health team to explore stages of change and design comprehensive patient-centered treatment plans. Due to this innovative approach, AHCH has had great success with MAT and supports over 400 individuals as they recover from substance-use disorders. 

Integrated Behavioral Health:

Our program provides a variety of services to persons experiencing behavioral health issues including individual therapy, group therapy, behavioral health assessments and crisis interventions both by walk-in or by appointment. Services are provided by licensed behavioral health professionals both onsite and on outreach. The program seamlessly integrates with and supports the AHCH medical, psychiatric, dental, social services, case management and harm reduction programs. The BH team supports AHCH services through emotional support and coaching to clients who have trouble managing medications, maintaining an apartment, addressing substance use issues, and communicating with their providers. AHCH optimizes client care through effective collaboration and communication between teams.

Harm Reduction: 

At AHCH, Harm Reduction is a part of everything that we do, as we understand the experience of homelessness is inherently harmful and can exacerbate any existing conditions. Therefore, as part of AHCH's comprehensive integrated health care, we must reduce that harm. 

Our program collaborates with the New Mexico Department of Health to serve nearly 5,000 individuals, reducing overdose deaths and the risk of transmissible disease through outreach, awareness, and education. Harm Reduction is a set of strategies and interventions aimed at reducing negative effects to an individual’s health or social wellbeing by encouraging client-driven change of high-risk health behaviors. This model relies on increasing awareness and health education, active listening to the client, exploring their readiness to make change, and collaboratively brainstorming behavior changes to reduce potential harm. While it has been historically applied and associated with substance use behaviors, it successfully reduces harms related to other health and wellness concerns, such as homelessness, diabetes, and mental health disorders. Harm reduction is guided by the principles of humanism, pragmatism, individualism, autonomy, incrementalism, and accountability. 

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AHCH's Impact

In 2022, AHCH treated 449 individuals with Major Depressive Disorder, 164 with bipolar depressive disorder, and 158 with other mood disorders (cyclothymia, premenstrual dysphoria, mania and non-specific mood disorders)

In 2022, AHCH treated 763 individuals with anxiety disorder and 438 individuals with PTSD. 

AHCH has a large population of clients seeking medication assisted treatment for opioid use disorder. An evaluation of utilization of services for those with suboxone treatment was conducted. AHCH suboxone patients consume approximately 13.47% off billable visits.  In 2023, 402 patients were prescribed Suboxone and are increasing engagement with not just the psychiatrist who prescribed the medication, but with behavioral health and primary care providers to meet more of their health care needs. 

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