On any night, about 553,742 individuals are without a home in the United States. Of those homeless people, nearly 40,799 are youth (Winiarski et al. 1). Disability intersects strongly with this population. Evidence suggests youth with intellectual disabilities experience homelessness at a rate almost twice that of their peers, and 89% of homeless 16-19-year-olds meet the criteria for one or more psychiatric mental disorders, about 60% higher than the national rate (Whitbeck et al. 135). Homeless youth are at increased risk for experiences of trauma and victimization (Morton et al. 1). Despite a large number of homeless youth with mental disabilities, very little work addresses this population. The literature base and policy options for homeless adults with mental disabilities fail to address additional systemic barriers homeless youth face, such as a lack of trust in social services or the inability of shelters to diagnose and support homeless people with mental disabilities, which often exacerbates health issues and reduces positive outcomes (Collins et al. 2). However, several successful programs - such as the Family Matters Reconnect Program and the “Know the Unknown” Project - use individualized, relationship-based models of care to address these additional barriers. By drawing conclusions from successful policy programs, this paper will argue that models of care for adult homeless people with mental disabilities fail to address the specific obstacles of homeless youth with mental disabilities. Instead, support programs should emphasize awareness about youth’s experiences and build trust-based individualized relationships between providers and homeless youth with mental disabilities.

Intellectual disability and psychological disorders are not the same, yet these two terms are often conflated in discussions about disability in homeless populations. To clarify the difference, an intellectual disability occurs when a person has below average IQ and severe social skills limits. Distinctly, a psychological disorder affects mood, behavior, perceptions, and thought processes in a way that changes everyday functioning (Lakhan 1). Although they can occur simultaneously and are often linked, they are distinct and can lead to radically different lived experiences and health outcomes (Lakhan 1). These differences are unfortunately lost when authors homogenize both populations, an occurrence too common. For example, Brown and McCann incorrectly use the term “people with intellectual disability” to categorize homeless individuals diagnosed with psychosis and behavior disorders related to substance misuse. Not only does the literature base surrounding the topic of mental disability and homelessness remain small, but by conflating different populations, they inadvertently reinforce ableistic logic against the very people they seek to support. Instead, in this paper, the general term “mental disability” will be used to describe individuals with intellectual disabilities and mental health issues, with an essential understanding that this is a critique directed at the academic and policy base. Homeless people with mental disabilities deserve a reflection of the diversity of their experiences through improved research and more targeted policy approaches, especially as both populations require distinct differences in support and care.

Youth often face the impact of homelessness and mental disability in early childhood, even before they leave their family and home. An estimated 60 - 70% of homeless youth face physical abuse, sexual abuse, neglect, and drug abuse from early childhood to adolescence (Winland 6). These early home experiences have lifelong impacts. Children in families with disruptive environments, precarious living conditions, poverty, ill health, and emotional difficulty are likely to have learning and developmental delays (Collins et al. 2). In addition to traumatic experiences, factors like poverty, inadequate affordable housing, discrimination, lack of social services, and barriers to healthcare access can all serve as initial stressors or one of the many complex factors that drive youth toward homelessness (Winland 17). Homeless youth don’t leave for one reason. Instead, it’s often the result of many repeated instances of neglect, abuse, or lack of support. The overwhelming number of factors contributing to youth homelessness demonstrates the issue’s complexity and emphasizes that a successful model of care must address youth’s desire to leave home to ensure they do not reenter homelessness. And, with the impact of homelessness extending before youth even leave their home, an intervention must begin early to provide the best possible health and wellness outcomes for homeless youth with mental disabilities.

Once they leave home, homeless youth with mental disabilities lack critical support services, exacerbating mental and physical health crises. Evidence suggests that youth with disabilities are more likely to become homeless than their non-disabled peers (Collins 1). Once homeless, other physical and mental health conditions commonly form for homeless youth with mental disabilities, such as respiratory issues, musculoskeletal and connective tissue complaints, visual impairments, respiratory disorders, etc. (Brown and McCann 7). In addition, stresses related to homelessness can exacerbate past trauma (Winiarski et al. 1), necessitating mental health support. These stresses often lead to drug and smoking addiction. Significant levels of drug misuse are reported in 56% of homeless people with mental disabilities (Brown and McCann 6). The impact of homelessness on youth with mental disabilities can lead to a cycle of increasing health complications, making getting support more expensive and complicated. Unfortunately, youth often lack the agency to advocate for themselves. They face isolation and ostracization for deviating from the “social norm,” the rules that govern what is considered socially acceptable, by being homeless, leading to a fear of judgment and rejection from social and support services (Kidd 2). Therefore, external sources of support and intervention that overcome the barrier of stigma are necessary to help these youth navigate the web of different resources to find care that fits their specific needs.

Current programs targeted toward homeless individuals with mental disabilities attempt to fill the role of outside support by providing opportunities to find stability and aid; however, the applicability of these projects toward the needs of homeless youth with mental disabilities remains variable. Many parts of the initiatives for homeless individuals with mental disabilities are necessary, such as improved housing guidance, mental health interventions, and community-based treatment proposals (Brown and McCann 8). But, they fail to address why homeless youth with mental disabilities avoid social services. One of the most significant barriers is recognition. Homeless shelter staff admit a lack of training in diagnosing mental disabilities and supporting homeless youth with mental disabilities, especially given the highly complex cases and issues these youth tend to present (Collins et al. 4). Often, youths' undiagnosed disability causes staff to perceive them as “acting up” resulting in eviction from the shelter (Collins et al. 5). The knowledge divide between shelter staff and support resources puts youth at risk for further trauma and injury. Additionally, accommodation programs often require additional paperwork, such as a medical diagnosis of disability. Unfortunately, youth are unlikely to take these documents when they leave their household, and without external support, they are even more unlikely to acquire them (Collins et al. 6). Another significant barrier is healthcare access, which is especially troubling given the high risk of co-morbidities and other health risks associated with being homelessness. Homeless youth often perceive the medical field as untrustworthy due to social stigmas and fear of judgment from medical providers (Collins et. al 5). There is an additional historical component: the vast majority of homeless people with mental disabilities are African-American males, a population that has historically and continuously faced medical and social service racism and stigma (Brown and McCann 5). Individuals’ own poor experiences attempting to engage with health and social services only reinforce these notions and breed mistrust. Given these problems, solutions must focus on improving knowledge of mental disabilities at points of contact for homeless youth and working to develop relationships between youth and individual caseworkers. These relationships can serve as a bridge, safely linking homeless youth with mental disabilities and the healthcare and social system.

Several successful programs have addressed the various barriers and developed better care models to address homeless youths’ needs. One of the most successful projects is the family reconciliation program, a model that bridges the gap between homeless individuals living at shelters or institutions with their families through therapy with family intervention counselors, intervention and support groups, psychiatric assessments, learning disability psychological assessments, general advocacy, and social services. The stereotype of runaway youth is they travel far from home due to unsolvable conflicts, abuse, or neglect; however, for an estimated third of runaway youth, reconcilable differences cause them to leave their families, although this varies by culture (Brown and McCann 7). Additionally, despite leaving the home environment and immediate family, youth will often continue to keep familial connections to extended family (Winland 17). Leveraging this evidence, programs like Ontario-based Eva’s Initiative Family Reconnect Program found success in reconnecting homeless youth to their family. Other programs — such as the “Know the Unknown” project in South India and a study of a pilot program in Maputo and Matala, Mozambique — found a 50% success rate in the reconnection of homeless individuals with mental disabilities to their families (Gouveia et al. 1). The family reconnects model is promising with its high cross-cultural success rate (Gowda et al. 1). The foundational success of these programs is from their focus on client-centered casework that targets social services to fit individual needs. Instead of solely providing social service opportunities, the family reconnects model builds a trusting relationship between an individual and caseworker, who then acts as a bridge to the broader medical and social service supports. This relationship allows for the caseworker to serve as an advocate for homeless youth with mental disabilities and work with them to access resources that fit their specific needs. By reconnecting youth to their family, the programs ensure a more extensive network of external, durable support, allowing individuals to leave homelessness.

The family reconnect model, although successful, still relies on shelter volunteers referring patients to the program. The knowledge barrier between shelter staff and homeless youth with mental disabilities must be addressed with improved education and awareness. Screening tools provide a viable option to support shelters identifying individuals with mental disabilities. For example, a Toronto pilot project named “Bridges to Housing” has developed a screening tool for adult homeless people at shelters with enough success to prompt other organizations to show interest. One such organization is Partnering for Change, which seeks to adapt the tool for homeless youth with mental disabilities (Collins et al. 8). Although screenings for mental disabilities have found some success, they should not replace shelter staff education and training. Building relationships and trust are still important, as shelter staff can serve to potentially act as the first line of intervention for youth before they are reconnected to a longer-term program. Unfortunately, volunteer organizations’ training programs and communications with other volunteer organizations are often disjointed and uncoordinated (Collins et al. 7). But, by improving communications amongst these groups, such as by developing partnerships between disability rights and justice organizations and homeless shelters, shelter workers would receive information about community resources and provide support. Additionally, shelter staff could increase their interactions with individuals with mental disabilities by volunteering with these organizations as part of the training. Shelter workers tend to recognize mental disabilities only after building relationships with homeless youth and interacting with them for some time (Collins et al. 4). Therefore, spending time with individuals with mental disabilities allows shelter workers to learn from the experiences of individuals with disabilities, which can better inform their later care and interactions with homeless youth with disabilities in the shelters.

These programs have found success because they fundamentally understand that homeless youth with mental disabilities have different lived experiences than their adult counterparts. Programs like Family Reconnect understand the need to build a system of relationships and trust among homeless youth and support systems to address their needs. And, by expanding these support systems to include homeless shelters through increased staff education and training, and improved community organization partnerships, homeless youth with mental disabilities will have improved health outcomes. It would be remiss not to draw a comparison to care webs: communities of social networks and support relationships composed of disabled and non-disabled individuals. Care webs have successfully created positive outcomes for people with mental disabilities for years by adopting models of mutual respect, trust, and relationships that meet the physical, mental, and social needs of these individuals. Thus, it's refreshing to see the model care webs amongst homeless people with mental disabilities involving the individuals, their families, and community partners potentially expand to include non-profit programs to better support homeless youth (Segal et al. 4). Policymakers, researchers, and organizations must keep in mind the importance of building programs with targeted, relationship-based care that centers on building trust when seeking to lift youth with mental disabilities out of homelessness.