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Behavioral Health

Youth who run away or experience homelessness have higher rates of alcohol and drug use than their peers. These differences are especially apparent for illicit drug use1 and are higher for youth on the street compared to those in shelters.2

  • According to the 2003 FYSB data, 23.5 percent of homeless youth in Basic Center Programs and 42.3 percent in Transitional Living Programs report alcohol and drug abuse.3
  • According to the National Survey on Drug Use and Health (NSDUH), 40 percent of 16- and 17-year-old youth who had run away from home during the previous 12 months had used marijuana, compared to 27 percent who had not run away from home.4

These youth also experience higher rates of a number of psychiatric disorders (e.g., depression, anxiety, and conduct disorders)5 and often lack access to health and behavioral health care.6

  • In a sample of 16- to 19-year-old runaway and homeless youth from the Midwest,
    • 42 percent met the criteria for alcohol abuse and 39 percent met the criteria for drug abuse;
    • 74 percent met the criteria for conduct disorder;
    • 31 percent met the criteria for major depression; and
    • 36 percent met the criteria for post-traumatic stress disorder.
    • Many of these youth, about 66 percent, met the criteria for co-morbid disorders.7

Running away and experiencing homelessness are also linked to long term substance abuse and mental health issues. Runaway youth were more likely to be dependent on drugs and show depressive symptoms at age 21 than youth who had not run away after controlling for early substance use, depressive symptoms, lack of parental support, school disengagement, general delinquency, and demographic characteristics.8

Because of the individualized and complex needs of runaway and homeless youth, one way to help youth address their behavioral health needs is through intensive case management. This can help youth navigate the health care system and understand how to fulfill their health care needs.9 A study of youth in Washington who received intensive case management found that they had fewer externalizing behaviors, less aggression, and a higher quality of life rating compared to those who received the normal treatment.10 Providing homeless youth with access to substance abuse and mental health treatment through federal programs and federally supported community-based programs can also help homeless youth facing behavioral health challenges access treatment.

Resources

Homelessness Resource Center: Homeless Populations
The Homelessness Resource Center, supported by the Substance Abuse and Mental Health Services Administration (SAMHSA), is an interactive community of providers, consumers, policymakers, researchers, and public agencies at federal, state, and local levels. The Center shares state-of-the-art knowledge and promising practices to prevent and end homelessness through the following:

  • Training and technical assistance
  • Publications and materials
  • On-line learning opportunities
  • Networking and collaboration

The Center includes a section focused specifically on youth.

Runaway and Homeless Youth Training and Technical Assistance Center
This is a centralized national resource for Runaway and Homeless Youth (RHY) grantees funded by the Family and Youth Services Bureau at the U.S. Department of Health and Human Services. Training and Technical Assistance Services are directed at assisting RHY grantees to engage in continuous quality improvement of their services and to build their capacity to effectively serve runaway and homeless youth.

Health Care for the Homeless
This site from the Health Resources and Services Administration provides data on the number of patients served and includes information patients by age and gender. Of these grantees, over 102,000 youth under the age of 18 were served according to data updated in 2014.

Projects for Assistance in Transition from Homelessness (PATH)
The PATH program is administered by the Center for Mental Health Services, a component of SAMHSA. The PATH program provides formula grants to the 50 states, the District of Columbia, Puerto Rico, the Northern Mariana Islands, Guam, American Samoa, and the U.S. Virgin Islands for people with serious mental illness, including those with co-occurring substance use disorders, who are experiencing homelessness or are at risk of becoming homeless. PATH services include community-based outreach, mental health, substance abuse, case management, and other support services, as well as a limited set of housing services. While some states provide services to youth under the age of 18, most do not.

Services in Supportive Housing (SSH)
SAMHSA’s SSH program helps prevent and reduce chronic homelessness by funding services for individuals and families experiencing homelessness living with a severe mental and/or substance use disorder. Grants are awarded competitively for up to five years to community-based public or nonprofit entities. Services supported under the SSH funding include, but are not limited to, outreach and engagement, intensive case management, mental health and substance abuse treatment, and assistance in obtaining benefits.

Grants for the Benefit of Homeless Individuals (GBHI)
GBHI is a competitively awarded grant program from SAMHSA that enables communities to expand and strengthen their treatment services for people experiencing homelessness. Grants are awarded for up to five years to community-based public or nonprofit entities and funded programs and services include substance abuse treatment, mental health services, wrap-around services, immediate entry into treatment, outreach services, screening and diagnostic services, staff training, case management, primary health services, job training, educational services, and relevant housing services.

References

1 U.S. Department of Health and Human Services, 2008; Greene, Ennett, & Ringwalt, 1997; SAMHSA, 2004; Nyamathi, Hudson, Greengold, Slagle, Marfisee, Khalilifard, & Leake, 2010
2 Greene, Ennett, & Ringwalt, 1997
3 U.S. Department of Health and Human Services, 2008
4 SAMHSA, 2004
5 U.S. Department of Health and Human Services, 2008; HRSA, 2001
6 U.S. Department of Health and Human Services, 2008; HRSA, 2001
7 Chen, Thrane, Whitbeck, & Johnson, 2006
8 Tucker, Rdelen, Ellickson, & Klein, 2011
9 U.S. Department of Health and Human Services, 2008; HRSA, 2001
10 Cauce et al., 1994

Other Resources on this Topic

Collaboration Profiles

Youth Briefs

How Individualized Education Program (IEP) Transition Planning Makes a Difference for Youth with Disabilities

Youth who receive special education services under the Individuals with Disabilities Education Act (IDEA 2004) and especially young adults of transition age, should be involved in planning for life after high school as early as possible and no later than age 16. Transition services should stem from the individual youth’s needs and strengths, ensuring that planning takes into account his or her interests, preferences, and desires for the future.

Youth Transitioning to Adulthood: How Holding Early Leadership Positions Can Make a Difference

Research links early leadership with increased self-efficacy and suggests that leadership can help youth to develop decision making and interpersonal skills that support successes in the workforce and adulthood. In addition, young leaders tend to be more involved in their communities, and have lower dropout rates than their peers. Youth leaders also show considerable benefits for their communities, providing valuable insight into the needs and interests of young people

How Trained Service Professionals and Self-Advocacy Makes a Difference for Youth with Mental Health, Substance Abuse, or Co-occurring Issues

Statistics reflecting the number of youth suffering from mental health, substance abuse, and co-occurring disorders highlight the necessity for schools, families, support staff, and communities to work together to develop targeted, coordinated, and comprehensive transition plans for young people with a history of mental health needs and/or substance abuse.

Young Adults Formerly in Foster Care: Challenges and Solutions

Nearly 30,000 youth aged out of foster care in Fiscal Year 2009, which represents nine percent of the young people involved in the foster care system that year. This transition can be challenging for youth, especially youth who have grown up in the child welfare system.

Coordinating Systems to Support Transition Age Youth with Mental Health Needs

Research has demonstrated that as many as one in five children/youth have a diagnosable mental health disorder. Read about how coordination between public service agencies can improve treatment for these youth.

Civic Engagement Strategies for Transition Age Youth

Civic engagement has the potential to empower young adults, increase their self-determination, and give them the skills and self-confidence they need to enter the workforce. Read about one youth’s experience in AmeriCorps National Civilian Community Corps (NCCC).