Traveling Behavioral Health Services for Youth Experiencing Homelessness

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April 19, 2023
Policy Brief

By: Rachel White, Senior Youth Policy Analyst

The State of Youth Experiencing Homelessness in the District

Youth homelessness is a significant problem throughout the District–roughly 1,934 youth (ages 16 to 24) experiencing homelessness received services from DC’s Department of Human Services (DHS) in 2022 alone. Nearly 300 of those young people were parents, creating a two-generational homelessness crisis. DC Action believes the number of unhoused youth is actually much higher because of the impacts of the pandemic and the inability of DHS to count youth who are not connected to existing programming.

The District’s Black and LGBTQIA+ young people are disproportionately likely to experience homelessness. In 2021, 40% of all youth 18-24 in the District identified as Black, while making up 77% of the youth homelessness population. In 2022, 15% of youth experiencing homelessness identified as LGBTQ+, but this number is probably much higher, however, as gender identity or sexual orientation data was not collected for 43% of all youth.

The root causes of youth homelessness are varied but often include an unsafe home environment due to domestic violence, parental addiction, or family conflict due to prejudice against sexual orientation or gender expression; transitions from systems involvement (foster care, detention, or other institutional placements); family poverty; undocumented status; and lack of affordable housing. This is why we need a multi-faceted approach to addressing youth homelessness. One of the solutions–improved mental health support–is highlighted here, but it must be advanced with other efforts, like targeted workforce support and greater access to housing.

Youth Experiencing Homelessness and Mental Health 

Youth experiencing or at risk of homelessness have higher rates of mental health issues, including suicide,depression, anxiety and conduct disorders than those in stable homes. Lack of access to behavioral health care further complicates most individuals’ ability to seek treatment. Increasing access to mental health supports will save lives.

Mental health outcomes for youth experiencing homelessness were worsened by the pandemic. Psychosocial outcomes included isolation, worsened mental health, and increased substance use. Impacts were magnified and distinct for subpopulations of youth, including for youth that identified as Black and LGBTQ+. To date:

  • Homeless students reported significantly higher rates of depression than housed students (45% vs. 27%).
  • Depression can lead to harmful behaviors such as alcohol and substance abuse. Homeless students reporting depression were more than twice as likely to binge drink as housed students reporting depression (41% vs. 19%).
  • School-age children and youth who are homeless are three times more likely to attempt suicide than students who live at home with a parent or guardian.
  • Homeless students who were the victims of bullying were much more likely to  report depression (63%) than those who were not bullying victims (34%).

Recognizing that the children, youth and families served by the public behavioral health care system in the District are primarily individuals of color, approaching improvements to our system as a matter of equity is fundamentally necessary. Children are disproportionately at risk for developing social and emotional problems when exposed to adverse childhood experiences, and living in an adverse environment with stressors without buffers such as adequate adult support. Stressors include poverty, abuse, neglect, homelessness, foster care; developmental disabilities or delays; and racism.

Current Challenges in the District’s Behavioral Health System

Improved access to behavioral health services is proven to be transformative for children and families, and can boost the long-term overall health and productivity of communities. Equal access to mental health is broadly acknowledged as a civil right, but this right is simply non-existent for many youth experiencing homelessness.

According to youth experiencing homelessness and their service providers, there is a lack of accessible, youth-friendly, and culturally competent mental health services throughout the District, which is also evidenced by data provided by the Department of Behavioral Health. In fact, behavioral health service access data received from DBH highlights that only 288 transition aged youth (16-24) experiencing homelessness received mental health services from DBH in 2022 despite close to 2,000 youth experiencing homelessness receiving services from the Department of Human Services.

Youth are often assigned to behavioral health services in different wards than where they reside, which is extremely burdensome if you are experiencing homelessness. Youth have indicated they are not met with culturally competent supports, which is exacerbated for youth who identify as LGBTQ+. This gap serves as a major barrier to youth achieving long-term stability and impacts the overall health and wellness of the District.

Policy Solution: Creation of a Traveling Behavioral Health Unit and Cost Breakdown 

The District needs to invest $1.7 million in funding to create a traveling behavioral health unit to bring culturally competent and trauma-responsive mental health supports to youth experiencing homelessness where they physically congregate. This investment will literally save people’s lives and give people the unrestricted right to reach their full potential. In addition, by addressing the mental health needs of youth experiencing homelessness now, we are saving the District money down the line.

This investment would increase access to mental health support for the youth who need it most. A mobile unit staffed by culturally competent clinicians trained in trauma-informed care would rotate among youth homelessness services programs to provide assessments, counseling, therapy, and medication management on a weekly basis.

With $1.7 million in funding, the traveling behavioral health unit would service approximately 188 youth of the 1,934 youth experiencing homelessness receiving services at DHS over the course of a year. Youth who reside in extended transitional housing and youth who sought services at drop-in centers but are not connected to emergency housing or transitional housing supports are the target population. The idea is increasing access to mental health supports with the help of other supportive programs, youth will begin to exit the system and transition into stable adulthood and the unit will help additional participants in future years.

By addressing the mental health needs of youth experiencing homelessness now, we are saving money in the future. With $1.7 million, the Department of Behavioral Health in partnership with community based organizations with be able to hire:

  • 10 provisionally licensed social workers with a caseload of 18-20 youth at a base salary of $75K
    • It is important that the client to clinician ratio does not exceed 1:20 to make treatment readily available to youth, ensure youth receive individualized treatment, and deter clinician burnout.
  • 2 independently licensed social workers to supervise clinicians at a base salary of $90K
  • 1 psychiatrist to administer medication as needed and provide medication management at a cost of $150K.
  • $1.48 million in administrative costs to support the employment of all employees of the unit.
    • Administrative costs will cover retirement, health insurance, and other benefits.

Conclusion 

Increasing access to mental health will not single-handedly end youth homelessness. Ending youth homelessness requires intentional investments in youth programs. Youth and young adults need access to low-barrier stable housing, supportive connections to caring adults, and access to mainstream services that will place them on a path to long-term success, including targeted educational and employment supports and accessible mental health supports.

Given the costs to those suffering from mental health disorders, which is exacerbated by lack of access to mental health supports, and the costs that spill over to society as a whole, it is important to consider ways that public investments can be made most effectively to improve overall outcomes. Currently, the behavioral health system is not meeting the needs of youth experiencing homelessness. We have heard from youth who indicate more needs to be done to increase access to mental health supports, paired with being met by culturally competent and trauma informed clinicians, a traveling mental health unit staffed by culturally competent and trauma-responsive clinicians will do just that. This is truly a matter of life and death.