As the United States faces a growing mental health crisis, a sweeping round of staffing cuts at the U.S. Department of Health and Human Services (HHS) has sparked deep concern among leading national mental health and substance use organizations.
In a rare joint statement in early April, 12 prominent advocacy groups warned that the dismantling of critical offices within HHS threatens to unravel years of progress in suicide prevention, overdose reduction and expanding access to mental health care.
The cuts — which affect key agencies like Substance Abuse and Mental Health Services Administration, the Centers for Disease Control and the National Institutes of Health — come at a time when more Americans than ever are seeking mental health support, and when federal leadership is essential to building a system that can meet the scale of the need. Without transparency about the changes or a clear plan for preserving life-saving services, experts fear this moment could mark a dangerous setback in the nation’s response to behavioral health challenges.
National data also shows a troubling connection between mental health and homelessness — one that’s long been understood by health professionals, social workers and advocates, but often overlooked in broader public conversations. According to the U.S. Department of Housing and Urban Development, an estimated 20 to 25 percent of people experiencing homelessness live with a serious mental illness such as schizophrenia, bipolar disorder or major depression. That’s four to five times higher than in the general population. But the connection isn’t as simple as mental illness causing homelessness.
Debbie Plotnick is the executive vice president of state and federal advocacy for Mental Health America, a national nonprofit dedicated to the promotion of mental health, well-being, and condition prevention. Plotnick says the experience of homelessness adds to and can sometimes be the cause of homelessness, as well as increases in anxiety, depression and particularly PTSD.
“It is a ‘chicken and egg’ situation,” Plotnick told The Contributor. “It does not matter if these conditions were present before someone became homeless. But being unhoused is in and of itself very demoralizing, frightening and traumatizing.”
The barriers to care are extensive. For someone without stable housing, keeping a therapy appointment or managing medications can be an uphill battle. Add in trauma, stigma and often criminalization, and the path to recovery becomes even more complicated.
“Depending on where an unhoused person is living there may be more or fewer barriers,” says Plotnick. “If there are street outreach teams, people can be (if they are willing) more easily connected to services and support. But being unhoused often means that people have lost their identification, which is often the first barrier to obtaining services. Once someone has services, which may include medication, life being unhoused often means medication may be lost or stolen. And it is very difficult to regularly get to appointments for treatment including obtaining medication. In some locations, street medical services may offer long-action medications, which some people want, some do not.”
SAMHSA emphasizes that the chaos and stress of homelessness worsen existing conditions and increase the risk for new ones. Depression, anxiety, post-traumatic stress — these are common in the lives of people sleeping in shelters, cars or other outdoor living spaces like encampments. For many, substance use becomes a form of coping.
“It is very difficult to be ‘clean and sober,’ facing the hardships of being unhoused,” Plotnick says. “Also, for people in recovery, returning to situations where substances are all around them makes maintaining sobriety harder.”
In recent years, most advocates in the mental health space have advocated for a Housing First approach — an evidence-based model that offers permanent housing with no preconditions, paired with access to voluntary mental health and substance use services, among other services. The idea is simple but powerful: secure housing first, then work on stability and healing and improved mental health.
“Life on the streets is hard on every aspect of a person’s health,” Plotnick says. “People almost always experience multiple health conditions. If you are sick, in pain, hurt or have chronic medical unmet medical needs, this impacts not only your physical health but worsens people’s mental health conditions.”
The CDC backs this up with data showing that housing instability contributes to higher suicide rates, more hospitalizations, and lower life expectancy. Homelessness is a public health crisis — one where prevention and intervention require sustained funding, cross-agency coordination, and a deep understanding of behavioral health as well as housing interventions.
Plotnick says increasing and maintaining House First policies has already shown to have a tremendous positive impact on people experiencing homelessness, Plotnick says.
“Policies or programs that require a person to be in treatment, or free from substance use disorder leaves people to compound all of their health needs,” she says. “But more than 30 years of research has shown that when people’s most basic needs such as food, and especially a safe place to live are met, then people are highly likely to enter treatment and grow and maintain wellness.”
The recent HHS staffing cuts could potentially derail the very little resources already dedicated toward addressing mental health and the housing crisis.
“These layoffs could undo years of work,” the joint statement reads, “and leave us with fewer tools to fight the overdose epidemic, expand access to treatment and support unhoused individuals with serious mental health needs.”