Homelessness in the United States-A Problem We Can Solve

Introduction

I have encountered many people who perceive that the problem of homelessness in the United States has been getting worse. After a recent conversation, I realized how little I actually knew about homelessness. I decided to see what I could find out.

Contrary to my expectations, homelessness in the United States decreased significantly between 2012 and 2016, when it began increasing again; the availability of shelter and housing for the homeless has been increasing; and the majority of those who experience homelessness here are not permanently or persistently homeless, but, rather, are only temporarily homeless. However, homelessness remains a severe and persistent problem in the United States. And compared to many developed countries, the United States is not doing a good job of ameliorating homelessness.

Moreover, mental illness and/or substance abuse or dependency are not the primary causes of homelessness in the United States. Mental illness, chemical dependency, and other factors certainly do contribute to homelessness, in particular among the population that tends to be chronically homeless. But the most important factors affecting homeless are the absence of affordable housing and poverty.

Thus, the primary cause of temporary or transient homelessness is simply a lack of housing that people with low incomes can afford, so that when people who are poor but otherwise capable fall on particularly hard times, they cannot afford even the most modest housing and they are forced to shelter with friends or family, to take refuge in homeless shelters, or to live on the streets. (Such situations are often exacerbated by domestic abuse and/or lack of support systems.) The primary means of addressing such temporary homelessness is clear: create more affordable housing or ensure that everyone has sufficient income to be able to afford housing in the locations in which they reside. Obviously, however, achieving these goals presents a challenge.

The primary causes of chronic homelessness are more complex, but appear to be mainly a lack of affordable housing and/or poverty combined with mental illness and/or chemical dependency. Chronic homeless appears to be most effectively addressed by a “housing first” approach, the concentrates on getting people into long-term or permanent housing without preconditions such as drug or mental health treatment, while also making available social support services such as drug programs, mental health treatment, rent subsidies, and/or supplemental income.

The persistence of relatively high levels of homelessness in the United States might lead some to the conclusion that it cannot be effectively addressed. However, while homelessness is a global problem with which many countries struggle, the examples of countries that have very little homelessness show that it can be.

Overall Homelessness in the United States

The homeless population of the United States is generally characterized as consisting of three groups: temporarily homeless, episodically homeless, and chronically homeless. Here is how the U.S. Department of Health and Human Services (HHS) defines these groups:

• temporarily homeless — persons who experience only one spell of homelessness, usually short, and who are not seen again by the homeless assistance system;
• episodically homeless — those who use the system with intermittent frequency, but usually for short periods; and
• chronically homeless — those with a protracted homeless experience, often a year or longer, or whose spells in the homeless assistance system are both frequent and long.¹

In purely numerical terms (i.e., not expressed as a percentage of the population), overall levels of homeless in the U.S. (including all of these groups) were relatively high and relatively stable from 2007 to 2012, when they began to decline. Between 2012 and 2017, levels of homelessness in the U.S. declined significantly.² Since 2017, levels of homelessness in the U.S. have increased significantly, although they have not yet reached pre-2012 levels.³

Chronic Homelessness in the United States

Most people who are homeless in the U.S. at any time are only temporarily homeless, not chronically homeless. According to the U.S. Department of Housing and Urban Development (HUD), the share of all individuals experiencing homelessness who had chronic patterns of homelessness declined from 29 percent of all individuals experiencing homelessness in 2007 to a low of 22 percent in 2016. Since that time, the share of individuals with chronic patterns of homelessness has risen steadily and was 27 percent in 2020.⁴

There is considerable research supporting the conclusion that there are higher rates of mental illness and/or substance abuse among the chronically homeless.⁵ As HHS has summarized: “The presence of a disabling condition is almost universal in the population. These conditions involve serious health conditions, substance abuse, and psychiatric illnesses. The prevalence of a disabling condition runs as high as 85 percent having one of more of these chronic problems.” Thus, addressing the problem of chronic homelessness is particularly complex.

Shelter and Housing for the Homeless in the United States

HUD identifies six categories of shelter or housing for the currently or formerly homeless:

• SHELTER FOR HOMELESS PEOPLE — Emergency Shelter (ES): provides temporary or nightly shelter beds to people experiencing homelessness. Transitional Housing (TH): provides homeless people with up to 24 months of shelter and supportive services. Safe Haven (SH): provides temporary shelter and services to hard-to-serve individuals.
• PERMANENT HOUSING FOR FORMERLY HOMELESS PEOPLE — Rapid Rehousing (RRH): provides short-term rental assistance and stabilizing services to formerly homeless people. Permanent Supportive Housing (PSH): provides long-term housing with supportive services for formerly homeless people with disabilities, and often those with chronic patterns of homelessness. Other Permanent Housing (OPH): provides housing with or without services that is specifically for formerly homeless people but that does not require people to have a disability.⁶

Overall, the amount of shelter and housing for people who are currently experiencing homelessness, were homeless prior to finding housing through one of the permanent housing programs, or were threatened with homelessness has increased significantly since 2007. The total number of beds in all categories has increased from 611,292 to 939,569, an increase of 51 percent. Only the number of beds in the transitional housing category has declined over this period.⁷

However, the increase in the amount of housing available does not appear to have resulted in a substantial reduction in the percentage of the homeless population living on the streets. Government estimates indicate that at any given time the majority of homeless people in the United States are in shelters of some kind (i.e., not living on the street). But both overall homelessness and unsheltered homelessness have increased over the last several years.⁸

Homelessness and Poverty

One would expect a correlation between poverty and homelessness, and it is clear that poverty is an important factor in homelessness. As one author has summarized the evidence and consensus regarding poverty as a cause of homelessness:

[T]here is significant consensus within academic, policy-maker and practitioner circles that people with economic and other resources to draw upon can generally avoid homelessness even if they face other difficulties in life such as mental illness or addiction . . . . This view is borne out of research conducted over many years and in a wide range of contexts internationally . . . . In the Unites States, for example, Shinn (2010) notes that the fact that housing subsidies virtually eliminate family homelessness is proof that poverty is at the root of homelessness, for families in that context at least. Analysis conducted as part of the comprehensive five-year longitudinal ‘Homelessness Monitor’ confirms that the relationship is also clearly evident in the UK. It has confirmed that even during and in the wake of the recent recession homelessness has continued to be heavily concentrated within the poorest and most disadvantaged sections of the community whom lack the financial and social ‘equity’ that enable most people to endure personal crises without becoming homeless . . . .⁹

But it is not clear that there is a consistent, general correlation between poverty and homelessness on a national level, at least in the United States. In other words, homelessness does not necessarily respond directly to general economic conditions. The following table shows the percentage of people living below the then-current poverty level in the United States between 2007 and 2020:

In the United States, the percentage of people living in poverty increased between 2007 and 2010 (coinciding with the Great Recession), from 12.5 percent to 15.1 percent. It then decreased slowly but consistently to a low of 10.5 percent in 2020, rising again by one percent in 2020.¹⁰ This does not consistently track with the number of homeless. In particular, after declining for many years, the number of homeless began rising in 2016 and continued to rise through 2020, even though the poverty rate was decreasing most of that time.

Homelessness and Affordable Housing

Not surprisingly, other than poverty, the availability of affordable housing, or the lack thereof, appears to be the most important factor affecting levels of homelessness. In fact, at least in the United States, housing affordability may be a more important factor than poverty. This is suggested by comparing data regarding states with high housing costs but not particularly high levels of poverty with states that have high levels of poverty but not particularly high housing costs.

For example, the percentage of people living in poverty in Mississippi (18.1%) is almost twice that of California (11.0%) but its rate of homelessness is only about a fifth of California’s. Obviously, housing costs alone are not determinative, but there is an overall correlation between high housing costs and high levels of homelessness in the United States.

This conclusion is supported by other sources as well. Citing several analyses or studies, the United States Interagency Council on Homelessness (USICH) reached the following conclusion:

Taken together, these analyses help support the assessment that severe housing affordability challenges, limited supply, increasingly high rents and rent burdens on households, and low vacancy rates with tighter competition for units in many communities are helping to drive the increases in unsheltered homelessness reflected in the Point-in-Time count data in 2017 and 2018.¹⁴

The authors of a recently published book that studied causes of homelessness concludes that lack of affordable housing is the primary factor contributing to homelessness in the United States:

In Homelessness Is a Housing Problem, [the authors] seek to explain the substantial regional variation in rates of homelessness in cities across the United States. . . . Using accessible statistical analysis, they test a range of conventional beliefs about what drives the prevalence of homelessness in a given city — including mental illness, drug use, poverty, weather, generosity of public assistance, and low-income mobility — and find that none explain the regional variation observed across the country. Instead, housing market conditions, such as the cost and availability of rental housing, offer a far more convincing account.¹⁵

However, as noted above, there clearly is evidence of a connection between poverty and homelessness. And, obviously, poverty is not negatively correlated with homelessness; in other words, poverty does not reduce homelessness. Moreover, there is a definitional issue in ascribing homelessness to the lack of affordable housing rather than poverty: what is “affordable” housing and how is it made affordable? For example, is a housing subsidy a form of supplemental income that alleviates poverty and hence reduces homelessness, or is it way of making housing affordable and thereby reducing homelessness? Therefore, in considering what is necessary to reduce homelessness, it is not particularly useful to distinguish between the availability of affordable housing and poverty. The central concern is how stable housing can be made accessible to people who do not have the income or resources to afford it.

Poverty and Lack of Affordable Housing — Not Mental Illness, Addiction, or other Issues — Appear to Be the Central Causes of Homelessness

In my experience, many people believe that drug dependency, or mental illness are the primary causes of homelessness. However, poverty and the lack of affordable housing and poverty, taken together, appear to be the most important factors in creating homelessness. This conclusion is supported not only by the data above, but by studies and experiential information regarding homelessness.

For example, a study comparing homelessness and the nature of homeless populations in the United States and Denmark concluded as follows:

Whilst recognising that shelter use does not measure the total extent of homelessness, our analysis — based on highly comparable data and research from Denmark and the USA — indicate that the homeless population in a relatively extensive welfare system as in Denmark is not only smaller but also more greatly consists of individuals with complex support needs such as mental illness or substance abuse problems than in the USA. The overall annual prevalence of shelter use in Denmark is only about one-third that in the USA. . . . The widespread income poverty and lack of social housing for poor people in the liberal welfare system in the USA produces a much larger extent of homelessness affecting wider segments of poor households than in the Scandinavian welfare system, with its higher level of income equality, mass-scale subsidised public housing, and more extensive social support systems.¹⁶

Citing data on rental costs and the number of renters who must devote more than 50 percent of their income to rent, the National Law Center on Homelessness and Poverty has concluded that “insufficient income and lack of affordable housing are the leading causes of homelessness.”¹⁷ In its 2014 report on hunger and homelessness, the United States Conference of Mayors noted: “City officials identified lack of affordable housing as the leading cause of homelessness among families with children. This was followed by unemployment, poverty and low-paying jobs.”¹⁸

There are certainly factors influencing homelessness other than poverty and housing affordability, including mental illness, substance abuse, childhood and/or domestic abuse, veteran status, and the presence or lack of familial or informal social support systems. However, it appears that the lack of access to affordable housing and/or the lack of income sufficient to afford the available housing account for the majority of those who experience homelessness in the United States.

However, there is at least one confounding fact that has be considered in reaching this conclusion. As noted above, the amount of permanent housing and shelter housing available to the homeless has apparently increased significantly since 2007. But, as also noted above, while homelessness declined from 2007 to 2017, it has since increased significantly, even though housing availability also increased during that time.

One explanation for the increase in homelessness from 2017 to 2020 despite the increase in the availability of housing for the homeless during that period may be this: If substantial increases in poverty or the cost of housing relative to income occurred during this period, the increase in the homeless population may have outstripped the increase in the supply of housing. However, as shown above, the poverty rate in the United States from 2017 to 2020 was lower than in prior years. And it appears that the percentage of households who were renting and paying more than 30 percent of their income for rent declined between 2012 and 2022.¹⁹

Thus, it is not entirely clear why the homeless population in the United States increased between 2017 and 2020, despite the increasing availability of housing for the homeless during this period. However, it is likely that the number of housing units made available for the homeless during this period simply was not adequate to address the levels of homelessness created by overall poverty and lack of affordable housing.

Homelessness and Crime

Before discussing solutions to homelessness, I want to address one of the principal objections to providing more housing for the homeless. Residents of areas where such housing is to be located are often concerned that that homeless populations are more likely to commit crimes, and therefore providing housing for them will increase local crime. It’s important to address this concern, because opposition to providing housing for the homeless (either by subsidizing existing housing stocks in order to house the homeless or by building more housing that can be afforded by people whose incomes are sufficiently low that they become homeless) is an important¾and perhaps the most important¾obstacle to addressing and reducing homelessness.

Although there is a common belief that the presence of homeless persons produces an increase in crime, there does not appear to be a clear correlation between homelessness and the commission of crimes other than “status” crimes related to being homeless.

For example, one study tracked people who were homeless at the commencement of the study to examine whether street homelessness, sheltered homelessness, and the severity of psychological symptoms predicted non-violent and violent crime. It found that both sheltered and unsheltered homelessness and psychological symptom severity predicted increases in non-violent crime, and that while sheltered homelessness and symptom severity predicted increases in violent crime, street homelessness did not.²⁰ This suggests that factors other than homeless status (particularly the severity of mental illness) may be responsible for violent crime by the homeless. As the lead author of the study remarked, in an article summarizing the study: “Criminal activity isn’t a staple characteristic of these people. It may be more accurate to think of them as people struggling to get by.”²¹

Another study supports the conclusion that crime related to homelessness consists predominantly of “status” crimes, not crimes in which people are victimized by the homeless. The abstract of the study summarizes its findings:

Background: It is well established that homelessness is associated with crime. Previous research suggests that this association is at least partially secondary to homeless status offenses (e.g., vagrancy and trespassing resulting from behaviors intrinsic to homelessness). To investigate this relationship, this study compared criminal behavior in a homeless population under housed and unhoused conditions. . . .

Results: At baseline, homeless status offenses were the most frequently reported charges and were the only type of crime for which charges were incurred more frequently in the homeless condition. Over the 2-year follow-up period, recent crime was consistently higher in groups who had been homeless relative to groups who had been housed, and crime rates fell after obtaining housing.

Conclusions: These findings suggest that homelessness itself is linked to criminal behavior through homeless status offenses. Negative effects of arrest and incarceration on housing acquisition warrant consideration of alternative legal system interventions to break the cycle of homelessness.²²

These studies indicate that the increase in crime associated with homelessness is largely a result of increased interactions between law enforcement agencies and the homeless related to the status of persons as homeless, rather than crimes committed by the homeless against others. Thus, concerns about the possibility of crimes committed by formerly homeless persons who are housed in a community do not justify refusing to provide housing.

Ameliorating Homelessness

There have been numerous approaches to reducing homeless over the years, and debate over the efficacy of various approaches continues. However, the solutions to temporary homelessness¾which accounts for the majority of people who are homeless in the United States at any one time¾are obvious, and at least a loose consensus has appeared with respect to how to treat chronic homelessness.

First, the solution to temporary homeless is to ensure access to affordable housing (i.e., housing affordable even those whose incomes and resources are so limited that they can become homeless), or to ensure that everyone has an income sufficient to be able to afford the housing that is available to them. In locations in which there is adequate vacant housing, measures such as subsidies or supplemental income may be sufficient to address homelessness. In areas in which there is a severe shortage of housing, building additional, affordable housing may be necessary.

The solution to chronic homeless is more complicated. In general, however, it consists of a combination of shelters with programs designed to transition homeless to people to free or low-cost permanent housing, more such housing, and structured constellations of services designed to assist the homeless with mental illness, chemical dependency, physical disability, lack of employment, lack of transportation, and other issues.

In particular, over the last 20 years or so, a consensus has emerged, at least in the United States, that “Housing First” programs are the most effective in addressing chronic homelessness. As described by HUD, “Housing First is an approach to quickly and successfully connect individuals and families experiencing homelessness to permanent housing without preconditions and barriers to entry, such as sobriety, treatment or service participation requirements. Supportive services are offered to maximize housing stability and prevent returns to homelessness as opposed to addressing predetermined treatment goals prior to permanent housing entry.”²³ There is extensive research supporting the efficacy of this approach.²⁴

Of course, partial solutions already exist, but the problem of homeless persists. I am aware of the obstacles to the implementation of additional solutions. But the obstacles are political rather than practical. The United States as a whole, or any of the individual states, can, if it wishes, substantially ameliorate the problem of homelessness.

That this is true is demonstrated by the fact that other countries have succeeded in largely eliminating or greatly reducing homelessness. For example, In 2022, Japan, with a population of about 124 million,²⁵ had a total homeless population of only 3,448.²⁶ In other words, as recognized by the Organisation for Economic Co-operation and Development (OECD), Japan’s homelessness rate is essentially zero.²⁷ According to the OECD, in 2020 Spain had a homeless rate of .05%, less than a third of the homeless rate in the United States that year (.18%).²⁸ Even Costa Rica has a much lower rate of homelessness (.07%) than the United States.²⁹

There will, no doubt, always be a minimal number of people who will remain homeless, either due to a combination of poverty and intractable mental illness or other disabilities, or merely out of choice. However, this segment of the homeless population is unquestionably very small. If a person is so disabled that they can be demonstrated, by clear and convincing evidence, to constitute a danger to others or to themselves, they can be involuntarily committed to a treatment facility.³⁰ If they are not, an effective housing and treatment program will probably be able to get them off the street. And the number of people who are capable and competent but choose to be homeless is probably so small that it does not present a meaningful public health or social policy concern.

Conclusion

The majority of the homeless are impoverished victims of circumstance. They are readily capable of becoming permanently housed. The resources required to house them are not extraordinary. As of September, 2022, the average rent for a two-bedroom unit in the United States was about $2,000/month.³¹ In 2020, the number of people in the United States who experience homelessness was about 580,000. The annual cost of housing this number of people would be about $13.92 billion. This is a substantial amount, but it’s a tiny amount of total federal and state governmental budgets. Of course, it’s an oversimplification of the cost of solving the problem of homeless, but it suggests that a solution is not in any way beyond our means. In other words, to the degree we consider homelessness to be a problem — as we should — it is a problem we can solve.

References

[1] U.S. Dept. of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, Ending Chronic Homelessness: Strategies for Action (2003). See https://aspe.hhs.gov/reports/ending-chronic-homelessness-strategies-action-1#2f1.

[2] The period of 2007–2020 is used because this is the period during which the U.S. Department of Housing and Urban Development (HUD) has been systematically collecting data on homelessness.

[3] 2020 Annual Homeless Assessment Report (AHAR) to Congress. The AHAR is based on the Point-in-Time Count published by U.S. Department of Housing and Urban Development. The Point-in-Time Count, or PIT Count, is an annual survey of homeless individuals in the United States conducted by local agencies called Continuums of Care (CoCs) on behalf of the United States Department of Housing and Urban Development. See https://www.huduser.gov/portal/sites/default/files/pdf/2020-AHAR-Part-1.pdf. See also https://en.wikipedia.org/wiki/Point-In-Time_Count.

[4] 2020 AHAR. Note that HUD defines chronically homeless individuals and families slightly differently. “Chronically Homeless Individual refers to an individual with a disability who has been continuously homeless for one year or more or has experienced at least four episodes of homelessness in the last three years where the combined length of time homeless on those occasions is at least 12 months. Chronically Homeless People in Families refers to people in families in which the head of household has a disability and has either been continuously homeless for one year or more or has experienced at least four episodes of homelessness in the last three years where the combined length of time homeless on those occasions is at least 12 months.” Ibid. See https://www.huduser.gov/portal/sites/default/files/pdf/2020-AHAR-Part-1.pdf.

[5] See, e.g., Kuhn, R., & Culhane D., Applying cluster analysis to test a typology of homelessness by pattern of shelter utilization: results from the analysis of administrative data. American Journal of Community Psychology. 26(2), 207–232 (1998), available at https://pubmed.ncbi.nlm.nih.gov/9693690/; Kertesz, S., Larson, M.J., Horton, N., Winter, N., Saitz, R., & Samet, J., Homeless chronicity and health-related quality of life trajectories among adults with addictions, Medical Care (2005), available at https://irasilver.org/wp-content/uploads/2011/08/Reading-Homelessness-Nino-Loya-Cuevas.pdf; Nino, M., Loya, M., & Cuevas M., Who are the Chronically Homeless? Social Characteristics and Risk Factors Associated with Chronic Homelessness, West Texas A&M University (2020), available at https://irasilver.org/wp-content/uploads/2011/08/Reading-Homelessness-Nino-Loya-Cuevas.pdf.

[6] See 2020 AHAR, United States Dept. of Housing and Urban Development, https://www.huduser.gov/portal/sites/default/files/pdf/2020-AHAR-Part-1.pdf.

[7] See 2020 AHAR, United States Dept. of Housing and Urban Development, https://www.huduser.gov/portal/sites/default/files/pdf/2020-AHAR-Part-1.pdf.

[8] See 2020 AHAR, Exhibits 1.1 and 6.1 above. Note that the AHAR defines “Sheltered Homelessness” as referring to “people who are staying in emergency shelters, transitional housing programs, or safe havens.”

[9] Johnsen, S. & Watts, B. 2014, Homelessness and poverty: reviewing the links, Heriot-Watt University, citing Parsell, C. & Marston, G. (2012) Beyond the ‘at risk’ individual: housing and the eradication of poverty to prevent homelessness, Australian Journal of Public Administration, 71(1), pp. 33–44; Quilgars, D., Johnsen, S. & Pleace, N. (2008) Youth Homelessness in the UK: a decade of progress? (York, Joseph Rowntree Foundation); Anderson, I. & Christian, J. (2003) Causes of homelessness in the UK: A dynamic analysis, Journal of Community & Applied Social Psychology, 13(2), pp. 105–118; Shinn, M. (2010) Homelessness, poverty, and social exclusion in the United States and Europe, European Journal of Homelessness, 4, pp. 19–44; and Fitzpatrick, S., Pawson, H., Bramley, G. & Wilcox, S. (2012c) The Homelessness Monitor: England 2012 (London, Crisis). https://pure.hw.ac.uk/ws/portalfiles/portal/7467281/Homelessness_Poverty_FullReport.pdf

[10] See Poverty in the United States: 2021, United States Census Bureau, https://www.census.gov/library/publications/2022/demo/p60-277.html.

[11] U.S. News & World Report, Affordability Rankings, https://www.usnews.com/news/best-states/rankings/opportunity/affordability (a low number represents relatively good affordability, a high number reflects poor affordability). Because the housing affordability ranking is based on median housing prices compared against median family incomes, it omits rental costs and thus provides only a very coarse measure of housing affordability.

[12] Poverty in the United States: 2021, United States Census Bureau, https://www.census.gov/content/dam/Census/library/publications/2022/demo/p60-277.pdf.

[13] 2020 Annual Homeless Assessment Report (AHAR) to Congress, United States Dept. of Housing and Urban Development, https://www.huduser.gov/portal/sites/default/files/pdf/2020-AHAR-Part-1.pdf.

[14] The Importance of Housing Affordability and Stability for Preventing and Ending Homelessness, United States Interagency Council on Homelessness (May 2019), https://www.usich.gov/resources/uploads/asset_library/Housing-Affordability-and-Stablility-Brief.pdf.

[15] G. Colburn & C. Aldern, Homelessness Is a Housing Problem: How Structural Factors Explain U.S. Patterns, University of California Press, March, 2022.

[16] L. Benjaminsen and S. Bastholm Andrade, Testing a Typology of Homelessness Across Welfare Regimes: Shelter Use in Denmark and the USA Housing Studies, 2015, Vol. 30, №6, 858–876, http://dx.doi.org/10.1080/02673037.2014.982517.

[17] Homelessness in America: Overview of Data and Causes, National Law Center on Homelessness & Poverty, https://homelesslaw.org/wp-content/uploads/2018/10/Homeless_Stats_Fact_Sheet.pdf.

[18] Hunger and Homelessness Survey: A Status Report on Hunger and Homelessness in America’s Cities, 2014, United States Conference of Mayors, https://www2.cortland.edu/dotAsset/655b9350-995e-4aae-acd3-298325093c34.pdf.

[19] “Rental affordability declined from 2001 to 2017. In 2017, 48 percent of renter households were rent burdened — that is, they paid over 30 percent of income for rent — which is 6 percentage points higher than in 2001.” United States General Accounting Office, RENTAL HOUSING¾As More Households Rent, the Poorest Face Affordability and Housing Quality Challenges (May 2020), see https://www.gao.gov/assets/gao-20-427.pdf. “Over 40% (19 million) of renter households in the country spent more than 30% of their income on housing costs during the 2017–2021 period, according to new American Community Survey (ACS) 5-year estimates released today by the U.S. Census Bureau. Households spending more than 30% on housing costs, including rent or mortgage payments, utilities, and other fees, are considered housing cost burdens according to the Department of Housing and Urban Development’s definition of affordable housing.” United States Census Bureau, More Than 19 Million Renters Burdened by Housing Costs, Dec. 8, 2022, see https://www.census.gov/newsroom/press-releases/2022/renters-burdened-by-housing-costs.html.

[20] Homelessness, mental illness, and criminal activity: examining patterns over time, Sean N Fischer 1, Marybeth Shinn, Patrick Shrout, Sam Tsemberis, PMID: 18956238 DOI: 10.1007/s10464–008–9210-z, https://pubmed.ncbi.nlm.nih.gov/18956238/.

[21] See https://www.apa.org/monitor/2009/12/violence.

[22] A longitudinal study of housing status and crime in a homeless population, Barbara Burton, David E Pollio, Carol S North, PMID: 30372505, https://pubmed.ncbi.nlm.nih.gov/30372505/.

[23] United States Department of Housing and Urban Development, Housing First in Permanent Supportive Housing. See https://files.hudexchange.info/resources/documents/Housing-First-Permanent-Supportive-Housing-Brief.pdf.

[24] U.S. Department of Housing and Urban Developments, The Applicability of Housing First Models to Homeless Persons with Serious Mental Illness (20017). See https://www.huduser.gov/portal/publications/hsgfirst.pdf; Peng, Y, et al., Permanent Supportive Housing with Housing First to Reduce Homelessness and Promote Health Among Homeless Populations With Disability: A Community Guide Systematic Review, J. Public Health Management Practice (2020), available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8513528/; Aubry, T., et al., Effectiveness of permanent supportive housing and income assistance interventions for homeless individuals in high-income countries: a systematic review, The Lancet (2020), available at https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30055-4/fulltext; Stergiopoulos, V., et al., Long-term effects of rent supplements and mental health support services on housing and health outcomes of homeless adults with mental illness: extension study of the At Home/Chez Soi randomised controlled trial, Lancet (2020), available at https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(19)30371-2/fulltext; O’Campo, P., et al., How did a Housing First intervention improve health and social outcomes among homeless adults with mental illness in Toronto? Two-year outcomes from a randomised trial, BMJ Open (2016), available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5030577/.

[25] United States Census Bureau, see https://www.census.gov/popclock/world/ja.

[26] See https://www.nippon.com/en/japan-data/h01323/.

[27] OECD — Social Policy Division — Directorate of Employment, Labour and Social Affairs, Homeless Population, see https://www.oecd.org/els/family/HC3-1-Homeless-population.pdf.

[28] OECD — Social Policy Division — Directorate of Employment, Labour and Social Affairs, Homeless Population, see https://www.oecd.org/els/family/HC3-1-Homeless-population.pdf. It is important to note, as the OECD report does, that there is no uniform definition of homelessness. The definitions of most OECD countries are more inclusive than that used in the United States, which affects the reported rates.

[29] OECD — Social Policy Division — Directorate of Employment, Labour and Social Affairs, Homeless Population, see https://www.oecd.org/els/family/HC3-1-Homeless-population.pdf.

[30] See, e.g., Fariba, K., & Gupta, V., Involuntary Commitment, StatPearls Publishing (2022), available at https://www.ncbi.nlm.nih.gov/books/NBK557377/.

[31] See https://www.rent.com/research/rent-report-september-2022/.