Northwest Michigan
Coalition to End Homelessness
Understanding Homelessness
Systemic factors often determine success
Homelessness among adults is a spectrum, not a single condition. It includes people living on the streets (unsheltered), those staying in shelters, and individuals who are couch-surfing or otherwise unstably housed. Each form reflects different levels of exposure to risk and varying access to safety, privacy, and basic services. In examining these experiences, it’s important to recognize how systemic factors—like shortages of affordable housing, gaps in mental health and physical health care, and economic instability—shape whether someone moves from temporary displacement to persistent chronic homelessness.
Housing as a foundation, then support
Effective responses center on housing as a foundation, paired with flexible, person-centered support. Approaches like Housing First prioritize immediate, permanent housing without prerequisites, then connect people to voluntary supports such as health care, case management, disability services, and substance-use treatment as desired. Interventions should address both the housing need and underlying disabilities, including access to disability benefits, continued medical and mental health care, and supports for daily living. Preventing relapse into chronic homelessness requires coordinated systems—housing subsidies, scalable supportive housing options, and community integration—so individuals who who have experienced long periods of homelessness and disabilities can achieve stability, dignity, and better health outcomes.
Focus on Chronic Homelessness
Defined as long-term instability with disabling condition(s)
When we talk about chronic homelessness, we’re focusing on the segment that has endured long-term instability. By most definitions, chronic homelessness means experiencing homelessness for 12 months or more in total, or having at least four episodes of homelessness in the past three years with a cumulative duration of 12 months or more, and having a disabling condition. Among this group, disabilities—whether physical, mental health, cognitive, or substance-use-related—are common, and they often interact with poverty, social isolation, and limited access to consistent health care. Chronic homelessness is thus not simply a lack of housing; it’s the result of multiple, reinforcing barriers that make it hard to obtain and maintain a stable home.
Higher risk of violence and past trauma creates distrust of others and the 'system'
Chronic homelessness compounds vulnerability in ways that go beyond the lack of a permanent address. People who have been unhoused for extended periods often face heightened exposure to violence and crime—on the streets, in shelters, or in abandoned buildings. They may be targeted for theft, assault, or exploitation, and avoidance of public spaces or confrontation with authorities can limit access to help. Trauma from these experiences can worsen mental health symptoms, disrupt sleep and daily functioning, and erode trust in systems that could provide safety and support. The result is a cycle where fear and incident exposure increase isolation, reduce social connections, and make it harder to seek or accept assistance.
Harsh living conditions create cycle of deteriorating health and higher mortality rates
Health outcomes tend to be markedly worse for chronically homeless adults, with life expectancy significantly shorter than the general population. They experience a higher burden of chronic physical illnesses (such as cardiovascular disease, diabetes, and infectious diseases), compounded by limited access to continuous medical care, medications, and preventive services. Mental health conditions and substance use disorders are common in this group and often interact with poverty and unstable living conditions, leading to frequent ER visits, preventable hospitalizations, and higher mortality from both natural and preventable causes. The combination of harsh living conditions, inadequate shelter, and delayed or fragmented care contributes to a cycle of deteriorating health and increasingly complex needs.
