Little is known about the vulnerabilities and past experiences of unsheltered individuals or how they differ from individuals in shelters. This study adds to our understanding by analyzing new data from a survey (VI-SPDAT) given to homeless individuals across the United States. Health and behavioral health and trauma are significant contributing factors to loss of housing, particularly for unsheltered women. Unsheltered people continue to experience major and worsening health conditions while homeless. People with the longest experiences of homelessness, most significant health conditions, and greatest vulnerabilities are not accessing and being served by emergency shelters. Rather than receiving shelter and appropriate care, unsheltered people with major health challenges are instead regularly engaged by police and emergency services.
Although based upon analysis of more than 64,000 surveys, for a variety of reasons this data is likely not fully representative of the unsheltered or sheltered population. Nevertheless, this analysis provides the most comprehensive national picture of people experiencing unsheltered homelessness in the United States to date and compares their experiences with homeless individuals in shelters. While this study compares these two groups, it does not make causal claims. For example, while individuals who are sheltered report on average fewer health and mental health conditions, the data does not support a finding that shelter is the cause of improved health. In fact, it is just as likely that people who are unsheltered for long periods of time are those who cannot access shelter for a variety of reasons. The findings do reinforce the importance of stable housing as a social determinant of health and as essential for ending homelessness, for people in both groups.