Homelessness data snapshot: Mental health, substance use, and homelessness in Canada

On this page

• Introduction
• Background
• Data
• Limitations
• Mental health, substance use, and other health conditions
• Demographic characteristics
  • Age
  • Gender
  • 2SLGBTQI+ identity
  • Indigenous identity
  • Former youth in care
  • Newcomers to Canada
  • Veterans
• Mental health, substance use, and homelessness experience
  • Overnight location
  • Chronic homelessness
  • Age of first experience of homelessness
  • Reasons for housing loss
• Key findings
• Annex A

Introduction

This report presents key findings about mental health and substance use among people experiencing homelessness in Canada, as observed through the 2020-2022 Nationally Coordinated Point-in-Time (PiT) Counts^{Footnote 1}. It includes an analysis of the prevalence of self-reported mental health and substance use issues among PiT respondents, as well as the experiences of homelessness among those affected by them.

Background

Previous research shows a greater incidence and prevalence of serious mental illness among individuals who are homeless compared to the general population.^{Footnote 2 Footnote 3} The correlation between housing insecurity and mental illness can be bidirectional. For some individuals, mental health issues can precede the onset of homelessness, as mental illness can negatively impact physical health, work, study, social interactions, and social and cognitive functioning.^{Footnote 4 Footnote 5} In many cases, mental health can be worsened with continued homelessness.^{Footnote 6} Similarly to the patterns seen with mental health and homelessness, there is evidence of greater incidence and prevalence of substance use among individuals who are homeless compared to the general population.^{Footnote 7} A better understanding of the characteristics and experiences of individuals struggling with mental health and substance use among Canada’s homeless population may inform policy and program development in the areas of harm reduction and recovery support. It may also present opportunities to enhance the accessibility and appropriateness of service delivery.

Data

Data used in this report were collected through the 2020-2022 PiT Counts, which surveyed over 26,000 people across 87 communities and regions in Canada to provide a one-day snapshot of homelessness. As a part of the survey, respondents were asked if they identified as having a mental health issue (e.g., depression, post-traumatic stress disorder, bipolar disorder) or substance use issue (e.g., tobacco, alcohol, opiates) at the time of the survey. Information about health challenges, including mental health and substance use issues, can be found in the full report.^{Footnote 8} Survey respondents were experiencing homelessness in different contexts, including shelters (40%), unsheltered areas (24%), transitional housing (11%), hotel or motel programs (9%), institutions of health or correctional systems (4%), and hidden homelessness, or staying temporarily with others because they had no place of their own (13%).

Limitations

There are certain limitations to consider when interpreting the results presented in this report. Since PiT Counts capture data regarding people experiencing homelessness on a single night, it is more likely to reflect individuals who are experiencing chronic homelessness and are facing complex barriers to exiting homelessness. Therefore, point-in-time data may overestimate the proportion of individuals experiencing homelessness who also struggle with mental health or substance use issues. Additionally, health conditions are self-reported, meaning that they do not definitively reflect clinical diagnoses and are therefore not necessarily limited by respondents’ ability to access healthcare. Conversely, responding to the question regarding health conditions was optional. Therefore, experiences of mental health issues and substance use issues may be underreported due to possible discomfort disclosing personal information, stigma, fear of discrimination, or lack of mental health awareness. Due to these multiple potential sources of bias in different directions, estimates of rates of mental health or substance use issues among people experiencing homelessness should be interpreted with caution. Furthermore, the survey data does not provide insight into the specific issues experienced by respondents, and does not take into account that respondents may experience more than one health condition from within the same category (e.g., a given person may simultaneously experience major depressive disorder and obsessive-compulsive disorder, or alcoholism and nicotine addiction, etc.).

Mental health, substance use, and other health conditions

During the 2020-2022 Point-in-Time Counts, health challenges were examined for the first time through the use of a new survey question that received responses from over 23,000 people (constituting an 87% response rate). A significant majority (85%) of these respondents reported having at least one health challenge. The most commonly reported health challenges were substance use issues (61% of respondents) and mental health issues (60% of respondents). For the purposes of this report, we analyze the population of respondents to the health question, broken down into sub-populations by reported mental health and substance use challenges. Taking into account the possibility of comorbidity – defined as the coexistence of multiple health conditions at the same time – these groups are represented as follows:

Figure 1. Proportion of responses, categorized by incidence of mental health and substance use issues (N=22,159)

Illnesses or medical conditions (40%), physical limitations (35%), and learning or cognitive limitations (33%) were comparatively less prevalent. However, respondents who reported experiencing at least one of these health challenges exhibited much higher rates of both mental illness and substance use. Experiencing an illness or medical condition was associated with a 33% greater likelihood of reporting a mental health issue and an 18% greater likelihood of experiencing a substance use issue. Experiencing a physical limitation was associated with an increased likelihood of reported mental health issues (27% greater) and substance use issues (20%). Experiences of learning and cognitive limitations were associated with the greatest increase in the likelihood of reported mental health issues (72% greater) and substance use issues (42%). These observed effects may indicate multimorbidity of health conditions, as well as the deleterious impacts of homelessness and housing insecurity on mental and physical well-being.

Demographic characteristics

Age

The prevalence of self-reported mental health issues declined with age. As shown in Figure 2, 67% of youth aged 13-24 reported experiencing mental health issues, followed by 63% of adults aged 25-49, 55% of older adults aged 50-64, and 40% of seniors aged 65 or older. Self-reported substance use issues were most prevalent among adults aged 25-49 (67% of whom reported experiencing substance use issues), followed by youth (56%), older adults (55%), and seniors (35%). Additionally, 47% of youth aged 13-24, 52% of adults aged 25-49, 39% of older adults aged 50-64, and 22% of seniors aged 65 or older reported having both mental health and substance use issues.

Figure 2. Proportion of survey respondents facing mental health and/or substance use issues, by age group

Gender

Gender-diverse people were more likely to experience mental health issues, which were reported by 83% of gender-diverse respondents, compared to 66% of women and 55% of men. Gender-diverse individuals were also more likely to experience substance use issues (66%), compared to men (62%), and women (57%). However, men were more likely to report substance use issues only (18%), compared to women (8%) and gender-diverse individuals (7%).

Figure 3. Proportion of survey respondents facing mental health and/or substance use issues, by gender identity

2SLGBTQI+ identity

Individuals identifying as 2SLGBTQI+ were more likely to report experiencing both mental health and substance use issues concurrently (59%) compared to those who didn’t identify as 2SLGBTQI+ (45%). Additionally, 19% of 2SLGBTQI+ individuals reported experiencing mental health issues only, compared to 12% on non-2SLGBTQI+ individuals. In contrast, only 8% of 2SLGBTQI+ individuals reported experiencing substance use issues only, compared to 15% of non-2SLGBTQI+ individuals. These patterns persisted across age groups, with particularly notable differences in rates of mental health issues without substance use issues among seniors (aged 65+) and youth (aged 13-24), which were respectively 78% and 71% more likely more likely to report solely mental health issues if they identified as part of the 2SLGBTQI+ community. This may speak to the unique experiences of mental health issues and homelessness among 2SLGBTQI+ youth, as well as the lingering traumatic impacts of systemic discrimination against and suppression of the 2SLGBTQI+ community, particularly those faced by older generations.

Indigenous identity

Respondents identifying as Indigenous were more likely to report substance use issues (69%) compared to non-Indigenous individuals (57%), while the rates of mental health issues were similar (61% for Indigenous and 59% for non-Indigenous). Additionally, Indigenous respondents were more likely to report experiencing both mental health and substance use issues concurrently (54%) compared to non-Indigenous respondents (43%). However, non-Indigenous respondents reported higher rates of mental health issues without substance use issues (15%), compared to Indigenous respondents (7%).

Former youth in care

People with lived experience being a youth in care (e.g., in foster care or a group home) were more likely to report experiencing both mental health and substance use issues concurrently ( (59%), compared to those who haven’t had experience as a youth in care (41%). However, respondents with and without past history as a youth in care were similarly likely to report substance use issues only (13% and 14%, respectively). Respondents without history as a youth in care were more likely to report mental health issues only (14%), compared to those with experience as a youth in care (10%).

It is important to consider the intersection of Indigenous identity and experiences of being a youth in care, an issue that persists to this day.^{Footnote 9} Just over half of Indigenous respondents report experiences in foster care, a group home, or residential school, versus 23% of non-Indigenous respondents. Indigenous and non-Indigenous respondents with experiences as a youth in care were similarly likely to report comorbid mental health and substance use issues (60% and 58%, respectively). In contrast, among those without an experience as a youth in care, Indigenous respondents reported higher rates of comorbidity than non-Indigenous respondents (47% versus 39%).

Newcomers to Canada

Newcomers to Canada (e.g., immigrants, refugees, asylum claimants) were less likely to report experiencing mental health issues (41%) compared to non-newcomers (62%). They were also less likely to report a substance use issue (31%) compared to non-newcomers (65%). Newcomers were less likely to identify as having both mental health and substance use issues concurrently (21%) compared to non-newcomers (50%). Additionally, newcomers (10%) were less likely than non-newcomers (15%) to report experiencing substance use issues without mental health issues. On the other hand, newcomers (20%) were more likely than non-newcomers (12%) to report experiencing mental health issues without substance use issues.

Figure 4. Proportion of survey respondents facing mental health and/or substance use issues, by newcomer status

Veterans

Veterans of the Canadian Armed Forces and RCMP reported rates of mental health issues (61%) and substance use issues (63%) that were not significantly different from those of non-veterans (59% of whom reported mental health issues and 60% of whom reported substance use issues). Similarly, the rate of comorbid mental health and substance use issues were reported between veterans as for non-veterans (49% compared to 46%).

Mental health, substance use, and homelessness experience

Overnight location

The incidence of mental health and/or substance use issues tended to be associated with differences in overnight location among those surveyed, shown in Figure 5. Individuals who reported neither mental health nor substance use issues were proportionally more likely to experience homelessness in shelters or hotels/motels.

Respondents who reported mental health issues were proportionally more likely to experience homelessness in transitional housing. Those who reported substance use issues were more likely to experience hidden homelessness.^{Footnote 10} Those who reported mental health issues, substance use issues, or both were also overrepresented in unsheltered locations^{Footnote 11} and in systems, including corrections, hospitals and treatment centres.

Figure 5. Proportion of survey respondents facing mental health and/or substance use issues, by overnight location

Chronic homelessness

The majority of individuals surveyed through PiT Counts (71%) report experiencing homeless for six months or more during the past year, one of the indicators of chronic homelessness.^{Footnote 12} It is important to note that rates of chronic homelessness will always be higher in point-in-time data than in data collected over the course of a year, since people experiencing chronic homelessness are more likely to be experiencing homelessness at a given time.^{Footnote 13}

Rates of reported comorbid substance use and mental health issues were higher among those experiencing chronic homelessness (49%) than not (42%). This appears to be a result of higher rates of substance use issues, in particular, as substance use issues were reported by 64% of those experiencing chronic homelessness, versus 54% of those who were not, whereas rates of mental health issues were similar regardless of chronic homelessness status (60% and 57%, respectively).

Age of first experience of homelessness

Experiences of homelessness earlier in life tended to be associated with greater incidence of mental health and/or substance use issues, shown by the gradual trend in Figure 6. People who had experienced homelessness prior to adulthood were disproportionately more likely to face comorbid mental health and substance use issues.

Figure 6. Proportion of survey respondents facing mental health and/or substance use issues, by age of first experience of homelessness

Reasons for housing loss

Survey respondents were asked about the reasons for their most recent housing loss (respondents could indicate more than one). The most frequently identified response was not having enough income (28%), followed by substance use issues (18%).

The majority of respondents selected only one reason for their most recent loss of housing. However, individuals living with mental health and/or substance use issues were more likely to indicate numerous reasons for housing loss. While only 8% of individuals with neither mental health nor substance use issues reported three or more reasons for housing loss, 18% of individuals with one or both of these health issues reported three or more reasons for housing loss. This may indicate a more nuanced and complex set of needs in order to restore and maintain housing among this population.

Reasons for housing loss are complex, with contributing factors that may be highly intersectional. It is important to note that facing a particular health condition and experiencing homelessness at the same time does not imply a causal correlation. Among respondents reporting mental health and/or substance use issues, 22% noted substance use issues as a reason for housing loss and 16% noted health issues as a reason for housing loss.

Respondents were similarly likely to cite financial or housing-related factors as reasons for housing loss, regardless of the presence or absence of mental health or substance use issues. Respondents that reported experiencing mental health issues were more likely to cite interpersonal factors (e.g., experiencing abuse, conflict, or family breakdown) as reasons for housing loss.

Key findings

Nearly three quarters (74%) of respondents reported experiencing issues with mental health and/or substance use. In total, 13% of survey respondents identified as having only mental health issue, 14% of survey respondents identified as having solely a substance use issue, and 47% of survey respondents identified as having both a mental health and substance use issues.

• Certain populations identified higher rates of comorbid mental health and substance use issues: Rates were generally higher among adults (aged 25-49) and respondents who identified as gender-diverse, 2SLGBTQI+, Indigenous, former youth in care, and non-newcomers. Demographic results are summarized in Table 1 (Annex A).  
• Rates of substance use issues were higher among those who experienced chronic homelessness over the past year (64% vs. 54%). Respondents who reported mental health issues reported rates of chronic homelessness similar to those who did not (60% vs. 57%).
• Early experiences of homelessness were associated with a greater incidence of comorbid mental health and substance use issues (56% among those who experienced homelessness before the age of 25), which declined among those whose first experience of homelessness occurred later in life.
• The most frequently identified reason for housing loss is insufficient income (28%), followed by substance use issues (18%). Individuals with mental health and/or substance use issues were more likely to report multiple reasons for housing loss, suggesting a more complex set of needs. However, financial or housing-related reasons for housing loss were reported equally, regardless of reported mental health and/or substance use issues.

Annex A

Table 1. Summary of demographic characteristics of people experiencing homelessness, by incidence of mental health and substance use issues

	Mental health issue only	Both mental health and substance use issues	Substance use issue only	Neither Mental Health nor Substance Use Issue
Youth (13-24)	20%	47%	8%	25%
Adult (25-49)	11%	52%	14%	23%
Older Adult (50-64)	14%	39%	16%	31%
Senior (65+)	18%	22%	12%	48%
Men	10%	45%	18%	28%
Women	17%	49%	8%	26%
Gender diverse	24%	59%	7%	11%
2SLGBTQI+	19%	59%	8%	14%
Non-2SLGBTQI+	12%	45%	15%	28%
Former Youth in Care	10%	59%	13%	18%
Non-Former Youth in Care	14%	41%	14%	31%
Indigenous	7%	54%	15%	24%
Non-Indigenous	15%	43%	13%	28%
Newcomers	20%	21%	10%	50%
Non-Newcomers	12%	50%	15%	23%
Veterans	12%	49%	15%	25%
Non-Veterans	13%	46%	14%	27%

• Copyright

  © 2024 His Majesty the King in Right of Canada as represented by the Minister of Housing, Infrastructure and Communities.

  Catalogue No. T94-60/4-2024E-PDF

  ISBN 978-0-660-74357-8