Denver’s Homelessness Emergency Highlights the Impact of Social Determinants in Perpetuating Trauma

Denver Mayor Mike Johnston declared a homelessness state of emergency on July 18 — his first act as the city’s new mayor. According to the U.S. Department of Housing and Urban Development, Denver ranks tenth in the nation for homelessness and third for sheltered homelessness — rates higher than Las Vegas and almost as high as San Francisco. This week, the Denver city council voted to extend the state of emergency to August 21 in light of new data indicating higher rates of homelessness than previously known. As of this writing, an estimated 9,065 people are homeless or sheltered homeless in the Denver metro area. “The homeless population has grown 31% over the year before. The number of those experiencing homelessness for the first time rose by 51%. The greatest percentage increases were among families, increasing 64%,” according to CBS News.

Homelessness and behavioral health disorders are strongly related. Addictive disorders and mental health conditions can lead people to become homeless or housing insecure, and these conditions can be the result of becoming homeless. However, evidence suggests that social determinants of health, including housing affordability and employment status, are the primary drivers of homelessness. This week's Dow Jones MarketWatch report indicates that rising rents are the leading causes of homelessness nationwide. The article cites Steve Berg, chief policy adviser at the National Alliance to End Homelessness, who says the "number of people who lose their housing and become homeless is [going] up faster than the number of people who are homeless and move back into housing." Berg goes on to say, “rent is the No. 1 issue…for 75 years, the long-term trend has been that the cost of modest rental housing has been going up faster than modest income."

The U.S. Department of Health and Human Services identifies “five domains” of social determinants of health, including economic stability, education access and quality, healthcare access and quality, neighborhood and built environment, and social and community context. Deficits in any of these domains can mean significant adverse life events for entire family systems, including medical problems, limited opportunities and upward mobility, mental and behavioral health disorders, housing insecurity, homelessness, trauma, suicidality, and more. As has been widely reported, social determinants of health, especially those linked to purposeful employment and a sense of community belonging, maybe a significant driver of the epidemic rates of suicidal ideation and deaths by affecting the nation in recent years — so-called “deaths of despair.”

As behavioral healthcare providers, we often treat clients who experience housing insecurity and homelessness, and subsequent trauma. Many experienced mental health professionals and policymakers know that traumatization resulting from financial setbacks and insecure housing can make drastically reduce the odds of rebounding.

Foundry Chief Clinical Officer Michael Barnes, Ph.D., suggests that mental health conditions and trauma can be precursors and results of homelessness, and acknowledging the role of trauma is vital to helping homeless individuals and families become safely rehoused. “As a medical community and public, we are just beginning to fully understand the profound role trauma plays in a multitude of health problems. People can become traumatized far more readily than we realize, our culture perpetuates and normalizes countless traumatic stimuli, and there is a general lack of treatment resources up to the task of treating traumatized people. When it comes to the issue of homelessness, we must understand that becoming homeless immediately reprioritizes our hierarchy of human needs and changes our patterns of behaviors and beliefs at a deep subconscious level. Homelessness is absolutely traumatizing, and trauma must be addressed, processed, and resolved before people are once again able to respond normally and restore emotional well-being.”

“Homelessness and addiction are inextricably linked. Regardless of the root cause of becoming homeless, there is almost always a mental health or substance use component involved. People who are otherwise healthy are less likely to become homeless because they oftentimes have the agency and cogency to seek available resources, though this is not always the case, and not enough resources are available. For many people, unfortunately, the experience of becoming homeless is a sea change so devastating that they feel the need to use substances to self-treat the symptoms of severe anxiety and depression. Many homeless people also use stimulants to stay awake for very long periods for fear of being victimized while asleep,” says Barnes.

Dr. Barnes believes that addressing the homelessness problem in Denver and elsewhere will benefit from trauma-oriented approaches. “We still do not have enough truly trauma-informed treatment providers for the housed patients seeking mental and behavioral healthcare. My hope is that policymakers anticipate the need for trauma-informed approaches to helping homeless people because without adequately treating their underlying trauma, other interventions are less likely to succeed, and they are more likely to end up back on the streets.”

Foundry Steamboat and other high-quality providers are beginning to assess client recovery capital to evaluate their prospects of successfully maintaining recovery and developing recovery-supportive lifestyles. The program instituted the Recovery Capital Index measure in 2022, which measures individualized social determinants of health and other extra-therapeutic factors to indicate advantages or potential areas that need to be addressed using available resources.

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