How and Why Do People Use Behavioral Health Services? A Qualitative Exploration of Service Use Among People Experiencing Housing Insecurity

People experiencing housing insecurity and homelessness are diagnosed with mental health and substance use–related conditions at higher rates than their stably housed peers and often engage with systems including housing and homelessness systems such as eviction prevention, emergency shelters, homeless outreach services, and transitional housing, health systems including emergency departments and criminal legal systems including police interaction and incarceration. This qualitative study’s aims are (1) to understand how people experiencing housing insecurity and homelessness access behavioral health services, including mental health and substance use-related care and (2) examine the role of social support, systems involvement, and previous treatment experiences in accessing or using these services. Thirty interviews were conducted with people experiencing homelessness or housing insecurity to learn about their experiences accessing and using mental health or substance use–related services, including the role of other service systems and social supports. A framework approach was used for analysis. The researchers identified five key themes related to use or non-use of services including personal networks as a conduit; housing situations as directly related to use of services; siloed systems; policies and procedures create barriers; and using services when there was a need. This study contributes to the literature by providing a more nuanced and in-depth understanding of factors related to use or non-use of mental health and substance use–related services among people experiencing housing insecurity and highlights the role that systems and social supports play, in addition to individual-level factors.