Barriers & Challenges to Receiving Help

 Homeless Street Outreach 

Barriers and Challenges to Receiving Help

Part 2 of our 3-Part Series By: N. Lunsford 07/25/2026

In this, the second of the three informative articles, we attempt to inform, dispel myths and bring awareness to our community about homelessness and what is happening in our own backyard.

 We hope to broaden knowledge about some of the barriers to services, and what can cause some unhoused people to remain homeless, fail to reach out for help and reasons they may experience denial of services.

You may be surprised at some of the challenges faced by those seeking help.

When we think of homelessness or see an unhoused person on the streets, we may think things like “There are tons of services and nonprofits to help them! They just don’t want it.”  Or maybe, “I’ve seen that guy for years, he will always be homeless” Or, worse yet “A lot of them want to be homeless to live off taxpayer money and get everything for free!”

There is little freedom in homelessness.

There is great dependency to meet every need, from toilet paper to food to medical care.

Barriers and Challenges:

In our work and Street Outreach experiences, the most prevalent barriers to receiving services are:

• Lack of state Id. Almost all agencies in our area require a state ID at intake to receive services.
• Lack of a street address to obtain a state ID.
• Lack of supporting documentation like a social security card or birth certificate, again - almost impossible to acquire without use of a street address or state ID.
• Substance use disorder (a/k/a addiction)
• Mental Illness
• Negative history with the agency. They may have left the program early or did not follow the rules.
• Whether an ESA (Emotional Support Animal) or not, the unhoused cling to their pets and will decline services if they have to leave their pet behind. They hold a strong emotional tie to the pet, which is an avenue to not only receive love, but to give it. Many service providers are not equipped to board, house or allow a pet inside their facility.
• Listed as non-compliant for by an agency for rule violations, or infractions, such as not returning a phone call in a day, or pushing back on stringent policies that do not meet their desired goals.
  • For example, one program participant was in the last semester of college to complete a degree, was newly sober and willing to work part time, but not willing to quit college. They were told they had to work at a liquor store full time (the job sourced by the service provider) if they wanted to remain housed in the transitional shelter and move on to permanent housing. The program participant, wanting control over their future, declined, and was removed from the program, because they wanted to finish their college degree while working part time, and remain sober, and they were labeled “non-compliant.”

High Barrier vs Low Barrier assistance options:

There are different levels of help given by nonprofits and service providers. The level of help from any given agency is based on internal policy, and the population served. For example, some agencies focus on Veteran’s, others on women and children, others on recently released inmates, and for others the focus lies with those in addiction recovery and sober living.

As the front-line engagement, and the “first responder” to a homeless individual, homeless Street Outreach programs commonly serve all of these populations.

You may remember, from our first article, “Street Outreach & The Importance of:

Meeting Them Where They Are” the job of Street Outreach is to connect the individual to the appropriate and applicable service providers and help.

 There are three types of service providers and shelter services:

High Barrier, Low Barrier, and No Barrier

 High Barrier Services and/or Shelter:

• Entry requirements: Guests must meet certain conditions before being accepted into shelter services:
  • Have a state ID,
  • Prove 30-90 days of county/town residency, this varies by service provider.  
  • Pass a legal background check, (even convictions over 10 years old may cause denial of services)
  • Sobriety,
  • Program participation,
  • Religious services attendance
• Restrictions: May limit activities, movement, or access to certain services until requirements are met.
• Seeking employment as a requirement.
• It aims to create a safe, controlled environment by setting clear standards.
• Encourages participation in recovery programs.
• Less flexible: Often used for specific populations or programs, rather than as a general emergency shelter for all homeless individuals (muni.org/Departments/Assembly/sitesassets.com)
• Many homeless people (about 40%) cannot meet these requirements, leaving them without shelter (Community Column: T.E.A.M (Together Every Agency Matters) — The high-barrier vs. low-barrier sheltering debate: By Richardson October 27, 2024)

 Low Barrier Services and/or Shelter:

• According to the National Alliance to End Homelessness, low barrier shelter services emphasize immediate access to shelterby lowering barriers to entry, ensuring that individuals can access shelter without stringent requirements.
• According to both the National Alliance to End Homelessness and the Lawinsider.com, low barrier shelter is defined as “an emergency shelter that does not require clients to meet certain criteria for entry.”
• No 30–90-day proof of residency in a specific county, city or town,
• No Criminal background checks (may decline services due to certain felonies, violent crimes, or sexual offender convictions regardless of how old the convictions may be)
• No: income verification, program participation, sobriety, or state identification.
• Focus on harm reductionand inclusivity, recognizing that homeless people have complex, intersecting needs

No Barrier Services and/or Shelters:

• No barrier services, such as Steven’s Home Street Outreach, provide immediate, unconditional accessto emergency hotel shelter and support, (the hotel requires an ID from any state – but this is not a Steven’s Home requirement) providing crucial emergency and immediate help with the intention to connect to partnering service providers for long‑term stability.
• No entry requirements: Program participants are not required to:
  • Provide identification.
  • Prove residency.
  • Be sober.
  • Abstain from certain behaviors, or
  • Follow strict rules about activities like working toward recovery. 
• No barrier help provides immediate access: Designed for people in desperate or urgent need, such as homelessness, extreme weather, or other emergencies like a medical or mental health crisis.
• No barrier help focuses on survival: The priority for Street Outreach is to keep people alive, safe and warm, rather than enforcing abstinence or behavioral standards as we connect to resources and services the program participant tells us they want.

• All populations – all inclusive: Because there are no rules, no barrier service providers do not focus on a specific person or area of need.

• Allow access to emergency shelter services during severe heat temperature advisories, blizzards, or other disasters.

In our county, when the person who does not meet requirements of an emergency or transitional shelter services they are referred to out of county low or no barrier service providers. This can be damaging when removing a person from their social circle where they feel safe and secure.

The International Journal of Social Psychiatry documents that “Homeless individuals face unique challenges when transferred out of their city or county for treatment (or shelter services) which are linked to higher rates of treatment drop-out or program noncompliance.

Research shows that anti-social personality disorder is one of the most common personality disorders among the homeless, with prevalence rates ranging from 4% to 57% depending on the study”. (Personality and Attachment Disorder in the Homeless: A systematic review Andreia Neves Horácio1, António Bento2 and João Gama Marques1, International Journal of Social Psychiatry 2023, Vol. 69(6) 1312 –1326 © The Author(s) 2023(

HUD does not require these restrictions listed in High and Low Barrier services, and HUD funded shelters are given standards and guidelines to follow.

 “Choosing not to serve people with a criminal record with CoC or ESG Program funds is not consistent with a Housing First approach. ESG and CoC recipients are allowed flexibility in designing their programs, which means they have the discretion to establish their own policies regarding individuals with criminal histories and sex-offenders.

However, HUD encourages providers to not exclude or deprioritize households on the basis of criminal history, with the exceptions of restrictions imposed by federal, state, or local law or ordinance (e.g., restrictions on serving people who are listed on sex offender registries). (hudexchange.info/homelessness-assistance/coc-esg-virtual-binders/coc-esg-additional-requirements/fair-housing-and-equal-access/criminal-history/)

Substance Use Disorder (a/k/a Addiction)

According to the most recent 2024 HUD Point-in-Time (PIT) count data, and the 2024 Annual Homelessness Assessment Report (AHAR) which can be difficult to accurately collect (2025 PIT data has not been published yet) 50%-80% of homeless have no substance or alcohol substance use disorder.

• Nationally, a broad 20% to 50% of homeless individuals are estimated to have a current substance use disorder,
  •  38% dependent on alcohol
  •  26% abusing other drugs,
  • These substance use disorders often overlap, therefore account for about 20%-50% of the total number of homeless.

Addiction, (now called substance use disorder) and homelessness are bidirectional. Meaning, some became homeless prior to having any substance use disorders, and the disorder is a result of homelessness. And for others, substance use disorder is the cause of their homelessness.

Regardless of the origin, substance use disorders can create barriers to help.

 A 2022 study by Statista found that 25% of homeless people said drug use was the cause of their homelessness. (“Homelessness and Addiction How are they Related?” By Grace Ogren Updated February 5, 2026, Clinically Reviewed by Dr. Malasri Chaudhery-Malgeri, Ph.D.)

Many of us turn to an outside substance (coffee, alcohol, marijuana etc.) to ease a painful or stressful time in our lives.

Think about the tough week you had, maybe you got fired or work was intense, the rent is due, you got a speeding ticket, the car broke down and you may not have the finances to fix it, the kids had several appointments. and all of it at once presents incredible stress.

So, you grab a few beers, or glasses of wine to de-stress, you may smoke a joint or eat a few gummies or go the local bar to socialize and forget your problems for a little while.

Now imagine all of your recent week’s problems, magnified by 50 times. That is how it can be, daily, for the unhoused person.

The person who lost their home, job, car, family member etc., may also turn to alcohol or substances to merely drown stress and intensity of the emotional pain and trauma of every single day waking up in a tent inevitably brings.

Those living outside seldom get a full night’s sleep and are perpetually exhausted. Using the bathroom, laundry, transportation and food are always an issue. Lack of safe food storage ensures that animals will invade and destroy their tents and belongings.

They don’t wake up, have a hot breakfast, and take shower to feel clean and fresh to start the day with a clear mind.  

They just wake up to another day of sheer survival, in a world of despair, hopelessness and sometimes repeated denials to help.

Homelessness does not CAUSE addiction, but it sure does hold its hand!

Lastly: Mental Health & Mental Illness

Approximately one-third of homeless individuals in the U.S. suffer from some form of mental illness. This includes those with serious mental illnesses, highlighting a significant overlap between homelessness and mental health issues. (https://www.health-root.com)

In our Street Outreach experiences, those suffering mental disorders or illness may be averse to intervention due to past experiences being forced into facilities, or on medications that believe changed them to a person who lacked energy, or clear thoughts, many believe the medications to be more harmful than good.

We guide them to engage in therapies and treatment, including trying different medications until one is found that both stabilizes the mental disorder/illness diagnoses, and they feel good, productive and able to make clear decisions.  

• Common conditions we encounter in Street Outreach include major depression, schizophrenia, bi-polar, antisocial personality disorder, and substance use disorders.
• Men are more likely than women to have a mental health disorder among the unhoused (85% vs. 69%)” (Medical News in Brief: Two-Thirds of Unhoused People Have Mental Health Disorders Emily Harris May 10, 2024)

The CDC (Center for Disease Control & Prevention) indicates mental illness and homeless to also be bidirectional, with a direct link between the two in that:

• “Homelessness can worsen mental health: Living in shelters, cars, or outdoors increases stress, trauma, and exposure to infectious diseases, raising risks for depression, anxiety, PTSD, and substance misuse; and
• Mental illness can increase homelessness risk: “Untreated or poorly managed mental health conditions can lead to unemployment, strained relationships, and difficulty securing stable housing.” (Substance Abuse and Mental Health Services Administration)
• Homelessness is now made mention of in the DSM5, (the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, which is the primary reference for professionals diagnosing and classifying mental disorders)

The DSM-5 includes this information on the subject of homelessness:

” Homelessness is not classified as a mental disorder in the DSM-5, but it is acknowledged as a critical factor that can influence an individual's mental health status. The DSM does not specifically address homelessness; however, it recognizes the importance of social determinants of health, which include housing stability.”

The mental health providers that Steven’s Home works with do incredible work yet, they are overwhelmed with the number of program participants seeking help. Intake can take days, then mental health services and treatment may take weeks or months to begin.

There is an undisputed need for increased mental health programs for the homeless person who is reaching out for help. Waiting weeks or months often leads to the person giving up and moving on without ever receiving therapy or treatment, or they fall into legal charges and additional barriers of the legal system and the new problems that it brings.

In conclusion, you can see there are many barriers (this article cannot mention all barriers) that the person trying to climb out of homelessness can face. For almost all, it seems to be “one thing after another” they may overcome one barrier, such as obtaining their birth certificate to then obtain an ID, then face another, no street address required by the state to obtain the ID. If that is accomplished, then proving 30-90 days of residency is yet another barrier for some services.

It only takes one life event to put someone into homelessness and then can become what can feel like endless obstacles to climb out of homelessness, unscathed by trauma and/or depression and hopelessness.

Thank you for reading this lengthy, but informative, article attempting to enlighten you on the “Why don’t they just ….. [ insert your own answer here]?” Or “Why they don’t just get a job? Some do have a job; however, it just isn’t that simple.

You can view the many pages of more information on our website, or provide support since we are NOT grant funded, any amount of support helps!

Stevens-Home.org