Behavioral Health Services in Emergency Shelters


  • Comprehensive Life Resources, Washington
  • Pierce County Human Services, Washington

Focus Areas

  • Health
  • Housing

“Trying to meet the most basic needs when you are homeless is often full time work. It's the priority to be safe, warm, sheltered, and find food, which doesn't leave much bandwidth to address additional needs beyond daily survival.”

James Pogue, Executive Director of Homeless Services, Comprehensive Life Resources

The Issue

For many people, receiving mental health care is an important step to escape the cycle of homelessness. Though there are higher rates of mental illnesses among those experiencing homelessness, the everyday struggles that come with being homeless also make seeking out mental health care extra difficult. This can leave those who are most in need of care as the ones without it.

Among individuals who suffer from mental illnesses, one study found that those who are experiencing homelessness are far less likely to receive outpatient care and much more likely to end up in inpatient emergency psychiatric units. Without earlier use of mental health care, growing challenges go unaddressed and transform into crises, both putting the individual at risk and resulting in higher medical expenses from the need for emergency care. To avoid these situations, we need to look for solutions that can help those in need access long-term mental health support before they become emergencies. 

Since persons experiencing homelessness have higher rates of mental health disorders than the general population, some innovators have recently introduced the idea of bringing the care to them. Behavioral health services could be brought on-site within housing shelters, allowing for clients to receive immediate care and also to be referred to further outpatient services. At a shelter which serves women fleeing domestic violence, an impact evaluation even found that on-site mental health care reduced PTSD and depression severity. 

However, these initiatives have only been tested in long term shelters. The impact of on-site behavioral health services has not been tested in emergency homeless shelters. The challenge of going to a community behavioral health clinic might seem even more overwhelming for individuals in emergency homeless shelters. Bringing the services onsite may make accessing mental health care possible for them even if it wasn’t before.


The Intervention

Within the Seattle metro area, Pierce County aims to provide resources and assistance that will foster empowered individuals, healthy families, and thriving communities. In order to make behavioral health services more easily accessible, their Department of Human Services (PCHS) is looking to implement talk therapy in their homeless shelters. To do this, PCHS has partnered with Comprehensive Life Resources (CLR) to start a program which sends therapists directly to shelters in Pierce County to offer therapy to guests. At the shelters (Tacoma Rescue Mission and New Hope Resource Center) participating in the new program, there will be two full time counselors from CLR working on site at each location twice per week. 

Those experiencing homelessness who are part of this program will receive eight free therapy sessions over a four-week period, with the therapist on-site in the shelter where they are staying. Therapy can consist of a variety of mental health care, adapting to meet the needs of the individual and prepare them for upcoming aspects of their life. After their final session, they will then be given instructions on how to continue participating in therapy through CLR’s outpatient clinic. 

PCHS hopes that this new program providing free on-site behavioral health resources within emergency homeless shelters will give people better access to immediate care as well as connect them with long-term care options.


Research Question

What is the impact of receiving talk therapy on-site in a homeless shelter on mental health, use of housing services, housing stability, use of benefits programs (such as SNAP and TANF), and healthcare utilization?

Intended Outcomes

PCHS aims that those who are offered on-site talk therapy at their emergency homeless shelters will have:

  • Improved participation in mental health services
  • Increased housing stability
  • Better health and well-being outcomes (i.e. decreased hospitalizations, use of crises services, and police involvement)

Research Study Design

PCHS is partnering with LEO to bridge the current gap in research and better understand the effects of offering free therapy within emergency homeless shelters. LEO’s researchers will be performing a randomized controlled trial (RCT) to test the impact of the intervention on mental health, use of housing services, housing stability, use of benefits programs, and healthcare utilization.

Currently, Pierce County cannot offer behavioral health services to everyone in their shelters. For this study, every four weeks new participating residents at the two homeless shelters (Tacoma Rescue Mission and New Hope Resource Center) will be randomly assigned by LEO to either the treatment group or control group. Treatment group participants will receive eight sessions with the therapist on-site in the shelter where they are staying, before then receiving instructions on how to continue participating in therapy at CLR’s outpatient clinic. Control group participants will not receive on-site therapy sessions, but they will be given information on how to access outpatient care at the CLR clinic.If any individuals need more significant mental health services than CLR is able to offer in this program, then they will be ineligible for this program and will instead be referred to other services.

By comparing the outcomes of clients that were randomly assigned to the intervention group against those who were randomly assigned to the control group, LEO will be able to isolate the effect of the program on outcomes of interest. Importantly, by using random assignment, the proposed research design ensures that the research team will generate causal evidence on the impact of providing behavioral health services in emergency shelters and allow the research team to determine the cost-effectiveness of the program. The evidence from this study has the potential to influence the way that Pierce County and other local governments allocate their funding for services. Results will improve our understanding of the decisions faced by those in emergency homeless shelters, and, if this program is effective, then it could also be used as evidence to expand similar programs in the future.


Learn With Us