risk of the "repeated exit-and-entry pattern": 511 institutional barriers shinn and gillespie (1994) argued that although substance abuse and mental illness is a contributing factor to homelessness, the primary cause is the lack of low-income housing. elliot and krivo emphasize the structural conditions that increase vulnerability to homelessness. within their study, these factors are specifically categorized into "unavailable low-cost housing, high poverty, poor economic conditions, and insufficient community and institutional support for the mentally ill.": 116 through their correlational analysis, they reinforce the finding that areas with more spending on mental health care have "notably lower levels of homelessness.": 122 furthermore, their findings emphasize that among the analyzed correlates, "per capita expenditures on mental health care, and the supply of low-rent housing are by far the strongest predictors of homelessness rates.": 127 along with economic hardship, patterns of academic underachievement also undermine an individual's opportunity for reintegration into general society, which heightens their risk for homelessness.: 470 on a psychological level, lee notes that the "stressful nature of hard times (high unemployment, a tight housing market, etc.) helps generate personal vulnerabilities and magnifies their consequences." for example, poverty is a key determinant of the relationship between debilitating mental illness and social maladjustment; it is associated with decreased self-efficacy and coping. moreover, poverty is an important predictor of life outcomes, such as "quality of life, social and occupational functioning, general health and psychiatric symptoms", all relevant aspects of societal stability.: 566 thus, systemic factors tend to compound mental instability for the homeless. tackling homelessness involves focusing on the risk factors that contribute to homelessness as well as advocating for structural change. consequences incarceration it is argued that persons with mental illness are more likely to be arrested, simply from a higher risk of other associated factors with incarceration, such as substance abuse, unemployment, and lack of formal education. furthermore, when correctional facilities lack adequate coordination with community resources upon release, the chances of recidivism increase for persons who are both homeless and have a mental illness. every state in the united states incarcerates more individuals with severe mental illness than it hospitalizes. incarcerations are due to lack of treatments such as psychiatric hospital beds.: 566 overall, according to raphael and stoll, over 60 percent of united states jail inmates report mental health problems.: 189 estimates from the survey of inmates in state and federal correctional facilities (2004) and the survey of inmates in local jails (2002) report that the prevalence for severe mental illness (the psychoses and bipolar/manic-depressive disorders) is 3.1–6.5 times the rate observed for the general population.: 192 in relation to homelessness, it is found that 17.3 percent of inmates with severe mental illness experienced a homeless state before their incarceration, compared to 6.5 percent of undiagnosed inmates.: 197 the authors argue that a significant portion of deinstitutionalized mentally ill were transitioned into correctional facilities, by specifically stating that "transinstitutional effect estimates suggest that deinstitutionalization has played a relatively minor role in explaining the phenomenal growth in u.s. incarceration levels.": 190 responses responses to mental health and homelessness include measures focused on housing and mental health services. providers face challenges in the form of community adversity. housing modern efforts to reduce homelessness include "housing-first models", where individuals and families are placed in permanent homes with optional wrap-around services. this effort is less expensive than the cost of institutions that serve the complex needs of people experiencing homeless, such as emergency shelters, mental hospitals and jails. the alternative approach of housing first has shown positive outcomes. one study reports an 88 percent housing retention rate for those in housing first, compared to 47 percent using traditional programs. additionally, a review of permanent supportive housing and case management on health found that interventions using “housing-first models” can improve health outcomes among chronically homeless individuals, many of whom have substance use disorders and severe mental illness. improvements include positive changes in self-reported mental health status, substance use, and overall well-being. these models can also help reduce hospital admissions, length of stay in inpatient psychiatric units, and emergency room visits. there is a new intervention called "permanent supportive housing" that was designed help independent living and help with employment and health care. 407,966 individuals were homeless in shelters, transitional housing programs, or on the streets. those with mental illnesses have difficulty not only with their current housing issues, but have issues with housing if they get evicted. youth can benefit from permanent housing, increases social activity, and improve mental health. federally funded rental assistance are in place, but due to the high demand of the funds, the government is unable to keep up. one study evaluating the efficacy of the housing first model followed mentally ill homeless individuals with criminal records over a two-year period, and after being placed in the housing first program only 30% re-offended. overall results of the study showed a large reduction in re-conviction, increased public safety, and a reduction in crime rates. a significant decline in drug use was also seen with the implementation of the housing first model. the study showed a 50% increase in housing retention and a 30% increase in methadone treatment retention in program participants. mental health services uninterrupted assistance greatly increases the chances of living independently and greatly reduces the chances of homelessness and incarceration. through longitudinal comparisons of sheltered homeless families and impoverished domiciled families, there are a collection of social buffers that slow one's trajectory toward homelessness. a number of these factors include "entitlement income, a housing subsidy, and contact with a social worker." these social buffers can also be effective in supporting individuals exiting homelessness. one study utilizing maslow's hierarchy of needs in assessing housing experiences of adults with mental illnesses found a complex relationship between basic needs, self-actualization, goal setting, and mental health. meeting self-actualization needs are vital to mental health and treatment of mental illness. housing, stable income, and social connectedness are basic needs, and when met can lead to fulfillment of higher needs and improved mental health. those with a brief history of homelessness and managed disabilities may have better access to housing. research calls for evidence based remediation practices that transform mental health care into a recovery oriented system. the following list includes practices currently being utilized to address the mental health needs of homeless individuals: integrated service system, between and within agencies in policy making, funding, governance and service delivery. low barrier housing with support services. building assertive community teams (act) and forensic assertive community teams (fact). assisted community treatment (act). outreach services that identify and connect homeless to the social service system and help navigate the complex, fragmented web of services. challenges fear surrounds the introduction of mentally ill homeless housing and treatment centers into neighborhoods, due to existing stereotypes that homeless individuals are often associated with increased drug use and criminal activity. the housing first model study, along with other studies, show that this is not necessarily the case. proponents of the nimby (not-in-my-backyard) movement have played an active role in the challenges faced by housing and mental health service interventions for the homeless. conclusion for some individuals, the pathways into homelessness may be upstream. e.g. issues such as housing, income level, or employment status. for others, the pathways may be more personal or individual. e.g. issues such as compromised mental health and well ‐ being, mental illness, and substance abuse. many of these personal and upstream issues are interconnected.