Psychological Costs and Administrative Burdens Produce Systemic Service Avoidance among People Experiencing Homelessness

Abstract

How do people experiencing homelessness make decisions about accepting or avoiding social services and health care? The study presented here seeks to answer this question by drawing on remotely-gathered surveys (n=244) and in-depth interviews (n=57) with unhoused people during the first wave of the COVID-19 pandemic. In this paper, we explore service-seeking behaviors and processes to understand how to best support people experiencing homelessness during current and future public health disasters. We find that homelessness services systems are often fragmented, increasing administrative burdens such as learning costs (Herd & Moynihan 2018, 2020) and driving unhoused people away from seeking the support they actually need. Four organizing themes centered on temporary housing, health care and medical racism, precarious employment, and self-preservation became apparent within the broader systems challenges. Findings provide insight into the survival strategies of people experiencing homelessness, including how and why people avoid services. Findings point to systems-level recommendations for better aligning homelessness-serving systems with the actual needs of unhoused people themselves. Lastly, the research approach described here offers lessons learned regarding doing social science research with people experiencing homelessness during public health disasters.