Low-Barrier Services to Facilitate Engagement In Behavioral Health Services: Evidence from a Midwestern Drop-In Center

Background and Purpose: Unhoused adults with substance use or mental health difficulties face persistent structural barriers to behavioral healthcare. Although street outreach is a common strategy to engage unhoused people into services, drop-in centers are another complementary strategy that expand access to care. Drop-in centers offer resources for individuals to address their basic needs, provide respite from the streets, and serve as a pivotal connection point to other services. As recent research on the use of drop-in centers has focused primarily on unhoused youth and young adults, this study aims (1) to identify clinical and demographic characteristics associated with drop-in center use among unhoused adults receiving community mental health services and (2) to explore retention in services for drop-in center guests.

Methods: This study leverages administrative data from a community mental health agency in the Midwestern United States. To identify clinical and demographic differences in unhoused clients based on drop-in center use, we stratified the sample into those who visited the center once or not at all (n = 133, 42.9%) and those who visited the center two or more times (n = 177, 57.1%). We provide descriptive statistics and bivariate tests of association to evaluate differences in demographic and clinical characteristics by drop-in center utilization. Cox proportional hazards regression models were used to estimate adjusted hazard ratios (aHRs) and 95% CIs for time to discharge from services.

Results: Between 1 July 2023 through 31 December 2024, 1,425 clients aged 18 and older were served through the agency. Nearly 1 in 5 were unhoused (21.8%, n = 310). Unhoused participants had a mean age of 41.7 years (SD = 12.4) and identified as male (65.2%) and Black (62.3%), and most (92%, n = 284) utilized the drop-in center at least once. Guests with two or more visits had significantly longer enrollment durations than those with one or fewer visits (M = 197.1 vs 167.5 days, p = 0.016). Drop-in center use was associated with enrollment into outpatient treatment services (p = .006). However, drop-in center use did not differ by sex, race, ethnicity, age, or use of residential treatment or court-ordered services. In the Cox proportional hazards model, only race was significantly associated with discharge from services, with White clients experiencing a higher hazard of discharge compared with Black clients (aHR = 1.47, 95% CI: 1.04–2.07, p = 0.028).

Conclusions and Implications: Drop-in center use among unhoused clients of a mental health agency was associated with a longer retention in services and higher rates of enrollment into outpatient services through the agency’s clinic. Findings highlight the potentially positive role that low-barrier drop-in services can play in supporting unhoused clients in meeting their behavioral health needs. Further research should compare outcomes of drop-in center services relative to street outreach and other low-barrier strategies on clients’ service use and recovery outcomes.