Explore New Hampshire’s converging mental health and homelessness crisis, showcasing data, policy changes, and actionable solutions for 2025.
By Granite State Report
Published: September 15, 2025
New Hampshire is living with two emergencies that increasingly overlap: a persistent mental-health treatment bottleneck and a fast-rising homelessness crisis. The stories are familiar—people in psychiatric crisis held for days in emergency departments, families priced out of rentals with nowhere to go, encampment clearances that shift the problem but don’t solve it. What’s different in 2025 is the volume of hard data confirming the scale of the problem and the mix of policy changes that could bend the curve—if we implement them well and fund them adequately.
This report pulls together the most recent numbers and policy developments and lays out a practical agenda for the year ahead.
1) The Big Picture: Two Crises That Feed Each Other
Homelessness in New Hampshire rose sharply coming out of the pandemic. According to the New Hampshire Coalition to End Homelessness (NHCEH), 6,806 Granite Staters experienced homelessness in 2023 (unduplicated people served), and the Point-in-Time count spiked 52.1% year-over-year in 2023—the highest percentage increase of any state. Those increases were driven by families and youth as rents rose and pandemic-era rental assistance ended. (NH Coalition to End Homelessness)
At the same time, the state has struggled to create timely access to psychiatric care. A federal court ordered New Hampshire to end “ER boarding” of involuntarily admitted psychiatric patients—limiting ER waits to six hours—yet compliance deadlines were extended into 2025 as the state scrambled to add capacity and staffing. (New Hampshire Public Radio)
These crises interact in predictable—and painful—ways. Untreated behavioral health conditions increase the risk of housing loss; unstable housing worsens mental health; and community safety debates—especially after the U.S. Supreme Court’s Grants Pass v. Johnson decision upholding camping bans—have led cities to lean more on enforcement tools that don’t add a single bed or a single treatment slot. (Supreme Court)
2) What the Numbers Say Right Now
Homelessness and Housing Pressure
- Scope & trend. NHCEH’s latest annual report shows 6,806 people experienced homelessness in 2023 via the HMIS system, with family homelessness up ~46% and youth homelessness up nearly 40% vs. 2022. The January PIT count jumped 52.1% year-over-year. (NH Coalition to End Homelessness)
- Beds and capacity. HUD’s 2024 Housing Inventory Count confirms that statewide bed capacity (shelter, transitional, permanent housing) remains tight relative to need; many categories are flat or rising too slowly to meet demand. (HUD Exchange)
- Affordability. Rents are out of reach for many working households. The fair market rent for a two-bedroom is $1,824/month, while 45% of NH renters earn under 50% AMI—a mismatch that makes exits from homelessness harder. (New Hampshire Bulletin)
- Vacancy. New Hampshire’s rental vacancy rate hovered around 4% in early 2024, below the ~5% many analysts consider balanced. Low vacancy increases rent pressure and lengthens time to housing for people in crisis. (FRED)
- Evictions. Eviction filings climbed ~66% from 2020 to 2023 as protections and rental assistance wound down—one more indicator of housing instability. A new end-of-lease eviction law (HB 60) takes effect July 1, 2026, which tenant advocates warn could further stress precarious renters without additional safeguards. (New Hampshire Fiscal Policy Institute)
Mental Health Access and Outcomes
- ER boarding & beds. After court pressure, the state expanded New Hampshire Hospital capacity to ~170 beds in 2024 through renovations, but bottlenecks persist and the compliance deadline for ending ER boarding moved into March 2025. (NH Health and Human Services)
- Forensic hospital delay. Construction on a new secure forensic psychiatric hospital in Concord—intended to move civilly committed patients out of a prison-based unit and relieve bed pressure—was halted in May 2025 due to construction defects, delaying anticipated 2025 completion. (InDepthNH.org)
- Crisis response. New Hampshire maintains a statewide Rapid Response Access Point alongside 988, offering 24/7 call/text/chat support and mobile crisis dispatch (833-710-6477). These services are core to “diversion” from ERs and jails. (childrensbehavioralhealthresources.nh.gov)
- Suicide risk. New Hampshire’s suicide burden remains above national rates in recent years; the latest statewide prevention reports track persistently high adult rates and very concerning youth indicators—even as some YRBS trends stabilized between 2021 and 2023. (NH Suicide Prevention Council)
Substance Use and Overdose
- Overdose trends. The Office of the Chief Medical Examiner’s preliminary read suggested opioid overdose deaths fell from 2023 to 2024, a trend state officials highlighted this spring; DHHS’s Drug Monitoring Initiative cautions 2024 data were not yet finalized as of March 2025. Bottom line: promising signs, but we should treat year-to-year changes as provisional. (The Rochester Post)
- The Doorway model. The state’s nine Doorway hubs (a “hub-and-spoke” approach) still anchor addiction access and referrals; monthly activity reports show continued volume across regions, with connections to treatment and recovery services. (Medicaid)
3) What’s Driving the Crisis
The Housing Math Doesn’t Work
When 45% of renters are below 50% of area median income, and a modest two-bedroom costs more than those households can safely afford, exits from homelessness slow to a crawl—even with vouchers, even with case management. Low vacancy locks people out of the market, and evictions have rebounded as pandemic relief expired. Add steep home prices (NH’s June 2024 single-family median hit $540,000), and the spillover reaches shelters and encampments. (New Hampshire Bulletin)
Behavioral Health Access Is Still Uneven
New inpatient capacity and mobile crisis options help, but workforce shortages, boarding backlogs, and the forensic hospital delay keep pressure on ERs and police. Local hospitals and community mental health centers report difficulty in timely placements, especially for people with co-occurring SUD, cognitive impairment, or justice involvement. (New Hampshire Public Radio)
Policy Shifts Emphasize Enforcement Without New Beds
After the Grants Pass ruling, some NH cities stepped up enforcement of camping bans. Manchester expanded and began enforcing its no-camping ordinance in July 2024, with fines and encampment clearances—even as officials also referred people to shelters. Enforcement may address immediate safety concerns in parks, but it does not increase shelter or housing—and often pushes people into more dangerous, hidden locations. (New Hampshire Public Radio)
4) What New Laws and Funding Will—and Won’t—Do
Housing Supply Reforms
In 2025, lawmakers passed and Gov. Kelly Ayotte signed two significant housing laws that could help over time:
- HB 577 (effective July 1, 2025): requires municipalities to permit at least one detached Accessory Dwelling Unit (ADU) by right on single-family lots—ending years of local bans on detached ADUs and standardizing guardrails. This doesn’t create units overnight, but it reduces a major regulatory barrier. (LegiScan)
- HB 631 (phasing in): requires cities and towns to allow multifamily residential development in commercial zones with adequate infrastructure—accelerating mixed-use conversions in downtown and corridor settings. (New Hampshire Bulletin)
These zoning moves are the “supply-side” backbone we need, but they will take years to produce units at scale. Meanwhile, shelter systems and homelessness prevention must hold the line.
Shelter and Prevention Funding
Lawmakers advanced SB 113 to dedicate $12 million annually to nonprofits serving people experiencing homelessness and added $3 million for the housing stabilization fund (eviction prevention, rapid rehousing). Whether the final budget fully funds these levels has been a point of advocacy among housing groups that argue last year’s allocations underfunded frontline operations. (New Hampshire Bulletin)
Behavioral Health Investments
The state added acute psychiatric beds at New Hampshire Hospital and continues to expand mobile crisis and Rapid Response. But the forensic hospital construction halt is a real setback for decompressing the civil bed base. The court-driven timelines to end ER boarding will require sustained staffing and operational dollars—not just bricks and mortar. (NH Health and Human Services)
5) Special Populations That Need Targeted Strategies
Families with Children
NHCEH reports family homelessness rose by ~46% in 2023. Family shelters are often full, and hotel placements are limited and expensive. Rapid rehousing with flexible financial support, landlord engagement, and childcare access are key levers. (NH Coalition to End Homelessness)
Youth and Young Adults
Youth homelessness grew by ~40% in 2023, and YRBS trends show persistently high rates of depression, trauma, and suicide risk for teens—even as some indicators improved slightly post-pandemic. Youth-specific host-home programs, drop-in centers, and school-based clinicians can prevent long-term harm. (Concord Coalition to End Homelessness)
People With Co-Occurring Mental Illness and SUD
This group is overrepresented in unsheltered counts and ER boarding. The Doorway system and low-barrier housing with on-site services (PSH) work best—but both require workforce and rental supply. Provisional state data show potential declines in fatal overdoses in 2024, which is encouraging; we’ll need final confirmation and to double down on MOUD, naloxone distribution, and harm reduction. (The Rochester Post)
Veterans and People Leaving Institutions
NHCEH’s 2024 report noted a decrease in veteran homelessness amid rising totals elsewhere, illustrating that targeted, well-funded pipelines (VASH vouchers, SSVF, and coordinated entry) can work. Discharge planning from hospitals, prisons, and residential programs remains a critical prevention point. (Concord Coalition to End Homelessness)
6) What’s Working (Evidence-Backed) in New Hampshire
- Crisis lines and mobile teams. The Rapid Response Access Point (833-710-6477) integrated with 988 gives residents a single, statewide front door to intervention—triaging to mobile crisis and stabilizing many situations without ER visits or police response. Early statewide adoption makes NH a national outlier in coverage. (childrensbehavioralhealthresources.nh.gov)
- Doorway hubs. The nine regional Doorways simplify entry to treatment and recovery supports; monthly activity reports document sustained call and referral volumes. The model’s hub-and-spoke logistics fit rural New Hampshire. (Medicaid)
- Zoning preemption for ADUs & mixed-use. These 2025 laws reduce years of friction for small-scale infill and adaptive reuse—exactly the production types that can show up fastest in tight markets. Municipal guidance is already rolling out to translate state law into local permitting. (New Hampshire Municipal Association)
- Shelter operating funds. Dedicated dollars for shelter operations (utilities, staffing, 24/7 coverage) are less flashy than groundbreakings—but they stop system collapse in winter and keep outreach linked to a real place to go. (New Hampshire Bulletin)
7) What Isn’t Working (or Isn’t Enough)
- Enforcement without exits. Post-Grants Pass, cities like Manchester clearing encampments without adding new “places to be” (shelter beds or sanctioned camping with services) simply shuffle people around—and can sever ties to outreach and medical care. (New Hampshire Public Radio)
- Bottlenecks at every step. From psychiatric bed availability to landlord acceptance of vouchers to workforce shortages in case management, a single snag can send someone back to the street or the ER. Bed additions at NHH help, but the forensic hospital delay blunts gains. (NH Health and Human Services)
- Underpowered prevention. Eviction trends and rent burdens suggest we’re spending too little on legal defense, mediation, utility arrears, and one-time back rent—the cheapest way to avert shelter entry. (New Hampshire Fiscal Policy Institute)
8) A Practical, New Hampshire-Sized Agenda
Here’s what a pragmatic, bipartisan playbook could look like for the next 12 months:
- Finish (and then staff) the forensic hospital; keep civil beds open. Resolve the construction issues in Concord and set a public commissioning timeline. Pair beds with competitive salaries for psychiatrists, nurses, and techs to avoid “paper capacity” that can’t actually open. (InDepthNH.org)
- Lock in shelter operations funding and winter surge plans. Ensure the $12M annual shelter/services funding envisioned in SB 113 translates into multi-year contracts, with winter surge beds and 24/7 sites in the largest hubs (Manchester, Nashua, Seacoast, Upper Valley). (New Hampshire Bulletin)
- Scale rapid rehousing and prevention. Expand the housing stabilization fund and set targets for diversions from shelter via short-term rental assistance, landlord risk mitigation, and mediation. Measure cost-per-household and time-to-lease up. (New Hampshire Bulletin)
- Make HB 577 and HB 631 real locally. Provide technical assistance, model bylaws, and small grants to help towns update ordinances fast. Track permits issued for detached ADUs and mixed-use conversions and report quarterly to keep momentum visible. (New Hampshire Municipal Association)
- Move from enforcement to “exits-first.” If encampment clearances proceed, pair them with a time-limited navigation center model: low-barrier shelter with storage, case management, and daily housing placement goals. This aligns with new legal landscape while prioritizing humane outcomes. (Supreme Court)
- Keep overdose momentum and integrate SUD with housing. If 2024’s provisional decline in fatal overdoses holds, press the advantage: expand MOUD access, ensure naloxone saturation, and prioritize supportive housing for people with co-occurring conditions using braided funding streams. (The Rochester Post)
- Double down on youth mental health. Fund school-based clinicians and community youth drop-ins; require every youth-serving agency to have a clear 988/NH Rapid Response referral protocol; and add family peer supports in each region. Track uptake with YRBS-aligned indicators. (CDC)
- Transparency and dashboards. Publish monthly ER boarding metrics, bed availability, Rapid Response utilization, shelter occupancy, time-to-housing, and exits to permanent housing. The state already posts bed availability snapshots; extend that ethos to the whole continuum. (NH Health and Human Services)
9) Manchester as a Case Study: Lessons for Local Leaders
Manchester’s 2024 camping ban demonstrates how governance choices after Grants Pass play out on the ground. Police cleared encampments and issued fines, while also referring people to limited shelter slots. For neighborhoods near parks, this felt responsive. For outreach teams, it meant starting over with clients who moved, lost tents, medications, or IDs. Cities considering similar policies should build in:
- Clear shelter pathways tied to enforcement timelines;
- Storage solutions so people don’t lose documents and meds;
- Daily bed dashboards for police and outreach to avoid citations when no beds truly exist;
- Regular public reporting on placements, not just citations. (New Hampshire Public Radio)
10) What to Watch Through Winter 2025–26
- Forensic hospital construction fix and timeline. Until that facility opens, pressure on civil beds (and ERs) will persist. (InDepthNH.org)
- Implementation of HB 577 and HB 631. Look for early ADU permits and the first wave of mixed-use conversions in commercial corridors. (New Hampshire Municipal Association)
- Shelter capacity and funding in the state budget. Whether the final numbers match advocacy targets will show up immediately in winter overflow needs. (New Hampshire Bulletin)
- Overdose mortality (final 2024 and 2025 provisional). If declines hold, lock in what’s working (Doorways, MOUD, naloxone) and replicate regionally. (NH Health and Human Services)
- Evictions under HB 60. With end-of-lease evictions allowed in 2026, watch landlord-tenant filings and consider safeguards to avoid a new wave of family homelessness. (New Hampshire Public Radio)
Bottom Line
New Hampshire didn’t get here overnight, and it won’t get out overnight either. But the state now has several pieces on the board that can change trajectories: crisis lines and mobile teams that actually answer, legal reforms that unlock small-scale housing production, and a clearer understanding of how shelter capacity and prevention funds keep the rest of the system from collapsing.
The hard part is execution—and sustained, boring, budget-line execution at that. If 2025–26 becomes the biennium when New Hampshire finishes the forensic hospital, stabilizes shelter operations, translates zoning reform into real permits, and keeps building out crisis response and treatment access, the data in next year’s reports will finally start moving the right way.
Sources & References
- State of Homelessness (NH & U.S.)
NH Coalition to End Homelessness, The State of Homelessness in New Hampshire (2024/2025 editions). Key findings include 6,806 people served in 2023 and a 52.1% PIT increase. (NH Coalition to End Homelessness)
HUD, 2024 Housing Inventory Count (HIC), New Hampshire. (HUD Exchange)
National Alliance to End Homelessness, State of Homelessness 2025. (National Alliance to End Homelessness) - Housing Affordability & Evictions
New Hampshire Bulletin: NH is the 12th most expensive state for rent; 45% of renters are under 50% AMI; two-bedroom FMR $1,824. (New Hampshire Bulletin)
FRED (U.S. Census) rental vacancy rate for NH (≈4% in early 2024). (FRED)
NHFPI: eviction filings rose ~66% from 2020–2023. (New Hampshire Fiscal Policy Institute)
NHPR/Keene Sentinel re: HB 60 (end-of-lease evictions) effective July 1, 2026. (New Hampshire Public Radio) - Zoning & Supply Reforms
HB 577 (detached ADUs by right) and municipal guidance (NHMA). (LegiScan)
HB 631 (multifamily in commercial zones), coverage and guidance. (New Hampshire Bulletin) - Shelter & Prevention Funding
SB 113 ($12M/yr shelters + $3M stabilization fund) coverage and budget advocacy context. (New Hampshire Bulletin) - Mental Health Capacity & ER Boarding
NHPR coverage of federal order and extended deadlines to end ER boarding. (New Hampshire Public Radio)
DHHS: NHH bed expansions to ~170 (2024). (NH Health and Human Services)
Forensic hospital construction halt (InDepthNH; Concord Monitor). (InDepthNH.org)
Bed availability dashboards (Designated Receiving Facilities). (NH Health and Human Services) - Crisis Response & Suicide
NH Rapid Response Access Point / 988. (childrensbehavioralhealthresources.nh.gov)
NH State Suicide Prevention Plan; CDC/YRBS 2023 overview. (NH Suicide Prevention Council) - Substance Use & Overdose
Governor’s statement on provisional 2024 overdose declines; DMI cautions (data provisional as of Mar 2025). (The Rochester Post)
The Doorway model—SAMHSA waiver and state materials. (Medicaid) - Local Enforcement & Legal Landscape
Grants Pass v. Johnson (U.S. Supreme Court, 2024) and analysis; Manchester camping ban action and enforcement. (Supreme Court)
If you or someone you know needs help
Call or text 988 (or chat at 988lifeline.org) for 24/7 crisis support. In New Hampshire, you can also reach the Rapid Response Access Point at 833-710-6477 for mobile crisis response and stabilization. (SAMHSA)
Have a story, data point, or local perspective to add? Email the Granite State Report team—we’ll keep this guide updated as new state data is released.
