According to the most recent annual survey by the U.S. Conference of Mayors, major cities across the country report that top causes of homelessness among families were: (1) lack of affordable housing, (2) unemployment, (3) poverty, and (4) low wages, in that order.
The same report found that the top four causes of homelessness among unaccompanied individuals were (1) lack of affordable housing, (2) unemployment, (3) poverty, (4) mental illness and the lack of needed services, and (5) substance abuse and the lack of needed services.

Risk factors for public expenses
Mental illness, substance abuse, incarceration history, and persistent homelessness all have a strong impact on public costs.
Some medical diagnoses are widely prevalent among homeless residents and also have a high cost profile. Mental health disorders are foremost among these, with 26 percent of homeless individuals diagnosed and 40 percent with the diagnosis having overall public costs in the top two deciles.
Diseases of the circulatory system, which include heart disease, chronic hypertension, and rheumatic fever, are diagnosed in 11 percent of Santa Clara County homeless residents, 41 percent of whom have overall public costs in the 9th and 10th deciles.
The highest public costs for homeless residents are in the health care and jail systems. If a homeless individual experienced any of the following over a two-year period, they were more likely than not to be in the top 5%:
• 7 or more hospital inpatient days,
• 11 or more emergency room visits,
• 4 or more emergency psychiatric service visits.
Comparable benchmarks for jail stays over a two-year period include:
• 7 or more days in cell block 8A, the jail mental health facility,
• 10 or more days in cell block 2B or 2C, jail medical facilities,
• 300 or more days in general jail facilities.
Substance abuse and mental illness double the likelihood of being and staying in the top 5%, with odds two and a half times greater than average for people with both of these attributes.

It's estimated that there are over a million homeless living in the disused tunnels of the New York subway system. In many cities, the homeless have been actively driven into the suburbs and beyond. In Portland, Oregon, many of the homeless live in woodlands and do not sleep in the city.
New York city only lists the number in shelters, 60,000, it does not include any official tally of homelessness in general. Assuming The Guardian's figure of 5% living rough is accurate as to some sort of count, it doesn't affect the core official number. It's just that the core official number is only 6% of the actual figure.
If we consider these to reflect the reality of the situation, and factor in the undercount by two thirds of those in cities, then we get a very different number.
Factoring in the undercount, we're probably nearer 1.5 million homeless in cities at any given time. Now, if we extrapolate the 6% figure across all States and say that this 1.5 million merely represents those on public display, then the real homeless levels in the U.S. would be closer to 25 million.
This is much more realistic. Manchester, in England, has greater homelessness than the official figures for the United States. That simply isn't realistic, but Manchester's levels are much better understood by homeless organizations. They probably aren't perfect, but they make an adequate sanity-check.
So America has about 25 million genuinely homeless. And ignores 24,500,000 of them.

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