In a society with so few social systems of support, there is a direct link between homelessness and incarceration. In fact, people who have been incarcerated are almost 10 times more likely to be homeless than the general public, according to a report by Prison Policy Initiative. Both homelessness and incarceration have significant impacts on health.
Certain populations are disproportionately impacted including women, people of color, and older adults. People who have been incarcerated more than once have double the chances of homelessness. People returning from longer prison or jail terms routinely release without stable housing and have fewer economic resources and social connections. Even individuals placed in transitional housing struggle to find permanent housing due to many challenges—formal laws (i.e. crime-related federal restrictions from housing assistance), systemic barriers (i.e. background checks by landlords), and discrimination against people with past involvement in the criminal legal system. Further, people experiencing homelessness or housing insecurity frequently cycle through the criminal legal system, serving short yet disruptive stints in jail for low-level penalties, which further impedes housing and employment.
Living unhoused increases one’s risk of police interaction, arrest, and imprisonment due to laws that criminalize homelessness. This risk of arrest is especially detrimental for people already under strict supervision through probation or parole, whose arrest could lead to a return to custody on technical violations. In the aftermath of the Supreme Court’s Grants Pass ruling and California Governor Newsom’s executive orders that followed, Bay Area authorities are intensifying encampment evictions and criminalization, even arresting service providers and advocates that support residents during sweeps. Through policing and force, state and local governments are putting resources toward “resolving” the “issue of encampments” rather than addressing the underlying causes of homelessness.
Incarceration, homelessness, and health are intertwined, having compounding negative—even deadly— impacts. Both homelessness and incarceration accelerate aging, decrease life expectancy, and are associated with higher rates of chronic disease. Often when one leaves incarceration, addressing health needs is secondary to meeting other basic needs, such as housing, which can exacerbate acute and chronic health concerns. People who have been incarcerated often return to medically underserved areas, experience stigma and discrimination within community health systems, and may not know where to go to access health care services.
Nobody knows about these realities more than those who have experienced the cycle of incarceration and homelessness. The Transitions Clinic Network (TCN) is a Bay Area-based nonprofit organization serving the health care needs of people coming home from incarceration. The foundation of TCN’s work is supporting community health worker (CHW) roles in health care clinics for people who are formerly incarcerated, aiming to increase employment opportunities for individuals who experience barriers to employment and to improve the health of people reentering our communities. Studies of TCN’s model of clinic-based care show it improves engagement in primary care services, decreases hospitalizations and emergency room visits, and decreases days reincarcerated for the reentry population. Through interactions with CHWs, patients are supported with both health and social needs.
Many of TCN’s CHWs have themselves struggled with unstable housing following release. One TCN staff person was declined release to the county where her family lived, and instead, left prison unhoused, exhausting her limited financial resources to pay for a hotel post-release. It was only after getting housed with the support of a community-based organization that she felt she had the safety and stability to focus on her reentry goals. Housing is vital to successful reentry, but for many it is hard to come by. It has been reported it can be “easier” to go back to jail (for “three hots and a cot”) than to overcome so many reentry challenges.
TCN operates a reentry health care hotline staffed by CHWs with lived experience of incarceration to provide safety-net support for people released from prison or jail. While the hotline is focused on navigating health care resources, the hotline staff report they regularly get calls from people inside prisons and jails, and people in the community who are looking for housing. The onus is often on the individual to figure out their housing plan for themselves. Community-based reentry organizations experience challenges across the state with supporting the success of their clients when housing resources are so limited.
Tens of thousands of people are experiencing homelessness in the Bay Area, and over 400,000 Californians are incarcerated or under criminal legal system community supervision. With so many community members impacted by homelessness and incarceration, housing solutions tailored to those impacted by the criminal legal system are drastically needed. There are promising federal and local initiatives, including statewide investment in housing, local organizations implementing the evidence-based Housing First model, city-level programs such as emergency financial assistance, and California’s ongoing statewide Medicaid reform which includes housing as a Medicaid-reimbursable service. Nonetheless, the millions of dollars a city might spend each year on incarcerating people from the streets could be better spent on resources and long-term solutions to overcoming housing barriers. We cannot police our way out of a housing crisis or sweep the needs of our neighbors away. Continuing the incarceration-homelessness cycle comes at the cost of public health, community resilience, and human dignity.
If you or a loved one has recently been released from incarceration and need linkages to health care providers in the community, call the Transitions Clinic Network’s reentry health care hotline at 510-606-6400.
Beth Divakaran and Anna Steiner are public health professionals, community activists, and harm reductionists. They are colleagues working for the Transitions Clinic Network, supporting the health needs of people coming home from incarceration.