Effective PMHC Responses to People Experiencing Homelessness
People who experience homelessness tend to have frequent (and often repeat) interactions with law enforcement. One key driver of these interactions is the prevalence of unmet behavioral health needs. PMHCs are well situated to intervene in these situations and help provide connections to care, but they can also connect these individuals to safe and affordable housing options, providing a longer-term foundation for both reduced justice involvement and improved behavioral health outcomes. This section discusses the connections between the experiences of homelessness and justice involvement, and provides an overview of the role of permanent housing in breaking the cycle of homelessness and incarceration. It then highlights key strategies that law enforcement and their community partners can use to support this population, including conducting effective outreach, connecting people with housing and other vital supports, and using data to guide and evaluate outreach efforts.
The Close Relationship Between Homelessness and the Criminal Justice System
There is an alarming overlap between people experiencing homelessness and people who are incarcerated.
- More than half of people experiencing homelessness in the U.S. have been previously incarcerated.
- People who have been incarcerated experience homelessness at 7 times the rate of people who have not, and people who have been incarcerated more than once experience homelessness at a rate 13 times higher.
Many factors lead to this overrepresentation of people experiencing homelessness in the justice system, as well as the additional overrepresentation of Black and Latinx Americans, who already are more likely to experience both homelessness and incarceration.
Text: These individuals are likely to have regular contact with law enforcement because their activities of daily living (sleeping, going to the bathroom, etc.) are often criminalized by local laws and ordinances.
High prevalence of behavioral health needs
text: People experiencing homelessness are more likely than the general population to have unmet behavioral health needs, placing them at higher risk of homelessness and incarceration5.
Racial and ethnic disparities in homelessness and the criminal justice system
text: Due to a history of policies perpetuating economic inequality, segregation, and residential discrimination, Black and Latinx Americans are more likely to experience homelessness than their White counterparts.
Graphic: Black, non-Hispanic individuals represent 13 percent of the U.S. population but 39 percent of people experiencing homelessness6.
Graphic: Black men who were formerly incarcerated experience unsheltered homelessness at higher rates than formerly incarcerated White or Hispanic men7.
The Cycle of Homelessness and Justice Involvement
In addition to the global factors above, a number of dynamics at the intersection of homelessness and the justice system can lead to a self-perpetuating cycle.
Criminalization of survival behaviors and disconnections from care lead to increased law enforcement encounters
- Many local laws and ordinances make functional behaviors illegal when they occur outside of a home—such as sleeping in public and going to the bathroom. In addition, minor crimes such as petit larcen are often associated with experiencing unsheltered homelessness and poverty, and behaviors such as drug use are easier to detect outside8.
- Many people experiencing homelessness have acute mental and physical health needs and are not connected to regular care. Therefore, these individuals will often call 911 in the event of a health crisis, and these calls are typically routed to police departments as first responders9. Despite law enforcement’s often critical role, these encounters also have the potential to become adversarial and unsafe for both the officer and the person experiencing homelessness.
Lack of housing makes exit from the justice system difficult
- Without housing, many judges are reluctant to divert people from incarceration, as homelessness is viewed as a potential risk factor for reoffense10. Even in cases where no cash bail is required, courts may impose conditions of release, such as maintaining a stable address; if these conditions are not met, a person must remain in jail11.
- Incarceration can also disrupt housing and contribute to homelessness. Even short jail stays can increase the likelihood that a person will lose a job and therefore be unable to maintain their housing12. In addition, prisons and jails often struggle with identifying people at risk of experiencing, homelessness and then connecting them to affordable housing upon release.
Criminal records serve as a barrier to obtaining housing
- Even when appropriate housing can be located, stigma and restrictions are another major barrier to access13. People with lived experience in the justice system often cite exceptional difficulties finding landlords willing to rent to them due to their criminal records. Some subsidized housing providers, including Public Housing Authorities and private management companies, also impose criminal record restrictions beyond those required by the U.S. Department of Housing and Urban Development (HUD)14. They often encompass offenses from many years in the past, and include minor drug and property crimes.
Lack of housing increases risk of supervision failure
- Residential instability and lack of transporation can make regular reporting difficult and increase the potential for technical violations15. The features of community supervision systems, such as frequent drug and alcohol testing and supervision fees, can also increase risk of homelessness due to the use of intermediate sanctions such as placement into temporary custody16.
1 Martha R Burt, et al., Homelessness: Programs and the People They Serve | Findings of the National Survey of Homeless Assistance Providers and Clients (Washington, DC: Urban Institute, 1999), https://www.urban.org/research/publication/homelessness-programs-and-people-they-serve-findings-national-survey-homeless-assistance-providers-and-clients/view/full_report.
2 Lucius Couloute, Nowhere to Go: Homelessness Among Formerly Incarcerated People (Northampton, MA: Prison Policy Institute, 2018), https://www.prisonpolicy.org/reports/housing.html.
3 HUD Exchange, The 2020 Annual Homeless Assessment Report (AHAR) to Congress. Part 1: Point-In-Time Estimates of Homelessness (Washington, DC: US Department of Housing and Urban Development, 2021), https://www.huduser.gov/portal/sites/default/files/pdf/2020-AHAR-Part-1.pdf.
4“Homelessness Programs and Resources,” Substance Abuse and Mental Health Services Administration, accessed February 26, 2020, https://www.samhsa.gov/homelessness-housing.
5 Greg A. Greenberg and Robert A. Rosenheck, “Jail Incarceration, Homelessness, and Mental Health: A National Study,” Psychiatric Services 59, no. 2 (2008): 170–177, https://ps.psychiatryonline.org/doi/full/10.1176/ps.2008.59.2.170.
6 “Homelessness and Racial Disparities,” National Alliance to End Homelessness, accessed May 4, 2021, https://endhomelessness.org/homelessness-in-america/what-causes-homelessness/inequality/.
7 Couloute, Nowhere to Go.
8 The Council of State Governments (CSG) Justice Center and the U.S. Interagency Council on Homelessness, Strengthening Partnerships Between Law Enforcement and Homelessness Service Systems (New York City: CSG Justice Center, 2019), https://csgjusticecenter.org/publications/strengthening-partnerships-between-law-enforcement-and-homelessness-service-systems-2/; Richard Peterson, “Brief No. 37: Arrested and Homeless in NYC” (New York: New York City Criminal Justice Agency, 2015) https://www.nycja.org/publications/research-brief-no-37-arrested-and-homeless-in-nyc.
9 CSG Justice Center and the U.S. Interagency Council on Homelessness, Strengthening Partnerships Between Law Enforcement and Homelessness Service Systems.
10 Raymond P. Caligiure, Arrested AND Homeless in NYC (New York: NYC Criminal Justice Agency, 2015), https://www.nycja.org/publications/research-brief-no-37-arrested-and-homeless-in-nyc.
11 Madeline Bailey, Erica Crew, and Madz Reeve, No Access to Justice: Breaking the Cycle of Homelessness and Jail (New York: Vera Institute of Justice, 2020), https://www.safetyandjusticechallenge.org/wp-content/uploads/2020/08/homelessness-brief-web.pdf.
12 Couloute, Nowhere to Go.
13 Danya E. Keene, Amy B. Smoyer, and Kim M. Blankenship, “Stigma, housing and identity after prison,” The Sociological Review 66, no. 4: 799–815 (2018), https://doi.org/10.1177/0038026118777447.
14 U.S. Department of Housing and Urban Development (HUD), “Admissions/Eviction Policies for Public Housing/Voucher Lease Holders,” (Washington, DC: HUD, 2013), https://www.hud.gov/sites/documents/FAQSREENTRYPOLICIES.PDF. HUD requires Public Housing Authorities to deny housing subsidies to people subject to a lifetime “sex offender” registration requirement or people convicted of manufacturing methamphetamines on public housing property, as well as to establish standards for denial of admission in the event of drug-related criminal activity or significant drug or alcohol use. HUD has also explicitly encouraged Public Housing Authorities who wish to house people experiencing homelessness to remove discretionary criminal record screening criteria, as this population is more likely to have past justice system involvement. HUD has also prohibited the use of arrest records in admissions decisions for HUD-funded programs. See also HUD, PIH 2015-19: Guidance for Public Housing Agencies (PHAs) and Owners of Federally-Assisted Housing on Excluding the Use of Arrest Records in Housing Decisions (Washington, DC: HUD, 2015), https://www.hud.gov/sites/documents/PIH2015-19.PDF.
15 Bailey, Crew, and Reeve, No Access to Justice: Breaking the Cycle of Homelessness and Jail.
16 Claire W. Herbert, Jeffrey D. Morenoff, and David J. Harding, “Homelessness and Housing Insecurity Among Former Prisoners.” RSF: The Russell Sage Foundation Journal of the Social Sciences 1, no. 2 (2015): 44–79, https://www.rsfjournal.org/content/rsfjss/1/2/44.full.pdf.
Connecting People with Permanent Housing: Why it Matters
Access to permanent housing is central to breaking the cycle of incarceration and homelessness for many people. Therefore, it is important for PMHCs to understand the types of housing options available in their community, both to build working relationships and referral mechanisms with housing providers as well as to connect people experiencing homelessness to the most appropriate options during their interactions.
The Housing First Approach
Programs using a Housing First approach are particularly well suited to people experiencing homelessness who have behavioral health needs and previous involvement in the justice system, as they focus on quickly connecting people with permanent housing with as few barriers to entry as possible. The core philosophy of Housing First is that housing is a basic need that, once met, provides a foundation for community stability and a platform for achieving other goals, including treatment engagement and recovery. Therefore, Housing First programs typically do not include mandated sobriety and treatment engagement as preconditions. They do, however, offer services assertively once people are housed.
Housing First: The Research Evidence
- Increased housing retention – A Housing First approach is effective in helping people with complex needs remain housed, including individuals who have been involved in the justice system17. One evaluation found that, among people who were frequently cycling between the justice, health care, and emergency shelter systems, 91 percent were able to remain housed after 12 months, and 86 percent after 24 months18.
- Reduced returns to jail or prison – People who participate in Housing First programs are less likely to return to jail or prison19. One study of people leaving prison in Ohio found that program participants were 40 percent less likely to be rearrested and 61 percent less likely to be reincarcerated than a peer comparison group20.
- Reduced costs to other public systems – Providing stable housing and supportive services also leads to reductions in the use of emergency shelter and medical care21. One study in New York City found that the average costs per person averted in all of these systems was more than $25,000 per year22.
Key Housing First Program Models
- Housing First encompasses two main types of housing models that are geared toward people with different levels of ongoing housing and supportive services needs.
- Permanent supportive housing (PSH) combines the provision of an affordable housing unit (either a dedicated unit or via private market rental assistance) with a range of supportive services such as case management, mental health treatment, supported employment, and more, often provided on site. Due to both the permanent subsidy and the high level of services, PSH is best used for people with the highest level of housing and behavioral health needs.
- Rapid rehousing (RRH), by contrast, is a short-term intervention designed to connect people with stable housing as quickly as possible and minimize the amount of time spent experiencing homelessness. RRH is not limited to a particular housing type, but rather involves an individualized, time-limited package of financial assistance and other supports such as rental assistance, funds for security deposits or utility arrearages, housing search assistance, and landlord mediation. RRH is a less resource-intensive intervention and is appropriate for people with a lower level of housing affordability and behavioral health needs.
Additional Housing Models
- While Housing First programs have been shown to be the most effective model for reducing people’s experience with homelessness and the criminal justice system, they only represent a portion of a community’s housing inventory. Local housing options can also include other housing types that may be appropriate for varying housing and service needs.
- Affordable housing is a broad term that refers to any housing type where a tenant pays a set portion of their income toward rent (generally 30 percent) due to either subsidy or rent restrictions. Affordable housing encompasses tenant-based rental assistance (e.g., Housing Choice Vouchers) as well as public housing and other privately owned subsidized developments. Support services are not typically provided, or at limited intensity, so these housing types are best for people who need an ongoing housing subsidy but also have relatively low behavioral health needs.
- Many communities rely on transitional housing placements (such as halfway houses) to provide short to medium-term options for people who have been incarcerated to transition to independent living. Recovery housing is another important resource for people seeking the support and structure to address underlying substance use disorder issues. However, to be effective in reducing homelessness and justice system involvement, these programs should provide direct connections to appropriate permanent housing options to both ensure housing stability and to accommodate for relapse as part of the recovery process23.
17 Paula Goering et al., National at Home/Chez Soi Final Report (Calgary: Mental Health Commission of Canada, 2014), https://www.mentalhealthcommission.ca/sites/default/files/mhcc_at_home_report_national_cross-site_eng_2_0.pdf.; Maria C. Raven, Matthew J. Niedzwiecki, and Margot Kushel, “A randomized trial of permanent supportive housing for chronically homeless persons with high use of publicly funded services,” Health Services Research 2020 (no. 55): 797–806.
18 Angela Aidala et al., Frequent Users Service Enhancement ‘FUSE’ Initiative: New York City FUSE II Evaluation Report (New York: Columbia University Mailman School of Public Health, 2013), https://www.csh.org/wp-content/uploads/2014/01/FUSE-Eval-Report-Final_Linked.pdf.
20 Jocelyn Fontaine et al., Supportive Housing for Returning Prisoners: Outcomes and Impacts of the Returning Home-Ohio Pilot Project, (Washington, DC: Urban Institute Justice Policy Center, 2012), https://www.urban.org/sites/default/files/publication/25716/412632-Supportive-Housing-for-Returning-Prisoners-Outcomes-and-Impacts-of-the-Returning-Home-Ohio-Pilot-Project.PDF.
21 Anirban Basu et al., “Comparative Cost Analysis of Housing and Case Management Program for Chronically Ill Homeless Adults Compared to Usual Care,” Health Services Research 47, no 1 pt 2 (2012): 523–543, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3393008/; Aidala et al., ‘FUSE’ Initiative.
22 Dennis Culhane, Stephen Metraux, and Trevor Hadley, “Public Service Reductions Associated with Placement of Homeless Persons with Severe Mental Illness in Supportive Housing,” Housing Policy Debate 13, no. 1( 2002), https://shnny.org/uploads/The_Culhane_Report.pdf; CSG Justice Cetner staff analysis using “CPI Inflation Calculator,” U.S. Bureau of Labor Statistics, https://www.bls.gov/data/inflation_calculator.htm.
23 HUD, Recovery Housing Policy Brief (Washington, DC: HUD, 2015), https://www.hudexchange.info/resource/4852/recovery-housing-policy-brief/.
Building Law Enforcement–Homelessness Services Partnerships at the Leadership Level
An effective, collaborative, and community-wide response to unsheltered homelessness requires commitment to sustained cross-system collaboration, dedication of resources, and alignment on a shared strategy from partners with different, sometimes competing priorities and a limited history of working together. Therefore, early and ongoing engagement of law enforcement, behavioral health, and homeless service system leaders is essential.
The following strategies can help leaders build the critical partnerships necessary to align perspectives, priorities, and resources to connect people experiencing unsheltered homelessness to housing with lasting solutions:
- Build a strong foundation. Criminal justice and homelessness service system leaders can lay the groundwork for a successful cross-system partnership by establishing and formalizing its foundations, including through statute, Memoranda of Understanding (MOUs), or other written agreements. These foundations include:
- Setting shared goals. Unite cross-system partners around shared public health and safety goals, such as reducing unsheltered homelessness or connecting people to housing and services.
- Facilitating data sharing. Understand relevant privacy laws and necessary data-sharing safeguards, and specify which data will be shared, with which persons/agencies, and under what circumstances.
- Establishing metrics. Assess progress toward shared goals by ensuring partners track key metrics, such as disposition of calls for service or connections to care, and by matching data as feasible across systems to identify and target people who most frequently use the systems.
- Defining roles. Establish the most effective and appropriate roles for the partners involved (i.e., who leads outreach efforts), with decisions focused on what works best for facilitating access to permanent housing and supportive services.
- Identify resources. Determine the resources each system can contribute to the collaborative effort, including:
- Staffing for outreach efforts based on the needs of the community and capacity of each agency (including outside agencies)
- Planning and data analysis staff support
- IT infrastructure
- Vehicles and equipment
- Enlist champions to elevate the issue. Another hallmark of a successful collaboration is engagement of high-profile champions—such as elected officials or community leaders—to build public support for the partnership and its goals23. Such a champion can help to:
- Broker community connections to build new agency and community partnerships
- Advocate for increased resources from partner agencies, or outside sources such as government or philanthropy
- Ensure the collaboration continues in the face of external pressures such as changes in the political environment
- Ensure cross-system representation. Housing/homelessness services and criminal justice leaders should actively participate in each system’s planning bodies, such as Criminal Justice Advisory Boards or Interagency Councils on Homelessness, enabling them to:
- Understand the available resources and constraints of each system
- Share information, such as data on frequent utilizers of these and other public systems to target outreach efforts – with appropriate privacy and legal safeguards
- Leverage and connect with evidence-based outreach, housing, and other program models across sectors
- Develop clear protocols and training for connecting people to housing and supportive services. These resources are vital to guide officer interactions with this population25. As these interactions may include on-site assessments of behavioral health, housing, and other needs, law enforcement should develop protocols in partnership with leaders from the homelessness services and behavioral health systems to ensure they are evidence-based.
- Consider appealing or amending policies that criminalize behaviors associated with homelessness. Working with local policymakers, law enforcement and homelessness services system leaders can examine how local ordinances and laws may contribute to high rates of arrests among this population without a clear public safety rationale26.
Case Study: Philadelphia’s Homeless Outreach Partnership
Nearly two decades ago, in response to residents’ concerns about unsheltered homelessness and panhandling, the City of Philadelphia adopted the intervention and treatment-focused Sidewalk Behavior Ordinance. This ordinance formalized a partnership between the Office of Homeless Services (OHS) and the Philadelphia Police Department (PPD) and mandated that officers connect people on the street in need of services to OHS outreach workers who provide linkage to supportive services and housing in lieu of enforcement action. The statute has clear language defining each partners’ roles and responsibilities, including transportation protocols and training requirements.
Data sharing is at the center of this longstanding cross-system partnership. In 2017, PPD, OHS, and Philadelphia’s Department of Behavioral Health and Intellectual Disability Services (DBHIDS) began to match their data. This revealed that many of the people experiencing homelessness in the Kensington neighborhood had histories of incarceration in the jail and previous experience receiving mental health or substance use treatment. The partners developed a shared list of people who had frequent contacts with these systems to facilitate outreach and engagement. As a result, the city has been able to stem the growth in the number of people experiencing unsheltered homelessness in Kensington.
The partnership’s strong foundation in statutorily defined roles and formalized metrics for cross-system data sharing ensures its focus can evolve to meet the shifting public health and safety needs of the unhoused population. In 2018, the partners launched the Encampment Resolution Pilot in an effort to humanely respond to encampments in Kensington. Outreach teams assessed the needs of people living in the two encampments and found that a majority had substance use disorders (93 percent) and co-occurring mental illnesses (65 percent). The pilot ultimately placed 126 people in housing or connected them to substance use treatment. These successful outcomes hinged on core partners’ strengthened collaboration with housing and substance use treatment providers, which helped secure dedicated low-barrier shelter beds and streamlined access to substance use disorder treatment27.
24 CSG Justice Center and the U.S. Interagency Council on Homelessness, Strengthening Partnerships Between Law Enforcement and Homelessness Service Systems.
26 Cassidy Waskowicz, “Homeless Persons Cannot Be Punished for Sleeping in Absence of Alternatives, 9th Circuit Decision Establishes,” National Law Center on Homelessness & Poverty, accessed April 4, 2019, https://nlchp.org/homeless-persons-cannot-be-punished-for-sleeping-in-absence-of-alternatives-9th-circuit-decision-establishes/.
27 CSG Justice Center and the U.S. Interagency Council on Homelessness, Strengthening Partnerships Between Law Enforcement and Homelessness Service Systems.