Bidirectional Association Between Homelessness and Incarceration Among Veterans Participating in HUD-VASH Dennis Culhane, PhD

Homelessness & Incarceration Homelessness and incarceration share risk factors and each increases the risk of the other Jail inmates have 7.5–11.3 the odds of recent homelessness compared with general population ¼ of unstably housed individuals had ever been incarcerated (compared with 7% of general population) Evidence of institutional circuit Exacerbated by substance use issues, experiences related to Veteran status

Permanent Supportive Housing Effective at supporting housing tenure for individuals with Criminal history Substance use disorders (SUD) Mental illness Participants with criminal history have similar tenure as those without, experience fewer days in jail Tenure often shorter—and risk of return to homelessness higher—among participants with SUD Evidence of decreased substance use over time, maintenance of housing post-relapse

Methods Administrative data for 1,060 male Veterans who enrolled in and exited HUD-VASH, June 2011–November 2014 Assessed 2 outcomes Exiting HUD-VASH due to incarceration Returns to homelessness following exit from HUD-VASH

Characteristics by Exit Reason Incarceration (n=70) Other Reason (n=990) Race Black 64.3 53.1 White 24.3 40.6 Schizophrenia 20.0 11.9 Substance use conditions Alcohol use disorder only 5.7 6.9 Drug use disorder only 27.1 13.0 Both alcohol & drug use disorders 18.6 16.2 Enrollment Priority Group >= 50% SC disability 11.4 26.4 No SC disability, Medicaid-eligible 68.6 50.5 History of incarceration 97.1 70.5 Tenure in housing – mean (SD) 407 (257) 481 (238) Return to homelessness 18.8 All differences significant at p<.05, except return to homelessness

Services Use Pre-Exit Decrease in outpatient services use between 61–90 and 0–30 days prior to exit Type of Service Incarceration (n=70) Other Reason (n=990) Medical 17.1 23.2 Behavioral Health 14.3 12.7 Substance Use* 12.9 3.5 Case Management 23.6 *Difference significant at p<.05

Risk of Exit Due to Incarceration Odds of Exit Due to Incarceration vs. Other Reasons *Only significant predictors displayed; controlled for site, age, race, combat exposure, mental/behavioral health conditions, SUDs

Risk of Return to Homelessness Odds of Returning to Homelessness within 600 Days of HUD-VASH Exit *Only significant predictors displayed; controlled for site, age, race, combat exposure, SC disability, mental/behavioral health conditions, SUDs

Summary 6.6% of sample exited HUD-VASH due to incarceration Increased risk among those with drug use disorder, decrease in related care, history of incarceration 24.3% of those who exited HUD-VASH due to incarceration returned to homelessness within 600 days Increased risk among those with schizophrenia, decrease in SUD care, history of incarceration

Implications Need services to break institutional circuit of homelessness and incarceration Community reentry programs Stable income Abstinence programs based on consumer choice Focus on matching Veterans with appropriate level of care

For More Information Cusack, M. C., & Montgomery, A. E. (2017). Examining the bidirectional association between Veteran homelessness and incarceration within the context of permanent supportive housing. Psychological Services, 14(2), 250–256.