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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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.