Sentenced to indefinite homelessness
It is universally acknowledged that the first wave of homelessness occurred when the mental health system was abolished. Many would argue that a second wave of homelessness occurred when vast amounts of affordable housing were eliminated. I would argue that a third wave of a more desperate, intractable, and frequently violent phase of homelessness has been created by our vast prison system.
How many people enter the prison system homeless? How many leave our prison system with no fixed destination? What subset of the 70 percent of ex-felons who return to prison are homeless?
Just for public safety reasons, you might assume the correctional system would want to know those numbers. A homeless person, by definition, is a wild card. You cannot know where they are at any point in time – much less immediately after a crime has occurred in the vicinity.
Surprisingly, according to both California Department of Corrections and Rehabilitation’s (CDCR) research division and the voluminous reports on its website, the prison system does not explicitly track that information. A well-funded assessment tool (COMPAS), which has the goal of predicting the inmates likely to become higher-risk parolees, was begun in 2008. A preliminary assessment of its data shows that 39% of inmates are at high risk of "residential instability."
The research branch of the CDCR also provided a summary list of the total number of parolees at one point in time, and the numbers among those whose address is listed as either “transient” or “homeless.” This is a very narrow definition of homelessness, since even listing a shelter’s street address, or your mother’s address (despite the fact that she won’t let you stay there), would remove you from the homeless category.
Even within this relatively narrow definition of homelessness, the figures provided by CDCR show that 1,193 released prisoners are homeless in Los Angeles County with no identifiable address. Using their own provided denominator of the total point-in-time parolees in Los Angeles County, that translates into approximately one in 25 parolees in Los Angeles County being homeless. Looked at another way, using instead as the denominator the total number of people homeless in L.A. (from L.A.'s 2009 point-in-time Annual Homeless Count), one in 50 homeless people in L.A. is a released prisoner.
San Francisco has similar numbers. Although only 199 felons are listed as homeless, that represents 13 percent, or nearly one in seven released inmates. Using San Francisco’s 2009 point-in-time Homeless Count, those numbers mean that one in 33 homeless persons on the sidewalk is a parolee.
In the 2009 San Francisco Homeless Count survey, 4.5 percent of street-living respondents stated that they were homeless because of incarceration, and that same number (4.5 percent) reported their criminal record as the reason why they could not obtain permanent housing. Those survey numbers translate into roughly that one in 20 of San Francisco’s street-living homeless became homeless, and stay homeless, due to their incarceration.
A felony conviction will ban you from almost all forms of transitional, subsidized or supportive housing; sex-offender status restricts options even further, with service providers reporting that more and more sex offenders are living on the streets.
For the Bay Area as a whole, although the numbers are small, Napa County has by far the highest percentage of listed homeless parolees (17 percent, or roughly one in six). Conversely, San Mateo and Solano counties were tied for the highest estimate proportion of released felons in their homeless counts (6 percent, or roughly one in 17 homeless being a parolee). And, state-wide, 388 released inmates on active parole had "blank" listed as their county.
From the relatively small numbers of studies done on this subject, and from reports from people working in this field, the CDCR numbers – as high as they are – likely represent not an over-estimate, but, instead, an extreme undercount. A cross-sectional survey of 360 California prisoners in 2004 all aged over 55 and within two years of release from prison found that the “Mean age was 61 years; 93.8 percent were men and 56.5 percent were white. Nearly 40 percent were veterans, of whom 77.2 percent reported likely VA service eligibility…Overall, 79.1 percent reported a medical condition and 13.6 percent reported a serious mental illness.” In our California prisons in 2004, older inmates (who make up nearly one in seven inmates) soon to be released had extremely high rates of health problems, and 1 in 12 reported a risk factor for homelessness.
And even those high rates of homeless risk, given our markedly depressed current economy, have likely only worsened.
Sick and on the streets
Inmates released from California prisons often have no food, no place to go, no money, no change of clothes, no pills, no identification, no phone, no strong family ties, and little to no hope of employment. One third were originally incarcerated for drug-related reasons. They’re older, and frequently ill. They’ve been stripped of qualified coverage and have no appointments or ongoing care. Without an address or a phone, obtaining those is nearly impossible for many. Even if a parolee had a sound education, and is extremely motivated to change, with no history of mental illness, impulse control, or disabilities of any kind, our current release-process from prison is a perfect storm of conditions to create and perpetuate homelessness, even among the most motivated and self-disciplined. And 130,000 Californians a year are experiencing this. What’s remarkable is that even more of them are not on our sidewalks.
But is this a public health problem?
Once a person loses their home, their life expectancy plunges. People on the streets die at rate four to 32 times that of people living behind a wall. Additionally, people struggling without a home often churn between states of street-living (called “sleeping rough”), transitional or sheltered living, and stints in marginal transient housing often called SROs (single room occupancy hotels). The reality of the homeless churn again points to the likely extreme undercounting of the true numbers of homeless released prisoners.
Once a person is living homeless, people often become trapped in a complex web of violence, mental illness and substance abuse. Starvation is not unusual, and homeless people increasingly learn to ignore physiologic signals that something is wrong. Head trauma is shockingly common (with reported rates of more than 70 percent), severe, and often results, short and long-term, in a loss of “executive functioning.” Executive functioning encompasses such abstract abilities as long-range planning, and goal-setting, and the loss can result in impulse control problems, depression and rage disorders.
Those struggling on the street often die of preventable and treatable illnesses. And when the health hit of living on the streets begins to take its toll, homeless people tend to access our safety-net public health systems in sporadic, ineffective and very expensive ways. All of these factors together converge into a profile of early mortality, immense suffering and high cost.
Changing the prison-homeless churn
There are many simple, relatively cheap institutional changes that can dramatically alter the barriers facing Californians released from prison, and decreasing their risks of homelessness. They include:
- Prior to release, automatically re-enrolling inmates who were stripped of their Medi-Cal and Medicare coverage at the time of incarceration, at least on a probationary basis
- Providing a California identification card to each released inmate who does not have one
- Printing for each inmate a one-page summary of their medical history and medications
- Creating and implementing sanctions and penalties for whenever the prison system fails to perform mandated case-management visits prior to the release of mentally ill inmates
- Collecting, tracking and analyzing homeless rates (based on any widely acceptable definition among the many that exist) of admitted, released, and reincarcerated prisoners
- Either reducing out-of-state prison transfers, or, at minimum, being highly selective about which prisoners are chosen for out-of-state incarceration based on the vulnerability of their relationship ties
- Arranging an identified post-release medical home and appointment for inmates with recent surgeries, on-going treatment for infections and a selected list of chronic conditions requiring uninterrupted medication compliance – not just mental illness and HIV.
There are more complex and highly effective ways to address the link between incarceration and homelessness. The good news is that the CDCR as a whole seems to be moving toward a much more rehabilitation focused approach. Models that have been developed for jail inmates could serve as a useful template for dealing with some of the most high risk and mentally ill inmates where appropriate. Mental health courts have been implemented in a number of cities, including San Francisco. Results of their effectiveness, from the CDCR website, include: “prior to program enrollment, a total of 887 bookings for new offenses were reported; post-program, only 126 bookings - an 86 percent reduction. With the exception of two counties, it appears programs are having a positive effect on reducing the severity of new offenses by 5 percent.
The number of days in jail also decreased significantly; there were 45,611 jail days pre-enrollment but only 2,320 jail days post-enrollment, a 95 percent decrease. Note: clients participating in programs with a mental health court spent less time in jail post-enrollment than clients not participating in a mental health court.
The number of individuals homeless for any amount of time decreased by only 65 percent although the number of days these individuals have been homeless post-enrollment has decreased significantly; 212 participants previously reported being homeless for an average of 72 days - these same individuals have now reported being homeless an average of less than seven days, a 97 percent decrease.
Those are impressive results.
So is it worth investing the kind of multi-system effort that creating, legalizing and setting up a mental health court for prison-level parole violations and convictions would require?
Recognizing the role that the prison system plays in creating, concentrating and condemning ex-offenders to a lifetime of homelessness may allow us to create effective interventions and change the culture on our streets. It might also buffer the long-term public health costs and consequences we all must bear from the complicated mix of homelessness, violence, substance abuse and mental illness. Prison churn certainly can explain at least in part the frustrations cities and communities feel of never making a dent in homelessness despite devoting large amounts of efforts to do so. Prisons will continue to release people at higher rates than they can be rapidly housed and reintegrated. Even if you ignore the toll in terms of human suffering, the economics cannot be sustained. Devoting $10 billion a year of our state’s dollars to incarcerate one in 1,000 people when a significant proportion will inevitably end up on our sidewalks dying premature, preventable deaths at additional exorbitant cost – that is a price too high to bear.