The Impact of Criminal Justice Involvement and Housing Outcomes Among Homeless Persons with Co-occurring Disorders

The relationship between criminal justice involvement and housing among homeless persons with co-occurring disorders was examined. Program participants assisted in moving to stable housing were interviewed at baseline, six months, and discharge. Those who remained homeless at follow-up and discharge had significantly more time in jail in the past month than those who were housed. However, criminal justice involvement was not significantly related to housing status at the six month follow-up or discharge. Findings suggest that housing people with complex behavioral health issues reduces the likelihood of further criminal justice involvement.     

Are jails replacing the mental health system for the homeless mentally ill?

The author explores the process of how homeless mentally ill persons become involved with the criminal justice system. The unique demands of homelessness and chronic mental illness were specifically examined in this naturalistically based study. The author concludes that a combination of severe mental illness, a tendency to decompensate in a nonstructured environment, and an inability or unwillingness to follow through with aftercare contributed to involvement with the criminal justice system. Changes in the mental health system that would prevent the criminalization of the homeless mentally ill are suggested.This paper is based in part on research supported by grant #717632 from the Office of Program Evaluation and Research, Ohio Department of Mental Health.     

Homelessness and predictors of criminal reoffending: A retrospective cohort study

Background

There are not many longitudinal studies examining people experiencing homelessness and interacting with the criminal justice system over time.

Aims

To describe the type of criminal offences committed, court outcomes, identify probable predictors of reoffending, and estimate the criminal justice costs in a cohort of homeless hostel clinic attendees.

Method

A retrospective cohort study of 1646 people attending a homeless clinic who had had contact with the criminal justice system (CJS) in New South Wales (NSW), Australia, using linked clinic, criminal offence, health and mortality data from 1 July 2008 to 30 June 2021. Initial comparisons were made with the 852 clinic attendees without CJS contact in the period. Multivariable logistic regression was used to identify predictors of recidivism.

Results

There were 16,840 offending episodes, giving an offence rate of 87.8 per 100 person-years (95%CI: 86.5–89.1). The most common index offences were acts intended to cause injury (22%), illicit drug (17%) and theft-related (12%) offences. Most people (83%) were found guilty of the index offence and received a fine (37%) or community-based sentence (29%). Total court finalisation costs were AUD $11.3 million. Three-quarters of those convicted reoffended within 24 months. Offenders were more likely to be younger, have a diagnosis of personality disorder (AOR: 1.31; 95% CI: 1.04–1.67), a substance use disorder (AOR: 1.60; 95% CI 1.14–2.23) and/or to have a previous charge dismissed on mental health grounds (AOR: 1.79; 95% CI: 1.31–2.46). Within the offending cohort, reoffenders had almost twice the odds of having theft-related offences as their principal index offence (AOR: 1.85; 95% CI: 1.29–2.66).

Conclusions

This longitudinal study finding of not only a high rate of criminal justice contact, but also a high rate of recidivism among people who have been homeless, lends support to a need for strategies both to address the root causes of homelessness and to provide a comprehensive systems-based response to reduce recidivism, that includes secure housing as well as mental health and substance use treatment programmes for homeless offenders.     

Factors predicting arrest for homeless persons receiving integrated residential treatment for co‐occurring disorders

Background Homeless individuals are at increased risk for health and criminal justice problems. Aims The aim of this study was to examine risk factors affecting arrest rates in a cohort of homeless people with co‐occurring psychiatric and substance‐abuse disorders. Methods Baseline data were collected from 96 homeless individuals residing in a residential treatment facility for people with co‐occurring disorders. Arrest data were obtained for 2 years following treatment intake. Regression analyses were employed to examine interactions between study variables. Results One third of the sample was arrested during the 2‐year follow‐up period, principally for drug offences. People referred to treatment directly from the criminal justice system were four times more likely to re‐offend than those referred from other sources. Participants' perceived need for mental‐health services reduced risk of arrest while their perception of medical needs increased this risk. Conclusions The relationship between referral from a criminal justice source and re‐arrest after admission to the treatment facility is unsurprising, and consistent with previous literature, but the suggestion of an independently increased risk in the presence of perceived physical health‐care needs is worthy of further study. The lower risk of arrest for people who perceive that they have psychological needs is encouraging. Copyright © 2009 John Wiley & Sons, Ltd.     

Childhood risk factors for criminal justice involvement in a sample of homeless people with serious mental illness

It has been suggested that criminal justice involvement among the homeless, particularly those with mental illness, is largely situational. The objective of this study was to assess, in a sample of homeless seriously mentally ill people, the prevalence of childhood conduct disorder behaviors as a risk factor for adult criminal activity as well as the extent and types of adult criminal justice contact. Data were taken from the national ACCESS program, which conducted extensive baseline interviews with 7,222 homeless seriously mentally ill adults. The interview assessed demographics, childhood risk factors for criminal activity such as conduct disorder behaviors, foster care, and parental abuse, as well as current illness severity and recent criminal justice contact. The 2-month arrest rate in this sample was much higher than national rates (11% compared with 1% annually in the general population). Although most arrests were for minor crimes (10.8%), there were also substantial rates of arrest for major (2.7%) and substance-related charges (2.0%). The prevalence of a history of conduct disorder behavior was also substantial (55% in male subjects, 40% in female subjects), and conduct disorder was a strong predictor of recent criminal justice involvement, even after controlling for other predictors of arrest (odds ratio = 1.76 for major crimes, 1.49 for minor crimes, and 1.98 for substance-related crimes). Recent literature has criticized a trend to criminalize homeless mentally ill persons for attempting to get needed food, shelter, or medical attention. However, these data indicate that at least some proportion of arrests in this population are of people who have been exhibiting antisocial behavior since early adolescence, and that early antisocial behavior is a strong predictor of all types of recent arrests in this population.     

Evaluation of Treatment Programs for Dual Disorder Individuals: Modeling Longitudinal and Mediation Effects

This study evaluated the effectiveness of the three approaches for treating dual disorder clients who were homeless at intake: integrated assertive community treatment (IACT), assertive community treatment only (ACTO), and standard care (SC). Multilevel Random Coefficient Modeling (MRCM) was used to analyze longitudinal effects and to identify mediators of significant treatment effects. The outcome variables were consumer satisfaction, stable housing, psychiatric symptoms, and substance abuse. The eight mediators were service utilization variables: program contacts, phone contacts, substance abuse contacts, assistance with activities of daily living, transportation assistance, help finding permanent housing, help with emotional problems, and medication assistance. The 191 eligible participants were randomly assigned to one of the three conditions and followed for a period of 30 months. Both ACTO and IACT produced better outcomes than SC on consumer satisfaction and stable housing. There were no differences on any of the outcome variables between ACTO versus IACT when comparing main effects. However, there were several treatment by time interactions. In addition, there were many mediation effects.     

Providing effective substance abuse treatment for young-offender populations: what works!

Previous research has documented a strong linkage between substance abuse and criminal activity among young offenders. Consequently, the provision of effective substance-abuse interventions for this population is of paramount importance to the criminal justice system. This article explores the literature on the treatment of substance abuse in offender and nonoffender populations. It reviews three major areas: pretreatment variables (eg, gender and psychopathology), in-treatment variables (eg, program targets, program setting, client-treatment matching), and posttreatment variables (eg, aftercare). The article concludes with a list of empirically derived guidelines for the effective development and implementation of substance-abuse treatment programs for adolescents.     

Jail incarceration, homelessness, and mental health: a national study

OBJECTIVE: This study sought to investigate the rates and correlates of homelessness, especially mental illness, among adult jail inmates. METHODS: Data from a national survey of jail inmates (N=6,953) were used to compare the proportion of jail inmates who had been homeless in the previous year with the proportion of persons in the general population who had been homeless in the previous year, after standardization to the age, race and ethnicity, and gender distribution of the jail sample. Logistic regression was then used to examine the extent to which homelessness among jail inmates was associated with factors such as symptoms or treatment of mental illness, previous criminal justice involvement, specific recent crimes, and demographic characteristics. RESULTS: Inmates who had been homeless (that is, those who reported an episode of homelessness anytime in the year before incarceration) made up 15.3% of the U.S. jail population, or 7.5 to 11.3 times the standardized estimate of 1.36% to 2.03% in the general U.S. adult population. In comparison with other inmates, those who had been homeless were more likely to be currently incarcerated for a property crime, but they were also more likely to have past criminal justice system involvement for both nonviolent and violent offenses, to have mental health and substance abuse problems, to be less educated, and to be unemployed. CONCLUSIONS: Recent homelessness was 7.5 to 11.3 times more common among jail inmates than in the general population. Homelessness and incarceration appear to increase the risk of each other, and these factors seem to be mediated by mental illness and substance abuse, as well as by disadvantageous sociodemographic characteristics.     

Cost-effectiveness of critical time intervention to reduce homelessness among persons with mental illness

OBJECTIVES: Cost-effective programs are needed to assist homeless persons with severe mental illness in their transition from shelters to community living. The authors investigated the cost-effectiveness of the critical time intervention program, a time-limited adaptation of intensive case management, which has been shown to significantly reduce recurrent homelessness among men with severe mental illness. METHOD:S: Ninety-six study participants recruited from a psychiatric program in a men's public shelter from 1991 to 1993 were randomly assigned to the critical time intervention program or to usual services. Costs and housing outcomes for the two groups were examined over 18 months. RESULTS: Over the study period, the critical time intervention group and the usual services group incurred mean costs of 52,374 dollars and 51,649 dollars, respectively, for acute care services, outpatient services, housing and shelter services, criminal justice services, and transfer income. During the same period, the critical time intervention group experienced significantly fewer homeless nights than the usual care group (32 nights versus 90 nights). For each willingness-to-pay value--the additional price society is willing to spend for an additional nonhomeless night--greater than 152 dollars, the critical time intervention group exhibited a significantly greater net housing stability benefit, indicating cost-effectiveness, compared with usual care. CONCLUSION:S: Although difficult to conduct, studies of the cost-effectiveness of community mental health programs can yield rich information for policy makers and program planners. The critical time intervention program is not only an effective method to reduce recurrent homelessness among persons with severe mental illness but also represents a cost-effective alternative to the status quo.     

Copenhagen Community Psychiatric Project (CCPP): characteristics and treatment of homeless patients in the psychiatric services after introduction of community mental health centres

The main purpose of the study was to describe the characteristics of homeless psychiatric patients, and to compare the treatment they are offered to that offered to domiciled patients by the psychiatric services. Another purpose was to analyse the prevalence of homelessness among psychiatric patients before and after the introduction of community mental health centres in Copenhagen. Cross-sectional studies were conducted in two intervention and two control districts before and after introduction of the new treatment modalities. In 1991, 80 of 1008 patients (8%) were homeless. Male sex, young age, living on general welfare, schizophrenia and alcohol or substance abuse were the factors that most markedly differentiated homeless from domiciled patients. Compared with the treatment of domiciled patients, the homeless were more likely to be offered no further treatment after consultation in a psychiatric emergency and, if admitted, they were more likely to be placed in locked wards, given compulsory medication, and medicated with depot neuroleptics. The homeless were also less likely to be offered psychotherapy and consultation with a social worker. Schizophrenia and alcohol or substance abuse characterised the majority of the patients discharged homeless. In the intervention districts, the number of homeless patients in contact with the psychiatric services was found to increase at the same rate as the number of all patients in contact with the psychiatric services. In the control districts, no changes in prevalence of homeless patients or other patients in contact with the psychiatric services occurred. It is concluded that homeless psychiatric patients comprise a difficult patient group, with problems of schizophrenia, substance abuse and lack of motivation for treatment. It is recommended that special efforts be made to create housing facilities that fit the needs of different types of homeless patients, and that the homeless mentally ill are assisted in obtaining and maintaining an acceptable housing situation.     

Adapting evidence-based practices for persons with mental illness involved with the criminal justice system

The overrepresentation of persons with mental illnesses in the criminal justice system is well documented. As more communities attempt to offer appropriate evidence-based practices in diversion and reentry programs, a major issue that has become apparent is that adaptations to the standard practices are often required because of the legal predicaments faced by clients. The associated question is how extensive can adaptations be before fidelity to the proven practice is compromised. To better understand these pressing issues, the National GAINS Center for Evidence-Based Programs in the Justice System held a series of six meetings focused on evidence-based practices (assertive community treatment, housing, trauma interventions, supported employment, illness self-management and recovery, and integrated treatment) and their applicability for persons involved in the criminal justice system. This Open Forum integrates the results of those meetings and proposes future steps to establish relevant evidence-based practices that can influence both behavioral health and public safety outcomes for persons involved with the criminal justice system.     

A National Study of Veterans Treatment Court Participants: Who Benefits and Who Recidivates

Although there are now over 400 veterans treatment courts (VTCs) in the country, there have been few studies on participant outcomes in functional domains. Using national data on 7931 veterans in the Veterans Affairs (VA) Veterans Justice Outreach program across 115 VA sites who entered a VTC from 2011 to 2015, we examined the housing, employment, income, and criminal justice outcomes of VTC participants; and identified veteran characteristics predictive of outcomes. VTC participants spent an average of nearly a year in the program and 14% experienced a new incarceration. From program admission to exit, 10% more participants were in their own housing, 12% more were receiving VA benefits, but only 1% more were employed. Controlling for background characteristics, a history of incarceration predicted poor criminal justice, housing, and employment outcomes. Participants with property offenses or probation/parole violations and those with substance use disorders were more likely to experience a new incarceration. Participants with more mental health problems were more likely to be receiving VA benefits and less likely to be employed at program exit. Together, these findings highlight the importance of proper substance abuse treatment as well as employment services for VTC participants so that they can benefit from the diversion process.     

Explaining Homeless Youths’ Criminal Justice Interactions: Childhood Trauma or Surviving Life on the Streets?

Homeless youth are at increased risk for involvement in the criminal justice system. This study investigated childhood trauma as a risk factor for arrest or jail among a sample of youth seeking services at drop in, shelter, and transitional housing settings, while controlling for more established risk factors including: substance use, peer deviance, and engagement in survival behaviors. Standardized and researcher developed measures collected quantitative data through face-to-face interviews with youth (N = 202). Two sequential logic regression models identified significant predictors of arrest and jail, with a particular interest in the effects of childhood maltreatment. Youth with a history of physical abuse were nearly twice as likely to be arrested and to be jailed compared to non-abused youth, controlling for the significant influence of drug use and survival behaviors. These findings suggest the need for trauma screening and trauma-informed services for homeless youth at risk of illegal behavior.     

Criminal activity among the homeless: a study of arrests in Baltimore

To illuminate the role of criminal activity among the homeless, particularly the homeless mentally ill, the author compared 634 arrests of homeless persons with 50,524 arrests in the general population that were made in Baltimore in 1983. Significant differences were found in the demographic characteristics of the two groups of arrested persons and in the types of offenses prompting the arrests. Among the homeless, those arrested were more likely to be male, white, and over age 45 and to have committed trivial, victimless crimes. Evidence suggests that ostensibly serious offenses such as assault, larceny, and burglary charged to homeless persons tended to involve petty thievery, entry into vacant buildings, and other acts aimed at maintaining subsistence in the absence of housing.     

Comparison of offenders with mental illness only and offenders with dual diagnoses

OBJECTIVE: The study compared offenders who had severe mental illness only and offenders who had severe mental illness and substance abuse problems-dual diagnoses-to determine whether these groups differed. Offenders with dual diagnoses who were involved with the criminal justice system at different levels were compared to explore their profiles and experiences after release. METHODS: Secondary data collected on offenders who had diagnoses of severe mental illness and of substance abuse in Massachusetts were used to examine sociodemographic, clinical characteristics, and criminal justice characteristics, service needs, and community reentry experiences in the first three months postrelease of 265 offenders with major mental illness and 436 with dual diagnoses. RESULTS: Offenders with dual diagnoses were more likely to be female and to have a history of being on probation and of using mental health services. On release from correctional custody, they had more immediate service needs than offenders with mental illness alone, including a need for housing and sex offender treatment, and they were more likely to require an assessment for dangerousness. They were also more likely to return to correctional custody. CONCLUSIONS: The data do not suggest that offenders with dual diagnoses have a distinct clinical background, but rather that substance abuse is an important feature that affects their real or perceived level of functioning, engagement with the criminal justice system, and dependence on social service institutions in the community.     

Homelessness in the state and federal prison population

AIMS: This study sought to investigate the rates and correlates of homelessness (i.e. living on the street or in a homeless shelter), including mental illness, among US adult state and federal prison inmates (ASFPIs). METHOD: Data from a national survey of ASFPIs based on a random sampling survey (N = 17,565) were used to compare the homelessness rate among AFSPIs with that in the general population. Logistic regression was then used to examine the association of homelessness among ASFPIs with factors including symptoms, treatment of mental illness, previous criminal justice involvement, specific crimes, and demographic characteristics. RESULTS: Nine percent of ASFPIs reported an episode of homelessness in the year prior to arrest, 4-6 times the estimated rate in the general US adult population after allowing for age, race/ethnicity, and gender. In comparison to other inmates, these homeless inmates were more likely to be currently incarcerated for a property crime, but also to have had previous criminal justice system involvement for both property and violent crimes, to suffer from mental health and/or substance abuse problems, and to be more likely to have been unemployed and with a low income. CONCLUSIONS: Recent homelessness is far more common among ASFPIs than the general population. Prior incarceration, mental illness, substance abuse and disadvantageous socio-demographic characteristics were all found to be associated with homelessness among prison inmates, suggesting that there are several important factors in addition to efforts to survive with limited resources through criminal acts that influence the rates of homelessness among incarcerated individuals.     

Homelessness in a National Sample of Incarcerated Veterans in State and Federal Prisons

The Veterans Health Administration (VHA) has been increasing efforts to reach out to assist incarcerated veterans. While previous studies have shown strong associations between incarceration and homelessness, few studies have examined distinctive characteristics of incarcerated homeless and non-homeless veterans. National administrative data on 30,348 incarcerated veterans served by the Health Care for Re-entry Veterans (HCRV) program were analyzed. Incarcerated veterans were classified into four groups based on their history of past homelessness: not homeless, transiently homeless, episodically homeless, and chronically homeless. Multinomial logistic regression was used to compare groups on sociodemographic characteristics, criminal justice status, clinical status, and their interest in using VHA services. Of the sample, 70 % were classified as not homeless, 8 % as transiently homeless, 11 % as episodically homeless, and 11 % as chronically homeless. Thus, 30 % of the sample had a homeless history, which is five times the 6 % rate of past homelessness among adult men in the general population. Compared to non-homeless incarcerated veterans, all three homeless groups reported significantly more mental health problems, more substance abuse, more times arrested in their lifetime, more likely to be incarcerated for a non-violent offense, and were more interested in receiving VHA services after release from prison. Together, these findings suggest re-entry programs, like HCRV, can address relevant mental health-related service needs, especially among formerly homeless veterans and veterans in need of services are receptive to the offer of assistance.     

Changes in subjective quality of life among homeless adults who obtain housing: a prospective examination

Background: The aim of this present study is to examine whether overall subjective quality of life and specific domains of quality of life change among homeless adults after they become housed, and if so, what factors predict changes in satisfaction. Methods: The data analysed here were collected through face-to-face interviews with a sample of 485 homeless adults who were interviewed as often as bi-monthly over a 16-month period. Bivariate analyses examined initial differences between three groups: homeless people who did not exit from homelessness; those with an exit from homelessness to dependent housing; and those with an exit to independent housing. Bivariate analyses also examined differences in subjective quality of life before and after an exit from homelessness among the three groups. Multivariate analyses identified predictors of changes in quality of life before and after exit. Results: This study has three main findings. First, homeless people who obtained independent housing had the largest positive and significant improvements in satisfaction with overall quality of life, and in satisfaction with housing, leisure and money. Second, becoming housed was not a predictor of changes in overall quality of life perceived by homeless people, nor in their satisfaction with leisure, clothing, food, and social life. Furthermore, a positive change in housing satisfaction was not associated with all types of exits from homelessness; only a move into independent housing predicted such a change, but a move into dependent housing did not. Finally, of all the covariates included as predictors at baseline, only two variables seemed to consistently predict changes in satisfaction; namely, self-assessed general health and self-assessed self-help skills. Conclusions: This study suggested that becoming independently housed may improve some aspects of quality of life for homeless people, but not others. The results suggest that homeless people prefer to be independently housed relative to remaining homeless or staying in a dependent housing situation, but that independent housing does not necessarily improve other aspects of their lives. Accepted: 21 March 2001     

Housing instability and homelessness among aftercare patients of an urban state hospital

Homelessness as a dimensional concept reflecting instability of community living arrangements was examined in an urban state hospital's sample of 187 aftercare patients with chronic mental illness. According to ratings by outreach clinicians, 17 percent of the patients were predominantly homeless, and 10 percent were occasionally homeless over the six months before evaluation. Younger, male patients were more likely to be homeless. Homelessness was strongly associated with abuse of alcohol and street drugs, treatment noncompliance, and a variety of psychosocial problems and psychiatric symptoms. Homeless patients were viewed by their primary clinicians as attracted to the hospital as a living alternative and, during prospective one-year follow-up, had a much higher rate of rehospitalization.