Access to Care

Inmates who are released from prison often join the ranks of the homeless

Efforts to eradicate homelessness must include the unmet needs of inmates who are released from prison, many of whom join or return to the ranks of the homeless. That's the conclusion of a study supported in part by the Agency for Healthcare Quality and Research (HS11415). Homeless people are more likely to be imprisoned than others, while former prisoners are more likely to become homeless because of their difficulty finding housing and employment after release. Homeless people and prisoners also share the same risks of substance abuse, mental illness, and infectious disease (such as HIV, tuberculosis, and hepatitis C), which make obtaining a job and housing difficult.

However, these risks are even higher for homeless former prisoners, explains Margot B. Kushel, M.D., of the University of California, San Francisco. Dr. Kushel and colleagues interviewed 1,426 community-based homeless and marginally housed adults in San Francisco during a 12-month period to analyze factors associated with a history of imprisonment. Nearly one-fourth of those interviewed (23 percent) had been imprisoned in a State or Federal prison at some point during their lifetime.

Those who had been imprisoned were 41 to 69 percent more likely than those who had not been in prison to have a history of drug use, mental illness, or HIV infection. They were also more likely to have a history of psychiatric hospitalizations and more than 100 sexual partners. The researchers suggest that high rates of imprisonment among homeless populations may be the end result of a system that does not provide access to timely services for homeless people, such as access to housing, health care, mental health care, and substance abuse treatment, and which prevents receipt of these services by people exiting prison.

See "Revolving doors: Imprisonment among the homeless and marginally housed population," by Dr. Kushel, Judith A. Hahn, Ph.D., M.P.H., Jennifer L. Evans, M.S., and others in the October 2005 American Journal of Public Health 95(10), pp. 1747-1752.

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