Poor people of color in urban areas in the United States have a reduced chance of living in safe surroundings because of the high prevalence of intractable conditions such as substance use, incarceration and homelessness. These conditions create a dangerous environment where the wellbeing of residents is in jeopardy. Substance use is the most significant risk factor for incarceration, and episodic periods of imprisonment cause unstable housing and homelessness. In turn, unstable housing and homelessness are closely correlated with substance use and recidivism, creating an all-too-common cycle of substance use, prison time and homelessness. Policies and interventions attempting to address this cycle do not appreciate the multidimensional nature of the problem. Current piecemeal strategies often exacerbate one risk while trying to address another. Even worse, existing governmental bureaucracies inhibit the creation of a comprehensive solution by employing organizational silos in which resources invested by one section (housing, for instance) reap benefits only for others (mental health and primary care).

To break this cycle of intractable problems and improve conditions in urban areas, a multilevel approach must be implemented. The approach must collaboratively engage communities at the street-level to provide services while simultaneously engaging the policy processes at the governmental level to establish comprehensive policy solutions.

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What You Need To Know

There is a lot of research-based evidence that indicates homelessness and incarceration are intertwined: a history of incarceration raises the risk of homelessness and vice versa. Additionally, high rates of substance abuse among incarcerated people increase the risk of homelessness and the need for social services after release.

Homelessness is tied to a prevalence of dangerous lifestyle habits and a decreased likelihood of obtaining needed healthcare services. In research studies, stable housing significantly reduced the rate of dangerous habits such as hard drug use, needle sharing, engaging in sex for exchange and unprotected sex. Studies also indicate that homeless people seldom use primary care services and are more likely to use expensive care services such as emergency rooms and hospitalization.

There are a growing number of barriers to implementing an effective solution to the problems posed by substance use, homelessness and incarceration. One is the Affordable Care Act (ACA), which actually could make getting care to the underserved populations in urban areas more difficult. The ACA encourages care agencies to save money by eliminating service to their costliest clients, those who require the highest level of care, such as the homeless and addicted. Additionally, agencies will be encouraged to provide more generalized care and eliminate specialized care for populations such as the homeless.

Another barrier is the siloed structure of the governmental agencies responsible for tackling social issues such as homelessness and substance use. Housing, mental and physical health, criminal justice, employment and welfare agencies are all housed in separate departments. In theory, these departments are in conversation with each other. In reality, however, collaboration is often absent. Making matters worse, budgets are seldom coordinated, with no incentives for one department to invest resources when another department will benefit from the improvement. Effective mental health services, for instance, might result in reduced incarceration episodes, creating savings in the criminal justice system. Mental health spends and criminal justice saves.

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TJ Ghose
About the author

Toorjo Ghose, PhD, MSW

Dr. Ghose focuses on structural interventions in the area of substance abuse, homelessness and HIV, both at the domestic and international levels. His research examines the manner in which contextual factors such as housing, community mobilization and organizational characteristics influence substance use and HIV risk. He is currently working with community-based agencies in New York city to study the effectiveness of providing housing as an intervention for substance-using women with HIV released from prisons and jails. A second project involves a collaboration with scholars at the Treatment Research Institute in Philadelphia, state substance abuse agencies in the U.S. and addiction treatment centers to examine the effects of facility-level financial interventions in treatment effectiveness. Dr. Ghose also works with collectives of sex workers and transgendered people with HIV in India, New York and Philadelphia to examine the effectiveness of social movement mobilization in reducing HIV risk.