First Do No Harm: Homelessness is Not a Crime
By: Mudit Gilotra, MD, MPH
With the deeply rooted belief that we do our best work when working together, Houston has made incredible strides toward ending homelessness. We have used the tried-and-true method of providing people housing first, and then working in partnership with them to help maintain their housing, find employment, and regain stability in their lives. We have become a model for other cities across the country. However, a case before the U.S. Supreme Court could upend the last several years of life-saving progress, and make it easier for politicians to return to the ineffective and punitive policies of the past.
On April 22, the Supreme Court will hear the case of City of Grants Pass, Oregon v. Johnson, the most significant Supreme Court case about the rights of people experiencing homelessness in decades. Amidst the worsening affordable housing crisis, the Supreme Court will determine whether a local government can arrest or fine people for sleeping outside when adequate shelter is not available.
Criminalization is not a solution to homelessness.
Arrests, fines, jail time, and criminal records make it more difficult for individuals experiencing homelessness to access the affordable housing, health services, and employment necessary to exit homelessness. Because of systemic racism in housing and other sectors, Black and Indigenous people experience homelessness at far higher rates than white individuals, and they are most likely to be harmed by criminalization. Further, as healthcare professionals, we have seen first-hand how being forced to move around without a consistent place to sleep can destabilize a person’s health and shorten their lifespan. If the Supreme Court decides that localities can arrest people who have nowhere to sleep at night, we may see even more resources wasted, lives harmed, and racial disparities deepened.
The inability to afford housing is the primary cause of homelessness. Nationally, there’s a shortage of 7.3 million affordable homes available to people with the lowest incomes. Without affordable options, 11.7 million renters pay more than half of their limited incomes on rent, leaving them with few resources to make ends meet. Any financial shock can cause these households to fall behind on rent and face eviction and, in the worst cases, homelessness. Despite the clear need, only one in four people eligible for housing assistance receive any help due to chronic underfunding by Congress.
Locally, more than 900,000 Houstonians, including 1 in 4 children, live below the poverty line and struggle to find and keep affordable housing. People in communities with high poverty rates are more vulnerable to chronic disease, mental and behavioral health conditions, higher mortality, and lower life expectancy. Children growing up in poverty are more likely to experience developmental delays, toxic stress, and chronic illness. They are less likely to graduate high school, have fewer employment opportunities, and are more likely to experience incarceration.
We know what works to end homelessness: providing individuals with immediate access to stable, affordable housing and voluntary supportive services, such as case management, mental healthcare, substance use services, and employment services to help improve housing stability and well-being. We have been doing this in Houston for years and have become the model of success for cities across the nation. In Houston, we have The Way Home: a collective effort of more than 100 community partners to prevent and end homelessness in the Houston region, led by Coalition for the Homeless Houston. The partners of The Way Home work together to make homelessness rare, brief, and non-recurring in our region. More than 30,000 people have been housed since 2012 with a 90% success rate of remaining within permanent supportive housing programs. Programs like the partnership between Healthcare for the Homeless - Houston, SEARCH Homeless Services, and New Hope Housing demonstrate that “housing first” yields better outcomes and more success in maintaining stable housing long-term. Healthcare for the Homeless - Houston began providing on-site primary medical, mental, and behavioral health services to hundreds of formerly homeless residents across seven permanent supportive housing sites in 2016. Within two years of launching the partnership, there was a 71% reduction in emergency room usage and a 54% reduction in hospitalizations for residents in supportive housing.
Congress must play a critical role in ending homelessness and housing security by investing in long-term solutions at the scale needed. This starts with making rental assistance available to all eligible households, preserving and expanding the number of homes that are affordable to people with the lowest incomes, providing emergency rental assistance to stabilize families and avoid homelessness, and strengthening federal renter protections. Congress must expand access to healthcare, including mental health and substance use services, and it must pay the workforce on the front lines a living and equitable wage.
Regardless of how the Supreme Court rules, we ask policymakers here in Houston and in Congress to continue to champion the successful interventions that we know work, rather than build obstacles for those struggling to survive.
Resources to Take Action
"Housing Not Handcuffs" Advocacy Campaign from the National Coalition for the Homeless
Template Letter for connecting with your Federal Congressional Representatives
You may also contact your Houston City Council Member and modify this template to encourage their support for local efforts.
—
Mudit Gilotra, MD, MPH is a family physician and Associate Medical Director for Healthcare for the Homeless - Houston, a nonprofit, federally qualified health center promoting health, hope, and dignity for those affected by homelessness. In addition to launching Street Medicine programs in three cities, including Houston, he has cared for people who are homeless for more than a decade in Houston and in other cities across the country. As a member of the Board of the National Healthcare for the Homeless Council, Dr. Gilotra is passionate about advocating for policies and programs that help all people live healthy, sustainable lives.