With the cost of living rising in the U.S., record numbers of Americans are experiencing homelessness. A panel of public health and public safety experts discussed prevention strategies and long-term solutions at an April 13 Harvard T.H. Chan School of Public Health Studio event.
Panelists included Monica Bharel, clinical lead for global health, public health, and public sector health at Google, and former commissioner of the Massachusetts Department of Public Health; Leslie Credle, founder of Justice4Housing in Boston; Gil Kerlikowske, former director of national drug control policy under President Obama and former police chief in multiple U.S. cities including Seattle; and Peter Koutoujian, sheriff of Middlesex County, Mass. The event was moderated by Howard Koh, Harvey V. Fineberg Professor of the Practice of Public Health Leadership and faculty chair of the School’s Initiative on Health and Homelessness.
Throughout the discussion, panelists emphasized that homelessness is a complex, multifaceted crisis that requires a cross-sector, collaborative approach involving stakeholders from public health, government, public safety, community groups, and those with lived experience. They talked about the need to shift the focus from punishing unhoused individuals to diverting those with mental illness and substance use disorders to treatment programs and forming partnerships to provide supportive services in communities.
Solutions discussed included the use of social workers instead of law enforcement to respond to certain police calls such as conflicts involving a person with mental illness. Social workers can help unhoused people avoid incarceration and get connected to resources they need to get back on track, Koutoujian said.
Bharel said that it’s important for people in public health to understand the perspectives of those outside of their field in order to tackle the complex reasons why people become homeless, from chronic illness, mental health, and substance abuse disorders to financial issues and childhood trauma.
She shared the general framework she uses to narrow her focus when thinking about such a large challenge: Start with localizing the problem and collecting data on the people most affected. And as the data is being analyzed, Bharel said that she works to provide services to meet acute needs and form partnerships to develop long-term solutions.
One data analysis example she cited was her work on overdose death prevention as commissioner. She pulled together criminal justice, medical, and behavioral health data to look at the problem from multiple angles. Among her key findings were that people with substance use disorders who were released from incarceration were 120 times more likely to die of an overdose than others in Massachusetts and that they were most at risk within the first month.
In regard to addressing homelessness, her approach included providing robust clinical services where people are able to access them—whether at a clinic, on a street corner, or in prison—and working with partners to help provide people experiencing homelessness with nutritious meals and income-earning opportunities.
Help after incarceration
Credle spoke about the stigma she encountered reentering society after incarceration, and the importance of having people with lived experience at the table when developing homelessness prevention solutions. She had owned her own home and was able to keep it because her teenage daughter paid her bills. But her daughter was shot and killed while Credle was still incarcerated. She created the organization Justice4Housing in her daughter’s memory. It provides formerly incarcerated individuals with an 18-month supportive re-entry program that includes stable housing and help from peers on getting reacclimated to society. The program has a 2% recidivism rate compared to Massachusetts’ 26% recidivism rate, Credle said.
Formerly incarcerated people are 10 times more likely than the general population to experience homelessness, said Koutoujian. He said that it was vital to start planning an individual’s reentry from their first day of incarceration to ensure that they are returning to a healthy environment.
Kerlikowske emphasized meeting people where they are when addressing homelessness. Seattle allowed “wet housing” (meaning that people are able to drink alcohol in their accommodations) while he was the police chief. He said that he had initial concerns but came to appreciate that such housing provided safety and helped residents reduce their alcohol consumption over time.
Panelists also shared myths about homelessness that they’d like to dispel. Kerlikowske said that unhoused people are not more likely to perpetrate crimes than the general population, and Koutoujian said the same about people experiencing mental health issues.
Bharel said, “People experiencing homelessness are more like us than they are unlike us. We should approach their issues with empathy and collaboration and with realistic optimism, because there are solutions that work.”
About The Author
Amy Roeder
Senior Editor, Harvard Chan Magazine; Senior Writer in the Office of Communications
