Jail Inreach: Healthcare for the Homeless - Houston

The Jail Inreach program run by Health Care for the Homeless-Houston begins helping Houston’s incarcerated homeless population in the jail itself. Prisoners who have a history of homelessness, mental illness, and/or multiple non-violent incarcerations are referred to Healthcare for the Homeless by the Harris County Jail. Case managers visit with the prisoners up to six or seven times to develop a discharge plan and to build trust. Once an individual is released, a case manager meets them at the gate and helps them through the process of finding housing, qualifying for benefits, and getting continued quality mental health and substance abuse care.

A more than 50% drop in rearrest rates occurred in the population of inmates that were a part of the Jail Inreach Program.

Advice on the challenges of helping this population and tips for overcoming these challenges from the Executive Director, Frances Isbell:

The biggest challenges are the basics. There isn’t enough housing available, notably permanent supportive housing. There also isn’t enough funding available from the state level.  The state government tends to push the issue down to the county level, but counties don’t usually have the same level of resources to address the robust need.  It actually saves the state money by helping these individuals with critical health care and substance abuse therapy as well as housing and benefits support.  These individuals circle in and out of emergency rooms and jail cells, and the best way to stop that cycle is with health care and housing.

Tips for other providers on ways to improve a program to help this population:

The Harris County Jail is a valuable partner in our program. If possible, try to establish a partnership with the local jail in your community as well. The corrections department helps us identify individuals that would be a good fit for our programs and they coordinate daytime releases so that we can have a case manager waiting at the gate.  This pick up is a critical moment for those reentering, as it is very easy for these individuals to go right back to their old neighborhoods and lifestyles. With this coordination, we can get to the individual first and offer them an alternative.

Substance abuse therapy and mental health care are absolutely critical. When prisoners are incarcerated they have access to behavioral health care and medicines that treat mental health disorders, but as soon as they are released that access disappears. In Houston, individuals are not given any extra medication when they leave nor, often, are they given a prescription.  It can take four to six months to schedule an appointment through the public health system; far too long for an individual with a mental health disorder to have no safety net. We are able to solve this problem by walking individuals over to our health clinic (which is four blocks from the jail) as soon as they are released.

Other partners can be helpful to providers as well. Case managers can’t do everything, so they need to be experts at finding the resources to help their clients. For us this means working closely with the county government health systems and the local housing providers. There are also specialty courts that have been very helpful in Houston to limit the incarceration of folks who are not serious criminals but who have other treatable problems like addiction and mental health disorders. These courts include a Homeless Court, a Mental Health Court, a VA court, and a Drug Court. Social workers at these courts also link individuals to services.