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Access to permanent housing, financial security, and quality health care are foundational for leading a healthy and fulfilling life. For many individuals, lack of stability in such dimensions of life correspondingly promotes repeated cycles of service use between the homelessness, criminal justice, and hospital systems.
Prior studies document the co-occurrence of incarceration, homelessness, and unmet health needs—in particular, mental health needs.1,2,3 High health care utilizers, defined as having at least four emergency department (ED) visits or at least three inpatient hospital stays per 12-month period were five times more likely to experience homelessness, and two times more likely to have an interaction with the criminal justice system than those who used health care less frequently.4 Individuals who experienced both homelessness and incarceration displayed increased prevalence of mental illness compared with those who experienced either homelessness or incarceration. People who were homeless prior to admission to the criminal legal system were more likely to report symptoms of mania, depression, psychosis, and substance use disorder, as well as use of mental health services or medications for mental illness, compared with people admitted to the criminal legal system who had not been previously homeless.5 Homelessness and mental illness also exacerbate negative outcomes once a person becomes involved in the criminal legal system.6 People in jail with prior histories of homelessness and co-occurring mental and substance use disorders were held longer than those charged with similar crimes but without prior histories of these experiences.1
Considering these documented patterns that affect both individual and societal well-being, this study sought to learn more about the characteristics and specific needs of people who cycle at comparatively high rates between multiple systems in the City of Chicago. Chicago has a sizeable homeless population (estimated at 76,998 as of 2018) and Cook County Jail (CCJ) is the nation's largest single-site jail, which houses a substantial proportion of individuals experiencing mental illness.7
This study sought to identify and describe individuals who had interacted with the city's homeless services, criminal justice, and hospital systems between January 1, 2014 and December 31, 2017. Four years of data allowed us to detect extensive cross-system use that might be missed within a shorter time window. This study distinguished individuals...