homeless to harvard essay

From Homeless to Harvard

Like other Harvard University freshmen this fall, Liz Murray is still adjusting - but she may have more adjusting to do than most new students.

Homeless off and on since she was 15, Liz Murray got herself through high school while sleeping on park benches and doing her homework by the light of apartment hallways. The New York City teenager did so well that she won a scholarship last year and was accepted by Harvard. After she was featured on the cover of this magazine (1/31/00), UPFRONT received hundreds of letters from readers who were touched by her story and wanted to keep up with her progress.

When we visited Liz at Harvard, she seemed very much at home, although she doesn't always have a lot in common with her classmates, more than a third of whom come from private schools. "I don't know polite conversation," she says. "A lot of people will stand and talk about the weather. Nobody communicated like that where I was from."

The weather isn't the only topic of conversation. Liz's story is generally known on campus, and people occasionally ask her about it. "People are impressed with something I did, and they want to think that I'm some zealous student," she says. "But I'm a normal student."

For a major, she's considering literature and film studies. "I can choose so many different directions from here," Liz says. "When I graduate, I have the whole world open to me. And before, that wasn't the case."

'Homeless to Harvard:' Child of Addicts Counsels Youth in Spirituality

Columbia University pioneers meditation therapies to protect against depression.

Oct. 10, 2013— -- Liz Murray forgave her drug-addicted parents for her fractured childhood in the Bronx, as the family lived from one welfare check to the next. She moved out at 15, figuring it was safer living on the streets than in a home where there was more cocaine and heroin than food on the kitchen table.

"People are surprised by the poverty and think that I wasn't cared for," Murray told ABCNews.com. "But that wasn't the case -- I was deeply loved."

Murray, now 33 and married with two children, is the inspiration for the television movie "Homeless to Harvard."

Living in stairwells and with friends, Murray turned to writing in her journal. When her mother died of AIDS at age 41, Murray had a spiritual epiphany and while crouching outside other families' apartments, felt "my mother's presence." Her mother asked her to promise to excel in school and her daughter decided to fulfill that pledge.

Murray became a top student at a Manhattan alternative school and wrote an essay on her personal journey that won her an Ivy League scholarship. But getting into Harvard was only half the battle. She struggled to be socially accepted and it took her nearly a decade to complete her studies.

At the same time, she lived and cared for her father, who was then sober, but also dying from AIDS.

Murray's story of resiliency was fodder for her 2010 memoir, "Breaking Night." By the time she was 19, she was motivating others on speaking tours and by 22, she was conducting workshops to guide others struggling with life's curveballs.

Now, in a new chapter in her journey, Murray is helping youth struggling with homelessness at New York's Covenant House, a nonprofit that provides shelter and support services for the city's youth population.

She is using storytelling as a tool to help abandoned youth tap into their inner spirit and to help them actualize their dreams. "Something in their family structure has fallen apart," said Murray.

"Our nature is biologically and inherently spiritual. It may take its expression through religious tradition, but every single one of us is innately born with a spiritual capacity in our genes." -- Lisa Miller, director, Spirituality & Mind/Body Institute

Her work is part of a psychology and spirituality program at Columbia University's Teachers College, a pioneering effort to use meditation therapies and mindfulness to help teens overcome trauma and successfully transition into adulthood.

"I always had a mind to go back to school," said Murray. "Then one day I picked up a New York Times article and the title was 'Merging Spirituality and Clinical Psychology at Columbia,' What? It sounded interesting."

She shot off an email to Lisa J. Miller, professor of psychology and education and head of the Spirituality & Mind/Body Institute , and was eventually accepted into the graduate program.

Miller had launched Youth Rising, a cooperative effort with Columbia's medical, social work and law schools to address the psychological, psychiatric and education needs of the city's 12,000 homeless youth, a third of whom had aged out of the foster care system.

The counseling component is funded by a $170,000 grant from the Goldman Sachs Foundation.

Miller said she has seen a "stampede" of interest in spirituality among her students.

"They've had years of practicing meditation and have a language of consciousness -- these are spiritual students."

Graduate students like Murray are trained to deliver counseling at Covenant House to focus on extreme stress, strength building and mental wellness.

Murray sees writing, alongside visualization and meditation techniques, as part of an important part of the healing process.

"I am experimenting with having them write a series of personal stories, but do it with a twist," she said. "I want them to go grab a journal and write a story about their lives. And at the very end of the semester, round them up and if a piece is particularly moving, to have a stand-up performance – get a microphone and read slam poetry."

As in her own life, Murray says, "when you take charge of your own narrative it gives you a handle on it."

The study of psychology and spirituality is now acknowledged by the American Psychological Association and Miller is co-editor-in-chief of its journal, Spirituality in Clinical Practice . She also conducts research on the benefits of visualization therapies on troubled youth.

Recent studies by Miller and others that have been published in the Journal of the American Medical Association and the American Journal of Psychiatry, show that spirituality can protect a person from depression, even if they have a high risk for the disorder.

"I come to this as a scientist," said Miller. "Our nature is biologically and inherently spiritual. I call it natural spirituality. It may take its expression through religious tradition, but every single one of us is innately born with a spiritual capacity in our genes."

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Breaking Night

30 pages • 1 hour read

Breaking Night: A Memoir of Forgiveness, Survival, and My Journey from Homeless to Harvard

A modern alternative to SparkNotes and CliffsNotes, SuperSummary offers high-quality Study Guides with detailed chapter summaries and analysis of major themes, characters, and more.

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Breaking Night: A Memoir of Forgiveness, Survival, and My Journey from Homeless to Harvard  is a memoir that opens with an adolescent, Liz Murray, who is homeless. She describes a picture of her mother (her only surviving photograph), and compares her own physical features with her mother’s,then wonders if they were alike in other ways, seeing as how they were both homeless by the age of sixteen. A story about forgiveness and redemption after addiction and isolation , Breaking Night follows Liz through her childhood and formative years as she struggles to fit in and succeed in her goals.

Liz’s parents, Jeanie and Peter, spend their days getting high. Their apartment is filthy and the family rarely has enough food to eat because not only do they spend what little money they get on drugs, but it only comes in in drips and drabs, through welfare. As Liz starts school, she struggles with truancy, which contributes to the wedge driven between her and her sister, Lisa , with whom Liz unintentionally competes for her parents’ love, affection, and attention.

Liz is taken by Child Welfare Services and placed in a group home, after which she is released to her mother’s boyfriend, Brick. Brick is cruel and ultimately drives Liz out of his house. After that, Liz lives on the streets and in motels with her friend Sam and her boyfriend, Carlos , both in an attempt to get away from Brick and to avoid her mother’s terminal illness due to AIDS.

Carlos eventually starts using and dealing drugs, and his behavior turns violent toward Sam and Liz after Liz’s mother dies. They part ways several times before their breakup sticks, and Liz ends up getting a job canvassing for a non-profit organization after she applies to an alternative high school. She starts school and manages to earn top marks and finish in just two years, completing a year’s worth of high school each semester.

Liz then applies for scholarships and wins one from the New York Times , which publishes her story of homelessness and a childhood of neglect. Her story becomes a national phenomenon and earns her, Lisa, and Sam support from strangers not only across New York City, where they live, but throughout the country.

After being waitlisted at Harvard University, Liz is accepted, though she later leaves college to look after her father in his last years of his life, as he has also contracted HIV. Finally, she graduates, and designs courses to inspire others, finding success in sharing her story.

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Homeless to Harvard: The Liz Murray Story

Based on a true story. Liz Murray is a young girl who is taken care of by her loving, but drug-addicted parents. Liz becomes homeless at 15 and after a tragedy comes upon her, she begins her... Read all Based on a true story. Liz Murray is a young girl who is taken care of by her loving, but drug-addicted parents. Liz becomes homeless at 15 and after a tragedy comes upon her, she begins her work to finish high school. Based on a true story. Liz Murray is a young girl who is taken care of by her loving, but drug-addicted parents. Liz becomes homeless at 15 and after a tragedy comes upon her, she begins her work to finish high school.

• Peter Levin
• Thora Birch
• Michael Riley
• Robert Bockstael
• 35 User reviews
• 4 Critic reviews
• 3 wins & 6 nominations total

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• Jean Murray

• (as Ellen Page)

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• Trivia Based on the true story of Elizabeth "Liz" Murray. The real Liz appeared in the movie as a social worker and was also a co-producer for the production.

Liz Murray : I'd give it back, all of it, if I could have my family back.

• Connections Featured in The 55th Annual Primetime Emmy Awards (2003)
• Soundtracks Miracle Performed by Joanna Pacitti Taken from the album "This Crazy Life"

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From Homeless to Harvard : The Lizz Murray Story (2012)

Movie review based on Psychological Perspectives

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Students & Alumni | 6.18.2024

The Poetics of Homelessness

A harvard graduate’s reflections on being unhoused.

For most of 2023, Jason Adam Sheets slept in unsheltered places, including next to railroad tracks. | MONTAGE ILLUSTRATION BY NIKO YAITANES/ HARVARD MAGAZINE ; PHOTOGRAPH COURTESY OF JASON ADAM SHEETS

After publication of the May-June feature “ The Homelessness Public Health Crisis ,” Harvard Magazine received an email from Jason Adam Sheets, M.T.S. ’21. A Pushcart Prize-nominated poet and essayist, Sheets earned a B.F.A. from Goddard College in Vermont and studied theopoetics at Harvard Divinity School (HDS). He has written three books of poetry: A Madness of Blue Obsidian, The Hour Wasp, and Theopoetica: An Anthology (all from April Gloaming Publishing); a fourth book of poems will be published this year. He has taught English at the University of New Hampshire and currently teaches for the Poetry in America program , associated with the PBS series of the same name.

Sheets is also homeless. For most of 2023, he slept unsheltered; this year he has been “couch-hopping” with friends in Cambridge, since he still cannot afford a fixed address of his own. In his email, he explained that the stereotype of guaranteed wealth for Ivy League graduates doesn’t always hold true: “If you enter poor, you leave poor,” he wrote. Sheets grew up in Plymouth, Massachusetts, in a lower-income, single-parent household, and after working numerous jobs, including as a steersman on a lobster boat and a taxi driver, he enrolled in college at age 31. Four years later, in 2019, he matriculated at HDS.

In this essay, Sheets reflects on his experience of homelessness, its meaning to him as a person and a poet, and its connection to the wider national crisis.

 —The Editors

I cannot remember the exact moment I became homeless. There was not one definitive event that led to my having to sleep beside train tracks or on bathroom floors. I was simply too broke for too long and unable to secure decent-enough employment that could afford me stable housing. I kept trying to save but couldn’t save enough, and before I knew it, I found myself outside one night, aimlessly walking with nowhere to go. Walking for hours each day, or night, has since become habit.

Years ago, I saw a raven for the first time. I was in Vermont attending my inaugural residency as a college undergraduate in a low-residency B.F.A. program in creative writing, four years before I received a full scholarship to study poetry at Harvard. We poets are drawn to crows and ravens, something about the magic in their mystery, so I had always hoped to encounter one. It was fitting that my first encounter occurred when I committed to pursue my calling. Hearing that deep musical caw evoked something within me, something about Emerson’s “long winding train reaching back into eternity” coupled with the difficulty of having both roots and wings.

All of us walk on a ground of many worlds, and we live in a world of many dualities. As a poet, I have each foot planted in a different world, perpetually tasked with distilling the effable from the ineffable without weakening the energy of the encounter. In both of these worlds, though, I’m a homeless Harvard alum—a paradox to most.

Sleeping on gravel is insufferable, but I can tell you how to make a comfortable makeshift bed on it out of practically nothing. Building a fire in the rain by the beach is insufferable, but I can tell you how to build a fire that will create just enough smoke to deter the horseflies from biting you while not drawing the attention of patrol officers. Guarding one’s belongings while homeless is insufferable, but I can tell you how to talk to the agitated drug addicts or untreated Cluster B personalities who fell through the cracks who won’t leave you alone because of something you have that they want, as addiction and mental illness run rampant in the homeless community. (See Lydialyle Gibson’s “Academia’s Absence from Homelessness” for more on this.)

A person’s capacity for experiencing suffering is the same as a person’s capacity for experiencing joy. As a poet, I find joy in words and symbols, and being homeless has gifted me with an abundance of both, which I keep in the front pocket of my life. I’m grateful for words such as home-less , dis-placed , and mis-fortuned . I thank these words, for in each of them, we find not only linguistic duality but the poetic duality—the poison and remedy of interpretation: in homeless we find home , in displaced we find place , and in our misfortune , we can find fortune . If it weren’t for poetry, I know that the experience of homelessness would have long since rusted my psychological gears to a locked state.

On April 30, 2024, I stood outside the gates of Harvard Yard in front of the Smith Campus Center waiting for a man from the City of Cambridge Department of Human Services to arrive and hand me a Verification of Homelessness through the window of his white work van. He pulled up to the corner of Dunster and handed me the document. I thanked him, then carefully placed the piece of paper into my backpack, the same backpack I wore each day from 2019-2021 while at Harvard. Two years ago, I walked across a stage at the graduation exercise for the classes of 2020 and 2021 and shook the hand of the dean of my school as he handed me a large white envelope that symbolized the master’s degree I’d earned. The envelope was empty. (We’d received our degrees in the mail a year earlier due to the COVID-19 lockdown.) When I returned to my friend’s place in Harvard Square, I pulled the Verification of Homelessness from my bag, feeling utterly unsure about how I felt about it. After uploading the photo of it to the places I needed to submit it, I pondered what to do with it and, for a moment, thought of that large white envelope.

There are many myths and stereotypes about being a Harvard graduate, but the one I attempt to reckon with most is the one that presumes that no matter who you are and where you come from, if you hold a degree from Harvard, you are free from having to worry about things such as job security, money, available credit, etc…. This is wishful thinking, especially if you were raised in a check-to-check single-parent household and entered college as an adult FGLI (first-generation, lower-income) student.

The thing about matriculating at Harvard as a working-class person living check-to-check is that you’ll still likely be a working-class person living check-to-check after you graduate, at least for a time, and typically for a longer time than most in your cohort. Like many post-COVID graduates, I’ve spent the past two years submitting countless application portfolios to talent-acquisition teams for positions in my field that, I feel, I’m well-qualified to interview for: research assistantships; instructorships in expository writing; publishing and editing positions; faculty assistantships, etc.—but I’ve yet to receive more than one invitation to interview. It’s important to note, too, that minimum wage employers won’t often hire those in my situation because they know we’re overqualified for their positions and that we’ll likely quit the moment we land the job we truly want; but if you omit your Ivy League credentials altogether from these applications, then the large gap in your employment history is presumed due to things such as jail or drugs. Then there’s the problem of not having a residential address to offer. Either way, you’re perceived as a risk and become stuck in a damned if you do, damned if you don’t situation.

I work two part-time jobs. I teach poetry via Zoom to a number of Title I high schools across the country (Title I is a federal program that provides extra funding to help students in high-poverty schools). This pays roughly $1,000 per month, so I receive roughly $4,000 per semester for this. I work another part-time job as an overnight safety coordinator youth worker for a homeless shelter in Harvard Square. I’d jump at the chance to work full-time at either of these, but the hours simply aren’t there. I’ve authored three books, published countless pieces in reputable and noteworthy journals and magazines, have given guest lectures at community colleges and at Harvard—and the Veritas of my situation is that I currently survive on roughly $23,000 per year. That’s $23,000 a year that some in my situation would kill for. Many homeless people live on much less than that, but most know the importance of having gratitude for every cent that they do have.

I recently had a conversation with a homeless Russian man, a conversation that inspired a poem I included in my next book, V Verse Is I . I’ll never forget how he reminded me to “always look at the shiny side of the coin, because when we find a coin on the ground, it has its shiny side and its dulled side, so always look for the shiny side.” There’s a geometry of gratitude in the poetics of homelessness. (I’ve found a lot of coins since then and always look for the shiny side…)

The last time I saw a raven, I was teaching a class via Zoom on the formal structure of sonnets. It was an orange-vanilla sky morning with a hint of saltwater in the air. I was taking my students for a walk down the train tracks,  performatively sharing how the train tracks served as a metaphor for the 14-line limit of the sonnet and how the train symbolized the words of the poem, while the tracks symbolized the structure; expounding how, just as the train would derail if the tracks became warped, the emotional impact of the poem would derail if the structure became warped. We talked about how the “ticket” to attend the sonnet is the attention we pay to it—how we must pay the poem our attention if we’re to experience it the way the energy of its structure intends. I concluded the lecture feeling that it had gone well, and as I bent down to put my laptop back in my backpack, I heard a rich, sonorous caw. The raven was perched on the eave of a large, abandoned warehouse a stone’s throw away. We locked eyes for a long moment before it swooped down and somersaulted midair, moving away from me. The slant of its movement recalled for me the slant one uses when quoting lines of poetry, “a moment’s monument,—/ Memorial from the soul’s eternity . . . / its face reveals/ The soul.” At that moment, I was home with nothing less than all I needed.

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Experts cite complexity of problem, which is rooted in poverty, lack of affordable housing but includes medical, psychiatric, substance-use issues

It took seven years for Abigail Judge to see what success looked like for one Boston homeless woman.

The woman had been sex trafficked since she was young, was a drug user, and had been abused, neglected, or exploited in just about every relationship she’d had. If Judge was going to help her, trust had to come first. Everything else — recovery, healing, employment, rejoining society’s mainstream — might be impossible without it. That meant patience despite the daily urgency of the woman’s situation.

“It’s nonlinear. She gets better, stops, gets re-engaged with the trafficker and pulled back into the lifestyle. She does time because she was literally holding the bag of fentanyl for these guys,” said Judge, a psychology instructor at Harvard Medical School whose outreach program, Boston Human Exploitation and Sex Trafficking (HEAT), is supported by Massachusetts General Hospital and the Boston Police Department. “This is someone who’d been initially trafficked as a kid and when I met her was 23 or 24. She turned 30 last year, and now she’s housed, she’s abstinent, she’s on suboxone. And she’s super involved in her community.”

It’s a success story, but one that illustrates some of the difficulties of finding solutions to the nation’s homeless problem. And it’s not a small problem. A  December 2023 report  by the U.S. Department of Housing and Urban Development said 653,104 Americans experienced homelessness, tallied on a single night in January last year. That figure was the highest since HUD began reporting on the issue to Congress in 2007 .

Abigail Judge of the Medical School (from left) and Sandra Andrade of Massachusetts General Hospital run the outreach program Boston HEAT (Human Exploitation and Sex Trafficking).

Niles Singer/Harvard Staff Photographer

Scholars, healthcare workers, and homeless advocates agree that two major contributing factors are poverty and a lack of affordable housing, both stubbornly intractable societal challenges. But they add that hard-to-treat psychiatric issues and substance-use disorders also often underlie chronic homelessness. All of which explains why those who work with the unhoused refer to what they do as “the long game,” “the long walk,” or “the five-year-plan” as they seek to address the traumas underlying life on the street.

“As a society, we’re looking for a quick fix, but there’s no quick fix for this,” said Stephen Wood, a visiting fellow at Harvard Law School’s Petrie-Flom Center for Health Law Policy, Biotechnology and Bioethics and a nurse practitioner in the emergency room at Carney Hospital in the Dorchester neighborhood of Boston. “It takes a lot of time to fix this. There will be relapses; there’ll be problems. It requires an interdisciplinary effort for success.”

A recent study of 60,000 homeless people in Boston found the average age of death was decades earlier than the nation’s 2017 life expectancy of 78.8 years.

Illustration by Liz Zonarich/Harvard Staff

Katherine Koh, an assistant professor of psychiatry at HMS and psychiatrist at MGH on the street team for Boston Health Care for the Homeless Program, traced the rise of homelessness in recent decades to a combination of factors, including funding cuts for community-based care, affordable housing, and social services in the 1980s as well as deinstitutionalization of mental hospitals.

“Though we have grown anesthetized to seeing people living on the street in the U.S., homelessness is not inevitable,” said Koh, who sees patients where they feel most comfortable — on the street, in church basements, public libraries. “For most of U.S. history, it has not been nearly as visible as it is now. There are a number of countries with more robust social services but similar prevalence of mental illness, for example, where homelessness rates are significantly lower. We do not have to accept current rates of homelessness as the way it has to be.”

“As a society, we’re looking for a quick fix, but there’s no quick fix for this.” Stephen Wood, visiting fellow, Petrie-Flom Center for Health Law Policy, Biotechnology and Bioethics

Success stories exist and illustrate that strong leadership, multidisciplinary collaboration, and adequate resources can significantly reduce the problem. Prevention, meanwhile, in the form of interventions focused on transition periods like military discharge, aging out of foster care, and release from prison, has the potential to vastly reduce the numbers of the newly homeless.

Recognition is also growing — at Harvard and elsewhere — that homelessness is not merely a byproduct of other issues, like drug use or high housing costs, but is itself one of the most difficult problems facing the nation’s cities. Experts say that means interventions have to be multidisciplinary yet focused on the problem; funding for research has to rise; and education of the next generation of leaders on the issue must improve.

“This is an extremely complex problem that is really the physical and most visible embodiment of a lot of the public health challenges that have been happening in this country,” said Carmel Shachar, faculty director of Harvard Law School’s Center for Health Law and Policy Innovation. “The public health infrastructure has always been the poor Cinderella, compared to the healthcare system, in terms of funding. We need increased investment in public health services, in the public health workforce, such that, for people who are unhoused, are unsheltered, who are struggling with substance use, we have a meaningful answer for them.”

“You can either be admitted to a hospital with a substance-use disorder, or you can be admitted with a psychiatric disorder, but very, very rarely will you be admitted to what’s called a dual-diagnosis bed,” said Wood, a nurse practitioner in the emergency room at Carney Hospital.

Kris Snibbe/Harvard Staff Photographer

Experts say that the nation’s unhoused population not only experiences poverty and exposure to the elements, but also suffers from a lack of basic health care, and so tend to get hit earlier and harder than the general population by various ills — from the flu to opioid dependency to COVID-19.

A recent study of 60,000 homeless people in Boston recorded 7,130 deaths over the 14-year study period. The average age of death was 53.7, decades earlier than the nation’s 2017 life expectancy of 78.8 years. The leading cause of death was drug overdose, which increased 9.35 percent annually, reflecting the track of the nation’s opioid epidemic, though rising more quickly than in the general population.

A closer look at the data shows that impacts vary depending on age, sex, race, and ethnicity. All-cause mortality was highest among white men, age 65 to 79, while suicide was a particular problem among the young. HIV infection and homicide, meanwhile, disproportionately affected Black and Latinx individuals. Together, those results highlight the importance of tailoring interventions to background and circumstances, according to Danielle Fine, instructor in medicine at HMS and MGH and an author of two analyses of the study’s data.

“The takeaway is that the mortality gap between the homeless population and the general population is widening over time,” Fine said. “And this is likely driven in part by a disproportionate number of drug-related overdose deaths in the homeless population compared to the general population.”

Inadequate supplies of housing

Though homelessness has roots in poverty and a lack of affordable housing, it also can be traced to early life issues, Koh said. The journey to the streets often starts in childhood, when neglect and abuse leave their marks, interfering with education, acquisition of work skills, and the ability to maintain healthy relationships.

“A major unaddressed pathway to homelessness, from my vantage point, is childhood trauma. It can ravage people’s lives and minds, until old age,” Koh said. “For example, some of my patients in their 70s still talk about the trauma that their parents inflicted on them. The lack of affordable housing is a key factor, though there are other drivers of homelessness we must also tackle.”

The number was the highest since the U.S. Department of Housing and Urban Development began reporting on the issue to Congress in 2007 .

Most advocates embrace a “housing first” approach, prioritizing it as a first step to obtaining other vital services. But they say the type of housing also matters. Temporary shelters are a key part of the response, but many of the unhoused avoid them because of fears of theft, assault, and sexual assault. Instead, long-term beds, including those designated for people struggling with substance use and mental health issues, are needed.

“You can either be admitted to a hospital with a substance-use disorder, or you can be admitted with a psychiatric disorder, but very, very rarely will you be admitted to what’s called a dual-diagnosis bed,” said Petrie-Flom’s Wood. “The data is pretty solid on this issue: If you have a substance-use disorder there’s likely some underlying, severe trauma. Yet, when we go to treat them, we address one but not the other. You’re never going to find success in the system that we currently have if you don’t recognize that dual diagnosis.”

Services offered to those in housing should avoid what Koh describes as a “one-size-fits-none” approach. Some might need monthly visits from a caseworker to ensure they’re getting the support they need, she said. But others struggle once off the streets. They need weekly — even daily — support from counselors, caseworkers, and other service providers.

“I have seen, sadly, people who get housed and move very quickly back out on the streets or, even more tragically, lose their life from an unwitnessed overdose in housing,” Koh said. “There’s a community that’s formed on the street so if you overdose, somebody can give you Narcan or call 911. If you don’t have the safety of peers around, people can die. We had a patient who literally died just a few days after being housed, from an overdose. We really cannot just house people and expect their problems to be solved. We need to continue to provide the best care we can to help people succeed once in housing.”

“We really cannot just house people and expect their problems to be solved.”  Katherine Koh, Mass. General psychiatrist

Koh works on the street team for Boston Health Care for the Homeless Program.

Photo by Dylan Goodman

The nation’s failure to address the causes of homelessness has led to the rise of informal encampments from Portland, Maine, to the large cities of the West Coast. In Boston, an informal settlement of tents and tarps near the intersection of Massachusetts Avenue and Melnea Cass Boulevard was a point of controversy before it was cleared in November.

In the aftermath, more than 100 former “Mass and Cass” residents have been moved into housing, according to media reports. But experts were cautious in their assessment of the city’s plans. They gave positive marks for features such as a guaranteed place to sleep, “low threshold” shelters that don’t require sobriety, and increased outreach to connect people with services. But they also said it’s clear that unintended consequences have arisen. and the city’s homelessness problem is far from solved.

Examples abound. Judge, who leads Boston HEAT in collaboration with Sandra Andrade of MGH, said that a woman she’d been working with for two years, who had been making positive strides despite fragile health, ongoing sexual exploitation, and severe substance use disorder, disappeared after Mass and Cass was cleared.

Mike Jellison, a peer counselor who works on Boston Health Care for the Homeless Program’s street team, said dismantling the encampment dispersed people around the city and set his team scrambling to find and reconnect people who had been receiving medical care with providers. It’s also clear, he said, that Boston Police are taking a hard line to prevent new encampments from popping up in other neighborhoods, quickly clearing tents and other structures.

“We were out there Wednesday morning on our usual route in Charlesgate,” Jellison said in early December. “And there was a really young couple who had all their stuff packed. And [the police] just told them, ‘You’ve got to leave, you can’t stay here.’ She was crying, ‘Where am I going to go?’ This was a couple who works; they’re employed and work out of a tent. It was like 20 degrees out there. It was heartbreaking.”

Prevention as cure?

Successes in reducing homelessness in the U.S. are scarce, but not unknown. The U.S. Department of Veterans Affairs, for example, has reduced veteran homelessness nationally by more than 50 percent since 2010.

Experts point out, however, that the agency has advantages in dealing with the problem. It is a single, nationwide, administrative entity so medical records follow patients when they move, offering continuity of care often absent for those without insurance or dealing with multiple private providers. Another advantage is that the VA’s push, begun during the Obama administration, benefited from both political will on the part of the White House and Congress and received support and resources from other federal agencies.

The city of Houston is another example. In 2011, Houston had the nation’s fifth-largest homeless population. Then-Mayor Annise Parker began a program that coordinated 100 regional nonprofits to provide needed services and boost the construction of low-cost housing in the relatively inexpensive Houston market.

Neither the VA nor Houston was able to eliminate homelessness, however.

To Koh, that highlights the importance of prevention. In 2022, she published research in which she and a team used an artificial-intelligence-driven model to identify those who could benefit from early intervention before they wound up on the streets. The researchers examined a group of U.S. service members and found that self-reported histories of depression, trauma due to a loved one’s murder, and post-traumatic stress disorder were the three strongest predictors of homelessness after discharge.

In April 2023, Koh, with co-author Benjamin Land Gorman, suggested in the Journal of the American Medical Association that using “Critical Time Intervention,” where help is focused on key transitions, such as military discharge or release from prison or the hospital, has the potential to head off homelessness.

“So much of the clinical research and policy focus is on housing those who are already homeless,” Koh said. “But even if we were to house everybody who’s homeless today, there are many more people coming down the line. We need sustainable policies that address these upstream determinants of homelessness, in order to truly solve this problem.”

The education imperative

Despite the obvious presence of people living and sleeping on city sidewalks, the topic of homelessness has been largely absent from the nation’s colleges and universities. Howard Koh, former Massachusetts commissioner of public health and former U.S. assistant secretary for Health and Human Services, is working to change that.

In 2019, Koh, who is also the Harvey V. Fineberg Professor of the Practice of Public Health Leadership, founded the Harvard T.H Chan School of Public Health’s pilot Initiative on Health and Homelessness. The program seeks to educate tomorrow’s leaders about homelessness and support research and interdisciplinary collaboration to create new knowledge on the topic. The Chan School’s course “Homelessness and Health: Lessons from Health Care, Public Health, and Research” is one of just a handful focused on homelessness offered by schools of public health nationwide.

“The topic remains an orphan,” said Koh. The national public health leader (who also happens to be Katherine’s father) traced his interest in the topic to a bitter winter while he was Massachusetts public health commissioner when 13 homeless people froze to death on Boston’s streets. “I’ve been haunted by this issue for several decades as a public health professional. We now want to motivate courageous and compassionate young leaders to step up and address the crisis, educate students, motivate researchers, and better inform policymakers about evidence-based studies. We want every student who walks through Harvard Yard and sees vulnerable people lying in Harvard Square to not accept their suffering as normal.”

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