Houselessness, Sexual Orientation, and Mental Health Among Adults in United States Prisons

Background: Lesbian, gay, bisexual, and other non-heterosexual (LGB+) adults and those experiencing houselessness report disproportionate risk of negative mental health and are overreported in carceral settings. However, we lack estimates of associations between sexual orientation, houselessness, and mental health among adults incarcerated in prisons. Methods: Using secondary data from the 2016 Survey of Prison Inmates (N = 24,848), multivariate logistic regression models were run to examine the associations between sexual orientation, houselessness, and mental health indicators. Results: Among respondents, 7.4% identified as LGB + and 9.7% reported houselessness in the 12 months before arrest. Identifying as LGB+, experiencing houselessness, and both (i.e., LGB + identity and experiencing houselessness) were significantly associated mental health indicators, compared to those who identified as heterosexual and/or had not experienced houselessness. Odds were higher for those who reported both houselessness and identified as LGB + compared to those who reported only houselessness or only LGB + identity. All models controlled for age, assigned sex at birth, and race/ethnicity. Conclusions: Targeted mental health interventions are needed for people with multiple minority identities (i.e., LGB + and experience of houselessness) who are incarcerated. These interventions should recognize that their needs may be more intersectional than their counterparts with one minority identity. Policy Implications: Addressing issues of mass incarceration, systemic violence, and mental health disparities faced by multiple minoritized adults in prisons will require new national legal standards and policies collectively established by policymakers, legal experts, public health practitioners, social advocates, and researchers.