Susan was found in a city park one chilly October morning, her beloved cattle dog guarding her body. Her death was unexpected. Everybody thought she’d been doing so well. In my office, my phone began buzzing with texts from long-term research participants and mutual friends wondering whether I’d heard the news. I curled my grief inward, a bundle of anger and confusion, scientific objectivity suspended, replaced by indignation. In a country that touts itself as the wealthiest and greatest in the world, how is it that so many live in the streets? How is it that people die there?

Susan was the first person to join my study on methamphetamine use in northern Colorado. She was the first of my research participants-turned-friends to die during its course. We first met in a borrowed office at the local resource center on a surprisingly sweltering spring day. Susan fussed over her dog, Rick, who was always at her side. She wouldn’t settle until he had water and a comfortable place to nap in the cool of the air conditioning.

She wasn’t naturally talkative, but she was candid and kind as she shared her history, her story. She cried as she explained how her husband’s illness was the beginning of their financial downturn. He couldn’t work, and eventually, neither could she. She left her job to care for him and for a while the two made do on social security.

But when Susan’s husband died, just a couple of years before we met, she was faced with more than grief. She lost both his social security income and hers as a caretaker. In her late forties at the time, she struggled to find work. Taking the time to mourn wasn’t an option as she struggled to navigate insufficient safety nets she’d never before needed to use. They had always been fine financially. They’d had dogs and motorcycles, a house, jobs and friends and money to splurge and go out on occasion. They’d had a “normal” life.

Soon, she found herself homeless. Having lost her own house and exhausted friends’ couch-surfing generosity, she was on the streets. Since Rick wasn’t a service dog, shelters weren’t an option, but neither was abandoning her one friend and connection to her old life. As a homeless woman on her own, Susan depended upon Rick’s loyalty, not just as a faithful companion but as a dauntless guardian.

Each night she managed threats that came from all sources, all directions. She was the first to tell me that sometimes she had to walk all night to stay alert and avoid the police or the risk for harm. She was the first to explain the importance and challenge of finding a safe place to rest.

Susan’s story provided my first window into the complex and harrowing realities of homelessness and housing insecurity in the United States. And while her story is individual, it isn’t unique.

On a single night in 2014, the U.S. Department of Housing & Urban Development’s (HUD) Point-in-Time survey counted nearly 600,000 Americans without shelter. As people struggle with unemployment, the battle for a living wage, and a shortage of affordable housing, the risk continues to grow. Increasingly, too many of us teeter on the brink, just one illness, car repair, or short work-week away from the streets.

Yet most places lack the resources to combat the underlying causes or immediate consequences of homelessness and housing insecurity. The same HUD study shows that 62% of reporting jurisdictions nationwide cannot meet the demand for shelter beds in their communities. In 2014, over 153,000 people had to sleep in the streets or actively seek alternate shelter each night.

Nearly two hundred years ago, America formally abolished its debtors’ prisons, institutions where the poor were incarcerated for failing to make payments. Following this, the notion of some people’s poverty as a social ill slipped into the background until the mid-20th century. Not until the early 1960s did we renew dialogue suggesting that hardship and vast wealth disparities represent a national problem.

Although many scholars and politicians agree that poverty in the U.S. tends to be intergenerational, there remains dissent as to the underlying causes. And while we, as a nation, struggle to get on the same page about the sources of these economic gaps, our communities are once again criminalizing poverty, especially homelessness. According to the National Law Center on Homelessness & Poverty, 34% of U.S. cities ban public camping, 57% prohibit it in certain areas, and 43% disallow sleeping in vehicles. Others have policies against sleeping in public, begging, and sharing food with homeless people.

Charles, a tall man with a booming baritone, first found himself on the streets in his early fifties. Previously an entrepreneur, a husband, and a father; he’d never imagined himself homeless. He’d always seen himself as a community member, a leader, never a criminal. But as we settled in on the porch of a local coffee shop, his eyes were bloodshot and squinty from lack of sleep. Clumsy with fatigue, he fiddled with his bag, pulling out his phone to charge at our table’s electrical outlet. He was waiting for a call from two young girls he had met the night before, who he had talked into attending an NA meeting with him later in the day.

“You ended up in jail because of all those camping tickets?” I asked. Charles looked at me solemnly. He was exhausted. He’d been up all night. Since we first met, when he had just lost his home, I had watched him become rundown, emotionally and physically. His girlfriend, Jackie, had been in jail all this time, but he never failed to keep money on her books.

Whatever he brought in panhandling or hustling or working odd jobs went to Jackie. She was his girl, his ol’ lady. And Charles had a traditional view of relationships. No matter what else he did, he had to continue to provide. So he typically spent his days working, earning, and to ensure there was money for her, his nights passed without shelter. This in a city with a camping ban and not enough beds.

“Yeah, I failed to appear,” he explained. “They caught me surviving, literally. The first ticket, the very first ticket, was our very first night outdoors. Less than eight hours from them giving us the sleeping bag. They’re gonna charge me $100 plus for each one of those. A $100 ticket and then there’s court costs and all this other stuff. It turns out to be $275, or sixteen hours of community service or six days in jail.”

“So you took the six days in jail?”

“Yeah, I took the six days in jail,” Charles said. “By default.”

For countless individuals like Charles, it is the crime of being poor that ultimately results in jail time when they are unable to pay their escalating fines. But the criminalization of homelessness has consequences that extend beyond spending a few days in jail. Some scholars and activists suggest that the underlying social intent of so-called “crimes of homelessness” may be to render these individuals invisible rather than reduce the problem itself.

University of Colorado Denver’s Dr. Stephen Koester has spent decades studying drug use and homelessness in Colorado. He observes, based on recent research on Denver’s camping ban, that the city’s police “don’t seem to want to give them [the homeless] tickets. They want to keep them moving, or out of sight.”

In the northern Colorado town of Fort Collins, recent plans to bulldoze a park where many homeless gather throughout the day support Koester’s theory. Los Angeles has tried on five separate occasions since 1997 to remove the “visual blight” of the homeless by removing and destroying their belongings. Though the city has repeatedly lost these cases, officials drafted a new ordinance for 2015 permitting law enforcement officers to promptly confiscate homeless individuals’ unattended property. Under the guise of gentrification, appealing to many for the ensuing influx of hipster-friendly, edgy watering holes, cities push their poor and homeless further toward the margins.

If the aim of criminalization is, in fact, to make the homeless disappear, we must consider its range of consequences. Surely, an abundance of these repercussions are intangible, even philosophical in nature. The haves wield their social power over the bodies of the have nots to avoid feeling uncomfortable over their craft cocktails or upon leaving their lunchtime yoga classes. But scattering the homeless doesn’t just damage disenfranchised bodies in the abstract. It directly and deeply damages social ties and disrupts access to social resources. Several researchers have highlighted the fact that when the homeless are relocated, they often lose access to safety net organizations and resources.

From a human interest perspective, the criminalization of homelessness is clearly bad politics. It dehumanizes people and perpetuates both poverty and suffering. But more specifically, notes Dr. Lee Hoffer of Case Western Reserve University, the promise of punishment forces geographic and social dispersion, and the results of these policies are “detrimental to public health.”

Initiating And Encouraging Drug Use

Fort Collins, Colorado is a medium-sized college town that has been voted one of America’s “most livable” cities several years running. Between college students, growing tech and start-up companies, and booming gentrification projects, affordable housing in the city is increasingly difficult to find. Vacancy rates continue to fall (1.8% in 2015) while housing prices and rental costs rise.

Like other cities along Colorado’s Front Range, Fort Collins has had a camping ban for years. In August 2014 alone, police targeted 54 illegal campsites and issued 32 citations. Those unable to find an approved place to sleep must remain invisible or risk incarceration. Thus, the town’s homeless stay on the move, camp solo and in small groups, and creatively bargain for couch space. These processes can have a peculiar but logical consequence of their own, encouraging and perpetuating drug use, even among people who would like to quit.

Before moving to Fort Collins in the mid-aughts, Dorothy had spent over a decade of her life on the streets. In her early thirties, she lost her children to policies that deemed her an unfit mother due to mental illness and her constant struggle to keep a roof over her family’s head. Though she had dabbled with methamphetamine to work strange hours driving a truck, she used regularly only after becoming homeless. At first, meth was merely a means of networking and negotiating for a place to sleep. By the time we met, nearly two decades later, she described herself as a full-blown addict.

“A lot of my meth use when I first started was, ‘gee, I suddenly became homeless and the way to find a bed to crash on is to get high with people,’” she explained during one of our early meetings. “ ‘Here, I’ll go buy a bag for you. I’ll do the running. I’ll take the chances.’ I’ll come back, I’ll get high. ‘Oh, I’m sorry, I fell asleep.’ You know, they gave you a bed and a hot meal. When you’re homeless, it’s how you put your feelers out. It’s how you couch surf.”

For homeless individuals who are already drug-dependent, quitting may be especially difficult. Eddie, a former health professional in his thirties, struggled to quit abusing meth. After losing his job he faced eviction and, eventually, landed on the streets with Boris, his best friend and dog of several years. Like Susan, Charles, and others who find themselves without shelter in cities with camping bans, Eddie sometimes walked all night. But hours of shuffling over concrete and asphalt, icy sidewalks or parched fields tore Boris’ feet apart, a consequence Eddie couldn’t accept. When he was denied entry or long-term stay in treatment and sober living facilities due to their “no dog” policies, Eddie turned to the only people who seemed willing to accept him — former drug using partners.

Like Dorothy, Eddie established credibility with his hosts by his willingness to use, undermining his intentions to quit. But there was also something simpler at play — temptation. By staying with fellow addicts and, specifically, people with whom he had previously used, old patterns quickly reared their heads, and thirty days sober became zero.

For others still, it’s the specific nature of methamphetamine that holds the key for survival. The central nervous system stimulant enables users to stay awake and alert, sometimes for days at a time. By some accounts, it even enhances vigilance. Policies that keep people on the move perpetuate the need to stay on the lookout for law enforcement, to remain ever-ready to get up and go.

Thus, many homeless meth addicts, including several participants in my own research, report using specifically to avoid problems with the police. Charles often camped on his own or with only one or two acquaintances. Not wanting to make the long trek out of city limits to avoid the authorities, he and a partner would sleep in shifts along river banks or under bridges. But he always felt vulnerable: “Some folks, they enjoy the mental torture of being up for days and days and days,” he explains. “And I don’t understand that part. I really don’t. I use the excuse, and generally it’s not an excuse because being out here living in the forest, to me, I’m vulnerable. If I go to sleep, I don’t hear nothing. That means somebody can slip on me, you know?”

The especially cold nights make even alert camping unrealistic and dangerous. And when left with no other options, Susan, Eddie, and others found that meth made the endless walking more bearable.

Aggravating Pre-Existing Mental Health Conditions

In the U.S. today, there are only about fourteen inpatient psychiatric beds for every 100,000 individuals in need. This is less than 5% of the resources available in 1955 and about the same coverage we saw in 1850. Official estimates suggest that between 20 and 50% of homeless individuals in the United States suffer from mental illness.

Given these severely restricted resources, they may represent one of the most drastically underserved segments of the homeless population. Conditions and particular experiences run the gamut but, in my work, I saw a lot of bipolar disorder, depression, schizophrenia, and PTSD.

For many, the consequences of mental health issues are greatly intensified by the circumstances of the street. Similar to addiction, mental illness can render sufferers ineligible for generalized safety nets, including some shelters unequipped to deal with related complications. Outbursts associated with schizophrenia resulted in Charles being temporarily banned from one Fort Collins shelter.

Paradoxically, homeless status can be cause for ineligibility to in-patient psychiatric services. When Dorothy sought in-patient psychiatric and drug abuse treatment, she was ruefully informed that no beds were available for people lacking a permanent address.

Furthermore, it is difficult to maintain a treatment schedule and adhere to prescribed medications when routines change daily and belongings must be carted around in a backpack. Many psychiatric medications not only demand ingestion on a strict schedule but some must be taken with food while others without.

For individuals rushing to make meal times at charities or hustling all day for cash or a place to crash, meeting these requirements is a challenge. And if that backpack is lost or stolen, as Charles’ was, people who can’t afford a place to sleep can rarely afford to replace expensive psychiatric medications.

But it’s not just the specifics of homelessness that present a problem. Policies that disproportionately target the poor and those without homes cause damages of their own. Having a history of arrest and incarceration limits access to safety net resources, including mental health services.

Not only can time spent in jail prevent individuals from meeting important appointments with mental health professionals, convictions can preclude them from access to supportive services, even outpatient services.

The very real and constant threat of getting caught is a source of stress that can directly damage psychological well-being. Of 441 homeless individuals surveyed, 36% had been arrested, 70% ticketed, and 90% harassed. Even the promise of such encounters with law enforcement presents a risk, especially for people with histories of trauma.

As Nancy Peters of Denver Homeless Out Loud (DHOL) explains, “There is all this emphasis right now on trauma-informed care.” And that’s fine; it’s important. “But,” she continues, “before we ever get to that, there is this potential for re-traumatization that is inherent in our policies.”

And while policies such as camping bans do nothing to prevent homelessness, they do ensure people stay hidden and on the move, devastating chances for social support. The streets thus become more dangerous, and those camping alone or in small groups become more vulnerable to violence. Homeless women are especially affected by the damage to social safety nets.

While Charles felt vulnerable when camping alone, as a large man, he knew most people, besides law enforcement, would leave him alone. Staying awake and alert all night was generally a sufficient, if still undesirable, precaution. But Susan, a petite woman on her own, was rightfully wary of any encounters. To avoid both law enforcement and intoxicated men, she and Rick often slipped into the auto-locking bathrooms in Old Town just before they closed. The small space provided a safe spot to overnight. But it wasn’t always an option.

Policies that scatter the homeless also undermine a very basic human need: sleep. In No Right to Rest, researchers observed that lack of sleep results in reduced quality of life, negative mental states, and an increase in visits to emergency departments. Bolstered by an abundance of supporting research, Peters will address sleep deprivation as a mental health priority in Denver Homeless Out Loud’s future campaigns.

Public Health In The Community At Large

As the bodies of homeless people are increasingly restricted by criminal legislation, policy undermines public health in the broader community as well. In an effort to keep people from using public bathrooms for personal hygiene, several communities place restrictions on their use. For example, a Denver Homeless Out Loud survey showed that, despite being inhabited by thousands of homeless, Denver has only 25 public restrooms that are accessible to the homeless. None of these are open around the clock, and many lack running water. Grand Junction, a smaller city on Colorado’s Western Slope, locks public bathrooms and shuts off water fountains in certain parks. And day shelters that offer showers often have long lines and lottery systems that interfere with the rest of the day’s survival tasks.

While limiting public restroom access may seem appealing to retailers and even customers, it directly curbs people’s ability to survive in public spaces and negatively impacts community health. Hindering access to basic hygiene services, and even all-important hydration, drives hygiene activities into far less appropriate, unsanitary places. Forcing homeless people to wash, urinate, and defecate in the open not only violates the United Nations Declaration of Human Rights, but is also detrimental to community sanitation and public health.

What Now?

Several organizations and communities nationwide are fighting for the reevaluation and dismantling of such troubling policies and pushing for the development of protective legislation. Thirteen cities and states have passed or are considering a “Homeless Bill of Rights.” The Western Regional Advocacy Project continues to advocate for a “Right to Rest Act” in California, Colorado, and Oregon. And some communities have begun to implement innovative programs that not only address the consequences of homelessness but also offer alternatives to its criminalization.

Initiatives such as Housing First have dramatically reduced homelessness; Utah was the first state to adopt the policy and their success has been astonishing. The Houston Police Department’s Homeless Outreach Team works to obtain housing for the chronically homeless. And Philadelphia’s Medical Respite Center assists in the transition of homeless people from hospitals back into their communities. Thanks to these and other programs, we now have a working laboratory from which to learn.

Still, challenging the criminalization of homelessness itself remains essential, not only in improving public health, but as a social responsibility. In recent years, many Americans have openly pushed for the reevaluation of policies and programs that disproportionately harm (or benefit) segments of our population. Yet as a society, we continue to be comfortable blaming and punishing the poor for “their” circumstances and “our” problems, ignoring any hint at social accountability.

As we support efforts to reenergize and “clean up” our urban downtowns, countless communities continue to adopt policies that directly and indirectly punish the homeless. With each camping ban and panhandling prohibition, we recreate the debtors’ prisons banned nearly two centuries ago. And in so doing, we further institutionalize the systematic oppression of the poor.

This article was originally published on STIR Journal. Reprinted with permission.