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For many, that meant \u2018(re)entering\u2019 the support system and having a chance to \u2018move on\u2019 to longer-term housing. This beneficial effect of some of the policy reactions to the pandemic on people experiencing homelessness was unexpected. On the flip side, however, particularly for people struggling with drug use and mental health issues, adequate support was not available for long periods of time; support was either suspended temporarily or people were excluded from institutional support for not adhering to, for instance, lockdown rules. Similarly, digital support alternatives\u2014modelled on increasingly widespread telemedicine\u2014did often not work specifically for people struggling with complex needs or women experiencing homelessness. This research paper reports detailed evidence of what we observed as continued and catalysed exclusions based on interviews and ethnographic observations with both people experiencing homelessness and service providers from the beginning of the COVID-19 pandemic. Referring to our insights and learnings from three locally and temporally overlapping research projects between May 2020 and April 2021, we also propose changes to redesign future (health)care provision to prevent such impasses\u2014which extend beyond lockdown situations to general conditional housing and support.<\/jats:p>","DOI":"10.1136\/medhum-2021-012367","type":"journal-article","created":{"date-parts":[[2022,7,12]],"date-time":"2022-07-12T13:20:38Z","timestamp":1657632038000},"page":"55-63","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Of not passing: homelessness, addiction, mental health and care during COVID-19"],"prefix":"10.1136","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2532-3415","authenticated-orcid":false,"given":"Johannes","family":"Lenhard","sequence":"first","affiliation":[{"name":"University of Cambridge, Cambridge, Cambridgeshire, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan","family":"Margetts","sequence":"additional","affiliation":[{"name":"University of Cambridge, Cambridge, Cambridgeshire, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eana","family":"Meng","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,7,12]]},"reference":[{"key":"2025092412013251000_49.1.55.1","unstructured":"(US), Center for Substance Abuse Treatment . 2014. \u201cUnderstanding the Impact of Trauma.\u201d https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK207191\/."},{"key":"2025092412013251000_49.1.55.2","unstructured":"A Tale of Two Epidemics: When COVID-19 and Opioid Addiction Collide - Harvard Health . 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