DOORS (Final Draft)

I remember when major mental health and social service institutions slammed shut. It was like a floodgate opened. The streets of Seattle swarmed with people trapped in their heads, yelling, and having altercations with thin air. In the early 1980's, I navigated my young children downtown, through an entourage representing various mental health and addiction issues. I gave the children the mom look that warned them not to stare or comment. They did anyway. Of course, the animation, pacing, gesturing and ranting grabbed their attention. I really thought that this phenomenon would pass. There would be an election. The doors from whence they came would open back up and they would go back. Someone would step up and do something. It's not polite to look. I looked away.

It was decades before I looked again. The problem did not go away. I had little information on the nature, the scope or the true cost of this evolved climate of homelessness. The topic of homelessness can be overwhelming. Conversations often highlight frustrations and are less apt to focus on solutions. I mistrusted the opinions I formed from my car window. I felt, like I think a lot of people feel, that my opinions were impotent anyway. The cardboard brandishing "panhandler" bears witness that the spider web of shelter and human service systems have been unable to put a noticeable dent in the homeless problem. This illustrates my belief that current methods of managing homelessness are ineffective and should be rethought.

Last year I had the good fortune to work an outreach program that increased my exposure to housing and homeless issues. I got to see first hand what worked and did not work. The myths I held about homelessness crumbled. I served individuals that were 60+ years old and adults with disabilities. It was surprising and disheartening for me to see "grandma and grandpa " on the streets; but they are there. They have mental health challenges. They have disabilities. They have addictions. Once someone is homeless, it is difficult to co-ordinate services. The shelters have daily intakes, late arrival times, and early release times. They also require sobriety and civility. Most of the time homeless are on the move. They do not have personal calendars, cell phones or bus passes. When there are resources, scheduling and keeping appointments are problematic. I was just as likely to find a client in the hospital as anywhere else. It was my experience that housing was a huge predictor of the success of other services.

The Washington State Housing Committee and The Committee to End Homelessness-King County published some enlightening statistics. The number of persons who are homeless on any given night in King County is 8,000. The Emergency Shelter Assistance Program in Washington State provides a place to sleep for more than 45,000 individuals a year. In another context those numbers would be dubbed a national disaster. In 2003, 42 people died out-of doors and homeless in King County. That’s an average of one person dying almost every week and this is a normal year. These deaths occur in rural as well as urban areas.

Housing First Programs purpose that a productive way to address homelessness is to provide housing for the homeless. This may seem simplistic, ridiculously naive and cost prohibitive. However this approach is proving to be quite viable and cost efficient. One of the factors is that homelessness cause increased use of high cost services. The cost of housing is offset by reducing the use of high cost services. High cost services include: 911, emergency rooms, mental health hospitalizations, detoxification, inpatient programs, child protective services and incarceration. A report on children in homeless shelters, published in Pediatrics Vol.192 No3. revealed that sheltered children used emergency room visits 2-3 times more than did their housed peers. They found that being homeless is an independent predictor of poor health in children. The UCLA Dept. of Family Medicine reported their sampling of homeless adults found that 37 percent had visual impairment, 36 percent had skin/leg/foot/conditions and 31 percent had a positive TB test.

Reduction in health costs alone, would justify providing housing. The Washington State Housing Finance Committee reported on a Plymouth Housing Group’s project. PHG's "Begin at Home" housed 20 hardest-to-reach, chronically homeless individuals. The project’s outcomes after 1 year showed a 75 percent reduction in medical costs. That translates to 1.2 million dollars. Another project,The Sound Families Initiative, funded by the Bill and Melinda gates Foundation, provided housing for over 1,400 families. Approximately 85 percent of these were single parent households. The project's evaluation by the University of Washington School of Social Work showed that the housing was instrumental in stabilizing the children's education. The vast majority of these families were able to procure permanent housing.

People involved with other target populations are turning their attention to housing also. Programs for foster children who "age out" now consider housing crucial in preventing further costs in dollars and quality of life. Correction facilities look at housing as an important component of reentry programs as they now know that housing is a correlate of recidivism. The work and positive outcomes of The Plymouth Housing Group, the Committee to End Homelessness - King County, the Sound Family Initiative and other housing first models are changing thoughts about homelessness. They are turning the conversation away from one of managing homelessness and to one of ending homelessness. I believe that the ability and resources to accomplish this exist. I feel that not only is it possible, but quite feasible, that homelessness can be essentially resolved in this lifetime. The benefits would be far reaching.


Sources:

A Roof Over Every Bed in King County, Our Community's Ten Year Plan to End Homelessness. Seattle: The Committee to End Homelessness - King County, 2005. 1-6.

Herman, Kim. "The Commitment Continues: Washington State's Efforts to End Homelessness." My View Feb. 2008.

The Evaluation of the Sound Families Initiative. NW Childrens Institute. Seattle: University of Washington School of Social Work, 2007.

Miller, Daniel S., and Elizabeth Lin. "Children in Sheltered Homeless Families: Reported Health Status and Use of Health Services." PEDIATRICS 81 (1988): 668-673. 4 July 2008 .
http://www.pediatrics.aappublications.org/cgi/content/abstract/81/5/668


Gelberg, L, R M. Andersen, and B
D. Leake. "The Behavioral Model for Vulnerable Populations: Application to Medical Care Use and Outcomes for Homeless People." Health Services Research 34 (2000): 1273-1302. 4 July 2008 . http://www.pubmedcentral.hih.gov/articlerender.fcgi?artid=1089079