Homelessness Causes More Deaths Than We Know, But We Know There Could Be Fewer

Tonight will be the longest night of the year. Here in the District of Columbia and in other communities across the country people will gather to share memories of homeless people who died during the year.

The National Coalition for the Homeless and partners invented National Homeless Memorial Day many years ago to focus attention on homeless people who died on the streets or the equivalent — and to strengthen our collective commitment to ending homelessness.

We don’t know how many homeless people died unnecessarily since last December. And we’ll never know how many future Memorial Days should commemorate, let alone who they were.

Knowing what we do know, we can guess that some froze to death in remote fields or abandoned shacks or died because they were so weakened by lack of food or untreated illness or injuries. Some perhaps died in fires they started to keep themselves warm and then couldn’t control.

Even in metro areas, homelessness is rarely, if ever the official cause of death. The same conditions I’ve just cited would be the causes, not homelessness itself.

This is also true for the fatal acts of violence that NCH periodically reports as a subset of hate crimes against homeless people.

The results of the acts — death from blood loss and injuries caused by a beating, for example — would be the cause, not homelessness, though that made the victims singularly vulnerable and even targets chosen for no other reason.

So the District’s evening memorial ceremony will include a reading of at least 41 names, most of people who died on the streets. But this doesn’t mean they were the only homeless people who died — and wouldn’t have if they’d had a safe place to stay.

Quite a damper on the holiday mood, I realize — and somewhat inconsistent with the commemorative nature of the rituals. So let’s look at the flip side.

We know that fewer homeless people would needlessly die if they could bed down in a shelter — and would go to a shelter rather than sleep on a park bench, under a bridge or some other “place not meant for human habitation.”

And we know that many won’t go because they object to the unsanitary and unsafe conditions in the shelters they could get into. Homeless individuals in the District have voiced additional griefs, as perhaps those elsewhere have as well.

Yet even in the best of cases, shelters are a makeshift sort of answer to problems indicated by the mortality rate of homeless people, i.e., the number who die within some predetermined period of time.

It’s four to nine times the rate for housed people, the Centers for Disease Control and Prevention reports. As one might expect, it cites health-related causes, e.g., exposure to infectious diseases, chronic illnesses, “poor mental health.” But it acknowledges violence too.

The obvious answer for most homeless people is simply housing at a rent they can afford. No more exposure to tuberculosis, for example, or to gun violence and random beatings than any of the rest of us risk when we venture out.

But for some, the better answer is permanent supportive housing — and more particularly PSH based on the Housing First model.

Housing First is the best answer for chronically homeless people, i.e., those who’ve been homeless for a long time or recurrently and have a disability (or disabilities). That, at any rate, is what both such research as we have and other evidence tell us.

As its name suggests, Housing First provides chronically homeless people with a safe, stable place of their own without requiring them to prove they deserve it — by successfully completing a substance abuse program, for example, or by agreeing to participate in one.

They are, however, offered services to overcome disabling substance abuse problems, as well as other services that can help them become healthier — and, in some cases, ultimately able to join (or rejoin) the workforce.

Not all Housing First participants can, however, become so financially self-sufficient as to afford rent at market rates. Many need long-term subsidized housing, though not an ongoing, intensive battery of supportive services.

This seems the case with a formerly homeless homeless advocate in the District who’s familiar to those of us who attend meetings, hearings and the like.

He often says that Housing First saved his life. Living on the streets, as he was, he couldn’t control his diabetic condition or other chronic illnesses in part because he had no safe, cool place to store his medications.

Even if he had, the pressures and chaos of street living — the need to somehow get enough food for the day and lug his belongings from one place to another — may have made it all but impossible for him to follow his medication schedule or resist the addiction to alcohol that led to his homelessness.

In short, he could have been one of the homeless people memorialized. Instead, he’s an active member of the People for Fairness Coalition, which has spearheaded a follow-on to this evening’s vigil.

PFFC members and others will march to the plaza across from the building that houses the Mayor’s executive office the the DC Council tomorrow morning. They will call on policymakers to, among other things, end chronic homelessness before 2018, as the local Interagency Council on Homelessness envisions.

The need is surely there. Last January’s one-night count identified 1,593 chronically homeless single individuals who had, at best, beds in shelters or temporary housing.

The current budget will fund PSH for 363 more such individuals, as well as 11o families with at least one chronically homeless member. So The Way Home, as the local Housing First campaign is called, has a long way to go.

But we see progress here, which is more than can be said for many communities, including a goodly number where homeless people die neglected and one one even takes account of them.



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