Understanding the Ten Year Plan to End Homelessness

On April 9th, I was appointed to represent HPCGC as a member of our local Task Force to End Homelessness, which is charged with developing the Greensboro/High Point/Guilford County Ten Year Plan to End Homelessness. Below is a summary from my notes of the presentation given to the Task Force by Martha Are, Homeless Policy Specialist for NC DHHS. She addressed these questions:

• “Why is it that we think we can pull off a plan to end homelessness?”
• “Why is this not a futile plan?”
• “”How did we get to this place?”

Some history behind homelessness in America:

1960-70′s – Deinstitutionalization

The intentional movement of the mentally ill, developmentally disabled and elderly out of institutional settings. Most of these people were poor. If they had money, they likely wouldn’t have been in these institutional settings to begin with.

1970-80′s – Loss of Resources

HUD‘s budget was cut by more than 50% and has never returned to that level. At the same time, we were intentionally moving low-income folks out of institutions and back into the community, even though we’d lost resources to pay for their housing.

1975-85 Mental Illness

Baby-boomers began showing signs of schizophrenia in high numbers. Because the sheer number of baby boomers is so high, the number of those with schizophrenia is also high. These folks began hitting the streets as homeless individuals.

HUD money hits the street slowly, so the cuts weren’t felt right away. The first folks who struggled to maintain their housing were those with mental illness, but then others began to struggle, as well. By the late 70′s and early 80′s, we started seeing a rise in homelessness.

First Responders

The first responders to the increasing issue of homelessness were churches and non-profits. They began opening short-term (30 day stay) shelters. The phenomenon of increasing homelessness was not expected to last. But over time, people were not rotating out of the short term shelters (because these individuals had significant issues), so more beds were needed. So the first responders built bigger shelters. And again, the beds filled up with “chronic” homeless folks, because their long-term needs were not being met.

The churches and non-profits needed help. This was requested at the federal level as it was seen as a national issue. In 1987, the McKinney-Vento Act was passed, affecting the departments of Education, Labor, Veterans Affairs (VA), Health & Human Services (HHS), and Housing & Urban Development (HUD.) But of these, HUD became the dominant shaper of policy, because housing is a consistent issue in homelessness. (Note: VA puts more money in homelessness than the other departments.)

HUD asked communities to develop a Continuum of Care (COC), which includes street outreach, emergency shelter, Safe Haven, transitional housing and permanent supportive housing. (Note: Permanent housing rarely means homeownership. It means that when you move in, you don’t have a predetermined move-out date, and that you can stay as long as you meet the terms of your lease.)

HUD Secretary Andrew Cuomo asked HHS for help with supportive services, but they were also experiencing budget cuts so instead, HUD began funding supportive services in addition to buildings. HUD set up a national funding model — transitional housing, mental illness and substance abuse counseling, food, etc.

There was a problem with this HUD model, though, for chronically homeless folks who needed ongoing care. When they stabilized and moved to another location, they lost their supportive services, so they decompensated. (The services were tied to the buildings, not the person.) At this point, they would be kicked out of their transitional program for relapse, go back to the street, and likely re-enter the cycle of binge, arrest, jail, street, detox, street, binge, arrest, jail, street, etc.

After going through this process, the individual would also likely “give up on the system” because it sets them up for failure. Too often homeless folks are thought to not want shelter when the truth is that we’re not asking them the right question. The question is not, “Do you want to go to a shelter?,” but “Do you want to go back into a system that you have already proven won’t work for you?” (And of course they answer “no” to that. That’s a sane answer.) The public perception is that they don’t want help. The truth is that they don’t want help that doesn’t help.

Most Expensive People In Our Community

The most expensive people in our community are the chronically homeless. They go through a cycle of public drunkenness and resultant city response that includes EMS, fire trucks, ER visits, doctors and nurses, police officers, jail, court. All of this is paid for by taxpayers.

A California study tracked 15 serial inebriates (chronically homeless folks) for a year. During this period of time, they cost taxpayers in their city $3 million in medical and law enforcement expenses.

An Asheville, NC study found that 19 chronically homeless individuals had 800+ arrests in a two year period and cost the county $1200 per person per month in jail and medical costs alone. The study didn’t cover costs for EMS, mental illness, detox, etc., and none of the money spent resulted in housing or recovery for the 19 individuals. Additionally, the study found that these were not transients. These 19 people were more native to Asheville than the population as a whole.

In Gastonia, NC, a study found that city resources used by two chronically homeless individuals over the course of three years would have paid a year’s salary for one of their police officers.

The Numbers

By organizational culture, social workers and non-profit workers tend to not be good with numbers, so this 20+ year-old industry had abysmal data. Homeless service workers tend to think, “People need a bed and food. It’s obvious, just common sense, why do I need to document this?” The data we did collect wasn’t helpful — just information such as bed nights, etc. So researchers came in to help. (And we didn’t like it.) Here’s what they found, in an unduplicated annual count:

• 75-80% of homeless people are homeless for less than two months. That doesn’t mean that life is good after that, but they’re not homeless.
• 10% of homeless folks are homeless for six months or less.
• 10-15% of homeless folks are chronically homeless. These 10-15% use 50% of the total resources for homeless services.

Q: What is different about the 10-15% of folks who are homeless for a long period of time?
A: They are almost exclusively people with disabilities.

Anybody can become homeless (as Hurricane Katrina showed us), but the people who remain homeless are those with disabilities. So if we could do something for the homeless folks with disabilities, that would free up 50% of the resources to deal with the other 85-90% of homeless folks.

Documented research shows good results when we engage these chronically homeless folks on the street, skip the shelters and transitional housing and go straight to permanent housing, with all the services provided to them there. Same services, different setting. Instead of transitional housing, transitional services. And for the length of time that you need them, whether it be six months, two years or for your lifetime. The idea is learning to make your life work where you’re going to be living.

Costs

Tax dollars are used to pay for housing and services. Initially, it’s cost neutral, but then there are cost savings. Over time, costs go down. Stable housing has therapeutic value.

In a model program in New York, 88% of chronically homeless individuals were still in permanent supportive housing after five years. (95% were mentally ill, and 60% were dually diagnosed –88% housed after five years is a huge success!!)

We should never permanently dismantle the current shelter system, because people will continue to become homeless and need to be identified for housing and services, but we can eventually shrink the shelter system.

Currently, we teach people to live and function in transitional housing and then when they’ve become successful, we send them to permanent housing in a different place, where they may relapse. Now we want to identify where they’re going to live and teach them to live there and support them until they develop the skills and relationships to do so on their own. It’s about linking folks up with mainstream services instead of parallel delivery in the homeless services system.

Changing the Visual Field

People will ask, “Why should we focus on the 10% who aren’t trying instead of focusing on families and people who are trying to help themselves?” So changing the public’s “visual field” is important. With 90% of homeless people, you’d never know they were homeless. The chronic homeless population is also the most highly visible homeless population and changing their circumstances will cause a very visible change in homelessness in your community. To make a big change, strategically, any new money should go to your most visible problem.

Business Plan

A successful 10-year plan is a business plan, not a social service plan. Partner between sectors. Use the wisdom of non-profits, but you’ll need the business sector and all the skills of the community. Your plan needs to be endorsed by the cities and the county. This process is different from previous ones, which were done by service providers who had no political clout and weren’t able to implement them. The overall strategy for a 10-year plan is to move people as quickly as possible into permanent housing and provide services to them where they live.

Government Dollars

The state of North Carolina has zero dollars appropriated for homelessness. The feds have put more money into homelessness each of the past five years, most targeted toward chronic homelessness, even while other domestic departments lose money.

Affordable Housing

For permanent supportive housing, if the buildings are already there in your community, focus on rental and operating assistance, which can be done quickly. If not, focus on developmental assistance – but this takes a longer time.

Critics

On average, 20-30% of the strongest critics of a community’s 10-year plan will be homeless services providers. It’s hard to hear that your programs may need to change over time.

Homelessness & PTSD

40% of the homeless have been discharged from public institutions (jails, hospitals, etc.) About 23% of the homeless are veterans. A big chunk of these vets have PTSD, which is a precursor to substance abuse. Trauma is also a precursor to substance abuse. 25% of kids coming out of foster care will be homeless in five years. These kids have twice the rate of PTSD as war veterans. Lots of homeless families have experienced domestic violence, also a form of trauma. We need better assessments. Lots of homeless folks are likely to have PTSD. Individuals with PTSD are a target population in community mental health reform.

Related Question: “Locally, individuals must be sober for 60-90 days in order to receive a psychiatric evaluation through our community mental health center. How do we get assessments for homeless folks who are still using?”

Answer: In San Diego, the serial inebriates program offered homeless substance abusers a choice of jail or treatment. They could get assessments in treatment. Or, if they chose jail, they had 180 days sober when they came out, and they could get an evaluation then.

– end summary of Martha Are presentation –

The Guilford County / Greensboro / High Point Task Force to End Homelessness includes representatives from the academic community, governmental agencies, non-profits, foundations, law enforcement and the clergy; as well as homeless advocates (like me.) The United Way of Greensboro and High Point will be involved in administering the Task Force. We are scheduled to meet again in June.

Update: 06/04/2007, “Ten Year Plan To End Chronic Homelessness Presented”