Greensboro police last week stepped up loitering enforcement and effectively cleared the place known as “The Block.” Just like that.

Through a series of 30-minute patrols, officers shooed away the clusters of mostly men who routinely gather at the notorious hangout near the corner of South Elm and Eugene streets.

People who live in the neighborhood see The Block as a blight and a nuisance, if not a danger.

The owners of a nearby convenience store also blame The Block for panhandling, theft and fights on their premises. “If we only call the police once or twice in a day, that’s a lucky day,” the manager of the FastServ at Elm and Eugene, Sun Post, told the News & Record’s Lorraine Ahearn last week.

Ron Surgeon, who once owned a McDonald’s franchise at the same location, voiced similar concerns eight years ago.

What took the city so long?

The groups who congregate there also tend to be clients of the Greensboro Urban Ministry’s soup kitchen and homeless shelter, as well as the HealthServe clinic. Most of them are addicted, unemployed or otherwise down on their luck.

The Block, of course, is only a symptom of other, tougher problems: homelessness, drug abuse (especially crack cocaine) and the state’s failed mental health reform efforts, to name a few.

The opening of a revamped, county-funded substance-abuse treatment center on Wendover Avenue has been helpful but provides very limited bed space for crack addiction.

A planned new homeless day center at Murrow Boulevard and East Washington Street also should help. The county commissioners’ pledge last week of $275,000 to help pay for the project should now allow construction to move forward.

The Block seems to have been around forever. But it drew renewed attention during a recent debate over the placement of artistic benches along a leg of the Downtown Greenway that passes through the area. Residents of the neighboring Warnersville community complained that the benches only made a bad situation worse, attracting more drug use, vagrancy and “lewd acts.”

As the greenway project expands, says one advocate for the homeless, Michele Forrest, expect more harsh realities to be exposed to plainer view. A homeless camp in the Freeman Mill Road area lies in the path of the next leg of the greenway, she says.

As for the benches, they eventually were removed, though some people disputed allegations that they attracted unsavory behavior.

No one disputes the existence or impact of The Block.

Residents have a right to expect to live free of the daily nuisances, and worse, that came with it. But enforcement won’t succeed in the long run without sustained attention to what drives people to street corners in the first place.

Until that happens, they simply will create a new Block somewhere else.

I usually just quote and link, but this time I’m reprinting the entire editorial. Sometimes older N&R links expire, and this a really good editorial, so I want to make sure I have copy of it.

Be sure to click through to the original, though, for the comments.

NOTE: The editorial says: “The groups who congregate there also tend to be clients of the Greensboro Urban Ministry’s soup kitchen and homeless shelter…” This is incorrect. While the guys on the block do eat at Potter’s House (soup kitchen), none of them stay at Weaver House (homeless shelter). Greensboro Urban Ministry has a strict policy that any shelter guest found hanging out on the block gets kicked out. You won’t find shelter guests on the block.

“The location of artistic benches, which were removed from the Downtown Greenway on Friday after neighbors complained, looked good on paper but ignored some basic urban topography. Just a stone’s throw from where the benches were removed, amid complaints that they drew drunken and lewd behavior, sits ‘The Block.’ At the southwest corner of Eugene and Lee streets, at the entrance to HealthServe clinic and Greensboro Urban Ministry’s night shelter, this stretch of sidewalk has been a magnet for loitering, drugs and prostitution for 20 years….”

The benches were never the problem, so removing them won’t solve it. The problem on the block is primarily addiction. People drink there, and buy and smoke pot and crack. And where you find crack, you find dealers and prostitutes.

The people hanging on the block are not all homeless. But a lot of them are. The day center is probably not going to solve the problem. You can’t drink and smoke there.  (And the day center opening has been delayed.)

In Lorraine’s article, Greensboro Urban Ministry director Mike Aiken talks about the ten year plan to end homelessness and says that “real steps had been taken to offer services to the chronically homeless for mental health and substance abuse problems.” With all due respect to Mike, who I know and admire greatly, our local services for mental health and substance abuse are lacking. They’re also voluntary. You have to want to go. And even if everybody on the block decided tomorrow that they wanted to go get help, where would we send them? Mental health and substance abuse treatment beds are full and outpatient services often have waiting lists. Some types of treatment are scarce or don’t exist, unless you have private insurance. (None of this is a judgment on our providers. It’s about mental health “reform” and lack of funding.)

The only way I can think of to clean up the block is to do heavy enforcement and stay on it. Right now, there is enforcement, but as soon as the police cars leave, the people come back. In order to clear the block and have it stay cleared, you’d have to keep officers there. We don’t enough officers now. And let’s face it. Even if you clear the block, those folks are going to continue to be addicted. They’re going to go somewhere — to someone else’s neighborhood. I don’t have an answer. That means I need to pray. Maybe God is already giving the answer to someone far wiser and more creative than me. If so, I’m excited to hear it! But I’m looking for a solution that heals, not hurts. I have friends on the block. I don’t want to just sweep them away. I want to see their lives changed.

“Mentally ill, addicted to pain pills, homeless at 53, Betty Ann Scott went through jail, hospitals, rehab, every place but where she wound up the afternoon of Feb. 15.

For once, her hospital stay would be long — 15 days. But there is no treatment here, and the room temperature is 42 degrees in this part of Moses Cone Hospital: the county morgue, where Scott was dead on arrival after a suspected drug overdose…”

>> Continue reading “Mental health reform is ailing,” online at News-Record.com
>> Download PDF of article

“…The hospital’s security video recorded Sabock’s care from April 28, when he choked on his medicine while a nurse stood by without helping him, and through his day without food until his death from a heart problem. Health care technicians, according to the report, are seen on the recording watching television through the night, playing cards, and talking on a cell phone while they were in the room with Sabock.

Technicians could not get Sabock to walk back to his bed after his time sitting, so they stood him up, pushed a chair under him and slid Sabock down the hall toward his bedroom. The video showed a cart of emergency equipment being pushed down the hall about five minutes later…”

This is just an excerpt of an article.  There is more.  And it is horrific, inhumane, and inexcusable.

Our mental health system is beyond broken. I see it at the local level. There is ample evidence at the state level, as well. There are just no words to express the shock and sorrow and ANGER that I feel.  When is somebody going to DO SOMETHING?

» “Report: Nurses ignored mental patient as he died,” News & Record
» “Nurses ignored patient as he died,” News & Observer (with related content)

Wednesday, Nov. 29th
6:00 – 8:00 p.m.
GTCC, Jamestown Campus
In the auditorium of Percy Sears Applied Technology Center
Parking in front, in Lot D

Need more info? Call Michelle Edelen at 919-715-2780 or email contactdmh@ncmail.net.

“At age 27, severely disabled mentally and physically because she once stopped breathing as an infant, Emily Massengill today has almost everything she needs.”

“Her room is neat and warmly furnished; she eats well and gets a long, daily bath. She gets the best of care in the comfort of her home from the one person who understands her needs better than anyone — her mom.”

And then there was Mental Health Reform.

Keep reading to find out what that means for Emily, and others like her.

Earlier this year, state funding for mental healthcare was increased by $80 million, and the Joint Legislative Oversight Committee on Mental Health, Developmental Disabilities and Substance Abuse Services will meet later this month to consider an additional increase of $600 million over the next five years.

A second look at mental health reform? Additional funds for mental health care? That feels like… hope.

“The… Mental Health Association in Greensboro [says], ‘When you cut mental health services, problems erupt elsewhere.’ I agree. However, none of the changes in Guilford should reduce services.” — Mike Mosely, Director, NCDHHS

An interesting choice of words, Mr. Mosely: “None of the changes in Guilford should reduce services.” Indeed they shouldn’t. But they already have, and they will continue to do so.

• “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”