Mayor Admits City’s Homeless Plan is a Failure
Mayor Admits City’s Homeless Plan is a Failure
By Mike Rhodes
Fresno mayor Alan Autry said "we have failed, government has failed on this issue. We are the status quo that has chosen through our wisdom over the last 40 or 50 years to pick the most expensive and ineffective, dis-compassionate way to address the homeless situation." Autry was addressing the joint meeting of leadership and planning councils of the County/City of Fresno 10 year plan to end chronic homelessness.
Autry told the task force, which was meeting for the first time, that he wanted them to develop a blueprint for how to develop a Housing First model that will provide homeless people a place to live without pre conditions. The mayor said "I’m having to change my thinking because we are talking about a home in a neighborhood where a guy comes up and passes out on the front yard. That is part of the process of getting well. There is no requirement on those individuals. I’m ready to go there."
What Autry was encouraging the task force to do is develop a Housing First program in Fresno that would take this community’s chronically homeless and provide them with decent/affordable housing. The plan was outlined by Eduardo Cabrera, HUD Region IX Homeless Agency Coordinator, who said this meeting would be "the beginning of the end of homelessness." Cabrera gave the same one hour power point presentation that Philip Mangano executive director of the Bush administration’s Interagency Council on Homelessness, gave four months earlier.
The presentation makes a powerful argument that government policy on homelessness over the last 20 years has failed to decrease chronic homelessness. The chronically homeless, Cabrera said, are only 10% of the homeless population, but they use 50% of the resources available. Those services include emergency medical services, primary health care (multi-day hospital stays), behavioral health care (psychiatric treatment, detox facilities), and interactions with the justice system (police, the courts, etc).
Cabrera said the Boston Health Care for the Homeless Program tracked 119 persons experiencing chronic homelessness for 5 years and discovered that they had more than 18,000 emergency room visits at an average cost of $1,000 per visit. Research prepared for the Tucson Arizona 10 year plan showed that downtown Tucson police officers spent about 200 hours in 1,070 encounters with people who are homeless during April of last year, at an estimated cost to the police department of $64,000. Tucson’s Fire Department last year spent an estimated $2 million answering an estimated 3,000 calls - out of a total 76,000 911 calls - from people who are homeless.
In Reno, Nevada Cabrera said two frustrated police officers tracked the costs of two chronically homeless individuals, who accounted for $100,000 and $120,000 in hospital expenses in less than a year. The officers determined that one individual, who they named "Million Dollar Murray" had cost more than $1 million in hospitalization, incarceration, detox treatments, and ambulance rides. Reno P.D. officer Patrick O’Bryan said "we spent $1 million not to do anything about him."
The University of California at San Diego followed 15 chronically homeless people for 18 months, tracking their use of behavioral health acute systems, mental health and substance abuse services, law enforcement interventions on the streets, and temporary periods of incarceration. Total cost: $3 million, $200,000 per person.
The solution, Cabrera says, is to provide chronically homeless people with housing so they can stabilize their lives and start getting the help they need. In the housing first program, people are given housing without any pre-conditions. In other words, they don’t have to end their drug or alcohol addictions before they get housing. Housing First gives them housing and offers them assistance.
According to Cabrera, Housing First is working. In Portland, Maine researchers tracked 99 chronically homeless individuals who moved to permanent supportive housing. They report a 50% reduction in service costs in ambulance and emergency room use, jail nights, and police contacts after housing placement, dropping from an average of over $28,000 per person annually to $14,000. Health care costs decreased 59% after housing placement and mental health care costs decreased by 41%.
In Denver, Colorado they had a 73% reduction in emergency costs or nearly $600,000 in the 2 years after chronically homeless people were placed in housing. Over 80% of the homeless people remained in the housing after 6 months. Mayor Hickenlooper of Denver says they will re-invest $20 million in savings in public systems to create 200 new units of housing for persons who are chronically homeless.
Advocates of the Housing First model say that the old status quo of ad hoc, uncoordinated crisis intervention isn’t working, it is more expensive, and less effective at helping the homeless. A Fresno Grand Jury report released in March 2008 came to the same conclusion. They wrote "the scattered and piecemeal public services provided to the unsheltered homeless add up to a very large public expense. It has been reported that as much as 50-80% of the total money
intended for homelessness is spent on the chronic unsheltered homeless." Writing about the Tool Shed City at the Poverello House and other efforts by the city to address homelessness, the Grand Jury report says "these various efforts to provide housing for the homeless have not been effective solutions for chronic unsheltered homeless in Fresno County."
The Grand Jury report pointed to Housing First as a solution. They wrote:
"Housing First" programs provide permanent transitional housing and support services for the unsheltered homeless. Clients receiving shelter are not usually required to be drug andalcohol free in order to be provided housing. Support services, including counseling programs to support a drug-free lifestyle, accompany the housing, rather than being a prerequisite to it.
The "Housing First" model was developed in Boston, Massachusetts after a study revealed that the community was paying an exorbitant amount to treat homeless individuals at hospitalemergency rooms. The study showed that giving the homeless person clean, warm, and dry shelter reduced medical costs by as much as 70%. Boston went on to construct permanent buildings to provide temporary or transitional housing for the homeless. Other cities including Chicago and Portland claim to have saved money and improved services by establishing a "Housing First" program.
Mayor Autry, in his talk to the task force, told them to "think outside of the box" and encouraged them to re-direct public policy on homelessness. Eduardo Cabrera, the HUD Region IX Homeless Agency Coordinator, said essentially the same thing. He told the group to "move from managing the crisis to ending the disgrace." The model they are advocating is at odds with the current social service providers like the Poverello House and Rescue Mission who seem content to maintain the status quo. Both organizations are represented on the task force and it will be interesting to see if there is resistance to changing, in a fundamental way, public policy on homelessness.
Cabrera was clear about the cost of maintaining the status quo. He quoted Albert Einstein, who once said "the definition of insanity is doing the same thing over and over again and expecting different results." Housing First costs far less than the current public policy, is much more effective at ending chronic homelessness, and now has the support of the mayor and a majority of elected officials.
The ball is now in the task force’s court. They have 100 days to develop a plan that and present it to Fresno City and County governmental body’s for approval. There next meeting is on Monday, April 21 at 3:30 PM at Fresno City Hall.
For a list of articles and documents about the struggle for civil liberties for homeless people in Fresno, see: http://www.fresnoalliance.com/home/homelessness.htm