Salem’s most vulnerable homeless people risk early death
SALEM, Ore. (AP) — People in Salem’s most vulnerable homeless population have three strikes against them: a chronic health condition, mental health diagnosis and substance addiction.
The most likely outcome is to die in their 50s.
More than 500 people experiencing homelessness in the Salem-Keizer area have been identified in this “tri-morbid” group in the past year, up from an estimated 200 in 2014.
Studies show many won’t get help in time.
But while this population is the most vulnerable, it’s the least likely to get help because many groups focus on people with fewer issues.
“I wish people would just see us as human beings — not garbage and an embarrassment to the city,” said Kathie Dollarhide, a tri-morbid woman housed this year through Salem’s Homeless Rental Assistance Program.
“We are human, we have feelings, we live and breathe, we put on our pants the same way every day that you do,” she said.
Jimmy Jones with the ARCHES Project in Salem advocates for housing this population first and directing the majority of resources to serve them, versus other homeless populations.
These housing-first models have had notable success across the country, Jones said, with the majority seeing participants remain in housing and utilize support services about 85 percent of the time.
Salem’s Homeless Rental Assistance Program reports a success rate above 95 percent so far in its first year.
Oregon programs that require sobriety or mental health treatment ahead of housing, by comparison, have a long-term success rate of only 28 percent, Jones said. “We did it for 30 years and it didn’t work.”
The housing-first system isn’t meant to take anything away from other programs, he said, but there is a case to be made for allocating resources to this traditionally under-served homeless population.
Ignoring the tri-morbid population costs economies enormous amount of money, Jones said, including hundreds of thousands of dollars in visits to hospitals and detox centers, as well as jail, police and court costs.
And when agencies provide housing to tri-morbid clients, some research suggests it extends these individuals’ lives by upward of 15 years.
SURVIVING ON THE STREET
Kathie Dollarhide used to sleep under the overhang of the Kohl’s department store downtown.
She recalls the friendly faces of people who greeted her and a woman who bought her a thick coat in the winter.
But Dollarhide, 53, also remembers the people who kicked her, the woman who spat on her face and the parents who pulled their children away “like (she) was a monster.”
“I was very fearful, very terrified of being hurt,” she said. “I was raped, and all of my things were stolen many times.”
Dollarhide was identified as tri-morbid in January after being assessed at Northwest Human Services in Salem. She’d been homeless since 2015.
She has chronic obstructive pulmonary disease and post-traumatic stress disorder. She proudly told the Statesman Journal she hasn’t had a drink since August 2013 or used drugs since August 2017.
Dollarhide first came to Salem a couple years ago, fleeing an abusive partner and working her way up I-5 from Grants Pass to Ashland to Roseburg.
She came during what she described as a mental blackout, a time when her anxiety and stress was so high she couldn’t remember who she was or have any idea what was going on.
That and pseudoseizures — when her body seizes but she remains mentally aware — are some of the effects of her PTSD.
TRAUMA CAN ALTER THE BRAIN
An estimated 40 percent of Marion County homeless adults living outside, in shelters or in cars have a mental health condition, Jones said.
Conditions vary, including anxiety and depression, bipolar disorder, schizophrenia and psychosis. And many people living on the streets have experienced traumatic events that worsen their conditions.
Past trauma and abuse compound these conditions for the majority of people facing homelessness, said Stephen Goins with Northwest Human Services.
Abuse, neglect and chronic stress from early childhood are powerful enough to change the physical structures of the brain, he said. For many, that results in debilitating mental and physical health issues.
Homelessness is its own form of trauma.
Those experiencing homelessness frequently feel an overwhelming loss, they rarely feel safe, they are frequently victimized, they lose a sense of belonging and their day-to-day life is unpredictable, Goins said.
He gave an example: Imagine you are in a room and a door suddenly slams behind you. You may jump, start to sweat, look around and tense up.
This is the amygdala — the part of the brain that shifts the body into survival mode — responding to stimulus.
But as soon as you realize you are safe, you start to relax and go back to neutral. That’s the work of the hippocampus and prefrontal cortex, the parts responsible for memory and learning, as well as rational thinking and decision making.
But the brain of someone who is homeless doesn’t always respond the same way, Goins said.
The chemicals released in this repeated flight-fight-or-freeze response have damaged the hippocampus and cortex, impairing the individual’s ability to form more logical conclusions about the slamming door.
Instead, the brain goes into survival mode, misinterpreting incoming sights, sounds and smells as a perceived threat.
For these individuals, it can take extended periods to reach a neutral state of mind again — if ever.
This makes it extremely difficult for them to seek medical care or mental health and substance abuse services.
“In reality, they simply lack the emotional tolerance and energy to navigate the complex systems of care,” Goins said.
Cydney Nestor, division director of Marion County’s Health and Human Services department, works with individuals with serious mental health conditions. Some have been hospitalized, some receive their income through social security and some have children with high mental health needs.
Marion County has two rental assistance programs, one focused on young adults. The programs provide intensive case management and peer support, as well as rental subsidies similar to the city of Salem’s new homeless assistance program.
Individuals learn skills necessary to maintain housing, Nestor said, and receive a subsidy until they are able to either use a housing voucher or pay for their rent themselves.
“When people are in safe and long-term housing, then they can focus on their other needs,” she said.
Dollarhide moved into an apartment in March through the city’s housing assistance program. She’s still learning how to adjust to her new life.
“It took me two nights to sleep in my bed; I slept on my floor,” she said. “It took me six weeks to sleep with the lights off.”
Knowing she has a stable and safe place has helped her go from suicidal and fearful to hopeful.
“I’ve come a long way since March,” Dollarhide said. “My PTSD has calmed down tremendously; I have calmed down tremendously. I’m no longer having seizures every five seconds.”
USING METH TO COPE
Dollarhide’s drug of choice was meth.
“It would numb me,” she said. “It was a painkiller — physically, mentally and emotionally.
“Um, I don’t really know how else to explain it,” she said. “It was an escape of the reality I was in.”
It’s common for people in a traumatic or survival state to seek out many forms of coping, including sexual relationships, alcohol and drugs.
In the last year, about 66 percent of the homeless adults in Marion County served by local groups had a drug or alcohol abuse history and 43 percent reported drug or alcohol treatments that didn’t stick, Jones with ARCHES said.
That’s about 830 individuals with abuse history and 540 who sought treatment that wasn’t effective long-term.
Jones said the growing opioid crisis has contributed to that, with Oregon seeing a five percent increase in drug overdose deaths in the last year.
“Meth remains the drug of choice among many homeless clients, but the rates of heroin use have increased, and (commonly) it’s laced with other drugs,” he said.
In addition to detox centers and sobering beds, there are a handful of other local resources.
Bridgeway Recovery Services in Salem, for example, is the largest and most successful drug treatment program in the area, Jones said. Methadone clinics also have seen notable success.
Jones argues expanded treatment options, needle disposal units and a needle exchange program downtown are additional opportunities to reduce some public health problems caused by intravenous drug use.
LIVING IN PAIN
Jones said most tri-morbid individuals will eventually get sick from long-term exposure to conditions on the streets — such as severe weather — and die in hospitals.
Some people contract diseases while on the streets. Chronic health conditions include hypertension, asthma, cancer, diabetes, exposure to severe heat or frost and liver disease.
Salem Housing Authority officials also have seen a number of traumatic brain injuries as well, typically from an incident on the streets when they were beaten with an object.
Of the 1,258 homeless adults surveyed in Marion County in the last year, Jones said more than a quarter had heart disease, 14 percent had diabetes and 14 percent had Hepatitis C.
“They will live shorter lives because of our inability to serve them,” he said.
This plays a large role in someone’s ability to seek employment, search for a home or use public transportation.
Dollarhide said she’s been “in every hospital from Ashland to here and kicked out of every one of them.”
She said her conditions make it hard for her to find and keep a job.
“And when you get one, you have to shower every day, you have to have clean clothes, you have to be well nourished so you have the energy to work.
“When you’re homeless,” she said, “you don’t have those resources.”
THE HOUSING-FIRST APPROACH
Many local program leaders focus on the “Tier II” population, Jones said — homeless people facing fewer barriers than the tri-morbid group. They may be homeless for the first time or haven’t been homeless for long.
The most likely outcome for this group is to receive services and generally re-house themselves within about six months, he said.
Jones contends that shifting the focus to housing the tri-morbid population first is more cost effective.
What could cost upward of $75,000 in regular hospital visits for someone who is tri-morbid, could be reduced to the cost to house one person for a full year — nearly $17,000 — which pays for rent, some utilities and case management, he said.
A case manager can help the individual receive therapy, medical services, support groups and more, but they also help with less tangible barriers.
Transitioning from the street to housing can be very difficult, Jones said.
Especially for those living on the streets for years, they have a sense of community and belonging with those they have lived near.
Moving into an apartment by themselves can feel isolating, he said. And they now have to adhere to rules they have not previously been expected to follow.
Jones said it’s common to see a person be housed who still returns to homeless camps, to visit their friends and chosen family.
In her apartment, Dollarhide loves to play and dance to her favorite music — rock from the 70s and 80s. She journals a lot, meditates and talks with her sister and son.
“I had a really hard time believing that they were gonna put me in an apartment and pay my rent and pay my power bill so I could calm down, so I could get refocused and create a life for me,” Dollarhide said.
“And that’s what I’ve been able to do for the first time in 53 years.”
Information from: Statesman Journal, http://www.statesmanjournal.com