Commentary: The bad habits have to go

By Heather Lyons
Contributing Writer

I’ve spent a lot of time looking at spreadsheets lately. These spreadsheets attempt to quantify programmatic need and calculate the resources necessary to develop permanent supportive housing. Many communities, from Los Angeles to Omaha have found this to be a valuable tool.  It provides a roadmap to determine an approach to creating supportive and affordable housing initiatives from a policy and funder perspective. I like working on them, because they are puzzles. We can deal with over a half dozen data sources in some cases, and we usually have to consider more than 20 complicated federal, state and local funding resources.

As I work on one particular worksheet, I have to do what we call “making assumptions.”  Because we don’t always have clear data, sometimes we need to modify a number or percentage in order to account for differences in data sources, and then we need to justify it.  Here’s an example I just typed to explain a percentage in one spreadsheet, “includes med-high acuity adult (adjusted for long-term homelessness).”

Well, what the hell does that mean?  Perhaps the better question is who does that mean.

After the tragedy of Jack “Jackie” Collins, a homeless man who died at Hoyt Arboretum here in Portland, I’m reminded of the vast inequities that people of little or no means and who suffer from untreated mental illness or addictions face. I’m not going to discuss the Portland Police Bureau’s response to the situation. There is enough out there about that. Plus, while difficult in some ways, it’s easy, because it’s a narrow point of view. What is more difficult is creating solutions for people like Mr. Collins. people who may be a “high-med acuity adult (adjusted for long-term homelessness).”

While a lot remains to be known about Mr. Collins as a person, it’s probably safe to assume that he was not healthy, definitely homeless, and may have spent some time in and out of jail and hospitals.

Here is something we do know.  People who do not have access to care and do not have a stable place to live are not only extremely vulnerable; they are a drain on public resources.

•            In New York, 11 percent of people returning from state prisons to New York City become homeless within the first few months after leaving prison; of this group, about a third return to prison within two years. The risk of return to prison is significantly higher for those who are homeless and mentally ill.

•            A study of chronically homeless inebriates by the University of California, San Diego Medical Center found that 15 individuals averaged $100,000 each in medical charges

•            A study of six California Health Initiatives  found that each frequent user averaged $58,000 a year in hospital charges ($13,000 related to Emergency Department visits, $45,000 related to inpatient days)

And, this is important, these folks experience no long-term benefit for these expensive services or jail time. These cost studies, along with cost analyses of the impact of the intervention of housing and services for individuals who fit this profile, have helped to make the case for creating supportive housing for several years now.

Here’s something I know. Better, here’s someone I know. When I first met Patty Katz, she was fresh out of jail and her story of heroin addiction was tragic. She cycled in and out of jail, went to treatment several times, got out to the streets without supportive housing and went back to her addiction. She often received her health care from emergency rooms, and she did not have a safe place to live for six years.

Once she became clean, it did not mean that her struggles were over. She faced tremendous obstacles taking care of chronic health conditions resulting from years of use; she also had to overcome the barriers of past criminal issues. She had to figure out her housing, look for a job, reconnect with family and find new friends that would help her be healthy. On top of all this, Patty became one of the best leader/organizers in the Recovery Association Project’s history.  Because of her work and others, more resources came to help others not die from heroin overdose in the early to mid-2000’s. She didn’t do all this on her own. She had help from the YW Housing (Now Second Step Housing) in Vancouver, and touts the value of their housing and services all the time. “Making the decision to quit using was easier said than done,” Patty said, “My success came from a safe place to live, in a community of people who wanted to improve their lives, case management, access to healthcare and treatment, coupled with my recovery program.”

I don’t know how she did all of it, and if you are interested, you should ask her, if you can catch her. Ten years later, Patty is more committed than ever to organizing. Now she’s focused on criminal justice reform – she even gets paid to do it.  She’s maintained a healthy lifestyle and is stably housed. If that’s not enough, Patty and others have just started a 501(c)3, Hands Across the Bridge Project, to continue the efforts of organizing in the recovering community. They hold their signature event (hundreds of recovering people joining hands across the Columbia bridge) every Labor Day to honor and celebrate recovery from a seemingly hopeless state of mind and body. She’s no longer a “high-med acuity adult (adjusted for long-term homelessness).” I tell her story because she’s amazing, and I also think many people believe that once someone becomes as bad off as Mr. Collins, he or she is a lost cause. It’s just not true.

Not only is Patty better, the world is a better place because she didn’t die. I believe that Mr. Collins shouldn’t have died. Not because of the actions of one officer who was in a situation that I wouldn’t wish on anyone, but because Mr. Collins is part of a growing social class that does not have the same access to services and housing that most of us have. That is what really needs to change.

Despite the overwhelming evidence of knowing what works to increase equity and save people’s lives, we often look past this or figure out how to justify what we already do as the response. Truth be told, we could all do more to promote what works. However, we are creatures of habit, and habits are very difficult to break – old behaviors are very difficult to change. Nevertheless, it is possible, just ask Patty.

Heather Lyons lives in Portland, Oregon, and works the Corporation for Supportive Housing’s National Consulting and Training Team to promote systems and policy change to create supportive housing to end homelessness.  Prior to this position, Ms. Lyons led the City of Portland’s efforts to end homelessness, with numerous partners, under the policy framework of Home Again: A 10 Year Plan to End Homelessness.

6 responses to “Commentary: The bad habits have to go

  1. Well said. It is clear from my work with mental illness that hospital stays costing many thousands of dollars and releasing a person to the community with no supports is a clear path to repetition of the problem. Providing supports, ONE of which is housing is necessary to break the cycle (or perhaps more appropriately REcycle) process. Housing is a critical component and part of a overall support system. It does not take many emergency room or treatment visits to exceed the basic costs of housing and support services. The stress from not having housing clearly makes the problems that much worse and sadly, that much more expensive overall.

    There are amazing stories of recovery and recovery is a possibility. We seem to not flinch at all when a person is afflicted with physical illness like cancer. When will we be able to view mental and addiction issues with the same sense of compassion and hope?

  2. Thanks Don. I think most people are getting there, but too slowly for too many who are suffering today. Government wastes too much energy putting out the fires of its own inefficiencies to rebuild the system. But I’m an optimist.
    — Joanne

  3. Peter Planteen

    i’m an street outreach worker in nor/cal, also worked on a county mental health team that worked with mentally ill/homeless and never heard the term ” med-high acuity adult” does that mean he takes his meds ? doesn’t take meds ? It sounds like another term meant to confuse us. I, as a worker in this field,find its intention insulting to the person and to anyone who works in my profession.

  4. Heather Lyons

    Hi there,

    Great comments. Specifically to respond to Peter. I agree that classifying a person by a label, like “med-high acuity adult,” can definitely be offensive, especially when you know and work with people and know their personal stories. That was one of the intents of the column. To say, “what the hell does that mean?” was to point out to readers that people are behind these labels. People with tragic stories and people with stories of great success.

    As someone who gets paid to try to figure out how much it costs to house and serve individuals in a healthy, therapeutic setting vs. the opposite (institutional settings and the streets), we need something to help identify the range of needs people have. There is no good way to do this without using some sort of description. It was not meant to be offensive.

    I hope, though, the column pointed out that the power of individuals and their stories (again, some tragic, some successful) and if we want more stories like Patty’s, and less like Mr. Collins, then we need to help the systems to change their habits and support people to transform their lives through the availability of housing and services rather than the current model of crisis intervention (if that) without consideration for the long-term for folks.

    Thanks for reading and posting comments. I really enjoy seeing them, and if this doesn’t make sense, post again. I’m happy to discuss more.


  5. Heather,
    Thank you for your insight. I’d like to mention that my story is similiar to Patty’s. I too came from that cycle of addiction /mental health issues, homelessness, criminality and the inability to hold down any type of job. That said, I was well on my way to becoming a statistic similar to Mr. Collins who clearly had difficulty accessing help for himself as do many others. Fortunately I found a system that had a continuum of care that helped me address the challenges of my lifestyle that in reality the only “way out” are generally in some unnecessary tragic and meaningless death.
    That continium of care started with me getting detoxed and stabilized and sitting with my counselor at Hooper to look at options that would support my journey into recovery. In the past, I frequently stopped shooting heroin for a day or so, but I could never stay stopped.

    The conversation with my counselor at Hooper led to an interview with the Recovery Mentor Program. The Mentor Program offered me a safe and sober housing environment, and brought me into an Alcohol & Drug Free Community (ADFC) while I engaged in treatment and addressed addictions, mental and physical health issues in an integrated system.

    The ADFC housing was the key ingredient in this process. It literally was a Therapeutic Community (TC) affording me that ability to regain or learn skills that were mising in my life. Those skills, to name a few, were learning how to simply come and go into my housing unit at reasonable hours (as I would when I became employable.) I met and developed a healthy support group and learned how to stay alcohol & drug free on a daily basis. This initial continuum of care process gave me that start to long-term recovery (10 years) and employment (9 years.)

    Today, I have a network of wonderful, supportive friends both personally and professionally. I get to truly participate in my community and care for it now. And I am in the process of using my VA Home Loan to buy my first house or condo. (I really dig living downtown.)

    I’ll share this with you as well: When I found out that a group of addicts in recovery helped form the Recovery Mentor Program, I was completely sold. Sold on the idea that a few committed people (think Margaret Mead) would stand up for me as I was falling down. They then would show me how to do the same for others. So I am standing with Heather, Patty and others who know that supportive housing, coupled with services that address addiction and mental health, primary care as well as provide employment support services, is economically the best way to allocate resources. It creates stability for that very same system. It helps return folks to being taxpayers. Taxpayers that help pay back into that system they got help through. It’s an investment in people. I stand for that! Thanks again Heather for the commentary that agitated me to respond.

    In service,

    Gary Cobb
    Community Outreach Coordinator
    Central City Concern
    503-200-3893 (office)
    503-737-8261 (cell)

  6. Heather Lyons

    Gary, I heart you and your story. Thanks for sharing. You and Patty are the tips of the icebergs of people who are not only changing their own lives, but making sure that others can have that opportunity, too. Time to keep chipping away at the “Titanic” of issues that challenge all of us to do better.

    Many, many thanks to Street Roots and all its partners for the opportunity for a public voice.

    Solutions are possible for everyone, no matter your path. Seriously. Listen to people who know.

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