We saw this story the other day about a shooting at a homeless encampment in Seattle. The initial report is that these people were not targeted because they were homeless. But, it serves as a reminder of the extreme risks people are exposed to when experiencing homelessness. As service providers, we know that survival—in the face of violent episodes like this one or complex health problems—is a constant struggle for many of our participants. The average life expectancy for a person who is homeless is 15 years lower than the average American. Housing is a critical determinant of health. For people experiencing homelessness there is a straightforward solution to alleviate their condition and improve their quality of life, provide housing first. An essential element of that approach is a Low Threshold Admission Policy (LTAP).
In my years of doing street outreach I’ve learned firsthand about the realities that people face when they live on the streets or in shelters. People I tried to help have died while waiting for the housing they so desperately needed. One woman died from her chronic health problems just days before she was approved to move into a housing program. I will always remember the pain of knowing how close she was to having a place of her own. Physical health conditions pose the greatest risk of mortality to people who are homeless, as opposed to substance use disorder or mental illness. However, all of these health conditions are exacerbated by the circumstances of homelessness—the lack of sleep, poor nutrition, difficulty maintaining medications, and exposure to the elements.
Random acts of violence and hate crimes targeting people who are homeless are another reality our participants face. One night, a person I worked with came into the shelter bloodied. He explained that he was attacked on his way there by a group of high-school aged kids. Others have told me stories of being woken up in the night by somebody robbing or assaulting them. The shelters can only provide limited protection since they are frequently overcrowded and underfunded.
But, my experience is not unique. We work with an exceptionally vulnerable population—people who are homeless, oftentimes with co-occurring disorders and limited resources. A tragic fact is that we will lose people we care about in doing this work. It’s not a question of if but when. For those of us that work in homeless services, we know that this is the world that our participants are living in and we hope to be a part of changing it.
The life-threatening risks of homelessness create an urgent need for the Housing First Model and its LTAP for supportive housing programs. LTAP means simplifying our intake processes and removing as many barriers to entry as possible in order to expedite the process of getting people off the streets and into housing. It should not be acceptable to deny a person entry to our programs because of ongoing substance use, untreated mental illness, or criminal background. We must open our doors to people and embrace the idea that housing is a human right.