Innovation Ecosystem/Opinion

Shelter from the storm

To support the unhoused requires wrap-around services, a continuum of health care, not just emergency shelter

Photo by Steve Ahlquist, Uprise RI, reprinted with permission

The display of a pallet shelter on the State House plaza, erected by community advocates, including Professor Ed Hirsch of Providence College.

By Benedict Lessing, Jr. MSW
Posted 11/7/22
A leading community advocate asks the impertinent question: Will the state invest in the necessary resources for the wrap-around services to help transition the unhoused into permanent housing?
When will communities such as Cranston move beyond its not-in-my-backyard mentality when it comes to how the city sees itself as part of a larger, inclusive, diverse place to live? How many people have viewed the series, “Dopesick,” based on the reporting by reporter Beth Macy, or her read her latest book, “Raising Lazarus?” Would you welcome someone who is unhoused to your family Thanksgiving dinner this year?
Covering last week’s announcement by Gov. McKee about the naming of a new director and a new community chair for the Governor’s Task Force on Overdose Prevention and Intervention, signing an executive order to expand the work of the Task Force, and announcing that the state had issued an RFP to move forward with harm reduction centers in Rhode Island, ConvergenceRI was struck by the apparent lack of curiosity displayed by some of the TV reporters.
One, from Channel 10, admitted she had never attended a single meeting of the Task Force, giving the excuse that she had only joined the station in January. She also admitted that she had never seen “Dope Sick,” the award-winning series streaming on Hulu, based on the reporting by Beth Macy. The reporter said her main interest was in covering how the state planned to move ahead with a harm reduction center. Gov. McKee had announced that the state had issued an RFP for the Harm Reduction Centers at the Nov. 2 news conference.
The reporter’s subsequent story had opened: “Rhode Island is moving forward with a controversial plan to try and help addicts by giving them a clean, safe place to use drugs.” Her story continued: “Addicts can enter the storefront, access clean needles and shoot up with staff nearby in case they overdose. It’s one of the most controversial ways society is trying to stop drug-related deaths.”
The problem: her story was missing the context. The biggest risk of overdose in Rhode Island today is from adulterants being added to the illicit drug supply. Yet, the Channel 10 reporter admitted she had never heard about the TestRI program at the School of Public Health at Brown, which in May had identified more than 50 dangerous adulterants in the illicit drug supply, beyond fentanyl, which in turn had dramatically increased the danger of overdose deaths in Rhode Island.
The reporter then questioned me: Are you member of the Task Force? She said she had never read ConvergenceRI when I answered: I was the editor and publisher of the weekly digital news platform.
The Channel 10 reporter’s lack of curiosity was even more stunning, perhaps, given the reporting being done at her station by Alison Bologna. [Bologna and ConvergenceRI had both been honored for our reporting at CODAC’s 50th anniversary celebration.]
The lack of curiosity exemplified the problem with the way many of Rhode Island’s media have reported on those who are “unhoused” – the way that they are stigmatized as the “other” – Rhode Islanders who are somehow seen as disposable and not worthy of investment.

PROVIDENCE – One of the things that’s clear is that Gov. Dan McKee is on track to fulfill his commitment to add 350 additional shelter beds to the current system to reduce the number of unhoused individuals and families from living outside this winter.

The McKee administration’s collaboration with nonprofit agencies and local municipalities to create these resources is a critical step forward. Owing to the growing volume of homelessness in Rhode Island, it may need to further expand.

A second consideration is to ask: What resources will be developed to transition this population to permanent housing? One of the realities is that a significant portion of the unhoused population struggles with serious mental illness and substance use disorders.

It is imperative that newly developed resources include both “supported” as well as “recovery” housing.

In search of wrap-around services
These types of housing that include community-based, wrap-around resources have not been consistently included in the dialogue or advocacy related to affordable housing. Yet they are nonetheless critical to the state's ability to reduce and eliminate homelessness.

This does not mean that these types of housing need be densely clustered within communities, but they can – and should be – integrated within neighborhoods.

Community Care Alliance and other organizations have successfully taken this approach over the course of the past 30 years, which contributed to the process known as deinstitutionalization, going back to the 1980s.

Unfortunately, the housing landscape has become much more expensive over the past two decades. There have been fewer affordable housing units being developed, due to lack of investment. The result: homelessness has increased, particularly for persons and families touched by serious mental illness and addiction, with the pandemic accelerating the process.

This has had a cascading impact on other health and human services systems of care. These impacts include: the “boarding” of patients in Emergency Departments at hospitals; inpatient over-capacity at the state hospital; more children being placed in foster care; and the overuse of corrections and public safety by local municipalities. The stress placed on these systems has resulted in cumulative economic consequences.

Absence of a community health system?
Another consideration related to the unhoused often overlooked has been the lack of involvement of the community behavioral health system in providing care. For decades, community mental health centers did not view the unhoused as one of their core patient populations.

Given the behavioral health needs of the unhoused population, this could not have been further from reality.

Absent solutions and resources such as “supported” and “recovery” housing, unfortunately, the R.I. Department of Corrections' system has become both the housing and treatment resource of last resort for many individuals.

Translated, what this should tell us is that the promise of deinstitutionalization was never fulfilled. Neither did the state’s behavioral health system evolve and adapt accordingly.

If there is good news to be found in the current crisis, it is that the community mental health centers and substance use treatment organizations are now focused on stepping up to meet the needs of the unhoused.

However, more must be done. The R.I. Department of Behavioral Healthcare, Developmental Disabilities and Hospitals [BHDDH] needs to exert more influence and provide leadership in bringing all the community mental health centers and other behavioral health organizations into this work.

Given the vulnerability of the state’s unhoused population, the state must employ a comprehensive approach that will both save lives and improve the quality of life for those individuals and families currently without shelter.

Addressing the needs of the unhoused always comes back to a question of resources. Gov. McKee has taken two important steps: the first is the commitment to expand necessary life-saving shelter so that people are not living outside; the second step has been the commitment to create additional affordable housing.

Now, it is critical that persons with serious mental illness and substance use disorders have access to the “supported” and “recovery” housing that will improve their quality of life, so that they no longer continue to reside at the margins of our communities.

Benedict F. Lessing, Jr. MSW is the President/CEO of Community Care Alliance.

[Editor’s’ Note: In the aftermath of the Nov. 8 election, expect that there may be additional announcements of investments for emergency shelter in Rhode Island.]

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