‘Living in the shadow of the system’: rising number of homeless deaths highlights gaps in services

ByShannon J. Cortes

Nov 12, 2022

According to records requested from the Milwaukee County Medical Examiner’s Office, the number of homeless deaths in 2018 was 21. By the end of 2021, the number had reached 52, an increase of 147%. (NNS file photo)

By Devin Blake

This story was originally published by Milwaukee Neighborhood News Service, where you can find other stories about fifteen neighborhoods in the city of Milwaukee. Visit milwaukeenns.org

Editor’s note: An earlier version of this story mentioned poor organization for Emily Kenney and Patricia Gutierrez. They are both with IMPACT. Also, a quote attributed to Gloriceliz Hernandez should have been attributed to Gina Allende, health promotions manager at UMOS.)

There has been a significant increase in deaths in recent years among people who lack regular housing but do not meet the standard definition of homelessness.

According to records requested from the Milwaukee County Medical Examiner’s Office, the number of homeless deaths in 2018 was 21. By the end of 2021, the number had reached 52, an increase of 147%.

The main cause: drug addiction, especially opioids and fentanyl.

Street Angels Milwaukee Outreach has been conducting homeless outreach activities across the city since 2015. Three times a week, its staff distributes items that meet basic needs, including packed lunches, hot meals and household items. ‘hygiene. The overall goal is to build relationships with people and begin to understand the services they need.

Two people who Street Angels worked with recently have died.

“We just had a gentleman murdered downtown,” said Dan Grellinger, homeless outreach specialist with Street Angels. “It shook people up.”

The medical examiner’s office provided numbers for January and February that indicate the county is on track to match or surpass the number of homeless deaths in 2021. The office did not respond to requests for data. for the following months of 2022.

The lack of standardized methods for determining who is homeless at the time of death creates challenges.

Karen Domagalski, operations manager for the Office of the Medical Examiner, suggested that the data available to her office underrepresents the number of people who died while homeless.

She said in an email that if a person “dies in a shelter, the address of the shelter is sometimes recorded as the address of the deceased, so it would not be obvious that the deceased was in fact homeless. .

“We put a homeless man to death…in an abandoned building. He may have overdosed or it may be hypothermia,” she said. “The family said he was homeless, but an address has been provided so he is unlikely to appear on a ‘list’ of homeless deaths.”

Accurately tracking this particular subsection of people is also tricky for homeless service providers. Most federal funds only go to help people who are “literally” or “chronically” homeless, as defined by the US Department of Housing and Urban Development, or HUD.

It identifies people living on the streets, in a “place not intended for habitation” or in a short-term shelter.

While government entities and nonprofit organizations carry out the work they are funded to do, people who lack stable housing but do not meet the technical definition of homelessness often go unnoticed and unserved.

HUD-funded assistance programs, for example, include four categories of homelessness: the first is for people who live in a place not intended for human habitation, in an emergency shelter, in transition or leave an institution where they were temporarily living; the second includes people who lose their main residence at night; the third is for families with children facing housing instability and likely to remain in this state; and the last category includes people who are trying to get out of domestic violence and have no other residence.

“There are pockets of the community that live in the shadow of the system and are suffering,” said Eric Collins-Dyke, assistant administrator of supportive housing and homeless services at the housing division of the Milwaukee County. “We have to honor this gap in the system and this missing piece. We have to look for more resources. We shouldn’t have to say we have a mandate to do something.

Emily Kenney, director of systems change at IMPACT, the parent organization of IMPACT 211, a free helpline and online resource directory that connects residents to services, echoed that need.

“Since 2019, we have been paying more attention to people who are unstablely housed and trying to provide services beyond preventing them from entering homeless support systems. . . beyond what HUD funds us.

Housing as the gold standard

Stable housing – whether it is shelter or permanently subsidized housing – remains one of the most effective and recognized means of preventing the death of homeless people.

Without this basic need being satisfied, “they freeze to death. They die of heat in summer. They have multiple health issues…. I’m not surprised,” said Sherrie Tussler, executive director of Hunger Task Force.

Advocates and homeless service professionals say they are aware of the lack of easily accessible shelter and housing.

“There are quite a few people who would like to take shelter but cannot,” Grellinger said.

Stephanie Nowak, community response specialist for the Milwaukee County Housing Division, pointed out that people with addictions or mental illness often feel less welcomed by shelters, further complicating efforts to get them out. the street.

“We understand why often homeless people on the streets don’t want to use a shelter or why it’s not a good or good option for them, and we recognize that, and we work with them to find what’s right for them. would be a better option,” Nowak said.

Grellinger tells people who want help finding long-term housing to expect to wait.

“We have people that we support that we have been through a few winters with, or three or four years. We usually tell people – best case scenario – if you get into 211 and get into a housing program and fill out an application and find a landlord, it’s six or nine months,” he said. “This takes lots of time.”

As the city grapples with its opioid crisis, homeless and drug-addicted residents need both housing and accessible treatment to reduce their risk of preventable death.

Shelly Sarasin, co-executive director of Street Angels, reported constant bottlenecks in connecting people to certain drug-related resources. “Fentanyl is really present in our community. Although we have many harm reduction resources, we don’t have many easy-to-access facilities.

Gina Allende, head of health promotions at UMOS, said a facility catering specifically to people with opioid addiction would also be important in helping those seeking treatment.

The only county-run drug addiction clinic serves people seeking services for many types of addictions, but “when people are addicted to opioids, it comes right away with withdrawals…and they worry they won’t get medicine right away and they’re going to suffer,” she said.

Little things go a long way

There are often barriers faced specifically by homeless people that limit their ability to access available treatment.

Location is one of them.

First Step Community Recovery Center, at 2835 N 32nd St., is the only county-funded facility that offers residential detox and MAT. MAT, or drug therapy, is the use of drugs such as buprenorphine or methadone to help suppress withdrawal and limit cravings.

First Step is in the North Side neighborhood of Sherman Park, so patients who live on the South Side “often don’t feel comfortable” when they find out where the facility is, Hernandez said. “It would be a lot easier if people could just walk over there.”

Patricia Gutierrez, director of alcohol and drug abuse services at IMPACT, said she understands this barrier.

“When someone calls us we usually ask ‘is there anyone we can call for you, is there a family member, friend we can call for you’ “, she said. “If it’s serious and it puts your life in danger, we’ll call an ambulance or the police to see if they can get you there. We just want to make sure the customer gets there, and we use every means possible to get them there.

UMOS and Street Angels regularly collaborate with the Milwaukee Fire Department through its Milwaukee Overdose Response Initiative, or MORI, project to help fill this transportation gap. When the UMOS or Street Angels staff encounter someone who wants treatment, they will call MORI to help arrange a run.

Some good news

Despite the challenges, advocates and homeless service professionals said there were two reasons for hope.

The first is the $400 million in opioid settlement money that Wisconsin will receive over the next 18 years. This money has been allocated to, among other things, prevention programs, residential treatment and MAT.

The settlement money will also go to harm reduction and overdose prevention resources, including naloxone and fentanyl test strips. And it is the growing availability of this type of resource that is the second source of hope for people working in the field.

Harm reduction refers to a set of practices aimed at limiting the dangers associated with risky health behaviors, such as drug use or sex work, rather than zero-tolerance policies. Many current works in the field of addiction have adopted such practices.

Fentanyl test strips and naloxone are lifesaving resources, and both are distributed by UMOS, Street Angels and MORI.

Milwaukee Fire Department Captain David Polachowski, who oversees MORI, helped develop its “hope kits,” which include naloxone, CPR face shields, fentanyl test strips, a card for Narcotics Anonymous and numbers for MORI and UMOS.

Polachowski said things like these are key to progress.

“Our success is: are these people still alive? Because then there is the potential for us, or anyone, to help. It’s a victory.