Connect mental health and substance abuse recovery services to unhoused individuals

50% INCREASE IN UNSHELTERED HOMELESSNESS WHEREAS, the unsheltered homeless population grew by 50% from 2,037 people in 2019 to 3,057 people in 2022 [i] ; and 700 OFTEN-MOVING CAMPS SCATTERED ACROSS PORTLAND’S 146 SQ MILES WHEREAS, the Impact Reduction Program of the City of Portland has observed over 700 self-sited unsanctioned encampments across the City’s 146 square miles [ii] ; and SERVICES ARE OUT OF REACH WHEREAS, sprawl of self-sited unsanctioned encampments makes outreach and charitable/service distribution difficult, uneven, and inequitable; and WHEREAS, in early 2022, 95% of homeless individuals surveyed said they were not offered temporary shelter, transitional or permanent housing or other services to meet their immediate needs prior to the removal of their self-sited encampment (Feb. 2, 2022) [iii] ; and LACK OF BASIC SANITATION WHEREAS, those camping in self-sited unsanctioned encampments often lack access to reliable sources of food, water, and hygiene services; and LACK OF SAFETY WHEREAS, Street Roots found that homeless individuals were more likely to be victims of violent crime than perpetrators [iv] ; and WHEREAS, homeless people with mental illness are highly vulnerable to violence, with a reported lifetime incidence of 74% to 87% of violence being perpetrated against them [v] ; and ROOT CAUSES OF HOUSLESSNESS WHEREAS, Dr. Solotaroff, the former President and CEO of Central City Concern, explained the essential root causes of homelessness as stemming from both individual factors (early childhood adverse experiences, serious mental illness, substance use disorder, personal history of violence, etc.) and structural factors (absence of affordable housing, absence of entry-level employment that can lead to meaningful wage employment, structural racism and discrimination, the criminal justice system and impediments to enable a person to thrive after incarceration, etc.) [vi] ; and BEST SOLUTION: AFFORDABLE HOUSING WITH NEEDED SERVICES WHEREAS, the ultimate solution to homelessness is housing, including rapid re-housing an intervention designed to quickly connect people to housing and services [vii] ; and YEARS-LONG WAITING TO GET INTO AFFORDABLE HOUSING WHEREAS, applicants for affordable housing units wait an average of five years, with some waits taking up to ten years, as they languish on the streets or in unstable housing (per data commissioned by Mayor Wheeler from Home Forward—Portland’s local housing authority) [viii] ; and WHEREAS, this wait turns deadly due to high rates of substance use disorder and the cheap, synthetic, and dangerously potent drugs on our streets (e.g., fentanyl and P2P meth) [ix] ; and LONG WAIT TIMES WITHOUT SERVICES EXACERBATESMENTAL ILLNESS, DRUG ABUSE WHEREAS, people experiencing homelessness experience overdose rates up to 30-fold higher than the general population [x] ; and WHEREAS, people experiencing homelessness, as a sociodemographic group, are more vulnerable to unhealthy substance use than those who are housed [xi] ; and WHEREAS, those experiencing homelessness are more vulnerable to suffering mental health issues—locally, a 2021 Oregonian survey found that 63% of homeless Portlanders suffered from mental health issues [xii] , and of those who reported suffering from mental health issues: 66% reported suffering from depression 65% from anxiety 52% from post-traumatic stress disorder 43% from bipolar disorder 40% from substance use disorder 27% from schizophrenia [xiii] ; and WHEREAS, homelessness has been associated with poorer mental health outcomes, and; homelessness may even trigger or exacerbate certain disorders. For example, studies show that homelessness relates to increased psychiatric distress and lower perceived levels of recovery from serious mental illness [xiv] ; and WHEREAS, in 2020, Oregon jumped from having the ninth highest rate of meth use in the country to the highest, according to the most recent National Survey on Drug Use and Health data [xv] ; and WHEREAS, the price of meth has decreased, while the potency has increased, allowing users to purchase three days' worth of meth for $5 [xvi] ; and WHEREAS, “[m]eth dependence gradually develops into not only meth psychosis but also persistent neurocognitive deficits” which impair daily living and working [xvii] ; and “[m]ethamphetamine-induced psychosis is often times clinically indistinguishable from paranoid schizophrenia” [xviii] ; and meth use can cause obsessive, hoarding behavior [xix] ; and WHEREAS, Oregonians voted overwhelmingly for Measure 110 in 2020, with the understanding that decriminalizing the personal possession of illegal drugs would be coupled with revenue (from marijuana sales and funds reallocated away from drug enforcement) to fund a new drug addiction treatment and recovery grant program [xx] ; and WHEREAS, Measure 110 is a public health approach and when implemented alongside treatment and recovery investment, is a laudable and more humane policy, but in the two years since the decriminalization of the personal use of drugs in Oregon, funds for drug abuse treatment and recovery have yet to be fully implemented [xxi] ; and WHEREAS, only 4.6% of people ticketed for a Measure 110 violation have called Lines for Life to be connected to services [xxii] ; and WHEREAS, there is a 49% gap in substance use disorder services needed by Oregonians [xxiii] ; and WHEREAS, among Oregon Health Plan members, rates of substance use disorder diagnoses suggest that less than half of those with a use disorder have been diagnosed or treated [xxiv] ; and WHEREAS, Oregon ranks second in the nation for percent of population with past year substance use disorder [xxv] ; and WHEREAS, Oregon ranks 50th in nation for percent of population needing but not receiving treatment for substance use disorders [xxvi] ; and DEADLY CONSEQUENCES OF SUBSTANCE ABUSE DISORDER WHEREAS, drug overdoses in Multnomah County increased 94% between 2019 and 2021 (from 215 in 2019 to 417 in 2021) [xxvii] , and fentanyl overdoses increased by 588% between 2019 and 2021 (from 25 in 2019 to 172 in 2021) [xxviii] ; and WHEREAS, drug overdoses (417) killed more people in Multnomah County in 2021 than gun violence (71) and automobile crashes (84) combined [xxix] ; and CAMP REMOVALS WITHOUT CAMPING BAN NOT EFFECTIVE WHEREAS, in Spring of 2021, with the lifting of COVID pandemic restrictions, Mayor Ted Wheeler, issued an Emergency Declaration that created the Street Services Coordination Center (SSCC) that coordinates homelessness outreach efforts by the City of Portland and Multnomah County with the purpose of providing streamlined services to those experiencing unsheltered homelessness [xxx] ; and WHEREAS, the SSCC improved its assistance to unsheltered individuals, including: An offer to reserve a shelter bed Free transportation to that shelter, and storage of personal belongings exceeding what is allowed in a shelter space for up to 30 days [xxxi] ; and WHEREAS, unsanctioned encampment removals increased by 2844% from September 2020 to September 2022 (from 9 to 265) (from IRP) [xxxii] ; and WHEREAS, despite the substantial increase in removals, the number of encampments has risen to over 700 [xxxiii] ; and WHEREAS, approximately 20% of those camping in self-sited unsanctioned encampments accept an offer for congregate shelter [xxxiv] ; and WHEREAS, even with the improved shelter referral process, of the thousands of people offered a shelter bed, only a total of 405 have accepted [xxxv] ; and WHEREAS, providers engaged in daily outreach around the city estimate that upwards of 60% of those living in self-sited unsanctioned encampments would accept an offer for a designated camping site [xxxvi] ; and WHERAS, qualitative evidence suggests that the majority of campers prefer to remain outdoors, rather than go into congregate shelter, and simply move to another unsanctioned camp location, putting them at risk of removal and continued lack of access to services; and WHEREAS, Portland’s City Council extended the duration of a housing emergency and continued the current housing emergency for three additional years in Ordinance 190756 on March 30, 2022 [xxxvii] ; and WHEREAS, stabilization of those living unsheltered in managed communities with peer support is trauma-informed and compassionate; and WHEREAS, the campus model and phased approach is more effective for connecting individuals with services such as charitable, government, and healthcare, for example, Vancouver’s meal train for its Safe Stay program [xxxviii] , Medford’s Urban Campground for up to 125 people, and Talent Gateway Transitional Housing Project for 159 people in 53 RVs [xxxix] ; and WHEREAS, the City of Portland will soon open all six Safe Rest Villages; and WHEREAS the City is committed to serving the needs of unhoused individuals with disabilities and connecting them with appropriate services in City shelters and campsites [xli]; and NOW, THEREFORE, BE IT RESOLVED , led by the Street Services Coordination Center (SSCC), the City Council directs City bureaus and Council offices to work together to develop a plan that identifies needed policy changes, investments, and public, nonprofit, and private partnerships to greatly expand the number of available shelter slots as quickly as possible; obtain all health and human services at key sites; as part of the annual budget process, the SSCC will provide an update to individual Council Offices by the end of each fiscal year regarding the total available beds and the safety of designated alternative camping sites; and, complete an operational plan to phase-in over 18 months, once funding has been secured, a citywide ban on self-sited unsanctioned encampments coupled with designated alternative camping sites with services, including: The City of Portland wants to partner with Multnomah County to: Facilitate the opening of remaining shelter beds that are currently funded but not available, including beds in new facilities that are currently under construction as well as beds in current facilities that are not operating at full capacity, and increase the shelter utilization rate to 100 percent. Designated camping sites will initially serve approximately 150 people per site, with the possibility of up to six campuses with a maximum of 250 each when divided up, managed 24/7, with hygiene, food, and access to services across the continuum of care and that are safe; City Council will need to approve each additional camp on each campus, with the first site opening within 18 months of securing funding. Establish at least six designated camping sites that must be diversely spread across the City that will serve as an alternative to self-sited unsanctioned encampments. Offer mental health and substance abuse treatment services to people in Portland experiencing homelessness. Gain access to the Built for Zero unified database that facilitates a client-centered public health approach. The City of Portland commits to partnering with Multnomah County to: Support the Behavioral Health Emergency Coordination Network and the opening of a polysubstance/meth stabilization center [xl] ; Increase its scope of work to engage in navigation outreach and connection to shelter options that provide behavioral and mental health service connections across the City of Portland. Hire 50 additional navigation team members as City employees to engage in outreach and navigation to shelter and services in partnership with the County and JOHS navigators. The City Council will prioritize investments associated with this resolution and related resolutions in the 2022 Fall Budget Monitoring Process. BE IT FURTHER RESOLVED , the City Council requests that staff return with implementation, operational and funding plans for its further consideration. [i] 2019 Point-in-Time Report [ii] https://www.google.com/maps/place/Portland,+OR/@45.542714,-122.6544011,11z/data=!3m1!4b1!4m5!3m4!1s0x54950b0b7da97427:0x1c36b9e6f6d18591!8m2!3d45.515232!4d-122.6783853 [iii] https://www.oregonlive.com/politics/2022/01/false-promises-95-of-unsheltered-portlanders-said-city-workers-didnt-offer-shelter-before-camp-sweeps.html#:~:text=%5C-,False%20promises%3A%2095%25%20of%20unsheltered%20Portlanders%20said%20city%20workers%20didn,offer%20shelter%20before%20camp%20sweeps [iv] https://www.streetroots.org/news/2022/07/13/violence-conflated [v] Roy L, Crocker AG, Nicholls TL, et al. Criminal behavior and victimization among homeless individuals with severe mental illness: a systematic review. Psychiatr Serv. 2014;65:739-750. See: https://www.psychiatrictimes.co… [vi] She has explained these root causes at various conferences . [vii] https://endhomelessness.org/ending-homelessness/solutions/ [viii] https://www.portland.gov/wheeler/news/2022/10/19/mayor-wheeler-releases-data-average-wait-time-many-subsidized-affordable [ix] https://www.opb.org/article/2022/08/04/oregon-mental-health-system-meth-use-portland-methamphetamine/ [x] Fine DR, Lewis E, Weinstock K, Wright J, Gaeta JM, Baggett TP. Office-Based Addiction Treatment Retention and Mortality Among People Experiencing Homelessness. JAMA Netw Open. 2021;4(3):e210477. doi:10.1001/jamanetworkopen.2021.0477 [xi] Office-Based Addiction Treatment Retention and Mortality Among People Experiencing Homelessness | Addiction Medicine | JAMA Network Open | JAMA Network Behavioral Health Services for People Who are Homeless (samhsa.gov) [xii] https://www.oregonlive.com/port… [xiii] https://www.oregonlive.com/port… [xiv] Castellow J KB, Townley G. Previous homelessness as a risk factor for recovery from serious mental illness. Community Ment Health J. 2015;51:674-684. See: https://www.psychiatrictimes.co… [xv] 2019-2020 National Survey on Drug Use and Health: Model-Based Prevalence Estimates (50 States and the District of Columbia) | CBHSQ Data (samhsa.gov) [xvi] https://www.thelundreport.org/content/meth-has-changed-and-it%E2%80%99s-sabotaging-oregon%E2%80%99s-mental-health-system [xvii] Tomohiro Abekawa, in Neuropathology of Drug Addictions and Substance Misuse, 2016 . [xviii] Nicholas T. Bello, Matthew R. Zahner, in Side Effects of Drugs Annual, 2017 . [xix] Sam Quinones , The Least of Us, page 4. [xx] https://www.oregonlegislature.gov/lpro/Publications/Background-Brief-Measure-110-(2020).pdf [xxi] https://www.opb.org/article/2022/09/20/oregon-measure-110-drug-decriminalization-substance-abuse-treatment/ [xxii] Oregon gubernatorial candidates weigh in on Measure 110, their plans if elected | KPIC [xxiii] Oregon Substance Use Disorder Services Inventory and Gap Analysis [xxiv] Oregon Substance Use Disorder Services Inventory and Gap Analysis [xxv] 2021.Oregon.NSDUH.Highlights.Final.pdf - Google Drive [xxvi] 2021.Oregon.NSDUH.Highlights.Final.pdf - Google Drive [xxvii] Multnomah County Medical Examiner [xxviii] Multnomah County Medical Examiner [xxix] https://www.oregonlive.com/crime/2022/01/90-homicides-in-portland-2021-closed-with-one-of-the-most-deadly-months-in-a-record-year.html [xxx] https://www.portland.gov/sscc/about [xxxi] Id. [xxxii] https://www.portland.gov/homelessnessimpactreduction/news/reports [xxxiii] Per Impact Reduction Program’s latest observation. [xxxiv] SSCC data average per quantitative (weekly reports) and qualitative (navigation and other outreach worker feedback) data. [xxxv] https://www.portland.gov/homelessnessimpactreduction/news/reports [xxxvi] Two service providers engaged in this work daily across the city made this qualitative analysis after specifically asking people if they would say yes to a designated camping site if it were an option. [xxxvii] https://www.portland.gov/charter-code-policies/changes/2022/3/ordinance-number-190756 [xxxviii] https://www.columbian.com/news/2022/sep/03/vancouver-safe-stay-community-nourished-with-meals-prepared-by-volunteers/ [xxxix] https://www.rogueretreat.org/housing-shelter/ [xl] https://www.portland.gov/wheeler/news/2022/10/4/mayor-wheeler-releases-rfi-project-report-polysubstance-stabilization-center [xli]https://www.portlandmercury.com/news/2022/09/07/46063805/class-action-lawsuit-accuses-portland-of-violating-americans-with-disabilities-act-by-allowing-tents-on-sidewalks