Housing Mr. X

Posted on July 17, 2012

Chances are you’ve seen him. For more than two years, Mr. X has been a fixture at a major downtown underpass, gesticulating wildly to himself, vaguely menacing, unapproachable. Every city has its own Mr. X. The individual considered most likely to decline outreach, most resistant to housing and services, the Mt. Kilimanjaro of the homeless services providers system. In New York, you find these individuals in The Bowery. In Los Angeles, they reside at Skid Row. In New Orleans, it was the legendary Mr. Coleman. In Richmond, agreement was unanimous that it was Mr. X.

When the announcement was first made back in April of 2011 that the state of Virginia intended to join the national 100,000 Homes Campaign and that Richmond, led by Homeward and Virginia Supportive Housing, would be the vanguard city, VSH received multiple e-mails from concerned citizens wondering if Mr. X would be outreached. At the time, it was not at all clear that he would – or could – be helped.

Mr. X wasn’t always this way. With several years of college on his resume, he was clearly intelligent and had the potential to be as functional and productive as you or me. However, as we all know, sometimes it only takes one tough episode to send a life careening off the tracks. Mr. X’s descent into mental illness and subsequent homelessness was apparently rapid, but not beyond treatment, if only someone cared enough.

The VSH support services staff became officially acquainted with Mr. X last August during Richmond Registry Week. Multiple survey teams approached him that week, but he declined to cooperate each and every time. And yet, he clearly met the survey criteria of chronically homeless and medically vulnerable, especially on the basis of mental health concerns. In fact, on one occasion, VSH’s HomeLink Team Leader Lynn Aumack offered to bring him coffee and he refused, suspecting that it would be poisoned and threatening to “cut off the head of the Dalai Lama” if “the people in the red shirts” didn’t stop coming around.

Despite his erratic behavior, VSH staff continued to try to connect with him over the next several months.  Mr. X’s symptoms were so severe that it was extremely difficult to build rapport, and he declined all offers of housing and services repeatedly.  On at least two occasions the Richmond Police Department’s HOPE team and RBHA (Richmond Behavioral Health Authority) Crisis team were called in for an assessment, but both times the conclusion was that he did not meet the necessary criteria for involuntary hospitalization.

Lynn didn’t give up, though, and saw an opportunity at the beginning of June that resulted in another Crisis team assessment. This time, the outcome was that Mr. X was admitted for inpatient psychiatric treatment. With medication, Mr. X’s symptoms improved rapidly and he was able to engage with an APTS (A Place To Start) team member with the result that he agreed to move into permanent housing! On very short notice and in the hospital, the APTS team was able to rapidly process his intake into that program and finalize his housing placement.

Less than a week later, Mr. X moved into his apartment where APTS staff continued to provide him with intensive services. Recently, Mr. X appeared clean-shaven and neatly dressed in the offices of VSH headquarters, working with case managers to sort out his benefits. And, best news of all, Mr. X has been reunited with relatives and will soon return to his hometown to recover with the support of his family. And it all started with housing.

As VSH clinical services director Kristen Yavorsky remarked, all it took was someone driven by the conviction that he deserved better than a life under the bridge.

Do The Math!

Posted on February 15, 2011

As the rhetoric in Washington heats up over the annual budget, it seems as if most lawmakers are still applying the same old equations to the problem of reducing the deficit. While it may be appropriate in some ways to cut spending by cutting services, many of us know that short-term savings now very often translate into long-term spending increases later. This is especially true for services that benefit vulnerable populations. When very low-income individuals lose access to fundamental programs that they can’t otherwise afford, the overall financial burden to the community actually increases. This is just an economic reality that we desperately need to face.

As the budget conversation moves forward (or not), it is important to remember that there is more than one way to save money. In January of 2011, Virginia Supportive Housing skillfully demonstrated this fact when it released a report on the success of one of its programs, A Place To Start.

A Place To Start is an innovative program that serves chronically homeless individuals who have serious mental illness. By providing permanent housing and support services for these individuals, the report clearly shows that a substantial amount of money can be saved. Given the report’s outcomes, only one conclusion makes sense. When it comes to homelessness, the solution is cheaper than the problem. We need to invest in – not cut – services that get the job done right.

The APTS report specifically tracks the costs associated with four “events” common to chronically homeless individuals: emergency room visits, hospitalizations, arrests, and incarcerations. The occurrences of these events were documented among the program’s fifty-two participants during a forty-month period (twenty months prior to entry into the program and twenty months following entry into the program).  A comparison of the two time periods reveals an astonishing $320,000 in savings to the community.

According to the National Alliance to End Homelessness, more than 112,000 individuals experienced chronic homelessness in the US in 2009. It’s easy to extrapolate this local data to conclude that if fifty chronically homeless individuals cost the community $320,000 over a twenty-month period, then 112,000 chronically homeless individuals must cost taxpayers at least $716,000,000 just in terms of those four common events. This is real money being spent right now without much to show for it. On the flip side, if these individuals had access to permanent supportive housing, the country could and would save at least that much within less than two years. Although that doesn’t completely solve our deficit woes, it does go a very long way AND it addresses a problem that our country has been struggling with unsuccessfully for decades.

So yes, lawmakers, let’s exercise fiscal responsibility by reigning in spending. But let’s do it in a way that won’t backfire on us three or five years down the road. There is a way, right now, for us to reduce the enormous cost of homelessness. Do the math. Invest in permanent supportive housing.

A Place to Start Saves Lives and Money

Posted on January 26, 2011

This week’s blog was written by VSH’s Executive Director, Alice Tousignant.

Five years ago, we were all scratching our heads trying to figure out what to do with a certain segment of the homeless population who weren’t getting helped.  These were individuals who were chronically homeless with serious mental illness, many of whom also had a co-occurring substance abuse issue.  Truthfully, many of us had gotten to the point of saying that this specific population chose to be homeless— that was our excuse.  The thing is, no one bothered to ask them what they wanted and if they really did want to be homeless.  The bottom line was that the community, including Virginia Supportive Housing, didn’t know how to help them and we had almost given up trying. 

But then two things happened: we starting hearing stories from around the nation about how chronically homeless people were costing the community money—in other words, even though chronically homeless people comprise a relatively small percentage (about 15%) of the overall population of people experiencing homelessness, they were using a disproportionately high amount of the resources in the community.  We also started hearing about some best practice programs that were successfully housing this population, and these programs were gradually spreading around the nation.

One of these programs was Pathways to Housing, a program that began in New York almost 10 years ago.  After hearing about this program, I must admit I was very skeptical. Not only did I not really believe it could work, it also seemed very costly.  Then PBS did a special on a gentleman called “Footie” who they followed as he entered the Pathways program.  One of the things I vividly remember from the Pathways video was that they talked to individuals who had been living on the streets for years and asked them what they wanted most.  And, guess what they said?  They wanted housing.  They didn’t say they wanted to remain homeless.  That video turned my skepticism to amazement and optimism.  I remember thinking, “We can do this here in Richmond.” 

Working with many partners in the community, including Homeward, the Daily Planet, the Community Services Boards of Richmond, Chesterfield and Henrico and the Virginia Housing Development Authority, A Place to Start (APTS) became our Pathways to Housing in Greater Richmond.  The program was launched in late 2007 and began taking individuals off the street shortly thereafter.

APTS places individuals with an extensive history of homelessness and a serious mental illness into permanent housing and wraps intensive services around them.  APTS has a dedicated service team of professionals, including a psychiatrist, nurse, social worker, peer counselor, substance abuse counselor and employment specialist who provide services 24/7.  APTS also has a housing specialist who works with landlords to broker leases, get clients into permanent housing, and ensure that program participants and landlords are getting what they need.  

We knew the program worked because it was evidenced based, but we needed to prove it worked here in Richmond.  So, we undertook an evaluation funded through the Greater Richmond Chamber Foundation and conducted by the Central VA Health Planning Agency.  The research looked at hospital and incarceration data on 50 clients enrolled in the program and measured costs and incidents 20 months prior to program entry and 20 months after.  The research is complete and the report was released today.

While we knew the program would work, we didn’t know how well it would work.  APTS has taken 58 people off the streets in three years with a 98% success rate in keeping people stably housed!  Only one person has returned to homelessness. 

And APTS is saving the community precious resources.  The research shows that the program has saved the community over $320,000 in the first 20 months in hospital and incarceration costs alone. This does not even include other costs, such as ambulance costs, judiciary costs, and the costs to the homeless services system.

Has this program made a difference in the community?  Yes!  In addition to cost savings, it is making a big difference in the community. We’re taking people off the streets. Most of the folks in the program were unsheltered prior to entering the program and were counted as such in the community’s twice yearly count of individuals experiencing homelessness.  In July 2008, there were 148 people who were counted as “unsheltered homeless.”  In July 2010, that number had gone down to 119, which is a 19% reduction in two years!  Some of this reduction is due to APTS.

What about peoples’ lives?  Just ask Jerome who has been in the program for over two years.  He had been homeless for eight years, living in alleys, dumpsters, and under cars and bushes in Richmond. He suffered frostbite in both feet.  “I struggled like a dog.”  He said that he would have died if he had lived on the street one more year. 

And, there are many more stories like Jerome’s. Despite all that we have accomplished through VSH and APTS, there is still plenty of work that needs to be done. There are still people living on the streets who need to get into housing and get the help they need, and we can’t do that without the community’s support.  To support A Place To Start and the work of VSH to provide proven permanent solutions to homelessness, click here. Thank you!

Happy Holidays From Virginia Supportive Housing!

Posted on December 21, 2010

This week’s blog was written by VSH’s Executive Director, Alice Tousignant.

I must be getting old because I’m not as stressed out as I usually am at this time of year.  It’s mid-December, the holiday craziness is in full swing, and there’s lots going on personally. It’s also the end of VSH’s fiscal year and the entire office is in an uproar, trying to wrap up reconciliations for our 2010 budget and finalize the budget for 2011. Yet, I’m still smiling and calm. Am I just completely out of touch or is this feeling really justified?

You decide.

Over the summer, we had the opportunity to transition 13 individuals out of South Richmond and into private housing in the community. One of these individuals, Joe Brightful, had been living at South Richmond for 14 years and is now feeling pretty happy. Once these folks had successfully moved on, we could then make their apartments available to 13 new clients who otherwise would be on the streets and in shelters.

We also had a groundbreaking at South Richmond to launch construction on 21 additional apartments that will be completed sometime next year, helping to reduce homelessness in the region. This is our first regional effort here in Central Virginia and we are extremely excited by the collaboration between Richmond City, Henrico and Chesterfield County to make this effort a success.

We have a brand new volunteer program which has given us 553 new friends who have performed 7421 hours of service helping us with a multitude of projects, saving us time and money in addition to spreading the word about VSH. You can see many pictures of these volunteers in action on our Facebook page and find out more by contacting our volunteer program coordinator at 804-836-1061 or [email protected].

We completed a 20-month evaluation of A Place to Start (APTS), demonstrating the incredible success of this program through two important measures: retention rate (98% for the first 50 people who enrolled in the program) and savings to the community (over $300,000 in hospital and incarceration costs alone)! In addition, we were able to enroll six new clients this year, one of whom had been homeless for over 10 years and in and out of psychiatric units many times.

We opened our third regional supportive studio apartment building in the South Hampton Roads area in late November. 33 people have already moved into South Bay, many of whom had been living on the streets and in shelters for a long time. Our property management staff services staff worked night and day to locate them and get them processed to move in. One staff member remarked “I’ve never seen people who had so few possessions.” Thanks to the generosity of many individuals and congregations, we were able to make sure that everyone had what they needed to feel “at home” in their new home.

I attended the holiday party for our clients in Richmond a couple of weeks ago, and lots of people showed up for great food and karaoke.  It gave me an opportunity to sit and talk with folks who are being housed and served by VSH, and it was very comfortable and normal. We didn’t talk about where they had been but about how they are doing now, and most are doing pretty well. With stable housing, they can focus on taking care of their health issues or getting their GEDs. They’re not homeless anymore. Many people simply told me, “Thank you.”

So, that’s why I’m still smiling.

I want to express my thanks to our amazing staff who perform miracles every day.  I also am deeply appreciative to our wonderful board, whose support and engagement are helping us grow to the next level. And finally, thank you to all of our friends and supporters in the community who help make this all possible. Happy Holidays and Best Wishes for the New Year!

Anyone And Everyone Can Make It In Permanent Housing

Posted on July 20, 2010

I have asked Katie Van Arnam, VSH’s Director of Housing Access Programs, to write this week’s blog. Thanks, Alice

Is this household able to maintain permanent housing?  Are they “ready” to be in their own place?  Will they be able to “make it”?  In my role at Virginia Supportive Housing, I hear these questions on a regular basis.  My answer is always “yes”.  I typically provide this response before I know any information about the situation and leave the individual asking me the question with a confused look on their face.  In my mind, the issue is not “is this person sustainable in permanent housing” but instead, “does our community have a housing option that meets this person’s needs?”

Communities should have an array of options for those experiencing a housing crisis including outreach, prevention, emergency and transitional shelter, and affordable rental housing, and permanent, supportive housing.  These options should be available to anyone who needs them, including those with physical disabilities and language barriers.  Most importantly, the services and programs should match the needs of the household.  Instead of blaming the person experiencing the crisis and saying “they will never make it in permanent housing” or “what did they do to get themselves here”, we should be looking at the services available in our community and asking why we do not have the capacity to meet this person’s needs.

VSH’s A Place to Start (APTS) program is a perfect example of this theory.  This program serves single individuals with an extensive history of homelessness as well as a serious mental health disorder.  By most standards, participants would not be able to “make it on their own” in permanent housing.  However, the APTS program has proven otherwise.  By matching the appropriate level of support services (in this case, intense service) to the needs of program participants, people are able to remain stable and avoid returning to homelessness.  After operating for two and a half years, this program has shown a 98% success rate.  This is for a group that most felt would not be “suitable” in permanent housing.    

This housing first approach to ending homelessness is not unique to Richmond.  According to HUD, more than 70,000 units of permanent housing as described above have been funded since 2001.  Nationwide, the number of chronically homeless individuals has decreased by a third since 2005 (dropping to 112,000).  Nationally, it is recognized that people may not “look ready for permanent housing” but they can, and will, make it in permanent housing if given the appropriate opportunity. 

In addition to being the socially just thing to do, this matching of needs with services makes fiscal sense.  The cost of homeless prevention, emergency shelters, transitional shelters, permanent supportive housing, and support services varies greatly.  It is our responsibility to ensure that the most expensive programs are utilized for those who truly need them, and to then demand outcomes that justify the expense.  In a recent article printed in the Washington Post, Dennis Culhane discusses five myths about America’s homeless.  He discusses the role of emergency shelters since the 1980’s, and stresses that shelters have become “institutionalized way stations for lots of poor people with temporary housing crises.”  He goes on to state, “To be in a shelter is to be homelessness, and the more shelters we build the more resources we divert from the only real solution to homelessness: permanent housing.” 

I have urged my staff, and I am urging you to change your frame of thinking and begin to believe that anyone and everyone is able to “make it” in permanent housing.  It is not our job to make that call.  It is, however, our job to ensure that a wide variety of options are available.

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