A new study confirms what experts have been saying all along, encampment sweeps can have detrimental outcomes for people experiencing homelessness who inject drugs and are already more susceptible to overdose deaths.
The research was published on April 10, 2023, and conducted by a multidisciplinary group of researchers including experts from the National Health Care for the Homeless Council (NHCHC), which is headquartered in Nashville.
The bottom line is that encampment sweeps, move-along orders and encampment bans that result in continual involuntary displacement have negative health impacts on people injecting drugs and could contribute to deaths. No scenario the researchers looked at in their simulation modeling study found a neutral impact or improved health outcomes for the population due to encampment sweeps.
On the contrary, the models showed significant increase in morbidity, mortality, and a shortened life expectancy. The following information is lifted from the NHCHC press release, which showed:
151% increase in overdose mortality;
11% reduction in life expectancy;
50% increase in hospitalizations;
6% increase in serious injection related infections (SIRI) mortality; and
38% decrease in Medication for Opiate Use Disorder (MOUD) initiations.
We already know that the life expectancy for people experiencing homelessness is significantly reduced, by 15-20 years, compared to the housed population. Therefore, housing is healthcare.
We hear this mantra over and over. Yet, when it comes to focusing on homelessness, politicians nationwide still want to find a silver bullet — or band aid — approach.
They overlook that the band aid is not sticking any longer. It’s been overused and resources would be better spent on actual solutions.
If sweeping encampments and forced closures would solve homelessness, we simply would not have a homelessness issue across the nation. And here is yet another study telling us the same thing for a specific subpopulation.
What we need to address the homelessness crisis and the opioid/drug crisis that also affects a percentage of people experiencing homelessness is to offer services, implement harm reduction, and work on reducing overall outdoor homelessness by offering people options that lead to non-time limited housing with wraparound services and access to medical care. (And be careful as you read this. We want to avoid stereotyping people more than we are already prone to do because not everyone who experiences homelessness is suffering from a substance use issue).
With so much focus on encampment closures in Nashville, which currently comes with a roughly $50 million investment, it is important that our local politicians pay attention — especially those on the Metro Council’s Homelessness Oversight Committee.
We have a chance here in Nashville to do this right and use the $50 million wisely with a long-term objective in mind.
I agree with the NHCHC press release that outlines what the focus of cities should be:
Stop sweeps.
Fund Housing.
Provide Supportive Services.
Prevent Criminalization.
Be Trustworthy.
On the surface, it looks like Metro is following that advice. But if you scratch the surface, the current approach becomes vulnerable to criticism. Unfortunately, it seems Metro has also taken to intimidation tactics of critical voices that want to improve the city’s tactics. I’ve been made aware of multiple occasions where Metro staff has attempted (and in some situations succeeded) to shut local experts up by either approaching supervisors of nonprofit staff to ask them to silence dissent from their staff, or otherwise reminding executive leaders that their nonprofits receive city contracts. I’ve heard of more than half a dozen such scenarios.
Several city administrations, including the Cooper administration, generally have tried to avoid sweeps without adequate notice, and if closures happened the city made some efforts to link people to support services, shelters, and in some situations even permanent supportive housing, which often does not work due to tight timelines. The reality though is that Metro Police officers have a lot of leeway in encampment closures, especially when it comes to small encampments, and often police don’t have much of a choice when private property owners request assistance with removals.
Furthermore, the state has systematically closed encampments on state property and is likely to increase that approach. We probably could call this an expected side effect of the current city policy that is focused on rushing encampment closures.
For Metro, it has become more important to meet encampment closure dates than to engage in a harm-reduction approach. City leaders are too focused on those quick wins, which are just that, quick and lacking the serious investment in low-income and subsidized supportive housing.
Housing ends homelessness. Support services help people maintain housing. And health care is most effective when people are in housing.
The new study also is clear that support services and healthcare need to start wherever people are and continue as people move into housing.
“Do not force people to relocate or mandate services,” the NHCHC press release states. “Provide supplies to maintain a healthy environment and offer to keep copies of vital information in case they are destroyed. Importantly, use harm reduction interventions to limit overdose mortality, including Medication Assisted Treatment (MAT), ensure naloxone is available and [offer] syringe exchange services.”
Another key element that cannot be overemphasized is the importance of building trust. To do so, people in encampments should be involved in the decision-making process. I am not talking about Metro officials and politicians visiting with people prior to an encampment closure and talking to folks who have a deadline looming over their heads before they are forced to gather their belongings and either be lucky to be assigned to a temporary housing location or — if not so lucky — receive a bus pass to a mass shelter (where they of course never show up and instead move to another encampment).
I am all for a well thought-out plan that includes interim housing options in addition to permanent supportive housing. After all, I helped craft some of the temporary housing models Metro is using. I just never thought the current administration would use those options to prioritize individual encampment closures based on politics rather than focus on an overall outdoor housing plan that works with and for people in encampments.
Temporary housing is not permanent supportive housing. Those places should be among the options for people to move out of encampments quickly and be a place to work on their housing searches. Rather, they have become locations to move encampments indoors, so that the Metro-imposed deadlines can be kept. Furthermore, Metro has rushed to open more temporary beds without allowing for the proper training of staff. What is more, there is clearly a lack of options for people to move out of encampments into permanent supportive housing directly, which would be part of a solid Housing-First-oriented plan.
The $9-million support services contracts, which are part of the $50 million American Rescue Plan allocations, are still not in place. And the Metro Council’s Homelessness Oversight Committee so far has served as a cheerleader club rather than an accountability body as they only seek reports from the administration and the Mayor’s Office consultant, who is contracted for $730,000 over two years. This body would be better served by seeking input from the different local homelessness services organizations involved who have built long-standing relationships with the people in encampments and who have been collaborating closely for years. This group of local providers has a track record of focusing on chronic homelessness and most recently coordinated efforts to house more than 600 people from outdoor situations during the pandemic.
This resulted in Nashville being able to keep its overall homelessness population steady even though the city did not listen to local experts to invest in permanent housing opportunities that were one-time opportunities through COVID dollars. We missed out on those chances to house more people.
What will happen next? I dare predict that the Mayor’s Office will revert to its standard and proven approach of bringing in national experts to parade them in front of policymakers and validate their focus on forced encampment closures to counteract the latest study findings. The language that the administration uses has been right. The national experts who are flown in are unfamiliar with the actual implementation, which has been rushed, ill-planned, and is certainly not focused on harm-reduction — a key approach to successfully housing people experiencing chronic homelessness when they have a substance use issue (see my column in the previous issue).
What could be done to immediately improve the current Metro approach?
Metro needs to move from an encampment closure plan to an actual outdoor homelessness plan that is not focused merely on messaging but actually works to move people into housing based on a solid Housing First approach that is person-centered and uses an equitable approach. Metro needs to increase its transparency. The Metro Council needs to turn its Oversight Committee into a real accountability body, calling on local experts familiar with the implementation and guaranteeing that no one who speaks up is intimidated by Metro employees.