The TYP held its fifth Public Conversation at 6pm on Wednesday, August 25, 2010 at the Cansler YMCA about addiction, addiction treatment, and how both of those relate to the TYP. Mary Thom Adams, a supporter of the TYP who works in development with Positively Living Park Ridge Harbor, Knoxville’s largest dedicated permanent supportive housing facility, acted as moderator. Hilde Phipps, Director of Adult Addiction Services, Helen Ross McNabb Center, discussed the nature and effects of mental illness, treatment options provided by Helen Ross McNabb Center, and other treatment modalities available in the community. The meeting was attended by about 45 people and the conversation, once again, was respectful and extremely informative.

Notes

[These are my notes. I tried to capture as much of what was said as I could. If I've misrepresented anything here, or left out something you believe to be significant, please mention that in the comments below this post. Please tell us who you are and where you live.]

Attendees included several City Councilpersons: Vice Mayor Bob Becker, Marilyn Roddy, Nick Della Volpe and former Councilman Barbara Pelot. County Commissioner Finbarr Saunders was present, too. Ten-Year Plan staff were present as were Grant Rosenberg and Linda Rust of the County’s Grants & Community Development department. Several members of the service provider community were also present, including Volunteer Ministry Center’s Ginny Weatherstone and Gabe Cline; Helen Ross McNabb Center’s Leann Human-Hilliard; and Stacia West with Knox HMIS (Homeless Management Information System); and Steve Jenkins, Positively Living/Parkridge Harbor. My apologies if I’ve missed anyone.

The format of this meeting was one hour. The first twenty minutes were used for presentation, the second forty minutes hour was spent in open dialog.

Ms. Adams, in her role as moderator, focused this meeting’s topic on addiction and homelessness. She introduced Ms. Phipps and her topic. Ms. Phipps is the Director of Adult Addiction Services for Helen Ross McNabb Center. Ms. Adams focused the purpose of the meeting: The first half hour is reserved for presentation and the following half hour is reserved for discussion. We’ll stick to the topic: addiction and chronic homelessness.

Ms. Phipps introduced herself. She has worked for eighteen years in the field of addiction treatment and loves her work. She said “I’m here to talk about addiction in our community and the availability of resources to treat it.”

What is addiction?

Ms. Phipps defined addiction:  Addiction is a chronic progressive illness that if left untreated is fatal, but if the illness is arrested at any point in time the addict can be restored to healthy, productive living.

• Chronic means that the disease is ongoing
• Progressive means that it gets worse over time unless treatment occurs. More on this below.
• With appropriate treatment, the illness of addiction can be arrested at any time in its progression, and the addict can be restored to productive, healthy living.

Impact of addiction

Addiction is very widespread and cuts across all societal boundaries. One in every four families is effected by addiction, and the effects can be devastating. BUT there is hope and there is the very real potential for recovery. Addiction does not have to be fatal, but it is always going to be painful. The illness effects sufferers physically, mentally, emotionally, spiritually. Addiction has a profound impact on every part of life and on every kind of ability.

Why are all of these areas effected? It’s a chemical issue. Something happens in the brain that tells an addict that he or she has to have the addictive substance in order to feel normal. The substance becomes necessary to survive.

Many kinds of substances can be addictive. Alcohol is still a commonly abused and very addictive substance. Opiod addiction is more and more common now because of the ready availability of prescription pain medication. Other kinds of psychoactive drugs can become addictive.

Factors that create the opportunity for addiction

Addiction has a physical component and a psychological component.

Genes: To become an addict, as opposed to someone who simply abuses substances without becoming addicted, a person needs a genetic predisposition to addiction. For example, the grandson of an addict is five times more likely to get addicted than is a member of the general population. Ms. Phipps pointed out that it is really hard for the general public to understand this. It’s not simply an issue of self control. One in four people have this genetic predisposition to addiction.

Access: The average age of first use is 12 years of age. In other words, the average addict has access to a substance that is addictive when he or she is very young.

Amount: To cross the line that separates the addict from the non-addict, you have to ingest a certain amount of the chemical to which you are addicted. And nobody knows how much this is. It’s a biologically-determined thing that is unique for each individual. A person might be able to ingest a substance fifteen times or fifteen hundred times before he or she becomes addicted to it.  Nobody can predict where that threshold lies, and nobody wakes up and says “I think I’ll become a destructive addict today.” If we knew where the magic line was, everyone would simply stop before they got to the line. We just don’t know where that is, but by the time you cross it, it’s too late. Once a cucumber becomes a pickle, it can never again be a cucumber.

Ms. Phipps stressed that this is not a moral issue. Once the line is crossed, the relationship to the drug becomes the very most important relationship in life. The pleasure of using the substance is gone after the first couple of years. The addict will still chase that original high, but can’t catch it, and are miserable and tormented. They keep using more of the substance to try to recapture the original high. They can never get there, but they need to use more and more of the substance to try, they have to keep using the substance to feel normal, and thus the disease progresses.

Medical Detox: Duration–five to twelve days.

Residential Rehabilitation: Duration–21-28 days.

Certain substances will kill you if you try to get off without medical help. Alcohol, opioid drugs, benzodiazepines like Xanax, Halcyon, etc., are among those, and necessitate medical detox and residential rehab. These drugs aren’t inherently bad. When used properly, they’re extremely beneficial, but some people simply can’t use them without becoming addicts.

If addiction sets in very early in life, then recovery is more difficult because the addict has not developed coping skills earlier in life. Teaching daily living skills is a very important aspect of treatment. We give people chores not to punish or penalize them, but to start teaching about how to live with daily routine. Very busy and highly structured because they don’t have the ability to structure their own lives.

There is a direct correlation between the length of time in treatment and success in recovery.

Addiction sets us up for a lot of moral judgment. Part of what we do is to educate families and others who are affected by the illness. There is tremendous hope. If arrested, restoration is possible. Chemical dependency alone is stigmatized among illnesses. Most people have a choice about substance use in the beginning, but the addict loses the choice when he or she crosses the magic line.

Q: What is the connection between addiction and homelessness? Is there a connection?  Ginny Weatherstone, CEO of Volunteer Ministry Center: Let me dovetail and feed back. The ramifications of addiction are severe and they effect every area of a person’s life. I think an addiction definitely can lead to homelessness. Ms. Weatherstone asked Ms. Phipps if she would concur?  Ms. Phipps: 70% of all addicts are in the workplace, and obviously not all of them are homeless. But of course, if addiction damages a person’s ability to work, it will damage their ability to maintain a house payment or to pay rent. Ms. Weatherstone: I agree. The impact of addiction on relationships can also effect the ability of a person to remain in his or her family. When a person begins to ask how they can end the cycle of addiction, one of the answers will be the kind of treatment that they can get at Helen Ross McNabb Center. That’s why people experiencing homelessness and residents of supportive housing will be referred to their programming. Gabe Cline, VMC: The first thing I feel compelled to say about this is that by no means are all homeless people addicts.  Part of what we do from the case management perspective is to look at the whole person. If addiction is an issue for you, we’ll work to get you connected with addiction experts, like those at McNabb. But we’re also looking at mental illness, housing, and other issues and the services available to help with them. People who are experiencing both homelessness and addiction live with a level of chaos that makes it very hard to follow an addiction treatment plan, to manage all the moving parts of a very chaotic life, while they are living in the streets. My experience is that housing plays a huge and very positive role in recovery.

Q: Bob Becker: You have spoken about what addiction is and that it can be cured. What gets you back on the other side of that line, out of addiction? Ms. Phipps: The first phase is medical intervention. That’s going to take a matter of a few days. That’s treatment. The next phase is longer term residential: 21-28 days. We don’t say that an addict is “cured.” We say that an addict is “in recovery,” and that’s what we try to draw people towards. We help them gain the skills they need to do things for the first time without using the substance to which they’d been addicted. How do you face the firsts of your life without using? How do you have fun? Attend a funeral? Go to work? Those are things you learn on the way to and during recovery. We encourage participation in recovery groups such as AA and NA and others. Recovery is a lifelong commitment.

Q: Dan Brown: Oftentimes in these sessions, we’re given the example of people who are homeless because they’ve gone OFF their meds. Is there a statistic that differentiates between that and becoming addicted? Could a person come off their meds and then become addicted to another substance? Ms. Phipps: There’s a difference between drugs and medications. Drugs are being used improperly. Medication has been prescribed by a health care or behavioral care provider for a certain set of symptoms. We encourage people to use medications. I think you’re talking about people using psychotropic medications. We encourage them to stay on those, and to use them properly, as prescribed, because they’re helpful.

Q: William Donegan: I’ve thought about this a lot. The fellowship of the recovery program is key and could be emphasized at this point. Involvement in community can reduce one’s need to find an external substance to medicate pain, because community and a sense of belonging can help with that pain. Gabe Cline: Community is helpful whether we’re talking about addiction or just alienation. There’s not good community on the street. Much of what we’re doing at Jackson Apartments and Minvilla is about building good community. We want residents of these apartments to learn to engage in healthy ways with the folks they live with. We encourage involvement in Circles of Support and other constructive and healthy groups. We emphasize skills development, too, in supportive housing. Mary Thom Adams: Would most supportive housing programs do the same things you’re describing? Ms. Cline: All of the supportive housing programs that I know of are doing that. Quality of life requires people connecting with other people.

Q: Eleanore Ripley: I am a recovering alcoholic. The smell of alcohol is still a trigger for me. Say for example that a person goes to Helen Ross McNabb Center for treatment. They finish and go into supportive housing, and their neighbor might be drinking. Have you made plans to accommodate that person so that you remove that trigger? Might a wing in an apartment building have a no alcohol policy, even if the whole facility is not a “dry” facility? I don’t know how else you would ensure that that person would be protected from relapse. My father was homeless in Knoxville for years. I wish there could be some way that once they go through treatment, they would not have to worry about their neighbor having a beer. Ms. Phipps: Triggers are as individual as people, and they might seem completely unrelated to the substance. For example, the trigger for some clients is a particular song. We can’t remove every trigger from every environment, not even in a treatment setting. We can’t remove them all, but we do all we can, especially in the early, most fragile time. Mary Thom Adams: Talk about VMC’s program. Ginny Weatherstone: I concur with Eleanore. If you’re recovering from addiction you don’t need to return to your old playgrounds. Can you remove all of the triggers from a given environment? I don’t know. All I can speak of is Minvilla, and there’s one part of the building where we could maybe control for that, but that remains to be seen. Leann Human-Hilliard: I oversee some of Helen Ross McNabb Center’s housing. Ours permits no alcohol on the premises. We struggle with that internally, but for us, that is what we have made the decision to do. We’re not out looking for violations of this policy, but if it becomes a problem, we address it; it’s part of their lease. Eleanore Ripley: Are you saying that there’s no alcohol and drug use allowed on the premises in housing for the homeless? Ms. Human-Hilliard: It’s whatever the people running the housing decide and how they set up their lease. Ms. Ripley: I’ve read that it’s allowed in TYP housing. Ms. Weatherstone: The true definition of housing first does not require sobriety at move-in. What research shows is that in housing, usage goes way down and residents with addiction issues are better positioned to succeed in treatment than are people with addiction issues who remain on the streets.

Q: Is Helen Ross McNabb Center part of the TYP?  Ms. Human-Hilliard: The TYP is a document, and it is one that I can fully support. Permanent supportive housing is what we need to move towards as a community.  The way that Helen Ross McNabb Center moves towards providing that type of housing might look different than the way another provider moves towards it.  Ms. Adams: So the TYP does not lay down rules and regulations for providing supportive housing. It’s about coordinating the efforts of the different providers in the community. Jon Lawler, TYP Director: The TYP is about working with different agencies while respecting their distinctives. But the DNA of supportive housing will be the same as it expresses itself across all the agencies. Mike Dunthorn, TYP Staff: Each individual’s needs are assessed and that assessment helps to determine the best housing placement to meet the needs of the individual. Different agencies bring their own approaches to the table, and what’s best for one person might not be for another. One size does not fit all, and variety is a good thing within the basic framework of supportive housing. The TYP respects that.

To hopefully further clarify this point, I posted the following at KnoxViews on Friday, August 27. “Helen Ross McNabb Center, Peninsula, Volunteer Ministry Center, The Salvation Army, and just about every other service provider that I could name have been around a lot longer than the TYP. The TYP does not control or “regulate” these various agencies. Let me attempt to be very clear here. At its most fundamental level, the TYP exists to reorient a system that has historically focused on managing homelessness into a system focused on ending homelessness. The TYP is about helping those who work within that system to coordinate their efforts to maximize their effectiveness and to minimize cost.”

Q: Is the Flenniken project a TYP, a City or a County project?  Vice Mayor Becker: The project will be managed by VMC and there will be a lot of different funding sources involved in making it work. And, back to Dan Brown’s question–please address the question of how many are addicted when you do next public conversation.

Q: William Donegan: Will statistics be created that can be used to assess the success rates and recovery rates of people in supportive housing?  Stacia West, HMIS: We can talk a lot more about that in the next few years as we continue to input data into HMIS.

Q: In re. stats for recovery from addiction: recovery from addiction happens at a very low rate. What would be the stats for a situation like one we’re talking about here? Is there a difference between treatment for people who are homeless and people who are not? Ms. Phipps: It’s the same treatment regardless. People don’t come to treatment because they see the light, they come to treatment because they feel the heat. And it’s not what gets you through the door that determines outcome. The stuff we do is basically the same for everyone, but we know that some therapeutic modalities work better for some populations. Nationally, the addiction recovery rate is 20%. Ours at HRMC is around 60%. The longer a person is engaged in the process, the better the outcome. Everything that we can wrap around them is gonna help the outcome.

Q: Joe Minichiello: What is your position on no-barrier housing (active addiction when you enter the program)? What are their chances for success? We’re allowing people to drug and drink themselves to death in supportive housing. Ms. Adams: I think I’ve heard that question answered. The TYP is not a policy, it’s a document. There are 6-7 agencies that provide permanent supportive housing in this community. Is it possible that they might operate in different ways?  Mr. Becker: It paints the picture of diversity. Housing and recovery are not the same thing. Ms. Weatherstone: Drinking and drugging themselves to death is what happens on the street. When they don’t want to do that anymore, they make the decision to stop the suicide by street and work with a case manager and get out of that cycle. Ms. Adams: Are you saying that when a person gets into permanent supportive housing, they’ve made a decision to get out of homelessness and to seek help for their addiction, if that’s their issue? Ms. Weatherstone: Yes, at VMC that is precisely the case. Ms. Adams: I think your question has been answered, wouldn’t you agree? Mr. Minichiello: Yes.

Q: Eleanore Ripley: So, how many times do people get to cycle back through all this? Gabe Cline: We would be leaving lots of people on the street if we had one-strike and you’re out policy. You must be living by terms of lease if you want to keep your housing. There can be no illegal activity. If a person goes back to the street life, they will probably lose their housing as a natural consequence of choosing to go back to that life. From the perspective of good case management, as long as that person is still working towards recovery, I’d hate to set up a situation that they’d lose their housing just because they relapse. If they stay in it with us, we want to keep them. Ms. Human-Hilliard: We all want to allows for more of a harm-reduction model to be in place. Reducing harm over time is very helpful and effective, over time.

Next meeting

The next public conversation is scheduled to take place at the Cansler YMCA from 6-7pm on Wednesday, September 22. The topic will be Who Are the Homeless? and the presenters will be Dr. David Patterson of the UT College of Social Work and members of his staff. A lot of this conversation will focus on HMIS, the database that is so helpful in helping us to understand people experiencing homelessness in our community. We’ll follow the same basic format as usual. First half hour presentation, second half conversation about the subject.

You are respectfully invited to the TYP’s fifth public conversation meeting. It will take place at the Cansler YMCA tonight, Wednesday, August 25 from 6-7pm and will address the topic of addiction treatment in the community as that treatment relates to the TYP.

Hilde Phipps, Director of Adult Addiction Services, Helen Ross McNabb Center, will be the main presenter. She will speak for the first half hour, and that time will be followed by a moderated half hour for questions and comments.

2. Community outreach brief

The TYP seeks opportunities to engage neighborhood and civic groups in outreach activities. August has been a busy month. Here’s a brief presentation of where we were and who we spoke with.

• August 11: Mayor’s Council on Disability Issues (CODI) panel. Taped panel discussion for broadcast on CTV.
• August 12: Nucleus Knoxville. Presentation and discussion.
• August 13: North Knoxville Business Association. Panel discussion.
• August 19: Oakwood Lincoln Park Neighborhood Association. Presentation at regular meeting.

The more we can engage in informative dialog about the TYP, the better. If you know of groups who’d like to know more about the TYP, please let them know about us and/or let us know about them.

3. Upcoming News Sentinel Round Table

The Knoxville News Sentinel has invited participants to a round table discussion at the News Sentinel’s offices on August 25. This round table will focus on the TYP. Participants will include Roger Nooe, Professor (Emeritus) U.T. Knoxville College of Social Work; Bill Lyons, Sr. Director, City of Knoxville Department of Policy and Communication; Jon Lawler, Director, Ten-Year Plan to End Chronic Homelessness; Ron Peabody, leader of TYPChoice, a group that opposes the TYP; and Stephanie Matheny, leader of ProTYP, a group that advocates for the TYP. We look forward to the round table, and appreciate the News Sentinel’s interest and invitation.

Thanks

Thank you for taking the time to be engaged with the issue of homelessness and our community’s work to address it. If you have questions or concerns about anything related to the TYP, please let us know.

It did contain some information that elicited a correction from Stacia West, Research Associate with Knox HMIS (Homeless Management Information System). Ms. West’s letter to the editor was published in the subsequent edition of MetroPulse. Here’s the conclusion:

Data from KnoxHMIS indicates a decrease in the number of people entering chronic homelessness coupled with a significant increase in the number of individuals who are already experiencing chronic homelessness who are now accessing the necessary services to emerge from chronic homelessness. We consider that to be a positive outcome of the coordinated efforts of the Ten-Year Plan to End Chronic Homelessness and the many homeless service providers in the area.

Keeping track of people who are homeless in our community is extremely challenging, but with the help of vital partners like Knox HMIS, we’re gaining a better understanding of the population we’re serving. Our thanks to Knox HMIS, and also to the dozen agencies that are using HMIS as a normal part of their practice. Working together, we’re making a positive impact on chronic homelessness in our community.

MetroPulse
Frank N. Carlson wrote last week’s MetroPulse cover story about the TYP. It’s very well-crafted, thorough, and fair. We encourage you to take the time to read it and pass it on to others. Carlson’s piece focuses attention on some of the controversy surrounding the TYP, and it also serves as a good introduction to the TYP.

We appreciate MetroPulse’s timely and thorough engagement with the issue of homelessness. Wherever its readers are in their thinking about the TYP, this piece will be very informative.

News Sentinel
Last Tuesday’s News Sentinel contained an excellent editorial on the TYP. It gave a good summary of the issue of chronic homelessness, the origin of the TYP, and what it is. As we all know, chronic homelessness and the context in which it exists are extremely complex. Implementing the TYP is anything but simple.

The comments after the editorial, in which Scott Barker, Editorial Page/Community Voices Coordinator, plays an active and evenhanded role, underscore the challenge of communicating about the plan.

The piece calls for a mid-term, community-wide re-engagement with the TYP. “…if the Ten Year Plan is the best approach to getting the chronically homeless off the streets, and we remain convinced that it is, then it will stand up under scrutiny. That doesn’t mean, however, that its implementation can’t be refined if necessary. Now, halfway through the plan’s projected life, is a good time to have a community-wide discussion about this community-wide problem.”  We couldn’t agree more.

2. Flenniken: Use on Review, working group forming, meeting cancellation

Last Thursday, MPC approved Southeastern Housing Foundation’s Use on Review (UOR) request for the Flenniken Housing development by a vote of 8-4. The vote was a positive shift from last summer’s UOR denial by MPC in a 12-1 vote. We commend MPC for its focus on the land-use issue before it, and are pleased that the developer is now one critical step closer to converting a blighted property into quality apartments that will help to end chronic homelessness in our community and that will be an asset to the community surrounding them.

The TYP has held meetings with residents of the community surrounding Flenniken School since spring of 2008. The last two, held at the South Knoxville Community Center, covered a wide variety of topics, including concerns about community safety and the site plan for the Flenniken project.

We appreciate the time invested in these meetings by everyone who has attended. We have listened to the concerns of residents near Flenniken School and of individuals from other parts of Knoxville, and we have answered a lot of questions. We have learned a lot in these conversations and have hopefully communicated good information about the prospective residents of Flenniken Housing and the role that housing will play in their rebuilding their lives in the community.

At these meetings, many questions focused on the Ten-Year Plan in general.  At the same time, we have been unable to devote appropriate attention to the concerns and questions of those individuals, institutions and businesses who live and work in close proximity to Flenniken.

Therefore, for now, the TYP will cease holding general meetings on the Flenniken project; the meeting previously scheduled at the South Knoxville Community Center on Monday, August 16, was cancelled. Individuals in South Knoxville and elsewhere interested in learning about and discussing the various elements of the TYP are encouraged to attend the TYP’s citywide public conversation meetings.

Since the Flenniken project will soon become a reality, the emphasis now needs to be on building relationships among those who will be involved in and live near the apartments. To that end, Knoxville Leadership Foundation/Southeastern Housing Foundation, Flenniken’s prospective owner, is in the process of developing a working group made up of stakeholders in the Flenniken development.

The purpose of this group will be to foster good communication among the owner, key service providers, residents of the community surrounding Flenniken, and other stakeholders. The ultimate goal of the group will be to help Flenniken integrate well into the community, and to help its residents to be good neighbors in a good neighborhood. We anticipate this working group being up and running this fall. Stay tuned. We’ll keep you informed of its progress.

3. TYP speaker’s bureau developing

One way we hope to reach neighborhood groups, civic groups, service clubs and other community organizations is through a speakers bureau made up of supporters of the TYP. If you know of any such organization you would like for us to contact about speaking, would you please let us know?

Please email your suggestions to Robert Finley.

Thank you

Thank you for taking the time to be engaged with the issue of homelessness and our community’s work to address it. If you have questions or concerns about anything related to the TYP, please do not hesitate to let us know.

The difficulty of addressing homelessness is that it is not one problem. It is many problems. The primary cause may be a house fire or a bad economy or a mental health diagnosis or an addiction or low wages or a health care crisis or – the list could go on and on, which is precisely why we need a good, comprehensive, long-range plan. The Ten Year Plan is our best hope, a product of conscientious, thoughtful and compassionate leadership.

Rev. Buice points out that many, many members of our community are active contributors to our efforts to help people who experience homelessness here, but “…that caring needs a structure.” And that structure is the TYP.

Our community’s TYP is not just about placing people in supportive housing. It’s quite comprehensive and has been all along. Strategy #3 in the TYP is Increase Coordination and Effectiveness of Service. There are eight strategies in addition to this one that make up our TYP’s approach, but it is still important to recognize that the TYP exists within the context of a caring and compassionate community whose people have proven their hearts by their actions.

Frank N. Carlson wrote the story. It’s very well-crafted, thorough, and fair. We encourage you to take the time to read it and pass it on to others. Carlson’s piece focuses attention on some of the controversy surrounding the TYP, but it also serves as a good introduction to the TYP.

We appreciate MetroPulse’s timely and thorough engagement with the issue of homelessness. Wherever its readers are in their thinking about the TYP, this piece will be very informative.

The city of Knoxville, Knox County, service providers, neighborhood activists and others developed the Ten Year Plan in 2005 to address the chronically homeless. Defined as those who have been homeless longer than a year or who have had a series of homelessness episodes, the chronically homeless consume local tax dollars through incarceration and medical expenses at a higher rate than other subgroups of the overall homeless population.

The Ten Year Plan calls for stabilizing the chronically homeless by getting them into housing first, then addressing whatever underlying issues have led to their plight through coordinated social services. Many are mentally ill, substance abusers or both.

That’s a good summary, but as anyone who’s been paying attention will tell you, chronic homelessness and the context in which it exists is extremely complex. Implementing the TYP is anything but simple. The comments after the editorial, in which Scott Barker, Editorial Page/Community Voices Coordinator, plays an active and evenhanded role, underscore the challenge of communicating about the plan.

Now, halfway through the plan’s projected life, is a good time to have a community-wide discussion about this community-wide problem.

We agree and are making strides to help that conversation along. Our monthly public conversations are off to a good start. They’ve been very informative and well-attended. The fifth one is scheduled for 6pm Wednesday, August 25 at the Cansler YMCA. We’ll be discussing addiction treatment. Please plan to attend.

Knoxville City Council will hold a workshop on the TYP, focused mainly on communication, at 5pm Thursday, September 30 in the main assembly room of the City County building.

The TYP office has been working with its advisory board to shape goals and strategies for year 5 of the TYP’s implementation. These goals and strategies will drive a detailed work plan, presently in development, that will inform the day-to-day activities of the TYP office for the next year.

Goal #1: The TYP Office will focus its communications strategy to: (1) educate the citizens of Knoxville and Knox County regarding the importance and value of ending chronic homelessness; (2) foster an open communications environment with on-going dialogue between the citizens of Knoxville and Knox County and the TYP staff; and (3) build consensus and develop community champions for the TYP that will help the city, county, and TYP staff effectively achieve the plan’s objectives.

Goal #2: The original TYP to End Chronic Homelessness will be updated through a “center-out” process which will involve all community stakeholders.

Goal #3: The Ten Year Plan Office will partner with other organizations to ensure that permanent appropriate housing options are increased.

The TYP will complete this work plan and present and discuss it at the next TYP Advisory Board meeting, on September 24.

2. TYP Speakers Bureau developing

One way we hope to reach neighborhood groups, civic groups, service clubs and other community organizations is through a speakers bureau made up of supporters of the TYP. If you know of any such organization you would like for us to contact about speaking, would you please let us know?

Please email your suggestions to me or to Robert Finley.

3. Public conversation reminder; request for input on locations

You are respectfully invited, as always, to the next community conversation meeting which is scheduled at the Cansler YMCA on Wednesday, August 25 from 6-7pm and will address the topic of addiction treatment in the community as that treatment relates to the TYP.

We would also like to solicit your input on good potential locations for these important meetings. The Cansler YMCA is a wonderful venue. It’s easy to get to, the meeting room is a good size, parking is easy, the location is central enough, and the price is right (free). The people there are also very good to work with. We have, however, received feedback from more than one person that it would be nice if we could move our public conversations around the community instead of staying with one location.

We’d like to get some input from you on some other good locations for public conversations about the TYP. As much as we can, we’d like to keep them relatively close to the center of the city for the sake of convenience. We need meeting space that can accommodate 40-70 attendees, with reasonably comfortable seating. It is best if we can avoid large open spaces like gymnasiums because it’s much easier to hear in smaller rooms. Any sort of building is fine: church, office building, community center, union hall, etc. Cost is a factor—we’d like to keep it as low as possible. We can do our own setup and bring our own sound equipment.

If you have ideas, please pass them on to Robert Finley.

Thank you

Thank you for taking the time to be engaged with the issue of homelessness and our community’s work to address it. If you have questions or concerns about anything related to the TYP, please do not hesitate to let us know.

The TYP held its fourth Public Conversation at 6pm on Wednesday, July 21, 2010 at the Cansler YMCA about mental health services and the role they play in relation to the TYP. Mary Thom Adams, a supporter of the TYP who works in development with Positively Living Park Ridge Harbor, Knoxville’s largest dedicated permanent supportive housing facility, acted as moderator. Sheryl McCormick, Coordinator, Recovery Training Services at Peninsula, delivered a thorough presentation about the nature and effects of mental illness, with a primary focus on treatment options in the community . The meeting was attended by approximately 45 people and the conversation, once again, was respectful and extremely informative.

Notes

[These are my notes combined with material presented by Ms. McCormick. I tried to capture as much of what was said as I could. If I've misrepresented anything here, or left out something you believe to be significant, please mention that in the comments below this post. Please tell us who you are and where you live.]

Attendees included several City Councilpersons: Vice Mayor Bob Becker, Daniel Brown, Nick Della Volpe and former Councilman Barbara Pelot. County Commissioner Finbarr Saunders was present, too.  Also present were several members of the staff of the City’s and the County’s Community Development departments–Madeline Rogero, Director City of Knoxville Community Development; Grant Rosenberg, Director Knox County Neighborhoods and Community Development; Linda Rust, also with Knox County Community Development. Several members of the mental healthcare provider community were present. My apologies if I’ve missed anyone. The format of this meeting was one hour. The first half hour was used for presentation, the second half hour was for conversation with attendees.

Ms. Adams, in her role as moderator, focused this meeting’s topic on mental illness and chronic homelessness. She also mentioned the date and topic of the TYP’s next public conversation, which will take place at the Cansler YMCA on Wednesday, August 25, and will focus on the subject of addiction treatment. She introduced Ms. McCormick and her topic. Ms. McCormick coordinates recovery services at Peninsula. She is also a respected mental health advocate. Ms. Adams described the format of the meeting: Ms. McCormick will speak for one half hour and share a PowerPoint presentation during that time. The following half hour is reserved for discussion. We’ll stick to the topic: mental illness and chronic homelessness, and limit each question and answer in the discussion to three minutes so that everyone who wants to has the opportunity to participate.

Ms. McCormick introduced herself and said that tonight we’re going to talk about mental health services for people in permanent supportive housing. She started off with background about the nature of mental illness. [Note: Much of the following material comes from Ms. McCormick’s PowerPoint presentation and is interspersed with her remarks.]

What is mental illness?

• A mental illness is a disease that causes mild to severe disturbances in thought and/or behavior, resulting in an inability to cope with life’s ordinary demands and routines. Symptoms may include changes in mood, personality, personal habits and/or social withdrawal.
• Mental illnesses cause more disability than any other class of medical illness in America.
• Mental illness is very common and is in no way limited to people who experience homelessness. In Knox County, 106,000 of 389,327 residents (about one in four) have a diagnosable mental illness of some type.
• More than half of these have more than one mental illness.
• Co-occurring mental health and substance abuse disorders are common.
  • 52 percent of people diagnosed with alcohol abuse or dependence have also experienced a mental illness.
  • 59 percent of people with a history of other drug abuse or dependence have experienced a mental illness.
• Mental illness frequently predates substance abuse problems by a period of four to six years. Alcohol or other drugs may be used by people who don’t know they have a mental health problem as a form of self-medication to alleviate the symptoms prior to diagnosis and effective treatment.
• People with serious mental illness die 25 years earlier than the general population. Their increased morbidity and mortality are largely due to treatable medical conditions and inadequate access to medical care.
• Although certain diagnoses do have lower treatment success rates, all mental illnesses respond to treatment, especially if the person participating in treatment accepts the need for change and is actively involved in his or her own recovery.
  • Treatment for mental illness is actually more effective than treatment for cancer, diabetes, and other chronic conditions.
• In a given year, only approximately 1/3 of people in the community with mental illness will receive treatment services.
  • Some people with mental illness suffer from a disorder called anosognosia. People with anosognosia do not recognize that they are ill, and therefore do not seek treatment. Once this challenge is overcome, they too can experience recovery.

Treatment providers

Community Mental Health Agencies

• Cherokee Health Systems
• Helen Ross McNabb Center
• Peninsula- A Division of Parkwest Medical Center

Other Providers

• Lakeshore Mental Health Institute
• Child and Family Tennessee
• Mercy St. Mary’s
• Various private mental health professionals

Adult services

• Crisis services
• Mobile Crisis Unit: Crisis services are provided by MCUs when there is a perception of a crisis by an individual, family member, law enforcement, hospital staff or others. MCUs are frequently actuated by law enforcement officers and are available regardless of ability to pay. Slide 14.
• Crisis Stabilization Unit: CSUs are accessible 24/7 by telephone and/or walk-in services with face-to-face crisis service capabilities including triage, intervention, evaluation/referral for additional services/treatment, and follow-up services. Helen Ross McNabb’s Crisis Stabilization Unit provides assessment, triage, medication management, group and individual therapy, and the opportunity for clients to work with a peer specialist. CSUs are cost effective, offering up to 72 hours of intensive, 24/7 mental health treatment in a less restrictive setting than a psychiatric hospital. Funding is provided partly by the Tennessee Department of Mental Health and partly by TennCare
• Inpatient hospitalization is provided in a physically secure setting in a licensed general hospital (Mercy St. Mary’s); Psychiatric hospital (Peninsula); or state-operated psychiatric hospital (Lakeshore). Inpatient hospitalization offers a full range of diagnostic, educational, and therapeutic services with the capability for emergency life-saving medical and psychiatric interventions. Average stays are three to seven days. Admission into this level of care results from a serious or dangerous condition that requires rapid stabilization of psychiatric symptoms. This service is generally used when 24-hour medical and nursing supervision are required to provide intensive evaluation, medication, symptom stabilization, and intensive brief treatment. It has been discovered that the vast majority of people who are hospitalized don’t need to stay in the hospital for long periods of time. The usual goal is to stabilize in the hospital and then provide ongoing treatment in the community.
• Intensive Outpatient services is more intensive than traditional outpatient services; is designed to achieve short-term stabilization and resolution of immediate problem areas; is offered by a team of professionals which may include a doctor, licensed therapists, nurses, and program specialists; is a time-limited program for people working on similar issues.
• Psychiatric Assessment is a process of gathering information about and from a person within a mental health service for the purpose of making a diagnosis, the assessment is usually the first stage of a treatment process, but psychiatric assessments may also be used for various legal purposes. The assessment includes social and biographical information, direct observations, and often data from specific psychological and lab tests.
• Medication Management is a service that includes psychiatric assessment with recommendations for treatment; medication evaluation and management– prescription and review of therapeutic effects and possible side effects; laboratory services and referral(s) to other specialists; and clinical documentation in an individual’s care record. Most provider agencies offer this service. Sometimes, a person receiving this service will see his or her service provider only four times a year for fifteen minutes at a time. There is a serious emphasis on this service now because it is especially cost effective and is extremely efficacious for many people.
• Therapy is offered by many providers and are especially helpful for people who have developed maladaptive coping mechanisms over long periods of time.
  • In individual therapy the client meets face to face with a therapist to talk about the things that are bothering the client, to help clarify and put problems and issues in perspective.
  • Group therapy is a form of psychotherapy in which a small, carefully selected group of individuals meets regularly with a therapist to assist each individual in emotional growth and personal problem solving.
• PACT (Program of Assertive Community Treatment). Helen Ross McNabb Center has the only PACT in East Tennessee for adults with severe mental illnesses. PACT is designed to help people reduce or eliminate symptoms, function in the community, live independently, and reduce hospitalization. PACT provides intensive, direct care and services 365 days a year, primarily in the home and in the community, which enhances accessibility and the comfort level of clients. There is no time limit on program participation. PACT is very effective for people who are very ill.
• Continuous Treatment Teams. Adult CTT is an intensive outpatient treatment program that is comprehensive in nature. CTT offers case management, medication management, crisis intervention, advocacy and goal-oriented therapy services. CTT clients have on-call crisis services 24 hours a day, seven days a week.
• Case management is a range of services to assist and support persons receiving mental health services to develop skills to gain access to needed medical, behavioral health, and other services/ supports. Case managers assess needs, link to services, train on use of community resources, and monitor overall service delivery. Case management is intensive, relationship based care coordination for people who have ongoing support needs in areas such as housing, employment, social relationships, and community participation.
• Psychiatric rehabilitation is self directed treatment for people who want to be in recovery. It reinforces and emphasizes hope, personal responsibility, self advocacy, support and skills development. It is extremely important that people with mental illness know that they have a voice because many of them have been so beaten down and forced into silence, resignation, and hopelessness. Some people who had been hospitalized twenty times per year or more have completed a program of psychiatric rehabilitation and do not have to be hospitalized any more as a result. Psychiatric rehabilitation promotes recovery, full community integration and improved quality of life for persons who have been diagnosed with any mental health condition that seriously impairs their ability to lead meaningful lives. Psychiatric rehabilitation provides independent living and social skills training, psychological support to clients and their families, vocational rehabilitation, social support, and access to leisure activities. Psychiatric rehabilitation services are collaborative, person directed and individualized.
• Transportation is provided to covered services for TennCare enrollees with no other means of transport through contracted transportation vendors, such as ETHRA and CAC. In a crisis, transportation to a psychiatric facility may be provided by a law enforcement officer if the person is deemed to need restraint or a secure vehicle.
• Peer support is run by peers for peers. Peer support promotes recovery through one-on-one peer support sessions or through group interactions. The service may include resource sharing, recovery education, support groups, and training about how to obtain and use services and supports. Peer support is offered at no cost through Helen Ross McNabb’s Friendship House and Peninsula’s Knoxville Wellness Recovery Center. Friendship House has operated in the Fourth and Gill neighborhood for twenty years.

Recovery refers to the process in which people are able to live, work, learn, and participate fully in their communities. For some people, recovery is the ability to live a fulfilling and productive life. For others, recovery implies the reduction or complete remission of symptoms of their mental illness. Recovery is very much an individually-determined thing. Contrary to what many people believe, recovery from mental illness can be complete and often is. For example, some people with psychiatric disorders like schizophrenia, bipolar disorder, and other severe forms of mental illness have experienced recovery from their mental illness to the point that they have been able to enter challenging and rewarding professional fields such as psychiatry, engineering, the law, and others.

Stigma plays a huge role in the lives of people with mental illness. It interferes with people accessing treatment; has a profoundly negative impact on their self-esteem; shapes public policy, including funding for research, treatments, and services, and for housing, in inappropriate and damaging ways; decreases the  likelihood of a person with mental illness admitting  that he or she has a mental health problem, which interferes with their accessing the treatment they need to recover. Stigma interferes with society’s acceptance of individuals who suffer from brain illnesses through no fault of their own.

Myths. Ms. McCormick discussed myths about mental illness and related them very powerfully to her own story.

The first myth she discussed was this one: There is no hope for people with mental illness. The fact is that there are more treatments, services, and community support systems than ever before, and more are being developed. People with mental illnesses lead active, productive lives. Ms. McCormick disclosed that she is one of them. “I am in recovery from bipolar disorder,  and severe anxiety. I’ve been delusional. I’ve been self destructive. And I’ve been homeless. I was able to get treatment, education, tools and resources that helped me in recovery. I’ve had people around me to help me who helped me.”

The second myth is that people with mental illness are violent and unpredictable. Actually, the vast majority of people with mental health conditions are no more violent than anyone else. People with mental illnesses are much more likely to be the victims of crime than the perpetrators of it. You probably know someone with a mental illness and don’t even realize it.

The third myth is this: I can’t do anything for a person with with mental illness. Ms. McCormick said that you can help, starting with how you act and speak. Don’t focus on people’s disabilities. Instead, create an environment that builds on people’s strengths and promotes understanding. For example:

• Don’t label people or define them by their diagnosis.
• Learn the facts about mental illness and share them with others.
• Treat people with mental illness with respect and dignity.
• Respect the rights of people with mental illness and don’t discriminate against them when it comes to housing, employment, or education.

The fourth myth is that people who develop mental illness can never recover. The fact is that most people with mental illness get better, and many recover completely. There are now approximately a hundred  people at any given time in the hospital at Lakeshore [Note: At its highest capacity, Lakeshore, which used to be called Eastern State Mental Institute, had approximately 2,500 beds.] and another hundred at Peninsula. There are not all that many people in institutions anymore. They’re in the community, everywhere, and many of them are integrated into the community and doing quite well.

Hope! Ms. McCormick emphasized that hope plays a key role in recovery. People who live in permanent supportive housing have a very good shot at recovery because they are living living somewhere safe that provides them with a support network. She said that recovery is almost impossible when you’re stressed out and living on the street.

Ms. Adams opened up the second half of the meeting for questions and comments, asking everyone to stick to the topic and to keep their interactions to three minutes or less. She expressed her willingness to help the conversation stay on track.

Councilman Della Volpe asked how many people with mental illness in the community seek or get treatment? Ms. McCormick said that about a third of them do, and that not all of those who seek and receive treatment have a severe, persistent mental illness–it runs the gamut.

Jerry Askew asked if we have stats that show how important it is for people seeking to recover from mental illness to be in housing as opposed to living on the streets. He said that it seems like it’s more likely that treatment is more effective for people who are in housing. Mike Dunthorn answered that studies show that housing has a tremendous positive effect on the efficacy of treatment and the ability of people to recover. Housing takes a person out of the chaos of the streets and out of survival mode and provides the stability a person needs to focus on the work of recovery.

A woman mentioned that she had seen the night before this meeting a television show on schizophrenia. That show said that the largest mental health facility in the nation is the Los Angeles county jail. 30% of inmates there have some kind of mental illness. Ms. McCormick said that if you want to get definitive information about this for our community that you can contact Ben Harrington at Tennessee Department of Mental Health. Leann Human-Hilliard of Helen Ross McNabb Center said that 18-20% of inmates in the Knox County Jail are on medication for psychiatric disorders, and reiterated that Ben Harrington would know precise statistics.

A man asked if mental illness leads to homelessness, or vice versa? Ms. McCormick’s response essentially was “Yes.” If you are mentally ill, that definitely places you at much greater risk of losing your housing than if you are not mentally ill. Too, being homeless can cause post-traumatic stress disorder, anxiety, depression. The chaos, fear, danger and abuse that goes along with homelessness can trigger mental illness in anyone who is predisposed to it.

A woman asked if people are kicked out of Peninsula when their insurance runs out. Ms. McCormick said that she doesn’t know, but she does know that Peninsula provides Safety Net services. Another woman said that Cherokee Health Systems takes up slack, providing services for those who are indigent. Safety Net was created by the State legislature when TennCare was being downsized. Ms. McCormick contrasted the cost of $853 per day to be hospitalized at Lakeshore versus the cost of $750 per year to provide services in Safety Net.

Councilman Della Volpe said that lots of times people get stabilized on medication, then they quit. He asked why this happens. Ms. McCormick’s response was “Because we’re human beings.” She went on to explain that when people start to feel better they stop taking meds, or they forget to take them, or they start to think that they don’t really need the meds. Anosognosia is a factor too. This is one reason why supportive housing is so important. Case managers and peer specialists on site can recognize these kinds of things when they start to happen and get people back on track before it becomes a real problem.

Joe Minichiello asked for Ms. McCormick’s assessment of the 48 to 2 ratio of clients to case managers proposed at Flenniken Housing. Ms. McCormick said that that ratio sounds about right.

Councilman Bob Becker mentioned that people with mental illness are more likely to be victims of crime than perpetrators. He asked for Ms. McCormick to discuss that in context. Ms. McCormick said that so many of us get our identity from work, where we live, and also from the people we associate with. A person’s identity can get really messed up by being adrift in homelessness. You’re worried all the time. You don’t know who to trust. Many times, other homeless people become your support network. Most predators are just passing through, but still they’re common enough and are a source of constant worry. And of course, when you’re homeless, some things happen to you that are pretty awful. Therapy can help you recover from the damage, but it doesn’t do anything to prevent it happening in the first place.

An attendee asked Ms. McCormick to discuss moving from negative coping mechanisms to positive ones. Ms. McCormick said that people who are homeless often cope by learning to live by manipulation. They have not been taught legitimate skills that they need to live legitimately in society. Also,  the mental health system forces some people to become manipulative so they can get into the hospital—they know they need to get somewhere safe, so they learn how to work the system. Once you move out of homelessness, you’re not just surviving anymore, and you have to learn how to function in a new way. You need to be taught the appropriate skills to do that, and services like therapy, among others, help with that. It takes the right services, hard work, and time, but it’s doable. People do it all the time.

Ron Peabody asked if Peninsula is a committed provider of treatment to residents of permanent supportive housing. Ms. McCormick said that she didn’t know how to answer that question. She said that she is sure Peninsula would provide services to people in permanent supportive housing. Mr. Peabody said that these meetings are supposed to be about providers who are providing services to residents of permanent supportive housing. Ms. McCormick mentioned that Peninsula used to provide a lot of services in rural communities and that their location in Knox County is a mile from the Knox Area Transit busline. Jerry Askew suggested that relevant relationship is the one between the TYP and Peninsula, and that most people aren’t mentally ill who are chronically homeless, although some are. If we can help them get into housing, we know that they’re going to do better. We also know that in absence of housing with good case management support, bad stuff happens. People in housing are far more likely to be treated well. Dr. Osborne with Peninsula said that housing increases effectiveness of the kinds of treatment Peninsula delivers. Sometimes it takes a time, and trial and error, to find the right combination of medications and other treatment, but it’s much better to be working on that with someone who is in housing than with someone who is trying to address mental illness while they’re still living on the street.

Bob Fischer suggested that the 1:24 ratio [the case manager to client ratio proposed for Flenniken Housing] seems like a stretch. 1:10 to 1:12 seems to be the norm elsewhere. Ms. McCormick replied that there are different kinds of case managers. Ms. Human-Hilliard affirmed that, and added that  the definition of case management is very broad. When you talk about onsite case management, a lot of those ratios are very small. Some of the intensive services offered by Helen Ross McNabb have case manager to client ratios closer to 1:10. But McNabb also has programs with ratios that exceed 1:30. It really depends on the level of severity of need.  Mr. Fischer suggested that unless our community makes a commitment to provide these services over the long run, we won’t succeed. A woman in attendance suggested that in fact the  ratios proposed for Flenniken Housing are really good. She went on to point out that a person might have three or four case managers from different programs at one given time working in a collaborative way, and that that is a dynamic thing that is responsive to the needs of the person in treatment.

Madeline Rogero suggested that the purpose of tonight’s conversation is to discuss the array of services available in the community to those seeking treatment for mental health issues. She asked, “If a person needs to be at Peninsula they can go, right?” Ms. McCormick said that yes, of course they could. Ms. Rogero said that that had not been clear in the foregoing discussion. Ms. McCormick went on to say that a person in supportive housing, or any other kind of housing, really, can stay where they live and get services from any of these providers being discussed tonight.  She added that people are not in crisis all the time. Some of these client to case manager ratios are what they are because not everyone is in crisis at the same time.

Ron Peabody said that it is not accurate to believe TennCare will provide for all of these folks. He pointed out that until April 2 of this year, the Safety Net was about to be cut, and was only saved by being re-funded. He asked how the TYP can guarantee that these services will be paid for in an ongoing way. A woman in attendance mentioned that a whole lot of people with mental illness in Knox County will receive services just because they’re here, they’re indigent, and/or they get put in jail. Michael Dunthorn pointed out that helping people gain access to supportive housing does not create more mentally ill people and does not increase the burden on our service delivery systems. In fact, people in housing place much less demand on those systems and make resources go further and serve more people who need them. It’s just much more cost-effective. Grant Rosenberg mentioned that Knox County spends, right now, five million dollars per year for indigent care, and that those are all local dollars, not federal pass-through. He also said that if we can help more homeless people find housing, their use of these dollars will decrease. Right now, he said, it’s the status quo that is not sustainable.  A provider who works at Peninsula said that Peninsula takes TennCare and Medicare recipients. Cherokee Health Systems delivers care to the indigent, and our jails and emergency rooms take the overflow. In Peninsula, we can use resources much more efficiently when we’re treating people who are in housing.

Jessica Bocangel, with The Compassion Coalition’s Circles of Support, said that she has had much conversation with a psychiatrist who constantly underscores the need to for our community to focus not so much on mental illness, but to focus instead on mental health. She posed this question: “Will we we become the kind of community that encourages mental health or will we be one that talks only about our fear of the mentally ill?”

Ms. Adams closed the meeting a few minutes after 7pm. She encouraged anyone with further questions to contact the TYP office.

Next meeting

The next public conversation will be held at the Cansler YMCA from 6-7pm on Wednesday, August 25. The topic will be addiction treatment in the context of the TYP. We’ll publish more information here about that as we get closer to the date of the meeting. We’ll follow the same basic format. First half hour presentation, second half conversation about the subject.

1. Coming up this Wednesday: Public Conversation #4 — Mental healthcare services delivery. The TYP will hold its next public conversation on 6pm Wednesday, July 21 at the Cansler YMCA.

2. Reminder: Neighborhood meeting about Flenniken Housing. The TYP will dialog with residents of the neighborhoods close to the Flenniken School about safety on Thursday, July 29 at the South Knoxville Community Center.

3. In the news: Transport of people who are homeless to Knox County. The TYP’s response.

The TYP will hold its next public conversation at 6pm Wednesday, July 21 at the Cansler YMCA. The topic will be mental healthcare services in the context of permanent supportive housing. Sheryl McCormick, Coordinator, Recovery Training Services at Peninsula, will present for the first half-hour with Q & A to follow.

Ms. McCormick, as a person who has experienced homelessness and who lives a full and active life with a psychiatric disorder, brings a unique and extremely well-informed perspective to this conversation. McCormick says that recovery would not have been possible for her if she’d been warehoused or otherwise segregated. Community integration, with housing built out in the community, is critical for the success of people with mental illness.

We encourage you to attend this important conversation and to invite people you know to attend with you. This is an excellent opportunity to gain a more complete understanding of how mental healthcare services are delivered in our community and why they are such a vital component of our own Ten-Year Plan’s strategy to end chronic homelessness.

2. Reminder: Neighborhood meeting about Flenniken Housing

The TYP will dialog with residents of the neighborhoods close to the Flenniken School about safety on Thursday, July 29 at the South Knoxville Community Center.

The last time we met was on June 21. At that meeting we discussed establishing a regular meeting concerning Flenniken Housing. Attendees agreed that a monthly meeting on Monday* evening would be appropriate, and that the meeting should continue to take place at the South Knoxville Community Center. Attendees also generated a list of potential topics for those meetings. It became apparent at that time that the most significant concerns shared by Flenniken’s neighbors are related to the over-arching issue of safety, and that is what the meeting on the 29^th will be about.

*Please note that this meeting had previously been scheduled for Monday, July 19. It was changed to Thursday, July 29 at the request of a City Councilmember whose schedule did not permit attendance on the previously-scheduled date.

Again, we encourage you to attend this meeting and to invite others to join you. Safety for residents of permanent supportive housing, as well as for their neighbors, is of vital concern no matter where it’s built.

3. In the news: Transport of people who are homeless to Knox County

We spoke this week with reporters for local television stations about the recent news that officials from some counties surrounding ours have been sending people who are homeless to Knox County. We sent them the following information:

• The TYP’s reaction to news that some surrounding counties send people who are homeless who get discharged from jail to Knox County so they can obtain shelter.
  • To keep this in perspective, Knoxville is a mid-sized city situated within an area that’s historically rural. We have all kinds of resources here. That’s true of any city like ours.
  • People come to Knoxville from surrounding counties for a lot of different reasons: healthcare, jobs, educational opportunities, and more.
  • Are people who are homeless from surrounding counties going to come to Knoxville to gain access to services here? Sure. I’d probably want to do the same thing if I had no family, friends and other resources available to me if I fell into homelessness nearby.
  • Contrary to an often-repeated myth, we are not a unique magnet for homeless people from all over the country. Over 60% of the people who experience homelessness in Knox County list an address in Knox County as their last permanent address, with just under 80% having their last permanent address in Knox or one of the counties that surround Knox.
  • Our situation is very similar to most other cities of our size in our part of the country.

• The TYP’s reaction to the Sheriff’s response to learning that KCSO employees were meeting their colleagues from other counties and bringing people discharged from jails to homeless shelters in Knox County.
  • Sheriff Jones was very responsive and acted fast to resolve the situation just as soon as it came to his attention.