The first story ran on Friday, and you can watch it here.

Click here to watch the second story.

The idea behind this series is to give viewers a window into PSH, which is such a critical part of our community’s strategy to end chronic homelessness.

What keeps a person living on the streets for years? How big a factor is mental illness? Addiction? What difference does it make to have a safe, secure place of one’s own? What about the role of case managers? How does housing with support change the life of a person who’s been on the street for long time?

Stay tuned. This series should touch on all of those questions, and more. We appreciate WBIR’s interest, and Ms. Morrow’s excellent work.

Lowe’s piece is focused on Marjorie Lopes, a woman who used to be chronically homeless and who now resides at Guy B. Love Towers, a KCDC property that houses several people who have left chronic homelessness behind and who are now succeeding in permanent housing with case management support. Marjorie’s story is moving, and Lowe tells it well.

The piece doesn’t mention Jessica Bocángel, the Mentoring Program Coordinator for the Compassion Coalition. Jessica played a key role in creating Circles of Support and helping to grow the program to its present scale. We believe this program is unique in some significant ways, and that it has the potential to move members of the faith based community in a new direction as it engages the issue of homelessness.

Circles of Support gives faith based communities (churches, synagogues, mosques, temples, etc.) a new way to get involved in ending homelessness. Each faith based community assembles a team of five mentors who are trained, and who commit to maintaining a relationship with one neighbor in permanent supportive housing for one year. Two members of the mentor team will get together to visit their neighbor each week for a specified time period. Mentor teams are trained not to proselytize, but if their neighbor wants to join them for event in their faith community, that’s certainly okay.

The emphasis in Circles of Support is on relationships instead of transactions. Relationships like the one Marjorie has with members of her mentor team have really transformed her life, as she will tell you.

Rita and I share a special love. I have changed a lot because of her and the group, and for the better. After all the hell I went through for 12-13 years, it means a lot to have somebody now.

The TYP is focused on ending homelessness. We’ve said since the beginning that homelessness is a community issue that the whole community needs to address ending it. We all acknowledge that the purpose of ending homelessness goes beyond just helping people get off the streets. It also means giving them the opportunity to build the kind of life they desire in our community. This story exemplifies that.  As Mike Dunthorn points out,

Marjorie has proven that, with a little help, someone who has spent considerable time lost out on the streets can successfully live in permanent housing. Even better, when a few everyday people offered her a welcoming embrace of friendship, her housing actually became a home. This is what ending chronic homelessness looks like.

So thanks, Jessica. And thanks to Rita and your team. And Marjorie, thank you for sharing your story.

Mental illness in jail

This piece cracks open the issue of mental illness among people who have run-ins with the law. The Knox County jail is the largest provider of mental healthcare in the County. A lot of  people in jail are mentally ill. A lot of them are homeless. Many are chronically homeless. Sheriff JJ Jones is an advocate of permanent supportive housing.

Providing the chronically homeless with supportive housing that ensures they receive consistent health care would end up saving lots of money in the long run, [Sheriff Jones] said, and would also allow society to stop treating people with health problems as criminals.

Some people believe that the Ten-Year Plan advocates for building more “homeless shelters.” Others believe that we want to simply place disabled homeless people in apartments somewhere, house them “on their own” with inadequate supervision and support. Sheriff Jones knows what we’re trying to do. Permanent housing with supportive services. That’s what we advocate. Because it works. Because it actually ends homelessness.

Neighborhood fear

We’ve said, since 2005, when the Ten-Year Plan document was first published, that we know we’ll need to build new facilities in our community to serve as permanent supportive housing.

This piece addresses some of the neighborhood response to that need. We have and will continue to open up avenues for dialogue with neighborhood representatives. Two of them have, as of December 2008, sat on our Advisory Board, and we’ve begun to develop good relationships with others. We’ll continue to do that, and our promise is to continue to develop an open and candid way of communicating with the public.

Collaboration, not competition

This article takes a look at what we consider to be one of the most important strategies for ending homelessness: agencies working together towards that common goal.

For the first time, the many local nonprofit agencies who serve the homeless are working together. Gone are the days when they competed with one another for funding and offered the same basic services to the same people, a strategy that was good at keeping the homeless alive but failed miserably when it came to giving them the kind of long-term help they needed to get on their feet. Each agency now has a designated function under the 10-Year Plan, which enables each of them to specialize in certain areas.

KNS also covered, back in November of 2008, a new program at KARM that brings agencies together in one place. That article focused on the Crossroads Welcome Center, which brings agencies together in one physical space to help people who are experiencing homelessness gain access to services and ultimately to housing.

A homeless person’s perspective: Seeking a normal life

Willie Earl Walker is the subject of this article. He’s 59, been in and out of prison, and is working to overcome his past, which has been influenced by his issues with addiction. He’s involved in programs offered at VMC’s day room. Lisa Wells, who manages the day room, gives Walker credit for being a good influence on younger people there, and she is hopeful for his future.

“With the proper case management, anybody can live anywhere,” said Wells, who encourages anyone to visit VMC and leave with a greater perspective. “People are people, no matter what situation they’re in. Nothing’s a guarantee. But as long as we have the proper people, and people willing to work with our clients, why not? Why not try to make an impact?”

What happened to the mental institution?

Dr. Clif Tennison is the main subject of this piece. Dr. Tennison says, “We closed down the hospitals and (the patients) ended up in the jails.”

Many people, when they learn that many people who are chronically homeless are mentally ill, ask why we don’t “reopen” Lakeshore. Dr. Tennison answers that question.

The policy initiative that led to the current crisis — called de-institutionalization — began in the 1960s as a response to endemic problems in mental hospitals, Tennison explained. Officials were working under the incorrect assumption that then-new drugs would cure psychoses, and they also were dealing with both skyrocketing costs and allegations of inhumane treatment. Their response was to all but shut down the system of mental asylums that housed the country’s mentally ill, a mistake that’s been compounded by subsequent budget cuts for public mental health care. In Knoxville, for instance, Lakeshore Hospital went from being a 2,000-bed asylum to a facility that today has less than 200 beds, he said.

That means we have neighbors now who suffer from mental illness. They often end up homeless. You can understand how that would happen. As Dr. Tennison points out, “You’re not wrong, you’re not evil because you’re uncomfortable around mentally ill homeless,” he said. “So are we. It’s horribly uncomfortable, and sometimes it’s scary. The only thing that’s wrong is making them feel hopeless.”

So, now what?

Bottom line: we need to change the way we think about homelessness. It’s a degrading, demeaning, destructive social ill, and what we do with it now, with the best of intentions, sometimes inadvertently serves to prolong it. We need to end homelessness as we know it, and to do that, we need to build more permanent supportive housing. We need to operate it with excellence, in appropriate locations throughout our community.

What Tennison wants is to see the joint city-county 10-Year Plan to End Chronic Homelessness implemented. If that happens, he said, the existence of hundreds of supportive housing units will give many of the most seriously ill people a chance at resuming something close to a normal life through aggressive community treatment programs. “It’s not perfect, but it’s a bigger chunk of people that you’re going to help,” he said. “We know exactly what to do. We now know how to treat them.”

That means that some disabled people who are leaving homelessness will be somebody’s neighbors. If we were into sugarcoating tough realities, we’d say that ending homelessness will be easy, and that it’s guaranteed to work every time. We’re not saying that. This is a problem that belongs to our whole community, and we’ll have to work hard to solve it.

We’re not going to sugarcoat anything about that. Here’s the straightup: most of these folks will be very good neighbors. That’s what they will be committed to being. They’ll have the support they need to help them make it happen. That’s the way it works for the majority of permanent supportive housing. Everywhere it’s done.

Thanks.

We appreciate the coverage the Sentinel is giving to issues that surround the meta-issue of homelessness. We hope you’ll take advantage of their work to bring these things into the light, that you’ll take the opportunity to understand better what’s going on and how some change could do our community a lot of good.

Mostly, we hope you’ll choose to be part of the solution, that you’ll embrace our neighbors who have chosen to leave the streets, get the help they need to become stabilized and deal responsibly with their issues, and participate as fully as they can in our community.

This project at Flenniken was to have been permanent supportive housing for people who are chronically homeless, one small part of addressing another part of a huge complex of issues.

Our focus is on one fraction of people who are homeless. The people that permanent supportive housing will help are people who have been homeless for a long time due to serious disabilities.

Disability does NOT mean they’re just bums, or that they just lack gumption or drive or people skills or that they’re simply lazy. These are people who struggle with various kinds of mental illness and substance abuse, much of the latter being due to their attempts to self-medicate for their mental illness.

These are also people who who have decided to leave homelessness. They need help. They know they need help. A lot of help.

And we should give it to them. Why?

Simple economics, for one thing. It costs less money to give them this help than it does to keep on doing what we’re doing now. It costs less to place these folks in a safe, secure, permanent environment and supply them with social services than it costs to leave them on the street where they’ll cycle through jail, rehab, the emergency room, and the streets on a perpetual, costly treadmill.

Those of you who are talking about your tax dollars being wasted are right. The way we do things right now is a waste of your tax dollars. You’re spending about $40,000 per year, right now, to keep a chronically homeless person on the street. Jail is no place to house people who are mentally ill, but that’s what it’s become, and you’re paying for it. Emergency rooms are no place to go for primary care at an average of around a thousand bucks a pop, but that’s where chronically homeless people go. You’re paying for that too. The list goes on, and it doesn’t do anything to end homelessness.

That’s the status quo: your tax dollars at work. Who wants to keep doing things that way?

Permanent supportive housing changes things for chronically homeless people. It ends their homelessness. It’s being done in other cities on a large scale, and it’s demonstrated by ample evidence to be cost effective. It also, not surprisingly at all, reduces the number of people you see hanging out in the streets in those cities.

Our office is not going to solve all the ills of the streets. We’re here to help this community tackle the issue of chronic homelessness, and that’s enough of a challenge all by itself. If we can meet it, we’ll end up saving public funds because chronically homeless people on the streets consume so many resources. We’ll make our city a better place to live. And we’ll give some of our most vulnerable neighbors their best opportunity to become healthy members of our community.

I said these things because, as you can see for yourself, some of the comments on this story got a little bit away from what we were actually trying to accomplish at Flenniken. I wanted to make at least an attempt to bring them back to the issue of what we’re actually trying to do: end chronic homelessness.

One commenter said

If they where from here, then we should help. Most are from other states (95%).

To which I replied

This statement is false.

Actually, when the last survey was completed in 2006, over half were Tennesseans. That’s been very consistent as long as this issue’s been studied here.

You’re repeating a little urban myth that’s common everywhere there are people who are homeless.

We hear this kind of assertion all the time. Even if it were true, it seems to me that it’d be irrelevant. To paraphrase a famous and obviously successful campaign meme of relatively recent vintage, “It’s about the economics, stupid.”

It doesn’t really matter where people who are chronically homeless come from. If they wash up on our shores, and start camping on our beach, they’re still going to cost us forty-thousand bucks per person per year to maintain them the way we do it now. Although maybe they should, the jail and the emergency rooms and the rehab programs and the ambulances don’t give us a discount just because people who are homeless in our community are born inside the boundaries of Knox County.

Anyway, we’ve got some thinking to do about how we’re thinking. I get the sense that many people are so frustrated with the issues of homelessness and panhandling and perceived increases in crime and violence and the obviously negative impact these things make on the livability of some parts of our community that they lump all of these problems together into a big emotional ember they carry around in their bellies. It feels like “a problem” when really it’s a whole system malfunction.

We can change the ways we think about this system. It’s not a problem to be solved by one agency or another. It’s a complex system that must be addressed in a different way, a much more holistic way, by our whole community–private citizens, faith-based organizations, service providers, law enforcement and other government types alike.

Meanwhile, dragonboaters have raised $77,000 for KARM. You can read about that here.

Hmmm. Maybe the TYP needs its own fundraiser. Perhaps an MSA-wide scavenger hunt…

Haynes acknowledges that panhandlers and homeless people are not necessarily the same. That’s true. He also concludes that if you give money to panhandlers, then you’re keeping the institution of panhandling happy and growing. Which is not something anybody but panhandlers wants to see happening.

So. Is “Just say no!” an outmoded, oversimplified response? Not necessarily. People in our community seem to be pretty big-hearted, generous people. We do encourage you to think before you give. That doesn’t mean you need an elaborate plan, but if you are led to offer financial support to homeless service providers, by all means do so.

And when a panhandler approaches you, you really can say “no” to a request for money. You can point them towards Knox Area Rescue Ministries, for instance, in the knowledge that the person you’re talking to will be able to find essential help there.

The Parkway’s efficiency units were to have provided permanent supportive housing for formerly chronically homeless people. Every resident would have paid rent, and every resident would have been intensively case-managed. Most importantly, every resident would have been off the street and in their own homes.

Permanent supportive housing is demonstrated to save cost. Right now, it costs our community something in the neighborhood of $40,000 per year to maintain a chronically homeless person on the street. When those folks move into permanent supportive housing, the costs to the community fall dramatically. Increasing numbers of studies back that up. Here’s a link to one from Portland, Maine.

The Parkway, located at 3701 Chapman Highway, is very suitable for permanent supportive housing. Prior to its closing, it had historically been used as low-income housing; it’s located close to multiple, appropriate employment opportunities; and its proximity to service providers and bus lines makes its location excellent.

The Ten-Year Plan office was working with a nonprofit developer of low-income housing to pursue funding from the Tennessee Housing Development Agency and the Federal Home Loan Bank. No local funds were anticipated in the budget for this rehabilitation of the Parkway, but timing was critical. THDA’s application deadline for Low-Income Housing Tax Credits is March 19. The Parkway deal broke down at the acquisition stage.

Permanent supportive housing is provided in low-income rental housing and is an essential component of the Ten-Year Plan to End Chronic Homelessness. Knoxville faces a shortage of low-income rental housing. The Ten-Year Plan will continue to work hard to change that situation, so that we can move chronically homeless people off the streets and into homes of their own.

As Mayor Haslam mentions in the article, many chronically homeless people are mentally ill and became homeless after discharge from mental health facilities. These people don’t have family capable of meeting their needs, and they don’t have anywhere else to go, so they are effectively discharged into the streets.

Think about it this way. Those homeless folks you see, over and over, when you go downtown? A lot of them would have been institutionalized 30 or 40 years ago. They’re not institutionalized anymore. The State has been reducing its institutional capacity since the 1970s. Most of the severely mentally-ill live among us now. A lot of them live on the street.

It costs us a lot to support a chronically-homeless person. We spend an average of about $40,000 per year to do that, not including food and emergency shelter. Click here to learn more about estimated costs in Knoxville. When chronically homeless individuals gain access to permanent supportive housing, this cost declines dramatically. Click here to learn more about that. The cost discussion is about halfway down the page, but all of it’s worth reading.

There’s a shortage of affordable rental housing in Knoxville, and we need more of it to house chronically homeless people. “Affordable” means rental housing that costs up to 30% of the income of a renter who makes at or below 80% of the Area Median Income (AMI). For chronically homeless people, we need to be even more affordable than that: up to 30% of an income that is at or below 50% of AMI.

One thing we’ll be working very hard on over the next several years is building more affordable rental housing. That’s where permanent supportive housing happens. There is money available from outside the local community to build and operate affordable housing. It comes in the form of grants and loans from agencies like HUD, the FHLB, and THDA. The monies that come from those agencies originate with the Federal government.

Why do we need help from the state budget, then? Mostly we need it to help us provide supportive services.

Remember, chronically homeless people are disabled, by definition. Many of them are disabled specifically by mental illness and addiction. They will not succeed in housing by themselves. They need to maintain a strong relationship to a case manager who works to connect them with other appropriate supportive services.

That’s part of the reason Mayor Haslam is asking the State for help. We would like the State to invest along with us in delivering solid case management and other supportive services to people in Permanent Supportive Housing. The Mayor and his colleagues are asking the State to invest specifically in ending chronic homelessness in our local communities.

Good question. It’s very hard to nail down an airtight answer. This year, Dr. Roger Nooe will be refining the data below. Until then, the following data, from 2006, are the latest local data.

Dr. Nooe’s work is posted here with his permission.

Local Cost Estimates (Knoxville, Tennessee)

A Study by Dr. Roger Nooe

Professor Emeritus: University of Tennessee College of Social Work

A number of national studies have documented that a homeless individual, suffering from mental illness and substance abuse will consume an average of approximately $44,000.00 annually in public services—jail, emergency room, and other community expenditures.

A local, one-year examination of twenty-five (25) homeless individuals in Knoxville, Tennessee, illuminates the cost of repeated cycling through jail, detox, hospitalization and homelessness.

The twenty-five individuals reported

• 20 instances of inpatient hospitalization (20 x a minimum one-day x $1,500.00 = $30,000.00)
• 14 instances of psychiatric hospitalization (14 x 3 days x $843.00 = $35,406.00)
• 85 admissions for detox (85 x 5 days x $500 = $212,500.00)
• 141 arrests for public intoxication (141 x $500 = $70,500.00)
• 2,551 days in jail (2,551 x $197.00 = $502,547.00).

These conservative estimates suggest that jail and hospitalization costs total approximately $850,953.00 for the twenty-five individuals examined locally.

Additionally, ten (10) of the twenty-five reported that they used emergency rooms for primary health care, (10 x $1,000.00 per visit = $10,000.00). Assuming that a third of the arrests for public inebriation required transportation to an emergency room (47 x $450.00 = $21,150.00) and a period of observation (47 x $1,000.00 = $47,000.00), the cost increases.

Thus, twenty-five individuals repeatedly cycling through jail, detox and hospitalization will incur costs of approximately $929,103.00 in one year.

These estimates are conservative. For example, they use an average of one emergency room visit with only one-third being transported by ambulance, without overnight hospitalization. Likewise, the cost of shelter is not is not included in this brief examination. Nonetheless, the fact that these 25 individuals consume approximately $929,103.00 in public service cost in just one year underscores the need to break the inefficient, costly cycle that presently characterizes the way our system addresses the issue of homelessness.

That’s Gary Waddell, in an interview with Yvette Martinez of WBIR that ran last night. Gary used to be homeless, but has been off the streets now for just over a year.

Read the whole thing, and watch the video too. It’s very cool. Encouraging, too.

Kudos to WBIR, and to the service providers like VMC, KARM, the Salvation Army, and many others who are on the front lines of implementing Housing First.

Props to Gary, too.