Free will, 'housing first' strategies not working
Former addict warns of community's biggest mistakes
Editor’s note: Richard Perkins confounds many who would put him on the spectrum of local attitudes on social issues. A former heroin addict and homeless person who later had a successful career in banking, he balances the needs of people suffering on the street with the interests of the wider community. He advises the Behavioral Health Resource Center and public officials on related issues. The following are his thoughts on homelessness and addiction.
By Richard Perkins
Most effective corrective action to homeless/behavioral health complex of problems
If we would make recovery (sobriety, social agency and self-esteem) the paramount goal of addressing homeless addicts with substance use disorder instead of harm reduction or Housing First, we can start looking for urgent ways to start the recovery process. Once the goal is clear, we can find ways to use existing infrastructure and staffing to initiate that process, which is complex and individual. The beginning, however, is detoxification from the drug one is addicted to, mostly fentanyl or meth or variations in Portland. This is true, irrespective of the demographics of the user, how they came to their addiction or the traumas they carry. It is the necessary first step, and we are failing.
Biggest mistake
We believe people with substance abuse disorder (SUD) have free will and should be allowed to make the decision when to seek detox. First, detox is a decision on the moment for an addict. It is fleeting. We don’t have enough detox facilities and if we did, we have erected too many logistical barriers to access them “on the moment.” Further, all opiate detox options I am aware of use methadone or Suboxone to deaden the withdrawal symptoms. Those drugs are themselves addictive, but don’t provide the high. There are no such drugs for meth users.
We can use the 250 unused and unstaffed beds located in five separate dorms at the Inverness Jail to initiate detox for both fentanyl and meth users through a combination of a 30-day civil commitment, criminal diversion or medically assisted detox for fentanyl users. Staffing these beds would allow up to 3,000 detox sessions a year. Using a centralized facility makes staffing more efficient and allows existing peer support staff, trained volunteers and clinical staff to visit and work with addicts during detox on a recovery plan, including post detox sober housing or reunification with family. And data collection would become possible and meaningful for measuring results.
The second biggest mistake is the belief that medically assisted withdrawal is the best path to recovery. It robs the addict of feeling the consequences of their drug addiction, the so called, “hitting bottom.”
The third big mistake is believing “jail” would be traumatizing. These homeless addicts are traumatized nightly living on the street, especially women or the LGBTQ community. These dorms bear no resemblance to a typical jail and can be easily monitored and are away from residential areas and NIMBYism.
Shelter beds
Shelter beds are a function of our devotion to housing first and the lack of affordable housing. We have been ignoring the fact that a majority of the homeless in Portland have SUD or psychosis. Unfortunately, we don’t have good data because of how we have tried to collect it. Let’s assume 50% of them (the police and outreach workers I talk with say the number is closer to 70%) have SUD, psychosis or both. If we focus on recovery for the addicts and treatment for those with psychosis, the need for shelter beds will decline dramatically and public resistance to shelters will also decline. That would allow us to redirect energies toward families and those with other short-term needs. Addicts will remain housed in sober housing with wraparound services, like Bybee Lakes Hope Center, Team Portland and Central City Concern. People leaving detox will have sobriety and a support network to get them ready to enter low-income housing.
What does compassion mean for those with behavioral health issues? How about the community overall?
Our devotion to the status quo of housing first, harm reduction and avoiding jail or civil commitment at all costs has resulted in universal pain, not individual compassion for those with behavioral health illnesses. In the face of extreme budget cuts, rising homeless populations and a historic lack of affordable housing, look at what we have done. We have left addicts addicted on the streets to be subject to more trauma every night. We have substituted Narcan, tarps and tents for detox and a chance at recovery. We have put our hospital system, which serves all of us, in severe financial stress. We have been the last of the major cities to recover from the pandemic. Businesses and high-income households are leaving Multnomah County and Oregon for lower tax environments.
Visitors are shunning Portland, reducing export income, and we are returning hotels to lenders. All of this lessens the resources we must generate to address homelessness and behavioral health.
Peacock (the progressive caucus of City Council) wants to reduce police resources while investors and banks are shunning Portland due to crime, hampering its recovery. And all the while, Multnomah County Commissioner Meghan Moyer insists that the perfect solutions for psychosis must take precedent over the good, further exacerbating Oregon’s financial woes and leaving untreated people on the streets. We have become our own worst enemy, all in the name of individual compassion.
We need to wake up. We need to deal with the reality we have, not the reality we would like to see.
Excellent, clear-headed, thoughtful, data-driven, politics-free analysis that addresses the -root causes- of homelessness. Most of our current “solutions” to homelessness are essentially circular and tautological,ie. the “cause” of homelessness -is- homelessness. Perkins’ argument breaks that cycle. He cogently argues that only by -first- tackling the root causes of most homelessness (drugs, mental illness) will we collectively stop chasing our tail and, sadly, getting nowhere.
I hope the Mayor reads this, because his current night shelter strategy is NOT working and is further harming the neighborhoods where they are located. Drug addicted homeless, when released from the shelters at 6 am, are spread across sidewalks in drug induced stupors and rage loudly and profanely as they wander throughout the neighborhoods. Streetcars are filthy and unpleasant and the chances of being verbally assaulted are good. Parks have become overrun by homeless during the day where they leaving syringes and garbage. Taxpayers are being denied their safety and use of the parks and other amenities they pay for. Making taxpayers the victims does nothing to combat the real problem of drug addiction and mental illness. Perkins is right…treat the problems first and homelessness will decline.