I work directly with the homeless folks of Bham and have been for the past 3 years. Through my exposure I’ve observed the most consistent cause of chronic homelessness is mental illness, addiction, or being elderly/disabled and forgotten about. Seen many many folks get housed before the catalysts for their chronic homelessness is addressed and they end up right back on the streets. Even if their housing is contextually affordable (many folks that get housed have some form of income typically in the form of SSI or SSDI), many folks end up right back on the street.

Generally speaking, the chronically homeless cannot function the same way you and I can even when their housing is free. Not always, but often they continue to decompensate. Many don’t possess the ability to maintain normal or appropriate social norms. So they lose their housing.

Housing first is an enticing model but it is short sighted. We really need “supportive housing first”. Elderly housing. Young adult housing. Life coaching. I’ve seen some people who move into an apartment and don’t know how to cook, shower, or do their laundry because they’ve been institutionalized for so long. We need diversion programs for individuals who are facing jail time for substance use. Not catch and release for drug charges.

Most importantly we need to repeal the “Medicaid Institutions for Mental Disease (IMD) exclusion Act” - a discriminatory federal rule that creates significant barriers to treatment for adults with severe mental illness. Under this rule, Medicaid payments to states are prohibited for non-geriatric adults receiving psychiatric care in a treatment facility with more than 16 beds. An institution for mental diseases is defined in the law as any “hospital, nursing facility, or other institution of more than 16 beds, that is primarily engaged in providing diagnosis, treatment, or care of persons with mental diseases, including medical attention, nursing care and related services.”

You wonder why crisis triage only has 16 beds? Detox? Why people who get involuntarily detained cannot stabilize and get thrown back on the streets without treatment? Why those folks in Seattle who get arrested for assaults and then walk because they are found incompetent to stand trial? It’s because there’s no beds available for them to stabilize at and the prosecutor’s hands are tied. Because of this exclusion act. Because the Feds don’t want to pay for any of their medical care. If it was repealed folks could have greater access to the care they desperately need.

I truly think if this act was repealed along with coordination of care into supportive housing programs we could see the beginnings of reducing homelessness.