MANCHESTER, NH – In an effort to address the city’s growing population of unsheltered people living in makeshift campsites, a homeless outreach team of clinicians, firemen, social workers and mobile mental health specialists was assembled two months ago, with members hailing from charitable organizations, the community mental health center, city employees and more.
Officials say the beefed-up outreach has meant more manpower with diverse expertise, enabling them to engage with the homeless on a daily basis, collect useful data, build trust and connect them to healthcare and housing resources like never before.
But they say the funding for that project, siphoned from various one-time grants, is due to run out in a matter of months.
Patricia Carty, the chief operating officer of the Mental Health Center of Greater Manchester, said the center had a few homeless outreach people prior to the newly assembled team, but they’ve since learned how much more effective they can be by teaming up with other organizations like Families in Transition – New Horizons and the Manchester Fire Department.
“I think that we learned a lot about the collaboration and the leveraging of our resources collectively can lead to better outcomes. We’ve really learned that,” Carty said.
Manchester Fire Chief Dan Goonan first reached out to the Mental Health Center on May 6, saying he had secured some emergency funds to dedicate two firemen to an outreach team on a daily basis from noon to 8 p.m., according to Carty. Over the next 36 hours, Carty worked to supplement the team with their own homeless outreach worker and a clinician from the mobile crisis unit.
Goonan said one of the biggest issues facing the homeless population is mental health.
“We know this population pretty well from operating the Safe Station program,” Goonan said.
The team also opened a line of communication with the separate Healthcare for the Homeless team operated by Catholic Medical Center, which provided physical health needs.
Having people out there in the camps every day made a big difference, Carty said.
“From a standpoint of intervention it’s just not as easy as offering the service. It’s much more complicated,” she said.
She said consistency, repeat engagements with the same individuals and being present to discover problems in real time go a long way toward getting homeless individuals to take social workers up on their offer to help, whether that means housing supports, medical care or mental health treatment.
“It’s not overnight. It takes a lot of engagement, it takes a lot of trust-building,” Carty said.
How it worked
In the initial months of the COVID-19 pandemic, homeless people were afraid to go to shelters, which had limited capacity to ensure social distancing. So the outreach team worked with the city to set up a number of supports at four large makeshift encampments that had organically grown, including portable toilets, food delivery, handwashing stations, fencing, trash pick up and police details, funded by the state.
As of July 1, they counted 173 unique homeless individuals and identified 31 camps across the city, according to the census compiled by the team.
The team encountered 38 individuals who were suspected of alcohol or substance misuse, 10 were treated for a visible or reported injury, eight were hospitalized and 16 applied for Medicaid, food stamps or other public welfare programs as a result of the outreach. In some cases, mobile phones were given to those who didn’t have any so they could access telemedicine or remote therapy services, Carty said.
Seventeen people expressed an interest in mental health services, 14 were interested in substance use disorder treatment, and 40 people declined services.
Carty said the internal Mental Health Center team members huddle every Friday to plan out the weekend, and the larger team of collaborators get together every Wednesday to discuss next steps and what they need to accomplish.
“I certainly think that this approach is much more effective than what we’ve been doing,” said Ken Norton, executive director of the National Alliance on Mental Illness of New Hampshire.
Norton said despite some smaller outreach efforts, he thinks that society in general tends to ignore homeless people and push them to the fringes. But the COVID-19 crisis forced communities to do better because of the immediate public health needs.
“The push this time was about medical concern, relative to COVID,” Norton said. “But I think it’s worked pretty well.”
In one case, Carty said outreach members heard a cry from a woman who had fallen down an embankment in the Valley Street Cemetery area and was badly injured. If the team hadn’t been out there, Carty said there’s no saying how long the woman might have been out there suffering.
Moving to shelters
Recently, the city initiated a push to get people out of the camps and into shelters, supportive housing or residential treatment for mental health or substance abuse.
Some camps were dismantled, hand washing stations and porta-potties were moved, and the outreach team worked to convince people that the shelters were safer now. As of this week, the view of the most visible makeshift encampment underneath the Amoskeag Bridge appears to be unchanged except for the absence of the temporary sanitation equipment and a police cruiser, which had been stationed next to the bridge 24/7.
In anticipation of the shift of services away from the camps, the outreach team started their referral process in late May. They were able to call and reserve a bed for individuals. Nearly 50 people were referred to a shelter, and Carty estimates about 20 to 25 transitioned from a camp to either a shelter or some other form of housing, as of July 1.
The whereabouts of about 130 homeless people are known by the outreach team but about 40 who have left the camps haven’t been seen by the team in over two weeks.
Finding the money
In the long term, the solution to homelessness is economical in nature, according to Bill Rider, president of the Mental Health Center of Greater Manchester. Mental health treatment alone will not stem the tide.
“The primary driver, hands down, of homelessness, are economic factors,” Rider said. “Homelessness is a driver of addiction and mental illness, rather than the other way around.”
The lack of affordable housing doesn’t appear to be a problem with an immediate solution. But until more housing becomes available, mental health supports and continuing outreach in the field will be critical components in battling homelessness in the short-term, Rider said.
Unfortunately, the funding used to boost that outreach is temporary.
“The sand is slipping through the hourglass as we anticipate the money running out,” Rider said.
With the help of Granite United Way, he said about $112,000 was added to their existing contract with the state to provide mobile crisis service in the Queen City, which came from federal State Opioid Response grants.
That extra money isn’t expected to last beyond September.
Goonan said the fire department has been using about $80,000 from a U.S. Department of Justice grant for its COVID-19 infection control response to set aside two firefighters for an eight-hour shift seven days a week.
He said if they continued using the money at this rate, it would likely run out by the end of July. But an additional influx of federal CARES Act money dispersed by the state to the tune of about $265,000 for two years is being used to create a separate “community response team” which will have an overlapping mission of community outreach to the homeless, substance use disorder and recovery populations.
Goonan said they just launched that team a few weeks ago. The idea was originally to create a sort of mobile Safe Station program, partnering with the CMC-led Doorway program, the city health department and the Mental Health Center.
“They trust the fire department. It’s kind of a natural fit,” Goonan said. “I’m kind of excited to see what can come of this.”
Now that there’s interest among the partnering organizations in maintaining the homeless outreach team, Goonan said he thinks he will be able to stretch out the DOJ money to carry them to the fall by reducing the coverage to about three or four days a week, and fill in the remaining days with the community response unit.
After that, the outreach coverage from the fire department will likely shrink.
“This is not our traditional role but we’re welcoming it and I think it will help the community in the long run,” Goonan said.
Replicating the model
While collaborators in Manchester want to find new funding sources to continue the enhanced outreach model, mental health experts say it is something that could be replicated elsewhere in the state, especially as record unemployment and other economic woes caused by the pandemic are likely to exacerbate homelessness in the region.
“I think we all intuitively know there are going to be more needs in this space than less,” said Roland Lamy, the executive director of the NH Community Behavioral Health Association.
Right now, he said most of the state’s 10 community mental health centers have a designated homeless outreach specialist, who work as field caseworkers going to camps, into the woods, wherever homeless people can be found in their community to tell them about the resources available to them or try to enroll them in Medicaid.
But having greater manpower and pooling resources from other organizations like Manchester is doing can have a much greater impact, he said.
“It would be great if we could do that everywhere, but the funding gets stretched,” Lamy said.
He said it makes more sense to focus resources on the state’s urban areas like Manchester, Nashua, Concord or Portsmouth, given the existing resources and population base. And service providers are already hiring from a limited labor pool. Finding the talent to serve homeless people in rural communities may be impossible, Lamy said.
Enhancing homeless outreach in places beyond the Queen City may also lessen the burden there. Most of the homeless people the city is trying to help right now are from elsewhere.
According to the census the outreach team took, only 38 percent of the individuals they counted called Manchester their hometown.
Norton said the enhanced outreach model is more humane and it might be more effective.
“It’s probably too early to tell but I would think that the outcomes are better,” Norton said.
Norton would like to see a statewide mobile crisis unit. Right now, only Manchester, Nashua and Concord have mobile teams deployed for mental health crises in the communities as a result of a class action settlement.
Why it’s needed
Lamy said doing a better job at helping the homeless is not just a moral imperative, it saves taxpayers money and strengthens the economy in the long run.
“Caring for our community means caring for all the people in our community,” Lamy said. “There are a lot of downstream costs to ignoring this population.”
He said ignoring the problem results in more spending by police and fire departments and more emergency room care in hospitals. And leaving physical and mental illnesses untreated for too long, Lamy said, results in more expensive treatments down the road. All that makes healthcare more expensive for the rest of the community, he said.
“Those costs come out in other aspects of our healthcare system,” Lamy said.
And Rider said the immediate impetus for the expanded outreach, the COVID-19 pandemic, is still an ongoing concern.
“If we properly take care of each other, we can hopefully stem the effects of the virus. And that means taking care of the homeless people as well,” Rider said. “Your community is only as strong as the weakest links.”
Contact reporter Ryan Lessard at firstname.lastname@example.org