About 40 people in Missoula account for a disproportionately huge chunk of service calls from city police, firefighters, emergency medical responders and homeless service providers.
Those calls cost taxpayers money and drain resources for responding to other community needs.
These people, most of them homeless and of all ages and backgrounds, were identified through the use of a $50,000 Frequent User System Engagement (FUSE) planning grant awarded to the City of Missoula by the Montana Healthcare Foundation.
“The demographics of these 40 people are across the board,” said Eran Pehan, the city’s director of the Office of Housing and Community Development. “Two things that unify them all are struggles with addiction and identified mental health issues. The key piece is the mental health needs.”
The planning grant team looking for solutions consists of representatives from Providence-St. Patrick Hospital, Missoula Police Department, the Missoula County Sheriff’s Office, the Poverello Center homeless shelter, Partnership Health Center, the Missoula Urban Indian Health Center, the Missoula Fire Department, the City of Missoula and other agencies.
“These are frequent users of health care, homeless and criminal justice systems,” Pehan said. “The goal is to end the revolving door and allow public service funds to be maximized for efficiency. We’re looking at how to serve individuals who are homeless who are costing the community the highest amount.”
Amy Allison Thompson, a licensed clinical social worker and the executive director of the Poverello Center homeless shelter, said the group is looking closely at how to help these "super utilizers."
"And really understanding what that population looks like and understanding what they need to become stable and to also not be a drain economically on the community as well,” she said. “Substance abuse issues and mental health issues are at the forefront for that group.”
The FUSE grant’s model, which has been used in other places, is a way to find supportive housing for these individuals. That's been shown in study after study to lead to better health outcomes, according to Pehan.
“The combination of stable permanent housing with wraparound services will stabilize life, and that will reduce jail recidivism and reliance on emergency rooms,” she said. “Services lead to better outcomes.”
Communities around the country waste billions of dollars on uncoordinated service responses as people without housing frequently cycle among shelters, hospitals, jails and the streets, Pehan added. Writer Malcom Gladwell wrote an article in 2006 about two Nevada cops who tracked chronic inebriates and found one man had racked up a medical bill of $100,000 at a single hospital and had more medical bills than anyone else in Nevada over that time period.
“The FUSE model (originally developed by the Corporation for Supportive Housing) has been formally evaluated and shows impressive reductions in the use of expensive crisis services and greatly improves housing retention,” Pehan noted. “Over 30 communities implementing FUSE are seeing positive results. Supportive housing is an evidence-based solution that leads to better health and other good outcomes for people that are homeless and disabled.”
Pehan said the key difference between these 40 individuals and others in Missoula County who receive services is that these people require responses from all of the three main systems on a regular basis.
“They’re in and out of homeless shelters, they are often in the emergency room to have their basic needs met, and they’re in and out of jail,” she explained. “Those that interface with those three systems, health care, homeless and criminal justice, is who this group planning work is centering around.”
They’re familiar faces to the workers in those three areas, Pehan said.
“They’re known to all three,” she said. “The individuals we identified are having frequent and consistent interfaces with all three over extended periods of time. Some use services at a higher dollar level. Some may be in jail or the hospital only once a quarter, but it’s an inpatient type situation. Some folks visit the emergency room every day for diabetes management.”
The goal is to have a report on possible solutions to issue to the community by December or January.
Allison Thompson of the Poverello Center said Missoula needs so-called “wet housing” that allows people who are under the influence of alcohol to have a place to sleep at night.
“There are people who are dealing with addiction in our community and are not housed, and there isn’t anywhere for them to go,” she said. “Because the Pov is a dry facility, if somebody is under the influence they’re not able to stay here and so that doesn’t leave a lot of options at this point. It’s just a gap in services in our community and so that will just continue to be a challenge until we come up with some solutions. It’s important we have some sort of intervention for them.”
After a public outcry among Westside neighborhood residents earlier this year about problems associated with transients, the Pov's "Hot Team" outreach crew has been spending more time in areas where homeless congregate.
Allison Thompson said the Pov made a commitment to its neighbors that it would not serve those who are under the influence. The Union Gospel Mission no longer has a warming shelter for those under the influence, she said, so there are no facilities in Missoula for people addicted to drugs or alcohol to sleep at night.
Another issue Allison Thompson sees as a root cause of problems surrounding homelessness is deep budget cuts at the state level to case management.
“We see folks who were stably-housed with a case manager showing up at our door because they’ve been evicted,” she said. “And because they need that support to stay housed. It’s a huge concern for us and we’re hoping that it can somehow be remedied.”
Missoula County and the City of Missoula are taking public input on housing, infrastructure and public service priorities for the next year, which will be used when considering how to apply for and spend grants. More info can be found at http://bit.ly/2OuzxvH.