by Miasmin Andre
The Low Barrier Approach
In just one year, Seattle’s homeless population has grown by over 900 people, according to a count done across the Seattle/King County area in January 2017.
There are currently 11,643 individuals in Seattle living with no home.
One person who has first-hand experience with Seattle’s homeless epidemic is Eric Seitz.
At 15 years-old, Eric Seitz left his family’s home on the Eastside of King County and began living on the streets of Seattle, Portland, and cities in between. At the same age, he started to abuse hard drugs.
“One hundred percent of my energy went towards using,” Seitz said. “I’d get up every morning and hustle, mostly through petty theft, to get money for drugs.”
It was not until 8 years later that Seitz received a wake-up call. In 2008, he was diagnosed with necrotizing fasciitis, a flesh-eating bacteria disease common among those who inject heroin. For four months, Seitz lived in a Seattle hospital while recovering.
The treatment he received at the hospital inspired him to get involved with homeless advocacy and public health in Seattle. After rehabilitation and physical therapy, Seitz achieved sobriety and lived with his brother while attending nursing school.
Now a registered nurse, Seitz works for a Seattle organization that aims to provide healthcare to low income, uninsured, and homeless individuals. Seitz asked that the specific name of the organization not be mentioned for confidentiality reasons.
Through his personal experience and work, Seitz has become a supporter of “low-barrier services,” seeing the importance of providing quality housing and healthcare to get homeless people back on their feet.
Essentially, low barrier services are shelters that minimize the number of rules people must follow to stay at the facilities. For example, individuals with pets, spouses, many belongings, or substance abuse disorders may be banned from shelters that do not follow the low barrier model, according to Bradford Gerber, the essential needs coordinator at the Low Income Housing Institute (LIHI) in Seattle. With low barrier services, though, more people are able to access temporary shelter because there are fewer shelter requirements.
These locations follow what scholars call the “housing first model,” which means that the facilities’ primary goal is to get individuals into housing, even before taking on any behavioral or substance abuse issues.
Currently, many shelters in the greater Seattle area do not follow the housing first or low barrier approaches. Instead, they are “zero tolerance” sites, where individuals are turned away from facilities if they are using or under the influence. Because of these barriers, certain shelters “can’t serve a portion of Seattle’s population,” said Gerber.
Although this option may look attractive in the short run, it does not help individuals work through their addictive behavior, according to Seitz.
In the long run, the housing first approach puts individuals in a better position to treat addiction and find permanent housing, according to Sharon Lee, executive director of LIHI.
Currently, LIHI is working to bring the housing first model to the streets of Seattle with the Licton Springs Tiny House Village. This site provides temporary, transitional housing to the city’s growing homeless population. It is the first of six tiny house villages to be deemed a low-barrier site.
The Broader Social Issue
Additionally, in just one evening, 817 individuals struggled with alcohol or substance abuse, according to a 24-hour count done by the Seattle/King County Coalition on Homelessness in 2016.
“The majority of people do use something, whether that is alcohol or other drugs,” said Seitz. “It’s a survival response. They get on the streets and are exposed to people who are just trying to be okay.”
The substance abuse problem is not limited to the Seattle area. Approximately 202,297 homeless individuals in the United States suffered from substance abuse disorders or other forms of mental illness in 2016, according to a study done by the Department of Human and Urban Development. Such numbers indicate a larger social problem across the country.
Despite the widespread substance abuse problem within homeless populations, not all homeless services are drug-friendly. In fact, it is common to see homeless individuals turned away from shelters or temporarily banned and punished if caught using on site, according to Gerber.
However, the Licton Springs Village avoids exclusion, taking a new approach to recovery. Following the housing-first model, the small lot off Aurora hosts 28 tiny houses, all providing shelter regardless of substance use or abuse status.
“The goal is to establish relationships of trust over time with folks who’ve been in crisis outdoor situations,” said Lee. “Housing first works because a stabilized life gives you a chance. People with shelter have better outcomes than people with none.”
In addition to providing basic shelter, LIHI partners with various sobering centers and other treatment programs in Seattle to help residents transition healthily, according to Lee.
Physical health and shelter issues are not the only hardships people without permanent shelter encounter. Those struggling with homelessness and drug addiction also face heavy social stigma from outsiders and even from those living in the shelters.
“If I was needing money, I would ask for spare change at the Dick’s on Broadway and I was mostly ignored,” said Seitz. “It wears at your spirit, but drugs are good at getting you to ignore your emotions.”
Zero-tolerance shelters can also add to this stigma by shaming people for drug use, according to Seitz. Both authority figures and residents living in these communities are much less tolerant of rule-breaking. If residents are caught using, they are often ostracized by both groups and punished rather than given access to treatment services, according to Seitz.
“Sober camps can have more issues with getting people in house and much more drama and stigma when people do get in trouble,” said Seitz.
Instead of homeless shaming, individuals should be working to widen access to healthcare, addiction treatment, and sustainable housing, according to Rick Reynolds, executive director of Operation Nightwatch in Seattle. “Fixing the healthcare in this country could go a long way towards fixing so many of these social problems,” he said.
In short, workers at LIHI and the Licton Springs Village hope to alleviate stigma and substance use by taking a judgement free, inclusive approach to shelter and providing access to healthcare services.
“Safe, stable, affordable housing on its own is an effective ‘treatment’ for mental health and substance abuse problems,” said Josephine Ensign, an associate professor at the University of Washington School of Nursing, in an email interview. “People typically get better and consume less alcohol and other drugs when they have a safe, stable place to stay in a safe and supportive community.”
What it comes down to is looking at homelessness as a public health issue, rather than an individual problem. We must do as much as we can to de-stigmatize addiction and the cycle of homelessness, according to Operation Nightwatch’s Reynolds.
“Making sobriety a pre-condition of the basic human need for shelter is inhumane,” said Reynolds. “Chasing addicts away will never help them recover. Keeping engaged is the only way to go. When people are integrated into the community, feeling safe and hopeful, they will have conditions conducive to recovery.”