A Small Agency Takes on a Big Problem: Building Solutions to Care for Homeless Mentally Ill Adults

By Spanbock, Howard | Behavioral Healthcare, April 2008 | Go to article overview

A Small Agency Takes on a Big Problem: Building Solutions to Care for Homeless Mentally Ill Adults


Spanbock, Howard, Behavioral Healthcare


Washington County is part of the tri-county metro area surrounding Portland, Oregon, and has experienced explosive population growth during the past 20 years. Before the 1990s, the county, which extends westward from the Portland urban center toward the Pacific Coast, consisted mainly of sleepy farming communities, with a population just over 300,000. During the past two decades, as downtown Portland pushed growth into the county's rural spaces, the population rapidly increased to more than 500,000, with a recent growth rate of more than 15%--nearly twice the state average.

Along with the benefits of a booming population (such as a larger tax base, rapid economic growth, and upscale housing developments) came the challenges of a diverse urban population, including a larger and more visible homeless population. What used to be limited to a few homeless individuals known to local residents on a first-name basis, and who were "taken care of" for the most part by the faith-based community and local law enforcement, now became a population of more than 1,200 homeless adults (according to the county's 2007 one-night count).

By 2003, Washington County human services agencies had responded to the shifting demographics by establishing programs that offered services to homeless families. No providers, however, offered services to the growing number of single homeless adults.

Stepping up to the Challenge

Nationally, almost half of homeless adults struggle with mental health challenges, a statistic Washington County's one-night street and shelter count has confirmed year after year. In 2004, the board members of Luke-Dorf, Inc., a small licensed adult mental healthcare provider, decided to establish programming for single homeless adults with severe and persistent mental illness (SPMI).

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We identified two priority needs for this population. First, a facility was needed to offer services that did not demand that clients initially engage in treatment and welcomed all homeless mentally ill adults, regardless of their treatment readiness. Second, a facility that specialized in providing treatment to chronically mentally ill persons challenged by both substance use and homelessness also was needed.

We determined that the Safe Haven model, developed by the U.S. Department of Housing and Urban Development in the 1990s in response to the first flood of homeless former state hospital patients, was a perfect solution to the county's need for a front-door low-demand facility. The model targets are the hard to find and even harder to engage homeless mentally ill population commonly found camping in doorways, alleys, and isolated urban settings who are often reluctant to participate in the mental healthcare system. Safe Havens nationwide have proven the effectiveness of offering housing first, and then a gradual entry into services at a person's own pace.

Our vision also included creating a freestanding 15-bed building dedicated to dually diagnosed clients, where we could practice evidence-based integrated dual-diagnosis treatment for individuals referred for the most part by corrections programs, emergency departments, and jails.

Making the Vision Reality

As we prepared to meet these goals, our agency was also transitioning from an annualized reimbursement rate to a fee-for-service model and simultaneously moving to a paperless chart and automated billing. In addition to these challenges, we realized that in order to fulfill our vision we had to commit to raising an estimated $1.7 million to renovate an existing structure and construct a building.

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As anyone involved in development surely knows, a project of this size and complexity happens only when a coalition of stakeholders is formed, all of whom have an interest, each for its own reasons, in a shared outcome. Using that premise, we began identifying both public and private entities committed to ending homeless-ness and invested in the cause of mental healthcare. …

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