- Hi, I'm Kirk Swenson here at Ideas Fest in Asheville, North Carolina.

In this conversation, experts discuss how to address homelessness through coordination among agencies and community involvement.

Please enjoy this program of Asheville Ideas Fest.

- [Announcer] Quality public television is made possible through the financial contributions of viewers like you, who invite you to join them in supporting PBS NC.

[bright music] - One of the things I wanted to do to sort of start us out with, and I'm gonna come take a seat over there after I do this, is to make sure that we do a little bit of a, I think this is an important level set when we were having our conversation, really to talk about who is homeless and housing instability 'cause I think that's very important.

And I think part of what we all who work in the space and sort of see on a regular basis, we kind of get caught up in our definitions a lot and our understanding of what homelessness truly is.

And I think for people who are out in the public who see people you know in different places, those definitions don't always align.

For me in the federal space when we talk about homelessness, it's very much people who are meeting some very specific definitions.

They're often unhoused, so they might be people that you might see living in tents or in campsites around town, or they're people who are in shelter.

Typically people who we would consider housing unstable would be a lot of the people that I think about in our last session, when we heard about people who might have been back of the house, might have been a dishwasher who might have been staying on someone's couch until they can become stable and get their own housing.

Sometimes it is young people who have had a history of family trauma, who had an experience in foster care or staying with a kind relative who says you can stay here until they do teenage things and people said enough.

And then also, someone has teenagers, yep.

[laughs] And also it's also families that we see in motels.

Those would be people that, according to the Department of Education, might fit their definition of homelessness, but in terms of some of the resources that they would be able to access in terms of housing assistance, they might not meet other definitions.

So baked into this conversation already is a very sticky problem of how do we understand who is homeless in our community?

And also I think that helps us to have a good setup for what do we need to really solve homelessness?

To me, it becomes almost kind of trite to say, but homelessness is a housing problem and I think we have all seen over the past few years, I think particularly in a community like this, the crunch of finding affordable housing.

I've had a lot of people who've told me that they have young people in their lives who have graduated from college and they cannot afford to live outside of their homes.

So there's a lot of hand wringing about that and I think that's become more real to people about how people cannot afford housing on their own as they're launching out into the world.

So homelessness really is about housing, but we also know in order for people to be really stable in their housing, they have to be able to meet a lot of other needs.

So those are some of the things that we're gonna talk about as a group today to be able to sort of tease that out.

And again, I wanna make sure that I leave with this, I think the speaker in the last session, the person who asked the question about equity, I wanna make sure I highlight this.

We have to have a paradigm shift if we are truly committed to ending homelessness in our country.

And we can talk about all of the things where we nibble around the edges of getting people services and supports and making sure people have food and education, but we truly have to be committed to getting the number of resources on the scale that we're going to need to truly address this problem if we are committed to this as a full scale solution.

So I start with that and I'm gonna move on over here so my fellow panelists can talk and share some of their information.

Thank you.

[audience applauds] - I think that she has water.

- Oh, we got a water.

Great, thank you.

So I think the way we said we would do this conversation, we all kind of got on a Zoom call and we talked about how we wanted to sort of set this up.

And I think what we wanted to do is kind of have each person talk a little bit about the vantage point that they sort of see homelessness from, this problem of homelessness and really from their various perspectives.

So we're gonna go ahead and start with you and if you don't mind talking a little bit, getting us set up, and I think we'll move down this way.

And each person just kind of say a little bit about who you are, what you do, and how you see this problem or understand it and the solutions.

- Great.

Well again, my name is Mandy Chapman Semple.

I have a consulting firm called Clutch Consulting Group.

But my origin really comes from running an emergency shelter and running homeless programming.

That's where I started in this work.

Actually started as the overnight manager in a homeless shelter in college because they paid you to do homework and hang out with people, seemed like a good gig.

And I eventually just found my way into more leadership roles and it gave me the ability to start to experiment.

Running a homeless shelter, what you very quickly come to find out is that a homeless shelter provides very little remedy.

It absolutely provides an immediate place for someone to sleep that night, it provides a meal for that individual, but a homeless shelter by itself can rarely fix homelessness.

And running a shelter, I became very frustrated at understanding this.

And so it afforded me the ability to start to experiment with how do we build out a larger continuum of service that actually gets individuals back into housing and back on a path to stability and recovery?

And I understood no matter how nice my emergency shelter was, no matter how many times I called them a guest instead of a client, it was still an environment of crisis.

And that getting individuals out of that environment as quickly as possible was what was absolutely necessary.

And so my career has really been about how do I build a system of care?

How do I stop seeing just the individual programs that might produce one or two success stories and how do I really think about taking all of the parts of the system, all of the different players in the system, and how do I get them rowing in the same direction, how do I get all the parts connected, how do I get us all in the same boat even?

And so I found my way into the mayor's office in Houston at a particular time when Houston was ready to transform its homelessness response system.

And I was afforded the opportunity to take all of those grand ideas and put them into practice.

And I'll never forget this moment, I like everyone else, was kind of walking in trying to convince the Mental Health Division of the Public Defender's Office in Harris County, Texas to pilot some permanent supportive housing.

You know, you have all of these individuals coming out of the criminal justice system with serious mental illness, they're facing homelessness, let's give them some some real supportive housing.

And they looked at me and said, "We have 900 of these individuals.

If you can't deliver 900 of these solutions, why are we even talking?"

And I was like, "Challenge accepted."

This is exactly where I wanna go.

And so that was the opportunity.

And the stars aligned in Houston.

I was brought into the mayor's office, kind of handed extraordinary political capital and we did exactly what we had envisioned.

We said we can connect all of the parts.

We're not just a shelter system, we're not just a transitional housing program.

We can become a rehousing system.

And so my vantage point, my perspective is that we actually need to work backwards.

We need to start building and connecting the pieces that get individuals back into housing and connect those to our front end crisis services.

All too often our immediate reaction when we see homelessness is send an outreach worker.

Right?

That outreach worker has nothing to offer that individual.

Right?

Friendship, a granola bar, some socks, that's it.

And so then we naturally say, "Well then, let's build a shelter."

Great.

And then what does that shelter offer other than a place to sleep that night?

And so I really came to this perspective of saying we appreciate all of those front end crisis services, but they're not being fully utilized until I go and build a system where we can rehouse individuals very quickly so that when we engage someone, we can say, "Let's get you out of homelessness and let's get you out of homelessness now."

Let's not wait.

And then I have the toolkit to make that happen in a matter of days or a matter of weeks, not in a matter of months or years.

And it really does transform the way everyone in our sector works together, but it also transforms the way individuals experiencing homelessness interact because they believe in a system that can actually deliver for them.

And I think some of the sentiment that has crept into our nation in this particular moment is that we believe people want to be outside.

And I can tell you, I go into encampments every day and when I offer housing with the support services to recover, almost every single person says yes and they don't even know me.

When I walk into that encampment and have very little to offer, the answer is, "I'll stay right here.

I at least have a tent with a door that closes.

I at least know how to fend for myself in this particular moment.

And what you're offering me isn't any better than that," until I offer them housing with the services that they need.

And what's remarkable to me is that when that happens, more often than not, we're literally moving individuals into their unit, there's a safe place for their belongings to be, there's a door that locks.

And all of a sudden, those individuals start thinking about what comes next for them.

And we keep the offer.

Keep in mind, services are present throughout this entire period of time.

And the number of people who say, "Okay, I'm ready to go to treatment."

And we say, "Great, your things will stay in this apartment and this is the apartment you'll come to when you leave treatment 30 days from now," or you know, in whatever period of time.

It just is a transformative experience and that's the perspective that I bring to this, is that we can build systems, those systems to end homelessness, but those systems have to be rooted in rehousing with supportive services.

That we have to move away from this notion that we keep people in crisis and that we concentrate services in crisis.

Because then people never leave, right?

Because we're not giving them a pathway and giving them the supports that they need.

So thank you for the opportunity to share that.

[audience applauds] - You gotta follow that.

- It's a tough act to follow.

I'm Christopher Mills.

I'm an outpatient psychiatrist in little Keene, New Hampshire, small community up in New England.

I'm humbled by my co-panelists because this topic was not something that was too much on my radar until we started to have the discussion and now I'm learning a whole lot just about how complex it is and seeing quite a few parallels actually between the homelessness challenge and the mental health and addiction challenge and a lot of problems with public perception and a sort of an us versus them divide, which really gets in the way of getting people the help they need.

Even though Keene, New Hampshire is not a thriving metropolis, it also has it's fair share of problems and shortage of mental health care is one of them.

I think it's all across New Hampshire, it's around New England, it's probably nationwide, it's probably worldwide.

There's not enough mental health care and addiction care and the problems have certainly grown since the pandemic and the number of new providers coming in to provide therapy or medication management has not anywhere near kept up pace with the growing need.

So it's gonna be challenging in the years going forward.

But the chicken and egg story about mental illness or addiction and homelessness is a very interesting one that I've begun to understand more clearly just in our discussions.

And something that I've known since I started my training was that the mental illness and addiction problems among our communities don't evolve in a vacuum, everything generally starts with preceding problems that need to be addressed, history, trauma.

So the idea that the people that are on our streets or in the tents or in the shelters are there because they have mental illness is not at all the case.

But there's still very much a need for mental health care and addiction treatment.

And it's becoming increasingly challenging to do that.

And I can say from my perspective as a community physician, our community mental health system, which is that organization which serves the most severely and persistently mentally ill, is being defunded.

It's having its budget cut.

Our Doorway system in New Hampshire, which is a fantastic concept, it's a great idea.

It's a hub and spoke model of somebody struggling with alcohol or substance use who needs treatment.

Two in the morning you decide you want help, you call The Doorway, you get the help, you get assessed, you get resources, you get determined as to your need for inpatient or outpatient or detox or whatever, and you get help.

That Doorway system which kind of sprang up in our state in the last 10 years is having its budget cut year by year or at least threatened.

I mean, we're saving some of it, but it's on the block.

So while the need keeps growing, my ability and my colleagues' ability to help take care of folks is getting limited more and more.

So there's a lot to think about in terms of how to solve it, but that's where I come at it from right now.

- Thank you.

- Thank you, Chris, for your perspective.

I'm Alyce Knaflich, I'm the founder of Aura Home Women Vets, but before that I was homeless nearly 10 years.

I served in the military almost 19 years.

Started, finished my college, started a new career, and 10 months later I was fired because I had PTSD.

I got diagnosed and I was told by the VA I can't work anymore.

I'm just under 40 years of age so what do you do for the rest of your life?

Without any income, I eventually lost everything I ever owned, went bankrupt.

So finally, the VA diagnosed me again, I keep on going back to VA.

Okay, now you're 100% service-connect disability, you are finally going to get a check.

That's my starting merging out of homelessness.

In the meantime, I roamed the country in an old beat up RV.

And in between that, when I didn't have the RV, I would pick up bottles and cans off the highway to cash it in for a meal.

But right here in Asheville is when I started emerging out of homelessness.

The VA hospital here and a veteran service organization called AMVETS pushed through and got my disability.

But it took me another four years just to recover from everything I lost.

First thing I did was rent out a room.

I lived in that room for four years just to try to build my income up so I could buy a car and things like this.

Once I got over that, I started paying back.

Started volunteering at the VA hospital.

I volunteered at the VA hospital here for 12 years.

Shortly after I started volunteering in 2007, the government says, "Hey, we gotta get all our homeless veterans off the street.

They deserve a place to live."

When all those programs started popping, I said, "Gee, wish they were around 10 years ago."

But I got involved with the local shelters and things and finding out where the veterans are and especially women veterans 'cause I know what it took me to get out of homelessness.

And then I found out there was huge disparities between how the women and the men veterans were being treated in the homeless department, just in the homeless realm.

Not only our healthcare, but other things.

And I said, "Why are the women veterans separated from the men veterans and then the women veterans are housed with other homeless women in the community and not even considered veterans?"

I started asking these questions.

I went to the shelter, I found out where the women were.

I started a cook team there.

I started case management there and I started finding out who the women veterans were 'cause they didn't know who they were.

I would wear my military garb, some would come up and say, "Oh yeah, I served in the Air Force" or Marines or whatever.

That's how I got to know who the women are.

Then we gathered together and I started telling 'em what their benefits were and they were, "What?"

Yeah, there's job training programs through the Department of Labor that's free to those who are homeless veterans.

"That means I didn't have to pay for my job training, my Green Jobs Training program that I'm taking here at the local college, A-B Tech?"

"Yeah, that should have been paid for."

So there's a lot of questions about that and healthcare and other things.

So we started a little group called Western North Carolina Women Warriors.

And so we got to talk more and women now starting to ask questions, "Well, where's my benefits?"

That's when the trouble started.

[audience laughs] And I asked the VA, the Homeless Department, I said, "Why aren't you counselors going over to this facility, this shelter and counseling the women on your housing programs?"

Oh well, you know, they're in what they call the grant and per diem program, which is a two year program that they could just house the veterans for two years and supposedly they're supposed to be getting their stuff together, either retraining jobs or education or whatever so they can be more self-sufficient, but they just housed them.

And one of the interesting things was they were teaching the women how to pot plants.

And I says these aren't job training for careers of any sort, whereas the men were getting nursing training through the arts.

Katie Button probably would enjoy that.

But they were getting all these training for jobs that could be careers and make a good wage.

I mean, I don't know how much money you can make learning how to pot plants.

But they were prided themselves on this with women.

And I'm like, "We're ex-military."

We have a wealth of first of all, experience and we're leaders.

We're people that we can do things, not just being a housewife.

And I'm gonna say this, I was gonna hold it but I'm gonna say it.

It happened to be the executive director of this organization one day and I heard it from his mouth, "There should not be any homeless women in our country.

'Cause they all should be hooked up with a man."

That was his words.

His exact words.

I heard that and other things.

Yes, yes, ma'am.

I heard those things and I said, "I gotta do something.

I gotta help my fellow female veterans."

- I'm sorry, I didn't mean to, I wanna ask you a question to this if I could, because I think one of the things that is really interesting when we were all talking, particularly with you and Chris, is really this idea of really asking people who are experiencing homelessness, have had housing stability, what do they need, right?

I think we kind of all have these solutions and I think Mandy and I kind of represent these big systems and I think even in your example just now in your story, you very much represented lots of things where systems don't kind of work together.

But I am very curious, particularly from the two of you all from talking to people at various parts of their journey to becoming more stable, what do people say that they need?

And I think just for everyone here, I think to articulate a value, really centering the voices of people who have been through this experience is I think very core to what we have learned over time is going to get us beyond just sort of these systems of shuffling people around, we know that we have to ask this.

So part of why we're sort of really trying to center these voices in this way is really to hear from what people have said.

So if you don't mind telling us about your experience of what people have said, both of you, I think it would really be helpful for this audience to hear.

- Well first of all, anyone is in a crisis or needs help, they just wanna be heard.

You ask 'em what they need.

There's a lot of people that hand you a $20 bill if you're standing on the corner, throw you a survival kit but what is it they need?

They may need a pair of socks, a new pair of shoes.

You don't ask 'em, you just assume what they need.

And that's the hardest thing, not involving the person who was experiencing homelessness what they need.

They are the experts to getting out of homelessness.

They've been in our systems.

They'll tell you what a shelter can do for you.

They'll tell you why they don't go to shelter, why they'd rather camp, even though it's 20 degrees below zero.

They'd rather camp than go in some of the shelters because of some of the rules and restrictions they have on it.

And I know the LGBTQ people have the hardest time being homeless because there's so many of those shelters and transition housing do not accept.

Yes.

I let you know, as Aura Home Vets, we had a pilot program, four years for apartment, three bedroom apartment we had, and the VA, as soon they would have trans women that was homeless, they wouldn't send them to the organizations, other organizations that were shelters, they sent them to me.

I help more trans women than regular women, however you call it, than anything because they wouldn't let them go to the other shelters, they wouldn't let 'em go to the men's shelter for obvious reasons and the women's shelter won't accept them for other reasons.

And then I said, okay, my thing is not to discriminate, but there's huge discrimination in our shelters here.

Agencies don't even allow service dogs.

They don't want animals period in their shelter.

Well, how is a homeless person with a service dog, where do you stay at?

I believe in solving homelessness starting with prevention first.

If someone's being evicted just 'cause they can't pay rent, let's help 'em pay their rent, keep 'em where they're at.

It's more cost effective.

Instead of them having to lose everything, they're on the street living out of the car and whenever they do accept services, they have to start all over again.

You have to come up with your deposits and all this, all this, all this, all this.

And really, the voucher system kind of sucks because part of your income has to go to the housing voucher.

And as soon as you make more money, they take more of that.

It's always that 30 to 40% of whatever your income is goes to the voucher.

So there's no means of building wealth.

So as you become self-sufficient, they're always taking from you.

So as soon as you get a dollar, they take the dollar.

Kind of like Social Security but we'll talk about that.

- Chris, do you wanna add anything to that in terms of what your experience has been in terms of what people say they need or what you think that they've also sort of articulated in other ways 'cause they might be at different points of their journey in recovery?

- Well, I think when a person's gone to the point of losing their home or they're struggling with alcohol or substance use to the point where it's become a disorder and impacting their job, their family, their friends, it's a very lonely journey.

They get isolated, they get cut off, and they lose their connections.

And I think connecting is the thing that needs to be reestablished.

I think without the connection to other human beings, there's really not a great path out of substance use disorders or homelessness.

I mean, you've gotta have people caring about you.

You've gotta have a feeling that there are people you can trust that care about you, that have your back, that are gonna help you through this dark time.

And when you get cut off from society, when you get cut off from your friends and family, when your self-esteem sinks so low that you don't feel like you can talk to anybody, then it's a really tough journey back.

- Mandy, you've been involved in building systems at a community level to address sort of the things that I think we've heard about.

What would you recommend if you're sort of giving a conversation to people in a community of what they should look for if they're really truly committed to the cause of addressing homelessness, what would the be the features that you've seen that are effective and that you would put out there to other people to sort of make sure that they are their north stars in their communities?

- Yeah.

You know, I think in this particular moment, that question is really important because in so many communities that is the demand on the table, is do something.

Do something because it feels like what we're doing right now isn't working.

And I agree.

And I wanna go all the way back to what was said at the very beginning.

Part of why it feels like what we're doing isn't working is we don't have enough of it.

And I think one of the first questions you really should ask is what we're doing not working or is what we're doing working and we need more of it?

Because I think so often we're very quick to kind of throw the baby out with the bath water when it comes to this particular issue.

And we keep searching for some magical, all inclusive solve this quick fix kind of remedy and the reality is it doesn't exist.

This is about real human journey.

And we can build systems to match that human journey, but we have to make those systems operate at scale.

So if we are playing a game of musical chairs and there's 20 kids in 10 chairs, 10 kids aren't going to to get a chair.

And so the first thing I would offer is inquire in your community.

Is in fact what we're doing working?

Are we rehousing people successfully?

Are we moving individuals out of homelessness successfully and do we just not have enough?

The second question then I would also encourage you to ask is to find out how focused you are in rehousing.

Because containing individuals in an environment will cost you money, so will getting them out.

And I'm a big advocate of using taxpayer dollars really efficiently.

So I would rather pay once than twice.

But sometimes because we're so eager to want to sweep up a problem and fix it and contain it, we inadvertently end up consuming all of our dollars on that solution and then we don't have the remedy that we're looking for.

And then guess what?

We find ourselves searching for the next solution again.

Which means we're never investing in scaling a system, we're never investing in getting to abundance so that we can really solve this from an equity perspective, that we can really solve this from a community health perspective.

As long as somebody's winning, somebody gets a chair and somebody isn't, we are losing.

So that's really what I would offer you, is to really think about how do I help my community focus on rehousing?

How do I help my community stay focused on rehousing even when we're not seeing the results that we want?

And then the third is how do I help prove that rehousing can get us the results that we want?

There are wonderful models out there where we can go directly into an encampment, directly to the individuals sleeping on the streets and we can rehouse them from that location and we can close that encampment.

We can make a visible difference with rehousing.

We don't need a containment strategy.

But we need our constituents, we need supporters in our community telling our elected officials we want you to do something about it and we want you to do the right thing, the efficient thing.

And very often the message kind of stops at, we want you to do something about it.

And the elected official goes, "What's the thing I can grab at in the very short period of time I have to prove to you I'm doing something?"

And that thing often is a containment strategy that costs a lot of money and changes nothing.

So that's what I would encourage.

- To add to this, I think this is really interesting and I'm gonna ask a question of the audience so this is where you guys have to participate a bit.

How many of you in this room on a personal level have donated or volunteered time with an organization that you would say alleviates homelessness or poverty?

All right.

- Bravo.

- Bravo to you.

And this is a both end kind of pieces.

I think one of the things that I have learned from my experience even working at a community and to this point is we have built all of these wonderful systems that we are all connected to.

If you think about the organization you thought about you volunteering for, you probably have a story.

You might have a story of a person, a family, a thing that really moved you in that experience.

And while those are all fine and good, we know that this problem is going to require us more than 15 hours every week at my church outreach bank in the basement where we give out clothes and toiletry kits.

I think Alyce sort of said that so elegantly and effectively in what she said.

So I also sort of challenge into this too is we have these systems of care of how we've supported people out of their journeys of instability and we're all very emotionally connected to them and tied to them.

But we know that the scale of what we're seeing now is going to require us to do something else and right?

And I think to Mandy's point is if you're thinking about in your community how that looks, it's sort of like you're volunteering your time at the outreach ministry and you're also thinking about advocating for additional resources in your community or thinking about how do you maximize the amount of space that people can build on or affordable housing.

I think we are savvy enough.

I like to feel like we have been through a lot in the past few years, but we are savvy enough in 2024 that we can hold two things at the same time and be just as committed to those as well.

So I also sort of put that out there as a challenge to people as they think about what to do at their community level because we're not gonna do a sock drive our way out of this problem.

We know that.

If we could, we would've solved homelessness decades ago and everybody would've had socks and warm homes, right?

We're not gonna do that, we're going to have to be very committed to these really sort of large scale, really resources to actually do this effectively.

So throwing that out there as a challenge to everyone on the panel to out in the audience.

I know we have a few more minutes before we get to the Q&A.

Are there other things that folks on the panel wanna make sure that they highlight or sort of lift up?

- Yes, housing first works.

- Does everyone know what housing first is?

- That means you get 'em in a house first.

You don't worry about their drug addiction or whatever they may have, whatever the issues are, get 'em in housing first.

And a good thing about that is then you know where they're at.

You know, you could find them.

I had more trouble finding women veterans in their encampment or in a car, I don't even know if they're still in the county 'cause they're here and there.

But if you know where they're at, where they're staying, where they're gonna sleep every night, then you could find them, you could help 'em with a discussion, you build a relationship with them, you earn their trust and then you can start talking about solving their situation.

Maybe they have drug addiction.

They'll say, "Oh I'm ready now to get detoxed.

I'm ready now to see a psychologist or psychiatrist, address my mental health, my anxiety."

Some of the things when I've housed the women veterans in my pilot program, they're unsheltered and they get their room.

Their own room, okay?

They didn't share, they only shared the bathroom together and stuff.

They slept anywhere from 24 to 36 hours straight.

Sleep deprivation affects mental health, physical health, everything.

And I think sometimes if they were not on drugs before they became homeless, they're on drugs because they're homeless 'cause they're trying to survive.

Nutrition, poor.

And then they're constantly trying to find someplace safe enough to take a nap without being harassed, abused, beat up or arrested by the police.

- And not to be the validator on this, but I think people often need to hear numbers in order to believe personal stories as well.

There's a study that's been recently done out of California looking at homelessness and looking at the survival techniques that people were using in order to stay safe, right?

So one of the things that we saw was a lot of people were using particularly amphetamines in order to stay awake.

Because if you think about sleeping outside by yourself, particularly as a single woman, that does not feel particularly safe.

So in order to be hypervigilant and diligent, you are probably helping yourself to stay awake.

So I think these very real examples of coping mechanisms that people are using in order to keep themselves safe or to feel secure are real.

And when we think about housing people and helping people to be housing focused, we can't undo what we knew people did in order to keep themselves safe in environments that were very dangerous and precarious for their survival up to that point.

- And also that's why there's camps.

In numbers you have safety.

So when the police and all that, they tear down these camps and throw away what little belongings they do have, that's a shame.

That's a pity.

This country could do better.

Thank you.

That's it.

- Anything else from the folks on the panel before we get to questions?

I see some folks lining up which is exciting.

Or maybe there's one person.

[laughs] I can exaggerate that but anything else anyone wants to share on the panel before we get to the Q&A portion?

- I'll just jump in, I'll say just two things which are probably not gonna make any sense without the background, but I've been trying to figure tracing things back.

When I get into the backgrounds and history of the folks that I'm trying to take care of, the two things that I've found I need to focus on most are taking care of our children, the community's children.

That's so much of where it starts.

So much of what I see and try to help take care of starts in childhood.

So if we can start there, we can change a lot.

And the other is be aware of the legislation that's going on in your state capital.

Learn about the laws that are being discussed and passed and what your elected representatives are arguing for or against because that's gonna decide where the money goes.

- Right, like legislation at the Supreme Court right now.

- That's right.

- Deciding on whether or not to criminalize homelessness.

Putting homeless people in prison.

- Do folks in this audience know a little bit about the case that is in front of the court?

- [Audience] No.

- It's Grants Pass and, yeah.

- Grants Pass vs. Johnson.

And it has to be a female veteran that is the case lead on this.

There's several communities that wanna criminalize homelessness and somehow this legislation got all the way to the Supreme Court to decide, this Grants Pass, Oregon.

Folks there are trying to push legislation to criminalize homelessness.

Now, getting out of homelessness is bad enough.

Now you have a criminal record on you too?

Try to find a job, try to find housing when you have a felony on you.

- And I know this afternoon there's a workshop where we'll probably talk a little bit more about those parts of the issues 'cause this situation I think is really kind of interesting in this is really sort of a community sort of saying we've had enough, right?

- [Alyce] Yes.

- And then there's sort of this response of, okay, now we're going to make it very impossible, hard for people to be able to be in those spaces and to do things that people need to do to survive.

And there's a tension here, which I'm thinking lots of people in communities all, well, we know communities all over the country are facing these tensions of they see people and they also know they've had enough but they also are thinking about how to have compassionate responses.

So I think this afternoon you'll hear a little bit more about that.

But I wanna turn now to the folks who've lined up for questions 'cause I think they've been waiting diligently.

So I know you were first, so have at.

- We can call it housing first or we can talk about doing outreach and asking would you immediately like help and housing.

- [Audience Member] Get closer to the mic please, thank you.

- The housing first approach, are you saying that you've got enough housing?

You're talking about scale.

So in your Houston example, was there enough housing that you could at scale say, "Do you want help?

We have housing, we have supportive services."

And then in keeping with this same point of view, one could imagine scattered housing versus congregate housing.

We've had difficulty here whenever we wanna do something like take over a motel.

So in terms of congregate versus scattered, what's the effectiveness?

And then finally, the image of addiction and mental health issues are clearly, one of the things people carry around in their head.

You made a mention of community mental health services which didn't develop as they were supposed to once we started talking about community mental health.

So there has been some talk of new kinds of institutions.

So I'm wondering how that fits in.

And we could talk about transitional housing, but what about permanent supportive housing, which are kind of two different things.

- So before you jump into the Houston one, I wanna just sort of say something 'cause you got a lot in that whole question.

- Yeah, yep.

- One thing to say about this, and I think hearing specifically how a community did this to scale is important.

One of the things I think has to be important for every community is the north star of people do well when they have options, right?

So you can get into the back and forth of congregate, scattered site, you know, what type of housing.

And we know that most communities have to have lots of different options to meet the needs of what people are going to want because it's a personal choice where people choose to live.

And I also would extend that as well to whether or not how people are seeking out treatment or accessing it.

We know that people do better, empirically we know this, when they have a buy-in to their treatment and the services that they're getting and they're able to sort of see themselves reflected in what they want.

So I wanna make sure I sort of say that as a general value 'cause your question would take us the rest of the time to unpack, but then I think talking about what happened there.

- Yeah and so here's the reality, Houston or any other community.

We have an affordability crisis in this country.

Every city does not have enough naturally occurring or you know, designed affordable housing scattered throughout its community.

And while that definitely contributes to more individuals experiencing homelessness, and certainly if we had enough, it would be a lot easier to get people out of homelessness.

We don't have to wait for that to solve these problems.

We simply buy our way into the existing market.

Are there units in the market?

Yes.

We just have to pay for them.

So we can't expect very low income individuals to be able to afford those markets.

But why would we let those markets go vacant when we have individuals who can live in them?

We just have to pay to do it and we're paying for these individuals to be outside.

It costs you more to step over that person on the sidewalk than it would to subsidize their rent in the existing units that are available.

- [Alyce] That's right.

- And the data is very strong that when we can help individuals get into those units.

And so we're gonna start with 12 months.

And this may not be their forever unit, they can't afford this unit forever.

And we don't wanna subsidize forever if they don't need that.

But we can buy 12 months of real stability and of no crisis so that we can actually build a plan and work a process to find what is the right next solution.

For whatever reason, we've tried to design systems that implied that somebody in crisis in a matter of days in a shelter environment could somehow figure out how to transform all of that complexity and that there's some magical affordable unit on the other side of that.

That's just not our reality.

So the answer is there are enough units, even in the tightest housing markets, you just have to get much more creative and buy your way into that market and start building a business relationship in that market.

If I expect an individual experiencing homelessness or even their case manager to go and find enough units, it's never gonna happen.

But I can build a dedicated unit acquisition team who have experience in real estate, have experience in property management.

I can give them a fund so that they can go and negotiate on a business relationship to hold a unit to pay the extra, to pay an incentive.

and we can buy our way into that market and help stabilize lots and lots of people.

So not to say that we have to continue the affordability crisis, but until we fix that, there is a way to solve homelessness, we just have to pay to do it.

And then as soon as we solve our affordability crisis, we don't have to pay as much, which is really nice.

So that's the answer in any market and we've repeated this in multiple markets across the country so it isn't just Hou- You know, I think a lot of people wanna say, "Oh, Houston doesn't have zoning, that solves all your problems."

Does not solve all our problems.

There was a recent study that indicated that Houston actually has the least amount of housing for the lowest income individuals of any city in the country, believe it or not.

So the market, while it doesn't have zoning, is not naturally developing for the lower end so we buy our way in to where they are developing.

- [Audience Member] I look forward to the workshop.

- Yeah, thanks.

- So I work for Asheville Fire Department.

I've been with Asheville Fire Department for 16 years, 12 of those I've worked downtown and we deal with our homeless population here in Asheville on a daily basis, multiple times a day.

In my time in Asheville dealing with our homeless population, the two common threads that I have seen the most and I'm not trying to generalize here, are first addiction and upstream from that, more foundationally are mental health issues where individuals that are in our homeless population are trying to self-medicate to deal with the mental health issues that they have and it's what them into being homeless to begin with.

That being said, I know that a lot of the individuals that we work with on a daily basis feel like they've been juggled around by the mental health system in our community.

And I think that's not just an Asheville problem.

So I'm no expert, but it seems to me that one of the biggest problems that we have in terms of fixing the issue that we have or preventing people from becoming homeless to begin with is fixing our broken mental health system.

So with that being said, of the panel, what is the number one main issue in terms of reform or fixing our mental health system in terms of helping homelessness in this country that you see?

- That's a good question.

- Well, all I gotta say is mental health and drug addiction is prevalent in our communities whether you're housed or not housed.

- Absolutely.

- So just happens you see it because they have no walls to hide behind.

- Yeah, I think the clarification, I mean, it's a wonderful question.

The clarification is we can fix the mental health system, but we're still going to have homelessness because homelessness is so deeply linked to the affordability crisis.

So just to appreciate that.

But if we fix the mental health system, would that substantially improve our ability to get people the care that they need?

Absolutely.

But is that care by itself going to solve the affordability crisis?

No.

So I think just laying that on the table is pretty important.

But from a preventative perspective, certainly I think there's value in that.

I would like to offer an answer and Chris, I'm sure you have lots to say here, but my experience is we need to fix a continuity of care issue.

So the problem is, and I think you are a first responder, and so you can appreciate this, always our systems are oriented around what's in front of us.

How is someone presenting right now?

What's the problem right now?

And then the expectation is if that problem is a longer term problem, then we give you a referral to where you're supposed to go next.

And if you're not capable of kind of navigating and advocating and self-managing your own care, then that continuity of care was just severed, right?

Because that individual was just released from care and we wait for the next crisis and the next crisis.

So from my experience with individuals experiencing homelessness, the individuals who have some of the most acute and extreme issues that are really getting in the way of their ability to navigate themselves out of homelessness, we find ourselves in that cycle.

And so fixing that continuity of care would really be helpful.

We've done lots of experiments with how to do it.

Mental health systems, primary healthcare systems, they're behemoths and there would be a lot of work to go in and correct those for what are really just a small number of people that that system isn't ultimately working for.

It just happens to be we see the consequence among that small number.

That's my experience, but I'm really interested to hear your perspective.

- Well, all I can say is I'm the only psychiatrist in our region right now.

We've had jobs posted for others, but right now it's just me so I work in an office in a clinic with primary care and I take care of the folks that go beyond the scope of primary care but don't fall under community mental health.

But then there's a lot of folks who would qualify for community and mental health if they could meet the requirements of going in for their visits and they can't, they don't have the transportation, they don't have the communication, they cannot do that but they're still my patients because they're still part of primary care.

Now if they don't have a house, they probably don't have a car.

They may not have a telephone.

I can't tell you how many people that I've started to see and then they've slipped through the cracks because they can't make it back into my office.

And if there were three or four or five of me, we could go out to where they are, but there's no numbers like that.

- I'm going to end us where we started on this one because I think we're close to time, but it's really interesting to have first responders sort of ask the last question.

I think about this from the standpoint of like, I would not call you if my garbage needed to be removed so you are a fireman, you know what to do with that and I think the part to this is, I sort of think what Mandy was sort of teeing us up for is these are really complicated systems.

And to get us back to this conversation that we were having about equity and resources, we kind of have built these systems, right?

These systems, we've got people who are experts in navigating it.

I'm gonna assume there are folks in this audience who have had to manage a lot of healthcare issues as they've aged or with aging parents or people in their lives who have lots of concerns like that and you know that's a full-time gig.

So when you think about how we have created systems that are very reliant on navigating really complicated systems, I think if we fundamentally think about how do we simplify these systems and put the things that people need upfront and really put our shoulder to the plow of coordination and really sort of working together to get people the right thing at the right time at the right level, I think that is how you see these larger shifts in your community.

So the charge I would leave you all with as an audience is to really demand in your community and be part of how to make things really simpler so it does not have to be people going from pillar to post to getting what they need when they're facing probably the most profound crisis that anyone could face without having housing.

Thank you.

- Well said.

[audience applauding] - See you at the workshop.

Thank you.

Thank you for leading us through a really important conversation.

I appreciate it.

I want to thank you not just for being here with us today, but also for the work that you do in your own communities.

[audience applauding] We've referenced a couple of times the workshop that's going on this afternoon.

And so I wanna put Mandy on the spot here and ask her, Mandy, would you share with the group why they might want to join that conversation this afternoon?

- Yeah.

Well, we're going to have the former mayor of Atlanta, Mayor Lance Bottoms there so that would be reason number one.

But you indulged us today listening to our perspectives, understanding and appreciating how technical and nuanced and complex this issue is.

But I hope what we've done is helped you appreciate that you have a role to play in this too.

And so the workshop this afternoon is really about exploring that role.

You hold the public perception on this issue.

You are constituents in your communities and how you view this issue and what you demand on this issue will absolutely dictate what happens in your community.

And so that's the opportunity we have this afternoon is to really explore how you hold that power and what you do with that power and the potential of how you wield that power and which direction your community can end up going and what the potential consequences could be.

And we really want it to be a dialogue with all of you so we're excited and hope you'll join us.

- We hope you enjoyed this program.

I'm Kirk Swenson and thank you for joining us for this year's Asheville Ideas Fest.