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Houston’s shrinking homeless population is dying from overdoses

Houston’s shrinking homeless population is dying from overdoses

Houston’s shrinking homeless population is dying from overdoses

A man waits for help leaving an encampment Thursday, Feb. 9, 2023, near Minute Maid Park in Houston. Harris County now has an annual report on homeless mortality that frames homelessness as a health issue: In 2022, a Harris County resident died while homeless an average of once every 36 hours, according to the report.

A man waits for help leaving an encampment Thursday, Feb. 9, 2023, near Minute Maid Park in Houston. Harris County now has an annual report on homeless mortality that frames homelessness as a health issue: In 2022, a Harris County resident died while homeless an average of once every 36 hours, according to the report.

Jon Shapley/Staff Photographer

On the longest night of the year, December 21, people gather in cities across the country. They light candles, say prayers, tell stories or simply list their names, all in remembrance of people who have died homeless.

On the Day of Remembrance for the Homeless, questions are swirling. To the existential, moral, painful and unknowable questions are added two that, in theory, should have clear answers: who is dying and how?

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In 2019, a team of researchers, officials, and advocates from around the country worked together to create a toolkit for cities to answer those questions. Now, an adjunct clinical professor on that team, Ben King of the University of Houston, has released the first annual report on homeless mortality in the state, showing that in Harris County, even as the homeless population shrinks, homeless deaths are increasing. In 2022, a Harris County resident died while homeless once every 36 hours on average.

A treasure trove of data from the medical examiner’s office

Fifteen years ago, when King was living in Austin, he realized that the database used by the local medical examiner’s office was not designed to flag such deaths.

In 2020, when King moved to Houston to work for the U of H, she immediately saw an opportunity to create a report because the Harris County Medical Examiner’s Office database reliably flagged homeless deaths. That year, the University of Houston formed a 10-year partnership with the medical examiner’s office to create annual homeless mortality reports for Harris County.

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For the first time in the state, annual, methodical analyses will be conducted of deaths in the homeless community, how people are dying and whether the problem is getting better or worse. The data has the potential to save lives.

“I hope the housing program will use it to advocate for housing,” King said. “I hope substance abuse treatment programs will use it to advocate for substance abuse treatment. The American Heart Association can use it to advocate for heart health in extremely low-income communities.”

Increase in deaths

Reports have brought to light a disturbing fact: While the number of homeless people in Harris County has dropped dramatically, the number of deaths has increased. In 2011, about 50 people died while homeless — roughly the same number as in the two years before and after. Since then, the homeless population has declined by more than two-thirds, but the number of people dying while homeless has increased.

In 2022, nearly 250 people died while homeless. While part of that increase could be related to a change in methodology in 2021, the uptick began years earlier.

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Homeless deaths are on the rise in Harris County, according to a new annual analysis of homeless mortality.

Homeless deaths are on the rise in Harris County, according to a new annual analysis of homeless mortality.

Ken Ellis/Staff

In other words, it is becoming increasingly deadly to live outdoors or in a shelter.

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Before King received the data, he expected his analysis to focus on cardiovascular disease, which is the leading cause of death worldwide and in the United States.

Until recently, this was also true among Houston’s homeless community. But in recent years, there has been a dramatic increase in overdose deaths. And the overdoses involved drugs that had not previously been a scourge for the homeless community.

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Deaths caused by opioids (primarily fentanyl) and methamphetamine increased in 2020, and in 2022, each was implicated in more than 50 deaths. In previous years, alcohol and cocaine had been the most dangerous substances in the community. Neither had been implicated in more than 20 deaths prior to 2020.

“What affected the East and West Coasts over a decade ago is now affecting Houston,” King said. “We have the opportunity to be more proactive, but we need to look at where the system is failing homeless people.”

Reaching a better understanding

King hopes that raising awareness of the problem will lead to solutions. In the meantime, he is looking for ways to use data to further improve our understanding of what is happening today.

For example, one of the first questions people ask is how the homeless population’s death rates compare to those of the general population. But because the medical examiner’s office doesn’t see everyone who dies, it doesn’t know the death rate in the general population. To answer that question, King has requested what’s known as the county’s “death file,” which is maintained by the state and records the total number of deaths in the county. (The medical examiner’s office investigates homicides, suicides, accidental deaths and natural deaths that are unobserved or have an unknown cause; King estimates that most homeless deaths are seen by the medical examiner’s office.)

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There are also questions about how Houston’s response to homelessness interacts with people before they… Homeless people are dying, and where things can be improved. Each region that receives funding from the U.S. Department of Housing and Urban Development for homelessness has to coordinate the various organizations working to address homelessness by collecting data on their clients and the services they receive. King has been working to integrate that system with health data for years — her thesis linked Austin’s Homeless Management Information System with health records.

In Houston, I could imagine working with the Coalition for the Homeless in Houston and Harris County to understand: How many interactions do people who are dying of homelessness have with providers before they die? And how are people doing after they receive housing?

“I think of housing as a healthcare intervention, so the fact that they are in two different data silos has never made sense to me,” King said. “I’m always trying to bring them back together.”

As King was working on his first report on homeless mortality, he found a cheerleader right off campus: Victor, who lived under I-45 on Cullen Boulevard. Victor was very interested in the leading causes of death in the homeless community because he had lost many friends himself.

He urged the king to get the information to agencies that could use it to save lives as soon as possible, rather than going through the lengthy peer review process to publish it in a journal.

As King prepared to release the pilot’s report, he passed through the underpass. He noticed a constellation of candles and a collection of letters arranged near one of the bicycles Victor had fixed. There was a sign with Victor’s name on it and a note about how those in mourning could contact his mother.