Thursday, September 5, 2013

Housing is Healthcare

Nowhere to Pee

Did you ever have a moment when something you already understood intellectually suddenly lands on an almost cellular level?

Last Thursday, a conversation at work did that, for me. "Robert" who endured chronic homelessness for nearly three years, was recently successfully referred into a permanent supportive housing program. He had come by our agency, Bethesda Cares, to chat, to report on his tremendous and rapid personal progress.

"I am so glad. I peed for, like, 45 minutes yesterday," he said, "because I finally could."

I thought he meant he was grateful for the "luxury" of ready-access to the toilet in his new apartment.

That "luxury" wasn't it, though. Robert was talking about the actual reason having a toilet matters: his health.

Robert has congestive heart failure, a condition that means his heart is not pumping adequately to keep his kidneys effectively processing waste. Thus, his body builds up fluids, swelling his ankles and legs. A free clinic had supplied him with diuretics, crucial for alleviating his symptoms. Yet Robert could not use his life-saving medication.

Think about it, Reader.

Diuretics, while you are living on the street. No option to just run to the bathroom when you feel the need.

Now housed, Robert has a bathroom with a medicine cabinet, and can finally properly store and take his meds.

Housing Is, In Fact, Healthcare

We all share same three-legged stool of basic needs we must meet for human survival: food, shelter, clothing. Take one leg away, and the stool tumbles. For the purposes of this post, let's look at existence without "shelter."

"Housing is healthcare" is a mantra around Bethesda Cares. Our work centers on housing as the stabilizing factor for recovery, health, and ultimately, survival. It's a model broadly known as "Housing First."

The people we serve, living unsheltered and homeless, are society's most medically vulnerable. They are routinely exposed to the hottest nights, the coldest days, blizzards, downpours, the occasional derecho. They suffer frostbite; multiple conditions from sleep deprivation; their cuts and scrapes are prone to infection; they are at risk of dehydration year-round. And yes, some of them "self-medicate" by drinking themselves into unconsciousness

All that is, of course, in addition to the ordinary illnesses and conditions we each encounter as we age.

How is the homeless woman with diabetes supposed to refrigerate her insulin? The man with high cholesterol, but no kitchen, to cook himself low-fat meals? People coping with both the frenetic uncertainty of life on the street, and with constant exposure to the natural elements are at abnormally -- and avoidably -- high risk of physical suffering, and premature death from treatable causes.

It's a disgrace.

You Don't Need to Be an Economist to Do the Math

If the humanitarian aspects of housing don't move you, consider the economics of "housing as healthcare." They are stark.

Where do people experiencing homelessness go for emergency care? To the nearest hospital ER, of course, maybe ferried there by a local rescue squad who intervened. In fact, people experiencing long-term homelessness are among the highest consumers of costly emergency medical interventions. A hospital must, by law, "stabilize" a person suffering an emergency even if the person cannot pay. The hospital then absorbs that expense.

(I'm just spitballin' here, but you think maybe hospitals pass on those costs on to other consumers, like, say, your insurance company?)

So after perhaps an overnight stay, and tens of thousands of dollars of services later, the patient is released... back onto the streets. Maybe the condition that sent him to the ER is permanently alleviated. Probably not. Regardless, returning to sleeping on a park bench will not speed anyone's recovery.

Even in pricey Montgomery County, Maryland, the cost of housing a person experiencing long-term homelessness is thousands of dollars less, per annum, than allowing that person to remain homeless.
Any third-grade readers out there get that mathematical calculation?


Any adults?

One Other Wrinkle

Emergency service costs are incurred only if someone seeks treatment; for people living unsheltered, that is not always the case. Why wouldn't someone want to go to a free clinic or check in to a hospital, if need be?

You ever see someone you think is experiencing homelessness, because he carts around a lot of "stuff"? That's everything he owns. Those bags and shopping carts might look like they are filled with detritus, but they are items of no lesser a personal value than are our own photo albums, laptops and favorite coffee mugs.

When you and I leave our places of residence, we lock the doors and expect our belongings to be there on our return. A person living at a bus stop, however -- I refuse to call a bus stop a "home" -- knows that his stuff may have vanished by the time he returns from the ER, either into a dumpster, or scavenged by someone else in need.

Seeking treatment is not a slam-dunk of a choice.

In the End

The reasons that people experiencing homelessness are tremendously medically vulnerable are both physical and psychological, the factors quite complex.

But there is that solution to the equation: Housing as healthcare. I have long understood that. Now I get it, too.

Amy Freeman wrote this article.  She is a staffer at Bethesda Cares, the organization leading the 100,000 Homes Campaign in Bethesda, MD.  100,000 Homes Campaign is a partner of Give US Your Poor in the American Music Project: Voices for Veterans. Amy recently reflected on an experience that drove home the importance of housing in personal terms. (This piece was originally published at and again on the 100,000 Homes website. You can view the original story here.)

Monday, July 29, 2013

Mario Frangoulis Concert

On June 6th Give US Your Poor partnered with world renowned Greek Tenor Mario Frangoulis at his concert at the Berklee Performance Center in Boston.  Frangoulis has been a friend and supporter of Give US Your Poor for many years.  He has performed in benefit concerts for Give US Your Poor in the past, as well as appearing on our album.

At the show we set up shop in the lobby of the venue.  We were there to spread awareness about our new initiative (American Music Project: Voices for Veterans) which aims to engage musicians and their fans in the attempt to end veteran homelessness by 2015.  We were able to talk with over a hundred of Mario's fans about the issue of veteran homelessness. 

Mario put on a wonderful show, seamlessly weaving together classical and modern pop music.  The concert also featured beautiful performances by the Women of the World and the Berklee Balkan Choir.  Throughout the show, Mario wore his heart on his sleeve, speaking about the recent tragedy in Boston and poverty among the children of the world. Mario also spoke about his work with Give US Your Poor and his friendship with the organizations director John McGah.

After the show we were able to go backstage and talk briefly with Mario. Mario is as friendly and charming in person as he is on-stage.  He kindly welcomed us and thanked us for what were doing to end homelessness.  He also posed for a photo with some of the Give US Your Poor staff.  Mario has been a great friend to our organization for several years now and we hope to continue that relationship for years to come.

Tuesday, February 12, 2013

Music as a Tool for Healing

Image from
The New Directions Choir is an acapella group that sings in a range of styles and is comprised of men and women who have served in the United States Military.  Besides their love of music and their military service, one other trait  draws them all together.  All of the members have experienced homelessness.  According to George Hill, the choir’s director, the group hopes that through music they will be able “to let veterans who may be suffering know that there is hope for them.”  Through music the New Directions Choir wants to help others heal just as music helped them heal their own wounds.

The concept of music as a means for healing has been around since the days of Ancient Greece.  Plato once spoke on the mystical power of music saying:

Music is a moral law. It gives a soul to the universe, wings to the mind, flight to the imagination, a charm to sadness, and life to everything

While abstractly seen as a way of soothing the soul for centuries, music wasn’t formally recognized by western medicine as a means of healing until the 1900’s.  During this time musicians played in hospitals to help heal WWI and WWII veterans suffering from physical and mental trauma.  The doctors noticed physical and mental improvement after these visits, leading them to request that the hospital to hire musicians.  Since then music therapy programs have grown in strength and popularity.

One area where music therapy has been shown to be particularly useful is with veterans, like the members of New Directions Choir.  Due to the high stress and traumatic situations they may experience during their tours, soldiers are highly susceptible to certain mental conditions.  According to the National Council for Community Behavioral Healthcare, mental illness is the second-largest illness area effecting veterans from the Iraq and Afghanistan wars.  There is a wide range of different mental illness that affect veterans, but the most prevalent of those are depression, anxiety, and PTSD. 

Mental illnesses, beyond just being a health concern, can also affect a veteran’s family and work life.  In severe cases, the mental illness can make it almost impossible for a person to make connections and form relationships with the people around them, leaving them in a state of social poverty.  This social poverty is huge risk factor for homelessness. 

Research has shown the music therapy is a helpful tool in combating the social poverty that often leads many veterans to become homeless.  In a study in the Tennessee Medicine Journal, researchers found that music therapy was useful in “ensuring trust and moving individuals from isolation to community so that services can be provided” among a homeless veteran population.  Music often allows people to connect and communicate with others in a way that they are unable to simply with words. 

Bob Marley once said, "One good thing about music, when it hits you, you feel no pain."  While music therapy may not, in fact, take away all of a homeless soldiers' pain, it may ease the hurt and make it easier to connect with the people around them.

Wednesday, January 30, 2013

Breaking the 4-Minute Mile & Ending Veteran Homelessness

Marilyn Paul and David Peter Stroh of Bridgeway Partners in their coursework tell the story of the British competitive runner, Roger Bannister.  The story goes something like this:

For centuries runners had been trying unsuccessfully to break the 4-minute mile.  Most people believed (their mental model) that doing so was simply beyond the limits of human capability and may, in fact, be unhealthy for humans. 

But they forgot to tell Roger Bannister it couldn't be done.  He focused his energies and preparation in meeting that very goal.  Race after race, he kept getting faster and closer to the breaking the 4-minute mile.

On May 6th, 1954 at Oxford University, he did what what experts for centuries had said was not possible: he broke the 4-minute mile.  In doing so he smashed the mental barrier that said, "Impossible."

But perhaps even more remarkable, just 46 days later, the mark was broken again by another runner.  Since 1954 the 4-minute mile mark has been surpassed 1,192 times and counting.

It's a remarkable example of not listening to the experts when you believe something is possible.  It's also an example of the Law of Attraction.  As Matt Frazier wrote in his blog, "When you become certain of something, when every part of your makeup believes it because you focus on it every single day, something “magical” happens...When you have a clearly-defined purpose, a mission, and when you live every moment in a state of certainty that you’ll achieve pay special attention things that help you achieve what you’re after, things you otherwise would have never noticed."

It reminds us too that so many of our limits are perceptions.

I believe ending veteran homelessness is a 4-minute mile.  It is within our grasp.  We see the path, we just need to execute.  The political will is in place like never before thanks to lessons from Vietnam in how we treat America's war veterans, and best practices in combining housing vouchers with support services (whether treating mental, physical, or other issues) are working.

And once veteran homelessness is ended, we might just say, "Hmm. We did it.  Turns out it was possible.  Now what?  How about we end, say, youth homelessness next..."

Sunday, December 16, 2012

A Woman Sings a Song for a Soldier Come Home (a poem by Wallace Stevens)

The wound kills that does not bleed.
It has no nurse to kin to know
Nor kin to care.

And the man dies that does not fall.
He walks and dies. Nothing survives
Except what was,

Under the white clouds piled and piled
Like gathered up forgetfulness,
In sleeping air.

The clouds are over the village, the town,
To which the walker speaks
And tells of his wound,

Without a word to the people, unless
One person should come by chance,
This man or that,

So much a part of the place, so little
A person he knows, with whom he might
Talk of the weather-

And let it go, with nothing lost,
Just out of the village, at its edge,
In the quient there.

Wallace Stevens was a poet born in Reading, PA in 1879 and who died in Hartford, CT in 1955.  This poem is taken from the book, The Palm at the End of the Mind: Selected Poems and a Play by Wallace Stevens (Vintage Books, 1972).  Robert Coles turned me on to Wallace Stevens.  This poem, which I found yesterday in a Western Mass. bookstore, was published in 1946.

Monday, October 22, 2012

Collaborating Across the System to End Homelessness

Dr. Jim O'Connell is founding physician and president of the Boston Healthcare for the Homeless Program.  He has long been a practitioner serving homeless people in Boston and a local and national advocate, writer and speaker advancing our thinking in how the nation addresses homelessness.  I recently came across this quote by Jim:

"The painfully obvious lesson for me has been the futility of solving this complex social problem solely with new approaches to medical or mental health care…I dream of writing a prescription for an apartment, a studio, an SRO, or any safe housing program, good for one month, with 12 refills.”

The quote because it rings true.  It immediately implies the interconnection of housing, mental health care and physical health care--in short, a systems view--in understanding homelessness.  If we think more about interconnections we also start seeing links to employment, to education, to food access.

It's all connected.  Our challenge is to see the interconnections, understand their interplay, and determine where best to intervene.

One way to do that is by applying "systems thinking."  That means mapping the interconnections (and interdependencies) to understand the structures of the "eco-system" that produces homelessness.  It means focusing not on blame of certain people/organizations but understating and addressing those structural forces.  ("Laziness," "choosing to be homeless," etc. doesn't explain epidemic homelessness.)  Systems thinking means looking for unintended consequences of our actions and continually testing ideas and assumptions.

And as much as anything, systems thinking (and the systems acting it leads to) requires collaboration, that is, practicing radical inclusion in the process, collecting different perspectives, listening (!), and reaching out across sectors, departments, and other boundaries.  As systems thinker, Paul Plotczyk, said to me, "Systems thinking is a team sport."  He's right.

The Dr. Jim O'Connell quote is taken from a paper he wrote titled, "The Need for Homelessness Prevention: A Doctor’s View of Life and Death on the Streets," (2007)

Most of my thoughts on systems comes from (stolen from?) a variety of systems thinkers I've met or read, chief among them is David Peter Stroh whom I regularly work with and learn from.  Poor systems thinking or articulation though is all me.

Monday, May 14, 2012

A Different Face of Homelessness – Ivy, Homeless in San Francisco (Part II of II) by Craig Wiesner

We hired a fantastic illustrator named Brian Bowes to bring Ivy and her story to life in pictures and he did a great job with black and white sketches and a beautiful color cover. We released the book in June 2011 and it has received two awards, the Moonbeam Book Award and the Children’s Literary Classics Award. We’ve been working since then to get the word out about the book. Unlike The Invention of Hugo Cabret or the latest Wimpy Kid book, this one’s been a bit harder to sell, actually quite a bit. When kids do read it, they love it. Adults too. Even my mother-in-law loved the book and she’s a pretty tough critic at 82!

Now we’re hoping to get teachers to use the book in their classrooms. We’ve just completed a chapter-by-chapter study guide where we map each chapter into standards, with a chapter summary, vocabulary preview, comprehension questions, active reading strategies, author’s craft/writing prompts, curriculum connections and awareness building promptings. The study guide was developed by Carol Beaumont, a teacher in the Palo Alto Unified School District. The study guide is being edited and readied for layout this month, though we’ll make it available in draft form to teachers who want to start using it right away.

Why should Ivy be in classrooms across the country? First, it is a darned good read! There’s drama, humor, adventure, and mystery wrapped in writing that keeps you turning the pages. Plus, there’s a girl or a boy like Ivy in most schools. Teachers, administrators, parents, and other children can’t make their schools truly inclusive if they have no idea of who is being left out. There are laws in place across the country to help provide homeless children with an equal education plus get them access to critical services to help them and their families transition from homelessness to a more stable life. Today there’s legislation before Congress, HR32, which would make it easier for homeless children and their families to register for and receive these services.

One of our dreams for Ivy was that she could become an advocate for children all around the country. To bring that dream to life we have Ivy blogging about homelessness through Summer Brenner’s writing. Check out Ivy’s most recent blog post about HR32:

We’ve also created a web page with a huge set of resources for learning about and taking action on the issue of homeless families and children.

We’re excited that Give US Your Poor has added Ivy Homeless in San Francisco to its web site’s bibliography. We will do whatever it takes to get her story, which represents the stories of millions of children and their families, out into the mainstream of American thinking. When Justin Bieber learned about the plight of the children at Whitney Elementary School in Las Vegas, a school with the highest homeless population in the state, he was so moved that he gave them $100,000 and put on a special holiday concert. Ellen DeGeneres, her viewers, and Target have been incredibly generous with that school. It will take much more than the wonderful generosity of people like Ellen and Justin for there to be fewer children like Ivy across America. It will take systemic change. We’re hopeful that Ivy will be one more spark for making that change real.

To read Part I of this post click here.

Craig Wiesner is the co-founder of Reach And Teach, a peace and social justice learning company.