New model aims to fix foundational issues of chronic homelessness

James Fernandez has a desk set up in the corner of his room with books towering over it, many of them inches thick and most of them covering topics in physics and mathematics.

But there are some lessons that books don't teach.

For Fernandez, that includes learning how to live with as many as 11 other men, the maximum capacity for transitional housing at Sojourners' Alliance in Moscow, the only homeless shelter in the region. And it includes learning that he has two mental health conditions.

After Fernandez was diagnosed with anxiety and depression in November, he realized those conditions had been effecting every area of his life. In the past four years, he had started and stopped pursuing a degree at Washington State University, started and stopped various odd jobs, and lived in and left two apartments because he couldn't keep up with the costs.

Living without the pressure of rent and bills at Sojourners' has "alleviated a lot of stress and given me the opportunity now to do other things," Fernandez said.

"Like right now, I'm pursuing furthering my education at the (University of Idaho) as a resident. So I get to do homework," he said. "I'm not pulling my hair out trying to make all these things work. That's what's changing my life."

That experience is what the federal government is trying to replicate on a national level.

THE HOUSING FIRST MODEL

One of the top priorities for the U.S. Department of Housing and Urban Development is ending chronic homelessness.

According to the department's definition, individuals are chronically homeless when they've lived in a place not meant for human habitation for at least one year or on four separate occasions in the past three years, and when they can be diagnosed with at least one mental, developmental or physical disability.

People who have mental health conditions are no small fraction of the overall homeless population. This year, more people in Idaho and Washington reported they had a serious mental illness that caused them to become homeless or is keeping them homeless, according to the 2015 point-in-time count.

The count, conducted once a year, collects data on the number of homeless in a region and submits it to HUD. In Washington, 2,749 people reported they had a serious mental illness, accounting for 14 percent of the total homeless population. In Idaho, that number came to 337 statewide, or 17 percent of the total homeless population. These figures are the highest they've been in each state in the past five years.

Most homeless shelters select tenants by utilizing either a first-come, first-served model or a screening process that admits those most likely to succeed. But, according to HUD, those methods haven't proven effective, especially in reducing homelessness among the chronically homeless and those that access the most services.

HUD's new Housing First model is looking to change that.

At its basic level, the model indicates homeless shelters should provide housing to a homeless person and then address the reasons that person is homeless.

"The hope is that (the Housing First model) is really looking at some of the root issues that are (there for) the homeless (that) are chronic," said Steve Bonnar, executive director of Sojourners' Alliance. "And typically, it's going to be mental health issues there."

Bonnar said he first received HUD's notice of the model in April. The Idaho Homelessness Coordination Committee, which oversees operations statewide, created a new subcommittee to address the implementation of the Housing First model. The goal is to complete implementation by October.

In cities where homeless shelters have used the Housing First model, "they're seeing greater success regardless of the individual's state of mind," Bonnar said.

INSIDE THE BRAIN

Krista Kramer, an independent living specialist at Moscow's Disability Action Center, said finding housing becomes a full-time job for people who have a mental health condition and face homelessness.

"If that basic need isn't met, there's no room in their life for treatment or worrying about the ongoing stability issues," she said.

That's why an individual's most basic needs are often the primary concern for service providers.

For a variety of reasons, the skills required to maintain those basic needs simply aren't there.

"When somebody's dealing with a mental health diagnosis, sometimes that consistency is a bit of an issue," said Mark Leeper, president of Moscow's Disability Action Center.

Following through on tasks becomes overwhelming - if not impossible - for those who never learned how to do them in the first place.

"Let's say they have ADHD (attention deficit hyperactivity disorder) and they struggled in school and they never truly, really learned how to read or write in a clear way, or their writing is atrocious. It embarrasses them, so then they're going to run and hide from that," said Sara Bennett, clinical supervisor at Riverside Recovery in Lewiston.

A person's reality then becomes a world in which they feel they don't know what to do and therefore don't do anything, Bennett said. "Their realities are just off from the reality that we would have when we're doing well."

People may turn to alcohol or drugs, which can mask symptoms of a mental health condition. Arnold Kadrmas, former medical director of the mental health unit at St. Joseph Regional Medical Center, said addiction isn't a conscious choice for people with mental health conditions, but it happens subtly over time. (See related story.)

"When you have a psychiatric illness or addictive illness, you don't feel safe because you don't feel like you have control over your life," Kadrmas said. "And, in a sense, you don't."

OUTSIDE MANIFESTATIONS

For people with a mental health condition, lack of stability internally can - and does - manifest itself externally, as it did for Fernandez. His first stay at Sojourners' was a three-month stint in 2011.

"I got on my feet a little too fast," Fernandez said. "I wasn't ready. I wasn't addressing any of my issues."

After leaving Sojourners', Fernandez would get a job, work there for three months, quit, and then repeat the cycle.

"Work would burn me out and I'd just be upset at everybody and the world," Fernandez said. "And then not being gainfully employed, you cannot afford the cost of living."

The logistical factors that can cause anyone to become homeless - like lacking adequate income or housing - pose an extra hurdle to those with mental illnesses.

Even if a person has found affordable housing, it may not be the best living situation for them, said Ty Williams, a social worker at the Idaho Department of Health and Welfare office in Lewiston. Most low-income housing is in the style of an apartment complex, he said, and some people have diagnoses that are "not conducive" to living in close proximity to a number of neighbors.

Difficulty obtaining and maintaining a well-paying job also means difficulty funding prescription medications. Bonnar said a lack of medication is often the root of the problem for people with mental health conditions who end up homeless.

When a person with no mental health condition finds themselves without income or housing, they often have support systems - like family or friends - who can help until they get back on their feet. But Bonnar said those with mental illness often burn out their support systems more quickly.

Kramer believes "the quality of the relationships that they have is the highest risk factor" for homelessness, she said.

"If they have social skills enough to have a support network ... the chances of becoming homeless are significantly less than for those people whose conditions interfere with their ability to have relationships," Kramer said.

WHY THE HOUSING FIRST MODEL COULD WORK

When homelessness becomes a real threat for a person with a mental health condition, it activates those feelings of being overwhelmed and helpless.

"The stress sometimes can be so great to them where I've literally had to spend hours just trying to reassure someone it'll be OK because they are on the verge of just saying, 'I don't know what I'm going to do,' " said Aerius Franklin, an independent living specialist at Moscow's Disability Action Center.

Sarah Willis, who's been living at Sojourners' transitional housing for about a year, remembered how the threat of homelessness sent her mind on a spiral of questions, exacerbating her anxiety disorder and schizoaffective bipolar disorder.

"I have a lot of fears always racing around in my head anyway, and then you put the fear of being homeless and not having a roof over your head on top of that and it just exaggerates things times 100," she said.

Service providers like the Disability Action Center and the Idaho Department of Health and Welfare will look at every aspect of a person's life that could be causing them to face homelessness. Both prioritize basic needs like food and shelter, and then help connect people to applicable Social Security benefits, jobs and job training, medications, counseling and support groups and any other skill-building a person may need.

HUD's Housing First model effectively does the same. When it's fully implemented, homeless shelters will offer housing to individuals and families regardless of sobriety, income, credit, rental history, criminal history or participation in supportive services. Tenants are simply given a roof over their heads and are then encouraged to pursue additional services as needed.

"Having that shelter is pretty critical because without that, then whatever services you have really don't amount to a whole lot," Leeper said.

Willis and Fernandez say they feel more secure, focused and centered because of Sojourners' Alliance. Willis has a job in the fast-food industry and Fernandez has goals of pursuing a career in science research and development.

"I think programs like these, we need a lot more of them," Fernandez said. "I'm going to make sure that I'm a success story, and a big part of my success is because I had a place like this to set up and launch from into the world."

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Embree may be contacted at cembree@lmtribune.com or (208) 848-2278. Follow her on Twitter @chelseaembree.