Homelessness In Anchorage - Thoughts On What I've Been Told In OLE Class

I've been to five 75-minute classes on Homeless in Anchorage offered through OLÉ.  The class is facilitated by Nancy Burke, the Mayor's homelessness point person.  Friday's class was presented by Thea Agnew Bemben, M. A.,  who works for a consulting company on mental health.  She gave us the results of studies on ways to improve how the civilian and forensic (criminal) mental health population are served.


So after this much, here's my sense of things:

1. Berkowitz's administration is better organized and on top of things than I thought
1. At least in the data gathering aspects of homelessness
1. They're part of a couple of national models for handling data and using the data to reduce homelessness
2. Gathering data is important because it gives a picture of 
1. how many homeless there are
2. what categories the fit in
3. what services they use
4. how long they've been homeless
5. best ways to use resources
2. The Muni's data gathering system is up and running, though the sense I have is that it's a fairly recent phenomenon and it still has more to do
3. Homelessness models identify three categories of homeless on a 1-10 scale
1. 1-3 folks basically need help finding social services resources and can get themselves back into housing - these are people who have been housed and through an unexpected event (lost job, health emergency, etc) lost the ability to pay rent or mortgage
2. 4-6 moderate problems,
3. 7-10  problem homeless - mentally ill and or substance abusers that cost the city the most in police and health  and the most expensive to take care of
4. The third category is about 50% of the homeless in Anchorage
4. So, the most important way to deal with the 50% who have serious problems is to have better ways to deal with mental health in the community.  To increase the number of providers and beds available for the people with the most serious mental health problems
1. Right now both on the civil side (hospital emergency rooms, API) and the forensic side (jai/prisons), we're failing woefully.  
1. People get minimal treatment and sent back out onto the streets on the civil side.
2. On the forensic side, people wait in jail until they  can be evaluated to see if they are fit to stand trial, if they aren't, they sit in jail.  They are off the streets, get fed, get some medical treatment, but not what they should get.  And they could be in jail for months before even going to trial.  
2. A serious obstacle to enough beds is Medicaid rules that restrict payments to facilities with about 16 beds or less.  
5. Despite all the Mayor's attention to homelessness, without improving mental health access early on, the part of the homeless problem people are most upset about isn't going to go away.  And getting money for improved mental health care for the indigent is going to be hard.
6. The $40 million fund to help the homeless in Alaska will help
1. The MOA is using several different national models - including Housing First - which seems to have an immediate effect on reducing lots of the other problems homeless people have.  And getting housing that's accompanied with social workers is an important factor. 
2. There's concern that the State will cut funding because of this new source of financial help for the homeless.  

OK, that's my take on this off the top of my head after five classes.  There are two more 3 more classes, but I'll miss the last one.  

------------------------------------------------------------
The chart below comes from the Executive Summary of the Alaska Behavioral Health Systems Assessment commissioned by the Alaska Mental Health Trust with other health co-sponsors.  Thea Agnew Bembem - the presenter Friday - was part of the study team.  The Executive Summary is short and has good visuals.  I recommend a visit.  The whole study is much longer and requires a serious commitment.

I would point out the numbers and percentages of people with problems compared to the numbers and percentages of people who get help.  It's an impossible gap and probably explains not only a lot of our homelessness problems, but also accounts for dysfunctional families which create a population of kids with serious issues.  (The chart format is different in the original, but I think all the data are there.)

YOUTH

Grant Funds in State Fiscal Year 2013

Risk Behaviors 1                               
Approximately One in Five
4,641 traditional high school students had a moderate or high-risk behavior for substance use.
• The prevalence of this behavior was similar for male
and female students (20.3% compared to 16.4%)
Mental Health Issues 1, 2         
Approximately One in Four
7,214 traditional high school students experienced a mental health issue in the past year.
• The prevalence of mental health issues among female
students was higher than among male students (37.8%
compared to 19.4%)
Among 9 to 17 year olds, 5,550 (6%) were estimated to have had a serious emotional disturbance in the past year.

Youth Clients Served 4     
Approximately One in Nine
12,147 unique youth clients were served with support from state Medicaid and/or behavioral health grant funds.
Breakdown of Youth Served
By diagnosis category:
• Substance Use Disorder: 1,324 (11%)
• Serious Emotional Disturbance: 9,350 (77%) • Mild or Moderate Mental Illness: 2,215 (18%) • Co-occurring Disorders: 482 (4%)By gender:Male: 7,129 (59%) | Female: 5,018 (41%)

ADULTS

Total Prevalence 3         
Approximately One in Four
145,790 adults needed treatment for illicit drug or alcohol use and/or experienced a mental illness in the past year.
Alcohol & Illicit Drug Use 3    
Approximately One in Nine
62,815 adults needed treatment for an illicit drug or alcohol problem.

• Estimated need for treatment among low income
  adults was higher than among adults above 138% of the
  federal poverty level (16.7% compared to 11.5%)
• Estimated need for treatment among adult males
  was higher than among adult females (15.5% compared
  to 7.5%)
• About one-third of those that needed treatment
  (22,990 adults) also experienced a mental illness in the past year
  Mental Illness 3                    
  Approximately One in Five   
  105,966 adults had a mental illness in the past year.

• 61,176 adults (11.2%) had a mild mental illness, 23,487 adults (4.3%) had a moderate mental illness and 21,302
  (20%) had a serious mental illness
• Estimated mental illness among low income adults was
  higher than among adults above 138% of the federal
  poverty level (23.8% compared to 19.4%)
• Estimated mental illness among adult females was

higher than among adult males (24% compared to 15%)

Adult Clients Served 4              
Approximately One in Twenty
27,728 unique adult clients
were served with support from
state Medicaid and/or behavioral health grant funds.
Breakdown of Adults Served
By diagnosis category:
• Substance Use Disorder: 14,442 (52%)
• Serious Mental Illness: 16,841 (61%)
• Mild or Moderate Mental Illness: 2,061 (7%) • Co-occurring Disorders: 3,690 (13%)By gender:Male: 11,480 (41%) | Female: 16,232 (59%)

Behavioral health services in Alaska are funded through a mix of Medicaid, state and federal grants, Indian Health Service Compact and other Tribal funds, private insurance, self-pay and uncompensated care so the utilization data analyzed tells only part of the story. Nonetheless, the report’s findings reinforce what we heard from stakeholders: the behavioral health needs of many Alaskans are going unmet resulting in higher costs and poorer health outcomes.