Behavioral Health Town Hall Addresses Homelessness in Arizona

The Arizona Behavioral Health Town Hall, held annually at the Summer Institute in Flagstaff, specifically focused on homelessness, as well as the issues facing individuals who are homeless, their needs, and available services in Arizona.

The causes and factors that lead to homelessness are complex; however, there are consistent, identifiable, and contributing factors for individuals and families in urban and rural communities. Far reaching and serious conditions such as physical and behavioral health issues, domestic violence, and substance use may contribute to homelessness. Diverse strategies, approaches and coordination are necessary to assist homeless individuals to regain their independence in communities across Arizona.

In CABHP’s annual Town Hall survey of behavioral health professionals in Arizona, over 300 respondents were asked about how services had changed in the community for various populations (e.g., persons experiencing homelessness, families in the child welfare system, racial and ethnic minorities, etc.). Over half of the responses indicated that services had gotten worse for those experiencing homelessness. Additionally, open-ended feedback related to the homeless population highlighted the lack of affordable housing and limited housing services for those with serious mental illness as some of the top areas of need in the state.

The Town Hall brought together experts across Arizona system levels. Facilitated by Dr. Joanna Lucio, the expert panel raised critical questions about how behavioral health providers can better meet the needs of the community. Through a strengths-based lens, experts spoke to major gaps across the service continuum while also discussing promising practices at community and agency levels. “We are grateful for new knowledge and insight about targeted services for individuals experiencing homelessness in Arizona” said Dr. Natasha Mendoza, Director of the Center for Applied Behavioral Health Policy (CABHP).

Dr. Mendoza addressed the burgeoning levels of chronically homeless, lack of affordable housing, the need for low income and affordable housing issues they face. Dr. Mendoza highlighted that opposition to affordable housing in Arizona is one of the largest issues contributing to the growing numbers of those living without shelter.

The panel included individuals who focus on issues surrounding homelessness and community involvement with the focus on solutions:

  • Dr. Joanna Lucio, facilitator, is part of the ASU School of Public Affairs. Her research explores how urban governance, planning and policy impacts diverse groups in society. She works to advance the rights of disenfranchised residents through the evaluation and analysis of housing and neighborhood policies and programs, particularly for low-income residents.

  • Ash Uss is the Advocacy and Partnerships Coordinator of the André House of Arizona, a place of hospitality for those less fortunate inspired by the Congregation of the Holy Cross in downtown Phoenix. Direct service was her first taste of homelessness curiosity, which began as a year-long immersive position at Andre House living and working among peoples who are unsheltered.

  • Margaret Killman, Faculty Associate from the ASU School of Public Affairs is part of the Valley of the Sun United Way on Ending Homelessness where she works on critical issues related to homelessness in Maricopa County, including the recent closure of the Men’s Overflow Shelter. She has developed a number of housing initiatives for chronically homeless individuals in collaboration with the city, county and state. “We need a full understanding of the scale and scope of the problem,” she stated.

  • Tom Litwicki, Chief Executive Officer of Old Pueblo Community Services (OPCS) and has supported the Tucson Homeless Work Program. He has been recognized for his work with the homeless and prison re-entry programs. OPCS is one of the most innovative nonprofits focusing on issues of homelessness and prison re-entry.

People experiencing homelessness have complexities that others do not. Are we addressing these needs and concerns? What do we need more of? What isn’t working? What works well? Research points to how life opportunities are dependent on living spaces and communities.

One important question arose: Do we have the right people at the table when we talk about policies and programs? Uss said, “In some sense we are all experts but we try to be a conduit—the folks experiencing homelessness are the experts. We need to be asking the individuals about their lived experiences and what more they need in the homeless services system.”

Litwicki added insight about the efficacy of peer services. “OPCS is working on a project called ‘Street to Home,’ which engages people who are currently homeless in paid positions to engage with other individuals who are experiencing homelessness.”

It’s impossible to ignore that there is a disproportionate number of people of color experiencing homelessness, disparities in access to services, acknowledgement and reckoning with structural racism. “It’s important to consider how we invite people with lived experiences to participate—do they have equal input and footing? Are the spaces accessible and comfortable for them? It’s impactful to put people with lived experiences on the same level as the others finding solutions,” Killman contributed. “But we can’t approach this from a tokenism standpoint.”

Uss agreed that outreach is the most critical thing for the unsheltered population. “The greatest obstacle on a daily basis for providers can be locating the person who is supposed to be receiving services. If providers are spending 3-4 hours a day locating people, they aren’t using the resources they have,” she added.

The crisis isn’t all about data, facts, figures and bureaucratic red tape. There’s a push toward healthy communities beyond housing. How do we get stakeholders to collaborate on the solutions? Uss pointed out the lack of empathy (“The Empathy Crisis”). “So many of us have a Housing First approach, but we also expect people to resolve their own homelessness whether they are sheltered or not,” she pointed out. “It’s clear we don’t just need to get people to the table, we need movement. We need empathy and understanding of what it would mean for you to take responsibility for your own behavioral health if you didn’t have access to a bathroom 24-hours a day. It can be easy to overlook those facts.”

Should the behavioral health system adapt to meet the needs of people experiencing homelessness?

Communication is key, according to Killman. “There’s an expectation that this is the job of the behavioral health system, but we need clear roles and accountability and expectations about what we can do to reduce miscommunication and improve communication protocols.”

“People experiencing homelessness are an intersection point of every other system in this country. You have to bring the right people to the table,” said Uss. “The affiliation that is made is people experiencing homelessness because of SUD (Substance Abuse Disorder) and SMI (Serious Mental Illness), but then we are missing all of the other things that intersect in terms of their identities. One of the major groups that’s been absent in this discussion so far is the healthcare industry,” she questioned. “Where are they in these discussions and conversations? The primary barrier of people experiencing homelessness may not be that they do not have a home, but may be something else that is not being addressed.”

There is especially a need for innovative solutions, including the need for inclusive low-barrier affordable housing and services that will keep people in their housing.

Uss cited specifically, “What’s forgotten is that everyone does everything along the way to get someone a key and a lease—but what happens after someone gets a key and a lease? Someone will have waited and overcome so many barriers to housing and finally gets a key, and then opens the door to an apartment that has nothing in it and perhaps don’t know how to cook or other important skills. How do they get furniture and other basic necessities? There needs to be a program or nonprofit that has staff and individuals to fill the needs outside of traditional case management.”

Litwicki believes that there is hope. “There is a common misconception that this is not a solvable problem, but now that we have energy around this big problem and finding solutions—and that’s exciting.”

Additional Resources:

Arizona Coalition to End Homelessness

MAG Continuum of Care Committee

Pathways, the founder of Housing First

RWJ Housing Report