SALEM, Ore. — People in Salem’s most vulnerable homeless population have three strikes against them: a chronic health condition, mental health diagnosis and substance addiction.
The most likely outcome is to die in their 50s.
More than 500 people experiencing homelessness in the Salem-Keizer area have been identified in this “tri-morbid” group in the past year, up from an estimated 200 in 2014.
Studies show many won’t get help in time.
But while this population is the most vulnerable, it’s the least likely to get help because many groups focus on people with fewer issues.
“I wish people would just see us as human beings — not garbage and an embarrassment to the city,” said Kathie Dollarhide, a tri-morbid woman housed this year through Salem’s Homeless Rental Assistance Program.
“We are human, we have feelings, we live and breathe, we put on our pants the same way every day that you do,” she said.
Jimmy Jones with the ARCHES Project in Salem advocates for housing this population first and directing the majority of resources to serve them, versus other homeless populations.
These housing-first models have had notable success across the country, Jones said, with the majority seeing participants remain in housing and utilize support services about 85 percent of the time.
Salem’s Homeless Rental Assistance Program reports a success rate above 95 percent so far in its first year.
Oregon programs that require sobriety or mental health treatment ahead of housing, by comparison, have a long-term success rate of only 28 percent, Jones said. “We did it for 30 years and it didn’t work.”
The housing-first system isn’t meant to take anything away from other programs, he said, but there is a case to be made for allocating resources to this traditionally under-served homeless population.
Ignoring the tri-morbid population costs economies enormous amount of money, Jones said, including hundreds of thousands of dollars in visits to hospitals and detox centers, as well as jail, police and court costs.
And when agencies provide housing to tri-morbid clients, some research suggests it extends these individuals’ lives by upward of 15 years.
Surviving on the street
Kathie Dollarhide used to sleep under the overhang of the Kohl’s department store downtown.
She recalls the friendly faces of people who greeted her and a woman who bought her a thick coat in the winter.
But Dollarhide, 53, also remembers the people who kicked her, the woman who spat on her face and the parents who pulled their children away “like (she) was a monster.”
“I was very fearful, very terrified of being hurt,” she said. “I was raped, and all of my things were stolen many times.”
Dollarhide was identified as tri-morbid in January after being assessed at Northwest Human Services in Salem. She’d been homeless since 2015.
She has chronic obstructive pulmonary disease and post-traumatic stress disorder. She proudly told the Statesman Journal she hasn’t had a drink since August 2013 or used drugs since August 2017.
Dollarhide first came to Salem a couple years ago, fleeing an abusive partner and working her way up I-5 from Grants Pass to Ashland to Roseburg.
She came during what she described as a mental blackout, a time when her anxiety and stress was so high she couldn’t remember who she was or have any idea what was going on.
That and pseudoseizures — when her body seizes but she remains mentally aware — are some of the effects of her PTSD.
Trauma can alter brain
An estimated 40 percent of Marion County homeless adults living outside, in shelters or in cars have a mental health condition, Jones said.
Conditions vary, including anxiety and depression, bipolar disorder, schizophrenia and psychosis. And many people living on the streets have experienced traumatic events that worsen their conditions.
Past trauma and abuse compound these conditions for the majority of people facing homelessness, said Stephen Goins with Northwest Human Services.
Abuse, neglect and chronic stress from early childhood are powerful enough to change the physical structures of the brain, he said. For many, that results in debilitating mental and physical health issues.
Homelessness is its own form of trauma.
Those experiencing homelessness frequently feel an overwhelming loss, they rarely feel safe, they are frequently victimized, they lose a sense of belonging and their day-to-day life is unpredictable, Goins said.
He gave an example: Imagine you are in a room and a door suddenly slams behind you. You may jump, start to sweat, look around and tense up.
This is the amygdala — the part of the brain that shifts the body into survival mode — responding to stimulus.
But as soon as you realize you are safe, you start to relax and go back to neutral. That’s the work of the hippocampus and prefrontal cortex, the parts responsible for memory and learning, as well as rational thinking and decision making.
But the brain of someone who is homeless doesn’t always respond the same way, Goins said.
The chemicals released in this repeated flight-fight-or-freeze response have damaged the hippocampus and cortex, impairing the individual’s ability to form more logical conclusions about the slamming door.
Instead, the brain goes into survival mode, misinterpreting incoming sights, sounds and smells as a perceived threat.
For these individuals, it can take extended periods to reach a neutral state of mind again — if ever.
This makes it extremely difficult for them to seek medical care or mental health and substance abuse services.
“In reality, they simply lack the emotional tolerance and energy to navigate the complex systems of care,” Goins said.
Cydney Nestor, division director of Marion County’s Health and Human Services department, works with individuals with serious mental health conditions. Some have been hospitalized, some receive their income through social security and some have children with high mental health needs.
Marion County has two rental assistance programs, one focused on young adults. The programs provide intensive case management and peer support, as well as rental subsidies similar to the city of Salem’s new homeless assistance program.
Individuals learn skills necessary to maintain housing, Nestor said, and receive a subsidy until they are able to either use a housing voucher or pay for their rent themselves.
“When people are in safe and long-term housing, then they can focus on their other needs,” she said.
Dollarhide moved into an apartment in March through the city’s housing assistance program. She’s still learning how to adjust to her new life.
“It took me two nights to sleep in my bed; I slept on my floor,” she said. “It took me six weeks to sleep with the lights off.”
Knowing she has a stable and safe place has helped her go from suicidal and fearful to hopeful.
“I’ve come a long way since March,” Dollarhide said. “My PTSD has calmed down tremendously; I have calmed down tremendously. I’m no longer having seizures every five seconds.”
