By Joanne Zuhl, Staff Writer
He was one of a kind — the man in the white tuxedo and
Mickey Mouse ears, playing his trumpet from a corner perch on the Hawthorne
Bridge.
But on Nov. 6, “Working” Kirk Reeves became one in a list of
Multnomah County’s “domicile unknowns.”
In its second annual report on homeless deaths released May
10, Multnomah County announced there were 56 such deaths in the 2012, more than
one a week, according to the Oregon State Medical Examiner’s Office. Ten of
them, like Reeves, took their own lives.
Last fall, Reeves wrote publicly about his struggles with
homelessness and depression, as well as his hopes in the few weeks before he
took his own life. But whereas Reeves was a local celebrity, so many others on
the list perished in social anonymity.
The title of the Medical Examiner’s, “Domicile Unknown,”
refers to the category on death records added in December 2010. The figures
begin to give a picture of how many people experiencing homelessness die on the
streets. The number is up compared to 2011, when 47 deaths were recorded.
But the figure is still just a snapshot, a subcategory of
mortality among the thousands of people who experience homelessness every night
in Multnomah County, and the estimated 16,000 who will experience a period of
homelessness here in the course of a given year.
“It’s a reflection on us as a community on how we value
people’s lives,” says Multnomah County Commissioner Deborah Kafoury, who along
with Street Roots spearheaded the report. “Just because someone is sick, or has
a mental illness, or a drug addiction, that doesn’t mean they’re any less of a
person. The fact is that each one of these deaths was preventable. It’s
incumbent upon us to do something about that.”
“Domicile Unknown” has been a joint project between
Multnomah County and Street Roots. Executive Director Israel Bayer says one of
the reasons Street Roots found it important to advocate for and coauthor this
report was to understand the real implications experiencing homelessness has on
a person’s health.
“Fifty-six people died homeless on the streets last year,
many of whom died absolutely horrible deaths, by burning to death, drowning,
suicide, etcetera,” Bayer says. “It’s up to the entire community to do better.”
The deaths were classified as natural, accident, suicide,
homicide or undetermined. The most common cause of accidental death is from
trauma and intoxication. The trauma cases included drowning, burns and
hypothermia. Among the cases of intoxications, Heroin was the most common
substance that caused death, followed by alcohol, methamphetamine, cocaine and
oxycodone. Here are a few more details on the numbers:
-The ages of those who died were between 21 and 72, with the
average age of death being 45. The average life expectancy in Multnomah County
is 71.
-The majority, 48 out of the 56, were male.
-30 of the deaths were categorized as accidental, including
trauma and intoxications.
-14 of the deaths were categorized as natural, including
complications from alcohol use and health conditions.
“What stands out is the preventable nature of the majority
of the deaths,” said Paul Lewis, deputy health officer for Multnomah, Clackamas
and Washington counties. “That, and the young age. 45 is too young.”
Lewis worked with the Medical Examiner’s office in compiling
the figures and determining who met the definition of homeless according to the
federal Department of Housing and Urban Development, or HUD.
The figures in the report do not necessarily reflect all
those who died homeless last year. It only includes those who are investigated
and certified by the medical examiner, and not necessarily those who may have
passed away in a hotel, for example, or those not in the care of a physician,
such as at the hospital, at the time of death.
“It’s a basement,” Lewis says of the numbers. “We know
there’s stuff on top of this. Even in the subset, incomplete though it is, it’s
a substantial number.”
“People knew I was suicidal and
all I could promise was I would wait before killing myself. Not easy when you
have no hope, no joy, no passion, nothing” … I did promise I would wait but
what do I have worth waiting for?
— Kirk Reeves, Oct. 23.
Reeves died from a self-inflicted gunshot wound by Bybee
Lake. He was believed to have been staying with friends for a period before his
death, a status consistent with the federal definition of homelessness. But
Reeve’s e-mails to friends and family reveal a long-term struggle with
depression and feelings of hopelessness. He spoke openly of committing suicide
after lamenting not only his lack of housing stability, but the deterioration
of his eyesight from cataracts, which he blamed on his homelessness.
On and off the streets, Reeves at one point writes about
finding an apartment, only to be told he couldn’t move in, he wrote, because
someone identified him as a “street performer.” It hurt, he wrote on Oct. 23,
“because no matter how I tried, this was telling me I would NEVER get off the
streets. I would never be nothing more than a street performer. … Hard work
and rainbows and people pulling for you were meaningless. But the things and
people telling me ‘We don’t want you here!’ were right and will win. And guess
what? I don’t want to be here either! It hurt that much.”
But there was hope, too. In the same long e-mail, he wrote
that his eyesight was better thanks to a surgery and new glasses. “I do like
seeing people smile, especially children. I mentioned many bad things, the
depression, being sick, people hurting me but the worse was I couldn’t see
people smile, especially children. Now I can.”
Seth Lyon is the senior program development specialist with
the Community Services Division of Multnomah County Human Services. Suicide is
just one measure of the physical and emotional toll of the prolonged economic
crisis, both on and off the streets. And it has been on the rise across Oregon
for the past 10 years.
“For me, suicide is really about hopelessness,” says Lyons.
“Opportunities have shrunk for people. And the capacity for becoming hopeless
is much higher.”
In his experience, working both in issues of mental health
and homelessness, Lyon says he finds that the streets bring with them their own
health syndrome — often a combination of traumas, including addiction, mental
illness and physical injury — that manifests its own condition, unique to the experiences
of each individual.
“That stuff just doesn’t always get better with a pill; it’s
a whole lif,” Lyon says, dismissing the notion that the homeless are some sort
of homogenous group, for whom programmed solutions serve the universal needs of
the deserving.
“Anybody could become homeless. It’s extremely detrimental
to your health and we should be thinking about that as a health care issue.
It’s a public health issue. We need to think of people’s health as something
that we look at holistically, and reach out to people.”
Lyon praises the work of agencies to prevent families from
becoming homeless, and getting families and individuals off the streets. But
the real challenge, and for Lyon an important measure of success, is connecting
with those who are the hardest to reach — those who are often found at the end
of their ropes.
“This is the time when hope is harder to come by,” he says.
“But it’s never been a more important part of what we do.”
This is only the second report on homeless deaths compiled
by Multnomah County, making any trend analysis premature. But Kafoury said that
since the initial report was published, there has been a greater emphasis on
prevention in the area of substance abuse and health care reform.
“We’re working with the legislature right now on a bill to
allow people to have access to naloxone, a drug that reverses overdoses. “Right
now it’s available if you have a prescription. We would like to make it legal
as an over-the-counter drug to drug users, their friends, families and
counselors.”
Senate Bill 384, now before the House Committee on Health
Care, would allow a person to possess and administer naloxone provided they
successfully completed training on the drug’s use. “Naloxone is proven to save
people’s lives,” Kafoury says.
Gary Oxman is the former public health physician for
Multnomah County. He retired at the start of this year after 28 years in the
county’s service. The number of homeless deaths by heroin and opiate overdoses
was not lost on Oxman, who has been lauded for his work in the 1990s to stem
the tide of heroin overdoses and save lives.
“These people are people,” Oxman says. “They’re somebody’s
son or daughter, somebody’s father, a brother, a friend. They are members of
our community. I think people all too often see the combination of homelessness
and drug abuse, and assume that represents a permanent state for these
individual. The reality is, people cycle in and out of the bad times in their
lives. No one is a throw away person, and that applies to the folks who are
affected by homelessness and drug abuse.”
Oxman is quick to note that the problems with heroin abuse
are not just an issue for people experiencing homelessness.
“There is a much larger opiate abuse problem in the
community,” Oxman said. “It’s certainly not isolated to the homeless
community.”
Indeed, heroin overdoses statewide rose 42 percent from 2002
to 2011, according to the state medical examiner’s report on drug related
deaths. Overdoses kill more Oregonians annually — 143 in 2011 — than motor
vehicle accidents, according to the report. Of all accidental deaths due to
overdose in Multnomah County last year, one in six were among people who were
homeless.
For more than two decades, the homeless youth center Outside
In has operated a needle exchange program. It deals in more than half a million
needles each year, removing more needles off the streets than it distributes.
Congress has prohibited any federal funding for needle exchange programs, with
much of the cost picked up by the county and the city. Oxman supports the
needle exchange program, which has been axed from the proposed city budget,
“Any reduction in needle exchange services will be really
unfortunate,” Oxman says. “Not only does it play a role in preventing the spread
of illness, but it’s also a critical gateway to keep substance abusers engaged
with the larger system, and continue to work with them around issues of
recovery.”
Oxman also says safe injection sites —— which operate in
Canada and Europe but not the United States —— could be another way to curb the
recurrent heroin crisis.
“Where they’ve been implemented internationally, they appear
to have reduced death and other complications of drug use. I think their value
has been shown,” Oxman says. “They improve health and they save lives. I think
it’s a question whether they can be implemented and gain political and
community support in this country.”
Another opportunity for change is in the state’s new
Medicaid delivery system that last year received a $2 billion boost in federal
dollars. The funding is helping launch coordinated care organizations, intended
to leverage greater flexibility in how they treat, charge and manage patients,
including social service. That Medicaid funding, County Commissioner Deborah Kafoury
says, also incorporates housing as part of the health care solution.
“Those of us who have worked in the field on issues related
to housing and homelessness, understand the correlation between health and
housing,” Kafoury says. “It’s realizing that housing is a health care
determinant.”
In 2014, Medicaid eligibility will be expanded and 200,000
more Oregonians are expected to be added to the rolls. The report calls for
increased outreach efforts to ensure that people experiencing homelessness are
enrolled.
“Homelessness often times is framed as a public safety
issue, but the reality is it’s a health care issue,” says Street Roots’ Israel
Bayer. “We know that by providing people a safe and stable home that we could
give people the opportunity to live long and successful lives. It’s been well
documented that homelessness literally takes years off of people’s lives and
costs the system an enormous amount of money. Housing is not only the safest
way to provide people adequate healthcare, it’s always the most cost
effective.”
Each year, several organizations, including Outside In,
Operation Nightwatch, and St. Andre Bessette Catholic Church, come together to
remember those who died, most of them either alone, homeless or in trauma. This
year, there were more than 120 names on the list, including “the man who jumped
from the balcony, Oct. 2.” They are all remembered, even if their names are
not.
Kirk Reeves’ memorial drew hundreds of people to the
Hawthorne Bridge to remember the man in the white tuxedo and Mickey Mouse ears.
They may not have known how much he struggled with his health and housing, or
how much he contemplated a future of war or god’s role in it all, as he did at
length in his writings. But they should know that he also wrote of the joy of
rainbows and “jungle butterflies,” a peaceful anomaly in a dog-eat-dog world.
He wrote of the reminders that despite all the challenges and problems, there
were still things worth living for.
“So what can I do? I can go out and perform,” he wrote. “I
can make at least one person smile.”
Read the Street Roots editorial here.
View the 2013 Domicile Unkown report on Multnomah County’s website: http://multco.us/sites/default/files/health/documents/2012_domicile_unknown_final_report.pdf
This article appears in 2013-05-10.