Drug overdoses and medical conditions contributed to the largest number of deaths among the 126 people who died while homeless in Multnomah County in 2020, highlighting need for services, permanent housing.
The last time Hope Yamasaki saw her son was at the end of January 2020. On Feb. 27, 2020, Chris Madson-Yamasaki died from a methamphetamine overdose at 26 years old, just a month before his 27th birthday.
Chris Madson-Yamasaki’s mom had begged him to let her take him somewhere. “He just didn’t look right,” Hope Yamasaki recalled. At the very least, she wanted to give him some warm clothes and a sleeping bag, but instead, he hugged her and vanished without accepting either offer.
Chris Madson-Yamasaki is one of 126 people who died in Multnomah County while experiencing homelessness in 2020. The Domicile Unknown report , compiled by Multnomah County and co-published by Street Roots advocacy, released Dec. 15 found methamphetamine use contributed to nearly half of all deaths.
The number of deaths recorded in Domicile Unknown reports increased each of the last three years, from 79 in 2017 to 92 in 2018, to 113 in 2019, to 126 in 2020.
Since 2011, when the medical examiner began tracking deaths among homeless people, the yearly average number of deaths has more than doubled; 47.75 average annual deaths from 2011 through 2014 have increased to 96.33 average annual deaths since 2015. Deaths of homeless people account for around 9% of all deaths investigated by the medical examiner in the last five years, according to the report.
“The majority of these deaths were preventable,” reads the executive summary of the report.
Deaths listed as accidental, including trauma and intoxication, were the most common in the report, accounting for 56%. Deaths from “natural causes” accounted for 32% of deaths and were the second most common cause listed in the report.
The report found no deaths recorded in 2020 directly caused by complications from COVID-19. However, some testing limitations and report methodology may have caused an undercount. For instance, people “hospitalized for at least 24 hours prior to a natural death,” were not captured in the report.
Jennifer Vines, health officer with the Multnomah County Health Department, points to a few reasons for no recorded COVID-19 deaths in the report: The low threshold that would’ve resulted in a COVID-19 test at the time; potential false-negative tests; and the fact that the big wave of illness occurred in December 2020 through January 2021.
“I think (an undercount) is possible, and I think there were some good questions that we don’t know the answer to, like how well the tests would pick up (COVID-19) 24 hours after someone died,” Vines said. “It depends on when and how people were found.”
To Vines’ knowledge, there were no COVID-19 outbreaks in communities living outdoors, in addition to the zero recorded deaths associated with the virus. A little over half of the people who died last year were found outside.
“People living outdoors, while it carries a ton of other risks, would presumably lower your risk of transmission,” she said.
Age at time of death The average age of death in this report was 43 for women and 46 for men. Since the population of those who died was so young and COVID-19 greatly impacted older people, this is another potential reason for no COVID-associated deaths. Still, Vines thinks this young of an average age of death is cause for concern.
“People in this country, when they are born, generally expect to live anywhere from 70 to 85 years depending on your social circumstances, but that is an incredibly young average age of death,” Vines said. “That’s a lot of years of life lost.”
Although there were no recorded COVID-19 deaths, the pandemic itself had many damaging impacts on the houseless community as a whole.
“COVID-19 ripple effects around mental health, behavioral health, people’s stress levels, their isolation levels, and violence, again are not directly attributable to COVID-19, but they are part of the disaster that has been COVID-19,” Vines said.
Racial Disparities The report found significant racial disparities in deaths. People of color are overrepresented in the homeless population in Multnomah County, and more likely to die homeless than white people .
White people made up 75% of the deaths, making them slightly underrepresented compared to their population makeup in the county — 79%. Black people made up 11% of the deaths reported which is nearly double their population in the county. Also overrepresented, American Indian and Alaska Natives accounted for 4% of the deaths relative to making up 1.4% of the county population.
Marisa Zapata, collaborative director of Homelessness Research & Action Collaborative, said the disparity has worsened in recent years.
“It’s heartbreaking,” Zapata said. “Every person that dies on the streets is a life we could’ve helped and potentially saved. The racial disparity numbers are always enraging, but they’re also not surprising.”
Black people tend to be worse off than their white peers while living on the streets, she said.
“In 2020, we were seeing disparities in things (like) the percentage of Black people experiencing homelessness who were unsheltered having fewer tents than people who were white,” Zapata said. “To me, that indicates that Black people and Native Americans are in an even greater threat situation when unsheltered.”
Effects of gun violence On Sept. 29, 2020, Amber Coughtry and her friend Billy Lewnes were fatally shot while parked overnight in their vehicles next to the Heron Lakes Golf Club. Coughtry was just 41 years old.
What exactly happened that night is still a mystery, but this occurred at the same time the city was seeing a spike in gun violence city-wide. Twelve deaths were due to suicide and homicide, and 75% of homicides were from a firearm.
Laurie Bushnell remembers all the good things about her daughter, like how she cared for others.
“Most kids bring home stray dogs or cats; she would always bring home stray people,” Bushnell said. “She was so caring in that way that everyone loved her.”
One of Coughtry’s three siblings is someone she brought home when he was 12 years old. Today he is 43 years old and part of the family.
“She was a good person, she was a sister, a daughter, a mother, a granddaughter, an auntie that loved everybody,” Bushnell said. “She didn’t have a bad bone in her body. Everyone was her friend. She had so many friends. People came to her memorial that we had from kindergarten. She was one of the most caring persons that you could imagine.”
Substance use Substance use was involved in 62% of all deaths in the report, and 79% included amphetamine and methamphetamine. Methamphetamine was the leading cause or contributor to death in 2019 and 2020.
Seeking help or a place to rest and recover after taking meth is hard to come by because many facilities and shelters don’t accept people using methamphetamine. Chris Madson-Yamasaki was turned away from many places, such as detox centers, because they didn’t accept methamphetamine users.
“They told me meth isn’t as dangerous as alcohol and heroin withdrawals, so there was nothing they could do with him, and he would just have to go on a waitlist,” Hope Yamasaki said.
Sam Junge, Portland People’s Outreach Program’s harm reduction volunteer and Portland Drug Users Union volunteer, said what people need when coming down from meth is a safe place to rest and recover. Still, options in the city are slim, especially during the pandemic.
“The reason more people may be dying from meth is a lack of resources, a lack of support and a lack of institutional investment in care,” Junge says. “With this pandemic, there are way more people using in general and way more people without access to housing or hygiene that are using.”
Junge has about 14 years of experience dealing with methamphetamine. The first seven of those years, he was a drug user himself. He’s spent the last seven years assisting and working directly with people struggling with the same issues.
“As I was using drugs and seeing how drug users were treated and depicted and cared for both among mainstream institutions and in the context of social justice or radical work, it became a very important issue for me,” Junge said.
One treatment that is lacking in the system is dual diagnosis centers that can simultaneously treat mental illness and drug addiction.
Hope Yamasaki said mental health institutions kicked her son out for being a drug user, and rehabilitation centers would kick him out for his mental illness.
“He needed to deal with addiction and mental health at the same time, and we couldn’t seem to get that to happen,” Hope Yamasaki said. “He got into (Native American Rehabilitation Association), but got kicked out for smoking cigarettes in the fire escape, and he wasn’t supposed to do that. With his mental health, he wasn’t able to follow instructions.”
Chris Madson-Yamasaki was on the waitlist for a dual diagnosis center when he died.
Dr. Eowyn Reike, medical director of outpatient and youth services at Fora Health, said she believes many people have dual diagnoses who have not yet had an official diagnosis. Reike said the lack of diagnoses results partly because of the stigma around both topics and the scarcity of places to get specialized treatment.
“We continue to think of people with substance abuse issues as people who are weak or have a moral failing or are using for some other reason,” Reike said. “We don’t look at them as people who are trying to treat a condition because we don’t do a good job of treating it.”
Often people begin using a substance to treat a mental illness they have but may or may not have been diagnosed for, she said.
“(Mental health and addiction) is an underlying part of so many people’s experience,” Reike said. “I think it can be really hard to recover from either substance abuse or mental health conditions without getting them treated at the same time. For example, if you have severe anxiety and you use opioids and they help reduce your anxiety, but if you only get help with your substance abuse. Your anxiety persists. It’s going to be very hard to stay sober.”
Since Chris was over the age of 25, he couldn’t go back into transition housing, which worked well for him in the past.
“When you’re under 25, apparently there’s more resources available to you, but once you’re over 25, you phase out of those,” Hope Yamasaki said. “He didn’t make it to 27 because that year was so hard.”
Zapata said the system change after 25 is hard for many people, and what needs to change is that people in need should not bear the brunt of the transition.
“It’s like exiting foster care, anytime that particularly a young person is having to exit one system and potentially enter a different system, it doesn’t work,” Zapata said. “Particularly if he’s having to get on new waitlists, that’s going to create a lapse in service.”
It is even more challenging for people dealing with addiction issues when combined with not having shelter.
“If someone is having a mental health crisis, they might get dropped at the mental health hospital just to be released 48 hours later or a week later, but then there’s nowhere to go,” Hope Yamasaki said. “So then, how can you do well if you don’t even have anywhere to sleep?”
Junge said so many people are limited in where they can go, and more people need help and a place to go. If they don’t get the rest and any treatment they need, it can result in methamphetamine-induced psychosis, producing delusions or hallucinations.
Junge said it’s essential to focus on where the system lacks services rather than the drug itself. Misplaced focus diverts attention from systemic issues that need significant improvements, such as more treatment centers accepting methamphetamine users and dual diagnosis centers.
“There’s nowhere for people to go, whether it’s nutrition, hygiene or warmth,” Junge said.
Hope Yamasaki experienced this first hand for years and did everything she could to get Chris the treatment he needed. She said she can’t imagine what it’s like for people living outside who don’t have anyone to help them.
“There’s no help for folks,” Hope says. “People assume that if you’re houseless and you’re on drugs that you can just walk into a detox center if you’re willing to get help, and then you’ll go into a shelter, but that’s not always the case.”
Reike also references the stress, violence and desperation, and the shame that often goes with homelessness, which may make someone more vulnerable to developing a mental health condition.
“I can’t imagine what it must be like to need to find a place to sleep each night, worry about getting woken up in the middle of the night by having someone forcing you to move, having your belongings taken or stolen frequently, never getting enough sleep, being out in the elements, and having people treat you badly when you’re just trying to survive,” Reike said. “If I was in that situation, I know I would feel depression or anxiety.”
Ultimately, Hope Yamasaki believes her son needed ongoing treatment that was less rigid and low-barrier entry to the resources he needed most right when he needed them.
“You have a small window, especially folks with mental health problems, they’ll want to go get treatment, and you don’t really get to plan ahead for that,” Hope Yamasaki said. “You just have to be ready when they are. It’s not as simple as everybody thinks to get help or get off drugs.
“I just want people to know he was really loved and that he mattered. He really mattered.”
Editor's note: The following sentence has been updated to clarify Hope Yamasaki's statements about mental health institutions refusing to treat Chris Madson-Yamasaki : Hope Yamasaki said mental health institutions kicked her son out for being a drug user, and rehabilitation centers would kick him out for his mental illness.
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