Yves AugustinHolistic Strategist

Table of Contents Who are the Homeless? Becoming Invisible Surviving the Streets Healthcare Cost San Francisco’s Ten-Year Plan The Big Picture Holistic System of Care My Holistic Care Approach Lessons Learned Human Interconnectedness

Who are the Homeless?

Primary homelessness: they are rough sleepers

Secondary homelessness: they stay in shelters, refuges or with relatives

Tertiary homelessness: e.g., they stay at boarding houses, SROs, motels, hotels (Butterfield, 1999)

Who are the Homeless, cont. Around 580,000 and

800,000 people are considered homeless in the U.S. - while there are about 18 million vacant homes around the country.

For every homeless person in U.S., there are between 20 and 24 vacant homes (Gibson, 2015).

Across Europe, 400,000 individuals are homeless on any given night – and the numbers continue to rise (Hwang & Burns, 2014).

Around 150,000 people are considered homeless in France - while there are about 2 million vacant properties around the country (McPartland, 2014).

Who are the Homeless, cont.

Becoming Invisible

Homeless people are de-humanized and become invisible to the point we are unable to even notice our own family members if they are living on the streets.

Becoming Invisible, cont.

Surviving the Streets Addiction treatment studies

are one popular option among homeless people to survive on the streets.

Many take drugs just so they can qualify for those studies –which are for psychiatric drugs: antipsychotics, antidepressants, anxiety drugs, and stimulants.

Drug study recruiters often park outside shelters and approach residents on sidewalks.

Volunteers are typically paid $40 to $50 per visit.

Surviving the Streets, cont. Homeless Man #1: “I used to take Risperdal. That drug will

turn you into a zombie. I couldn’t sit up without falling asleep.”

Homeless Man # 2: “I was on Depakote and I almost killed someone out of anger. It made me a wrecking machine.”

Homeless Man #3: “I only do schizophrenic research studies, even though I’m schizophrenic and bipolar…I tried to do the one for severe patients but they wouldn’t let me in. You have to hear voices every day of the week, and I only hear once or twice a month.”

Shelter Program Supervisor: “These guys have no job, no home, and a habit. You have people at their lowest state, and they’ll say yes to anything.”

Surviving the Streets, cont. In 2007, Bristol Myers Squibb settled federal charges

over the illegal marketing of Abilify.

In 2009, Eli Lilly pled guilty to criminal & civil charges, and paid a $1.4 billion penalty for illegal marketing of Zyprexa.

Large settlements or penalties against AstraZeneca (for Seroquel), Pfizer (Geodon) came later.

In 2013, Johnson & Johnson paid $2.2 billion for illegally marketing Risperdal (Elliott, 2014).

Surviving the Streets, cont. Homeless people are the sickest in our

society:

Their rates of tuberculosis infection are at least 20 times higher than the general population.

Their rates of depression and psychosis are up to seven times higher in the homeless population than the general population.

They are also 2 to 5 times more likely to die prematurely than the general population.

They are old decades before the rest of the population because of their poor health (Hwang & Burns, 2014).

Surviving the Streets, cont. Consequences of Homelessness include:

difficulty recuperating from illness

exposure to gratuitous violence, theft of possessions

social isolation, malnutrition

exposure to extremes of weather

low self esteem, poverty and poor continuity of needed health care

mental illness: from distress to disorders

Surviving the Streets, cont.

Healthcare Cost Homeless individuals make about 1 million hospital visits

per year in US, which is the equivalent of $6.7 billion in ‘unnecessary’ health care expenditures, according to the federal Agency for Healthcare Research and Quality (Pearson, 2012).

In the UK, homeless people are around four times more likely to use emergency hospital services than the general population, costing the National Health Service around £85 million a year (Hwang & Burns, 2014).

Repeated emergency room visits and nights in jail by that chronically homeless people in US cost around $30,000 to $50,000 per person, per year – approximately $3 billion annually (Gibson, 2015).

Healthcare Cost, cont.

San Francisco Fire Dept. reports that 201 frequent fliers, use an ambulance 4 or more times in 1 year; 50 of those use the service 10 or more times and about 20 have taken ambulance rides between 30 and 120 times.

Alameda County officials report: 82 frequent users who rode in an ambulance 11 times or more in 1 year. The top frequent flier used the service 73 times (Noyes, 2012).

San Francisco’s Ten Year Plan

In 2004, San Francisco launched an ambitious effort to end chronic homelessness.

In 2014, this 10-year effort has had limited successes and many failures at moving people off the streets (Knight, 2014).

San Francisco’s Ten Year Plan, cont. SF homeless population is

up 3% since 2005. In 2004, SF had 1,910 shelter

beds, and now it has 1,145. It has half the drop-in centers for homeless people during the day than it did 10 years ago.

SF has about 74 shelter spaces for families. There is a 6-month wait to secure one of them. Currently, about 200 families are on the waiting list(Knight, 2014).

San Francisco’s Ten Year Plan, cont.

From 2004 t0 2014, SF spent roughly $1.5 billion to move around 19,500 homeless people off its streets. But the homeless population hasn't budged, showing that as one homeless person is helped, another takes his place.

SF spends $165 million a year on homeless services, about half of which funds supportive housing. That's one of the highest levels of per-capita spending on homelessness of any American city (Knight, 2014).

The Big Picture “A lot of people in our

industry haven't had very diverse experiences. So they don't have enough dots to connect, and they end up with very linear solutions without a broad perspective on the problem. The broader one's understanding of the human experience, the better design we will have.” ~Steve Jobs

The Big Picture, cont.

Steve Jobs attained unprecedented success in business thanks to his holistic approach to innovation.

A holistic approach to homelessness will produce unprecedented results that are beneficial to all.

The Big Picture, cont. The more you understand

the big picture, the more you can use your personal journey in your healing process and/or to inspire others.

Australian motivational speaker, Nick Vujicic , shares his journey of hardships with a young audience.

The Big Picture, cont.

The Big Picture, cont. The relationship

(between client & service provider) also involves sharing vulnerability to create safety and foster personal connection.

Brené Brown’s talk : The power of vulnerability.

The Big Picture, cont.

Holistic System of Care

Holistic medicine practitioners believe that the whole person is made up of interdependent parts (body, mind, spirit, and emotions) and if one part is not working properly, all the other parts will be affected.

“The Part Can Never Be Well Unless the Whole is Well” ~Plato

Holistic System of Care, cont.

Holistic System of Care provides behavioral health care, promotes health, and prevents disease.

The holistic model links treatment, prevention, and recovery.

Holistic System of Care, cont. Well-being refers to the medical, social, economic,

psychological, spiritual and/or environmental state of an individual or group.

High well-being means that, in some sense, the individual or group's experience is positive, while low well-being is associated with negative happenings.

Healing is related to wholeness, and wholeness is experienced in connection with others.

Holistic System of Care, cont.

“Holistic System of Care: a ten-year perspective” – a published report by Nebelkopf and Wright in 2011.

Holistic System of Care, cont.

490 adult substances abusers enrolled in this series of studies from 2003-2008

24% reported using alcohol or drugs in the prior 30 days at baseline – but 5 % decline 6 months later

A decreasing rate of change from 47% to 23% regarding experiences with stress, emotions, depression, etc.

Holistic System of Care, cont.

14 Social Determinants of Health were determined at York University Conference in Toronto (Canada) in 2002.

1. aboriginal status2. disability3. early life4. education5. employment & working

conditions6. food insecurity7. health services8. gender9. housing10. income & income distribution11. race12. social exclusion13. social safety net14. employment & job security

Holistic System of Care, cont.

Immigration and language barrier must be added as the 15th social determinant of health.

Past and present trauma are inextricably linked.

My Holistic Care Approach

I worked for a supportive housing program in Berkeley-Oakland area (CA) from 2009 t0 2011.

13 clients were enrolled. Twelve had around 5-10 years of chronic homelessness. The 13th client was homeless for over 30 years.

I developed and managed holistic education projects to provide all clients with necessary life skills, restore self-sufficiency, and foster social reintegration.

My Holistic Care Approach, cont. 12 clients kept their housing

during my 2 years of employment despite ongoing challenges: depression, anger, alcohol & drug abuse, eviction threats from landlords, etc.

Their frequent trips to the ER and jail, prior to being housed, were reduced significantly from 10 times or more per year to 3-4 times per year.

My Holistic Care Approach, cont.

13th client was Roland Bacon – a 78-year-old blind homeless man in the Oakland-Berkeley for over 30 years.

I placed him in a nursing home 1 year after initial contact. He died 3 months later after he was placed (picture on the right).

My Holistic Care Approach, cont.

Many former homeless individuals, who live in supportive housing, do not find those programs as much supportive as they should be. As a result, their housing becomes instantly in jeopardy.

In 2007, a federal study reported that 80 to 85 percent retention rates on average (Bridegam , 2007).

The real question is: why did 15 to 20 percent fail to keep their housing???

My Holistic Care Approach, cont.

My holistic care approach was successful thanks to my combined ability to both identify and meet the multiple needs of each client, such as: physical, mental, social, financial, educational, cultural, emotional, recreational, vocational, spiritual, etc.

Holistic Care Approach, cont.

My holistic model integrates primary care, mental health, housing, education, employment, life skills education, life coaching, community building, art therapy, animal-assisted therapy, cultural competency, spirituality, etc.

Lessons Learned Each of us needs a support

support system thatcorresponds to the variousdimensions of our humanexperience.

Without a support system, our development and survival are in seriousdanger.

Our human expereince iseverything but linear –although our social programming keepsteaching us the contrary.

Lessons Learned, cont. Questioning our social

programming is both a right and a duty.

The relationship “teacher-student” is neither linearnor one-way. It is alwayspresent in every single of our intereactions withothers. In reality, we playboth roles all the time, even when we are not aware of it.

Failure teaches success(Japanese proverb).

Lessons Learned, cont.

Human Interconnectedness Homelessness is a human problem , which

requires human-centered solutions.

Key ingredients of my holistic care approach: acceptance, compassion, commitment , consistency, empathy, faith, honesty, hope, kindness and trust.

My holistic care approach enables my clients and me to see each other first as humans in order to leverage our human interconnectedness - despite our differences in race, gender, age, creed, class, national origins, sexual orientation, etc.

Human Interconnectedness, cont.

Human Interconnectedness, cont.

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