LAST SPRING, Multnomah County, the Portland Housing Bureau, and Street Roots offered us a sobering glimpse at something we'd never seen before: an attempt to tally—over the course of 12 months—how many humans died on our streets.
That first report, dubbed "Domicile Unknown," found at least 47 people died while homeless in 2011. It was a slap in the face. And it led to questions: Was it an aberration? Would the next year be better? The answer, unfortunately, is no.
The county's second annual report on deaths among the homeless, officially released on Friday, May 10, shows the number actually climbing in 2012, to 56.
It's too soon to draw any definitive trend lines, but an increase of any size has advocates worried about what future years might hold.
Especially since both reports, so far, mask a potentially huge undercount. The death count draws only from cases worked and investigated by the county medical examiner's office—and doesn't include anyone lucky enough to make it into a hospital before dying. Every day, according to the most recent point-in-time snapshot of Multnomah County homelessness, some 1,700 people go without shelter every single day.
"That's pretty alarming in my mind," Israel Bayer, director of Street Roots, told the Mercury.
In light of an unscientific comparison to King County in Washington State—with nearly triple the overall population of Multnomah County and an unsheltered population only 900 people larger—the local numbers seem even worse. King County recorded 47 deaths in 2010, according to a similar survey—down from a high of 110 homeless deaths reported in 2006.
The report comes at a time of intense local scrutiny of homelessness. Multnomah County and the City of Portland this spring agreed to revise their joint plan to combat homelessness, pooling money in a way they've never before managed. Safety-net services were a big winner in Mayor Charlie Hales' proposed budget.
And everyone's watching the code-enforcement spat that's embroiling Right 2 Dream Too, a self-managed tent refuge that's provided a safe place to bed down for hundreds since a Chinatown landlord opened up his vacant land in 2011.
But the ongoing pain of life on the streets is borne out in a series of grim details:
• The average age of the 56 human beings recorded in this year's report was just 45.6 years old. Most were men. On average, a man in Multnomah County should expect to live until age 75.
• One person burned to death, in a case believed to be an accident, while another froze, dying of hypothermia, and three others drowned. (None of the deaths was listed a homicide. Reports including the details behind those deaths were not available as of press time.)
• Almost half of the deaths—20—were the result of overdoses. And, further, 18 of those overdoses involved opiates—usually heroin.
• Ten people committed suicide.
Advocates and health officials say the suicide and overdose counts should rightly be seen as related. Drug abuse can lead to suicide; the need to mute suicidal feelings can lead to drug abuse. Homelessness, with its isolation and shame, compounds both.
The hope, in a few more years, is to make a case for better funding of prevention services—including outreach to the homeless—and maybe build some leverage for housing construction.
"It's the idea that homelessness is not just about public safety," says Bayer. "We're talking about a health care issue." We should be able to prevent 56 people from dying homeless."
Advocates also desperately hope to expand the count to include hospitals—and thereby provide a more precise snapshot of the problem at hand. Both years, they've lamented hurdles that they say keep the goal out of reach.
It's difficult to share data. And hospitals don't have the time to investigate whether someone in their care was homeless or not—though officials say they're interested in working more closely with the county.
"Say somebody comes and gives an address, when, in fact, that address is a shelter," says Brian Terrett, a spokesman for Legacy Emanuel, which runs three hospitals in Multnomah County and treats loads of indigent patients. "How do we then determine that person's really homeless? It's beyond the medical scope."
Dr. Paul Lewis, Multnomah County's deputy health officer and the technician behind the death count, says poring over the medical examiner's files left him convinced that every single one of last year's deaths was avoidable.
"I work in public health," he says. "We see accidents, and what we say are accidents aren't really accidents.” We have to see if there are existing or future policies that can address these avoidable deaths, not only among the homeless but among the rest of the population."