Many of the homeless who die on San Francisco’s streets have little contact with city shelters or services for mental health or substance use in the years before their deaths, according to a new city report.
The findings of the three-year homeless death report, which was presented to the Health Commission Tuesday night, show the need for The City to do more to reach out to those who are not engaged in services, according to the report’s author Dr. Barry Zevin.
Zevin, who provides medical care to the homeless for the Department of Public Health, has worked for the past several years to improve on The City’s imprecise method for measuring homeless deaths, as previously reported by the San Francisco Examiner.
His new report takes a deeper dive into medical examiner cases to better ascertain who was homeless, and provides additional details about the deaths, such as causes and demographics.
There were 128 homeless deaths in both 2016 and 2017, while in 2018 the count was at least 135. More cases from last year are expected to be reported in the coming months.
There was a concentration of deaths in the Civic Center, Tenderloin, SoMa and Mission, but “these deaths occurred all over the city,” Zevin told the Health Commission.
Drugs like methamphetamine or opioids caused or contributed to 52 percent of the deaths while alcohol caused or contributed to 32 percent of the deaths.
Nearly 70 percent of the homeless residents who have died since 2016 had not stayed in a shelter or Navigation Center in the 12 months before their death.
“Most people had no stay, not even a single night, in a shelter or Navigation Center in the past 12 months and even if we go back to past years, many of those people had very scant shelter or Navigation Center use,” Zevin said.
Forty-two percent had been homeless for more than a decade, the report said.
San Francisco has a relatively high number of homeless deaths per capita; Zevin said that while New York City has about double the number of deaths, its homeless population is about ten times larger.
There “are likely many reasons” for San Francisco’s “proportionately dramatically larger number of deaths,” but New York City’s law requiring everyone have a right to shelter is likely one factor, Zevin said. “We don’t currently have the capacity to shelter everyone who needs to be sheltered,” he said.
He also highlighted that many of those who died were not engaged in city services. “Although we talk a lot about high users of multiple systems, most of the people here had very little use in our emergency and urgent systems and even less in our primary care mental health and substance use disorder treatment systems,” he said.
Zevin recommended The City improve alcohol treatment services, a “system that may not be put together in such a way to reach the highest risk individuals.”
Deena Lahn, of the San Francisco Community Clinic Consortium, said she hoped the report would change the way The City prioritizes housing, citing a “lack of coordination between our housing opportunities, which I know are very limited, and people’s health status.”
Lahn said that those treating the homeless are frustrated that “no matter how they evaluate the person’s care, it doesn’t seem to affect their ability to eventually get into some kind of housing situation.” Fixing this, she said, will “hopefully avoid some of the preventable deaths here.”
More than 50 percent of the deaths were the results of accidents, such as unintentional overdose, fall, drowning, being hit by a driver or exposure. Some 30 percent died of natural causes, 11 percent by murder and 4 percent by suicide. The largest single cause of death was accidental overdose at 35 percent, based on the autopsy reports.
Of those who died, 47 percent had methamphetamine in their system, followed by 45 percent with opioids. The City recently announced a task force to address methamphetamine use.
Kelley Cutler, an organizer with the Coalition on Homelessness, helps put together the community’s count for an annual homeless death memorial. That tally is higher since it counts those who may have been recently sheltered in supportive housing or single-room occupancy hotels but were previously homeless. In 2017, for example, the coalition tallied 198 homeless deaths.
”It’s a tragedy in a city, a country, with such obscene wealth, people are literally dying on our streets,” Cutler said. “I don’t believe homelessness is viewed as the emergency and crisis that it is.” She said the response should be much like responses to earthquakes or fires.
Zevin acknowledged the need to look at the deaths of the formerly homeless living in supportive housing and single-room occupancy hotels as well. “We know from the medical examiner that there is a large number of deaths in those settings and there may need to be responses that go beyond just people on the street,” he said.
To provide an official homeless death count, the Department of Public Health has long relied on the Homeless Death Forms that the medical examiner must fill out since the Board of Supervisors required it in June 2005, but they only capture a limited number of cases, when a person has no fixed address.
In 2017, for example, the homeless death forms totaled just 63.