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Homeless substance abusers need better-funded treatment options

Liz Gryzmala

As winter arrives, temperatures drop below 0. A homeless person in Hennepin County, let’s call him Charlie, struggles to find a warm place to sleep during these frigid months. In addition to this, Charlie suffers from an addiction that keeps him cycling in and out of the emergency department. He has a mental illness, and because of this continues to self-medicate through the use of substances. This makes it difficult for him to obtain a job, remain in good health, and maintain adequate housing. He continues to fall back on substances, and cannot see a way out.

This is the reality of many homeless individuals suffering from substance abuse in Hennepin County. This problem is pervasive; according to a 2016 Wilder Research Study, approximately 21 percent of homeless adults have been diagnosed with a substance abuse disorder in Minnesota, with even more likely struggling with an undiagnosed addiction. This is a big problem for an urban city center like Hennepin County, whose rates of homelessness are the highest in the state. In 2015, 3,125 people were homeless in the county, accounting for 40 percent of the homeless population in Minnesota. These high rates of homelessness are accompanied by high rates of substance abuse.

Lack of adequate medical care; expensive ED visits

This problem is fueled by many issues, including previous trauma, mental health issues, and ineffective treatment options in the form of recurrent emergency department (ED) visits. Frequent ED visits must be addressed, as they account for a disproportionate share of total health visits and costs. Lack of adequate treatment and continuous hospital visits are ineffective in getting these individuals the help they need, and are extremely costly for the state of Minnesota. According to Green Doors, a homes through community partnership organization, the average homeless individual costs the state $18,500 to  $44,400 per year in emergency care. Among these expensive ED visits for homeless individuals, nearly 60 percent of “treat and release” visits involve a mental or substance use disorder.

It’s clear that the abuse of substances such as drugs and alcohol impact the health of many homeless individuals, and contribute to inappropriate health service utilization. Underlying social, political, and economic forces also play a role in this equation. With many other items on politicians’ agendas, substance abuse among the homeless is often not properly addressed. Low-cost housing is often lacking, and accessible substance abuse services are frequently not available. Homeless individuals lack social support networks, further fueling abuse. On top of that, funding for programs that account for these factors while properly treating substance abuse for low income patients is lacking. Previous substance abuse policies in Minnesota fail to account for these factors, and often neglect the disadvantaged homeless population.

Coordinated care model

It’s essential to address these broad contributing forces while also tackling the problem of ineffective treatment via recurrent ED visits for homeless substance abusers. Policy makers need to take action now. Hennepin County has employed a coordinated care model, care facilitated by 2 or more team members, which targets low income individuals, integrating medical and social services to better serve low-income patients living in Minneapolis. This model has shown reductions in cost as well as fewer emergency department visits. We need to apply this model to the Hennepin County homeless population to better address their health and social needs while getting them effective substance abuse treatment. Since this problem is multidimensional, with many related issues, an integrated model coordinated by a community health worker specifically targeting the homeless could address all angles of this issue. Policy makers need to consider financing this care model to help some of our county’s most vulnerable.

With appropriate funding for this treatment model, we can help the homeless who are facing serious addictions during these cold winter months, while saving the state money.

Liz Gryzmala is a master of public health candidate at the University of Minnesota.

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