Image: Daniel Fishel

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ne gray morning in January, community health worker Haika Mushi made her way down a paved path along I-205, stopping at dozens of tents, and notifying occupants that free showers, haircuts, and meals were available at nearby Lents Park.

“Hello, is anybody home?” she called out at each nylon door. “We’re from Portland Street Response. We have some coffee, if you’d like some.” 

Most of the people there recognized Mushi and her colleagues at the emergency responder program, which sends paramedics and social workers to some crisis calls instead of police. This March, the program is expanding citywide, and similar weekly events in new parts of town will begin the careful process of relationship building anew—“starting from scratch,” Mushi says.

It’s a big opportunity to improve the city’s treatment of some of its most vulnerable citizens. Nailing the rapid expansion would be a win celebrated by Portlanders across the political spectrum, from the progressive reformers to the business interests pouring money into People for Portland, a group that’s advocated for faster action on curbing houselessness. But it’s also a lot to expect a few dozen roving social workers and first responders to transform problems caused by deep and long-standing societal structures.

The small team’s success depends on support from the most recalcitrant of quarters: the police union and bureaucratic city agencies. Standing in the way are overwhelmed emergency call lines, the city’s lack of detox and sobering centers, and a target population largely unaware that such a program even exists—an evaluation this fall found that after six months of operations in Lents, only one quarter of those surveyed in the area who were living outside had even heard of Portland Street Response. 

“The no. 1 challenge here is managing expectations,” says Jason Renaud, managing director for the Mental Health Association of Portland. “People think this is a solution for all our problems, post George Floyd.” Programs like this, Renaud says, can’t replace the police, who were never even meant to be the de facto response to mental health crises.

The city’s emergency line is clogged with calls, many of them from Portlanders who perceive someone living outdoors to be in crisis, or who want them to move along. But the people Portland Street Response wants to reach aren’t calling: nearly 58 percent of unhoused Lents community members surveyed as part of a six-month evaluation of the progam said they didn’t feel safe calling 911 because police might respond.

It’s a perception mirrored by the US Department of Justice, which has struggled to rein in city police after finding an unconstitutional pattern of excessive force against people with mental illness. After nearly a decade, the Portland Police Bureau is not in compliance with agreements it made with the federal government intended to correct the situation.

“It doesn’t make sense to send an armed, uniformed officer to a call that has no criminal activity, that’s strictly mental health related,” says Portland Street Response program manager Robyn Burek. “It makes the most sense to send in a mental health clinician.”

Even so, Portland Police have so far refused to allow Portland Street Response to go to calls where people are indoors, or to those involving people who are suicidal. In the labor agreement negotiated between the city and the police union this winter, the police remained noncommittal, agreeing only to form a committee to consider questions like “the types of calls for service that may be appropriately handled by PSR.” In a sign that police rank-and-file are worried that PSR might usurp their jobs, the agreement also spells out that no Portland Police Association positions will be reduced as a result of Portland Street Response’s expansion. 

Another obstacle: In order to do the kind of long-term work that results in people transitioning to permanent housing, the team also has to be able to find their clients. That can be challenging among a population that is inherently mobile, without reliable phones or internet access.

Back in Lents, Mushi and a nursing student spent about an hour working their way from one tent to another, offering people blankets and toiletry kits, trying to build trust in and awareness of PSR. But when they hit SE Holgate, they ran into Rapid Response, a city contractor. The area was set to be swept, evicting everyone living there and removing any belongings they left behind. 

Usually, Portland Street Response is in the loop about such sweeps, and can do outreach to existing clients to help them get into temporary shelters, or find a friend to stay with.  

In this case, the city had posted notices in at least one location that shelters would be removed and anything left behind taken within 72 hours. But the notification hadn’t made it to the PSR crew. Communication with outreach workers about the timing and location of upcoming sweeps is always a work in progress, Burek says.

But the import is clear: losing contact for any reason with people they’ve worked to build trusting relationships with takes a toll, Mushi says, and can curtail the chance to build on some of the painstaking long-term work that Portland Street Response has accomplished in its first year.  

So far the team helped eight people find permanent housing, and helped two others avoid looming evictions. 

Portland Street Response community health worker Heather Middleton calls these voluntary services “aftercare,” an important coda to the team’s core mission. City and county agencies provide similar services to people living outdoors, but meeting people for the first time during an acute crisis gives Portland Street Response teams a unique entry point into their clients’ lives, reaching people who slip away from overburdened caseworkers.

Middleton says one man she helped into permanent housing at Bud Clark Commons often angrily cussed out and “fired” those who tried to help.

“I would say, ‘OK, I’ll call you on Monday and see if you still feel that way,’” Middleton says. “Then I would call and [he] would say, ‘I’m sorry, I was just in a bad mood or I was really high. Thank you for calling me.’”

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