As medical and behavioral health clinicians who work in the neighborhood of Mass. and Cass (the intersection of Massachusetts Avenue and Melnea Cass Boulevard), we are witness to the daily struggles and distress of people who are living on the street. Although some people come to this neighborhood to prey on others, the majority of people we meet are overwhelmed by some combination of severe substance use disorder, mental illness, and social deprivation; and nearly all are suffering from the effects of mental and physical trauma.
A recent survey conducted by Boston Health Care for the Homeless found that the number one concern of people living in the area is safety. Many want to engage in treatment for substance use disorders, but myriad barriers often stand between them and receiving help — such as hopelessness, stigma, wait lists, fear, and needing the effect of substances to help them survive on the streets. People tell us that they are afraid they will be assaulted if they sleep during the night, and so they use stimulants in order to stay awake and on guard. Others rely on the effects of drugs to blot out traumatic memories and symptoms of PTSD.
People who live on the street are also desperate to obtain housing. Although some elect not to enter the shelter system, their decision to avoid shelter is often driven by their inability to manage their addiction in a setting in which drugs and injection equipment, including sterile needles, are confiscated. This leaves them at risk of severe withdrawal in the middle of the night. Withdrawal is an excruciating experience that causes symptoms such as uncontrollable vomiting, diarrhea, and severe anxiety; and with some combinations of substances, it can be deadly. There is a severe shortage of transitional housing across the city and state, and in the past, housed residents have blocked efforts to establish facilities that would provide more transitional housing in their communities. When the rare transitional housing beds become available, caseworkers are swamped by requests.
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In spite of this grim picture, there are solutions that can be enacted in the near term. Establishing transitional housing is a key part of the solution. People are typically unable to transition directly from the street into permanent supportive housing due to issues such as lack of the necessary identification documents, the mental and physical impacts of untreated addiction, and trauma. A place for temporary stabilization allows people to escape their fear, and to sleep, wash, think about engaging with treatment, and prepare to transition to permanent supportive housing. Supportive housing organizations, such as Victory Programs and the Commonwealth Land Trust, are prepared to help operate these facilities, and to help residents to manage practical needs, such as obtaining identification documents and avoiding overdose. Medical providers in our neighborhood could provide on-site access to clinical care in a transitional housing facility, including addiction treatment. A similar model has been implemented successfully in Denver.
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Boston will soon receive hundreds of millions of dollars in federal American Rescue Plan Act funds. A small portion of this money can be used to purchase a building that would provide temporary stabilization for a hundred or more people at a time. The city and its next mayor have the power to leverage this unique infusion of federal funding to solve this twofold humanitarian and housing crisis and coalesce all stakeholders in support.
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During the initial months of the COVID-19 pandemic, the city, the Boston Public Health Commission, and Pine Street Inn were able to swiftly secure private space at Suffolk University to house hundreds of homeless people as the public health crisis unfolded. Unlike that partnership, a partnership of service providers operating a city-owned building and delivering supportive services would offer an ongoing solution.
Once people have stabilized in transitional housing, then supportive housing organizations can work with the Boston Housing Authority to identify federally supported housing options and help these residents to finally attain stable housing. This would provide an off-ramp from the nightmare that people are living on the street in the Mass. and Cass neighborhood. It is a practical, humane, dignified, treatment-oriented approach that will offer a road to stabilization and permanent housing. The solution is within our reach, if we have the will to act.
Dr. Miriam Komaromy is medical director at the Grayken Center for Addiction at Boston Medical Center and a professor of medicine at Boston University. Brendan Concannon is the strategy manager at the Grayken Center for Addiction at Boston Medical Center. Sarah Porter is executive director of Victory Programs.
