They all go into the dark...

Coalition on Homelessness, SF (coh@sfo.com)
Fri, 24 Dec 1999 07:53:22 -0800


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HOMELESS PEOPLE'S VIEWS, News, Alerts, Actions & Research
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Hey all you HPN'ers-

Thought I'd let you all know why I've been silent lately.  The annual 
homeless deaths report - a collaboration between various community 
organizations serving poor and homeless people and the San Francisco 
Department of Public Health - was the reason.  Quite a somber 
counterpoint to all the seasonally-related festivities and public 
acts of charity.

We look at homeless deaths each year because they offer us solid 
evidence of what kinds of services are needed to prevent these 
tragedies.  It wasn't pretty, but it wasn't too difficult to 
accomplish since the methodology was standardized when we 
successfully lobbied DPH to institutionalize this annual report of 
homeless deaths.

I was honored to author the first draft of this document, and pleased 
that most of what I included from the advocacy agenda of the 
Coalition's Substance (Ab)use / Mental Health work group remained 
intact.  I'm pretty optimistic that DPH and COH are on the same page. 


Building these cooperative efforts between the City and the Coalition 
on Homelessness is key to establishing credibility in the mainstream 
media, and really helps homeless people who are at risk. I wish we 
could include a report of all the successfully prevented deaths, but 
that's another step in the ladder.  The homeless deaths research 
methodology is outlined on our website, so check it out.

Peace to all of you. We're sorry if our gift to you might prove 
painful, but our respect for you demands that we give you only the 
truth.

chance martin
COH-SF

PS - If a Messiah was born into poverty this xmas, would he die of 
sudden infant death syndrome, or be crucified at the front door of a 
middle school for over two years by a society in which compassion is 
merely a seasonal exercise?


For Immediate Release	Eileen Shields, Public Information Office
December 22, 1999	415/554-2507


1999 Deaths of Homeless San Franciscans
Preliminary Results - December 22, 1999

J.R. was a Latino male in his mid-thirties that had slept on the 
stairway landing at the front entrance of the Horace Mann Middle 
School for two years. A school custodian was the first person to 
learn he had died one morning in mid-March. He was found covered in a 
blanket lying on his right side, with his head resting on a pillow. 
Rigor mortis was present, and there was no evidence of violence or 
illicit drug use. An investigation of medical records revealed that 
J.R. suffered multiple disabilities and had over 100 Emergency 
Department admissions in the previous year. He was discharged from 
the hospital  less than a week before his death - an emergency 
admission after he was found lying in the street suffering from 
hypothermia.

For 13 years San Francisco has counted the numbers of its people who 
die homeless.  We do this so that their names won't be forgotten 
and-for more practical purposes-to help us identify the gaps in our 
City's system of care where we can best focus our efforts to prevent 
future homeless deaths.

At least 169 homeless people died in San Francisco in 1999.  The vast 
majority of these deaths were preventable.   As in past years, 
substance abuse was the most common cause of death among homeless 
persons.  We know that substance treatment prevents unnecessary 
morbidity and mortality.  Many of the deaths occurred among persons 
with recent contact with the health and social services system.  This 
indicates both the limitations of our existing services and the 
potential for using our contact with homeless individuals to improve 
the circumstances of their daily lives.

The total of 169 likely represents an undercount of 1999's total 
homeless deaths. This report captures only those deaths identified by 
the Medical Examiner.  Also, the report does not count persons who 
were newly housed for more than 28 days, but whose death was hastened 
by their recent bout of homelessness.  The report does include 
persons who died who had shelter, but who were unstably housed. 
This includes persons living in single room occupancy hotels (SROs) 
for less than 28 days, people living in shelters, and those 
hospitalized.

Despite the limitations of this study, the ME-recorded deaths provide 
us with valuable  data on homeless deaths due to intentional and 
unintentional injuries (i.e. accidents, drug overdoses, suicides and 
homicides), and point out areas where community and public health 
efforts can better prevent future premature deaths among homeless San 
Franciscans.

I. Finding
169 homeless deaths were identified from Medical Examiner records 
dated from December 1, 1998 until November 30, 1999.

Drug poisoning remained the leading cause of death among homeless 
people (54), liver and pancreatic disease (16) the second, and heart 
disease (14) the third.  Alcohol use claimed 11 lives, accidents 8, 
severe infection 7.

68 (41%) of the death occurred outdoors; 60 indoors; 39 persons died 
in hospitals; 1 died in a homeless shelter and in 1 the location 
could not be determined.

86 deaths occurred between December 1998 and May 1999.  83 deaths 
happened during the months of June 1999 and November 1999.

Homeless deaths occurred in 30 different neighborhoods of San 
Francisco with the highest concentration in poorer areas of the 
city--82 in the Tenderloin (22), South of Market area (26), and Inner 
Mission (34).


A Human Face
M.B., a 44 year-old male suffering from heart disease, mental illness 
and an ulcer, was found dead in the cab of a stake-bed truck by the 
truck's owner. The owner was a friend who permitted M.B. to sleep in 
the truck until he could find affordable housing.  Numerous 
medications were found in the truck's glovebox, as well as an empty 
40 oz. bottle of King Cobra malt liquor on the truck's floor.

Significance
This is the highest number of homeless deaths ever recorded. A total 
of 1271 homeless people have died in San Francisco in the past decade 
(1990 - 1999), for an average of 131.8 homeless deaths per year. 
There were 103 homeless deaths in 1990, 110 deaths in 1991, 125 
deaths in 1992, 98 deaths in 1993, 113 deaths in 1994, 138 deaths in 
1995, 154 deaths in 1996, 104 deaths in 1997, and 157 deaths in 1998.

Lack of affordable housing is recognized as a health emergency in San 
Francisco. Vacancy rates of less than 1% have driven average rents 
far beyond the means of low-income San Franciscans. This, coupled 
with San Francisco's dwindling numbers of public housing units and 
the loss of over 600 low-income SRO rooms due to fires in nine hotels 
during the past two years, has greatly exacerbated the problem of 
homelessness. Without permanent affordable housing, homeless people 
cannot successfully manage life-threatening health conditions such as 
heart and liver diseases, mental illness, diabetes, and addiction. In 
response to this critical dilemma, the Departments of Human Services 
and Public Health assisted over 2,600 homeless individuals with 
housing, rental subsidies and support services in 1999.

II. Finding
The average age of persons who died homeless in San Francisco was 
43.6 years, with an average of 41.2 years for females and 44.2 years 
for males.

Included in the homeless deaths were 2 children (a 39-day-old boy and 
a 4-month old girl) who died from Sudden Infant Death Syndrome 
(SIDS).  SIDS is not known to be related to homelessness, but these 
two deaths were included in the report because the children were not 
permanently housed at the time of their death.

24 (14%) of those dying were female; 144 (85%) were male; one was transgender.

The ethnic distribution among the 144 males was 59% white, 32% 
African American, 4% Latino, 2% Asian and 3% unknown; among the 24 
females 43% were white, 48% African American, 5% Latino, and 4% 
unknown.  The transgender person was Hispanic.

A Human Face
R.A., a male approximately 44 years of age, had been sheltering 
himself in his vehicle following a divorce. His two juvenile nephews 
in the home of his brother discovered his body, where R.A. received 
his mail, the victim of an apparently self-inflicted shotgun wound to 
the head.

Significance
In 1996, average life expectancy at birth in the United States was 
76.1 years: 73.1 years for males and 79.1 years for females.

III. Finding
In 1999, 65 homeless San Franciscans died as a direct result of drug 
or alcohol use.  28 of these deaths involved heroin-16 of these in 
combination with other substances.  15 deaths involved cocaine, 20 
involved other poly-drug overdose and 16 involved alcohol.


A Human Face
G.S., a 24 year-old male to female transgender patient, hung herself 
with an electrical cord at an assisted care facility in the 
Tenderloin. She reportedly had struggled with transgender issues and 
alcohol abuse. She had no known prior self-destructive acts or 
ideation.

Significance
1999's tally of drug and alcohol related deaths represents 
significant reductions from 1998's total of 86 drug and/or alcohol 
related deaths with heroin involvement in 62 among a total 157 
homeless deaths.  However, substance use continues as the leading 
cause of premature deaths in 47.1% of ME-evaluated cases.  31% of 
homeless people who died this year had no drugs or alcohol present at 
death.

The decrease in the number of substance abuse deaths likely reflects 
the positive impact of the City's Treatment on Demand program. 
Nonetheless, more substance treatment services are needed, especially 
in the areas of residential treatment and methadone maintenance.

A growing body of evidence shows that many homeless people who suffer 
mental illnesses are unable to access treatment.  Some use alcohol 
and illicit substances to cope with their illnesses.  Implementation 
of the Health Department's Dual Diagnosis program and increased 
mental health treatment slots will help address access issues for 
those with concurring substance use and mental health concerns.
 
IV. Conclusion

This year's number of deaths were the highest ever recorded in San 
Francisco since these reports began.  We are unable to determine from 
these records why the number of deaths have increased; possible 
reasons include the following: an increase in the number of homeless 
persons, more or higher risk drug use (e.g. more pure heroin), or 
changes in drug treatment availability.  A recent survey by the U.S. 
Conference of Mayors (that included San Francisco) reported an 
increased demand for emergency housing in U.S. cities since 1994 
suggesting the number of homeless have increased during this period. 
The nation's economic boom, together with a higher demand for housing 
and increased rents may result in placing more low-income persons at 
risk for homelessness.

A memorial service to remember the lives of those homeless people who 
died was held
in Civic Center Plaza on Tuesday, December 21, 1999.  It was presided 
by Reverend Glenda Hope .



END FORWARD

**In accordance with Title 17 U.S.C. section 107, this material
is distributed without charge or profit to those who have
expressed a prior interest in receiving this type of information
for non-profit research and educational purposes only.**



*******************************************************
HOMELESS PEOPLE'S NETWORK <http://aspin.asu.edu/hpn>
6,000+ POSTS by or via homeless & ex-homeless people
Nothing About Us Without Us - Democratize Public Policy
*******************************************************

Coalition on Homelessness, San Francisco
468 Turk St.
San Francisco, CA 94102
vox: (415) 346.3740
Fax: (415) 775.5639
coh@sfo.com
http://www.sfo.com/~coh
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Content-Type: text/enriched; charset="us-ascii"

***********************************************************

HOMELESS PEOPLE'S VIEWS, News, Alerts, Actions & Research

6,000+ ONLINE POSTS by or via homeless & ex-homeless people

HOMELESS PEOPLE'S NETWORK http://aspin.asu.edu/hpn

***********************************************************

Hey all you HPN'ers-


Thought I'd let you all know why I've been silent lately.  The annual
homeless deaths report - a collaboration between various community
organizations serving poor and homeless people and the San Francisco
Department of Public Health - was the reason.  Quite a somber
counterpoint to all the seasonally-related festivities and public acts
of charity.


We look at homeless deaths each year because they offer us solid
evidence of what kinds of services are needed to prevent these
tragedies.  It wasn't pretty, but it wasn't too difficult to accomplish
since the methodology was standardized when we successfully lobbied DPH
to institutionalize this annual report of homeless deaths.  


I was honored to author the first draft of this document, and pleased
that most of what I included from the advocacy agenda of the
Coalition's Substance (Ab)use / Mental Health work group remained
intact.  I'm pretty optimistic that DPH and COH are on the same page.  
 


Building these cooperative efforts between the City and the Coalition
on Homelessness is key to establishing credibility in the mainstream
media, and really helps homeless people who are at risk. I wish we
could include a report of all the successfully prevented deaths, but
that's another step in the ladder.  The homeless deaths research
methodology is outlined on our website, so check it out.


Peace to all of you. We're sorry if our gift to you might prove
painful, but our respect for you demands that we give you only the
truth.


chance martin

COH-SF 


PS - If a Messiah was born into poverty this xmas, would he die of
sudden infant death syndrome, or be crucified at the front door of a
middle school for over two years by a society in which compassion is
merely a seasonal exercise? 



<bold><fontfamily><param>Arial</param><smaller>For Immediate
Release	Eileen Shields, Public Information Office

December 22, 1999	415/554-2507



</smaller></fontfamily>1999 Deaths of Homeless San Franciscans

</bold><italic>Preliminary Results - December 22, 1999


J.R. was a Latino male in his mid-thirties that had slept on the
stairway landing at the front entrance of the Horace Mann Middle School
for two years. A school custodian was the first person to learn he had
died one morning in mid-March. He was found covered in a blanket lying
on his right side, with his head resting on a pillow. Rigor mortis was
present, and there was no evidence of violence or illicit drug use. An
investigation of medical records revealed that J.R. suffered multiple
disabilities and had over 100 Emergency Department admissions in the
previous year. He was discharged from the hospital  less than a week
before his death - an emergency admission after he was found lying in
the street suffering from hypothermia. 


</italic>For 13 years San Francisco has counted the numbers of its
people who die homeless.  We do this so that their names won't be
forgotten and-for more practical purposes-to help us identify the gaps
in our City's system of care where we can best focus our efforts to
prevent future homeless deaths.


At least 169 homeless people died in San Francisco in 1999.  The vast
majority of these deaths were preventable.   As in past years,
substance abuse was the most common cause of death among homeless
persons.  We know that substance treatment prevents unnecessary
morbidity and mortality.  Many of the deaths occurred among persons
with recent contact with the health and social services system.  This
indicates both the limitations of our existing services and the
potential for using our contact with homeless individuals to improve
the circumstances of their daily lives. 


The total of 169 likely represents an undercount of 1999's total
homeless deaths. This report captures only those deaths identified by
the Medical Examiner.  Also, the report does not count persons who were
newly housed for more than 28 days, but whose death was hastened by
their recent bout of homelessness.  The report does include persons who
died who had shelter, but who were unstably housed.   This includes
persons living in single room occupancy hotels (SROs) for less than 28
days, people living in shelters, and those hospitalized.


Despite the limitations of this study, the ME-recorded deaths provide
us with valuable  data on homeless deaths due to intentional and
unintentional injuries (i.e. accidents, drug overdoses, suicides and
homicides), and point out areas where community and public health
efforts can better prevent future premature deaths among homeless San
Franciscans.


<bold><underline>I. Finding

</underline>169 homeless deaths were identified from Medical Examiner
records dated from December 1, 1998 until November 30, 1999.


Drug poisoning remained the leading cause of death among homeless
people (54), liver and pancreatic disease (16) the second, and heart
disease (14) the third.  Alcohol use claimed 11 lives, accidents 8,
severe infection 7.


68 (41%) of the death occurred outdoors; 60 indoors; 39 persons died in
hospitals; 1 died in a homeless shelter and in 1 the location could not
be determined.


86 deaths occurred between December 1998 and May 1999.  83 deaths
happened during the months of June 1999 and November 1999.


Homeless deaths occurred in 30 different neighborhoods of San Francisco
with the highest concentration in poorer areas of the city--82 in the
Tenderloin (22), South of Market area (26), and Inner Mission (34). 



A Human Face

</bold><italic>M.B., a 44 year-old male suffering from heart disease,
mental illness and an ulcer, was found dead in the cab of a stake-bed
truck by the truck's owner. The owner was a friend who permitted M.B.
to sleep in the truck until he could find affordable housing.  Numerous
medications were found in the truck's glovebox, as well as an empty 40
oz. bottle of King Cobra malt liquor on the truck's floor.


</italic><bold>Significance

</bold>This is the highest number of homeless deaths ever recorded. A
total of 1271 homeless people have died in San Francisco in the past
decade (1990 - 1999), for an average of 131.8 homeless deaths per year.
There were 103 homeless deaths in 1990, 110 deaths in 1991, 125 deaths
in 1992, 98 deaths in 1993, 113 deaths in 1994, 138 deaths in 1995, 154
deaths in 1996, 104 deaths in 1997, and 157 deaths in 1998.


Lack of affordable housing is recognized as a health emergency in San
Francisco. Vacancy rates of less than 1% have driven average rents far
beyond the means of low-income San Franciscans. This, coupled with San
Francisco's dwindling numbers of public housing units and the loss of
over 600 low-income SRO rooms due to fires in nine hotels during the
past two years, has greatly exacerbated the problem of homelessness.
Without permanent affordable housing, homeless people cannot
successfully manage life-threatening health conditions such as heart
and liver diseases, mental illness, diabetes, and addiction. In
response to this critical dilemma, the Departments of Human Services
and Public Health assisted over 2,600 homeless individuals with
housing, rental subsidies and support services in 1999. 


<bold><underline>II. Finding

</underline>The average age of persons who died homeless in San
Francisco was 43.6 years, with an average of 41.2 years for females and
44.2 years for males.  


Included in the homeless deaths were 2 children (a 39-day-old boy and a
4-month old girl) who died from Sudden Infant Death Syndrome (SIDS). 
SIDS is not known to be related to homelessness, but these two deaths
were included in the report because the children were not permanently
housed at the time of their death.


24 (14%) of those dying were female; 144 (85%) were male; one was
transgender.


The ethnic distribution among the 144 males was 59% white, 32% African
American, 4% Latino, 2% Asian and 3% unknown; among the 24 females 43%
were white, 48% African American, 5% Latino, and 4% unknown.  The
transgender person was Hispanic.


A Human Face

</bold><italic>R.A., a male approximately 44 years of age, had been
sheltering himself in his vehicle following a divorce. His two juvenile
nephews in the home of his brother discovered his body, where R.A.
received his mail, the victim of an apparently self-inflicted shotgun
wound to the head.


</italic><bold>Significance

</bold>In 1996, average life expectancy at birth in the United States
was 76.1 years: 73.1 years for males and 79.1 years for females.


<bold><underline>III. Finding

</underline>In 1999, 65 homeless San Franciscans died as a direct
result of drug or alcohol use.  28 of these deaths involved heroin-16
of these in combination with other substances.  15 deaths involved
cocaine, 20 involved other poly-drug overdose and 16 involved alcohol.



A Human Face

</bold><italic>G.S., a 24 year-old male to female transgender patient,
hung herself with an electrical cord at an assisted care facility in
the Tenderloin. She reportedly had struggled with transgender issues
and alcohol abuse. She had no known prior self-destructive acts or
ideation.


</italic><bold>Significance

</bold>1999's tally of drug and alcohol related deaths represents
significant reductions from 1998's total of 86 drug and/or alcohol
related deaths with heroin involvement in 62 among a total 157 homeless
deaths.  However, substance use continues as the leading cause of
premature deaths in 47.1% of ME-evaluated cases.  31% of homeless
people who died this year had no drugs or alcohol present at death.


The decrease in the number of substance abuse deaths likely reflects
the positive impact of the City's Treatment on Demand program. 
Nonetheless, more substance treatment services are needed, especially
in the areas of residential treatment and methadone maintenance. 


A growing body of evidence shows that many homeless people who suffer
mental illnesses are unable to access treatment.  Some use alcohol and
illicit substances to cope with their illnesses.  Implementation of the
Health Department's Dual Diagnosis program and increased mental health
treatment slots will help address access issues for those with
concurring substance use and mental health concerns.  

 

<bold>IV. Conclusion


</bold>This year's number of deaths were the highest ever recorded in
San Francisco since these reports began.  We are unable to determine
from these records why the number of deaths have increased; possible
reasons include the following: an increase in the number of homeless
persons, more or higher risk drug use (e.g. more pure heroin), or
changes in drug treatment availability.  A recent survey by the U.S.
Conference of Mayors (that included San Francisco) reported an
increased demand for emergency housing in U.S. cities since 1994
suggesting the number of homeless have increased during this period. 
The nation's economic boom, together with a higher demand for housing
and increased rents may result in placing more low-income persons at
risk for homelessness.


<bold><italic><smaller>A memorial service to remember the lives of
those homeless people who died was held 

in Civic Center Plaza on Tuesday, December 21, 1999.  It was presided
by Reverend Glenda Hope .




</smaller></italic></bold>END FORWARD


**In accordance with Title 17 U.S.C. section 107, this material

is distributed without charge or profit to those who have

expressed a prior interest in receiving this type of information

for non-profit research and educational purposes only.**




*******************************************************

HOMELESS PEOPLE'S NETWORK <<http://aspin.asu.edu/hpn>

6,000+ POSTS by or via homeless & ex-homeless people

Nothing About Us Without Us - Democratize Public Policy

*******************************************************

Coalition on Homelessness, San Francisco

468 Turk St.

San Francisco, CA 94102

vox: (415) 346.3740

Fax: (415) 775.5639

coh@sfo.com

http://www.sfo.com/~coh

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