Homelessness etiketine sahip kayıtlar gösteriliyor. Tüm kayıtları göster
Homelessness etiketine sahip kayıtlar gösteriliyor. Tüm kayıtları göster

17 Şubat 2017 Cuma

The death of Karen Batts: the homelessness case that shocked Portland

The maintenance worker found the woman just before 2pm. She had made her way inside the parking garage in downtown Portland, Oregon, and now stood in the corner of the second floor, mumbling something the worker could not understand. The temperature was about 18F (-7C) with a wind chill. The woman started to remove her pants, a common reaction to severe hypothermia.


He ran to get help from a parking attendant, but by the time they returned, Karen Batts was lying on her back, naked from the waist down and unconscious.


Outside in America

At 2.16pm, medics called Portland police to notify them that Batts, 52, was dead. Within days it would emerge that, months earlier, she had been evicted from her apartment, in part because she had been unable to pay $ 338 in rent.


The death of Batts on 7 January has shaken Portland like few other events in recent memory.


The city’s image of itself as a bastion of liberal values and affable quirkiness is increasingly undermined by the plight of its homeless residents. Amid unusually brutal weather, Batts was among four homeless Portlanders who died of exposure in the first 10 days of 2017.


In the same period, a homeless woman was found holding a dead infant at a bus shelter; the medical examiner ruled it a stillbirth.


The toll on the city streets is rising with each passing year, up from 47 in 2011 to 88 in 2015. Of the recent deaths, Batts’s appears to have resonated the most. And while her death made headlines, a deeper investigation of her story raises difficult questions about whether Portland is failing its neediest citizens.



The SmartPark garage in downtown Portland, where Karen Batts died.


The SmartPark garage in downtown Portland, where Karen Batts died. Photograph: Jason Wilson for the Guardian

About five miles from where Batts was found, there is a white craftsman cottage in the middle-class, rapidly gentrifying Hollywood neighborhood. The mantelpiece in the living room is laden with family photos, including one of Batts, a studio portrait taken almost a decade ago at JC Penney. Her smile is broad and unforced. Her hair, in long ringlets, is just beginning to gray at the temples.


The cottage is home to Batts’s mother, Elizabeth, 77, and her brother, Alan, 53. The family knew that Batts’s health was declining. The last time Alan saw her, “she had her fingers in her ears to keep out the voices in her head”, he said. “I asked her if she wanted me to hug her and she said she didn’t want me to touch her.”


But it seemed impossible to do anything. “I was trying to help her,” he said, “but I just kept getting resistance.”




I was trying to help her, but I just kept getting resistance


Alan Batts, brother



Batts was born in 1964 in the German town of Heidelberg, while their father was serving in the US army. They returned to Portland when she was six years old, a mixed-race child in a town where African Americans were just 6% of the population.


At Grant high school she was a vivacious, outgoing cheerleader. She loved to dance. Even then, there were signs of what lay ahead. Her mother would find “little jars of spit-up” around the house. Later the family realized that she had an eating disorder, but at the time “I didn’t know what that was,” Elizabeth recalled.


Batts graduated with honors in 1982 and enrolled at Fisk University, a historically black college in Nashville, for a pre-dentistry course. Although she received several small scholarships, it became unaffordable and she dropped out after her first year. She came back to Portland and took intermittent classes at Portland State but was unable to finish the degree.


From then on, Batts drifted between short-term jobs and unstable housing arrangements. The family found it hard to keep track. “She lived in maybe 20 places” from the early 1990s onwards, her brother said. A comment that Batts once made to her mother revealed her mental disarray: “Don’t say too much in the apartment, they can hear me over the sprinkler system.”



Elizabeth and Alan Batts at the family home.


Elizabeth and Alan Batts at the family home. Photograph: Jason Wilson for the Guardian

In 1995, she went missing altogether, leaving her brother to put up flyers all over the city. When she returned after a few months, she telephoned and acted as though nothing had happened. The family suspects that she was homeless between 2000 and 2002.


Batts’s illness came to a head in December 2003, when she was found unconscious on a Portland street with alcohol poisoning. She was committed to Oregon State Hospital for a year.In 2004, having recovered sufficiently, she moved into a suburban halfway house.


She would never hold down another paying job and survived on disability benefits. At some point she was diagnosed with schizophrenia.Still, taking her medication and attending addiction meetings, it seemed like Batts had regained a measure of control over her life.



Batts spent most of her last decade in a downtown building for seniors and people with disabilities, owned by a nonprofit called Northwest Housing Alternatives, or NHA. For most of her time there she was stable – well enough, even, to join a family vacation to Hawaii in 2009.


Yet years later something tipped her off balance. Her brother theorizes it was when she stopped taking her medication.


Martha McLennan, the executive director of NHA, said that Batts started displaying serious behavioral problems in early 2016. She caused “damage, disruptions and hazards of different types”, such as entertaining rowdy guests, and was apparently consuming wood alcohol. Police records indicate that Batts was the victim of an assault.


As she racked up lease violations, on-site staff tried to connect her with mental health services, but Batts declined to engage with them. McLennan said there was nothing else they could do. “We’re a housing organization, not a mental-health organization,” she said.


Alan also pushed to get help for his sister, but she often refused visitors, including him. He called various county authorities and services, but each time found himself stymied. Police spoke to her through the door and did not consider her a danger to herself.



333 Southwest Oak, in downtown Portland, from which Karen Batts was evicted last year.


333 Southwest Oak, in downtown Portland, from which Karen Batts was evicted last year. Photograph: Jason Wilson for the Guardian

In September of last year, Batts received an eviction notice over her erratic behavior and failure on two consecutive months to pay rent.


Batts did not attend her eviction hearing, and on her last day, 27 October, the sheriff’s department was called to provide an escort off the property.


McLennan said that such evictions on NHA properties are rare and usually prevented. “She was evaluated for a mental health hold a number of times,” McLennan said, but “the standard required is a really high bar.”


Batts fell into an impossible middle ground, according to McLennan: healthy enough to refuse help, but perhaps too sick to recognize that she needed it.


“She didn’t really have the capacity to make positive choices, but the system says she has the right to make bad choices.”


It is not entirely clear how Batts spent her final months. But it appears she drifted into Portland’s homeless population, only occasionally attracting attention from law enforcement.


In early November, police found Batts in the middle of the street in a run-down part of downtown. She wasn’t wearing a jacket, shoes or pants.


As they got closer, they realized that she had been consuming hand sanitizer. “She was drinking it to keep her mouth clean,” according to a police report of the incident. “She had several bottles on her person.”


The police took Batts to the hospital, where she was placed on psychiatric hold. But soon, for reasons that are not fully clear, she was let back out onto the streets.


The following month, she received a ticket for sleeping on the train. The month after that, she would find her way to the parking garage where she died.



A Multnomah County investigation is under way into Batts’s death, involving what it calls a “full system analysis”.


McLennan said her organization has done some “soul-searching” since Batts’s death. “If things fall apart again, what systems are there to provide resilience? If someone doesn’t have strong systems, what is going to catch them?”


She also said she regrets the eviction. “But given the same set of circumstances, would it have the same result? You know, there’s a point at which we have to look after the interests of the neighbors and the property.”


Instead of laying individual blame, onlookers condemn a fragmented web of social services that prevents even the most well-intentioned from averting tragedy. “I am angry all the time, justifiably so,” said Benji Bao Vuong, a Portland activist. “There is no holistic, integrated treatment for the houseless person.”


A spokesperson for Portland’s new mayor, Ted Wheeler, defended his record, noting that the city opened 750 additional beds during the severe weather and that nobody who sought shelter was turned away.


Housing and homelessness were already hot-button topics in the city, but since the deaths there is a sense of greater urgency. Wheeler has co-sponsored an ordinance that will compel landlords to assist with relocation costs for tenants subject to no-cause evictions.


Back at the Batts family home in the Hollywood district, Alan, who spent 11 years in the air force and is a calm and steady man, struggled to control his emotions as he remembered his inability to help his sister. He recalled the last time he saw her alive, about a year before she died. They were walking together to a local train station.


“She asked me for a cup of hot water,” he said. “She didn’t drink tea or coffee, she just wanted to warm her hands.”


He watched as his sister walked into a bank where there was a counter offering drinks. She got what she needed. Then she walked away.



The death of Karen Batts: the homelessness case that shocked Portland

21 Eylül 2016 Çarşamba

Debt, homelessness, domestic violence: the GP practice acting as a one-stop shop

Lisa Baxter*, a mother of three from Oldham, was trapped with a violent partner, difficulties controlling her children, threats of homelessness and frightening debt. Her only ways of coping with her desperation were by abusing drugs and alcohol, and frequent appointments with her GP for antidepressants – until she was referred to community nurse, Ruth Chorley.




I don’t know what I would have done without Ruth. Without her, I think I would have had my children taken off me




Since the 28-year-old started seeing Chorley five years ago at Hill Top surgery, in Fitton Hill, Oldham – as part of a groundbreaking scheme aimed at helping the most deprived families – she has stopped abusing drugs and alcohol, is securely rehoused, her ex-partner is in prison, her children attend school and she manages her finances with only occasional support. Her mental and physical health are transformed and her GP attendances are a fraction of what they once were.


Baxter says: “I don’t know what I would have done without Ruth. Without her, I think I would have had my children taken off me. I would not have been able to cope with social services. Before I started seeing her, I was just being seen by the doctor, given tablets and sent away, but it wasn’t any help, so I would be back again.”


Chorley is a focused care practitioner – one of four employed by Hope Citadel Healthcare, a not-for-profit community interest company, to lead a pioneering approach to delivering healthcare to the most needy families in its four Greater Manchester NHS GP practices, by filling in the gaps between health and social care.


A visit to Hill Top surgery overlooking the former mill town of Oldham, perfectly illustrates how this transformation in Baxter’s life has come about. Chorley emerges with Baxter, having been on the phone for more than an hour on her behalf. She has arranged food vouchers and funds to pay for three school uniforms, and has prevented the cancellation of Baxter’s child tax credit. She has also helped Baxter write a letter of appeal against the cancellation of her housing benefit.



Ruth Chorley


Chorley: ‘How can you expect patients to look after their health, when they don’t know where they will be living next week?’ Photograph: Jason Lock

Passionate about her work, Chorley says: “How can you expect patients to look after their health, when they don’t know where they will be living next week? You can not separate people’s physical health from their psychological, social and spiritual health.”


The reality of doctoring in Oldham is stark. Oldham is the most deprived town in England, according the Office for National Statistics, with 65.2% of its local areas in the most deprived 20%. Men and women in these areas can expect to die more than 10 years sooner than inhabitants of Trafford – Greater Manchester’s most affluent suburb.


Clinical director of Hope Citadel Healthcare and GP at Hill Top surgery, Dr John Patterson kick-started the Focused Care scheme from a belief that social conditions determine heath and that those in greatest need are the least likely to receive it. Patterson says: “In areas of deprivation you need more multifactorial medicine and psychosocial support.”


He asked Chorley – because of her reputation as an energetic champion of families in poverty – to design a scheme in 2010 operating from the Fitton Hill practice, to support frequent attendees at the surgery with complex problems.


Recent figures show something of the scale of human need she and her colleagues face. Of the 120 families on Focused Care in 2014-15, 92% presented with mental health issues, 58% of households had housing problems and 17 women disclosed domestic violence.


The scheme took off and Patterson was astonished by the two-year figures. Of the initial 50 to 60 households dealt with by Chorley, 24 had stopped using A&E inappropriately, 25 no longer had parenting problems, 10 had stopped abusing alcohol and 12 homes no longer had a domestic violence problem.


Seven years on, Focused Care has expanded into eight practices.



Ruth Chorley visits patient at home


Chorley has supported a man through insolvency and encouraged him to stop smoking and drinking. Photograph: Jason Lock

Audits of the 160 families receiving Focused Care over the four Hope Citadel surgeries show that they visit A&E 57% less in the year following intervention. Smear rates over the four practices have rocketed from around 40% to 94%, while at Hill Top surgery alone, 91% of over 65s have had their flu vaccine, outstripping the target of 80%.


A patient can be referred to Focused Care by health staff, social care workers or even police. In each case a patient is seen, problems identified and a care plan drawn up, tackling anything from immigration to parenting and benefit problems. The practitioner then contacts or visits the family on a regular basis and supports them in whatever way is most appropriate for their wellbeing.


It’s usually a painstaking task unpicking the problems. Chorley has supported Baxter through the trial and jailing of a former abusive partner. In another case, she helped a man through insolvency and encouraged him to stop smoking and drinking, enabling him to become a mover and shaker in his local housing association.


Just occasionally Chorley’s job can be short and simple – accessing £20 from a Hill Top practice fund to pay the taxi fare to enable a woman refugee to leave her violent husband with her children.


Hope Citadel is now working with Shared Health – a charity centred on identifying good practice and using the Greater Manchester health devolution agenda to roll it out into the most deprived parts of the conurbation.


Patterson says: “We call Focused Care the ‘Macmillan Service for deprivation’. We want to have an impact on the whole community – not just our patients.”


*Name has been changed


Doctors Working in Deprivation will be held on Wednesday 28 September at Gorton Monastery in Manchester from 8.30am to 4.30pm. To book a free place please register.


Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.



Debt, homelessness, domestic violence: the GP practice acting as a one-stop shop

22 Temmuz 2014 Salı

Homelessness is a public health crisis

Doctor at work

Hospital care for homeless folks fees the Uk £85m a year. Photograph: Christopher Thomond




Going through homelessness significantly increases your possibility of having lengthy-phrase bodily well being dilemma or getting diagnosed with a psychological overall health issue. More than 70% of respondents to a survey of far more than two,500 homeless folks across England reported a single or much more physical wellness troubles, even though more than much more than eight out of ten reported a psychological wellness situation.


Although it ought to come as no surprise that being homeless is undesirable for your wellness, what is surprising is the extent of the inequality amongst individuals who do and do not have a residence, and the lack of progress we seem to be creating in addressing the situation. More than forty% of homeless folks in our research reported a prolonged-term bodily well being issue, compared with just 28% of the general population, while 45% had been diagnosed with a mental wellness problem, nearly double the level noticed in the basic population.


The big difference with the common population is even starker when it comes to distinct well being problems. Charges of depression, for illustration, are much more than 10 occasions higher in the homeless population, whilst long-term abdomen issues are 4 occasions much more common.


In 2010, Homeless Link first published national information looking at the well being of homeless men and women in England and in four years we have noticed little improvement. Our study indicates that not possessing a stable residence is really damaging and those living in the worst problems, such as sleeping rough or in squats, knowledge the best amounts of unwell well being.


With government figures showing that rough sleeping continues to rise, and the amount of homeless households in short-term accommodation at its highest considering that 2009, the value of tackling this situation is greater than ever.


Above all, we think that well being and homelessness solutions can work better together to make sure that an individual’s wellness needs are identified and addressed as swiftly as feasible. NHS acute companies at present bear the brunt of the wellness and other complex issues skilled by those who are homeless. A&ampE visits per homeless particular person are 4 occasions higher than that of the standard public and more than a quarter of people surveyed had been admitted to hospital in the preceding six months. All of which comes at a significant value to the taxpayer – the government estimates that homeless hospital care alone expenses £85m a year.


In spite of the fact that the bulk of homeless individuals are registered with GPs, a important proportion advised us they have been not acquiring the help they need. If people’s well being circumstances are left untreated, their journey out of homelessness will turn out to be more and more hard. It is clear that treating the two together can make sense.


There are examples of services throughout England that are previously bridging the gap in between homeless and primary care companies and displaying what can be attained when pros function together more effectively.


There are GPs who supply long lasting registration to homeless individuals and work in partnership with hostels to give treatment to residents. There are multi-disciplinary NHS and housing teams who target the housing, health and substance misuse issues in unison. There are trained volunteers who support individuals to increase their health and entry health solutions.


However, these examples are not the norm. This is why we’re calling on the NHS at all amounts to recognise homelessness as a wellness situation. At a strategic level, this implies keeping investment and the far better commissioning of overall health solutions to make sure they meet the demands of homeless folks and are linked with housing help. On the frontline this implies checking the housing standing of individuals accessing companies.


Homelessness need to act as a set off and outcome in the offer of a complete overall health assessment and care plan to deal with any concerns recognized. Over all, even though, we need to see a change in frame of mind. Homelessness and sick wellness are intrinsically linked and pros in the two sectors have a role to play in tackling the problems together.


Rick Henderson is chief executive of Homeless Hyperlink


This article is element of the Beveridge Revisited series from Guardian Society Professionals, revising Sir William Beveridge’s five fantastic social evils for the 21st century. Click here to find out what the evils are and study a lot more from the Beveridge Revisited series.




Homelessness is a public health crisis

16 Ocak 2014 Perşembe

How One City Ended Continual Veteran Homelessness

Final month Phoenix completed some thing no community has ever carried out before: it brought the amount of chronically homeless veterans down to zero.


The city’s work was the topic of a White Property blog post and is featured these days in The New York Times.


The accomplishment, according to the Times, is the end result of an strategy recognized as Housing Initial. This evidence-primarily based practice focuses on supplying steady housing to the homeless not as a reward for recovery from addiction, for example, but as basic commencing point. Then further solutions are provided to address the variables that drive persistent homelessness, such as psychological or physical illness.


Related Story: VA Awards $ 60 Million To Aid Homeless Vets


In Phoenix, the place rents are more reasonably priced and there is a lot more area to create, placing veterans in housing or constructing new developments is an less difficult process than in a denser cities.


In 2011, in accordance to the Times, there were 222 chronically homeless veterans in Phoenix, “a vulnerable, difficult-to-reach population of primarily middle-age males, nearly all battling some kind of physical or mental ailment along with substance abuse.” Now people veterans are living in temporary or long term housing.


It is a victory for a system coordinated by the Departments of Housing and Urban Growth and Veterans Affairs, which aims to finish veteran homelessness by 2015. Since 2010, the Times notes, far more than $ 900 million housing vouchers have been awarded to veterans.


Lest this look like a short-term victory, the Instances factors out that 94 percent of veterans surveyed in the city remained in everlasting housing soon after one 12 months compared to a nationwide average of 85 %.


That’s a excellent signal, and perhaps it implies that cities are presently adapting lessons realized in Phoenix.


In the meantime, the city’s efforts seem to be to be creating a huge variation in the lives of veterans. “If I had to do this on my own,” mentioned a single veteran, “I’d never ever have created it here.”


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How One City Ended Continual Veteran Homelessness