The policies of Mayor Smiley are sickening and killing unhoused people - maybe that's the point

The policies presently pursued by the Smiley Administration are cruel, ineffective, and without any scientific or moral merit. Why won't the Mayor do better?

According to the Journal of the American Medical Association (JAMA), a peer-reviewed medical journal published 48 times a year by the American Medical Association, “[a]t least 500 000 people in the US experience homelessness nightly. More than 30% of people experiencing homelessness also have a substance use disorder. Involuntary displacement is a common practice in responding to unsheltered people experiencing homelessness.”

In an attempt to understand “the health implications of displacement,” on April 10, 2023, JAMA published the results of a simulation modeling study of 23 United States cities that projected “that involuntary displacement of people experiencing homelessness may yield substantial increases in morbidity and mortality over 10 years. Involuntary displacement is estimated to worsen overdose and hospitalizations, decrease initiations of medications for opioid use disorder, and contribute to deaths among people experiencing homelessness who inject drugs.”

This policy of “displacement” that is, evicting unhoused people sleeping in tents from public property, is exactly the policy pursued by Providence Mayor Brett Smiley and the Providence Police Department. Despite knowing that these policies bring death and misery, Mayor Smiley continues to pursue them, and at least 38 people have overdosed and three have died in the last month or so.

The American Public Health Association writes that “grassroots leaders and direct service providers have identified and outlined four general problems associated with displacements,” - which I quote in full here:

1. “...displacements compromise personal safety, disrupt community, and erode civic trust. Forced displacement events have caused harm and loss of trust and culture. Encampment displacements destroy autonomy, safety, security, and stability for people experiencing homelessness in a system that has already failed them. They break important connections within a formed community. Encampments embrace a community of peers and often are served by a comprehensive network of outreach and service providers who meet people where they are. Displacements are punitive and reinforce the criminalization of homelessness. They can also end in false promises (of shelter, housing, or other services) that damage trust and hope among those within the camp. Encampment communities often serve as protection from violence and predation as well as other forms of community safety. A mixed methods study in Toronto demonstrated the benefits of mutual peer support from encampment residents for mental health, daily survival needs, and safety.

"Encampment displacements often result in police interactions that increase the likelihood of nuisance arrests. Arrests resulting from displacements create criminal records, court dates and fines, and community service judgments for minor offenses and can result in jail time. The resulting criminal records prevent people from obtaining housing vouchers, make them ineligible for some assistance programs, and bar them from employment opportunities, all of which lead to the elongation of homelessness.

2. “...displacements undermine paths to housing and financial stability. As with those who are housed, people experiencing homelessness often choose where to stay based on proximity to transportation, support networks, and access to employment, services, and other resources. Displacement can undermine people’s progress in working toward resolving their homelessness by destroying personal property, including vital documents (i.e., photo identification, birth certificates, proof of disability, and Social Security cards) and medications that may be needed daily. A survey of homeless encampment residents in Hawaii showed that 57% of people lost their identification. In addition, tools and clothing necessary for employment are often removed or disposed of.

“Replacing vital records can take months and poses a high financial cost. Such documents are essential for jobs, income, housing, mainstream services, and police interactions where proof of identification is required. Organizations and local governments spend hundreds of thousands of dollars annually to support people experiencing homelessness to obtain and replace these documents. To obtain replacement identification, one often needs additional identifying documents, such as a birth certificate, creating a spiral of work and frustration to replace essential documents. The implementation of federal REAL ID laws has made the process of securing these documents even more complex and lengthy. Often residents of encampments have completed benefit applications, and housing assessments and have been entered into the community’s coordinated entry system. After years of waiting, it is not unusual for a housing voucher to become available but go unused (and for the case to then close) because the encampment where the client had been living has now been cleared, and residents cannot be located after being dispersed.

“Furthermore, continual threats of displacement impact health and can result in insufficient sleep. Long sustained periods of sleep deprivation can lead to increases in chronic disease, mental health disorders, and substance use. Individuals living in encampments have reported an associated sense of safety and community, which can contribute to improved sleep patterns. However, threats of continual displacement disrupt these spaces. Healthcare workers also report displacement-related disruptions to the management of infectious diseases such as HIV and hepatitis C, resulting in the potential for increased disease transmission and health-related costs, including lost medications and treatment failures. Similarly, displacement-related disruptions in managing chronic conditions can result in increased emergency room visits and hospitalizations, either to replace medications confiscated or lost during displacement or to address exacerbations of chronic conditions due to lapses in care."

3. “...displacements disproportionately harm people of color, racial minorities, and, increasingly, women. The U.S. Department of Housing and Urban Development (HUD) 2022 point-in-time (PIT) count showed an overrepresentation of unsheltered people who identify as Black, African American, African, or indigenous (including Native Americans and Pacific Islanders). People who identify as Black made up just 12% of the total U.S. population but accounted for 37% of all people experiencing homelessness. The number of unsheltered people experiencing homelessness who identified as Hispanic or Latino increased by 16% between 2020 and 2022. A 2017 American Journal of Preventive Medicine article reported that sexual minority women and men had increased odds of housing insecurity, housing instability, and food insecurity. Although fewer women than men experience homelessness, HUD estimates that the 35% increase in unsheltered status among women observed through PIT counts from 2016 to 2020 is significantly higher than the increase seen for men. Homelessness among women has increased by 16,500 to 115,635 since 2016.

4. “...displacements create unnecessary costs for local communities. Emerging evidence suggests that displacement results in increased costs to the health care system in the form of increased emergency room visits, increased hospital stays, and lapses in early interventions and preventive care leading to more complex needs at presentation. Also, while displacement actions carry a significant monetary burden for communities, they produce little to no measurable success in decreasing homelessness. Money spent on repeated displacements depletes funds that could be made available for permanent housing solutions for unsheltered individuals. Multiple studies have shown that investments in housing save money over the cost of continued homelessness. Costs incurred secondary to displacements, such as emergency room visits and hospital stays, incarceration, and emergency response, also increase after encampment displacements. Data have shown that some cities confronting unsheltered homelessness spent heavily on encampment closures and displacements while spending little on permanent solutions to end homelessness.”

There are better ways to do this. One year after the JAMA study, the United States Interagency Council on Homelessness published “19 Strategies to Address Encampments Humanely and Effectively.” Instead of police and displacement, which inevitably leads to negative outcomes, the Interagency Council on Homelessness urges the use of “evidence-based strategies to collaboratively, equitably, and humanely address the housing and service needs of people without homes - even when housing is not available.”

“When an encampment is prioritized for closure, the process must be implemented in a humane and trauma-informed way, and the goal must be to connect every person to housing and services to help them overcome and avoid future experiences of homelessness,” writes the Interagency Council on Homelessness. “Addressing encampments effectively and humanely is not easy, but there are alternatives to criminalization.”

You can go more in-depth with these strategies at this link, but here's a quick breakdown:

The Interagency Council on Homelessness also has guidance for municipalities trying to deal with the issue of homelessness. In June 2022, they released “7 Principles for Addressing Encampments.”

• Principle 1: Establish a Cross-Agency, Multi-Sector Response

• Principle 2: Engage Encampment Residents to Develop Solutions

• Principle 3: Conduct Comprehensive and Coordinated Outreach

• Principle 4: Address Basic Needs and Provide Storage

• Principle 5: Ensure Access to Shelter or Housing Options

• Principle 6: Develop Pathways to Permanent Housing and Supports

• Principle 7: Create a Plan for What Will Happen to Encampment Sites After Closure

Doing this work is hard and takes effort. Mayor Smiley wants an easy solution, so he turns to criminalization and policing - which lead to morbidity and death. The City issues eviction orders and sends in the police. If the displaced people establish another encampment, the police evict them. If the state can't provide beds or if safe places to lay down are not available, the displaced residents find themselves outside, unsheltered, and alone. There, they become sick and/or die.

Perhaps this is the goal.

The policies presently pursued by the Smiley Administration are cruel, ineffective, and without any scientific or moral merit. Why won't the Mayor do better?

Maybe he needs to hear from you.