Although only 1% of Seattle’s population identifies as Indigenous, “hundreds of years of colonization, systemic racism, broken treaties, forced reservations, and more have resulted in native peoples making up a startling 15% of Seattle’s homeless population,” as well as 32% of people experiencing chronic homelessness (quote from the Chief Seattle website). Yet we have important Native-led organizations like the Chief Seattle Club coming up with innovative, culturally relevant health, housing, and social programs to reduce homelessness for our Indigenous community members.
Derrick Belgarde, who is Siletz and Chippewa-Cree, is the executive director of the Chief Seattle Club. He has lived experience of homelessness on the streets of Seattle. Leading the Chief Seattle Club through the COVID-19 pandemic and into its current expansion of services, including permanent supportive housing, Belgarde shared his insights and experiences with me. There’s so much good stuff within this interview that I hope you listen to it in its entirety.
Focusing on the story of the police killing of the Indigenous woodcarver living in homelessness and in permanent supportive housing, John T. Williams, I wrote a chapter, “Displaced,” in my forthcoming book Way Home: Journeys Through Homelessness. It was one of the more emotionally challenging chapters to write. In the chapter, I include content from my oral history interview with Derrick Belgarde. In addition, Belgarde graciously agreed to read, comment on, and suggest changes to the chapter. As a non-Native person, I wanted to honor the stories of people like Williams and Belgarde.
In early 2017, I had the pleasure of talking with Dr. Reddy about his work. At that time, he had been working on homeless veteran health care for five years. He said, “When I took my job, actually, that was the first time I learned of the VA’s commitment to end homelessness. And I laughed because I thought it was ridiculous. After having seen what the VA has done, I think it is possible.”
A significant reduction in veteran homelessness is one of the little-known (among the general public) successes in the US response to homelessness. Beginning in 2008, the Department of Veterans Affairs and the Department of Housing and Urban Development, with bipartisan support and funding from Congress, have reduced veteran homelessness by half while overall homelessness has risen. There was a recent slight increase in veteran homelessness caused by rising rents, especially in cities like Los Angeles. But even this increase was much smaller than for other groups of people experiencing homelessness. A recent New York Times article, “Decline in Veterans’ Homelessness Spurs Hopes of a Broader Solution,” by Jason DeParle (August 6, 2024), explains all of this well. What DeParle doesn’t cover well in this article is the role of VA health care, especially community-based programs like that run by Dr. Reddy.
Housing without access to good trauma-informed primary care, including behavioral health care, will never work to reduce homelessness. VA Health provides access to comprehensive health care through its more than 13,000 hospitals and clinics nationwide. It is always imperfect, as with any healthcare system, but it is much better than the still fragmented, chaotic, and expensive US healthcare system for non-veterans. Housing First is the model of intervention used by the federal approach to reduce veteran homelessness. Housing First only works well if housing is combined with ongoing medical and social support services.
Towards the end of my conversation with Dr. Reddy he had this to say, “People sometimes have preconceptions of what a homeless person looks like, what a homeless veteran looks like. That’s it’s a drug-addicted, mentally ill, Vietnam-era veteran standing on a street corner with a sign. Maybe. But that person can get their life back together. I’ve seen that.
“But the other thing that has been remarkable to me is how close to the edge we all are. That the people I’ve cared for, all of them certainly, have been soldiers, sailors, veterans of all kinds, and have served their country, and have fallen on hard times at some point in their life by the time that I’ve seen them. But they have all been real estate agents, small business owners, cooks, priests, actually nurses, social workers.
“And what leads to homelessness is typically a crisis of some kind, and none of us are immune to a crisis. The loss of a family member. The loss of family through divorce, or something like that. A health issue. And those are the things I wish people could see; that we are so much closer to the edge than we think. But that if we live in a society where, if somebody falls over, there’s somebody willing to help them stand back up, we are going to live in a better place. That is an investment in our people. And that’s important.”
The best part of my job is working alongside smart, dedicated, and compassionate people who make a positive impact on the lives of people experiencing homelessness. People like Hannah Glover. She is a health navigator at the Elizabeth Gregory Home, a day shelter for women and female-identified people in the University District (U District) of Seattle. Located in one of the few remaining churches in the recently upzoned U District, Elizabeth Gregory Home is a true sanctuary for people surviving homelessness. (For a recent Seattle Times article on changes in homelessness in the U District and the roles of upzoning, see “How-and why-life for unsheltered youth on The Ave has shifted,” by Brendan Kiley.)
Think about the last time you tried to access health care, like making an appointment with a primary care provider, or for updating your vaccinations. Was it easy? If it was easy, you likely are housed, have ready access to the internet, and have a job providing decent health insurance. And you likely already have established care with a provider covered by your insurance. People who are experiencing homelessness have a much harder time with access to health care due to lack of (or confusion over) health care insurance, transportation to/from health care, lower levels of health literacy, and competing basic needs like finding shelter, food, and safety. In addition, as described in my interview with Hannah Glover, too often, a major barrier to care for people experiencing homelessness is a previous bad experience with health care. Experiences like negative stereotyping, judgmentalism, and all the ‘isms’ you can think of. Having a skilled health navigator available to people in community spaces they trust is essential.
When I provide basic health care onsite at the Elizabeth Gregory Home, Hannah Glover makes my work much more efficient and effective. The nursing students I have with me benefit from her experience and insights. We need more excellent health navigators in community settings, not just within hospitals.
Tim Harris, founder and longtime director (1994-2020) of Real Change, Seattle’s “street paper” anti-poverty newspaper, talked with me about his life and work in 2015. Real Change turns 30 this year, with the first issue published on August 20, 1994. My purpose with this Skid Road oral history project and podcast is to highlight and celebrate the visionary people in Seattle who have impacted the landscape locally in terms of housing and homelessness. Tim Harris is one of these visionary leaders.
In April, I interviewed Seattle-based housing advocate and consultant Ginger Segel. I know a lot about health policy, especially as it relates to care for people experiencing homelessness. I do not know as much about housing policy as I would like to, so I was eager to hear her stories and perspectives.
Segel first spoke of how, as a student at Columbia University in NYC, she witnessed the role of the university in displacing low-income people in the expanding area around the university. When she moved to Seattle in the 1980s, she got involved in tenant’s union organizing and in Operation Homestead. Operation Homestead’s mission was to counter the harmful effects of the closing of Single Room Occupancy Hotels (SROs) happening throughout the country. The activists occupied emptied-out buildings so that homeless and other low-income people could live there.
Segel then worked for the Low Income Housing Institute (LIHI) on establishing the consumer-led housing building, the Aloha Inn, now renamed The Inn and run by Catholic Community Services. Currently, LIHI is a major player in the Seattle-area (and beyond) efforts to provide more affordable housing to people experiencing or at risk of experiencing homelessness. Segal and other advocates helped form the state Housing Trust Fund, which, since its formation in 1986, has provided over $2 billion in capital financing to affordable housing projects throughout Washington State.
Now working as a consultant on affordable housing projects throughout the state, Segel has seen first-hand some of the drawbacks of Housing First and permanent supportive housing, including through the newly established Apple Health and Homes Initiative. I was involved tangentially in the formation of this initiative and testified in its favor (when it was House Bill #1866) before the House Health Care and Wellness Committee of the Washington State Legislature. The Apple Health and Homes Initiative pairs healthcare and housing resources for permanent supportive housing for vulnerable (and high-needs) individuals. Segel points out that we need to examine the benefits and pitfalls of Housing First closely. Communities she works with sometimes say that they are forced to take people they cannot handle and that creates safety issues for other residents and staff members.
Segel stated, “Another problem in the advocacy community is we have said we’re going to solve this (homelessness) too many time but we never could solve it because the economic forces were always much stronger than our strategies.”
Dr. Ben Danielson, Odessa Brown Clinic, 2015, photo credit: Josephine Ensign
I had the pleasure of working with Dr. Ben Danielson when he was the medical director of Seattle Children’s Odessa Brown Children’s Clinic in the Central District. I was a nurse practitioner at the co-located community health clinic, the Carolyn Downs Family Medical Center. I remember conferring with Dr. Danielson over the care of a young adult woman with sickle cell disease who had aged out of care at the pediatric Odessa Brown Clinic. Most of our patients were African American, Latino, and recent immigrants. Carolyn Downs Family Medical Center began as a Black Panther community clinic. Both clinics have long histories of providing quality care to people marginalized by race, ethnicity, and poverty.
Five years after I interviewed Dr. Danielson at the Odessa Brown Clinic in 2015, he resigned in protest over alleged racism towards the clinic’s patients and him by Seattle Children’s Hospital. Since then, he has helped launch a project to address the overrepresentation of Black and Latino young people, especially males, in our King County Juvenile Detention Center. This is an issue he talked about in his interview with me. “With a system that is so broken, and feeds other broken systems that fail people consistently and predictably–in other words, fail, especially young African American males–it’s hard to see yourself feeding into that. (…) Maybe our health system is set up to keep young Black males just well enough to feed them into a system of enslavement in the prison systems. That’s a heavy thing. That’s a powerful thing to think about. How much are we doing that is just supporting a process that is so harmful to so many people?”
Dr. Danielson also spoke of lessons he learned from Elizabeth ‘Liz’ Thomas, the first African American to graduate from the University of Washington’s pediatric nurse practitioner program. “When I had finished my official orientation to the job here, she (Liz) grabbed me by the ear, took me aside, and told me what I really needed to do to do a good job. And she said, ‘You have to get outside of these walls. You cannot just do medicine at the length of your stethoscope. Good care is care that happens as much for the kids who never come into this clinic as it does for the kids that do.’ More than that, she also pushed me to think a lot more about treating kids before they’re kids–pregnancy–and helping mothers have healthy pregnancies so that they have healthy births, so that they have healthy kids, and that that sequence is really important.”
I am grateful for the first reviews of my newest book, Way Home: Journeys Through Homelessness, now available for pre-order. Here are the book’s description and the reviews:
Can one city’s solutions to homelessness help the United States face the issue nationally?
The United States grapples with a solution for the unhoused by employing a patchwork of uneven rhetoric and policy. How can policymakers and public health professionals address this urgent problem in more innovative and sustainable ways? In Way Home, Josephine Ensign explores the contemporary landscape of homelessness by focusing on Seattle in King County to assess how their innovative local solutions can be scaled up nationally.
From consumer-led shelter programs to the expansion of the Housing First model of care, Seattle-King County is a leader in this area. Ensign assesses the effectiveness of policies such as child tax credits, rental subsidies, eviction moratoriums, and programs for vehicle residents. As an expert in the field who has also experienced homelessness, Ensign draws from an extensive oral history project to share poignant firsthand accounts that inform and enrich her storytelling. This narrative incorporates human rights, support services, public health issues, and a path forward that acknowledges the true realities of people living unhoused.
Amid the rapidly evolving public health and political landscape accelerated by the COVID-19 pandemic, Way Home deepens our understanding of the historical roots of homelessness and highlights innovative public policy and program efforts at the national, state, and local levels to address it.
Reviews:
“What Ensign accomplishes in her new book is remarkable. Way Home is one of the most important books on homelessness I’ve read, and I couldn’t put it down.”
— Sara Rankin, Seattle University School of Law
“As a nurse, researcher, advocate, and person with lived experience of homelessness, Josephine Ensign invites us into the lives of people experiencing homelessness with this beautifully written, exhaustively researched, and evidence-based work. Way Home emphasizes the need for individual and societal empathy in any successful and durable solution to homelessness.”
— Gregg Colburn, University of Washington, coauthor of Homelessness is a Housing Problem: How Structural Factors Explain U.S. Patterns
“Ensign masterfully and memorably portrays individuals and their homelessness in the larger context of societal structures and policies. I will never forget the tragedy or the strength of her subjects. Way Home is valuable for practitioners, policymakers, and students in understanding the causes, effects, and solutions that can help us end homelessness.”
— Bobby Watts, National Health Care for the Homeless Council
“Way Home explores Seattle’s homelessness crisis through the lives of those who have experienced it. With depth and empathy, and drawing on decades of experience working with homeless communities as a nurse practitioner, Ensign examines causes and promising solutions such as safe parking programs and the Housing First model, while sharing stories of those affected. Through deep research and evocative prose, she sheds much-needed light on this complex issue and its human cost.”
— Tony Sparks, San Francisco State University, author of Tent City, Seattle: Refusing Homelessness and Making a Home
In the midst of a prolonged heat wave two years ago in July, I talked with Washington State Representative Nicole Macri about her work on homelessness, housing justice, and behavioral health issues. Macri has worked at Downtown Emergency Service Center (DESC) in various capacities for the past twenty-two years. In the Washington State House of Representatives she serves on the Health Care and Wellness Committee.
In Seattle, as throughout much of the West, we’re in another prolonged heat wave. Excess heat is deadly, especially for the elderly, people living with mental health and substance use disorders, and people who have to work–and live–outside. People who live in isolation. Excess heat events are becoming more frequent due to the effects of climate change. When I spoke with Rep. Macri two years ago, she had visited Harborview Medical Center, our area’s Level 1 Trauma Center.
When she visited Harborview Medical Center, all the area hospitals were on alert because of the extended heat wave causing heat-related injuries. “The emergency room Medical Director said, ‘This afternoon, we had no available ambulances to go on call in Seattle because they were all at emergency departments waiting to transition their patients to the ED,’ but they struggle to do that because the hospitals are all backed up.” Rep. Macri told me that at that moment, she realized that our medical system is going through a crisis similar to what the behavioral health system has been in for years. She said, “So we have all these people who are homeless, living with severe behavioral health conditions. They are trying to get in the front door, usually through the crisis system, and the crisis system is totally overloaded and can’t respond.”
Rep. Macri went on to talk about her legislative work on community behavioral health policy and investments. “It’s a long endeavor. I knew that going into it, but it seems like every year we go back to the Legislature, we discover how a gap in the system is really profoundly harming people. It’s like a dam that’s just spurting water everywhere… And as behavioral health concerns have become more universal as more families have seen the impacts of the stress of the pandemic, there has been more of a focus on behavioral health. But we certainly didn’t have a system that is or will be anytime soon ready to respond to the growing needs we see in the community.” Towards the end of our conversation Rep. Macri added, “I just wonder and hope that we continue to have the same conversation of not making the sam mistakes; that tightening of the belt has a disproportionate harm to vulnerable communities and does not help us recover economically as quickly as investing in the communities that need the most support during these challenging times.”
As of this month, I have been a public health nurse for forty-two years. Public Health nursing rocks. It requires compassion and a heart for advocacy and activism, as its foremothers and founders demonstrated. Here are images of a younger me at the 1993 March on Washington for Lesbian, Gay, and Bi Equal Rights and Liberation when I was working as a nurse practitioner at Baltimore’s Chase-Brexton Clinic. And me in 1982 in my first job as Hypertension Control Nurse with the Richmond Health Department and the Richmond Urban League. Taking the blood pressure of then mayor of Richmond, Dr. Roy West and shaking the hand of then governor of Virginia, Charles Robb when he declared a hypertension awareness month.
I love public health nursing and everywhere in this world it has taken me. No regrets on my career choice.
Yesterday, at a community homelessness resource and health fair where I was faculty preceptor for a footcare clinic with some of our medical and nursing students, I was reminded of the powerful role of libraries in the lives of people experiencing homelessness. Among the tables and tents offering warm winter coats, gloves, hats, behavioral health resources, pizza, bagels, coffee, haircuts, youth shelter and women’s day shelter services, and our footcare, the University Branch of the Seattle Public Library table was quite popular. Amidst the absurdity of a return to backward-looking book bans throughout our country and in a season of thanksgiving, let us remember that public libraries literally save lives.
It is not hyperbole to say that public libraries save lives, especially for people experiencing homelessness. Libraries give sanctuary and shelter, both emotionally and physically. Libraries yield quiet, peacefulness, community, heat, and, hopefully, air conditioning when it’s hot and smokey outside. Libraries have public restrooms, which are surprisingly scarce in Seattle as in most US cities. Harried parents can find respite in libraries with their bright, colorful children’s book sections, free access to the internet and computers, and children’s story hours. Children, teens, adults, and older adults, no matter their race, ethnicity, gender, sexual identity, differing abilities, socio-economic and housing situations, can all find stories of people like them who deal with challenges they face and who find ways to not only survive, but endure, resist, and thrive.
If you are fortunate enough to be comfortably and stably housed, please remember that not all of our community members have these basic necessities. When visiting public libraries, try to practice tolerance for all people who seem different to you. That extends to people who ‘appear’ to be experiencing homelessness.
A growing number of public libraries throughout our country and internationally are hiring social workers to assist library patrons from all walks of life to access needed health and social support. Whole Person Librarianship is a library-social work collaboration hub with resources and a map of social work-supported libraries. A recent and excellent book is Libraries and Homelessness: An Action Guide by the librarian and homelessness advocate Julie Ann Winkelstein–available, of course, in many public libraries.
