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Transitional housing is critical to addressing the Mass. and Cass. housing crisis

Transitional housing is critical to addressing the Mass. and Cass. housing crisis

As medical and behavioral health clinicians who work in the neighborhood of Mass. and Cass (the intersection of Massachusetts Avenue and Melnea Ca s Ca's 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 severe substance use disorder, mental illness, and social isolation, as well as the effects of mental and physical trauma.

12 hours at Mass. and Cass.

A recent survey conducted by Boston Health Care for the Homeless revealed that the number one concern of residents living in the area is safety. Many people want to seek treatment for substance use disorders, but many barriers prevent them from getting help, such as hopelessness, stigma, wait lists, fear, and needing substances to help them survive on the streets. People tell us that they are concerned they will be attacked if they sleep during the night, and so they use stimulants to stay awake and on guard. Others rely on the effects of drugs to neutralize traumatic experiences and symptoms of PTSD.

People who live on the street are also desperate to acquire housing. Although some individuals opt not to enter the shelter system, their decision to avoid shelter is often driven by their inability to manage their addiction in a setting where drugs and injection equipment, such as sterile needles, are confiscated. They are at risk of experiencing severe withdrawal in the middle of the night. Withdrawal is an excruciating experience that causes symptoms such as uncontrollable vomiting, diarrhea, and severe anxiety, as well as severe consequences for some combinations of substances. There is a severe shortage of transitional housing across the city and state, and housed residents have in the past stifled efforts to establish facilities that would provide more transitionally housing in their communities. Caseworkers are swamped by requests when the rare transitional housing beds become available.

During the outbreak, the number of overdose deaths in the United States jumped to a new high of 93,000 last year.

Despite this sad picture, there are solutions that may be implemented in the near term. Transitional housing is a crucial component of the solution. People are typically unable to move from the street into permanent supportive housing because of problems such as lack of the appropriate identification documents, the mental and physical consequences of untreated addiction, and trauma. A temporary stabilization facility allows people to relax, wash, think about treatment, and prepare for the transition to permanent supportive housing. Supportive housing organizations, such as Victory Programs and the Commonwealth Land Trust, are available to assist with the running of these facilities, and to help residents with practical tasks such obtaining identification documents and avoiding overdose. Medical providers in our neighborhood may provide on-site access to clinical care in a transitional housing facility, including addiction treatment, in addition to addiction treatments, if they have access. In Denver, a similar model has been successfully implemented.

Boston will soon receive hundreds of millions of dollars in federal American Rescue Plan Act funds. A portion of the money can be used to purchase a building that would provide temporary stability for tens or more people at saa time. The city and its next mayor have the ability to utilize this unique federal funding injection to solve this twofold humanitarian and housing crisis, as well as unite all stakeholders in support.

Mass and Cass, an unoccupied hotel with homeless people sleeping on the streets, is a place to be.

During the initial months of the COVID-19 epidemic, the city, Boston Public Health Commission, and Pine Street Inn were able to quickly secure private space at Suffolk University to house hundreds of homeless people as the public health crisis unfolded. A partnership of service providers operating a city-owned building and providing support services would be an ongoing solution, not merely based on that arrangement.

Once people have settled into transitional housing, supportive housing groups may work with the Boston Housing Authority to identify federally supported housing options and assist these individuals in obtaining stable housing. This would provide an escape from the street tumult that residents in the Mass. and Cass neighborhoods are living in. It is a practical, humane, dignified, treatment-oriented approach that will provide sanity and permanent housing. If we have the will to act, the solution is within our reach.

Dr. Miriam Komaromy is the medical director of the Grayken Center for Addiction at Boston Medical Center and a professor of medicine at the Boston University. Brendan Concannon is the strategy manager at the Grayken Center for Addiction at Boston Medical Center. Sarah Porter is the executive director of Victory Programs.

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