By Erica C. Barnett

As the Seattle City Council closes out its budget deliberations this week, two big-ticket items that the King County Regional Homelessness Authority asked the city to fund will not be on the list. Both proposals were targeted specifically at unsheltered people living in downtown Seattle, a political priority for both mayor-elect Bruce Harrell and downtown business interests, including the Seattle Metropolitan Chamber of Commerce.

The first, a high-acuity shelter to help stabilize unsheltered people experiencing health crises in downtown Seattle, will only receive a $5 million downpayment on the KCRHA’s $19.4 million ask. The city plans to combine with another $5 million from the county to begin work on a shelter—or multiple shelters—that will eventually be able to accommodate 150 people.

The second, a $7.6 million plan to hire 69 “peer navigators”—people who have been homeless themselves—to help unsheltered people navigate the homelessness system, will not receive any funding, although the council’s proposed budget doesn’t preclude the possibility of funding such a program in the future. Peer navigation programs are common in other service areas, such as behavioral and public health, but are a fairly new concept for the homeless service system. 

Instead, the budget includes a statement of legislative intent—basically, a short-term directive—asking the KCRHA to come up with a plan for peer navigation that includes existing service providers that are already doing essentially the same work, rather than inventing an entirely new program from scratch that leaves current providers out. REACH and the Public Defender Association already employs outreach workers who have experienced homelessness, criminal legal system involvement, behavioral health challenges, and other circumstances that qualify them as their clients’ peers, for example.

“We’re asking the authority to develop the idea a little bit more with some existing organizations who do extensively employ people with lived experience [by talking] about how we can sync up the peer navigation concept with some of our existing outreach techniques to make sure there’s not redundancies with existing organizations or issues with delivering that service,” City Councilmember Andrew Lewis, who chairs the council’s homelessness committee, said. “We didn’t feel like we were quite at the place where that was a fundable-level project yet.”

KCRHA director Marc Dones agreed that REACH and other groups do “some longitudinal case management,” in which one person serves as a consistent point of contact for an unsheltered person over time, but added that scaling up this kind of work will require far more funding than the authority currently has.

“We’re going to have to see what’s the maximum here that we can realistically do, without saying we’ll do it in on bubblegum and shoestring,” Dones said. “In this instance, we are lucky that we do have some really strong place-based organizations downtown,” such as the PDA’s Just Care program and REACH, “and we do have organizations that have that longitudinal capacity, so it’s not like we’re just not going to do anything, but we do have to step back and take stock. People are burned out right now. … I don’t think it would be at all a great time to turn to any of our providers and say, ‘Now do 220 percent,’ so we have to figure out what’s possible inside the capacity that exists.”

One issue council members, as well as some service providers, have raised is whether it’s premature to hire dozens of new “navigators” when there are so few housing options to navigate people to. “There are a lot of places in our budget where there’s heavy emphasis on outreach, versus where people are going,” council budget chair Teresa Mosqueda said. “And we’re trying to correct for some of that”—by adding funds for mobile crisis units, for example—”but we have to have a place for these folks to go.”

Dones acknowledged that “navigation to where” is an ongoing problem (one faced, it must be said, by Mayor Jenny Durkan’s Navigation Team, which removed encampments without offering viable shelter options to most of the people they displaced). But, they added, peer navigators can do much more than coordinate housing. “I see peers as not just people to navigate [unsheltered people] to shelter or to housing, but people who could really be the glue between systems that are deeply fragmented and deeply siloed.”

The high-acuity shelter (which may, in reality, end up being multiple shelters) is one such place—a respite for people in crisis to stabilize for a month or two before moving on. Currently, the city has no shelter designed specifically for people experiencing acute physical or behavioral health crises—those who are underserved in traditional shelters, which lack nurses and other medical staff, but who don’t require hospitalization. Although there’s no technical definition of “high-acuity,” Dr. Simha Reddy, a member of the KCRHA implementation board, said candidates for such a shelter would likely include people with major physical or behavioral health problems that will continue to get worse if they stay outside.

“We cannot, as the city council, solely [and] fully fund the $19 million request right now, A, because we don’t have that amount of money sitting around given the revenue shortfall and B, because I think we all want to be working in coordination.”—City Council budget chair Teresa Mosqueda

“When you look at the population of people experiencing homelessness, we know that homelessness worsens physical and mental health, and we have an aging population, too—it is not longer surprising to see people in their 80s living unsheltered,” Reddy said. While traditional shelter staff do “an amazing job” of serving people with complicated health challenges, “they’re not trained to care for people who have chronic illnesses or in the midst of a crisis, so there’s this huge gap” for people who need extra care, he added.

“Some of these shelters have even started to look like nursing homes from hell, [with] people who are on dialysis and need oxygen and have significant dementia and they have nowhere else to go.  Shelter staff do their very best, but they are not health care workers. They don’t know what to look for when somebody is starting to fail or how to prevent a problem form occurring,” Reddy said.

Mosqueda said the council’s decision to fund a quarter of the KCRHA’s request “does not tell the full picture,” because King County will also be contributing $5 million in the short term to site and acquire land for a shelter or shelters. (Representatives from the King County Executive’s office and human services department did not respond to questions about where the shelter will be located, although Dones said it will probably not be in downtown Seattle itself.)

“We cannot, as the city council, solely [and] fully fund the $19 million request right now, A, because we don’t have that amount of money sitting around given the revenue shortfall and B, because I think we all want to be working in coordination,” Mosqueda said. “I think this is great example of where we are helping to scale up and be better partners with King County, and in doing so, offer to the regional homelessness authority a more comprehensive way to leverage those dollars and basically create greater economies of scale through the city and county working together.”

For many businesses in downtown Seattle, changes can’t come soon enough. Rachel Smith, the CEO of the Seattle Metro Chamber, told PubliCola she was disappointed that the council didn’t give the authority the additional funding it requested this year. “Urgency is the order of the day when it comes to addressing homelessness and public safety, and trying to take a coordinated approach to our fragmented homelessness response system means investing urgently where the experts say we need to invest,” Smith said.

“Not investing in the entirety of the authority’s request or investing in other sorts of things in lieu of that request doesn’t get us where we need to be. … If we’re not doing everything we can to set up the authority to urgently take action, we’re just delaying seeing the outcomes that we want to see.”