In May 2015, I had a chance encounter in the parking lot of Hot Metal Bridge Faith Community in Pittsburgh’s South Side. There, at the age of 45, for the first time in my life, I met a man who was experiencing homelessness.
We seemed to hit it off right away and ended up talking over coffee for nearly an hour. Looking back now, I think our connection stemmed from our shared experience of upheaval. We weren’t coming from the same place and we didn’t end up in the same physical space, but somehow we seemed to land in a similarly dislocated social context.
My social dislocation came after the loss of my marriage, my business and my mother, plus a brief 60-day stint under house arrest. His was even more extreme. Having recently finished 10 years of incarceration, he found himself trying to navigate a very different world than he had experienced in prison and prior to incarceration. As he put it, “I went to jail with a pager and a pocket full of quarters and when I got out, someone handed me a phone with no buttons.”
Our friendship grew quickly, and it wasn’t long before he introduced me to the community he found while living under a bridge in the South Side. There I found individuals with different stories all sharing societal dislocation. It was with them that I started to learn about the streets, the services available to someone living in the streets, and this immense bond that forms when a diverse collection of traumatized humans live in community outside of social norms.
He taught me about street medicine and introduced me to the founder of that concept, Dr. Jim Withers.
My friend also taught me about the long pathway to housing services in Allegheny County. Every day, he went to Wellspring Drop-in Center — not to receive services, but just to sign in. As he explained, to get housing you first had to prove you have been homeless for one continuous year. By signing in every single day, he knew he would have a detailed record to prove he was homeless when he reached the one continuous year the U.S. Department of Housing and Urban Development required for someone to be considered “chronically homeless.” He was getting close to his one-year mark and preparing for the next step.
Once he hit a year, he would call the Allegheny Link hotline to get an assessment so he could be put on the waitlist for a supportive housing program. After that, he explained, he would have to call back every day to remain on the list until a housing referral became available. To me, this process seemed lengthy and extremely challenging for someone experiencing homelessness.
I quickly learned that there were a lot of resources available for someone experiencing homelessness, but knowing those resources and how to navigate them was a serious challenge. As a result, in 2017, I founded my own nonprofit and started coordinating resources for anyone experiencing homelessness in Allegheny County.
Pittsburgh pioneered street medicine
I could spend a lot of time writing about me and my organization, where we are today and how we got here, but that’s not why I’ve chosen to express my thoughts here.
Over the past year, I’ve seen a lot of media coverage and listened to a lot of public discourse over the “homeless crisis” we are experiencing here in Pittsburgh. I hear and see a lot of people in places of authority, in the media and in public conversation coming forward with their analyses of the state of our community experiencing homelessness and their prescriptions. Most of these ideas and suggestions have seemed to be focused on what’s being done in other cities and fad trends such as tiny houses.
There is an obvious lack of understanding about the systems, processes and services we have here in our city and county. Some stories highlight new initiatives in other cities, suggesting they would be new to Pittsburgh and Allegheny County, when those efforts are actually modeled after what we have been doing here for years. There seems to be little or no recognition of the ways in which we as a community of providers have in some ways led the nation in innovation of services for individuals experiencing homelessness.
The first is street medicine, a term coined and is copyrighted by the Street Medicine Institute, a global organization founded by Dr. Withers here in Pittsburgh. Dr. Withers started the practice now known as street medicine — meeting people on their own terms and in their own spaces — 31 years ago while working at a Mercy Hospital division that later spun off to become Pittsburgh Mercy.
He has incorporated education into his work, and hundreds of medical students and residents have rotated through his street rounds, gaining experience in this innovative way to provide medical care. As these students and residents moved on to other areas of the country to begin their careers, many started their own street medicine programs. Today, the 14-year-old Street Medicine Institute serves as a gathering place to support the movement and assists programs in 140 cities in 27 countries across six continents.
Last month, street medicine was officially recognized by the federal government and for the first time given its own billing class code so medical insurance can support the care. In Pittsburgh, we now have four medical organizations bringing vital medical care to our community of individuals experiencing homelessness.
The second area of service I’d like our community to better understand refers back to the process of obtaining housing. A few important things have changed since 2015.
HUD changed the federally accepted definition of “chronic homelessness.” One can now be considered homeless after 12 continuous months spent unhoused, but also after “episodic” homelessness totaling 12 months over three years and including hospital stays, jail stays and short-term stays with friends and family.
The county also changed its reporting requirement for those on the list for housing help from daily check-ins to monthly check-ins.
Lastly, the Allegheny County Department of Human Services introduced the Office of Community Services Field Unit. Now someone seeking housing has the opportunity to have someone sit down and perform the assessment at a campsite or on a sidewalk, rather than over the phone.
These three changes created a far more efficient process for getting people into housing. As a result, every year we are for the most part working with an entirely new group of individuals living outside.
COVID quiet, then the storm
In 2022, though, we had a surge in the number of people experiencing homelessness.
We knew it was coming, because during the early part of the COVID pandemic we saw our numbers drop substantially. I can recall being on medical rounds with Dr. Withers in April 2021, feeling like we were in “The Twilight Zone” because there was almost no one in the streets or in camps. We knew it had to be a result of COVID-related measures to keep people housed and anticipated that the dam would burst as the temporary measures fell off.
We just didn’t know exactly when the wave would land or what kind of numbers we would be looking at.
As it all started to let loose and the surge began, we did what we always did and started scrambling to make new engagements and get people aligned with services. As the media started bringing attention to certain areas, we quickly found political and public pressure to prioritize resources based largely on location. This had an unsettling and disruptive effect on our resources that we are still struggling to overcome.
As I write this, the problem remains daunting, but the overall approach is moving in a more effective direction. The turmoil that we are experiencing this year has created opportunities for change that we would have otherwise been hard-pressed to find.
We’ve always been very efficient at providing long-term housing for people. But as a result, we’ve only needed to be OK at providing emergency shelter. I’ve seen much better shelter models in other cities — like smaller, true low-barrier shelter spaces for dozens or scores of people each, and supportive housing built around fostering community — that I’d very much like to see here.
Right now, there is an appetite for change and willingness to collaborate at our highest levels of local government, the likes of which I’ve not previously experienced. Those of us with our boots on the ground have been pushing for years for a greater focus on the effects our programs are having on the humans we serve. Prior to this year, the status quo seemed to stand steadfast in opposition to change. Now, though, it seems as if the status quo got scooped up by the front-end loader at the Stockton encampment and dropped in the dump truck.
I’m optimistic about the potential I see for reshaping our shelter systems, our housing systems and the continuum of care in homeless services. As the public eye begins to shift away, as it has always done in the past, I only hope we can find enough momentum to continue to lead.
Dave Lettrich is the founder and director of Bridge to the Mountains, which includes Bridge Outreach; serves on the executive committee of the county’s Homelessness Advisory Board; co-chairs the city and county Homeless Outreach Coordinating Committee; and can be reached at dave@bridgepgh.org.
