The number of unhoused Americans is at a historically high rate right now. This podcast is produced in Seattle, a city with the third highest homeless population in the U.S. Though many Seattleites identify as progressive, we can’t reach a consensus on how to help our most vulnerable populations—or even find agreement on the root causes of the housing crisis. Why are perspectives on homelessness, and possible solutions to it, so polarized? Josephine Ensign, a University of Washington nurse and health care provider for people experiencing homelessness, shares some of her insights from her career on the frontlines of this crisis.

Josephine Ensign is a professor in the School of Nursing and an adjunct professor in the Department of Gender, Women & Sexuality Studies at the University of Washington. Her most recent book is Skid Road: On the Frontier of Health and Homelessness in an American City.

Twitter: @josephineensign

Skid Road: https://bookshop.org/books/skid-road-on-the-frontier-of-health-and-homelessness-in-an-american-city/9781421440132

Homelessness Rises Faster Where Rent Exceeds a Third of Income: https://www.zillow.com/research/homelessness-rent-affordability-22247/

WA Department of Commerce: http://www.commerce.wa.gov/wp-content/uploads/2017/01/hau-why-homelessness-increase-2017.pdf

Website: https://pitchforkeconomics.com/

Twitter: @PitchforkEcon

Instagram: @pitchforkeconomics

Nick’s twitter: @NickHanauer

 

Nick Hanauer:

This is a podcast about economics, not about homelessness, but I feel really strongly that these two things are inextricably intertwined.

Josephine Ensign:

It’s not just a housing problem. It is also the sense of belonging, the sense of community.

David Goldstein:

We need a much more robust system in order to deal with very real trauma that both gets people into homelessness and that comes from being homeless.

Speaker 4:

From the home offices of Civic Ventures in downtown Seattle, this is Pitchfork Economics with Nick Hanauer. The best place to get the truth about who gets what and why.

Nick Hanauer:

I’m Nick Hanauer, founder of Civic Ventures.

David Goldstein:

I’m David Goldstein, senior fellow at Civic Ventures. One of the things about out here in Seattle here in Washington state is that we get to be proud about having a very progressive city, a very progressive state, a very affluent and forward looking region. But there are two things here that we’re kind of ashamed of. One is we have by far the most regressive tax code in the country and the other is we have one of the highest rates of homelessness in the country. And I don’t think that they are unconnected.

Nick Hanauer:

This is a podcast about economics, not about homelessness, but I feel really strongly that these two things are inextricably intertwined. And I’m drawn to believe that our homelessness problem is a consequence of the social and economic arrangements we have chosen both in our city and our country. And to be clear, everywhere in the country is facing homelessness at historically high rates right now. But even here in this supposedly very progressive city/county, we can’t come to an agreement about how we should even deal with or help our most vulnerable populations. And we can’t even come to an agreement about how, how we got to where we are

David Goldstein:

And so much of it has to do with policy choices. As we talk about a lot on this podcast, that a lot of the problems we face today are the result of specific choices we’ve made over the past 40 years. But also I think when it comes to homelessness, it’s about how we misunderstand the problem. If you don’t understand the problem, you’re not going to be able to solve it. If you believe that homelessness is just people choosing to be homeless because, “Man, look at all the great services that Seattle provides. Let’s move to Seattle.” Well, then you’re not going to come up with the proper solutions. You won’t have the funding for mental illness, for behavior viral issues. You won’t take into account the high rates of trauma that people experience prior to homelessness and not to mention the high rates of trauma that they experience within homelessness. And that’s going to, as we said before, it’s, if you don’t understand the problem, if you’re telling the wrong story, you’re going to end up with the wrong policies.

Nick Hanauer:

But to be clear the numbers kind of don’t really lie. A 2018 study found that in communities where people spend more than 32% of their income on rent, you could expect a much more rapid increase in homelessness. And that study estimates that the scale of homelessness nationwide has been under counted by roughly 115,000 people or 20%. And the other piece of data that I think is just so persuasive is this 2017 bit of research. It showed that a $100 average increase in rent in a place is associated with an increase in homelessness of between six and 32%. So a big part of the problem is the disconnect between the wages that people earn and the cost of housing.

David Goldstein:

When you take that cost burden number, and they say people who spend more than 32% of their income on rent, that is a function of both housing costs and income. We often rally against neoliberalism, Nick. And part of that neoliberal trickle down story is that people are poor because of bad choices they made. And if they only made better choices, they’d be doing as well as everybody else. But one thing we know is that people are not choosing to be homeless. People are homeless because they’ve fallen through an inadequate safety net because we didn’t catch and treat their traumas early. And because of extremely high rates of inequality, where we have flat wages and rising home prices.

Nick Hanauer:

Yeah. I’m super interested in talking to our guest today, Josephine Ensign, who is as in the weeds and on the front lines of homelessness as, I think, anybody we’ve ever talked to. Who’s both a professor in the school of nursing here at the University of Washington, but also has spent not just a career, but a life directly interfacing with homeless people and helping them to try to tease out what the city can do and by extension what the country can do to address this problem.

Josephine Ensign:

Josephine Ensign and I am a professor in the school of nursing at the University of Washington and have worked in terms of homelessness for about going on 40 years, both as a nurse, as a researcher, as a policy worker, and also as an author. And my most recent book is Skid Road: On the Frontier of Health and Homelessness in an American City by Johns Hopkins university press, which is my alma mater. And it chronicles the history or the historical roots of homelessness in Seattle King County with some three lines in terms of what we’re dealing with now.

Nick Hanauer:

So Josephine, you have been at this for a long time. What drew you to the work?

Josephine Ensign:

Well, to tell you the truth what drew me to the work was a service learning project that I had as an undergrad at Overland college. And I was a big sister for a foster care group home. Young woman who had been homeless and also had fairly serious abuse in her early years and continued that when I had a stunt at Harvard divinity School and was working with people experiencing homelessness in Boston, this was early 80s. And then when I moved back to my hometown at Richmond, Virginia, to go to nursing school immediately got into volunteering and then working with people experiencing homeless in Richmond. And this obviously was all during the time of what has become to be called the rise of new homelessness during the Reagan years. Not that we can completely blame all of it on Reagan, but there definitely were federal policy changes that did not help. And so that’s when I got into it probably since 1979 when I was 19 years old.

Nick Hanauer:

Wow. That’s amazing.

David Goldstein:

So I remember that period when… I grew up in and around Philadelphia and it was around that time, around 1980, the early 80s, when we started to see this rise. What were the Paula policy changes that led to those increases?

Josephine Ensign:

Well, it was pretty complex. But what a lot of researchers and kind of policy makers and people who worked in homelessness for this length of time point to is the kind of steady defunding of HUD services, housing urban development, in terms of support for low income housing redevelopments. There was the gentrification of inner city areas that been displaced especially persons of color and people living intergenerationally in poverty. So that’s one of the main factors. And then also, and this actually started in the late 50s and then took off during the civil rights era in the 1960s that we started seeing more of the kind of rolling effects of it in terms of deinstitutionalization of people with pretty severe mental health issues, developmental issues.

And where it was very well intentioned, a federal policy to try and have much more community based mental health treatment. And again, really good idea, get away from the one… Flew over the cuckoo’s nest kind of abuses that were happening in the institutions like that. But the federal government and also states did not adequately fund the community health centers and all of the support programs that were needed with that, with supportive housing. So we started seeing more severely impacted people on the streets and in our shelters.

Nick Hanauer:

Interesting. So in the quickest sort of the most efficient way that you can, when your friends ask you why do we have such a bad homelessness problem in Seattle and around the country? What is your response? How do you explain the causes?

Josephine Ensign:

In the shortest, most succinct way possible. No, I know because we always want kind of a quick and easy answer. What I say now is housing and… It’s not just a housing problem. A lot of people, I think, very well intentioned have started using the term houselessness instead of homelessness, which I understand where they’re coming from. But it’s not just a problem with inadequate, low income, and supportive housing. It is also the sense of belonging, the sense of community, the community supports in terms of health and social services that are needed for people to be safe and healthy and happy in low income and long term permanent housing.

Nick Hanauer:

Interesting. So we know, obviously, that there’s that significant trauma often precedes the experience of being homeless. But our policy around caring for those experiencing homelessness is not really built with that in mind, is it?

Josephine Ensign:

No, it’s not. And this is one of my biggest frustrations with our current system. If you look at the data for people experiencing homelessness. And especially for people experiencing chronic homelessness which is more extended like homelessness for a year or at least four times episodic times in the past three years. The ACE scores, the adverse childhood events which is a very well tested, researched, and easy to do tests. The ACE scores are off the charts, anything over four of severe childhood events, traumatic events like sexual abuse, like physical abuse, but also seeing violence in the home.

Those types of things that for people experiencing homelessness, the fact that they have had really serious childhood traumas and that have not been addressed. Because the other thing that’s super important for us to understand is that with interventions, with quick interventions and appropriate counseling and treatment for the child and for the family, that those can be overcome and can actually become sources of strength. But yes, traumas oftentimes precede homelessness and then are compounded by the actual being homeless which is very unsafe and unsettling for all of us. That then complicates kind of getting out of homelessness and being healthy and have more stable livings situations.

David Goldstein:

Do we have more mental illness and more childhood trauma than we had in the past, or I’m assuming the rise in homelessness is attributable to other issues.

Josephine Ensign:

Yes. I’m talking kind of nationally now. I’m not just in Seattle. But I think, obviously stresses on families because most families really want to be, and most parents or parenting figures want to be good parents, good guardians of their children. But the stressors on them in terms of economic kinds of fallout to being evicted, all of those types of things can filter down to frustrations and violence towards their children. And then we’ve seen this again nationally, but in Seattle as well. A really severe rise in intimate partner violence and also domestic violence during the pandemic. And that compounded for children and adolescents with the fact that they haven’t been able to be in school where their school nurses and in many cases, at least in the Seattle area, school-based clinics for middle school and high school. Where that can kind of be screened for and also kind of tied into other social services and supports. So I think there actually has been an increase and we were seeing this in Seattle, in King County, even before the pandemic.

David Goldstein:

Because in your book you chronicle the history of homelessness in Seattle. And our history as you describe it, it’s pretty mean to the poor.

Josephine Ensign:

It’s pretty gnarly. Yes, it is. I learned a lot about Seattle and King County. I think one of the most surprising things to me was being able to chronicle. Because Seattle is a relatively new city in terms of the history of our country. Obviously in terms of settler colonialism, part of it. And being able to Chronicle from the very beginning with Doc Maynard and Henry Essler, how they were confronted with our first official homeless person who was also mentally ill. Sailor and what to do about him and then the Washington territorial and then state laws that were basically our poor laws. And how those were adapted from English poor laws and how our kind of social stratification and how we view and treat people experiencing poverty is really pretty cruel.

Nick Hanauer:

Do we do it worse than other places?

Josephine Ensign:

We being Seattle?

Nick Hanauer:

Yeah.

Josephine Ensign:

It’s like Delaware where they literally branded people who… They had to have armbands saying, “I’m a poor person.” So no, they did not. And in jails.

Nick Hanauer:

My personal view is that in a society where more and more families are economically fragile, one of the byproducts of that is that families that used to be able to deal successfully with a difficulty within the family now don’t have the resilience to do it and that person becomes homeless. So do you agree with that? That economic inequality and rising housing prices and all the sort of economic stresses on people are driving this problem?

Josephine Ensign:

Yeah, it’s an interesting point. Obviously there’s also the whole thing of where, especially within healthcare social services where we screen for and recognize intimate partner violence more. But I think the other thing besides rising inequality and especially in the Seattle area, our housing crisis. There’s also been, and again, before Reagan, can’t completely blame it all on him, but it definitely accelerated with his presidency, of cutting back on social services and supports at the federal level. And then also states having to balance their budgets, like in the case of Washington and having to cut certain things. So I think that kind of safety net, which especially because I’ve lived in and done research in the UK. They’re not perfect obviously, but they have a more robust… Well, they have a national healthcare service for one thing, but they have a more robust social service safety net. And so I think that, that’s a big factor as well.

Nick Hanauer:

Yeah, it has to be because I’m actually in London right now and I was in Madrid and Barcelona last week. And you very occasionally see people on the street in these big cities. But it’s at a hundredth the rate at which you see it in the United States. At the most fundamental level it has to be deeply connected to the healthcare system, the social safety net system and just the generally sort of healthier state of working in middle class families in those places as a consequence of those supports.

David Goldstein:

And Josephine you point out in the book that Seattle has the third highest number of homeless in the country after New York and San Francisco and likely the highest per capita. What is it about Seattle then?

Josephine Ensign:

Well, one thing, the data in terms of being able to make those kind of comparisons in urban areas in the U.S. about homelessness. Those got paused during the pandemic, because we couldn’t do the one night count last January. They’re hoping to do it this January. I think again, and looking back at the history from the very beginning of, again, settler or colonial founding of Seattle, we’ve had one of the highest per capita rates of homelessness in the country. And a lot of that-

Nick Hanauer:

For how long?

Josephine Ensign:

Since the beginning. Because if you think about it, what were the main industries at the beginning of Seattle? Was logging, fishing, high rates of injuries. Mostly men who were separated from their families came west or came from other countries to work and it was very seasonal work. And so during the off season, they really didn’t have a place to stay so they would camp out on Seattle beaches, the shanty towns that kind of grew up down in pioneer square. And so again, looking at that, just in terms of the history of the founding of Seattle, what traditionally are industries had been based on. And then also the whole thing. And that’s why I have frontier still in the title of my book, because Seattle has always been kind of a frontier, the end of the world kind of the thing in terms of the Western notion of just go out west to find your fortune. And even obviously as the railroads were being built, it was literally the end of the line.

So that’s why, I think that we had traditionally had one of the highest rates of homelessness. And then just looking at the more contemporary picture of it, it’s a city of opportunity. Some of the richest people in the world but it’s also the contrast with people in abject poverty and homelessness. And especially around the cost of living and especially the cost of housing has been a main factor. And it is interesting that you have to remind people that the overwhelming majority of people who are homeless in Seattle first became homeless in Washington state. They didn’t move here intent on becoming homeless because we’re the land of plenty for people who are homeless. That’s not the case. I’ve had a lot of patience. I had one on Sunday, a woman who moved here from Kentucky. Used all of her savings to move out here with a promise of a job that fell through. And then just the cost of living, she’s living in shelters and she’s highly educated too.

David Goldstein:

That’s an important point that people move out here for the opportunity. You point out, I think you cite that rush [chatty 00:23:27] study that actually Seattle is one of the places where people growing up in poverty have the best chance of getting out.

Josephine Ensign:

Moves to opportunity, yes. And that’s true kind of overall for Seattle, but there definitely are kind of zip codes and neighborhoods that have that highest possibility of moves to opportunity. And they’re not necessarily the richest zip codes. It’s really based on diversity, two parents or at least supportive parenting for kids. And then also of the quality of public schools, which I think is also a really important point for all of us to recognize it’s not private schools, it’s public schools.

David Goldstein:

So what do you think is the biggest disconnect? Obviously, we’ve become a very affluent city. I have trouble talking to my neighbors about this issue. In your conversations, what is that people just were not getting about this issue. And that gets in the way of us solving it, that misunderstanding.

Josephine Ensign:

Yes. And this again, having lived, worked, listened within kind of the whole sphere of homelessness for 40 years. There’s always that kind of backlash in our tendency, especially in our country with a whole pull yourself up by your bootstraps, wanting to blame individuals. So again, you hear, “Oh, they’re all mentally ill, they need to be locked up at Western state. The police need to do more or they’re all drug users.” Like some of the really bad news things like Seattle’s dying have portrayed. And so that’s just been a constant. I heard it back in Boston and back in Richmond ages ago. But of helping people, if they’re open to it, just like with anything else. Kind of using motivational interviewing skills of trying to meet them with where their values are.

And if they’re open to having some education on it, not from a lecturing perspective but from, “Have you bought Real Change newspaper?” And if you have at your local market or whatever, have you talked with the vendor? And not an intrusive way, but have you started to get to know them? Or have you volunteered with, I don’t know, Window of Kindness and Facing Homelessness. And helping people understand more of the stories and the lived experience of what people have to deal with when they’re homeless and starting to see them as people, instead of blaming them for their problems. “Why are they in my park? Why are they set up in a tent next door?” Which are legitimate frustrations, but that’s what I say.

David Goldstein:

Well maybe I’ll just buy people your book since it is… Because you provide that narrative history, you’re telling these personal stories, it really does, I think, get at the issue in a way that statistics clearly cannot.

Josephine Ensign:

Right. Thanks.

Nick Hanauer:

Okay. So Josephine, one of the questions we always ask our guests is the benevolent dictator question. Which is if you were in charge, what would you do?

David Goldstein:

And that means unlimited funds. There’s no laws or constitution getting in your way. How would you address this?

Nick Hanauer:

How do you fix this problem? What should we do?

Josephine Ensign:

Well, first of I find hope in the newly formed King County homelessness regional authority. Because it’s been piecemeal for so long and places kind of working against each other. I also find encouragement and would fund more in terms of what Mark Duns is doing. Been with the lived experience in the past of homelessness. I think that’s super important. They’re starting on the downtown corridor, I’m sure with pressure from businesses, but that is where the most people visibly homeless are.

I think the biggest thing that I would fund is ongoing supportive services in shelters and day shelters and outreach programs. That includes really good quality mental health and substance use kind of services. Because those are so needed. I saw, again, a woman this past Sunday at a clinic at a women’s shelter. And the lack of her being able to have trust to go to any place, any institution for mental health services, it doesn’t exist. So having much more in terms of the supportive services for housing first models of care that are quality and that are sustainable. Because if they’re not quality, they’re not sustainable, it actually does more harm, I think, than good for people trying to become more stable in housing and health.

Nick Hanauer:

Awesome. And we always ask one final question, although it’s not hard to understand your motivations, but why do you do this work?

Josephine Ensign:

Because I have to. Because I have to, it’s just something that obviously since the beginning of my identity formation, it’s been something that I’m passionate about. Again, having lived through a version of homelessness as a young adult, of knowing that part of it, I know many other people don’t have the advantages that I have for getting out of that fairly quickly. But I feel that it’s just something that I have to do, not necessarily from a religious calling perspective, but just from a humanistic perspective. It’s something that I love. I love working with people and trying to build trust and connect them with services that they might want and benefit from. And then also from a kind of policy perspective too, looking at what we can do as a society to kind of bend the arc on this and improve the situation for all of our neighbors.

Nick Hanauer:

Well, thank you for being with us.

Josephine Ensign:

Well, thank you for having me.

Nick Hanauer:

Really fascinating. So Goldie, we should explain to our listeners what Real Change is because Josephine mentioned it.

David Goldstein:

Right. So Real Change is a weekly newspaper in Seattle that is partially written and edited by homeless and formerly homeless people. But more importantly, distributed by the homeless. So there are Real Change vendors throughout the city. And I think it’s $2 an issue now, and it’s a way to get them back into work and hopefully back into a home.

Nick Hanauer:

What are your takeaways, Goldie?

David Goldstein:

Again, I urge people to read the book. It’s called Skid Road: On the Frontier of Health and Homelessness in an American City. And I wish a lot more Seattlites would read it so they’d understand the long history of homelessness in Seattle. And how our instincts in responding to it are basically all wrong. My big takeaway from this conversation is that we don’t do the one thing, the couple things that are necessary to be done. As Josephine points out, we vastly underfund mental health and social services in Washington state and throughout the country. We need a much more robust system in order to deal with the very real trauma that both gets people into homelessness, and that comes from being homeless.

But the other thing is there is a solution and it’s actually not the most expensive solution, Nick. And that is house people. Build more housing, build more shelters, build more permanent supportive housing. I’ve seen estimates that say it costs between 30 and $50,000 a year, every homeless person in terms of dealing with the criminal justice system and emergency rooms and everything else. It’s just so much cheaper to house people than it is to leave them homeless.

Nick Hanauer:

Yeah, absolutely. And at the end of the day you reap what you sow. We have this neoliberal economic system that’s made a few people rich and everybody else more fragile. And homelessness is the inevitable output of that system. It’s an outcome that you basically cannot avoid if you accept the economic system that we have. Again, please buy and read Josephine Ensign’s new book, Skid Road: On the Frontier of Health and Homelessness in an American City.

Speaker 4:

Pitchfork economics is produced by civic ventures. If you like the show, make sure to subscribe, rate, and review us wherever you get your podcasts. Find us on Twitter and Facebook @civicaction and Nick Hanauer. Follow our writing on medium @civicskunkworks and peek behind the podcast scenes on Instagram, @pitchforkeconomics. As always, from our team at Civic Ventures, thanks for listening. See you next week.