What does a public health approach to unsheltered homelessness look like?
Camp Nenookaasi organizer Nicole Mason films police during a clearing of the recently relocated Camp Nenookaasi encampment in the East Phillips neighborhood on Thursday.
Tim Evans for MPR News
Police evicted residents of a homeless encampment in south Minneapolis Thursday for the second time in a few days. The encampment was the fourth iteration of Camp Nenookaasi, which was shut down Tuesday by the City of Minneapolis due to “imminent public safety concerns.“
A city hearing on the encampments Wednesday night ended in a shouting match, with council members divided over how to approach the encampments. The city’s operations officer, Margaret Anderson Kelliher, reiterated the city’s stated core values — that every unsheltered person deserves dignity and respectful treatment.
“Every effort has to be made to connect people to housing, shelter, and services,” Kelliher said. “Encampments are a serious public health risk to safety, including and centering on people staying in the encampment itself. They are not a dignified form of shelter.”
The city has offered shelter for the residents, but people in the camp say they would rather be at Camp Nenookaasi. Josh Leopold, a Senior Advisor on Health, Homelessness and Housing at the Minnesota Department of Health joined MPR News host Cathy Wurzer for more perspective.
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Editor’s note: This story has been updated to correctly state the number of times Camp Nenookaasi has moved to a new location.
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Audio transcript
CATHY WURZER: Right now, police are evicting residents of a new homeless encampment in South Minneapolis. Last night, a city hearing on the encampments became quite heated, ending in a shouting match, with council members divided over how to approach the encampments. The city's operations officer, Margaret Anderson Kelliher, weighed in, reminding the city of its core values that every homeless person deserves dignity and respectful treatment of their rights.
MARGARET ANDERSON KELLIHER: Every effort has to be made to connect people to housing, shelter, and services. Encampments are a serious public health risk to safety, including and centering on people staying in the encampment itself. They are not a dignified form of shelter.
CATHY WURZER: Now, the city has offered shelter for the residents, but people in the camps say they would rather be at Camp Nenookaasi. Joining us now for more perspective is Josh Leopold, a senior advisor on health, homelessness, and housing at the state department of health. Josh, welcome.
JOSH LEOPOLD: Hi. Thanks for having me.
CATHY WURZER: I understand you went to the city council meeting last night, not in an official capacity. You're invested in this situation. What was your takeaway to what you heard?
JOSH LEOPOLD: Well, I wasn't able to stay for the entire hearing, but it was instructive hearing the presentation from the city just to better understand sort of, as you mentioned in the lead-in, sort of what their perspective is and what informs their decision making around addressing encampments.
CATHY WURZER: Now, this is a new position, I understand, at MDH, created in response to the increased visibility of homeless Minnesotans after the pandemic, and looking at it through a public health lens. What is your job? What's your task and what's your goal here?
JOSH LEOPOLD: Yeah. So you're correct. So this position was created partially as a response to the COVID public health emergency and the kind of increased visibility that gave into the challenges that homelessness can create in terms of following public health guidance. And one of my jobs is to better understand, because this is a new position, what are the biggest public health risks for people experiencing homelessness? And then that can inform our plans that we work on both within the health department and with our partners across state, and local, and tribal governments in terms of, how do we address those risks?
CATHY WURZER: When you look at public health in this particular situation, Camp Nenookaasi, last week, I guess there was an outbreak of a gastrointestinal bug among folks living in the camp. Is that what you're looking at, or is it something broader?
JOSH LEOPOLD: That's one piece of it. So one of the things that we did in partnership with the Hennepin Healthcare Research Institute was a homeless mortality study. And so we looked at all people who used a homeless service as reported in the statewide homeless management information system data from 2017 to 2021, and merged that with our state death certificate data.
And what we found was that people experiencing homelessness, their risk of dying during this period was three times higher than the general population. And the risk of dying from a substance use related cause was 10 times higher. So that's really, I think, one of our top priorities right now is addressing that substance use risk for people experiencing homelessness.
CATHY WURZER: Substance abuse, as you say, illness, deaths. But I'm wondering, though, are there public health risks when you displace people? Because there's just so much upset. This seems to be kind of a delicate balance. Am I right about that?
JOSH LEOPOLD: You're correct. Yes. So there are public health risks associated with the encampments. And then there are also public health risks with closing the encampments, because-- and there's data on this-- it can be disruptive of people's connection to services. It can be disruptive of people's connections to community. And so those can increase risks for both infectious disease and drug-related deaths.
CATHY WURZER: I don't know if you have an answer to this, but many residents at Camp Nenookaasi say they don't want to be in shelters. They want to rely on the community of the camp. Are there any other models out there where an outside encampment like this can serve as a bridge to more permanent housing?
JOSH LEOPOLD: Yes. I think so. So one of the shelters we have in Minneapolis is Avivo Villages, which was designed with the perspective of people who were staying outside in the encampments in mind. So I think those kind of low barrier shelters that are informed by know people with lived experience can be part of the solution. And as the city officials mentioned at the hearing yesterday, they were successfully able to connect many of the people who were staying at the Nenookaasi camp to both shelter and longer term housing.
CATHY WURZER: We've been talking about some of the statistics here. The department of health, I understand, is rolling out a new grant program to create, help me out here, maybe you have better information than I have, new hubs with services focusing on housing, and health, and harm reduction. What about that new effort?
JOSH LEOPOLD: Yeah. That's correct. So this is our harm reduction health and housing grants. And these were funded as part of the comprehensive Drug Overdose and Morbidity Prevention Act, which was passed by the state legislature last year. And the goal is to get at that intersection that I was talking about between homelessness, and substance use, and drug-related fatalities.
So how do you connect those harm reduction services with health care, drug treatment, and shelter and housing so that we're both improving people's housing stability while we're also addressing their substance use-related risks?
CATHY WURZER: And do you also look-- all these services are out there, but there's also this culturally sensitive piece that we hear about. The folks in Camp Nenookaasi are mostly Native. Do you offer services that have that piece attached to it that you do concentrate on services that are culturally sensitive and relevant?
JOSH LEOPOLD: Yeah. So there are fantastic service providers who are from that community-- Native-led service providers-- who are doing a great job with connecting with folks there. And we try to support that however we can. And so one of the things that we're doing, for example, with these hubs is that we're committed to ensuring that some of those grants go to those organizations with expertise in working with people in the American Indian community.
CATHY WURZER: Final question-- as you know, the pandemic didn't do much to improve trust between people and those in public health. And I'm wondering, trust-- as you build trust with unsheltered people, is that a key part of what you're doing, a key part of public health?
JOSH LEOPOLD: Yeah, absolutely. That's really probably the key part of public health is to build trust in the community so that they feel comfortable working with you, and then that can be kind of a gateway into providing public health services.
CATHY WURZER: Well, I appreciate your perspectives here, Josh. Thank you, and best of luck.
JOSH LEOPOLD: Thank you.
CATHY WURZER: Josh Leopold is a senior advisor on health, homelessness, and housing at the state department of health.
MARGARET ANDERSON KELLIHER: Every effort has to be made to connect people to housing, shelter, and services. Encampments are a serious public health risk to safety, including and centering on people staying in the encampment itself. They are not a dignified form of shelter.
CATHY WURZER: Now, the city has offered shelter for the residents, but people in the camps say they would rather be at Camp Nenookaasi. Joining us now for more perspective is Josh Leopold, a senior advisor on health, homelessness, and housing at the state department of health. Josh, welcome.
JOSH LEOPOLD: Hi. Thanks for having me.
CATHY WURZER: I understand you went to the city council meeting last night, not in an official capacity. You're invested in this situation. What was your takeaway to what you heard?
JOSH LEOPOLD: Well, I wasn't able to stay for the entire hearing, but it was instructive hearing the presentation from the city just to better understand sort of, as you mentioned in the lead-in, sort of what their perspective is and what informs their decision making around addressing encampments.
CATHY WURZER: Now, this is a new position, I understand, at MDH, created in response to the increased visibility of homeless Minnesotans after the pandemic, and looking at it through a public health lens. What is your job? What's your task and what's your goal here?
JOSH LEOPOLD: Yeah. So you're correct. So this position was created partially as a response to the COVID public health emergency and the kind of increased visibility that gave into the challenges that homelessness can create in terms of following public health guidance. And one of my jobs is to better understand, because this is a new position, what are the biggest public health risks for people experiencing homelessness? And then that can inform our plans that we work on both within the health department and with our partners across state, and local, and tribal governments in terms of, how do we address those risks?
CATHY WURZER: When you look at public health in this particular situation, Camp Nenookaasi, last week, I guess there was an outbreak of a gastrointestinal bug among folks living in the camp. Is that what you're looking at, or is it something broader?
JOSH LEOPOLD: That's one piece of it. So one of the things that we did in partnership with the Hennepin Healthcare Research Institute was a homeless mortality study. And so we looked at all people who used a homeless service as reported in the statewide homeless management information system data from 2017 to 2021, and merged that with our state death certificate data.
And what we found was that people experiencing homelessness, their risk of dying during this period was three times higher than the general population. And the risk of dying from a substance use related cause was 10 times higher. So that's really, I think, one of our top priorities right now is addressing that substance use risk for people experiencing homelessness.
CATHY WURZER: Substance abuse, as you say, illness, deaths. But I'm wondering, though, are there public health risks when you displace people? Because there's just so much upset. This seems to be kind of a delicate balance. Am I right about that?
JOSH LEOPOLD: You're correct. Yes. So there are public health risks associated with the encampments. And then there are also public health risks with closing the encampments, because-- and there's data on this-- it can be disruptive of people's connection to services. It can be disruptive of people's connections to community. And so those can increase risks for both infectious disease and drug-related deaths.
CATHY WURZER: I don't know if you have an answer to this, but many residents at Camp Nenookaasi say they don't want to be in shelters. They want to rely on the community of the camp. Are there any other models out there where an outside encampment like this can serve as a bridge to more permanent housing?
JOSH LEOPOLD: Yes. I think so. So one of the shelters we have in Minneapolis is Avivo Villages, which was designed with the perspective of people who were staying outside in the encampments in mind. So I think those kind of low barrier shelters that are informed by know people with lived experience can be part of the solution. And as the city officials mentioned at the hearing yesterday, they were successfully able to connect many of the people who were staying at the Nenookaasi camp to both shelter and longer term housing.
CATHY WURZER: We've been talking about some of the statistics here. The department of health, I understand, is rolling out a new grant program to create, help me out here, maybe you have better information than I have, new hubs with services focusing on housing, and health, and harm reduction. What about that new effort?
JOSH LEOPOLD: Yeah. That's correct. So this is our harm reduction health and housing grants. And these were funded as part of the comprehensive Drug Overdose and Morbidity Prevention Act, which was passed by the state legislature last year. And the goal is to get at that intersection that I was talking about between homelessness, and substance use, and drug-related fatalities.
So how do you connect those harm reduction services with health care, drug treatment, and shelter and housing so that we're both improving people's housing stability while we're also addressing their substance use-related risks?
CATHY WURZER: And do you also look-- all these services are out there, but there's also this culturally sensitive piece that we hear about. The folks in Camp Nenookaasi are mostly Native. Do you offer services that have that piece attached to it that you do concentrate on services that are culturally sensitive and relevant?
JOSH LEOPOLD: Yeah. So there are fantastic service providers who are from that community-- Native-led service providers-- who are doing a great job with connecting with folks there. And we try to support that however we can. And so one of the things that we're doing, for example, with these hubs is that we're committed to ensuring that some of those grants go to those organizations with expertise in working with people in the American Indian community.
CATHY WURZER: Final question-- as you know, the pandemic didn't do much to improve trust between people and those in public health. And I'm wondering, trust-- as you build trust with unsheltered people, is that a key part of what you're doing, a key part of public health?
JOSH LEOPOLD: Yeah, absolutely. That's really probably the key part of public health is to build trust in the community so that they feel comfortable working with you, and then that can be kind of a gateway into providing public health services.
CATHY WURZER: Well, I appreciate your perspectives here, Josh. Thank you, and best of luck.
JOSH LEOPOLD: Thank you.
CATHY WURZER: Josh Leopold is a senior advisor on health, homelessness, and housing at the state department of health.
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