As Brown County homeless population jumps, advocates say mental health treatment is key

GREEN BAY - Paul Van Handel's job is to count. He can spot a newcomer by their hulking backpack, remember the familiar faces who bounce in and out of homeless shelters, and recognize the cars crammed with sleeping families in overnight lots.

Of course, counting goes beyond simply tallying the unhoused in Brown County. Van Handel, an outreach coordinator for community health nonprofit Newcap, listens to individuals and families in the hopes of establishing trust and connecting people with the services they need to exit a brutal — and costly — cycle of poverty.

In Van Handel's experience, trust only happens if there are obtainable "next steps" toward stability. He can talk all day long about a program's rehabilitating powers, but if there's a wait time or capacity issues within a facility, the program might as well not exist.

"If it's not there when they need it, it's not there," Van Handel said.

Without services, a majority of unsheltered homeless people remain trapped in a cycle of hospitalizations, emergency shelters, and incarceration, only to return to the streets and start over. As that pattern holds, so does the growing number of people living with neither home nor shelter in Brown County. Van Handel counted a double exponential jump in Brown County residents living on the streets in 2022, a number that rivals even Milwaukee County, which has three times the population of Brown County.

By the end of 2022, about 235 people were observed living without shelter on the streets of Brown County. In 2021, the number was 84.

In May of this year, alone, Van Handel counted 123 living on the street, which far surpassed the 77 counted in May 2022.

A new grant puts more homelessness advocates on the street to get care to the unsheltered

It's important, Van Handel said, to focus on the gaps in Brown County's systems that led to residents resorting to street life.

"We have this mistaken belief that everybody (unhoused) comes from outside of northeast Wisconsin. Most of who I work with lived in Brown County," Van Handel said. "We have to be asking the question, 'Where did their predicament begin? Was it somewhere else, or was it here?'"

Van Handel hopes a grant awarded by Substance Abuse and Mental Health Services Administration (SAMHSA) called Projects for Assistance in Transitions from Homelessness (PATH) offers a true continuum of care for the unsheltered.

The PATH grant arms Newcap with additional outreach staff, screening and diagnostic treatment, substance use disorder treatment, habilitation and rehabilitation, and referrals for community mental health, primary healthcare, and job training, among other important elements for people experiencing unsheltered homelessness.

The grant comes at a crucial time for the unsheltered homeless. Not only are numbers of unsheltered and unhoused going up in Brown County, but people on the street are older and less healthy these days, said Terri Refsguard, CEO of New Community Shelter.

On a regular basis, Refsguard said it isn't uncommon to see people in the lobby in wheelchairs and on walkers and canes. In her 20 years of service in the community, that's a new hardship to witness, one that comes with its own specific health concerns that require additional expertise and training.

It's a pattern that many outreach coordinators, case managers and law enforcement officers are also newly encountering.

"Our community didn't used to have this unsheltered issue where it was so recognizable," Van Handel said. "Now, nobody is surprised when they see a homeless person. We're getting to the tipping point."

A majority of people experiencing homelessness struggle with mental health, whether they realize it or not

When new clients go through the intake process at New Community Shelter, they're not always aware of their own history of mental health challenges, Refsguard said. They may choose to dull their struggles by consuming alcohol and drugs, which requires its own treatment path. They may not struggle with substance use disorder, but neither do they realize their struggles to maintain work and keep up with bills is the result of an undiagnosed mental illness.

Those unrealized mental health conditions skew some of the available data. It sometimes takes talking through those unrealized conditions with case managers, counselors or social workers for people to understand the full scope of their troubles.

"At the end of the day, we're trying to ask, 'What does this group need?' It's obviously a group that's been experiencing unsheltered homelessness for quite some time — their life has really never been stable," Van Handel said. "They may not know that we're trying to help them get wraparound help. Many have never had ongoing treatment for any length of time."

As many as 70% of Brown County's homeless population has a mental health condition, whether they realize it or not, according to data obtained from Homeless Outreach Team (HOT), a committee within the Brown County Homeless and Housing Coalition.

In Tollef Wienke's experience, about 30% to 40% of people he engages with as a case manager at St. John's Ministries don't report a mental health condition despite exhibiting behavioral difficulties. When Wienke does outreach work, he's careful to not push the button on mental health too much.

"You're not going to have that conversation the first time," Wienke said. "You have to observe them, you have to know who they are. A lot of this is just building relationships and what you can say to people."

Brown County's tipping point marked by lack of affordable housing, shelters closing, spiraling addiction rates

Life on the street, Van Handel said, tells a community's story. It reveals a community's willingness to rehabilitate as it also shows the shadows of inaction. Too often, Van Handel said, action doesn't go beyond analyzing and reanalyzing the data.

But the data, too, tells a story.

For the 235 people unhoused in 2022, 90 went to shelters, but 89 others — nearly 40% — met unknown fates. Another 37 remained unsheltered, three people died, two went to jail and six left the area. Just eight found stable housing.

The numbers are even worse this time of the year.

Much of that can be chalked up to another condition of being unhoused in the summer: shelters like St. John's Ministries — the lone shelter that accepts clients actively using drugs as long as they're able to provide complete self-care — close from May to October.

Summer Safe Sleep, a program on offer at St. John's Ministries, does allow certain unsheltered, unhoused people to sleep indoors, but it doesn't include food, showers and laundry services. And it only applies to people without income, Wienke said.

Tuesday morning, Wienke talked to two men, both retired, formerly incarcerated and living on fixed incomes, who lost their apartment when a different management company bought the residence and didn't renew their lease. A lack of affordable housing is the biggest reason so many end up on the streets. Then, a person's history trails them wherever they try to go.

Some landlords don't want to lease units to anyone with a criminal history, Wienke said, and if someone doesn't have money saved up or a consistent income, housing options quickly fall apart.

Sheila Carlson, behavioral health officer for Green Bay Police Department, said evictions can irreversibly stain an applicant's rental candidacy, even if the eviction happened years ago when the person fell on bad times and made poor decisions.

She tells the story of a woman who took painkillers for a shoulder injury, which morphed into a familiar sequence of events: addiction led to eviction.

"Once she was on the street, she found the less desirable, less safe drugs. That generates an exceptional downward spiral that you can't get out of," Carlson said. "Pills are expensive. Heroin is not."

Agency coordination, treatment options and housing opportunities must all be in place to rehabilitate unhoused unsheltered

With all the strewn clothes, blankets and backpacks dotting the grass, St. John's Park hardly seems like an oasis to outsiders. But during the summer months, it can feel like the closest thing to community for anybody who is unhoused and unsheltered.

That's especially true on Tuesdays and Fridays, considered drop-in days where people can gather, use restrooms, eat warm meals provided by St. Vincent de Paul and receive services for mental health conditions, addiction treatment and general check-ups.

On a sunny Tuesday afternoon, Wienke engaged with fellow case managers, volunteers, and people in need of services while eying the white tent where people congregated.

Wienke always comes back from outreach work with a new set of stories. Monday evening, he checked in with four people sleeping at Lily Lake Park and reported these interactions on an ongoing email thread that includes members of the Brown County Homeless and Housing Coalition.

An unsheltered person's final destination depends on how well a community balances agency coordination, treatment options and housing opportunities, Van Handel said, which can feel impossible to access for individuals and families on the streets.

If one of the three elements collapses, rehabilitation and stability are that much further out of reach. As Van Handel often tells it, "You can't treat on the streets."

Eliza Killian agrees. Killian, a behavioral health manager for the Brown County Adult Behavioral Health Unit, said transience is a major challenge when treating the unsheltered homeless population. Being unsheltered makes someone an easy target of theft.

A week's worth of medication is just one more item for someone to carry around and potentially get stolen, Killian said. A phone, someone's only connection to a case manager, could break or get stolen. The scramble to survive can mean someone misses a counseling appointment or the transportation to services.

"There's really nowhere else for them to go," Killian said. "That's the conundrum for everyone working with them: how do we help keep them safe and accessing services?"

Natalie Eilbert covers mental health issues for USA TODAY NETWORK-Wisconsin. She welcomes story tips and feedback. You can reach her at neilbert@gannett.com or view her Twitter profile at @natalie_eilbert. If you or someone you know is dealing with suicidal thoughts, call the National Suicide Prevention Lifeline at 988 or text "Hopeline" to the National Crisis Text Line at 741-741.

This article originally appeared on Green Bay Press-Gazette: Brown County focuses on mental health amid rise in homeless population