Urban Matters: Way Home, like your previous book Skid Road, describes homelessness in Seattle in ways vivid and immediate while also very historically grounded. It’s a subject with a lot of moving parts. But first, some context: What makes homelessness in Seattle, and all along the West Coast, such a hot-button issue? 

Josephine Ensign: A greater proportion of homelessness along the West Coast is visible homelessness, including informal encampments and vehicle residents. The high cost of living, lack of affordable housing, and limited viable emergency shelter options contribute to this, rather than a particular political climate or the prevalence of behavioral health issues. Visible homelessness grew exponentially during the first years of the Covid-19 pandemic due to closures of emergency shelters and the economic fallout of the pandemic, translating into this being more ‘in people’s faces.’

All along the West Coast we have high and growing income disparities that weaken social cohesion and diminish empathy towards those experiencing poverty and homelessness. It increases political pressure to eschew evidence-based solutions in favor of immediate reduction of visible homelessness. I do think that remnants of the frontier notion of the West being a place of opportunities, where one can reinvent oneself, factor in, with some people moving here in hopes of landing jobs and better living opportunities, only to meet harsh economic realities and fall into housing insecurity if not outright homelessness. 

UM: In a case originating in Oregon, the U.S. Supreme Court in June ruled cities may criminally penalize sleeping and camping in public places. Seattle filed a legal brief for the winning side, joined by San Diego, Honolulu, and other cities. On the other hand, citing constitutional concerns sheriff’s officers won’t clear encampments in a Seattle suburb. Why these conflicting policies – and what’s been the local upshot?

Ensign: The local upshot is confusion, legal wranglings, and increased hostility towards people experiencing homelessness and to outreach workers. Seattle Mayor Bruce Harrell, backed by a conservative majority City Council, has conducted a record level of encampment and vehicle residency sweeps. Meanwhile, in the suburb of Burien, a federal judge recently ruled in favor of city leaders against the sheriff’s office for refusing to enforce stricter anti-camping bans. They remain at an impasse. My public health nursing students have been verbally harassed in Burien and the behavioral health outreach workers they are with have been physically assaulted by community vigilantes. 

The Supreme Court ruling has deepened the suffering, despair, and social marginalization of people experiencing homelessness. Criminalizing homelessness is linked to an increase in hate crimes, something we see happening in Seattle and elsewhere.

UM: After the Supreme Court decision, California’s governor directed agencies to clear encampments on State-owned land, and said localities that don’t also act could lose State funds. San Francisco is ramping up a program that buses homeless people out of town.  What do you expect the effects to be?

Ensign: Criminalizing homelessness, such as through encampment clearances, has a long history in our country. San Francisco’s busing homeless people out of town and Seattle’s recent resumption of exclusion laws, the Stay Out of Drug Area and Stay Out of Areas of Prostitution laws, are modern-day examples. A plenitude of data indicates such policies do not reduce homelessness, drug use, or prostitution. They deepen social exclusion, which contributes to higher morbidity and mortality of people who are the targets. These exclusion laws make it more difficult for people affected to access needed medical and social services that can help them become stably housed. 

Outreach workers often lose contact with people they have established trusting relationships with. Encampment residents lose important medications and assistive devices like wheelchairs. Overdose deaths increase. Encampment sweeps are ineffective since there are insufficient viable housing and shelter options, so unsheltered people are forced to reestablish themselves in another encampment nearby. Encampment sweeps are expensive to carry out, yet are politically expedient for elected officials pressured by local businesses and residents to ‘clean up’ their cities and towns.

UM: Way Home hints at impatience with what can seem like intermural squabbling, like: ‘Homelessness is just a housing market problem. No, what about drug dependency and mental illness?’ No question, in the long run more housing is crucial – but in the short run, what should Seattle and other cities be doing that they’re not, or not doing sufficiently, to relieve immediate human distress?

Ensign: Homelessness is as much about fallout from social exclusion, stigma, despair, fraying of family and community bonds as it is about lack of affordable housing or underlying behavioral health issues. Poor health and medical debt are leading contributors to homelessness. Homelessness is a deep trauma that too often precipitates or worsens physical and behavioral health issues. 

In more than 40 years working in homelessness, I find it frustrating that not much has changed. As a society, we’re still squabbling over what to do. I am encouraged by promising policies and programs, like permanent supportive housing (with significant caveats, which I discuss in Way Home), the successful coordinated efforts in Washington State to prevent youth homelessness, and effective programs reducing veterans’ homelessness. We need to increase temporary supported communities in the form of well-run and well-sited Tiny House Villages and sanctioned encampments that have onsite medical and social services. 

An increase in human distress is not only occurring for those struggling to survive homelessness but also for housed people who care about the visible and extreme suffering in their midst. This includes moral distress and high levels of burnout of outreach and other frontline workers. Providing living wages and other support for them is essential. 

UM: Final question. Your first book, Catching Homelessness, described your own experience with becoming homeless early in your public health career. How does that personal history affect your views on public policy? 

Ensign: My lived experience of homelessness deeply informs my work.  But while I applaud policies of inclusion of and leadership by people with the lived experience of homelessness, implementation is not always well-considered. People who have gotten out of homelessness too often fall into judgmentalism towards people still in homelessness. Or they apply their experiences, which are by definition unique, to all types of homelessness. I try to recognize and address these tendencies in my work. 

Even after 30 years working and being stably housed in Seattle, the fear of becoming homeless has never left me. Homelessness is a deep trauma leaving permanent scars. One of the biggest risk factors for adult chronic homelessness is having been homeless as a child or adolescent. We cannot adequately address homelessness without a focus on evidence-based, upstream prevention.

Josephine Ensign, DRPH, is a professor of nursing at the University of Washington, Seattle. Way Home will be published in November by Johns Hopkins University Press.

Photo by: David Lee