The number of deaths among Orange County’s homeless population has skyrocketed over the past decade, driven largely by a surge in fatal overdoses, according to a Voice of OC analysis of county Sheriff-Coroner data.

From 2005 through the end of 2015, the annual number of homeless deaths in the county tripled — going from 53 per year to 164, the data show.

And most of this startling jump in deaths occurred while the number of homeless  has actually gone down in recent years, according to county estimates based largely on homeless counts.

Homeless deaths jump

The spike in deaths has been driven mainly by drug and alcohol overdoses, which grew nearly fivefold from 2005 through 2014 and accounted for nearly two-thirds of the increase. In 2005, nine homeless people died from overdoses — a decade later the number had climbed to 43, the data show.

Homeless overdose deaths

Beyond overdoses, the data show significant increases in homeless people dying from chronic diseases, homicide and being hit by a car or train.

Homeless cause of death increases

(Click here for the full coroner’s dataset in Excel format.)

Altogether, Orange County saw a 209 percent increase in homeless deaths.

But during the same period, homeless deaths in neighboring San Diego County – which has about the same population as OC – only went up 25 percent.

Advocates for homeless people call the Orange County numbers alarming and unacceptable.

“I think we’ve done a fairly tragic job of seeing to the health of the homeless,” said Dwight Smith, who runs Isaiah House, a home for homeless staffed by Catholic Worker volunteers.

Paul Leon, CEO of the Illumination Foundation, an Irvine-based homeless services organization, said the increases in deaths are yet another indicator of how much further the county still has to go to address chronic homelessness.

“Access to care is still not available for this population,” Leon said. “There [are] not enough mental health programs, [and there are] definitely not enough substance abuse programs to direct the individuals that really need the help.”

Orange County remains one of the few large metropolitan areas nationwide without a permanent year-round homeless shelter. And though there has been progress on that front, with county supervisors last year buying a shelter site in Anaheim, officials continue to be criticized for what critics say is a largely passive and fractured approach to the problem.

Most recently, homeless advocates sharply criticized county leaders for failing to follow through on promises to provide extra shelter beds for homeless people during El Niño storms.

The advocates acknowledge that not all of the health problems of homeless people can be addressed, especially when it comes to issues like drug overdoses, which have also become an epidemic in the general population.

The county saw a 61-percent increase in overall overdose deaths between 2000 and 2012, which mirrored a nationwide trend. Growing addiction to prescription painkillers and heroin has driven much of the increase.

But even in the face of such daunting odds, significant progress can be made, Leon said.

“We probably can’t get them [all] in time,” Leon said, referring to homeless drug users. “But I bet ya a lot of them — with little bit of effort — their lives could have been saved.”

As an example of the kind of innovative approaches needed, Leon said his group received a grant to find the most frequent and costly homeless hospital users and offer them housing and support services for two years.

The program cost about $700,000 but saved $35 million, Leon said. And of the 36 people placed in permanent housing, 35 are still there, he added.

Orange County Health Care Agency officials declined to be interviewed for this article. Instead, they addressed questions through an emailed statement.

The statement listed their recent efforts, which include assigning two full-time staff members to do mental health outreach to homeless people in the Civic Center, buying an emergency shelter site in Anaheim, and improving social services outreach.

Health Care Agency Director Mark Refowitz also pointed to Leon’s Illumination foundation as having provided “some critical successes of recuperative care.”

(Click here for the county’s statement.)

As for what’s driving the increase in homeless deaths, the county’s current homelessness chief, Karen Roper, had no answers.

“It is difficult to comment on the data and the conclusions for a couple of reasons: 1) I do not know the causes of death; 2) I am not a doctor or nurse that could give a qualified opinion on causes of death even if I had the cause of death information,” Roper, who serves as executive director of OC Community Resources, said in the county statement.

Roper is apparently unaware that the data, which is made publicly available by coroner’s office, includes detailed information on the causes of death. 

County supervisors Lisa Bartlett, Andrew Do, Todd Spitzer, Shawn Nelson, and Michelle Steel also did not respond to interview requests made through a county spokeswoman.

Advocates say it’s critical for supervisors to learn as much as they can about the issue, and for their constituents to keep the pressure on.

“I would challenge any of the Board of Supervisors to go out” in the field and ask tough questions, said Leon, who said he would join them.

Successful examples of programs, advocates said, can be found in UtahPhiladelphia, and San Diego County.

They also said a good starting place for the county would be analyzing the deaths data, with an example being this report by the city of Philadelphia. County officials said they had not yet done an analysis, but that one is in the works.

“I think that would be very important for the county to analyze this data, to determine the reasons for the increase in the risk for mortality for people who are homeless, and to implement interventions to” reduce that risk, said Eve Garrow of the ACLU of Southern California.

How we treat homeless people also speaks to what kind of community we want to live in, she added.

“What are we doing? People are living out on the streets and people are dying out on the streets,” Garrow said. “Is this the society we want to have?”

Update (Feb. 4 at 4:47 p.m.): The story has been updated to include death increase figures for San Diego County.

Nick Gerda covers county government for Voice of OC. He can be reached at

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