Last year was a particularly deadly one for people living on the streets of Southern California – and especially in Orange County.
All three of the state’s most populous counties saw big jumps in homeless deaths in 2015, with deaths in OC going up a staggering 75 percent that year compared to 2014. The increases in San Diego and Los Angeles counties were 42 percent and 17 percent, respectively.
It was the biggest single-year jump in each of the counties in at least a decade, and the death counts have gone up even though the overall homeless populations have remained relatively stable.
All told, 266 more homeless people died in the three counties in 2015 than the year before. And so far, there are few official answers for why the numbers have jumped so much.
Orange County public health officials, who started an analysis of the deaths jump about two months ago, say they’re still working on it. San Diego County health, coroner and homelessness task force members didn’t have any explanation. And leading advocates in Los Angeles County weren’t aware of any analysis of their county coroner’s data, with county health officials there saying they don’t have the data.
But a Voice of OC review of the data points to drug overdoses as a driving factor, with that cause being the largest among the extra deaths in San Diego – accounting for about a third of the increase. Such a firm conclusion can't be reached in Orange or Los Angeles counties because in many 2015 cases the coroner's final cause of death determination is still pending.
However, there are indications that once the cause of death data is complete, the numbers will likely be similar to those in San Diego. Consider that a tripling of homeless deaths in Orange County from 2005 to 2014 was driven mainly by fatal overdoses, which grew nearly fivefold.
Homeless Part of Overall Epidemic
The jump in overdose deaths among homeless people mirrors a nationwide surge of fatal overdoses -- mainly involving heroin and prescription drugs -- in the overall population that federal officials say has reached epidemic levels.
“Deaths in heroin are just spiking all over the place,” Herb Johnson, president and CEO of the San Diego Rescue Mission.
Beyond overdoses, 20 percent San Diego County’s homeless deaths in 2015 were attributed to heart conditions and 15 percent due to vehicle-related accidents, the data show. And though specific percentages are not yet available in Orange and Los Angeles counties, the numbers are expected to be similar.
Experts say the increases, especially those attributed to heart problems and other chronic conditions, are a consequence of a lack of preventive care for an aging population. The result is a reality in which homeless people rotate in and out of emergency rooms and end up costing taxpayers and hospitals more than if they received preventative care, experts say.
“There’s so many senior citizens out there…it’s just an absolute tragedy,” Johnson said.
Advocates in Los Angeles say the criminalization of homelessness, among other factors, has made it difficult for people to seek services.
Many folks don’t seek services “because they literally can’t leave their stuff,” for fear of it being seized by police, said Eric Ares of the Los Angeles Community Action Network, a major homeless advocacy group.
People are arrested “all the time,” Ares said, for homelessness-related issues the same day they’re trying to see their outreach provider. “It makes it all the more harder for folks to get services that keep them alive,” like food, drug treatment, and housing case managers, he said.
“There are [successful] programs locally that just aren’t scaled up,” Ares added, like LA County’s C3 program, which puts outreach teams in the community to help direct people to services, as well as other programs that pair mental health professionals with police.
As for drug abuse and overdoses, Ares said his group supports the “harm reduction” model, which emphasizes things like providing clean needles to prevent infections and the spreading of diseases, as well as treatment and helping addicts replace drugs with safer alternatives like methadone.
A needle exchange program run by the non-profit Homeless Health Care Los Angeles has been “extremely successful,” Ares said, and reflects national evidence that engaging people who are addicted to drugs rather than prosecuting them is the “main way to lower those numbers” of overdoses and harmful health effects.
In OC, the nonprofit Orange County Needle Exchange Program provides clean needles in the county Civic Center on Saturdays, and is supported by the county’s main doctors’ trade group, the Orange County Medical Association, among other groups. But the service is provided just three hours per week.
Johnson noted that “drugs are readily available on the street” in the San Diego area and elsewhere.
"When I talk to people, I can tell you people are just so down and out about a situation they seem not to be able to resolve,” which often leads to drug use, he said.
Data from the state Department of Public Health show overdose deaths in the overall population growing at a much quicker rate in Orange County than in its neighbors to the north and south.
From 2006 through 2013 – the earliest and latest years available on the department’s online data system – Los Angeles and San Diego counties saw 27-percent and 46-percent increases in overdose deaths, respectively. In Orange County, the number jumped nearly 70 percent over the same period, from 316 to 535 per year.
And compared to Los Angeles County, Orange County has had a much higher overdose death rate -- 17 deaths per 100,000 residents, versus 6.6 in 2013.
Programs Lost After Bankruptcy
Many of Orange County's substance abuse treatment programs for homeless people were shut down in the wake of the county’s late-1994 bankruptcy, along with numerous other social and health care services.
As for where the substance abuse efforts stand today, Orange County spokeswoman Jean Pasco said there are “a plethora” of different services available for homeless people.
Those include a team of 17 full-time outreach workers focused on connecting homeless people with mental health and substance use treatment, a mental health services hotline (855-OC-LINKS), a one-stop service center for mentally ill homeless people, and a variety of mental health and substance abuse treatment programs, officials say.
Pasco also provided a long list of over 600 private groups – largely non-profits and faith-based groups – that provide homeless outreach and services, including many for which “substance abuse” is listed.
Despite the alarming increase in deaths, Johnson and others are optimistic about an upcoming “coordinated entry” system that will be a collaborative way for providers to connect homeless people with services, as well as track data and outcomes across the homeless population. Such systems are in the works in all three counties.
The shift to coordinated entry systems is now required in local communities that receive federal homeless funding from the federal Department of Housing and Urban Development.
“I think coordinated intake is going to be one of the probably biggest uplift in getting people into a system, not having them have to talk to five agencies, six agencies in order to get into the system,” Johnson said.
Other SoCal Counties Lack Data
While the region’s three largest counties had homeless deaths data, two other major counties in the area – with about 2 million residents each – had incomplete or nonexistent data.
Riverside County has no reliable data for homeless deaths, because death investigators typically find a family member’s address to put down as the residence for homeless people, according to their sheriff-coroner’s department.
And San Bernardino County’s data doesn’t categorize causes of death, making it time-consuming to analyze without significant research of medical terminology. And over two months after Voice of OC first requested the data, the county hadn’t provided homeless deaths data for 2005 through 2008, saying they’re still entering in the deaths by hand, one-by-one.
Nick Gerda covers county government for Voice of OC. He can be reached at firstname.lastname@example.org.