Last month, Dallas Mayor Mike Rawlings stood atop a small stage on a wooded sliver of land blocks south of Deep Ellum in the shadow of Interstate 30. The two microphones he’d been given failed, so he was instead shouting to the crowd of about 100, all gathered to see the groundbreaking of a pilot project to help the county’s most chronically homeless men and women.
“Nobody wants to talk about mental illness in Texas because it’s so badly funded,” he yelled over the hum of cars from the freeway. “We in Dallas are changing that.”
Mental health is at the center of the Cottages at Hickory Crossing, an $8.2 million public-private partnering that hopes to empower and treat the chronically homeless. They’re given their own residence on the nearly three-acre site and provided on-location mental healthcare and treatment.
One thing that’s quite different from most outreach efforts: They won’t be required to pass a drug test or undergo rehabilitation before being admitted into the program. They’re encouraged to come as they are.
“Someone who is homeless, their first need is a stable place to stay,” says Ron Stretcher, Dallas County’s director of criminal justice. “You’re not going to begin working on your treatment needs or even coming to grips with it until you’ve got stable housing.”
Stretcher has seen the effects of this cycle again and again. They cycle through the criminal justice system, typically for nonviolent offenses such as criminal trespassing. They cycle through the county’s safety net public health system, receiving acute care for illnesses left untreated.
Each individual in the subsection this project is targeting costs the county $40,000 annually. It will cost an estimated $15,000 to provide them with shelter and treatment they will receive at the Cottages, Stretcher says. That’s about a two-thirds savings.
“Yes, at first glance this looks like a fairly high cost per unit,” he says. “But we’re talking a really, really difficult, hard-to-serve group of folks who we’re already spending a lot of money on.”
According to the Baltimore-based Healthcare for the Homeless, 39 percent of those living on the streets surveyed nationally reported having a mental health problem. Among the more severe chronically homeless, that amount becomes concentrated and soars. Stretcher estimates there are about 200 such men and women in Dallas County. Officials are already looking for a second location to expand the Cottages project, he adds.
“You’re talking about a group that has a higher incidence of severe mental illnesses usually accompanied by substance abuse disorders,” says Dr. John Burruss, CEO of Metrocare Services, the Dallas nonprofit that will provide onsite treatment to the residents.
Substance abuse counselors will make daily trips to lead 12-step programs. A nurse will be onsite five days a week to give immunizations, monitor blood sugar levels if need be, and provide general preventive care. Social workers from nearby CitySquare will offer therapy up to three times a week.
The care each resident receives will be personalized, determined by a standardized initial evaluation that everyone is required to take before Metrocare takes them on.
The treatment and the residency would be all for naught if there wasn’t a way to track the combined effectiveness. Which explains why Dr. Madhukar Trivedi is so integral to its purpose: The UT Southwestern researcher will lead a team that keeps a database of different metrics for all of the Cottage’s residents before and after they started living there.
How many hospital days are they using? How many times did they check into the emergency room? Has the housing affected the amount of time they’ve spent in jail? He’ll also track costs: Is providing comprehensive care at the Cottages leading to fewer unnecessary hospital days?
Trivedi has a history of working with persistently mentally ill populations. He’s developed disease management models that weren’t content with prescribing someone antidepressants and sending them out the door clutching an orange pill bottle. He knows the importance of continuing to monitor the patient: It’s not an easy fix.
He said what initially drew him to the Cottages was its comprehensiveness. Here was a project that would house everything in one place for the patient: Diagnosis, treatment, and an efficient way to track progress or the lack-thereof.
“The goal is to stabilize 50 people and monitor their outcomes,” he says. “The hypothesis there will be that all of their outcomes will be better. Mental health will improve and substance use severity will go down and they will stay out of the criminal justice system. That is the goal, moving them out is not the primary goal.”
The residents will stay in their 400 square foot cottages as long as they like. When the construction wraps late this year, the Metro Dallas Homeless Alliance and the Dallas County Criminal Justice System will select the first 50 to take part: “But here’s the deal,” says Stretcher, “most of us on the front lines know who these folks are, we deal with them a lot.”
All this hasn’t come easily or quickly. Funding was an initial dilemma, until a $2.5 million challenge grant from the W.W. Caruth Jr. Foundation Fund at the Communities Foundation of Texas proved that there was money to build from.
By the end of it, the James and Elizabeth Sowell Foundation donated $2 million, the city tossed in $1.5 million, Dallas County and the Dallas Housing Authority each offered up about $1 million, and the rest came from area churches and private donations. The council district the Cottages presides in also switched during redistricting in 2011.
It’s taken eight years for those involved just to turn the dirt.
And so, during last month’s groundbreaking, Burruss climbed on the stage and immediately veered from his script: “I feel like I’m on Monty Python where the castle keeps falling into the swamp.”
“I’m telling you, if it feels like a huge release for me and I’ve only been here for 13 months, I can only imagine what it feels like for the people who have been pushing this rock up the hill for the last eight years,” he said in an interview on Thursday. “I’m not sure relief is my primary emotion; my primary emotion is excitement, you know, eagerness now that it’s going. It’s even harder to see it keep building. I’m ready to start helping people.”