For Carolyn Williams, it’s the grieving mothers she often thinks of when she considers the toll a life on the streets can take on a person.
That toll can shorten a person’s life by 20 years – 20 years lost due to all of the hardship associated with unsheltered homelessness, per findings in a new report published by the Ending Community Homelessness Coalition.
For some, the direct cause of death is unmanaged illness. For others, it is caused by an attempt to manage illness or pain (physical or mental) with drugs.
Because so many life-saving harm-reduction tools are unavailable to Texans (strips that can test drugs for fentanyl, for example, are illegal in the state), even casual drug use can be dangerous. But reliance on drugs can morph into an addiction that increases a person’s exposure to potential overdose.
Williams is currently living in a house but recently was living in a shelter. She is also working to help advocate for better homelessness services as a community leader with VOCAL-TX. Williams said that many people living on the street don’t want to be addicted. But even for people with stable housing and income, successfully treating addiction is difficult. For people on the street, the options for treatment are much harder to come by – even when a person is ready and willing to enter recovery.
“Housing saves lives.” – Matt Mollica, ECHO’s executive director
That’s the situation Williams’ son, Haison Akiem Williams, found himself in two years ago. Ready to confront his addiction, Williams sought behavioral health care from Integral Care. “He told me, ‘mama, help me. I need help,’” Williams recalled. He sought that help – but he would have to wait. The next available appointment for him was three months out, Williams said.
The wait proved too long. Soon after seeking care, her son died of a fentanyl overdose and Carolyn became one of those grieving mothers. “My boy needed help, and I knew he needed help, and I was there to try to get him help, but that didn’t do any good,” Williams said. “So I think about the grieving mothers, too. I wanted to help my son, but he got turned away. It’s coming up on two years, but it still feels like yesterday,” Williams added.
The Scope of Loss
The ECHO report, authored by ECHO Healthcare Systems Manager Danica Fraher and public health master’s student Sarina Attri, looked at just over 1,000 deaths among people experiencing homelessness in Austin between 2018 and 2023. ECHO’s researchers found that about 64% of those deaths occurred on the streets (as opposed to a hospital setting) and that the average age of death for people living on the street was 48 years old. The average age of death for the general population, per the CDC, is 70.
The discrepancy is startling, but the staggering impact drug overdoses have had on the lives of people living on the street is even more troubling. Between 2018 and 2023, overdose deaths increased by 333% (from 21 to 91), with methamphetamine being the primary driver. But, the report notes, fentanyl has played a troubling role as well: 119 of the recorded overdose deaths involved fentanyl, but only 10 involved fentanyl alone – which, according to the report, suggests that many of the fentanyl-related deaths can be attributed to “unintentional exposure due to contamination in the drug supply.”
For Matt Mollica, ECHO’s executive director, the agency’s mortality report highlights the urgency behind the agency’s central goal: getting people off of the streets and into stable housing. “Housing saves lives,” Mollica told us. “Which is why everything we’re trying to do is about reducing unsheltered homelessness.”
On the street, people are not connected to services that could save their lives, Mollica said. Indeed, another startling statistic from the report: 47% of people who died on the street had no record of ever interacting with any homeless services. Although Mollica notes that much of that figure comes from the earlier years ECHO researchers studied and, in the past two years, community groups have improved street outreach efforts.
Solutions
To better address the problems highlighted in the mortality report, ECHO also published a State of the Homelessness Response System report that identifies gaps in service for people seeking to exit homelessness – and what the community will need to do, over the next decade, to fill those gaps.
In short: housing, of all kinds. Specifically, at least 5,000 new units of permanent supportive housing (places where people exiting homelessness can live and access health care and other case-management services; 990 PSH units are expected to come online over the next two years). The report also calls for an additional 1,700 rapid rehousing units (short-term stays of 6-18 months that give people a chance to stabilize while they find permanent housing), 600 new emergency shelter beds (like those offered at Downtown’s Austin Resource Center for the Homeless), and 1,750 “short-term service spots” that can provide outreach, navigation, prevention, or diversion.
Mollica also said that Austin is in dire need of more dedicated respite care facilities, where people can receive treatment for acute medical conditions – which may be driving people to substance abuse. “Substances are sometimes the only way they can manage that pain,” Mollica said. Central Health, Travis County’s hospital district, is hoping to soon open a dedicated respite care facility at the former site of Austin’s children’s hospital between 15th and MLK.
ECHO estimates that the Austin-Travis County community will need to commit $30 million per year for the next 10 years to fill gaps within the Homeless Response System. City Council is expected at their first meeting of the year, Jan. 30, to adopt a resolution that will commit the city to that funding goal (ECHO will ask Central Health, Integral Care, and Travis County commissioners to do the same).
For Williams, the solution is clear. “[City Council] can give all these millions to police,” she told us, “so why can’t they give millions to homelessness? It’s ridiculous.
“For my son,” Williams said, “his addiction was overpowering. He needed mental health care and he needed medication. Why can’t we help more people like him?”
This article appears in January 17 • 2025.