Major new study highlights the deadly toll of being homeless in Minnesota

Jonda Crum has a recurring dream in which she is wandering a deserted city after nightfall, desperately seeking a warm place to sleep, but every door in every building is locked and no one can hear her pleas for help.

The nightmare once was close to a daily reality for Crum, who spent a decade living on the streets, struggling with addiction, before a near-fatal medical emergency compelled her to seek treatment and stable housing. "These days, I feel grateful to be alive," said Crum, of North St. Paul, who provides peer support for people in recovery from substance use. "I probably aged two years for every year that I lived on the streets."

Crum's experience underscores the devastating health risks of being homeless.

A major new study shows that Minnesotans experiencing homelessness die at three times the rate of other Minnesotans, and substance abuse accounts for about a third of their deaths. The study, released last month by the state Department of Health, found that deaths from substance use are 10 times higher among homeless Minnesotans than the overall state population. Alarmingly, researchers found that 20-year-olds experiencing homelessness in Minnesota have the same likelihood of dying as 50-year-olds in the general population.

"What this study shows ... is that there are tremendous and incredibly detrimental health effects to be a person experiencing homelessness in our state," said Dr. Kate Diaz Vickery, a primary care physician and co-director of a research lab on health, homelessness and criminal justice at the Hennepin Healthcare Research Insitute, which prepared the report.

The report calls for a coordinated effort to elevate housing as a "life-saving strategy," though it stops short of analyzing current methods for combating homelessness. However, some Twin Cities-based homeless providers and advocates say the findings raise questions about the recurring sweeps of homeless camps, which they say worsens health problems by isolating people and making it harder for agencies to reach them.

Early in the coronavirus pandemic, the U.S. Centers for Disease Control and Prevention urged cities to stop clearing encampments, unless housing units are available, citing concerns that forced evictions would cause infections to spread.

Margaret King, senior director of housing at Catholic Charities, which operates large homeless shelters and drop-in centers in Minneapolis and St. Paul, called the report's findings deeply troubling. She noted that the sweeps of homeless camps have been "super disruptive to people's survival," and likely are correlated to the high death rates among the unsheltered population.

"People who are living in tents and encampments sometimes are getting health care, and they sometimes do have medications and vital documents that that they carry around with them," King said. "But when those camps get swept, all that stuff gets tossed and has to be rebuilt again."

Much of the study confirms the prevalence of substance use and mental health problems among people experiencing homelessness. But the analysis provides the most extensive data so far on the impact of those problems over time and the causes of death among Minnesota's homeless population, which is estimated to number nearly 8,000 statewide.

Researchers analyzed records of nearly 93,923 Minnesotans who accessed shelter or other homeless services over a five-year period ending in 2021.

The use of substances like fentanyl stands out as the most common cause of death among Minnesotans experiencing homelessness. Compared to the overall population, homeless Minnesotans also were nearly eight times more likely to die from pedestrian accidents, five times more likely to die from homicides and more than twice as likely to die by suicide, researchers found. They also were seven times more likely to die from HIV infections.

The findings did not surprise Freddy Toran, a longtime homeless advocate and shelter volunteer who spent 11 years living on the streets.

Toran, who is 60, said he still feels the lasting health effects of being unsheltered for so many years without access to medical care. HIs knees and back are sore, and he suffers post-traumatic stress from seeing so many of his homeless friends die. Toran has struggled most of his adult life with high blood pressure and is at high risk for a stroke. But it was impossible to stick with a medication regimen while he was homeless because his drugs were constantly being lost or stolen, he said.

"I could easily have died out there," said Toran, who has been in living in his own place since 2015. "Every single day, it was an ongoing thought: If I don't get my medicine, I will get a stroke and pass out in an area where no one could find me. Fear of death was a constant, everyday reality."

Crum turned 46 early this month, but she said there are days when she feels 20 years older from her experience being homeless.

For 10 years, she lived on the streets without health insurance or access to medical care. Crum said she avoided going to the doctor or to clinics, she said, in part because they would "look down on her" once they saw the track marks on her arms from needle use. In 2017, she suffered a staph infection brought on by a needle and spent 104 days in the hospital. Only then did Crum get sustained care and treatment for her addiction.

Now, Crum wants to help others avoid a similar fate, and she is sharing her apartment with two people who recently were homeless. But every so often, an incident or a person will bring back memories of that painful chapter of her life. Something as simple as a letter from her landlord can cause her mind to replay the experience, frame by frame, of being out in the elements alone, with nowhere to rest or feel safe.

"Being homeless is my number one fear," she said, "and it will be my number one fear for as long as I live."