by Bill O'Connell

Learn how ACCESS-RI is helping to turn homelessness into hope.

Raymond Goodman hadn't talked to his son in 13 years. A Vietnam veteran, Raymond was homeless and battling substance abuse. Severe problems with his knees and wrists prevented him from working. "I was thinking 'I don't want to talk to my son because I'm out on the streets and basically a bum, and how do you say to a kid, "How are you? I haven't seen you in several years, how'd you like to get to know me?"' No, it's kind of hard to do that," Raymond says.

Call to action
But things had started to change for Raymond, thanks to ACCESS-RI, a program run by the Mental Health Association of Rhode Island that serves chronically homeless individuals with a substance abuse and/or mental health disorder. With ACCESS-RI's help, he stopped drinking and taking other drugs. He started getting the care he needed. And, he moved into permanent supportive housing, which provided him with a home he could afford and ongoing case management. "I gradually got a little bit of my pride back," he says.

With ACCESS-RI's encouragement, Raymond finally made that long overdue call. At first, his son was a bit hesitant. But, when Raymond explained why he had been out of touch for so long, his son agreed to see him.

"He came here and I made dinner," Raymond says. "We talked and had a great time." Since that night, Raymond has visited his son at his place, and his son has returned to see him. They're building a relationship, one that may not have been possible if Raymond didn't have a place to call home.

"Without that I probably wouldn't even have called him," Raymond says.

It's the little things
Contacting his son was one of the goals Raymond set when he first became an ACCESS-RI client. Goal-setting by clients is a key component of the program.

"When clients come aboard, they make their goals," says Sheryl Marshall, ACCESS-RI Program Director. "Housing may not be their first goal. In some cases it's not. It might be medical care. They set their goals so we're not forcing them to do anything they're not ready for. You can't just bring a person in and say, 'You need help, you need medical coverage, you need to get sober.' It's not going to work that way. You work with them where they're at, instead of telling them where they should be at, which is a little bit different than other approaches."

By providing intensive case management, psychiatric care, and other support, ACCESS-RI helps clients take the sometimes small—but always important—steps that can lead to big life changes. For example, ACCESS-RI helps clients obtain financial and legal assistance, access substance abuse or mental health services, and locate housing. Before housing is found, they provide clients with conveniences such as use of a phone, showering facilities, and a mailing address.

"Once you start doing a couple things, and you get praised for it, you start feeling good about yourself again," Raymond explains.

Filling a critical need
ACCESS-RI obtains new clients through referrals from various agencies and word of mouth from existing clients. They also visit the homeless in shelters and out on the street. Unfortunately, finding clients is not a problem. Sheryl says ACCESS-RI's biggest challenge is locating affordable homes for those clients, and she encourages people who want to help to support legislation for permanent supportive housing. Ultimately, she says, it will pay off.

"It's a proven fact that permanent supportive housing saves money in the long run because people who have it are less likely to be incarcerated, use the emergency hospital system, need ambulance rides, and use the shelter system," she says. "Actually, it's cheaper to support permanent supportive housing than it is the shelter system."

A study that appeared in The Journal of the American Medical Association in May 2009 found that providing housing and case management to homeless adults with chronic medical illnesses reduced hospitalizations by 29 percent and emergency department visits by 24 percent. Meanwhile, a study in a 2010 Massachusetts Housing and Shelter Alliance report on a program that provides housing and intensive case management to chronically homeless individuals estimated the program saved the state $9,400 per housed person. The study compared Medicaid, shelter, and incarceration costs before and after housing, and took into consideration the cost of the program.

"Once the homeless get housing, that's when they start to show interest in their health," Sheryl says. "Everything seems to fall into place once they get that housing. They want to get a primary care physician. They want to get dental coverage. Once they do, they get the care that they need."

"The help is there"
Sheryl says that chronically homeless individuals who have a substance abuse problem or mental illness—or people who know someone who meets that description—can contact ACCESS-RI for assistance. Although there's a waiting list, ACCESS-RI can offer some help right away. That includes providing guidance, information, and referrals that can help the person start to turn things around. In some cases, a simple visit to ACCESS-RI can help someone who is struggling with homelessness.

"Sometimes just seeing other people who have improved helps them," Sheryl says. "They see people who have been where they're at and see how those people have progressed, and it gives them hope that they can do it too." Raymond says it's a lot of work, but not to give up.

"It's a tough road back," Raymond says. "Just keep going. Find someone you can talk to, a place that can help you, because the help is there."

For more information about the services ACCESS-RI offers, call Sheryl Marshall, ACCESS-RI Program Director, at (401) 726-2422, or visit ACCESS-RI online.