Come inside: Homeless outreach workers gently encourage mentally ill clients to get help

July 8, 2017

Kristen Felegy and Dave Katzenmeyer
MinnPost photo by Andy Steiner
Kristen Felegy and Dave Katzenmeyer following a path toward an encampment.

It’s part of Katzenmeyer’s job to make inroads with folks like Nick, people with significant mental illness who don’t have permanent homes and choose to avoid the shelter system, spending their nights on the streets, on Metro Transit, or in improvised camps hidden away in plain sight, just steps away from everyday life. He spends about 10 hours each week meeting potential clients at camps like Nick’s, and still more time in other places homeless people tend to congregate, including the Maplewood, Rosedale and downtown St. Paul libraries.

To get to Nick’s tent, Katzenmeyer followed a narrow, wooded pathway down a hill. It was a cool June morning, a little before 10 a.m., and the sun was shining through the trees, casting dappled shadows. Nick’s camp had three tents set up near a long-dead cooking fire. Outside the tents stood lines of shoes, folding chairs and a baby stroller.

Katzenmeyer walked directly to Nick’s tent, and called out, gently, “Hey, Nick. It’s Dave from People Incorporated. How are you doing?”

Nick appeared to be just waking up, but he recognized Katzenmeyer’s voice, and greeted him in a friendly manner. He smiled, but stayed zipped up in his tent, shirtless, speaking through the mesh opening. His friend Jean had spent the night, and she was also just waking up, still bundled in her sleeping bag.

Katzenmeyer approached the tent’s opening, leaned down and began speaking. “I brought you some blankets,” he said, pulling two out of a bag. He also handed over two bottles of water, some nonperishable food, and something people like Nick and Jean find invaluable: two pairs of clean, dry socks — a lifesaver for anyone who lives out in the elements.

Building bridges

Handing out essential supplies is one way Katzenmeyer tries to connect with people like Nick. It’s his goal to slowly introduce them to services designed to help them make the transition from sleeping outside to eventually finding mental health care, addiction treatment and supportive housing.

Outreach workers must tread carefully in these interactions, said Jill Wiedemann-West, People Incorporated’s chief executive officer. 

“With some of these people it can take years to build a basic level of trust,” she explained. “After many interactions with outreach workers, some are finally able to come in to our drop-in center to wash their clothes or get a cup of coffee. That’s a first step, and that helps. But to get them to sign up for case management, to allow us to help them get the services they need, a lot of trust has to be developed —and that can take a long time.”

Dave Katzenmeyer talking to Nick through his tent flap.

MinnPost photo by Andy Steiner
Dave Katzenmeyer talking to Nick through his tent flap.

Matt Horn, People Incorporated’s homeless outreach program manager, said that outreach workers like Katzenmeyer work patiently and persistently to build a relationship with the people they meet on their walks.

“It varies person by person,” Horn said. “One thing we do is provide basic supplies for engagement purposes, things like socks, water bottles, hygiene supplies, to help meet a basic need. Doing that helps because you can provide something tangible. My experience is if people are by themselves they might be hesitant if a person just comes into their space. But if you keep offering something with persistence and you are nonjudgmental and open, people are generally interested in signing up for services. It takes an average of three to six months of engagement to get just get most people to enroll in case management.”

All this effort is worth it, Wiedemann-West said. People Incorporated’s homeless outreach program not only helps people like Nick live safer, healthier lives, it also helps local governments save nearly $725,000 a year by reducing shelter use, arrests, incarcerations and hospitalizations.

“Case management is a benefit to everyone,” she said. “We just have to get people to feel good about signing up.”

Co-occurring conditions

Living without a home is rough — and especially hard on people with mental illness, Wiedemann-West said. A majority of the homeless adults in the state —as many as 60 percent, according to “Homeless in Minnesota,” a 2015 study conducted by Wilder Research, report struggling with a significant mental illness.

While some people like Nick feel distrustful of institutions and resist the urge to sign up for any kind of help, their off-the-grid lives can be extraordinary difficult. 

“Think about how anxious you might feel if you were forced out of your normal routine,” Wiedeman-West said. “Then imagine an individual who has been living outside in all kinds of conditions, enduring the hostility that comes from other folks trying to take their things or maybe being aggressive or dysregulated. It’s an incredibly stressful life.”

As Katzenmeyer passed out his supplies, Nick started to talk. He said he’d been having a hard time sleeping, having bad dreams and struggling with people who want to “ransack” his tent. He listed the medications he takes for depression, stress and anxiety, and told Katzenmeyer he’d lost his state ID card.

An ID card is key to getting even the most basic of services. As Katzenmeyer explained the process of obtaining a new one, Nick, who’d been thankful and kind for everything he’d done, had one more request: “I need candles,” he said, abruptly changing the subject. “It gets dark down here. Could you bring me some the next time you come?”

On a nearby track, a train moved by, slowly and noisily.

Kazenmeyer kept following the path in the woods until he met Cleveland, a slight, nervous man who’d been sleeping in a structure made of wood scraps, sleeping bags, and corrugated metal. When Katzenmeyer walked up to the tent and explained who he was, Cleveland stepped out into the sunshine. He was barefoot and wearing only underwear. He told Katzenmeyer that his phone had run out of charge and he asked if he knew where he could find a spare outlet.

While this would have been the perfect opportunity for Katzenmeyer to tell Cleveland that he could charge his phone at People Incorporated’s walk-in center, to lure him to a place where he could sign up for services, instead he tried to gently explain what he does and the services he can offer. Cleveland didn’t seem interested. Not yet anyhow.

“Folks who are sleeping outside meet the definition of long-term homelessness,” Katzenmeyer said. “That’s who we can work with on case management. Our goal is to normalize that interaction and slowly bridge them into People Incorporated’s services.”

It works best to take a subtle approach, Katzenmeyer added. “I don’t always want to dump this on them all at once. It can feel overwhelming.”

Come inside

The rest of the morning continued in a similar fashion, with Katzenmeyer walking worn paths to different camps. In two hours, he talked with 10 or 15 people who were living outside, in hidden communities near doctors’ offices, union halls, the state Capitol. Some of the people he spoke with that morning had been living outside for days or weeks or months; others were new to the camps, forced to live here because they’ve been evicted or because their drug addiction made it hard for them to find a safe and stable place to live.

As he had with Nick, Katzenmeyer had already begun to build a relationship with some of the other people he met, and he felt hopeful that his regular, reliable presence would encourage them to take the next step, to come inside, if not for regular shelter, at least to People Incorporated’s drop-in center on York Avenue, where they can do a load of laundry, pick up some free clothes, play a game of pool, try out tai chi or massage, or attend a recovery or smoking cessation group. Somewhere along the line, they may also meet a caseworker and get signed up for services.

Dave Katzenmeyer approaching Cleveland's tent.

MinnPost photo by Andy Steiner
Dave Katzenmeyer approaching Cleveland’s tent.

The long process of building bridges with people like Nick and Cleveland can feel frustrating, but Katzenmeyer said he’s seen plenty of people successfully transition from life on the street to a safe, permanent homes.

“My experience with the individuals we engage is once they enroll in our program we are able to help them access basic things like identification and medical insurance,” he said. Once that bridge is crossed, life starts to take a positive turn: “The majority of people we work with eventually start getting medical help and eventually move into housing.”

‘Training wheels’

Later that morning, at People Incorporated’s clean, bustling drop-in center, a group of people played pool. Others gathered around a conference room table, drinking coffee and chatting. A cell phone charged in an outlet. 

One or two people appeared to be speaking with case managers.

Horn led a brief tour of the facility, pausing at a calendar that lists a full schedule of activities and classes available for clients. There was at least one activity every day.

“We support people who are really vulnerable,” Horn said. “I like to call outreach ‘case management training wheels.’ ” Like training wheels on a bicycle, he explained, building a relationship with an outreach worker can help a shaky person begin see the stabilizing benefits of accepting help: “Case management eventually helps people start getting used to having appointments regularly, showing up routinely, checking their email, helping them get insurance for the first time. These are important steps. Once they sign up for case management, about 80 percent of the people that we work with have made progress and achieved one of their goals within six months.”

Maybe because he’s seen how his outreach has helped many people move from desperate situations to more settled, healthy lives, Katzenmeyer said he does not often experience compassion fatigue in his work.  

“Over time, I see how I am helping people make progress,” he said. “When people enter case management with us, we can be successful in helping them meet their needs.” Sounds simple, but getting there is a long, delicate process.  

The signs of that progress could be subtle, Katzenmeyer added, but they are there, if you listen carefully enough. Take Nick, for example, who said, softly, as Katzenmeyer got ready to move on to the next tent: “Hopefully things will get better.”

It’s not much, but it’s progress. And maybe it’s a good sign. 

By Andy Steiner