AUSTIN, Texas — A new report from the Ending Community Homeless Coalition (ECHO) is shedding new light on the deaths of some of Austin’s most vulnerable residents over the past few years.
ECHO released its first unhoused mortality report, “Bridging for Better Outcomes,” on Wednesday. The report examined data from several sources, including the Homeless Management Information System (HMIS), hospital records, medical examiner death data and the Centers for Disease Control and Prevention, over the past six years. It paints a picture of how and why unhoused people died on the streets of Austin.
The report found between 2018 and 2023, 1,010 unhoused people died. The average age was 50, which is 20 years younger than the life expectancy of someone with stable housing.
“People are dying too often and too early in our community, and it’s entirely preventable,” ECHO Health Care Systems Manager Danice Fraher said. “I feel that our community can join together and alleviate early preventable deaths that are happening in our house community.”
Overdoses, cardiovascular diseases and accidents involving either cars or trains top the list of causes of death.
According to the report, four out of five deaths in the homeless community were men. However, women have a lower life expectancy.
The number of deaths has been steadily increasing, from an average of seven people per month in 2018 to 22 people per month in 2023.
Fraher attributes that to the growing unhoused community, the rising cost of living in Austin, and the arrival of fentanyl in 2021, which led to a skyrocketing 150% increase in overdose deaths.
“It’s unaffordable to live in Austin, and the more people who are outside, and the longer folks are outside, the more folks are going to get sick. You cannot heal from an open wound outside. It’s just not possible,” Fraher said. “We don’t have enough hospital beds, shelter beds or affordable housing to keep people indoors.”
However, only 10 deaths in the six years involved fentanyl alone. It’s often paired with methamphetamine.
In those six years, overdoses have surged by 333%, from 21 deaths in 2018 to 91 deaths in 2023. According to the report, 223 of the 304 known overdoses during this period involved meth. 109 cases involved both fentanyl and meth.
The health care costs are staggering. According to the report, the costs of medical services, ER visits and inpatient care for 364 people before their deaths is $11.1 million.
Just under half of the catalogued deaths occurred in hospitals. Most were in places like under bridges, in wooded areas or at encampments.
The report highlights how finding stable or permanent housing can substantially increase life expectancy. Those who transitioned to stable housing lived, on average, 9.5 years longer than those who were not housed.
“Housing is healthcare. It is the cure, and it works,” Fraher said. “We just need to get people inside.”
Nearly half of the people who died on the streets had no record of ever interacting with the Homelessness Response System. Only 6% of people who died between 2018 and 2023 accessed a shelter bed in the six months prior to their deaths.
The report noted there are 36 known deaths from environmental factors, like extreme temperatures.
That includes 20 deaths related to heat in the sweltering summer months and 16 related to extreme cold. 17 of the 20 heat-related deaths happened in 2023.
Fraher said the mortality data should be used in planning and to build a proactive system that responds to our community’s needs.
“We can look at the opportunities that we have in our community to improve different services that we can double down on, that folks are accessing in the year before their death,” Fraher said.
The report had several recommendations related to affordable housing and healthcare, which the study’s authors believe will reduce the number of deaths in the unhoused community.
The recommendations include increasing the number of affordable housing options, expanding substance use support services, developing integrated medical triage teams, and improving the transparency and accessibility of shelter.
Fraher said that in addition to traditional, HUD-funded permanent supportive housing and rapid rehousing, non-traditional services like long-term care, hospice, recovery homes, and sober living need to be expanded.
“Sometimes unintentionally, our services can have barriers for people. When folks are very sick and unable to complete activities of daily living, there aren’t shelter resources presently available for folks to be able to handle that level of care,” Fraher said. “There is a gap in our community that we can solve. It will take a little cross-collaboration and ingenuity, but I think we can fill that gap.”
An example of integrating mortality data into the planning and development of proactive systems would be pairing the medical triage team with the Coordinated Entry Program, the housing assessment for the homeless response system.
“When we do things like that, we can engage a whole person, look at their needed levels of care, and adapt to meet their needs and choices,” Fraher said. “Getting that information can be transformative to that person and their experience as well as our system.”
Fraher said they plan they plan to work with partners in the the healthcare field, city and county government and local nonprofits in hopes of bringing these recommendations to fruition, and that they already have a meeting set up with the City of Austin to discuss them.
You can read the full unhoused mortality report here.
ECHO is gearing up to conduct its homelessness census later this month. The biannual Point in Time count of people experiencing homelessness in Austin and Travis County will occur overnight from Saturday, Jan. 25 to Sunday, Jan. 26.
The organization said it still needs volunteers to help canvas the city and try to count as many people experiencing homelessness as possible in one night.
The last survey, in 2023, identified 2,374 people experiencing homelessness at that single point in time. Of the more than 2,000 people counted, 1,266 were unsheltered and 1,108 were in transitional housing.
These counts are required by the U.S. Department of Housing and Urban Development (HUD) to determine federal funding.