Overdose deaths in shelters and supportive housing in King County demand scrutiny

Editor’s note: The Mental Health Project is a Seattle Times initiative focused on covering mental and behavioral health issues. It is funded by Ballmer Group, a national organization focused on economic mobility for children and families. The Seattle Times maintains editorial control over work produced by this team. As part of this project, editorial writer Alex Fryer has been examining issues related to behavioral health and substance use disorders.

Clement Place in North Seattle offers 100 studio units for people with significant disabling conditions such as mental illness and substance use disorder.

It boasts round-the-clock staff and on-site case management and mental health care services. In social service parlance, it’s called permanent supportive housing.

In 2022, seven people presumed to be living at Clement Place died of drug overdoses, according to preliminary data from the King County Medical Examiner’s Office.

That is the most deaths at any single permanent supportive housing location, but it’s far from an isolated problem. In all, 179 people died of overdoses last year who were presumed to be living in permanent supportive housing, income-restricted units, transitional housing and recovery housing.

This is unacceptably high and deserves special attention from King County and other funding agencies.

For the first time last year, the county Medical Examiner tried to assess the housing status of people who died of overdose. A final report has yet to be published.

Just more than half of all deaths — 522 — occurred in private homes. In 21% of lethal overdoses, the deceased was presumed to be living unsheltered. Sixteen incidents occurred in emergency shelters, according to the Medical Examiner.

The 18% who died while living in permanent supportive housing and other locations operated or funded by government or social service agencies is the most troubling and raises the most difficult questions.

By definition, permanent supportive housing is intended for people with chronic conditions who are not able to live alone. Just persuading these individuals experiencing homelessness to leave the streets can take weeks and sometimes months of cajoling by outreach workers.

Tenants in permanent supportive housing do not face eviction for using drugs behind closed doors in these facilities, said Leo Flor, director of the King County Department of Community and Human Services, which funds most of this type of housing.

When contacted by the editorial board to discuss the Medical Examiner’s findings, Flor pledged to decrease the number of overdose deaths of people in the county’s care.

“We’re going to be looking at ways that we can increase supports and reduce deaths of this particular cause in permanent supportive housing. We’ve got to. It’s important,” said Flor. “We bring people into housing because we care about them and we certainly care if they pass away.”

The King County Regional Homelessness Authority, which oversees the region’s shelter and crisis housing response, echoed Flor’s sentiments.

“KCRHA continues to work with Public Health Seattle-King County to ensure that providers are trained in harm reduction and overdose response, and is also partnering toward a broader multisystem plan on this critical topic,” according to an agency spokesperson.

To be sure, the lethality and prevalence of fentanyl plays a large part, as it does in all overdose deaths.

According to the Medical Examiner, there were 1,015 drug and alcohol poisoning deaths in King County in 2022, up from 709 in 2021. Fentanyl-involved deaths accounted for 701.

Fentanyl is a slow-rolling public health disaster. But the number of overdose deaths in facilities intended to help people start a new life is especially tragic.

The Medical Examiner was right to focus on the housing status of people who died of overdose. In its 2022 Overdose Death Report, the Medical Examiner detailed numbers of those who died while housed and those living unsheltered. After fielding inquiries from the editorial board, those statistics have been removed for further review. The office should quickly evaluate the data and republish the statistics.

It is appropriate that the major funders of King County’s homelessness efforts take the situation seriously and pledge further action.

In all types of housing and temporary shelter, governments and publicly funded agencies must focus on substance use disorder and emergency treatment such as naloxone to ensure the safety and well-being of those they are attempting to serve.

The public ought to expect appropriate follow through as more robust overdose plans are drafted and implemented throughout the housing and shelter systems.

Correction: Public Health Seattle-King County corrected an analysis of overdose deaths provided to The Seattle Times editorial. This editorial stated that 16 overdose deaths were linked to emergency shelter. Public Health affirmed that the 16 overdoses do not capture all ODs that are linked to an emergency shelter. Public Health’s current data reflects 225 fatal overdoses occurred in areas unfit for habitation and emergency shelters.