Amid 'overwhelming' service gaps, St. Paul launches mental health outreach initiative

Frost crunched under Christine Michels' tires as she whipped her car around downtown St. Paul. It was 6 a.m. on a cold December morning and Michels spotted Jeff, a client she's chased for months, sleeping on a sidewalk outside the Xcel Energy Center.

It had been two months since Michels referred Jeff, who declined to share his last name, to permanent housing. Michels and her staff struggled to find him afterward. As she approached Jeff that morning, city cleaners arrived and asked him to leave.

"Good morning Jeff, How are ya?" Michels asked, helping him into his wheelchair with the help of her coworker Sam Stoltz. One city worker said Jeff's hands were blue and his feet appeared frozen. "You good?" Michels continued before wheeling him indoors, "A little chilly?"

Though Jeff is one case, he represents thousands of vulnerable residents who St. Paul hopes to reach through its Familiar Faces initiative.

Familiar Faces uses outreach and a personalized approach to connect people who frequent shelters, jails, hospitals or emergency services with city resources that could help them. The program is still hiring workers and looking for a permanent building, but Michels plans to partner with more organizations to create a health network for such residents.

Michels has worked with unsheltered populations for 16 years, but she started work as Familiar Faces' program administrator this year. That past experience taught Michels that a people-centered approach goes a long way, and she believes their work has built trust with vulnerable residents. But current gaps in the county's health systems are frustrating.

"[It's] overwhelming," Michels said of coverage lapses in Ramsey County, adding that many organizations lack the funds to make a difference. "It makes you want to pull the covers over your head."

In 2018 officials launched the Community Outreach and Stabilization (COAST) unit within the St. Paul Police Department to address some of those gaps. The unit paired mental health practitioners with officers, offering guidance and referrals for people the police interact with. That unit phased out this year when contractors declined to renew their agreement with the city.

Police Chief Axel Henry said that motivated city officials to try a different approach that partners law enforcement with a collective of city and community organizations. Familiar Faces is part of that approach, which Henry believes is an evolution in how the city serves residents.

"We want to create a system where the system is set up to say, 'It doesn't matter what you bring us, we are equipped and we stand ready to help you and create solutions,' " Henry said, adding that he and Michels talk four to five times a week. "This is an evolution that's happening here, and we're going to a new, better 2.0 or 3.0 version of this that better addresses the current situation."

A study published last month by the nonprofit Wilder Foundation says homelessness has increased in the past decade. Most of those unsheltered people had been homeless for a year or more, or four or more times in the past three years. Data from that study also found that drug use increased as people spent time outside without shelter, often worsening their conditions. St. Paul's Midway neighborhood is an example of that challenge; advocates there say unsheltered people have turned to fentanyl to cope and medicate themselves.

Sue Abderholden, executive director for the National Alliance on Mental Illness Minnesota, said mental health conditions worsened for many Minnesotans during the coronavirus pandemic. And without federal funding provided during that time, the state's mental health system suffered.

"We have a workforce shortage, but we also have more people who are struggling with their mental health," Abderholden said. "And then you add on the fentanyl crisis and things like that ... so we have greater needs, and frankly we're not able to meet those needs."

St. Paul hopes to meet some of those needs through Familiar Faces and work with Heading Home Ramsey, a community-wide partnership helping to connect organizations addressing homelessness.

Until then, Michels labors to help clients like Jeff one at a time. Michels believes the work is important because her clients are "someone's somebody. [They] could be somebody's parent, [or] grandparent … they're human beings." But she laments that the stigma around homeless people being criminals makes her work difficult.

Jeff is someone's somebody, Michels said. He is the brother of a Los Angeles man who worries for his safety. Jeff is special to Ling, a woman he lost contact with months ago and whom he's desperately worried about. And Jeff is an outdoorsman who grew up loving to camp, hike, and canoe — going so far as to snowshoe and polar dip in Canada.

A week after being lifted from that sidewalk, staff connected Jeff with permanent housing. He toured an apartment and moved in on Dec. 11.