Homelessness has been a key issue for residents living in King County and Seattle. With an estimated 11,751 homeless people living in the greater Seattle and King County region, according to the most recent report in 2020, the area is one of the nation’s worst for homelessness.

Local leaders and state politicians have been scrambling to find a solution. But how do we find a solution to a problem that we don’t truly understand?

Homelessness is a highly inter-sectional and complex issue intertwined with socio-economic factors like housing affordability and stagnant wages, as well as health factors that reflect on our collective equity of access to healthcare and the way we take care of those with mental illness and drug addiction. Not to mention the public attitudes toward these issues and the homeless themselves, which ultimately influence the way we try to help these people — or how we try to forget about them.

How did we get here?

Josephine Ensign, professor of nursing at the University of Washington, recently published a book through Johns Hopkins University Press called “Skid Road: On the Frontier of Health and Homelessness in an American City.”

The book examines the history of homelessness in Seattle and details the policies, systems and shortcomings that are at the historical roots of the issue in the region.

As it turns out, homelessness is not a new issue to Seattle. In fact, it is about as old as the city itself.

Ensign said in the early years of Seattle’s founding, it was the “end of the line” geographically for many who migrated west, looking for different kinds of work and ultimately a better life. She said many settlers were single men who came here for tough jobs like logging or sailing. With many of them being disconnected from family and other kinds of support, she said many of them ended up being “washed up here” when plans fell through.

Ensign contextually centers the history around Edward Moore, the first documented homeless person in Seattle. He fell on difficult circumstances after he moved here for a job he was promised — but was not given — when he arrived. He was found in 1854, only 32 years of age, sleeping in a tent on the shores of what is now Belltown, surviving on raw shellfish.

Moore, suffering from frozen extremities, had his toes amputated by Doc Maynard, Seattle’s first doctor. The physician diagnosed Moore as “crippled, insane and a stranger,” meaning he had no connections in Seattle and was not a resident.

With no in-patient mental healthcare institutions established at that time, or really any form of a mental healthcare system, Moore’s care was determined by what was then known as “poor laws” or policies that determined who were the “worthy poor” or the “unworthy poor” and what kind of care they would receive, if any.

Ensign said the “worthy poor” were often considered to be widowed women, especially the ones with children and people with severe physical disabilities. The “unworthy poor” were single unmarried mothers, prostitutes and able-bodied men.

Much like today, there was debate over who was responsible for taking care of the poor. Was it the role of the county or the state, or was it up to charitable religious institutions?

As someone who Ensign said would probably be considered to be schizophrenic by today’s medical standards, Moore’s care was determined by a practice that was then known as a “trade in lunacy.”

With no governmental resources or programs to provide care for the poor, mentally ill and disabled, the care of the forgotten and neglected homeless was auctioned off to private citizens or organizations that would accept the lowest payout. Ensign said the “trade in lunacy” practice was “widely abused” by people looking to make money and not interested in providing quality care. As a result, people would often bid to take care of the homeless just to lock them up, chain them to beds and cut corners like not feeding them properly.

While this may seem like an archaic and cruel system to ensure care for the most marginalized, vulnerable and neglected individuals, Ensign said the principles of the “trade in lunacy” system draw parallels to the ways that we care for the same populations today.

She used the example of the publicly-funded Western State Hospital, which was eventually lost federal funding for the substandard and abusive care it offered to patients who ended up there as an absolute last resort.

Ensign said access to quality mental and behavioral healthcare is still an issue in the region and more than likely contributes to the rates of homelessness we observe in the area.

“Yes we have good healthcare if you can afford it,” she said. “Access is not always easy.”

She believes that equitable access to behavioral and mental healthcare is not only important for helping those who are currently experiencing homelessness, but it will also be an important part of preventing homelessness.

According to Ensign, it is often unresolved trauma that people experience in their lives that becomes a factor in mental illness, drug abuse and homelessness. She said having resources for teens and young adults to help them deal with trauma in a healthy way could go a long way in intervening and preventing an individual from becoming chronically homeless.

Through studying the history of homelessness, she compared today’s chronically homeless people with unresolved traumas to real cases in Seattle’s history. Men like Moore, who had lost their connection with their family and their social safety net; others who had experienced wars and shipwrecks; young women who had endured sexual abuse and trauma at a young age; mothers who had lost their husbands. All of these things, when not coped with in a healthy way, can snowball into mental illness, drug abuse and ultimately homelessness.

Ensign believes our understanding of the roots of homelessness is definitely a factor in our currently less-than-effective efforts to resolve the crisis.

“No one agrees on the causes, much less the solutions,” said Ensign.

According to Ensign, there has always been a tension that has permeated through our culture between those experiencing homelessness and those who are more fortunate. The way in which the houses blame the ones without roofs over their head for their own predicament, the “pull yourself up by your bootstraps” attitude, and the way the homeless are scapegoated as immoral drug addicts all exist today as they did centuries ago.

Ensign said these attitudes come from a lack of understanding, an understanding that is not often challenged, informed, or educated. She said documentaries such as “Seattle is Dying,” which attempts to report on the homeless crisis in Seattle by framing business owners as the victims of the crisis and without interviewing any people actually experiencing homelessness, only further perpetuate the stigmas surrounding the homeless.

She believes that using the lived experience of those who have survived homelessness will be valuable for public education on the issue. She said these experts by experience are in the best position to not only educate the public on the issue, but also to identify solutions that worked for them.

Ensign said it is ultimately the collective responsibility of our entire community to help end the homelessness crisis and it will take economic solutions, improvements and resources in schools, improved healthcare and social and financial support to help families stay together and to maintain an adequate social safety net across the community.

“We all contribute to its causes, as well as its solutions,” she said.

The Snoqualmie Valley Shelter Services’ new bed setup at its 24/7 homeless shelter. Courtesy photo

Cover of Josephine Ensign’s “Skid Road: On the Frontier of Health and Homelessness in an American City.” Courtesy photo Cover of Josephine Ensign’s “Skid Road: On the Frontier of Health and Homelessness in an American City.” Courtesy photo