The Portland, Oregon metro region continues to face a persistent and worsening crisis of street and unsheltered homelessness fueled by:
- A chronic shortage of deeply affordable and permanent supportive housing (PSH).
- Large, core populations with high prevalence of severe substance use disorders (SUD).
- Large, core populations with co-occurring severe and persistent mental illness (SPMI), including substance-induced psychosis and decompensated schizophrenia.
- A system of behavioral health care that has, for decades, been under-resourced, and even with some new resources from the state coming online, it will continue to be under-resourced.
- An acute behavioral health continuum that does not empower meaningful civil commitment, stabilization and subsequent community re-entry for a core population repeatedly cycling through healthcare and housing systems.
- An entire network of affordable housing, including PSH, operating within an environment lacking a behavioral health system of care sufficient to meet identified population health needs.
Individuals with high acuity behavioral health needs are disproportionately represented among those who are chronically houseless (San Francisco Benioff Homelessness and Housing Initiative, 2025). Some of these individuals are too clinically unstable to benefit from housing alone, resulting in eviction and return to unsheltered homelessness. Assessed as individuals who are highly vulnerable with qualifying barriers to housing, these individuals are often prioritized by our region’s Coordinated Entry System (CES) for Housing First oriented placement with the belief they will seek services and, through engagement, clinically stabilize.
