From Asheville Watchdog: Down Town, Part 4 — The Responders

By Andrew R. Jones, avlwatchdog.org 

Some need only a little assistance: a bus pass to their sleeping spot, access to a computer, a sandwich or a kind word. Others are in deep crisis, shouting or crying out in public, convulsing on drugs or in need of life-saving medical intervention. Still others are just sleeping, but the mere sight of them on a sidewalk or under an overpass has prompted someone to call Buncombe County’s 911 operators.

These scenes play out across Asheville daily, and handling them falls to a small cadre of responders: community paramedics, homeless outreach workers, police and firefighters, librarians, hospital nurses and technicians — people whose jobs have changed dramatically in the past few years, reshaped by the same forces that are creating turmoil in downtown Asheville.

In previous installments of Asheville Watchdog’s series Down Town, we’ve examined the reality of how central Asheville has changed since 2020 from the perspectives of local merchants and downtown workers; the city’s understaffed and overstretched police department; and the people who live unhoused in tent encampments, under overpasses, in city parks and in vehicles.

For Part 4, Watchdog reporters shadowed the first-responders on the front lines of dealing with the recent rise in homelessness, substance abuse and addiction, and untreated mental health issues.

We invite you to ride along.

Community Paramedics

Justin Hall checks his supplies for the day in the back of a black Ford pickup truck: blankets, hand warmers, wound care supplies, oxygen and naloxone (brand name Narcan) nasal spray to reverse the effects of potentially deadly opioid overdoses.

Hall, 38, is a Buncombe County community paramedic, one of nearly two dozen members of a specialized team created in November 2020 to supplement Buncombe County’s traditional Emergency Services staff, allowing first-responders to focus on large-scale emergencies.

Hall, an emergency medical technician and peer support coordinator, opened his laptop and showed a narrative of a downtown call, the kind the paramedics often must navigate.

“Asked to look for a gentleman on College St who was having a crisis,” the note began. The paramedic could not locate the man until a second caller on Church Street reported a “man who had barricaded himself in a Dumpster.”

“Met him,” the report continued. “We chatted until he was willing to come hang out with me at the Haywood St. garden because the sun there is much nicer than a Dumpster. Afterward he needed a bus pass to get to his sleep spot, so I provided him with one.”

The man, Hall said, was “just in a crisis moment and didn’t know who to reach to.”

Buncombe’s community paramedics operate with two teams units — two paramedics in separate vehicles, each shift working 24/7, and two on an EMT and community outreach team, working 12 hours every day.

About three to five times a day, a team answers calls from downtown about drug-related incidents, people yelling in public, sleeping on sidewalks or threatening harm, sometimes to themselves. The immediate goal is to prevent those crises from escalating into self-harm or arrests.

Although their primary duties are to provide support for people who have overdosed or need substance use-disorder support, they also provide food and shelter emergency assistance, and wound support or other basic medical issues.

Shortly after the creation of the community paramedicine program in 2020, Claire Hubbard, manager of the program, said: “This program is truly unique in that we don’t have an agenda to get people in trouble or tattle on them. We don’t want people to associate our program with the typical model for public safety. Our agenda is to provide care and support to those who need it. That’s it.”

The CPs wear many hats: social worker, health care provider, driver and friend.

“We’re kind of the Swiss Army knife of EMS,” Buncombe County Emergency Medical Services director Taylor Jones said.

The community paramedics try to connect people in need with the resources they need.

“Sometimes they’ll spend an hour and a half just walking around with somebody making sure that they’re not a danger to themselves or others,” Hubbard said.

The community paramedics see an urgent need in Asheville for a “low barrier” shelter that accepts unhoused people who are actively using drugs or alcohol, or with other needs, like pets, that prevent them from entering existing shelters.

“Until we have places to bring people,” Hubbard said, “the most effective thing we can do to manage a crisis is to spend time with that person until they’re no longer in crisis.”

Tranq: The newest threat

Asheville Watchdog shadowed the community paramedics on one recent morning.

Getting ready for their shift, emergency medical technician Kenny Davall dug in a handbag and pulled out a box of small, white nasal spritzers.

Each CP unit carries about eight doses of naloxone, known as Narcan, plus extra spritzers to distribute at homeless service centers. Treating an overdose is supposed to take only a few doses of Narcan, but recently, Davall said, that hasn’t been enough.

“What’s that new drug going around?” Davall asked another CP team member.

“Xylazine,” another responds.

Xylazine, known on the street as “tranq” or “tranq dope,” is a powerful tranquilizer approved for veterinary use in horses and other animals, but not humans. Drug dealers often add it to other drugs including heroin, fentanyl and cocaine, to increase bulk and prolong the effects of short-acting opioids like fentanyl.

Although it has heavy sedative effects like an opioid, Xylazine isn’t an opioid, and it doesn’t respond to the opioid overdose antidote, naloxone.  “Narcan’s pretty much not working against it,” Davall said.

“We don’t really even know how to address it just yet,” Hall added. “We’re still trying to figure out what to do.”

Earlier this week, the U.S. Drug Enforcement Administration issued an alert about the widespread threat of fentanyl mixed with xylazine.

“Xylazine is making the deadliest drug threat our country has ever faced, fentanyl, even deadlier,” DEA Administrator Anne Milgram said.

“I’ve got to be doing surviving out here”

One call for the community paramedics took the crew to AHOPE Day Center on North Ann Street, a place where the unhoused can shower, receive mail and connect with resources. The problem sounded simple: A man with a cut on his hand who was concerned about infection.

He was shaking and nervous and told the paramedics he was coming off alcohol withdrawal. He said he was waiting to reconnect with his family in Tennessee, maybe even get a job in organic farming.

Hubbard and Davall examined his hand and offered bandages. “Soaking it is really good, in warm water,” Hubbard said. “Do you have any baby soap?”

This was the man’s second interaction with the Buncombe community paramedics, he told Asheville Watchdog.

“I just went to the front desk (of AHOPE) and said ‘OK, I’m screwed over. Let me call these people.’ I didn’t want to go wait five hours in the hospital because I’ve got to be doing surviving out here. I don’t have time to go starve in a hospital.”

The man, who declined to give Asheville Watchdog his name, called the interaction with Hubbard and Davall “very, very positive.”

Davall recalled another trip to AHOPE for a man with a cut on his foot. “While I was there, their staff came out and said, ‘Hey, I called for EMS,’ ” Davall said. “And I said ‘For what?’ Well, there was [another] guy on the back porch wanting to kill himself.”

Asheville Police also responded. The community paramedics found a man with a pocket knife sitting on a picnic table “ready to kill himself right then and there,” Davall recalled.

“My partner Joe, he ended up talking to the guy,” Davall said. “He’s like, ‘I’m not gonna go with APD. I will put up a fight.’”

Davall and his partner kept talking to the man, who put the knife on the table, and, after about 10 minutes, agreed to let them take him to Mission Hospital. “Go with us,” they told him. “It’d be a lot easier.”

The Emergency Room

The unhoused often don’t have health insurance that covers doctor visits or medicines. But under the Emergency Medical Treatment and Labor Act (EMTALA) of 1986, any hospital that accepts payments from Medicare — as Mission Hospital does — is required to evaluate, stabilize, and provide care to any patient who arrives in its emergency department for treatment, regardless of the patient’s ability to pay.

“Asheville has a lot of addiction services,” Hannah Drummond, a Mission ER nurse said, “so we get a lot of folks who have issues with substance use disorders.”

The ER is the most expensive place for medical treatment. One national study found people experiencing homelessness visited the ER five times more often than those with housing.

The hospital does not track whether its visitors are homeless or not. But on some days, Drummond said, it feels like half of the patients waiting for care in the Mission ER just south of downtown could be people without housing or having a drug or mental health crisis.

The ER “has experienced an uptick in mental health and addiction crises related to homelessness along the same lines as what we are seeing across America,” said Mission spokeswoman Nancy Lindell. “When colleagues are caring for patients with these diagnoses, there is increased risk of violent behavior.”

Every day, Drummond said, someone lashes out in anger or frustration — at the healthcare bureaucracy, at the chronic understaffing at the hospital, or maybe because of a mental health or substance abuse crisis, or the slow but crushing pressure of being homeless — and takes it out on the nurses, technicians or doctors.

Mission declined to make any doctors or nurses available to Asheville Watchdog for interviews. The National Nurses United labor union that represents 1,600 nurses at Mission Hospital made Drummond available to talk.

Drummond said the rise in the number of people seeking ER services in Asheville, coupled with what she said was chronic understaffing at Mission since HCA took over in 2019, has created a nearly constant pressure zone that tests caregivers and patients alike.

With a bed shortage because of understaffing, patients are at times parked in hallways, Drummond said, where they may wait for hours before being treated.

On Valentine’s Day, Drummond told Asheville Watchdog, so many people showed up at the understaffed ER  that senior nursing managers had to be called in along with the Buncombe County EMS mass casualty bus, basically a giant ambulance that can hold as many as 28 patients, to handle the overflow.

“Someone not in a mental health crisis is probably going to get to the point of frustration and anger,” Drummond said. “And then you have someone who is on the other side of that in a mental health crisis, maybe fragile housing situation or unhoused. Everywhere they’re going, they’re hitting a brick wall with access to getting help, and who do you typically take out your frustration on? The person who’s in front of you.”

In the past year, she said, she’s seen “a huge increase in violence, and it’s across the board: Like, I’ve been punched in the face. I can’t go into all the details because of HIPAA, but it was when we had hallway beds and confused people. And, like, I’ve had coworkers get punched in the face, people bitten, people kicked, people’s nails, like, into them.”

Drummond said violence is such a pervasive issue, especially at Mission’s mental and behavioral health facilities — seven assaults on staff in one week recently, she said — that union nurses confronted hospital leadership last week to air grievances.

Lindell, the Mission spokeswoman, said violence “is sadly not uncommon in any ER or behavioral health unit.” She said the hospital has security, including a Buncombe County Sheriff’s deputy in the ER, and staff “wear duress badges which they can press to receive quick assistance with any issue.”

The ER as a safety net

Tricia Killion, vice president of case management for the North Carolina Division of HCA Healthcare, which owns Mission, said, “A lot of patients come in homeless that don’t have preventative care” and the ER becomes “their safety net,” sometimes when it’s not medically necessary.

“For whatever reason, usually some type of mental health,” Killion said, “that’s where they feel comfortable, that’s where they can get a meal, that’s where they can get a cot.”

“There are folks,” she said, “that visit that [ER] nearly every day.”

Some patients resist treatment and leave the hospital “against medical advice,” Killion said.

“We can’t hold people prisoner, so maybe they leave the hospital before they’re really ready to, and we see those folks cycle back in within a day or two,” she said.

Drummond said many of the ailments suffered by Asheville’s unhoused population can’t be fixed with a single visit. But trying to set up wound care or physical therapy with people who don’t have homes “can get really complicated,” she said.

Moving people who are homeless out of the ER system can be just as complex as finding them care, Drummond added. “Some people just want to leave [the emergency room] and that’s their choice, but there are other people who that’s not what they want to do. And we get to a point where from an emergency room standpoint, there’s not anything else that we can do. Our hands get tied. And that feels awful. You worry what’s going to happen to this person when they go back out.”

Killion said hospital social workers try to line patients up with help when they leave. She said Asheville has a handful of “respite beds” for the unhoused to recuperate after a hospital stay, but needs more. “They’re very vulnerable,” she said. “They can’t go and recover on the street after surgery.”

Often the best Drummond can do, she said, is to make sure she gets someone a taxi voucher after they’ve picked up their medication.

“I worry about that all the time,” she said. “And then it’s like, ‘OK, if we gave you a taxi voucher, to the pharmacy, can you even pay for your medication? And then if I get you to the pharmacy and your meds are covered, how do you get back to wherever it is that you’re staying?’ And I’m not given the resources to make all that happen.”

Firefighters and EMTs

Homelessness and drugs have drastically changed the traditional jobs of fire rescue in Asheville.

At the Asheville Fire Department, the firefighters and emergency medical technicians now rescue unhoused people camping on river embankments as floodwaters rise. They revive drug users from cardiac arrest.

And on a really bad day, they’re sometimes the first to discover a corpse inside a tent in the woods.

Asheville’s firefighters have become a central part of the response network to homelessness.

“The homeless epidemic in downtown Asheville, I mean, it’s high,” Senior Firefighter Jonathon Sgroi said.

Firefighter Ky Emmons added, “It’s also the vast majority of our overdose calls.”

“We’ve got a lot of repeat people,” Sgroi said. “You say, ‘Oh my gosh, I’ve been to this girl before for an overdose.’”

Crews take calls related to the unhoused population roughly 12 times a day, said Asheville Fire Chief Scott Burnette.

Some of those actually involve containing and extinguishing fires, he said.

In 2019, Burnette said, Asheville fire crews responded to 95 outside fires “directly related” to the unhoused community — fires started for warmth or cooking that were left unattended. By 2021, that number had more than doubled to 206, he said.

Heavy rains bring a different kind of danger to unhoused campers who set up tents along the banks of rivers.

“We’ve had a number of water rescues where we’ve needed to rescue folks that are living near the rivers,” Burnette said. “We didn’t have that as much five years ago.”

Now, before a heavy rain, firefighters go out to warn campers. Sometimes the campers move, sometimes they don’t, Burnette said.

Last fall, a downpour pushed the banks of the French Broad River high enough that a portion of land where two people were camping turned into an island. “The water was continuing to rise and so our folks, using paddle craft, went and got those folks off,” Burnette said.

Fire crews checked on one man at a busy downtown intersection four times in 12 hours after different callers reported concerns to 911 that he had overdosed, Burnette said. The man was, in fact, just sleeping.

Although it does not happen often, some of the most disheartening calls send firefighters inside tents to respond to one – or more – overdoses.

“Our folks are responding to those situations and trying to treat folks who are in cardiac arrest inside of a tent and sometimes multiple patients inside of a tent,” Burnette said.

Other times, firefighters find people inside tents who have died, perhaps days earlier.

“It’s our firefighters that are going into that tent to retrieve this person who has been dead for several days,” Burnette said. “It’s just difficult on our firefighters and just to see the tragic loss of this human life, to try to provide as much dignity for this person that’s died alone.”

“We really want to change that,” Burnette said. “We want to be able to make a difference in that person’s life and get them good access to health care, get them good access to shelter or whatever their needs might be so that doesn’t get to that tragic situation.”

Beginning in April, Burnette said, the Asheville Fire Department will redeploy four to five firefighters in a pilot program to work with the county community paramedics or on their own to assist the unhoused and collect information on how Asheville’s first responders can better serve the downtown area.

The police

The role of the police has also changed since 2020. As reported in Part 1 of this series, the police force is operating at 60 percent strength, and the remaining officers increasingly are tasked with calls related to drugs and homelessness.

Asheville Police Capt. Mike Lamb on a recent night shift spent five and a half hours resolving a half-dozen calls. He brokered a domestic complaint from a woman who said her ex-boyfriend was threatening her at Bartlett Arms public housing apartments south of downtown. He checked on a sweating, nervous methamphetamine user “tweaking” in Pritchard Park. And he told a man sleeping under the I-240 bridge over Central Avenue that he was trespassing and had 24 hours to leave.

Lamb had to announce himself a half-dozen times to rouse the man, Simon Davis, 35.

“Hello! Hello! You okay?” Lamb shouted as vehicles clattered overhead.

Lamb peeked inside the tent and retrieved a small knife Davis had next to him, placing it outside on Davis’s bicycle.

“Are you okay? Sit up and talk to me real quick,” Lamb said. “Simon, I want to make sure you’re okay, that you’re not overdosing.”

Lamb knew Davis from previous encounters. He told Davis that Homeward Bound, a local nonprofit, could help him relocate.

Davis, his eyes a piercing blue, agreed to speak to an Asheville Watchdog reporter accompanying Lamb. He said he’s originally from New Hampshire and moved to Asheville to live with his brother. They couldn’t afford the rent, and Davis said he had been unhoused for 16 months.

Davis acknowledged his addiction problems, saying he started using cocaine and Adderall (a combination of amphetamine and dextroamphetamine) as a teenager.

He said he doesn’t stay in local shelters because they require COVID-19 vaccinations, and he doesn’t believe they’re safe.

Lamb asked Davis if he’d eaten lately. When he said no, Lamb drove back to the police station, retrieved a food box provided by a local nonprofit, and delivered it to Davis.

“Simon isn’t a bad guy, he’s just fallen on hard times,” Lamb said.

The Librarians

At 9:30 a.m. on a recent chilly Tuesday, the first day of the week that Pack Memorial Library downtown is open, Sheena Robinson was the first person standing outside. The library doors wouldn’t open for another 30 minutes.

She wore several layers with a pink hoodie on top and carried a plastic bag containing a Coca-Cola bottle filled with water. She snuggled her head into the layers as she talked.

“It gets so cold at night, it’s unreal,” Robinson said. She said she sleeps at a bus station near McDowell Street in downtown Asheville, then comes to the library every other day to get warm, make calls, read books, use the internet, and try to figure out her next steps.

Robinson, who used to live in Weaverville, said she had been without a home for four months by mid-March. Like many experiencing homelessness, Robinson said she suffers from the effects of trauma: witnessing the shooting death of her mother as a teen, and losing a sister to diabetes.

“I had a home and I was fine. I was just like everybody else, when it all first started. I had paid my home off. And I had a car and everything,” she said.

But between a hospital stay, her brother entering her life and her landlady telling her she needed to move her trailer, things cascaded over a couple of years and forced her onto the streets, she said.

Now, she waits in line with other unhoused people, waiting to use Asheville’s main library, which has increasingly become a shelter, a warm, safe place and a resource for people living on the streets.

A brochure on the front door, “Where to Go When It’s Cold,” lists two shelters and a free shuttle “that is very close to the library!”

Inside, in the main hallway, is a table with more brochures on homeless services.

In the restrooms, a disposal box is bolted to the wall for used needles and syringes.

The Librarian’s Guide to Homelessness

The table with brochures for homeless services is staffed four days a week by Sam Stanley, a member of Homeward Bound’s outreach team. For the past three years the City of Asheville has contracted with Homeward Bound to provide street outreach and help for people experiencing homelessness.

The library is an ideal place for Homeward Bound to meet potential clients, Stanley said. “I think that’s a pretty uniform thing. At any town or city or what have you that has any kind of a substantial population of people that are unhoused, there’s a library. This is a place that people are going to hang out because it’s a public space. And it’s really one of the last vestiges of public spaces.”

Stanley said he sometimes tries to help people get housing. “It really depends on if I have anybody that I’m working with that has income, without any recent evictions …  like in the last 7-10 years, [or] realistically, any criminal charges.”

“When I have somebody that meets those criteria, I will spend more time with them putting in applications for housing,” he said.

Ken Miller, the library’s Adult Services Supervisor, has worked at the downtown library since the 1990s. He said the Pack Memorial has been committing time and resources to people without homes ever since he can remember.

“The first person in the job that Sam’s in now,” Miller said, “one day, early in her tenure, she walked out of her office and looked into the public computer area … and she said, ‘I know every one of those people,’ because she had worked for Homeward Bound. She recognized that every person out there at that time, at that moment, was somebody who had been receiving services.”

Last week, as Miller talked to Asheville Watchdog, three of his employees were in a training session based on a book titled “The Librarian’s Guide to Homelessness,” by Ryan Dowd.

“It’s about how to make your library a more inclusive place, hopefully de-escalate situations and … build confidence with patrons in experiencing homelessness, mental health, mental illness, addiction, trauma, et cetera,” Miller said.

Besides navigating the Dewey Decimal System, today’s librarians also study de-escalation techniques and Narcan administration. Like most public libraries across the nation, Miller said, serving people in insecure living situations is a significant part of Pack’s function today, and especially after library systems reopened in the pandemic.

“It’s been on the increase since then, and I anticipate that it’s going to increase even more,” Miller said. “For this downtown library, as a challenge it sits side-by-side with providing traditional library services. It’s hard to provide a ranking, but I would say it’s as important and as critical for the community.”

A concern about safety

What Pack employees see sometimes is not unlike what people see in the streets and storefronts of Asheville’s downtown.

People lay on the floor to sleep, they bring food into the library, they leave personal belongings unattended, all of which are against library policy.

“But those rules are hard to abide by if you don’t have somewhere to live,” Miller said. He said he frequently imagines himself in the place of patrons.  “If I were in that position, I would find those rules harder to abide by.”

Asked if librarians have seen drug use in Pack, Miller answered by saying the county put sharps containers in the restrooms to collect used needles and syringes.

To his knowledge, Miller said, librarians have not needed to use their Narcan training at Pack.

De-escalation training is a different story.

“Without a doubt we’ve been able to utilize that,” Miller said, agreeing they use it on a consistent basis. “I mean when there are raised voices in the room, and employees are approaching a situation they have a better idea of how to handle it so that the situation does not get worse. And people, you know, I can only imagine that living without a place, living without a home is an extremely frustrating experience for people … and what could seem to be a reasonable civil exchange between people can just lead some people to boil over.”

But, Miller said, “What I’m impressed by is how many people who seem to be in that situation are pleasant and kind and seem to not be overwhelmed at the moment. That just floors me. I don’t want these most vulnerable people to be seen as villains.”

Homeward Bound

Mike DeSerio is Homeward Bound’s outreach manager, part of that team contracted with Asheville to provide one-on-one services to what he calls “people living outside.” They help people obtain identification, renew food stamps, search for jobs and explore viable paths to  more permanent housing.

The team also does mediation, often between business owners and the unhoused.

“Lots of times the businesses don’t want to necessarily involve the police or trespass the person, but that person’s either causing trash or the needles or they’re a business deterrent because maybe they’re sleeping right by the stoop,” DeSerio said. “There’s just so many instances of that being necessary: someone to advocate on behalf of the person who’s outside but someone to also give an ear to what the businesses and neighborhoods need for them to feel supported and safe.”

DeSerio has worked with the team since October 2021.

“There’s just so much tension around the subject that it’s really polarizing,” he said. “Sometimes you just have people that are just done. They can’t put up with another person who is either leaving trash outside their business or leaving trash outside their neighborhood.”

Often, the resolution is that the unhoused person just moves. “Their behavior doesn’t necessarily change,” he said. “It ends up basically being a problem for somebody else.”

With the number of unhoused people in Asheville — 637 according to the 2022 Point-in-Time census — DeSerio said, “I don’t think that is necessarily going to go away anytime soon. I think most people that are frustrated, whether they have a business or live in a neighborhood when they see this, I think they are thinking they’re just waiting for it to go away, so they can be like it used to be.”

DeSerio said he hopes as awareness increases that “homelessness is a thing now” in Asheville, more people will look to help through church and community organizations.

Two major projects expected to be completed this year will open nearly 200 permanent housing beds for many of the city’s chronically homeless.

“It will get a lot of people off the streets,” DeSerio said.

But, he said, “This is not gonna go away … overnight.”

BeLoved … and others

The nonprofit BeLoved is perhaps Asheville’s most visible and vocal independent homeless outreach group, a wide-reaching and many-armed organization that builds homes, sends out street medics, and distributes food, tents, blankets and sleeping bags to people living outside.

“We get the heartbreaking calls every day,” BeLoved’s director, Amy Cantrell, said, “people that are losing their house … due to no fault of their own.”

In 2016 the death of Janet Jones, who didn’t have a home and died of hypothermia, inspired the BeLoved Village in East Asheville, a 12-unit micro-home prototype of what is planned to be permanently affordable housing.

Asheville Watchdog accompanied Cantrell on a recent visit to the village. Cantrell recalled looking around the parking lot and seeing a van that looked just like hers. She thought it was a worker. She was wrong.

“It was a family of five, living in that minivan,” Cantrell said. “It was gut-wrenching. Then every day I would get in my minivan and think, ‘There’s a whole family living in this van.’”

When Alanna Kinsella started working at Homeward Bound a decade ago, the unhoused in Asheville were mostly middle-aged, single men.

Now, “we are seeing an increase of folks . . . 18 to 26,” she said. “We do have a couple of folks who are chronically homeless that are under the age of 30.”

Many of the younger people “have been aging out of foster care” in the Asheville area, Kinsella said.

Teens who have been removed from their families for abuse or neglect have the option of remaining in foster care under the supervision of county social services workers until they’re 21, or they can leave at 18 with $3,000 a year provided by the state for certain living expenses — as long as state funds are available. Sometimes the pool of funds dries up, and is not replenished until the new fiscal year starts in July.

Many choose independence. “They’re like, ‘Nah, I’m done,’ ” Kinsella said. “They leave thinking, ‘I can do this by myself, I’m gonna get my own place. They all want to live in their own apartments, they just can’t.”

Just a few years ago, a young person could work a minimum wage job at a fast-food restaurant, grocery, or retail store and afford to pay their bills, Kinsella said. “The likeliness of that now is not real, not in Asheville”

Kinsella said she has encountered her son’s former school classmates among the newly homeless. “And it’s heartbreaking because they’re young. It’s the story of like, ‘I couldn’t stay at home anymore. I haven’t been living with my parents since I was 15.’ ”

They wind up on the streets, she said, without basic skills. “I’ve seen foster kids that don’t even know how to ride the bus, and they’re homeless.”

The younger people typically don’t start out with drug addictions, she said, “but the longer they’re on the streets,” the more likely they develop dangerous habits.

“The amount of overdoses that are happening, the amount of deaths that are happening just in Asheville and Buncombe County right now is pretty significant. And scary,” Kinsella said. “If you’re on the streets, and you started using meth, and now you’ve watched three of your buddies die, and you’re only 22, that’s a hard start.”

Improving Asheville’s homeless crisis is not “rocket science,” Cantrell said. The city needs to prevent people from becoming unhoused, provide more shelter to those who need it, invest in long-term substance abuse and mental health treatment, and reconsider responses to crises, she said.

“When you call 9-1-1 what do they say? ‘Fire. Police. Medical,’” she said. “What if there were other things on that list?”

[Editor’s note: Another option is dialing 2-1-1-, which refers callers to organizations in Asheville and Buncombe County best equipped to address health and human services needs including food, shelter, housing, healthcare, and substance abuse.]

The co-responder model

Asheville Police Chief David Zack said he would like to see police more often teaming up with mental health and substance abuse workers for crisis calls.

“Most of law enforcement, if not all, have long been saying, ‘We are not the best to do this job,”  Zack said. “It was thrust upon us.’”

In his previous job as chief of police in Cheektowaga, New York — a suburb of Buffalo, with a population only slightly smaller than Asheville’s — Zack partnered with a mental health agency to hire a full-time mental health worker.

The “co-responder” model, Zack says, allows the professionals responding to do their jobs, safely. It’s also more efficient.

“If they’re comfortable with their level of safety, then we can leave and leave much earlier,” Zack said. “And that’s the advantage for everyone involved — the clients getting the professional help, (and) the officer is there to protect both the social worker and the individual. And ultimately, it’s better care, and the police are freed up to do what their mission is.”

The issue, he said, is cost. “You can’t do it with two or three people who are only available 8-to-4, Monday through Friday.”

To fully staff Asheville with mental health professionals and social workers could require 20 to 30 positions, he said.

“And is anybody prepared for that level of commitment?” Zack said. “That’s oftentimes where great ideas die on the vine — when the price tag comes in. And half an idea rarely works.”

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Watchdog journalists John Boyle and Sally Kestin contributed to this report.

Asheville Watchdog is a nonprofit news team producing stories that matter to Asheville and surrounding communities. Andrew R. Jones is a Watchdog investigative reporter. Email arjones@avlwatchdog.org.