"They actually did something to help us, not to set us back in life": Documenting the experiences of unhoused community members with an alternative first response program.
Journal of prevention & intervention in the community · 2025-12-21 · Qualitative study
Abstract
Police are often called to address concerns about people experiencing homelessness and mental health crises. These interactions often lead to arrests, which lead to fines that many are unable to pay, loss of personal belongings, and additional barriers to housing and employment. Based on concerns about the over-policing of people experiencing homelessness, communities have become increasingly interested in alternatives to police response to calls involving people experiencing mental health distress and homelessness. Portland Street Response (PSR) is one such alternative that was developed and implemented in Portland, Oregon. Although specifically focused on mental and behavioral health crises, a large portion of PSR's calls respond to individuals experiencing homelessness. For this reason, it is critical to assess unhoused community members' knowledge of PSR and their experiences with and attitudes toward the program. 719 surveys of unhoused community members and 29 follow-up qualitative interviews were conducted across four evaluation timepoints. Knowledge of PSR was low at the beginning of the program but increased significantly over the evaluation period. Unhoused community members, particularly those who were Black, Indigenous, and other People of Color (BIPOC), reported feeling unsafe calling 911 to request service from PSR, though their trust increased over time. While only a small percentage of unhoused community members we spoke with reported direct experience interacting with PSR, those who did expressed high levels of satisfaction, appreciating the compassionate, person-centered care they received in the community; the connection to housing, health services, and other resources; and the collaborative manner in which PSR staff engaged with them. As cities across the country implement alternative first responder programs, our findings help identify important areas to consider to ensure that unhoused community members are aware of how to access the programs, and, importantly, that they trust the programs will help them rather than harm them.
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Tags
Clinician perspective · Equity & disparities · People experiencing homelessness · Patient experience
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