As she wanders St. Paul’s downtown skyways, bus stops, overnight drop-in shelters and hideaways tucked into banks of the Mississippi River, Tonya Lenox’s opening line to the long-term homeless people she encounters is almost always the same: “I know you don’t want to talk to me, but …”

Lenox and other case managers know that housing the chronic homeless can be a long, slow process. But in Ramsey County, proponents of a new effort to reach these folks say they’re ready to speed things up.

A collaborative composed of the county, the city of St. Paul, Catholic Charities of St. Paul and Minneapolis, RADIAS Health and additional partners have assembled a list of the 100 most frequent shelter users.

These are long-term homeless residents in need of extra support to get into permanent housing. The organizations recently hired two case managers to prioritize outreach through a two-year effort dubbed “Re-directing Users of Shelter to Housing,” or RUSH.

So far, the pair have moved at least 28 people off the RUSH list, many of them senior citizens. Most have been prioritized for single-occupancy rooms at Catholic Charities’ new Higher Ground St. Paul facility near Interstate 94 and the Xcel Energy Center, and a few have been placed in group homes or subsidized housing in the community.

‘BEEN HERE THEIR WHOLE LIVES’

Lenox said many of the people on her list are in their 60s and 70s. Most suffer from severe and persistent mental illnesses. Many have been homeless since the 1990s. One of the newly housed residents lived on the streets for 30 years.

Lenox said she was taken aback by how many had family in the area they were disconnected from.

“A lot of them have been here their whole lives,” she said.

The other common thread? Most of them want to be left alone.

“Almost all of them are in survival mode, where they are just worrying about their most basic needs,” Lenox said. “To look beyond that is almost overwhelming.”

The RUSH strategy reasons that individuals who use emergency services for a year or more need more outreach and different kinds of support than folks who have lost housing as a result of a sudden crisis, such as job loss or a death in the family.

Ramsey County Commissioner Jim McDonough, who sits on the RUSH governance team, said treating the homeless as a monolithic population hasn’t worked. He calls targeted outreach key.

“There’s many pathways into homelessness,” McDonough said. “When you have individuals that have been homeless long-term, they take up beds for people who really need emergency shelter — people who have had a crisis in their life and all of a sudden they’re homeless.”

By prioritizing housing, social service organizations can help chronic shelter users better focus on their long-term needs, such as mental health concerns that may be contributing to their homelessness.

The Minnesota Housing Finance Agency defines “chronic homelessness” as someone who has been homeless for periods that equal at least a year and has a diagnosable disability, such as addiction or mental health issues. To work with the population, the RUSH collaborative has hired two case managers through grant funding from the St. Paul Foundation and F. R. Bigelow Foundation. In addition to Lenox, who is employed by Catholic Charities, a second case manager is assigned to RADIAS Health, a St. Paul-based behavioral health organization.

Brooke Schultz, associate director of clinical services for RADIAS Health, said her organization focuses on shelter users with demonstrated mental health needs. “A lot of times folks who have been homeless for a long time and struggle with mental illness really struggle with the ability to trust, and maybe some paranoia,” Schultz said. “They may have significant histories of trauma that may make it hard to engage with professionals.”

‘HOUSING FIRST’

Serious mental health concerns may be a barrier to housing, but officials say it’s not an insurmountable one. “A lot of times it comes down to developing a relationship with a person, so they feel like they can call you when they’re struggling in the ability to live in their own apartment, or in a place that’s not a shelter,” Schultz said.

These days, the buzzword among social service agencies is “housing first.”

“Typically, in other programs, you respond to referrals, or you wait for people to say, can you help me out?,” said Chris Michels, senior program manager with Catholic Charities. The collaborative “turns that upside down and you engage with your chronic users, regardless of wants.”

Critics sometimes dismiss efforts to house the homeless as futile or expensive charity, but McDonough said doing nothing also comes with a hefty price tag.

He noted the county runs adult mental health services, the adult correctional facility and the detox center, three taxpayer-funded services or institutions that many long-term homeless residents will end up interacting with. In addition, every ambulance trip to a hospital emergency room for an uninsured homeless person costs taxpayers thousands of dollars.

“A lot of the times, they’re accessing our services at the most expensive end, and they’re not really getting their needs addressed,” McDonough said.

The RUSH effort is modeled after a 2 1/2-year outreach program launched by Hennepin County in 2012, which focused on the “Top 51” users of shelter services. The Hennepin County pilot program tracked 20 of the longest-term shelter users to determine whether moving them into housing improved their situation. Hennepin County found a 43 percent decline in arrests and a 76 percent decline in emergency room use. Health care costs also dropped as a result of having stable housing.

In addition to St. Paul and Ramsey County, the RUSH collaborative includes the St. Paul Foundation, F. R. Bigelow Foundation, St. Paul Area Chamber of Commerce, Regions Hospital, Guild Incorporated, Radias Health, People Incorporated, Catholic Charities and Listening House.

The Higher Ground St. Paul facility, which opened in January, includes 193 units of permanent housing, as well as 280 traditional shelter beds. Catholic Charities also plans the St. Paul Opportunity Center and Dorothy Day Residence, which will include an additional 171 permanent housing units.