Regularly clearing out homeless encampments in Denver and other major American cities could lead to a nearly 25% increase in deaths among unhoused people who use injection drugs over a 10-year period, a new study released this week found

Encampment sweeps — or cleanups as city officials prefer to call them — have been the source of protests, lawsuits and legal settlements in Denver in recent years. A 2019 ballot measure sought to lift the city’s urban camping ban and do away with sweeps, but it was forcefully rejected by more than 80% of voters.

How best to address the homeless crisis, particularly unsheltered homelessness that includes encampments on the city’s streets, has been a focal point of Denver’s 2023 mayoral race.

Kelly Brough and Mike Johnston, the two mayoral candidates facing off in the June 6 runoff, each referenced the study linking sweeps to increased deaths at different points during a forum on Wednesday night.

Both have pledged to end homeless encampments if elected. And both propose to do that by offering people living on the streets new, short-term options beyond the traditional shelter system, where people often sleep in one big room.

In Johnston’s plan, that would take the form of 10 to 20 “micro-communities” featuring 40 to 60 tiny homes apiece with on-site services to get people out of tents.

Brough’s plan is less specific. She plans to engage with service providers like the Colorado Village Collaborative, which already contracts with the city to offer managed camping spaces called Safe Outdoor Sites, to come up with best practices. But her proposal also involves relocating people in mass to areas where temporary sanctioned camping could be contained and backed up with sanitation and support services instead of spread across sidewalks or in alleys near homes and businesses.

“This study really reinforced how critical it is that we stop doing what we’re doing today,” Brough told The Denver Post on Friday. “We have to stop endlessly sweeping people immediately. So for me, the temporary outdoor sites are so important.”

“I will eliminate unsanctioned encampments within my first year in office,” Brough’s plan says in bold letters at the bottom of its first page.

Johnston also feels the study supports how he plans to intervene and achieve one of the tent-pole promises of his campaign: ending homelessness in Denver by the end of his first four-year term.

The key is that micro-communities will allow entire encampments to relocate at once, allowing people to preserve the social bonds and supports they have formed on the streets, Johnston said. The camps would be given notice about the opportunity.

“I think that actually feels like an anxiety-reducing event, instead of an anxiety-inducing event,” Johnston said.

“Hopefully, it makes them more open to the next intervention or support,” like on-site mental health care or workforce training, he added

Stopping the sweeps by giving people a better alternative to living on the streets is an ideal outcome, but it still relies on involuntary relocation. Neither candidate has said they would stop enforcing the camping ban and both have discussed what they would do in the event they encounter people who won’t voluntarily move to sanctioned spaces.

Brough has said she will use arrests and mental health holds to get people who refuse to go to sanctioned camping areas off the streets. She has emphasized that is a last resort she hopes never to have to employ. Johnston, at Wednesday’s forum, said that while he won’t arrest people who reject services, he will move them along — in essence, what the sweeps already do.

“He’s been very clear that he won’t incarcerate, and she has been very clear that she will. The biggest problem with both of their plans is it doesn’t actually solve the problem,” said Josh Barocas, the study’s lead author and a Denver-based doctor specializing in infectious disease care.

A study that peers into the future

The study, published Monday in the Journal of the American Medical Association, used a probability-based model to project outcomes for unhoused people who inject drugs between 2019 and 2028.

The model relied on data collected by the National HIV Behavioral Surveillance program in 2018 in Denver and 22 other cities to generate a population of hypothetical people living on the streets of those cities with different ages, sexes and drug-use habits. Possible outcomes on a week-by-week basis included individuals who develop injection-related infections and need to be hospitalized, people who get prescribed drugs like methadone, and those who overdose and potentially die.

“We can’t simulate the entire world of risk. There are things like frostbite and trauma that we did not include. But we did say, ‘OK, what are things that people who inject drugs are at risk of’? Overdose and infections,” Barocas said. “At the end of that week’s cycle, the model calculates their probability of life and their probability of death in that week.”

The study’s authors, which included Denver addiction medicine specialist Dr. Sarah Axelrath and Emily Mosites, an epidemiologist with the Centers for Disease Control and Prevention, only tweaked three variables:

• Whether the individuals had access to the overdose prevention drug Narcan
• Whether they had access to prescribed medication for opioid use disorder
• Whether they had access to clean injection equipment

Taken together, those three things stand in as an avatar for sweeps, which often separate people from medications and other critical supports they need.

The results were striking. Projected deaths among unsheltered individuals rose between 15.6% and 24.4% over the 10-year window when those people were subject to the possibility of continual involuntary displacement.

“We should not be doing things that we now know, based on my study, lead to death,” Barocas said. “This is a longer version of the death penalty.”

Barocas does not support either Johnston’s or Brough’s plans. He feels a much better intervention would be to provide sanitation services to existing encampments, an approach suggested by Lisa Calderón, the third-place finisher in this month’s mayoral election.

“Temporary housing isn’t the answer, except that it’s not the encampments. Tiny homes won’t happen tomorrow,” Barocas said. “There is this notion that encampments are health hazards. There is garbage, there is feces, there are needles. I totally understand and agree. So why are we moving people away from resources instead of taking away the garbage?”

Brough has yet to identify any locations for sanctioned camping, but said she would work with the community and the City Council on that effort starting on Day 1 of her administration. It’s a matter of safety for the unhoused that they move to sanctioned sites as quickly as possible, she said.

“We know that we should not be centralizing all of the support and services in one neighborhood,” Brough said of where those sites might be.

Johnston also hasn’t mapped out his proposed micro-communities except to say he is looking for 1/2-acre sites away from dense residential areas and schools. He would begin site scouting work before he is even inaugurated should he win on June 6, he said. He expects there to be ample demand for tiny homes among the city’s unhoused, and rapidly expanding the model will be critical.

“I think we should be able to open the first two or four in the first 100 days,” he said. “I think there is a really exciting opportunity for us to make Denver a national model on this.”

New data collected early this year has yet to be released, but the results of the point-in-time homelessness count performed in Denver on Jan. 24, 2022, show 1,313 people slept in tents on the streets or another place not meant for human habitation that night. That is almost certainly an undercount, Barocas and other homelessness advocates and researchers say.

“It’s like they’re playing ping-pong with us”

Under outgoing Mayor Michael Hancock’s administration, the sweeps have hit legal snags but have not stopped. They can have negative, life-upending effects on unhoused people even if those people don’t use any drugs, advocates say.

On Thursday morning, around a dozen people living in a cluster of tents along 20th Street just east of Broadway were surprised when city crews showed up to move them along. Only after the people there began gathering their belongings and bagging up trash did the cleanup crew realize they didn’t have the authorization to carry out the work and left abruptly, fencing still in place around the encampment.

Denver officials failed to post a proper seven-day notice announcing the cleanup and could not legally proceed. Officials plan to post a notice next week and come back on April 25, a mayor’s office spokesman said Friday.

Daven Turner threw up his hands in frustration Thursday morning when he heard he could stay put for another week if he wanted. He already had broken down his tent to move.

“The sweeps are for nothing. It’s like they’re playing ping-pong with us. We move two blocks this way, then we moved two blocks back. We were just here,” he said, pointing across the street to a corner where he stayed last month before being swept.

Petar Frákes was also part of that camp. He believes he has been through 30 or 40 sweeps now. He counts 26 times his belonging were confiscated in the process. He has missed appointments because of the city’s cleanups and lost nice clothes he was keeping to wear to job interviews, highlighting to him that the sweeps are a self-defeating cycle.

“If they get thrown away, what am I going to look like? I’m going to look like a homeless guy,” he said of his clothes.

After Thursday’s aborted sweep, his plan now is to set up two camps. Both can’t be swept at once.

“We know how to play this game and they know how to play it. too,” Frákes said.

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