A letter with 1,000 signatures was recently sent to Portland’s City Council. Concerns centered around people languishing and creating issues for businesses on Congress Street. We can see people struggling. The question is what to do. Community leaders asked for additional attention and support. That’s a great start. And there is more to consider.

Substance use is a factor. Opioids and meth can showcase lethality or erratic and public behaviors not previously witnessed. And substance use often masks serious mental illness; people self-medicate. Homelessness is a factor. It compounds people’s stress. People facing their worst times are often on full display, with us as the audience. Housing has to be part of the answer.

No one does better without housing or support. What we are witnessing confirms that. And it costs less when we house people and support them there.

There are several other things to consider as well. People in this climate die outside. People in encampments risk becoming prey to substance use and human trafficking — we watched this play out in 2023. We agreed that shelter is crucial if housing isn’t available, and we were right; Portland’s encampment crisis has diminished markedly.

Back then, we were racing toward 282 tents outside; today we have closer to 30. Shelter is working. Housing is better still, and three times less expensive than shelter. Conversely, jail is four times more expensive than housing, and hospitalization is 28 times more expensive than housing. Riverview Psychiatric Center is 85 times more expensive than housing.

The status quo has us heavily relying on these systems. People who are chronically homeless are up to 29 times more likely to be in the hospital and 57 times more likely to be in jail when unhoused than when housed. People ricochet through our most expensive emergency systems because they are not housed.

When we move people into housing and offer them support, nearly all begin to thrive. People with mental illness often do the best of this group; subtracting the stress of homelessness is a huge part of wellness. Supportive housing works. We have space in the Homeless Services Center — where dedicated staff work to house people. They have been successful; in June there were between 9 and 37 beds available each night. Shelter leads to housing.

Can we bring this group inside? Should we be more insistent? Insisting that people deserve to be inside does not mean criminalization — it means coordinated care with a shared end goal. It means police nudging while working in concert with outreach workers on the same page. It means structure and accountability.

Our district attorney’s office has proven that we can use the law to encourage good choices, dropping minor charges if people agree to come inside. This strategy has been tested, and it works. It’s a move toward being assertive rather than hands-off, insisting that people deserve
to be inside where they are safe and supported by professional staff, a proven pathway to housing.

There were 490 fatal overdoses in Maine in 2024. From Maine drug data, people were 47 times more likely to have a fatal overdose if unhoused than housed. And this group is predominantly concentrated in unsheltered situations. That’s where people die. It’s also where they contract illnesses.

Another Maine city has 27 people HIV-positive — a crisis because they ordinarily have, at most, two. And the number of HIV cases continues to increase. This follows a multi-year entrenched encampment. We will pay the equivalent of five-plus years of housing for each of them in the first year alone just to treat HIV and hepatitis C, the side effects of leaving people unhoused.

Supportive housing works. We can bring people inside and house them from there, something admittedly more easily said than done. We can be careful to preserve people’s rights and autonomy while adding accountability and structure to help them to a better place. Let’s intervene and insist on healthier outcomes, both for people struggling and the city struggling to watch.

Cullen Ryan is executive director of Community Housing of Maine.