Behind the struggles with drugs, crime and extreme poverty in Portland’s Bayside neighborhood – described in a lengthy article in the May 6 Maine Sunday Telegram – is a fundamentally broken mental health system and inadequate treatment for those suffering with substance use disorder.

It’s really that simple.

I’ve seen this crisis grow through my work at Preble Street, a nonprofit social service provider committed to fighting poverty at its roots.

From my first week on the job in 1991 and until she died just a few years ago, I received regular phone calls from a sweet older woman who called me to “check in” on her daughter who was living on the streets. These were heartbreaking phone calls, almost always ending in tears. Because of severe paranoia and delusions, this woman’s adult daughter refused to speak with her or take the help her family repeatedly offered.

Earlier in her life, her daughter did receive mental health treatment but because of her paranoia, she abruptly stopped taking the psychotropic medications that had been prescribed, stopped meeting with her psychiatrist and outright refused to engage in any way with the mental health system.

So the mental health system gave up on her.


No assertive outreach, no creative approaches, no lasting commitment to do whatever it would take to reach this woman and help her.

She joined the long line of people living sad and tragic lives on the streets and in shelters because she was “noncompliant,” to use the language of mental health agencies. Somehow it doesn’t seem to matter that it is because of her mental illness that she is “noncompliant.”

Twenty-seven years after I took the first phone call from this desperate mother, her daughter still wanders the streets of Portland, is still homeless, talks to herself loudly sometimes and behaves strangely in public places.

The last few times I spoke with her mother, this lovely old woman repeatedly asked me – begged me, really – not to forget how much her daughter was deeply loved and asked me to “keep an eye out” for her and keep her safe. I assured her we would always be there for her daughter.

Which we are, of course. That is our job at Preble Street. While we’re immensely proud of our work developing lasting solutions, we “keep an eye out” for her and do everything we can for her and so many others who are abandoned by a health and human service system that is nowhere near the strong social contract that most Americans think is in place in this country.

It wasn’t like this 40 years ago. It can stop. Public policy can improve.


We must transform our approach to caring for vulnerable people, and the only way change can come is for all of us to insist that policymakers do the right thing.

Thousands of shelters have opened in the United States since the early 1980s. But those shelters and soup kitchens – all well-meaning, all local efforts, many faith-based – are not the answer. Nor are they the problem.

Shelters like the Oxford Street Shelter, or Tedford Shelter in Brunswick, or Greater Bangor Area Shelter do extraordinary work. They keep our brothers and sisters and children and parents alive, they give people hope, and they and other shelters across the state all cobble together scarce resources as best they can to develop programs that help people move out of shelters and off the streets.

In Portland, those of us who do this work are proud of the basic emergency services we provide. And we’re perhaps even prouder of the solution-oriented work that has seen documented success. Housing first and other supportive housing developments, the long-term stayer initiative, veterans services and the mobile outreach HOME Team are just a few examples of the good, solid work being done. Thanks to those creative and dogged efforts many people have gotten off the streets, out of shelters and moved on with their lives.

But we’re nibbling on the edges.

And this is even more true when it comes to the opioid crisis.


If anyone had told me five years ago things would get even more complex, and more tragic in anti-poverty work, I never would have believed them. How could things possibly get worse?

But they did.

In almost four decades of service, Preble Street had never had an overdose in one of our buildings or in one of our programs. Five years ago, we had our first. A client was found on the floor of the soup kitchen bathroom. He was not breathing and his lips were blue. Within a couple of months, a similar incident occurred. And then again and again. By 2017, there was an overdose once every eight days at Preble Street.

What is even more tragic than someone dying alone and desperate in a soup kitchen bathroom is that every single person who overdosed had asked us for help before that overdose – help in getting into detox, getting into a recovery program.

Every social worker’s dream is that you’re talking with someone suffering from substance use disorder and they ask for help getting sober. And it is that precious moment of clarity when a social worker wants to jump on it. Make some calls. Make a plan. Walk the person to the detox center.

But too often, it can’t happen.


The services simply are not there. The few treatment programs that exist are mostly for people with insurance.

And most of our clients don’t have insurance and don’t have Medicaid. So, over and over, they are denied treatment.

So, while it is not right for homeowners and renters in Bayside to live in fear because their neighborhood is asked to bear the brunt of the city’s and state’s untreated behavioral health needs, it is also absolutely not right for poor people to be ghettoized, to be exploited, vilified and publicly shamed while being largely abandoned by the health and human service system.

Without a serious and sustained commitment from federal and state governments to provide the resources needed to the mental health and substance use disorder system of care – and to hold them accountable – not much is going to change; and there will be more articles in the future with photographs of people struggling to get through yet another day on the streets.

Preble Street and its board, its 260 employees and interns, its 6,000 volunteers and its many thousands of stakeholders have been stalwart believers that it is our obligation to serve – to feed, shelter and heal – and to be advocates for public policies that can change circumstances for individuals and the places they live. These solutions require empathy, commitment and funding from the public and private sectors.

Please join us in advocating, fighting, screaming for large-scale changes in how this state and this country treat people suffering from mental illness and substance use disorder.


Speak up when the Maine Legislature adjourns leaving critical work unfinished.

Insist that the people we send to Congress protect and strengthen the Affordable Care Act and refuse to allow the erosion of vital health care programs and benefits that pay for mental health and substance use disorder services.

Demand that our next governor implements Medicaid expansion and have a comprehensive plan to solve the mental health and substance use crises.

As Franklin Delano Roosevelt implored us, we must “choose the path of social justice, the path of faith, the path of hope, and the path of love.”

— Special to the Telegram

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