ECHO report shows growing mortality rate among the area’s homeless community

The most comprehensive study of homelessness mortality in Austin shows that more than 1,000 people died between 2018 and 2023 with the average age of death falling at 50 years – which is 20 years younger than those living in stable housing.

The Bridging for Better Outcomes report from the Ending Community Homelessness Coalition (ECHO) sheds light on the growing crisis of unhoused mortality in Austin and Travis County. The data show an alarming rise in mortality rates among Austin’s unhoused population. Deaths increased from seven per month in 2018 to 22 per month by 2023. Men constituted the majority (82.5 percent) of those who died, yet women faced even starker realities. Unhoused women who died outside hospitals had the lowest average age of death, just 46 years old.

Overdose, transportation accidents and cardiovascular disease were the leading causes of death. The report attributes at least 223 deaths to methamphetamine overdoses, with fentanyl playing a significant role in 119 cases. Only 10 overdose deaths were linked solely to fentanyl, highlighting the dangers of unintentional exposure through drug combinations.

Less than half (47 percent) of individuals who died were in hospitals at the time of their deaths, while many died in tents, parks, motels or on streets. Nearly half of those who died had no documented interaction with Austin’s Homelessness Response System.

In the year preceding their deaths, 364 individuals collectively incurred $11.1 million in public costs for emergency medical services, emergency room visits and inpatient care. The report notes that this amount could have funded 81 percent of permanent supportive housing services and rent for the same group.

The report notes that permanent housing can significantly extend life expectancy, with median life expectancy increased by 9.5 years for individuals who transitioned to permanent housing compared to those who remained unhoused. Only 6 percent of those who died had accessed a shelter bed in the six months before their deaths.

Actions recommended in the report include scaling permanent housing initiatives, expanding substance use treatment and developing a medical triage team integrated with Coordinated Entry systems. The report also urges improvements in access to low-barrier shelters, such as real-time availability tracking and clearer processes for entry.

Danica Fraher, ECHO’s health care systems manager, said the city, Travis County and homelessness services groups already have many of the resources needed to address gaps in the system that lead to mortality, with better access to recovery housing, reentry housing and long-term care seen as a priority.

Fraher also said statewide expansion of Medicaid would cover the costs for wraparound services for those in permanent supportive housing, which currently must be paid for at the local level.

“Medicaid expansion would massively provide insurance, much-needed insurance for folks who are in the gap, and also it would largely fund a lot of our supportive housing dollars,” she said. “That’s not something most folks really know. But we have to think very creatively in Texas about how we can blend health care and housing together. It’s often done through philanthropic donors, but those are hard to have as sustainable funds.”

The report comes after ECHO leaders have spent time in front of City Council to build support for a 10-year, $350 million plan that could effectively end homelessness in the area.

Fraher said the report, which compared medical examiner data with reports from local hospitals, offers the clearest picture yet of the result of ongoing gaps and shortcomings in the area’s system for helping people experiencing homelessness.

“If we begin to use mortality data in our systems planning, we can prevent death happening in our unhoused community. If we don’t, this will continue,” she said.

“The report is a first of its kind … and it really tells this raw, life-and-death story of homelessness. And it does this by integrating the housing data, health care data, mortality data and then blending it all together with storytelling so we don’t forget why we’re here.”

Photo made available through a Creative Commons license.

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