The report, available online, is the most detailed look yet at homeless mortality in Austin and Travis County given the historic lack of data on the unhoused community, according to ECHO. It also includes strategies proposed for local governments, organizations and community members with the goal of limiting future deaths.
“If we continue to not include mortality data in our systems planning, people are going to continue to die preventable deaths," ECHO Healthcare Systems Manager Danica Fraher said in an interview. "We need to look at service delivery needs and gaps that are not just based on those that survive our system, and I feel that we can learn more ... from those who do not survive our system.”
By the numbers
The findings are based on records from hospitals and the county medical examiner as well as interviews with social service providers and homeless people.
From 2018—when the medical examiner's office first began identifying people as homeless at the time of death—through 2023, at least 1,010 homeless people died across the community. That total is likely an undercount given limitations related to the data, death reporting and privacy, Fraher said.
Deaths have also steadily increased from year to year, alongside increases in the region's homeless and overall populations. The average number of monthly deaths more than tripled during the six years of ECHO's analysis.
The average age of death for a homeless person on the streets in the Austin area is now 48, while life expectancies across the county fall between the high 60s and high 80s, according to Centers for Disease Control and Prevention estimates. Homeless people who died in the hospital were a slightly higher average age, 55, ECHO found.
“The report does a great job highlighting what we all know to be true, which is that homelessness can be deadly. It definitely has an extreme human toll and extreme human cost," Gray said in an interview. "If we’re not able to get people off the streets and into housing, not only are people literally losing years off of their life, but they are dying in our streets. ... That’s really something that nobody should find acceptable."
Zooming in
ECHO also detailed several demographic findings from the recent research, including:
- The majority of people experiencing homelessness who died from 2018-23—56%—were white, according to ECHO. That's a higher share than the area homeless population, which is just 29% white, and closer to the demographic's 47% share of the overall countywide population.
- Regardless of race, life expectancy for homeless people fell at least a decade below local averages for each demographic.
- More than 8 of 10 homeless deaths were men.
- Nearly 60% of those who died on the street were chronically homeless—living with a disabling condition while homeless for at least a year straight, or for a total of 12 months over a three-year span.
- Nearly 20% of those who died had experienced domestic violence, and 41 people were actively fleeing it at the time of their death.
- The vast majority of people who died had little to no medical coverage or other social benefits
"Most of the time it’s paired with methamphetamine, and because there are so few people who are dying of just fentanyl, this is suggestive of unintentional exposure," she said. "It's really where things like fentanyl testing strips could absolutely save lives and should be something that our policymakers consider this spring.”
The outlook
Fraher said she wasn't aware of local mortality trends from 2024 but that further analysis could take place in the future.
She also noted the Austin-area reporting is among the first of its kind nationwide as there's no standardized federal data on homeless deaths, leaving cities or regional groups like ECHO to compile information. It also includes new testimony from people living on the streets, and local volunteers and service providers, collected during listening sessions.
“Overwhelmingly, folks were just really happy to have a space to talk about this. Death has become a very normalized part of working with folks experiencing homelessness or being homeless," she said.
ECHO Executive Director Matt Mollica said the ideas followed decades of "failed policy and disinvestment" in housing for people experiencing homelessness.
“All of these deaths were preventable and avoidable with access to quality affordable housing and health care that meets the needs of those seeking it. It is for these more than 1,000 people and many more suffering on our streets that we spur action and demand change," he said in a statement.
Gray said the city is already making progress on some of the proposed action items, like constructing hundreds of new supportive housing units and streamlining shelter entry processes. While 90%-95% of shelter beds in Austin are taken up on any given night, he said anyone in need can call the Sunrise Homeless Navigation Center hotline to get on a list for entry.
On the streets, Gray pointed to the city's new policies for opening overnight shelters during extreme weather as another potentially live-saving update. As temperatures dipped below freezing in early January, Austin sheltered almost 1,900 people across six days. And last summer, Gray said a pilot program with the Trinity Center offered extended cooling center hours during the hottest times of the day.
He also credited the response of city first responders and service providers amid a wave of dozens of overdoses last spring, and the city policy to stock shelters with Narcan for distribution or individuals in need.
“We have a number of tools at our disposal to help meet peoples’ health care challenges, both physical and mental health care challenges, when they’re unsheltered. And we’ve made programmatic changes to make shelter more accessible to those who need it," Gray said. "We’re carrying that attitude forward in 2025. We’re going to continue to evaluate all of our programs, all of our policies and all of our practices to ensure that the health and safety of people experiencing homelessness in this community is put first.”
