There was something about the woman that reminded me of the girls back in Kensington.
We were in the middle of the Second Avenue Commons engagement center on one of the first blisteringly cold nights of the winter. The woman had two large, black garbage bags full of her wares, and we needed to condense them. The task of sorting through a homeless person’s dirty clothing to decide which articles stay, which articles go and which need to be washed might be frustrating to some, but I revelled in it. The woman was in her 70s, schizophrenic and chronically homeless, and there was a perfect her-shaped hole in my heart.
That hole had been left by women I lovingly refer to as “the girls” — I can’t help but hold them close in my mind. I spent two years working with “the girls” in one of my first social work jobs in Kensington, Philadelphia, one of the largest open-air drug markets in America. That experience imprinted upon me the importance of not only a robust safety net for vulnerable citizens, but of one that was deeply loving and rooted in unconditional, positive regard.
That night at Second Avenue Commons made it official: I’d found that kind of love again, in Pittsburgh. I’ve come to learn that there’s much about Pittsburgh’s safety net that would be enviable across the state, but also plenty of reason for concern.
Days full of loss
On Kensington Avenue in Philadelphia, I was managing a drop-in center for women. My clients were women who struggled with severe opioid use disorder, most having survived tens of overdose reversals, use-related infection and disease, and the unimaginable horrors of profound street homelessness.
At the drop-in center, we tried our best. We provided meals and snacks, clothing and underwear, a place to shower and use the bathroom. Too often their personal belongings — down to their shoes and belly button rings — were stolen while they were sleeping. There just wasn’t enough of anything to go around. It was only a half-truth to say that our being there alone was enough. Our presence was freely available— but only to be tapped during working hours.
There was no medical care beyond the emergency room and the occasional street nurse. Shelters were worse than sleeping on the street. For us, it was difficult to coordinate care beyond the front doors of our tiny haven. Between dangerous working conditions, a serious dearth of resources, and open political hostility toward providers, it is no wonder Philadelphia’s homeless service providers kept their distance from others when they could.
I often came home from work in a sheen of sweat and dust, bursting into tears when I inevitably couldn’t locate a parking spot, the final hurdle in a day full of loss, a day full of sticking corks into a dam just for bigger leaks to spring elsewhere. I took time away from working in Kensington and opted for a position at the Philadelphia District Attorney’s Office, helping to divert people from criminal prosecution to social services. Even with the DA’s stamp, social workers in the diversion unit were met with distrust, unanswered emails from potential partner organizations and political queasiness around the idea of giving people with nonviolent firearm possession charges a second chance.
Unexpected connection
I came back to Pittsburgh in August 2024, for reasons I initially thought were not related to work.
I had been feeling isolated, sandwiched between New York and D.C., the liminal land of cheesesteaks and mid-Atlantic attitude. Like many people who love or have loved Pittsburgh, I wondered why I had ever felt the need to reach toward the glamour of the eastern seaboard when what I wanted was to feel safe and connected to those around me. I had attended the University of Pittsburgh for a bachelor’s degree in writing that I had assumed would free me.
When I found a job as a crisis mental health clinician before moving into a Wilkinsburg craftsman last summer, I didn’t ever consider how deeply this personal need for community could translate into the work. But ultimately, I am unsurprised — the comfort of home in Appalachia, through the kindness and grit of Pittsburghers, is undeniable.
When I was introduced to Street Medicine at Pitt — the University of Pittsburgh’s institute for training clinicians interested in taking medicine to unhoused people — I was giddy.
Back in Kensington, we’d been desperate for street medicine treatment. I had assumed it was a concept reserved for futurist Scandinavian harm reductionists, a dream as shiny and incomprehensible as flying cars. Wound care became an issue beyond our comprehension. Some street nurses made rounds, but not nearly enough. At one point, the city offered resources to laypeople so they could assist with basic wound care in the streets.
On one of my first rounds with Street Medicine at Pitt, I asked Assistant Medical Director Dr. Max Hurwitz if they had enough wound care supplies. I was so used to cutting strips of tape lengthwise and allocating gauze pads with dedicated precision to ensure there was enough to go around, it never occurred to me it could be a non-issue. The casualness with which he informed me of their access to supplies was shocking, as if we were, once again, transported to some mythical place beyond imagination that cared about the well-being of our homeless and underserved neighbors. That mythical place was Pittsburgh.
And what was also mythical was the warmth with which I, an interloper, a “back in Philadelphia”-spewing know-it-all, was welcomed. My team and I were called on by physicians and nurses when there were acute behavioral health needs. For once, I was experiencing a completely collaborative, no-strings-attached continuum of care where knowledge and experience were freely shared.
Unlike the distance I’d felt in Philadelphia, Pittsburgh’s not-quite-midwestern coziness seemed to bubble up wherever it found air. It’s something I’m still getting used to compared to the East Coast tradition of professional competition, even in a sector designated for helpers.
Pittsburgh’s forward-thinking homeless services don’t stop at street medicine. When I began working with the unhoused in Pittsburgh, I was introduced to a deeply interconnected network of providers in all sectors — food, housing, shelter, behavioral health and specialized services for people with disabilities or in the LGBTQ+ community. All of these programs, despite their flaws, are largely staffed by people who take a genuine interest and care in the well-being of their clients.
Still, we face needs we can’t possibly meet. Most impossibilities in care didn’t come from a lack of trying, but from the same scarcity of resources I faced working in Philadelphia.
A revealing recount
That scarcity was on full display this month, as this season’s winter shelter closed on May 15. With every city shelter at full capacity, night after night, there was nowhere for people to go. I saw outreach workers scramble for tents and sleeping bags, and ways to distribute them. Shelter workers had to painfully turn desperate people — sometimes newly homeless — away to the streets, completely empty handed, no other resources available. Crisis clinicians, including me, encountered tens of people a week whose already fragile mental health was on the edge of collapse.
This scarcity comes from a complete misunderstanding by civic leaders of how dire the issues of poverty and homelessness are in the city.
As recently as March, Allegheny County’s idea of what is realistic for the homeless community is not in alignment with what service providers are seeing. This reality was crystallized in decisions on counting the unhoused population.
The annual point-in-time count, an assessment mandated by the U.S. Department of Housing and Urban Development, aims to accurately identify the number of people experiencing homelessness on a single night. In Allegheny County, this is done by outreach groups that know the community well.
These providers know the community so well that, after 2025 point-in-time count numbers were collected, the county elected to hold a recount. The message some of us in the homeless services community took from this: The county felt the number of unhoused people reported was too high, artificially inflated by errors in data collection techniques. This is despite the fact that the point-in-time count has existed in the county, on the same night, for nearly 10 years, and that data repeatedly shows a year-over-year increase in homelessness. To me, the message was clear and offensive: The county doesn’t believe the community providers — who regularly visit people at encampments, inside abandoned buildings, and on the street — can effectively count the population they work with.
The truth is that the job was done too well, exposing troubling truths about the number of people still unhelped by human services policy and programs. There are major gaps between the political powers in Pittsburgh and the people who work around the clock to ensure unhoused people here are safe and afforded every opportunity for success.
[Editor’s note: In response to questions raised by this essay, Allegheny County Department of Human Services Director Erin Dalton wrote that the recount was not intended to deflate the numbers but to ensure accurate data. “After completing the initial 2025 point-in-time count, we had serious questions about the results,” Dalton wrote. A count done in January “did not align with any of our other data,” was not fully verifiable and stemmed from methodology that was different from pre-COVID counts.
“We are committed to transparency,” Dalton added, noting the recount report should be made public “in the coming weeks” after a draft analysis is shared with “a wide range of stakeholders, including people who spend significant time with those who are unhoused.” Dalton wrote that the department is “grateful to our partners, particularly the outreach teams who help to facilitate the annual count,” and is working with those teams to help to revise the count methodology and interpret the results.]
Healing, and not alone
In this line of work, we often refer to a person’s environment as an integral piece of their story. Not only is the world around a person part of what has led up to the present — not what is wrong with them, but what has happened to them — it is also an important piece of their recovery.
When I moved back to Pittsburgh, I could have never imagined how important it would be for my own recovery. I found my sense of self and community again, but also healed my relationship to the work, which is often draining, emotionally wrought and unfair.
I came home the other week on a rainy night, completely depleted, dragging my bag of bones into my dark house, wondering why I even try. Homelessness will never be eradicated, and our neighbors will continue to be failed by systems that have supposedly been set up to help but often feel like the result of half-true campaign promises and bureaucratic paper-pushing.
I still see the woman whose garbage bags I help sort, and she usually has even more every time. I wonder if she’ll ever have a place to keep those things. The system set up to get her into a stable home may never be perfect. But I know that in the meantime, in Pittsburgh, I’m far from the only person who would be happy to help her with her laundry.
Jordan Mondell is a crisis mental health clinician and licensed social worker. She can be reached at jordanmondell@gmail.com.
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