Combating homelessness: Where do we go from here?

Mental illness does play a role in causing so many people to be homeless. (Mar. 16, 2017)

Years ago, Matthew Duval said he worked for Microsoft, then later for an aviation company. Finally, he said, he went into property management, because the job kept him close to his wife.

Now, however, Duval lives inside a car with his wife, a woman known to him and others as “Mama Bear.”

“I got run over by a U-Haul and got injured,” Duval explained. “When you work in property management and you lose your job, you lose your home. It’s a lot of pressure on everybody”

Like Duval once did, most Americans live paycheck to paycheck, many of whom are one paycheck, or even one emergency, away from homelessness.

In Sacramento County, at least 2,600 people are homeless on any given night, according to the most recent data from Sacramento Steps Forward, the area’s lead agency in homeless advocacy. Nearly one-third of the county's homeless population are unsheltered.

Since taking office, Sacramento Mayor Darrell Steinberg has made homelessness one of his main priorities. 

In January, the city, in a joint effort with the county and local donors, opened a homeless shelter near the American River. Weeks later, after two homeless men died on the steps of City Hall, the city opened a temporary emergency shelter downtown.

Those are just two of the shelters recently opened to combat homelessness.

There are dozens of programs and services in Sacramento that help homeless families, adults and youth. One such program is a housing voucher.

But even that has its issues, Duval said.

According to Duval, the places where they have applied have waiting lists, and since those vouchers expire, they are constantly on a race to find a home

“I have got a list of places, but the problem is when you go to them you have to provide credit checks, any type of background and so on and so forth,” Duval explained. “You have to be presentable and a lot of folks look like this.”

Counting those counting on the system

Every odd year, hundreds of trained volunteers converge at the Department of Human Assistance in Sacramento for the federally-mandated point-in-time count of the county’s homeless population.

The count provides the city and the state with an accurate assessment of how many unsheltered people are out in Sacramento.

“Any community receiving dollars from [the Department of Housing and Urban Development] as we do, has to do a point in time count,” said Ryan Loofbourrow, the CEO of Sacramento Steps Forward. “And we do what I call a full count every other year on the odd year.

“So every year we looked at how many people are in shelters and transitional housing. On this night, on the odd years, we count also those who are unsheltered.”

Loofbourrow added that although the dollars the county is able to receive from HUD helps provide help to some of the homeless population, “it does not meet the need that we see in the field.”

According to the HUD, with more than one-fifth of the country’s homeless living in California, the state has the largest homeless population in the US. Two-thirds of those people are unsheltered.

As part of President Donald Trump’s efforts to cut domestic spending by $54 billion and beef up defense spending, as much as 13 percent of HUD’s budget could be cut, according to USA Today.

Those working in this field are worried.

“That’s the reality of having Republicans controlling the Congress and the White House,” said Ben Metcalf, the Director of Housing and Community Development. “They are going to pass budgets that are going to ratchet down spending. Agencies like HUD are going to feel it the worst because they don’t have much room to give on their budgets.

“The first thing to go is going to be programs like these—ones that we work with that help give housing for people who are homeless.”

California saw an increase in homelessness, as well as a dramatic increase in the imprisonment of people suffering from severe mental illness, in 1972 when the Lanterman-Petris-Short Act went into effect under then-Governor Ronald Reagan.

The LPS Act made it much harder to involuntarily commit mentally ill people to institutions in the state.

These days, experts are citing the housing crisis as an explanation to California’s high rate of homelessness.

A recent report by California's Department of Housing and Community Development found that as a state, we have built less than half of the housing that we knew we needed in the past eight years.

With such high rents, the number of people living right on the edge goes way up, Metcalf said. According to the Legislative Analyst Office, the majority of low income households spend more than half of their income in housing

“There are a lot of people in California today that are just one paycheck away or one car accident away or one medical injury away from being out on the streets,” Metcalf said. “So the money that you have to make to pay rent means that it’s that much less of a car accident, or that much less of a medical injury that’s going to put you out on the street.”

But it’s not as easy as just giving people housing, Metcalf said. Even when housing is available for them.

The Chronic Homeless

A lot of the people that are counted during the point-in-time count are chronically homeless.

According to Anna Darzins, the Outreach and Mobile Medicine manager at Elica Health Center, chronic homeless are those likely suffering from mental illness or substance abuse issues and have been on the streets for years.

Darzins is one of a few volunteers with Elica Health Center in Sacramento that goes out on the streets, oftentimes with Sacramento police officers, to provide physical and mental health care to those living on the street.

“We’re seeing chronic conditions—physical conditions as well as behavioral health or psychiatric diagnosis together with substance use,” Darzins said. “So you almost don’t see anyone that doesn’t have those three presenting problems, because they kind of contribute to one another in a cyclical fashion.

“Your behavioral health kind of contributes to your use of substance, which declines your physical health, and it just kind of gets worse and worse and worse.”

According to data from the 2015 count, over 580 unsheltered homeless adults were counted as having serious mental illnesses.

Without access to proper care or medication, people suffering from severe mental illness, who are sometimes under the influence of narcotics are at high risk of hurting themselves or others, Darzins explained.

To better understand how the city approaches the issue of homelessness, we spent some time with the Sacramento Police Department’s impact team and their health provider partners.

Throughout the ride along, officers and Elica volunteers helped a number of homeless people in Midtown and downtown Sacramento.

“Our unit, we really strive to do what we call compassionate policing and collaborative outreach,” said Sgt. Greg Galliano. “So it’s very rare that we take enforcement action, that’s really a last resort.”

But that’s not always the case.

In California, according to a Washington Post database documenting police shootings, nearly one-fourth of people shot dead by police last year were mentally ill. One of those people was Joseph Mann, a 50-year-old homeless man whose family said had suffered from mental health issues.

Mann was shot and killed by two Sacramento police officers last July.

Family members and activists questioned the use of deadly force, but District Attorney Anne Marie Schubert cleared the two officers concluding they had “to prevent the escape of a suspected felon who posed a significant threat of death or serious bodily injury to others.”

According to Galliano, Sacramento police officers receive training, but because they aren’t mental health professionals, their priority is safety for all.

“Good Training is a great key," Galliano said. "Good training in deescalating, but also understanding—society understanding—that there’s a lot that goes into these types of situations and there’s a lot of different entities out there. Mental health is not uniquely a law enforcement invention."

To help with that, a mental health clinician from the Sacramento County Behavioral Health is available to work with police in cases where a person is suffering from a mental health episode.

The clinician, however, cannot intervene until it’s safe for them to do so, Galliano said.

“We have an obligation to keep the community and the public safe,” Galliano explained. “If we’re dealing with someone who maybe armed and presenting as violent at the time, the experts may not want to be put in that situation where they could now become a victim or be exposed to violence.”

Finding a permanent solution

More than 80 homeless people died in Sacramento last year, an over 12 percent increase from the 78 deaths in 2015, according to data from the Sacramento County Coroner’s Office.

As the federal dollars may become scarce and the housing crisis deepens, Steinberg, has made it a top priority to ease the issue.

He has pushed for prioritizing federal vouchers for the homeless, founded an institute, along with private partners, to expand services and produce housing for the mentally ill across the state—something that Darzins said is lacking.

“Sadly, there’s not enough resources for individuals who just need that support and care, until they’ve gotten to such a high level of crises that they require a 51-50 hold,” Darzins said. “No that requires the officer to place you on a hold, take you to the emergency room … and what happens sometimes is people get lost, because emergency is not designed to deal with that crisis.”

One such person to receive the needed resources to survive is Alicia Craft.

Craft has a history of schizophrenia. A year ago, she said she was evicted from her home and ended up spending nine months sleeping on the street.

Despite the hardships, however, she said she couldn’t get herself to look for help.

“And all I could do was think of, ‘I don’t belong there. It will be over with me.’ Because that’s a hard life. Very hard,” Craft said. “I just sat there, just waiting to die. I didn’t look at all, but now things is looking up better.”

Craft recently received help with her schizophrenia through Elica Health Center while the group was in the field. According to her nurse, Sachiko Kageyama, Craft was treated Invega, a long-acting injection that lasts for up to one month.

“Many of those people who have a severe mental illness,” Kageyama said, “it’s harder for them to do things like keep appointments and continue to keep track of their medications and take their medications every day.”

According to Kageyama, patients like Craft start out orally taking Invega for three days before they get their injections. The goal, Kageyama said, is to get patients on a longer-lasting form of Invega.

And Craft said it’s helped.

“It’s relaxed my nerves and everything, because I was very, very stressed, and I didn’t trust nobody, because it was people that I trusted that got me in this situation," Craft said.

Since the treatment, Craft has lived at the Salvation Army facility, and is in the process of getting into a new home.

“Between the impact team and [my case manager],” Craft said, “they helped me bring up my self-esteem—noticed that I am worthy of whatever I needed to get.”

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