Is California trying to solve its homeless crisis by stiffing mental health?

Published on
February 11, 2019

For my last piece, I visited one of Los Angeles’ ubiquitous homeless encampments, trying to gauge if California’s new $2 billion program to house the mentally ill could dent an epidemic of urban displacement.

For this blog, I’ve reached out to a veteran mental health director in rural California, who is wading into the process of seeking funding from that program — known as “No Place Like Home” and established though the ballot measure Proposition 2.

The proposition passed in November with more than 60 percent of the vote, a testament to how much Californians want to alleviate shamefully visible homelessness that has spread along freeway embankments, underpasses, and public parks that have become shantytowns of RVs, tents and tarps. The measure promises to establish housing and services for mentally ill homeless people.

But if anyone has a right to be skeptical of Proposition 2 and the controversial method used to pay for it, it’s Tulare County Department of Mental Health Services Director Dr. Timothy Durick. Over the past four years, he has utilized funds from a preceding mental health ballot measure, Proposition 63, to overhaul his department and convince his most resistant, even violent, mental health patients to embrace treatment. 

His county of farmland and forests between Fresno and Bakersfield, was one of the few statewide that utilized Proposition 63 money effectively.

Now the state is essentially robbing Peter to pay Paul. Proposition 2 is a bond measure that will siphon money from Proposition 63 to raise as much as $2 billion for itself over time. That means Durick’s mental health funding stream will be reduced, and he will be forced to readjust his mission just as years of labor have started to bear fruit.

While the bond measures are statewide, it falls to each county to use the funds effectively.

Is there enough staff and housing stock, particularly in his rural area of the Central Valley, to provide mental and behavioral health support to No Place Like Home recipients? Can his small department, focused on providing mental health treatment and services, abruptly pivot to a housing mission?

“We’re going to have to,” Durick said.

“Certainly, we are open to a different way of doing business,” he continued. “This gives us a different option for individuals who are really challenging to engage.”

The No Place Like Home program is not an effort to build mental health hospitals. It seeks to provide neighborhood-based housing, where participants live in their own space, typically a subsidized low-income apartment or group home, in conjunction with the supportive services they need to become relatively independent members of society.

Is there enough staff and housing stock, particularly in this rural area of the Central Valley, to provide mental and behavioral health support to No Place Like Home recipients? Can a small department, focused on providing mental health treatment and services, abruptly pivot to a housing mission?

A recent story in The New York Times showed just how perilous housing severely mentally ill patients can be without sufficient treatment, support and supervision. More than 700 patients in New York State were funneled into what was billed as supportive housing. Despite having a roof overhead, more than 30 died in squalid and dangerous conditions that were no improvement over life on the streets.

Tulare County is not New York, or Los Angeles for that matter. But it sees the same heartbreaking display of homelessness on its small-town streets. And because housing and help can be spread out over vast parcels of cropland, more than 80 percent of Tulare's approximately 670 homeless people are classified as “unsheltered,” meaning they have found no soup kitchen or friend’s couch to take occasional refuge.

Statewide, an estimated 140,000 people are homeless, with an estimated 30,000 suffering from severe mental illnesses such as schizophrenia, bipolar disorders and major depression. With Proposition 2 funds, an estimated 20,000 supportive housing units could be built, according to some projections.

Tulare County’s Department of Mental Health Services will use a mixture of existing strategies and new ones to implement No Place Like Home.

One of its most successful efforts under Proposition 63 funding was the establishment of a community outreach team made up primarily of county mental health patients themselves, not clinicians. (Tulare mental health prefers the term “consumers” when referring to those who use its services.)

Members of this group have been diagnosed with serious mental illness, embraced treatment though a mixture of traditional methods and peer counseling, and now perform outreach in an effort to get others to follow their example.

“Helping someone understand, ‘I’ve also experienced the same issues and have been able to recover.’ That’s very powerful,” Durick said.

The county has also entered into a contract with Self-Help Enterprises, a community development nonprofit that has rehabilitated housing in the county seat of Visalia for low-income residents and plans to integrate formerly homeless residents into other units.

According to Durick, Tulare County currently has 123 beds for mental health consumers that offer varying levels of support and supervision based upon clinical needs. It has 36 more units slated to open this spring, and plans to work with Self-Help Enterprises on determining how many more could be built under Proposition 2 to get people off the streets.

It won’t be easy. Many homeless men and women been self-medicating their mental illness for years, he said, and are in need of substance abuse treatment. But Durick sees fundamental advantages in getting them housed.

“It gives our clinicians a longer opportunity to assess them and make sure they are receiving the most appropriate treatment,” he said. “Since those basic needs of housing and shelter are met, the individual becomes more amenable to opening themselves up.”

Using its peer-support model, Tulare County convinced 22 of its most expensive and resistant individuals in 2015 to embrace voluntary treatment for the first time in their adult lives. They cut the price of their mental health hospitalizations and emergency room visits by more than a third by 2016, according to figures provided by the county.

That effort and others in Tulare were funded by Proposition 63. And though housing was not the focus, Tulare officials estimate that 71 percent of people helped by Proposition 63 dollars in the county were recently homeless, or at risk of being so.

Tulare mental health will receive $900,000 in automatic funding from Proposition 2, and it is asking for more through an optional competitive grant process.

But it’s still a net loss for Durick’s department, in terms of sheer funding dollars. The county, like all in California, is essentially losing more in Proposition 63 funds than it’s gaining in Proposition 2 dollars.

The nonpartisan California Budget and Policy Center found in a 2018 report that the debt incurred by No Place Like Home bonds “would far exceed” the amounts borrowed from Proposition 63. Assuming a typical 4.2 percent interest rate, the state would end up withdrawing $3.6 billion from Proposition 63, to funnel $2 billion into Proposition 2.

“Counties would receive well over $100 million less in Proposition 63 funding each year,” the report found.   

So why did California voters do this? Because Tulare County truly was an outlier when it came to innovative and meaningful use of Proposition 63 funds, which were first approved back in 2004. Billions sat on the shelf, while other counties engaged in 15 years of strategy sessions on how to spend the money.

Meanwhile, statewide homelessness grew to tent city proportions. The wonkiness of interest rates was drowned out and we shifted taxpayer money, at a net loss, from one crisis to another.