Shaping a Statewide Strategy for Housing Persons Living and Languishing on the Streets with Severe Mental Health and Chronic Substance Abuse Issues

A comparison of recent homeless count data reveals a 19% increase
in the number of persons identified as severely mentally ill and
a 72% increase in the number of chronic substance abusers

 A comparison of data entered in the State’s Homeless Data
Integration System reveals that 40% of persons
had a disabling condition in 2018 which
increased to 42% in 2020

  • Increased attention and action by the Governor and a growing number of Legislators provide California with an unprecedented opportunity to create a statewide strategy for housing persons living and languishing on the streets with severe mental health and chronic substance abuse issues.
  • Recently introduced legislation and proposed budgeted funding can shape an extraordinary strategy that can be collectively implemented counties, cities, communities, and continuums of care across California in partnership with State agencies, departments, councils, commissions, and committees.
  • Recently introduced legislation, which is detailed below, includes 1) addressing the housing needs of incarcerated persons with serious mental health needs who are released to the community; 2) providing housing, housing-based services including mental health, substance use disorder, and medical treatment, and workforce development programs to formerly incarcerated persons; 3) facilitating a local accountability system that fosters continuous quality improvement in county programs funded by the Mental Health Services Act; 4) amending the Mental Health Services Act to provide the counties with more flexibility in shifting county MHSA money between programs for persons who are homeless and have serious mental illness; 5) administering a competitive grant program to enable local law enforcement agencies to establish and operate a homeless outreach team composed of, at a minimum, a law enforcement officer, a mental health professional, a medical services professional, and a representative of the county welfare department; and 6) establishing a Homeless and Mental Health Court Grant Program.
  • The recently introduced CARE (Community Assistance, Recovery, and Empowerment) Court by the Governor provides “a proposed framework to deliver mental health and substance use disorder services to the most severely impaired Californians who too often languish – suffering in homelessness or incarceration – without the treatment they desperately need.

The recent homelessness data noted below supports the need for the increased attention and actions the Governor and Legislators have initiated regarding persons living and languishing on the streets with severe mental health and chronic substance abuse issues.

Homeless Count Data

While we await 2022 homeless count results, a comparison of 2018 to 2020 homeless count data reveals a significant increase in the number of persons counted as homeless who were unsheltered and identified as severely mentally ill and chronic substance abusers.

The chart below notes that the

  • Number of persons counted as unsheltered was 81,027 in 2018 and 102,275 in 2020, which represents an increase of 21,248 persons or 26%;
  • Number of persons identified as severely mentally ill was 24,990 in 2018 and 29,615 in 2020, which represents an increase of 4,625 persons or 19%; and
  • Number of persons identified as chronic substance abusers was 17,680 in 2018 and 30,460 in 2020, which represents an increase of 12,780 persons or 72%.

Homeless Data Integration System Data

The recently created Homeless Data Integration System (HDIS) also supports the Governor’s and Legislators’ increased attention and actions regarding persons living and languishing on the streets with severe mental health and chronic substance abuse issues.

HDIS is a statewide data warehouse that compiles Homeless Management Information System (HMIS) data submitted by California’s 44 Continuums of Care. Data points include a category for Disabling Conditions, which is defined as “Individuals with one of the following: 1) a physical, mental, or emotional impairment that has a significant, long-term disabling effect on the individual and could be improved with more suitable housing; 2) a developmental disability; 3) HIV/AIDS; or 4) an injury or illness incurred or aggravated during military service.

Recent data from HDIS concerning s disabling condition reveals that

  • In 2018, the number of persons with a disabling condition in California was 81,241 representing 40% of the 203,644 persons included in HDIS.
  • In 2020, the number of persons with a disabling condition in California increased to 104,464 representing 42% of the 246,142 persons included in HDIS.

New legislation introduced between the time the Legislature reconvened on January 3 and the last day for bills to be introduced, which was February 18, included several bills that reveal new proposed actions that legislators want to enact to help house persons living and languishing on the streets with severe mental health and chronic substance abuse issues.

These bills, which are grouped below, must pass through a process that includes the preparation of bill analysis, committee hearings, second and third reading, resolution of differences between the Assembly and Senate, and approval or not by the Governor by September 30.

Legislative Actions:

Reentry Housing and Services

SB 903 Prisons: California Rehabilitation Oversight Board

Requiring the California Rehabilitation Oversight Board in the Office of the Inspector General to examine the Department of Corrections and Rehabilitation’s efforts to address the housing needs of incarcerated persons, including those who are identified as having serious mental health needs, who are released to the community as parolees or subject to postrelease community supervision and to include specified data on homelessness in its reports.

AB 1816 Reentry Housing and Workforce Development Program

The bill would require the department to score applicants to the program competitively according to specified criteria. The bill would require recipients of funds from the program to use those funds for, among other things, long-term rental assistance in permanent housing, incentives to landlords, and innovative or evidence-based services to assist participants in accessing permanent supportive housing. The bill would require the department to distribute funds allocated by executing contracts with awarded entities for a term of 5 years, subject to automatic renewal.

SB 1427 Board of State and Community Corrections: Homeless and Mental Health Court and Transitioning Home Grant Programs

This bill would establish two new grant programs administered by the board: the Homeless and Mental Health Court Grant Program that would, subject to an appropriation by the Legislature, provide grants to counties for the purpose of establishing or expanding homeless courts and mental health courts, as specified; and the Transitioning Home Grant Program that would, subject to an appropriation by the Legislature, provide grants to county sheriffs and jail administrators to fund programs aimed at reducing homelessness among inmates released from custody, as specified.

Mental Health Services

SB 1283 Mental Health Services Act

Requiring the intent of the Legislature enact legislation that would amend the Mental Health Services Act to provide the counties with more flexibility in shifting county MHSA money between programs for persons who are homeless and have serious mental illness.

SB 970 Mental Health Services Act: Accountability and Planning

This bill would require the California Health and Human Services Agency, by July 1, 2024, to establish the California MHSA Outcomes and Accountability Review (MHSA-OAR), consisting of performance indicators, county self-assessments, and county MHSA improvement plans, to facilitate a local accountability system that fosters continuous quality improvement in county programs funded by the MHSA and in the collection and dissemination by the department of best practices in service delivery. The bill would require the agency to establish specific process measures and uniform elements for the county MHSA improvement plans and updates. By imposing new requirements on counties, this bill would impose a state-mandated local program.

SB 1006 Law enforcement: Homeless Outreach Teams

This bill would require the Department of Justice, to the extent funding is provided for these purposes, to administer a competitive grant program to enable local law enforcement agencies to establish and operate homeless outreach teams. The bill would require a homeless outreach team funded with a grant to be composed of specified individuals. A homeless outreach team established or operated using a grant awarded pursuant to subdivision (a) shall be composed of, at a minimum, a law enforcement officer, a mental health professional, a medical services professional, and a representative of the county welfare department. 

AB 2547 Housing Stabilization to Prevent and End Homelessness Among Older Adults and People with Disabilities Act 

This bill would require the California Department of Aging to create and administer the Housing Stabilization to Prevent and End Homelessness Among Older Adults and People with Disabilities Program. Person with a disability means an individual or head of household experiencing a condition that limits a major life activity, including, but not limited to, the following: physical disability, mental disability shall also include a substance use condition, medical condition, and developmental disability, and chronic illness. 

Substance Use Disorder Treatment

AB 1928 Hope California: Secured Residential Treatment Pilot Program

This bill would, until January 1, 2026, authorize the Counties of Contra Costa, San Joaquin, Santa Clara, and Yolo to offer secured residential treatment pilot programs, known as Hope California, for individuals suffering from substance use disorders (SUDs) who have been convicted of qualifying drug-motivated felony crimes, as specified. The bill would require the program to meet certain conditions relating to, among other things, a risk, needs, and psychological assessment, a comprehensive curriculum, a determination by a judge of the length of treatment, data collection, licensing and monitoring of the facility by the State Department of Health Care Services, and reporting to the department and the Legislature. 

The bill would require the judge to offer the defendant voluntary participation in the pilot programs, as an alternative to a jail or prison sentence otherwise imposed, if the defendant’s crime was caused, in whole or in part, by the defendant’s SUD, the crime was not a sex crime, serious or violent felony, or nonviolent drug possession, and the judge makes their determination based on the recommendations of the treatment providers, on a finding by the county health and human services agency that the defendant’s participation would be appropriate, and on a specified report prepared with input from interested parties.

SB 1282 Homelessness: Addiction Treatment and Prevention: Funding

Requiring relevant state and local departments to consider the use of funds received under the terms of the 2021 Multistate Opioid Settlement Agreement settlement for the treatment and prevention of addiction within the homeless population. The funds may be used for purposes including, but not limited to, the following: (1) Expanding proven housing programs that address root causes of homelessness, including those programs that require sobriety as a condition of participation. (2) Creating new or expanded substance use disorder treatment facilities within the Behavioral Health Continuum Infrastructure Program. (3) Covering new operating costs for expanded substance use disorder facilities within the Behavioral Health Continuum Infrastructure Program.

Conservatorships 

SB 1303 Conservatorships: Serious Mental Illness and Substance Use Disorders: Counties

Authorizing any county or city to adopt conservatorship provisions for the appointment of a conservator for a person who is incapable of caring for the person’s own health and well-being due to a serious mental illness and substance use disorder, as specified, for the purpose of providing the least restrictive and most clinically appropriate alternative needed for the protection of the person. 

SB 1143 Conservatorships: Serious Mental Illness and Substance Use Disorders

Until January 1, 2024, this chapter applies only to the County of Los Angeles, the County of San Diego, and the City and County of San Francisco. Before the county board of supervisors may authorize the application of this chapter, the county mental health department, the county welfare department, and, if one exists, the county department of housing and homeless services shall do both of the following:

Develop a plan to implement this chapter in consultation with representatives of disability rights advocacy groups, a provider of permanent supportive housing services, the county health department, law enforcement, labor unions, and staff from hospitals located in the county or the city and county.

Present before the county board of supervisors on the plan and available resources for the implementation of this chapter.

In order to approve authorization of the application of this chapter, the county board of supervisors shall determine, after a public hearing, based on materials presented, that all of the following services are available in, at a minimum, sufficient quantity, resources, and funding levels to serve the identified population that the county board of supervisors intends to serve, within the county or city and county for utilization in connection with the application of this chapter.

Proposed Budgeted Actions

Proposed budgeted actions submitted by the Governor by the required date of January 10, 2022, helps ensure vulnerable people have the necessary help to get off our streets and get the mental health treatment they need. The budget adds $2 billion for mental health housing and services and clearing encampments. The Governor’s new investments expand on last year’s $12 billion package.

The Budget includes an additional $1.5 billion General Fund over two years in dedicated resources to address immediate housing and treatment needs. Funding will be administered through DHCS’ Behavioral Health Continuum Infrastructure Program.

Building on the $50 million of Encampment Resolution Grants to local jurisdictions that will be awarded in Spring 2022, the Budget includes an additional $500 million one-time General Fund to deploy a substantially expanded program for jurisdictions to invest in short- and long-term rehousing strategies for people experiencing homelessness in encampments around the state.

Next Steps: 

Implementing the CARE (Community Assistance, Recovery, and Empowerment) Court

Next steps include the CARE (Community Assistance, Recovery, and Empowerment) Court, which is a new policy framework introduced by the Governor to assist people living with untreated mental health and substance abuse challenges. The framework focuses on people with schizophrenia spectrum and other psychotic disorders, who may also have substance use challenges, and who lack medical decision-making capacity, and advances an upstream diversion from more restrictive conservatorships or incarceration.

The new policy framework also notes that In the event that a participant cannot successfully complete a Care Plan, the individual may be referred for a conservatorship, consistent with current law, with a presumption that no suitable alternatives to conservatorship are available. And also notes that All counties across the state will participate in CARE Court under the proposal. If local governments do not meet their specified duties under court-ordered Care Plans, the court will have the ability to order sanctions and, in extreme cases, appoint an agent to ensure services are provided.

Aligning Proposed Legislative and Budget Actions

Next steps involve aligning legislative and proposed budgeted actions into an unprecedented plan. CARE Court could become a bill that would codify it into action upon the Legislature’s approval. The Governor could move the CARE Court through the budget process.

Aligning legislative and proposed budgeted actions that include reentry housing and services, mental health services, substance use disorder treatment, and conservatorship reform would be unparalleled. Weaving these legislative and proposed budgeted actions together has the potential to significantly reduce the number of persons languishing while living on the streets with severe mental health and chronic substance abuse issues.

Further aligning these legislative and proposed budgeted actions with 1) other recently proposed legislation concerning homelessness if approved; 2) legislation that was approved last year, and 3) funding that was approved last year and available this year would be an unmatched accomplishment.

Taking “Some Damn Responsibility”

“We could take some damn responsibility to implement our ideals” said Governor Newsom or “We could hold hands, have a candlelight vigil, (and) talk about the way the world should be.”

“There’s no compassion stepping over people in the streets and sidewalks,” the Governor told reporters. “We are taking action to break the pattern that leaves people without hope and cycling repeatedly through homelessness” and “a new approach to stabilize people with the hardest-to-treat behavioral health conditions,” said the Governor.

Taking responsibility to implement our ideals should also be unprecedented and unparalleled, which the Governor is emphatically encouraging. The Governor and Legislators need to continue to align and weave together past and proposed legislative and budgeted actions into an unmatched plan.

However, implementing the plan should also be unprecedented and unparalleled. Counties, cities, communities, commissions, committees, and continuums of care across California in partnership with state agencies, departments, councils, commissions, coalitions, and committees need to come together unlike ever before and efforts to implement the plan should also be unmatched.

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