ENDING THE GRIDLOCK: A STRATEGY FOR ADDRESSING HOMELESSSNESS

By Tom Ammiano

<http://www.ammianoformayor.com>

A STRATEGY FOR ADDRESSING HOMELESSNESS

Homelessness is one of the most acute challenges facing San Francisco. The homeless themselves are the hardest hit, many of whom also struggle under the burden of mental illness as well as drug and alcohol addiction.

But the effects of homelessness are not limited to the homeless. Our neighborhoods suffer, our businesses suffer, and the engine of tourism, that is so important to our city, suffers.

The reasons the problem has gotten worse over the past decade are well-documented. San Francisco has suffered enormous losses of very low income housing in the City due to fires in SRO hotels and extreme pressures in the housing market. A local General Assistance check no longer covers rent for a SRO room (as high as $600 per month). At the same time, federal housing subsidies for low-income housing development have dried up.

My administration's efforts to address homelessness will be guided by the belief that housing is the solution to homelessness and that community-based treatment and rehabilitation is the solution to mental illness and drug and alcohol addiction.

My policies will also be based on the belief that shelters are generally unsafe and unstable environments and should be utilized only on an emergency basis. Shelter occupants have difficulty seeking and holding jobs and remaining in mental health or drug and alcohol treatment. Shelters are also inappropriate environments for certain populations: those with serious mental illness, seniors, youth and pregnant women, to name a few. Warehousing people at night and turning them onto the streets during the day does nothing to help our neighborhoods.

Homelessness is a national and statewide problem. Our first challenge will be to raise the level of debate about homelessness to the statewide and federal level.

Here in San Francisco, the ills of homelessness are greatly aggravated by several factors:

• A lack of involvement in local planning by state and federal legislators and decision-makers;

• A lack of strategic focus, particularly directed to the mentally-ill;

• Severe mismanagement of homelessness programs; and

• Politicization of homelessness policy.

1. Bring Federal and State Decision-Makers to the Table

Much of our local homeless problem is a direct result of changes to federal and state law. As documented in both the City Controller's Homeless Services Performance Audit "The City Lacks Commonly Accepted Goals and an Effective Plan for Its Homeless Services " and "Homelessness in a Progressive City" by SPUR, the federal government housing dramatically decreased its investment in very-low income housing construction, in mental health care and in substance abuse treatment.

My first step as Mayor will be to work with the Board of Supervisors to reformulate and streamline the Local Homeless Coordinating Board to include representatives of state and federal legislative representatives and to invite HUD, whose West Coast office is headquartered in San Francisco, to serve on the Board. State and federal decision-makers cannot promote effective policy to deal with this issue without first-hand knowledge of local problems and the solutions that work.

I will also direct the City's lobbyists to consult regularly with the Local Homeless Coordinating Board to keep the Board apprised of legislation that has the potential to either negatively or positively impact local efforts to address homelessness and to promote legislative solutions proposed at the local level.

2. Focus on the Mentally Ill Homeless

There is no consistent strategic direction to homelessness programs. Due to the shifting political winds outlined in the Controller's report, the City has failed to develop a strategic plan with consistent goals.

For much of the past two years, the City has been locked in a debate regarding the approximately ¼ of our homeless population (the 3,000 homeless recipients of County Adult Assistance Programs: PAES, GA, CALM and SSIP). Meanwhile, we have failed to focus on the needs of the estimated one third of our homeless population who suffer from mental illness.

The individuals on GA and PAES are primarily single, able-bodied adults capable of some form of work, provided work is available and they receive some form of appropriate job-training. The Board of Supervisors has passed Real Housing, Real Care and the Mayor has signed it into law. As mayor, I will direct the Department of Human Services to implement this measure.

We need to shift our local debate to focus on the mentally-ill homeless. In September, 2003, the Department of Public Health (DPH) released a report in response to the Board of Supervisors resolution I authored requesting comprehensive strategies for homeless individuals with mental health diagnoses, substance abuse diagnoses and chronic medical conditions. In its report, DPH called for a dramatic increase in its current supportive housing programs to serve this population. The Director of Public Health underscored the fact that DPH recoups its investment to these programs through savings in the other parts of the Health Department.

DPH estimates that there are 1,350 homeless San Franciscans who access City services who have been homeless for more than a year and who suffer from a mental health diagnosis, dual diagnosis or other chronic medical condition. Many of these individuals receive federal SSI or VA benefits, benefit programs that are not locally controlled.

Without housing and services, these individuals access City emergency services (police, paramedic, jail psychiatric, SF General and Community Health Network services) at great cost to the General Fund. Due to their diagnoses, these individuals are often at the greatest risk of serious harm to their health on City streets; they can also display behaviors that are most disturbing to residents.

I have asked the Director of Public Health to circulate his draft report to City groups that assist in the formulation of local homeless policy, including, but not limited to, the Local Homeless Coordinating Board and the Supportive Housing Committee of the Comprehensive Housing Affordability Strategy Committee and to seek a hearing at the San Francisco Health Commission to obtain public comment on the report.

My strategies for dealing with homeless populations with chronic medical conditions will be straightforward:

• Expand residential community-based mental health treatment programs. People with clinical diagnoses should be served in a clinical setting, with the full range of consumer rights;

• For individuals who do not require a clinical environment, consistent with DPH proposals in 2002, I will expand the Direct Access to Housing program. I will also work with community groups to expand the number of access points to the DAH program, develop consumer rights protocols and hire and train appropriate staff for these programs;

• Expand residential and outpatient drug and alcohol treatment programs;

• Expand SSI advocacy efforts to qualify individuals for federal benefits; and

• Expand rep-payee programs to help individuals manage money received through federal benefit programs.

I endorse the Mental Health Initiative proposed by a broad coalition of mental health advocates for the November, 2004 California ballot which will provide $600 million in additional statewide funding for mental health programs, including children, seniors and homeless mentally-ill. The initiative, funded by a modest increase in tax rates for the wealthiest Californians, will provide services for the approximately 50,000 homeless mentally-ill residents in the State and for the 50,000 additional mentally-ill residents who are at risk of homelessness. The initiative will expand AB 34/2034 pilot programs in California that have demonstrated remarkable success in stabilizing approximately 5,000 homeless mentally-ill.

Without bold solutions of this type, we cannot solve the mental health crisis in San Francisco.

TABLE 1: Operating Budgets and Funding Sources for 1350 Units of Supportive Housing

Homeless Clients with Mental Health,
Substance Abuse and Other Chronic Medical Diagnoses

Expense
		Unlicensed Permanent Housing	Licensed Permanent Housing	Total
	Number of Units/Beds	1,200	150	1,350
	Annual Operating Cost	$10,080,000	$4,106,250	$14,186,250

Revenue
		Unlicensed Permanent Housing	Licensed Permanent Housing	Total
	Client Rent	$4,320,000	$1,350,000	$5,670,000
	Medical		$1,050,000	$1,050,000
	General Fund	$5,760,000	$1,706,250	$9,172,500

• Table 1 Notes: Based on estimates provided in 2002 by the Department of Public Health. Operating costs do not include capital costs of construction. General Fund costs could be covered largely through funding from the California Mental Health Services Act, if adopted by voters and through cost-savings realized through reduced emergency services.

• Redevelopment tax increment for affordable housing (particularly in the proposed South of Market Redevelopment Area to acquire SROs along 6th Street and elsewhere in SOMA);
• State of California Affordable Housing Bond (for supportive housing);
• A portion of the existing pipeline of affordable housing projects under development (and already funded) # which represents 300 to 500 studio units.
• A portion of a new affordable housing bond approved by voters.
• Utilize the "offsite" portion of the City's inclusionary affordable housing program (which requires market rate developers to build affordable housing when they build housing) to supportive housing only.

TABLE 2: Operating Budgets and Funding Sourcesfor 200 Units of Acute Diversion and Transitional Treatment Beds

Homeless Clients with Mental Health,
Substance Abuse and Other Chronic Medical Diagnoses

Expense
		Acute Diversion Beds	Transitional Treatment Beds	Total
	Number of Beds	50	150	200
	Annual Operating Cost	$5,475,000	$9,855,000	$15,330,000

Revenue
			Acute Diversion Beds	Transitional Treatment Beds	Total
	Medical		$2,190,000	$5,913,000	$8,103,000
	General Fund		$3,285,000	$3,942,000	$7,227,000

• Table 2 Notes: Based on estimates provided by nonprofit mental health providers. Operating costs include capital costs. Assumes 40% Medical recovery rate for acute diversion beds and 60% Medical recovery rate for transitional beds. General Fund costs could be covered largely through funding from the California Mental Health Services Act, if adopted by voters and through cost-savings realized through reduced emergency services.

3. Establish Modern, Professional Operations and Management

As mayor, I will require that programs be run according to modern professional standards for City government.

The Controller's report recommends a strategy of developing Citywide policies based on shared goals; programs designed to fulfill policies; and data collection regarding program performance designed to measure success and inform future policy development.

In addition, the Controller recommends that all homeless policy initiatives and proposed budgets be submitted to the Local Homeless Coordinating Board as the centralized body, established pursuant to federal requirements in order to receive McKinney funding, where local policy is developed and vetted.

Finally, the Controller recommends that the City develop multiple service providers to bid on homeless programs to ensure high quality services.

As mayor, I will implement this approach to homeless program management.

In addition, I will:

• Hire professionals to staff the Mayor's Office of Homelessness and direct these professionals to staff the Local Homeless Coordinating Board;

• Develop a shelter monitoring committee to monitor shelter conditions, identify under-utilized shelter beds (if any), and refer people waiting at intake centers to such beds;

• Direct the Mayor's Office of Community Development to work with City departments and the non-profit community to develop competent, multiple bidders for homeless programs; and

• Regularly report to the Board of Supervisors and the public progress and shortcomings in each facet of the City's homeless programs.

4. End the Politicization of Homelessness Programs

Homeless programs must be insulated from initiatives attempting to exploit the ills of homelessness for political gain. Currently homelessness programs are driven by political ambitions, not by common sense. The debate on homelessness and the resulting policies and programs have become completely politicized.

As mayor, I will promote and establish a new standard for addressing homelessness. No one -- and no mayor -- should "own" the issue of homelessness and no one should be allowed to exploit the issue for political gain.

Policy will be crafted in a conversation that includes the voices of all stakeholders. Proposals will be required to be based in hard data and will be required to answer to the principals of public health science and common sense.

Finally, I will require that all programs and proposals will be measured against two final yardsticks:

• Is there more housing for the homeless?

• Are City neighborhoods less troubled by the ills associated with homelessness?