A Seven-Point Plan on Homelessness, Mental Health and Substance Abuse

Annie Oliva
for State Senate

Overview

The Peninsula is a prosperous place. There is no reason any person should be forced to live on the street. Yet, homelessness is the reality for thousands of residents, and the crisis is personal for my family as well — one of our sons who was struggling with addiction, was temporarily homeless before we could intervene. The shocking truth is that there has been a dramatic increase in the number of people dying on our streets from exposure, lack of medical care, alcohol abuse and drug overdose.

This tells us that the crisis is multi-faceted and requires a supported comprehensive approach that is not just reacting to the crisis but demanding preventative measures to keep more families and individuals from becoming homeless. We must solve this together as Californians — not one city or town or region at a time. We must provide treatment for those in mental health crisis, and require it in certain circumstances. We must create shelter for everyone, and require everyone to use this shelter when it is available so we can transition homeless people out of our streets, parks, creeks and sidewalks. We must recognize the dignity of everyone and remember the dignity of work — so homeless individuals can work their way off the streets. And we must dramatically increase the supply of housing. The following is my plan to address homelessness, mental health and substance abuse issues affecting the Bay Area and our state.

1. Declare a State of Emergency on Homelessness.

2. Support and expand a system of conservatorship.

3. Support and expand medication-assisted treatment (MAT).

4. Create a broadly coordinated approach.

5. Reform the laws that make housing more expensive, incentivize building more housing and embrace innovation in housing.

6. Harness economic growth to fund new services.

7. Hold ourselves accountable.

1. Declaring a State of Emergency
on Homelessness

We need to immediately address the public health needs of our homeless population while expanding shelters, supportive and permanent housing. That’s why I am calling for a State of Emergency on Homelessness that would allow us to mobilize state resources and deploy them to cities and towns to assist in response efforts.

Politicians call homelessness a “crisis.” But their deeds don’t match their words. If an earthquake, fire or flood put tens of thousands of Californians onto the streets without shelter, we would declare a State of Emergency and immediately begin to organize a statewide response. We have nearly 130,000 Californians experiencing homelessness and over 89,000 without shelter according to the most recent government estimates. These Californians are suffering and dying on the streets. We need to act now.

The public agrees on the urgency. A new PPIC poll shows that Californians rank homelessness as the state’s most pressing issue — above education, immigration and crime.

Homelessness needs to be addressed in a compassionate and comprehensive way while being treated with the urgency of an emergency. We also need to make sure that the whole state is involved — and that the homelessness crisis is not just addressed by the cities and counties with the political willingness to do so. That is not fair to the counties and cities that step up, because they take on an extra burden. And it is not workable for the homeless living in places where there is not the will or the way to address the crisis. We need the full attention of the entire state to turn the corner towards solving this crisis. That is why I’ve already called on others to support me and sign my petition demanding that we issue a State of Emergency on Homelessness.

California's share of unsheltered people is double the nation share.

Both the federal and state governments classify “homelessness” in a few different ways – specifically “sheltered” and “unsheltered.” A “sheltered” homeless individual may live in an emergency shelter, or transitional or supportive housing. An “unsheltered” homeless individual is defined as living in streets, parks, or other locations not meant for human habitation.

Source: PPIC

2. Supporting and Expanding a
System of Conservatorship

We should adopt and expand State Senator Scott Wiener’s legislation, SB-1045, to expand conservatorship efforts. The proposal allows judges to grant requests to hold someone involuntarily. Sheriffs, officials of mental health and social services, would be required to report individuals with a history of serious mental illness or substance abuse disorder and who are a danger to themselves or others.

It has been demonstrated that a small number of frequent heavy users of public health services who cycle through the system often account for the majority of the costs for all users. For example, in San Francisco, 12 percent of people who use the services of the San Francisco Department of Public Health account for 73 percent of the costs. The ratio is similar in other cities. The majority of these heavy users have medical, psychiatric and substance use issues.

By requiring compassionate and comprehensive treatment, we will help minimize frequent public health service visits of the chronic users and therefore lower recurring costs allowing us to use the rest of funds to help more individuals.

The life expectancy of homeless people is dramatically lower than the housed population.

We must also rally behind Sacramento Mayor Darrell Steinberg’s Right to Shelter/ Requirement to Shelter initiative.

Allowing people to live on the streets is deadly to them and destructive to everyone else. The life expectancy of homeless people is dramatically lower than the housed population — it is literally a slow death sentence that has been called a human rights violation. We need to build basic, decent and hygienic shelters for everyone. At the same time, we have the right and responsibility to require people to use this shelter when it is available.

3. Supporting and Expanding Medication-Assisted Treatment And Mental Health Services

For those individuals experiencing homelessness concurrently with mental health and substance abuse issues, these problems are amplified.

We must expand logical points of intervention for our most vulnerable when it comes to addiction and mental health. We can do so by using our courts and correctional centers for transitional jail diversion programs and medication-assisted treatment, or MAT.

I support giving those struggling with addiction the option to receive treatment as an alternative to incarceration. States like Washington have shown the success of providing transitional jail diversion programs that focus on those who are mentally ill and/or struggle with substance abuse and have committed a low-level misdemeanor. Our existing drug courts must continue to find ways to motivate frequent misdemeanor offenders, or serve as alternative courts where the goal is not to punish, but to facilitate rehabilitation.

In addition, the correctional system was not designed to be a center for treatment. Given the crisis we are in, we must help those who are already incarcerated. We must support and expand medication-assisted treatment, or MAT, to help inmates safely detox from opioids and other drugs to stay clean while they are behind bars and after they are released.

Today in the US, around two-thirds (63%) of sentenced jail inmates meet the criteria for having a SUD (Substance Use Disorder). Several programs that provide medication-assisted treatment have demonstrated success, including ones in New York and Rhode Island, which offer drug therapies such as methadone, buprenorphine and naltrexone. These medications help participants by reducing withdrawal symptoms and blocking highs from opioid use. A study on the Rhode Island program found a 61 percent reduction in opioid overdose deaths among recently freed inmates.

Whether it is after court-required treatment or getting out of a correctional facility, continuing success requires ongoing treatment. There are three main pieces of the program that allow MAT patients to stay clean with Community Organization for Drug Abuse Control (CODAC):

Group meetings and counseling help MAT patients eliminate behaviors that were common during their addiction phase.

  • Medication

    They can come in at any time on any day and receive medication that will help them with withdrawals and other negative symptoms.

  • Counseling

    Generally, the counselors will be located in the same building as doctors and medicine providers, meaning patients have a one-stop shop to receive all of the treatment that they need; counselors can help with eliminating behaviors that were common during the addiction phase.

  • Group Meetings

    Patients can share their experience with others who have dealt with similar issues in the past and can share common practices that help them today; group meetings can happen up to three times per week.

However, help should not be dependent on criminal arrests alone to combat addiction and the crime it causes. Instead, transitional programs can provide greater opportunities for those seeking treatment to overcome their substance abuse, mental illness, and/or homelessness by connecting them to appropriate services for help with mental health, substance abuse, trauma, primary care and general wellness goals. This is an important step to break the twin cycles of recidivism and addiction.

Self-reported health conditions of Santa Clara County’s homeless.

4. Creating a Broadly Coordinated Approach

We must develop a comprehensive inter-county, interagency plan that uses much needed federal and state resources to supplement our existing local efforts. 

Using available technology and resources, we must design a plan that is modeled after successful initiatives across the country to better coordinate services:

1. Identify all available resources, agencies and programs across the area. Much of the funding currently committed to addressing homelessness is being spent inefficiently because it is distributed across various agencies, departments and organizations. That means the services they provide are often either duplicated or siloed from working together. A coordinated approach will rely on partners, including cross county homeless services, local governments, public housing authorities, the local Veterans Affairs offices, dedicated agencies, other nonprofits and community stakeholders.

2. Understand the population who rely on these services. Before we can provide help to those who need it, we need to know who it is that needs our help.

We must be especially active in identifying and helping those who are slipping through the cracks, such as those aging out of foster care, exiting correction institutions, and others. It is crucial that we intervene at the earliest possible juncture to educate individuals on the resources available to help them. Through true and organized coordination of services and resources we can provide the early referrals that can help provide stability and prevent more Californians from losing their homes.

There has been a double-digit rise in homelessness in Santa Clara County and San Mateo County since 2015.

My child’s period of homelessness is just one experience, but it provided key insights to which I might have otherwise be unaware. That is why I propose to include those currently experiencing homelessness to join the fight at the table. These are the experts about where the shortfalls in our current system exist. They are part of the community and their perspective and ideas are vital to finding a solution.

3. Coordinate available social services and resources to provide a refined system-wide intake process and secure more housing help with a collective approach. With better coordination between state and local agencies we can more efficiently deploy the resources available to individuals and low income families at-risk of homelessness.

As wages remain stagnant and rents continue to rise, many of our neighbors find themselves at risk of eviction. Housing stability is crucial for homelessness prevention; therefore, we must provide financial assistance for low-income tenants facing financial stress. Already established programs like CalWORKs Homeless Assistance should be expanded to include crucial prevention services like emergency rental assistance, financial management counseling, education and job placement assistance. Providing ample resources to at-risk individuals and families can prevent eviction, help residents overcome immediate housing crises and ultimately reduce the number of Californians entering chronic homelessness.

As an example of coordinating services across agencies, part of the outreach expansion would pair mental health specialists with paramedics, police officers and other first responders to provide quick and direct referrals to the full array of appropriate services, ranging from substance use disorder treatment to shelter beds. This approach has shown positive results in Spokane, WA. There, a Community Diversion Unit currently consists of four full-time mental health clinicians from Frontier Behavioral Health who ride along with patrol officers five days a week to respond to 911 calls.

I also plan to work with non-profits, shelters and local governments to empower participants by providing work opportunities — so that more people have the opportunity of earning their way off the street in a dignified way. Clean Slate, a program in Fort Worth, Texas, serves as a model that uses city funding and shelters to run the program employing homeless people to clean up streets and offer custodial jobs at businesses throughout the city.

We should follow their lead to build on similar “Downtown Streets Teams” in our area. My goal will be to help participants get hired in long-term positions.

We must better coordinate available services and housing across agencies and across counties. Homelessness is not an issue of any single entity—we must work together.

5. Reform the Laws that Make Housing More Expensive and Embrace innovation in Housing

High housing costs are driving residents away, damaging the state’s economy and forcing families into homelessness. One of the reasons why rents and home prices are so high is that construction costs are high. That’s why I propose we reform the laws and practices that continue to delay construction, and support new innovations in home construction.

According to our state’s Legislative Analyst’s Office, over two-thirds of cities and counties in California’s coastal metros have adopted policies unequivocally aimed at limiting housing growth, which has been found to increase home prices by three to five percent per growth control policy added. We must require local governments to meet housing goals — while giving them the flexibility to do it in their own way.

To mitigate long project review timelines, I support streamlining project reviews and permitting processes. According to our Legislative Analyst’s Office, additional review time is linked to higher housing costs. For example, in the Bay Area, it was found that each layer of independent review was associated with a four percent increase in home prices. In 2015, the average approval time for rezoning in coastal metros was about three months longer than a typical inland community or other U.S. metros.

California has 3.5 million fewer homes than needed, and since the 1950's
home building and construction have significantly decreased statewide.

According to a 2016 McKinsey study, California has 3.5 million fewer homes than needed, and a 2015 report by the Legislative Analyst’s Office has demonstrated a statewide decrease in housing construction since the 1950s.

Source: California’s Legislative Analyst Office

In addition, I support reforming the California Environmental Quality Act (CEQA) to help prevent litigation abuse. The law currently defines environmental impact too broadly, and as a result anyone can file a CEQA lawsuit against a project by alleging that the approving agency made a mistake in evaluating any of the nearly 100 impact issues that CEQA addresses. The consequences of CEQA have delayed projects for years and allowed numerous challenges in the very locations where the state’s climate and related environmental polices recommend construction, thus hurting the very practice of environmental protection. For example, a study from 2015 found that nearly 70 percent of the challenged housing units in the Los Angeles region were located near high-quality transit corridors — a clear sign that CEQA is being abused and contributing to housing delays and costs.

As noted in the previous section, we must also work in other ways to lower the cost of new housing construction. The state has set a goal of building 3.5 million new homes. But even at current costs, with modest cost escalation, estimates say this could cost nearly $3 TRILLION dollars. 

I will push for a Statewide Housing and Innovation Fund dedicated to the production of more housing — permanent solutions, not just a temporary roof. The program would look into exploring a variety of solutions ranging from homesharing, co-housing, easing construction for additional dwelling units (ADUs or “granny units”), negotiating down the cost of bulk materials, prefab/ modular housing units and other ways we can dramatically lower the cost of building new housing, particularly low-cost housing.

I propose incentivizing cities and local governments to set and meet housing-production targets for their communities. Housing goals will be determined by identifying areas of land near existing transit options or planned transportation infrastructure that would benefit from the building or revamping of properties; like the neighborhood empowerment zones in Dallas, Texas. Such zones promote affordable housing, economic development, increase the quality of public services – such as public safety for existing residents — stimulate business and commercial activity, retain and grow smaller businesses, increase occupancy, encourage reinvestment in existing building stock and increase workforce development and job training programs. Building incentives will have to appeal to our communities and local government — not just developers. Public policy experts recommend speeding up development and upzoning by incentivizing local governments with auctions for development rights. While incentives are good, they will only be effective if all efforts are transparent and the state can hold cities accountable.

6. Harnessing Economic Growth to Fund New Services

In the past, California cities and counties had the ability to direct a portion of revenues from new growth toward important local priorities, like housing. In the depth of the recession, the state took this power away. I believe, with strong and appropriate safeguards, we should bring it back.

This program was generating nearly $1 billion per year to help fund housing when it was discontinued. It is not an accident that our affordable housing problem got worse when we stopped investing as much in creating new housing.

My proposal would allow counties to earmark revenues from new growth to fund affordable housing and homeless interventions, particularly early interventions. So, for example, if Facebook creates a new campus and that generates new tax revenue, a portion of those new revenues would stay local to fund programs like preventing homelessness with rental assistance, help for kids coming out of foster care, building new low-cost units and other proven homeless treatment and prevention policies.

7. Hold Ourselves Accountable

The federal, state and local governments are now spending tens of billions of dollars a year to address homelessness. In every program, we need to hold ourselves accountable. In this endeavor most of all we must do so—because lives are on the line.

As I have written, this is more than a policy paper to me. This document reflects my personal experience as a parent who saw a beloved child temporarily homeless. That experience changed me. I can never see a homeless person as anything less than a person in need of our help. And I can’t ever accept that we should tolerate waste, inefficiency or simply the wrong or outdated approach to addressing this crisis.

I believe we must implement regular comprehensive financial and performance audits of every state agency and program to eliminate waste, fraud and abuse and increase efficiency so our tax dollars go farther—starting with the programs that address homelessness. In the State Senate, I will work to enforce a culture of efficiency and constant improvement by preventing any pay raises for state elected officials unless they reduce waste and improve the effectiveness of state agencies. People’s lives are on the line. Our values are being tested. We must make sure that as we address this great challenge—we address it effectively.

Conclusion

We know the impact that our housing shortage and the growing homelessness epidemic has on our communities. The impact has been assessed time and time again. We know how many more units need to be built — 3.5 million. We already know the factors contributing to families and individuals experiencing homelessness. We already know the reasons for chronic homelessness and have an estimated headcount. It is time for a response with a plan. As a realtor, longtime housing advocate and as the mother of a child who faced a period of homelessness, I know we must do more to put families into homes and to help our homeless neighbors off the streets and into shelters, treatment facilities and stable housing.

When it comes to homelessness, cities and counties can no longer go it alone. It's time to declare a Statewide Emergency on Homelessness. If you agree, join us, and sign our petition.