By Moryt Milo
Four walls, a foundation, and roof provide shelter but not a safety net for those with mental health needs. It’s the supportive services within this structure and the next structure and the one after that that will determine an individual’s ability to recover.
It’s this continuum of care that provides the critical framework to prevent our most vulnerable from falling into the housing gap. Whether it’s a locked residential facility, permanent supportive housing or supportive housing in a step-down program, appropriate housing makes a difference.
California State legislators, Santa Clara County officials, professionals in the behavioral health field, and families who have loved ones with mental illness and developmental disabilities readily acknowledge it won’t happen overnight. But it’s not impossible, and the pandemic has opened an unexpected door to effectuate change.
Covid exposed, in real time, an undeniable array of weak links in the Santa Clara County mental health system including inadequate mental health services, staffing, and levels of care, crowded group homes, a dearth of supportive housing, and the shortage of facilities for individuals transitioning out of acute care, residential housing, and jails. The pandemic brought on an increase in substance abuse, put more individuals in mental health crisis, and on the streets.
On April 13, 2021, NAMI-Santa Clara County held a panel discussion on the housing gap dilemma and potential solutions. The panelists included former California State Senator Jim Beall, Santa Clara County Deputy County Executive Ky Le, Momentum for Health President and CEO David Mineta, NAMI-SCC peer mentor John Duckworth, and NAMI-SCC family member and Family-to-Family instructor Matt Jacobsen.
The group discussed housing inventory and future supportive housing in the pipeline. They tackled problems that included additional funding assistance to help individuals move into affordable housing. They proposed outside-the-box solutions that could accelerate the ability to provide supportive services and housing, and they spoke passionately about advocacy.
COVID Changed the Roadmap
Former California State Senator Jim Beall started the event with a heartfelt example of his own experience during COVID to reinforce the need for mental health advocacy. One of his family members needed mental health subacute care for 85 days. The emotional stress of no personal contact and the reliance on FaceTime was difficult.
“We’d have to step outside afterwards, take a break, and cry a little,” Jim said. “It makes me more resolved than ever to work on this issue, and I hope everyone feels the same way. We have to fight the fight right now.”
Although the county has $6B from the passage of two state bond measures to construct and provide supportive services and housing for those with developmental disabilities and mental illness, Jim said these dollars run out in a few years. An eye-popping admission of what it costs to construct housing and provide supportive services in Santa Clara County. Not to mention the four-to-six-year timeline to bring these facilities online. In the meantime, the State has applied to MediCal to allow a portion of MediCal dollars to go toward supportive services and housing for projects that provide mental health services on site. But more needs to be done on a local level.
Ky Le acknowledged this and said the County has made significant strides in the last six years authorizing the issuance of $950M in general obligation bonds through the passage of Measure A in 2016. The majority of the proceeds applied toward housing construction and rehabilitation of apartments for extremely low-income earners and individuals with disabilities. Over $600M will be allocated to develop 3,600 new housing units. Of those, 1,800 will be for supportive housing for the homeless and the County’s most vulnerable. The County also allocated 500 units for extremely low-income earners.
In that regard bona fide progress has been made. Prior to 2015 there were only 250-300 units of all types of supportive housing in the County. An illustration of the massive amount of catch up required. Since 2015, with the passage of various bond measures, the county has contributed to the development of almost 800 units of permanent supportive housing, with 500 units under construction, and an additional 900 units in the pipeline.
David Mineta mentioned that Momentum had a new facility with 14 beds coming online that will provide full partnership services, adding to the nonprofit’s housing inventory for a total of ten supportive housing sites. At this new facility, Momentum created a partnership with the County, with the County providing supplemental payment assistance. The model enables Momentum to add more beds with supportive services. If the partnership works, Momentum will consider converting some of its existing sites into the same model. Still, David emphasized that none of it holds together without the continuum of care. The individual must be able to move seamlessly from hospitalization to transitional residential treatment facilities, to permanent supportive housing, or a supportive housing step-down program. Otherwise falling into the housing gap is not a matter of if, but when.
An individual with lived experience, such as NAMI-SCC peer mentor John Duckworth, understands this best. John survived drug addiction and homelessness until he became clean and sober at Montgomery Street Inn in San Jose. Today he lives in a senior living apartment subsidized through Section 8. He said, “It’s about baby steps. Each small step is a victory.” He notes that one of “the biggest enemies of homelessness is the boredom and tedium of being homeless and not having a place to just relax or sit.”
For Matt Jacobsen, a NAMI Family-to Family instructor, his housing journey started with his two sons, who struggled with mental illness. “I learned there was a shortage of housing. But I also learned it’s really a shortage of the right type of housing. I became aware of how important housing was as a piece of the puzzle in treatment and recovery.”
To that end, he found a house for his son and saw how the living environment, which also was home to Matt’s pastor, gave his son stability and the willingness to stay on his medication. From there, Matt created an affordable housing group-home model where individuals with and without mental illness live together. The organization, UPL Enterprises, LLC has grown to fourteen houses.
Financial assistance plays a major role in finding affordable housing for individuals on limited income. This is especially true for individuals with severe mental illness and developmental disabilities in need of permanent supportive housing. Subsidies are equally important for the providers of those residential care facilities (RCF). Owners of licensed board and care homes in Santa Clara County have continued to close and sell off their properties. Unable to stay afloat, Ky said the County has tried numerous times to bring new residential care facilities online, but it has been a challenge because the “numbers need to pencil.” In the last two months, the County tried to purchase multiple facilities with no success. In fact, Ky put out a call during the panel, “If you have properties that could be used as residential care facilities, I want to talk to you about acquiring them. If you are an operator with experience obtaining community care licensing and then operating RCFs, I definitely want to talk to you.”
The problem has become so severe that bringing on new providers and holding on to existing providers has turned into “a very difficult, pernicious problem,” David said. He has called around to discuss the situation with existing providers. One provider told him that she had four sites and is down to two due to the high cost of living, the rates being too low, and the regulatory system becoming too burdensome. She also told Dave that the mental health population has become more acute over the last thirty years, triggering more 911 calls from her facilities.
Think Outside the Box
So how does the County and those providing services and housing for the mentally ill and individuals with developmental disabilities ramp up the inventory? Ky cited the HomeKey Project created during COVID. The goal has been to swiftly repurpose properties to house the homeless. These projects were exempt from local entitlements and CEQA (California Environmental Quality Act) requirements that add months to the completion of housing developments. He suggested that the same exemptions could be applied to supportive and permanent housing projects designed for those with mental illness. Such a change in policy would reduce the four-to-six-year construction window down to two-to-four years.
Jim also pointed out that due to COVID, the prison population has dropped by 25 percent, and will likely stabilize at this new level. “This could provide extra money in the state budget,” he said. California spends $15B on the prison system and fewer people behind bars “gives us an opening for more funding to go toward supportive and residential housing for people who need drug and mental health treatment,” he said. “The judges and mental health courts are strongly in favor of this because they can’t find placement for these people and they don’t belong in these facilities.”
He suggested that places such as Elmwood Correctional Facility could repurpose and redesign parts of their jail to house those in need of mental health services. “That would immediately add one hundred beds,” he added.
Throughout the discussion, the panelists urged greater advocacy for mental health services to close the housing gap.
“We need to support our legislators and demand their accountability. Get behind them when they are proposing things and for God’s sake don’t stand on the sidelines. Get involved,” Jim said.
To listen to the NAMI Housing Panel in its entirely on NAMI-SCC’s YouTube channel, go to our Video Gallery
To learn more about the lobbying activities of the housing coalition Roadmap Home 2030 to reduce homelessness and provide housing from those with mental health needs, go to roadmaphome2030.org