Homelessness is one of the most challenging issues facing Marin County, and particularly District 1. As a member of the Board of Supervisors sub-committee on Homelessness and Chair of the Criminal Justice and Behavioral Health Committee I consider homelessness and the oftentimes related issue of behavioral health as top priorities. I continue to support bolstering County mental health services and strengthening our partnership with the City of San Rafael and local service providers, with a focus on alleviating the impacts of homelessness on Downtown San Rafael. I challenge our departments to ensure that County funded programs and services are evaluated in terms of their outcomes to maximize their efficiency and effectiveness.
The term “homeless” encompasses a wide spectrum of people and circumstances. Many individuals who rely on key services do not fit the stereotypical image of homelessness. They are often working people and families who have lost a job, housing or some other support system, or have encountered medical issues that led to loss of a job or housing. In many instances this includes children in our local schools and results in families doubling up in unstable, overcrowded apartments. These individuals need different services than those who suffer from mental illness or other disabling conditions and who are unable to take care of their own basic needs, different still from the disproportionately visible individuals who impact our Downtown business area and surrounding neighborhoods.
The Homeless Outreach Team, “HOT” identifies specific individuals who are high-utilizers of expensive public services (hospitals, jails) and have a disproportionate impact on our neighborhoods and public systems. The HOT team aims to end the “revolving door” by working intensively on individualized plans towards permanent housing, with whatever supportive services are needed to keep the person housed.
Each service provider is accountable for implementing the individualized plan. Through assessing each person’s vulnerability, that is, determining how long he or she has been living on the street, how fragile they are medically or mentally, a list is created with the most vulnerable people at the top, the first to go into housing. Through this Housing First approach, capitalizing on the work of the HOT Team and coordinated entry, we have been successful in housing 100 of our most vulnerable people living on our streets.
Improving Mental Health Services
The County Department of Health and Human Services, through its Behavioral Health and Recovery Services Division, is the safety net provider for people living with a serious mental illness diagnosis and Medi-Cal eligible. During the last few years, the County added three units to our mental health outreach program: the Mobile Crisis Response Team, which responds to mental health crises throughout the County; the Outreach and Engagement Team, which proactively seeks out the homeless; and the Triage Team, which works with the precariously housed and those whose mental illness threatens their housing status. We continue to leverage County resources towards the most proactive, effective services to address the underlying mental health conditions that lead to homelessness. The goal is to keep someone with mental illness stable in their housing through case management and wrap around services.
We also have what is called full service partnership. This is a way to provide a complete range of services, using a ‘whatever it takes’ approach to the individual and their family. Programs include “Helping Older People Excel” and Senior Peer Counseling; homeless outreach through the Odyssey Team, supporting adults who struggle with severe mental health symptoms and, as a result, homelessness; Support and Treatment After Release, “STAR”, supporting adults with serious mental illness and who are currently involved with the criminal justice system; and finally, Transitional Age Youth, “TAY,” providing services to young men and women, ages 16-25, who are struggling with mental health challenges.
The Behavioral Health and Recovery Services Division Access Line is available to answer questions about services, arrange appointments and make referrals. Call (888) 818-1115 24 hours a day, 7 days a week. You can read in greater detail at the County website by clicking on the following link: County Mental Health and Substance Abuse Services.
Better Coordination with the Court System and Expanded Mental Health Services in Jail
We are not alone in Marin County in struggling to effectively address the unique needs of people with mental illness in jail and in the criminal justice system. I spearheaded County efforts around how our Health and Human Services divisions can work in concert with the Sheriff’s Office and the Courts to expand medical and mental health resources to those in detention as well as going through the Court system. We are fortunate to have visionary leaders in Detention Services and on the Bench in this County and willing partners in Health and Human Services committed to doing what it takes to support people with serious mental illness.
The Stepping Up Initiative is an innovative nationwide effort to address the mental health crisis in our county jails. Through my advocacy, the Board of Supervisors passed a Stepping Up resolution and has also made these efforts a budget priority. I have been working with our criminal justice system partners to achieve a more coordinated relationship between County service providers and the Courts to ensure that people in the judicial system have access to appropriate behavioral health resources.
- We now have 20 hours, 7 days per week of staff coverage in the jail to ensure safety cell checks are done within 4 hours from time of booking. We also have implemented 28 hours of face to face psychiatric coverage in custody and telephonic psychiatric consultations 24 hours per day, 7 days per week. This is a dramatic increase in access to mental health professionals for people in jail.
- We have expanded Licensed Crisis Specialist staffing including one Bilingual (Spanish) Crisis Specialist.
- We now have group programming and stabilization which allows people in jail more social interaction.
- Increased Re-Entry planning: Working with MH inmate patients to identify short- and long-term goals for reentry into the community post incarceration.
Laura's Law --Assisted Outpatient Treatment
Assisted Outpatient Treatment through Laura’s Law is a valuable tool connecting people who are suffering from disabling mental health issues to the full-service partnerships they need. Based on specific court-evaluated criteria, Laura’s Law, or AB 1421, provides outpatient services to those suffering from severe mental illness who have refused treatment yet are at risk of harming themselves, others, or unable to care for their own basic needs. I originally brought the issue to the Board of Supervisors in early 2016 but was defeated on a 4-1 vote. I then worked closely with families, advocates, mental health professionals and members of the community, building the case as to why Laura’s Law could be a tool for helping those with severe mental illness oftentimes living on our streets. In March 2017, the Board of Supervisors agreed, and on a 5-0 vote decided to implement a two-year pilot program enacting Laura’s Law in Marin. We now have an Assisted Outpatient Treatment program in place. We are pleased that those people who have been referred who meet the criteria have been linked to care. Referrals can be made by calling 415-473-4321.
Creating a Program that Addresses the Impacts of Chronic Inebriates
The County funded a two-year pilot program for 8-10 of the people who create the greatest impact on our communities due to alcohol-related behavior and arrests. They are the “frequent fliers” between the back of a patrol car or ambulance to the hospital emergency room, jail, or Helen Vine Recovery Center. This pilot program has provided intensive services and housing, time and opportunity for the participant to find a new way of being in the community. Seven of the participants are now stably housed.
In addition, our partners in the criminal justice system, the Public Defender, District Attorney, Probation, the Courts, City officials and law enforcement are all working together to interrupt this problematic revolving door cycle.
Helen Vine Recovery Center
Buckelew Programs operates Helen Vine, a 26-bed non-medical detoxification program with recovery-oriented services for people with alcohol and drug addiction issues as well as co-occurring psychiatric services. Helen Vine is considered the best of three options for law enforcement to take people who are arrested for public drunkenness, for example. The other two options, jail or hospital emergency room, come with a booking and arrest in the former and a hefty price tag the community bears in the latter.