Homelessness is one of the most challenging issues facing the Bay Area and close to home in Marin County, particularly District 1. We have all seen homelessness exacerbated by COVID. 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 often related behavioral health issue 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, focusing 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 for both clients and community members.
Many individuals who rely on essential services do not fit the stereotypical image of homelessness. They are often working people and families who have lost a job, housing, some other support system or have encountered medical issues that led to the loss of employment 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 challenged by their mental health or other disabling conditions who cannot care for their own basic needs. This segment of the homeless population is different 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. By assessing each person's vulnerability, that is, determining how long they have been living on the street, how fragile the state of their physical or mental health, a list with the most vulnerable people at the top is created. The most vulnerable are the first to go into housing. Through this Housing First approach, capitalizing on the HOT Team's work and coordinated entry, we have successfully housed over 315 of our most vulnerable people living on our streets with a 94% housing retention rate. During COVID, we have house people 46% faster.
In Marin, we share a vision to end veteran homelessness. Together, Health and Human Services, our community partners, and the Marin County Veterans Services Office are working to ensure that veterans are treated with dignity and respect and that no veteran in Marin is unhoused. In 2021, the construction of 24 new apartment units for homeless veterans is scheduled to begin.
Improving Mental Health Services
Through its Behavioral Health and Recovery Services Division, the County Department of Health and Human Services is the safety net provider for Medi-Cal eligible people living with a serious mental illness diagnosis. Over the last few years, the County has made significant changes to how services are provided to community members and provides a range of outreach services.
Mobile Crisis Response Teams answer the call to behavioral health crises throughout the County. The Transition and Outreach Team proactively seeks out individuals experiencing homelessness or who are in need of additional outreach to engage them in behavioral health services. They will provide short term case management to maximize the likelihood of a successful linkage to services. Assisted Outpatient Treatment, or Laura’s Law, provides medium and long-term outreach and engagement services to individuals at risk of psychiatric decompensation, hospitalization, and incarceration. The focus is on voluntary engagement in services after outreach, though the Court can also get involved to order clients into outpatient treatment.
Proposition 47 or PIVOT, works on care coordination for individuals with behavioral health disorders in the criminal justice system. The program includes proactive outreach to people experiencing homelessness, being released from incarceration, and those at risk of repeated arrests for low level crimes. Recovery Coaches embedded in multiple BHRS programs and other County departments support outreach and linkage to substance use treatment. Full Service Partnerships include outreach to clients who need wraparound behavioral health services. This includes field-based clinical work, advocacy, and engagement in services.
We are more effective when we can address challenges early on with prevention and early intervention. Marin is among the Counties with the highest suicide rates in the Bay Area. Suicidality impacts people of all ages and backgrounds. In response, the County has launched a Suicide Prevention initiative, strategic plan, and Suicide Prevention Collaborative. Together, experts from schools, behavioral health, the medical field, veterans, underserved communities, and people with lived experience will continue to address our community's needs.
We continue to leverage County resources towards the most proactive and 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 so they may participate in the activities they enjoy.
With our Full Service Partnerships we provide a complete range of services, using a 'whatever it takes' approach to the individual and their family. Marin services encompass children, youth, adults, and special populations. Programs include "Helping Older People Excel" and Senior Peer Counseling; homeless outreach through the Odyssey Team; Support and Treatment After Release, "STAR," helping adults with serious mental illness and criminal justice involvement; Transitional Age Youth, "TAY," services for young men and women, ages 16-25, often learning how to adapt to mental health challenges; and Youth Empowerment Services, "YES", serving children and youth up to 18 years of age.
Our Mobile Crisis Response Team provides an expert mental health response to residents in crisis. However, the hours of operation are not currently sufficient; crises do not limit themselves to 1:00 pm – 9:00 pm. Through a California Health Facilities Finance Authority grant focused on school-based youth, we are expanding the services to cover school hours. The hours are Monday – Friday: 8:00 am – 9:00 pm; Saturday: 1:00 pm – 9:00 pm through June 2021, the grant end date. The grant offers a welcomed expansion, with more needed and underway.
Working with our partners, I'm exploring the possibility of additional crisis teams, improved geographic coverage, and expanded evening coverage. With strong partners at the table, we continue to unpack the central question of how we best serve our community in response to a crisis and do it in a coordinated and cooperative fashion.
In January 2021, the Board of Supervisors approved the creation of a 16-bed Adult Transitional Residential Treatment Program for individuals with serious mental illness and co-occurring substance use disorders in San Rafael. The first of its kind in Marin. Simply put, there is a lack of available beds and costs increase year over year for residential treatment. Out of county services may be less expensive per bed but incur transportation costs and disconnect families from clients, clients from communities, and treatment teams from clients. The facility will assist in a more successful transition from residential placement back to the community, and decrease costs associated with out of county residential treatment placements and transportation.
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 anytime, 24 hours a day, 7 days a week. You can read in greater detail at the County website by clicking on the following link: Marin County Behavioral Health and Recovery Services.
Better Coordination with the Court System and Expanded Mental Health Services in Jail
Marin County is not alone in struggling to effectively address people's unique needs with mental health in jail and the criminal justice system. Issues arising from the intersection of mental health and criminal justice is a nationwide problem. In 2021, I joined the California State Association of Counties (CSAC) Administration of Justice Policy Committee as Vice-Chair. We are tackling many of the issues we see firsthand play out in this County at the State level. We discuss the intersection of criminal justice policy and homelessness, and I share the work happening in Marin.
Discussions on policies and budget actions will pave the way for a more effective government response. I expect to address a range of challenges and promote local successes. The discussions include specialty courts, housing opportunities, conservatorships, and Laura’s law. We recognize that the term homelessness encompasses a broad range of people and circumstances. 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 and the Court system. We are fortunate to have visionary leaders in detention services, on the bench, 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 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 mental health staff coverage in jail. Any inmate placed into a safety cell due to danger to self or others is seen by mental health staff within 4 hours. We 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, allowing people in jail more social interaction and addressing problems before they become crises.
- Increased re-entry planning: Working with mental health inmate patients to identify short and long-term goals for re-entry into the community post incarceration and linkage to appropriate resources.
Through AB 1810, Marin can access state funds to help individuals with a mental illness who are alleged to have committed a misdemeanor or felony offense. AB 1810 allows for pretrial diversion programs, allowing for treatment to begin before sentencing. This legislation is in response to the lack of access to state hospital beds. Marin received a $536,476 grant from the Department of State Hospitals to fund a three-year pilot diversion program. Marin expects to serve 25 people. I am glad to see this pilot starting.
Laura's Law - Assisted Outpatient Treatment
Assisted Outpatient Treatment through Laura's Law is a valuable tool for connecting people 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 who have 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 worked closely with families, advocates, mental health professionals, and community members, building the case as to why Laura's Law could be a tool for helping those with severe mental illness frequently living on our streets. In March 2017, the Board of Supervisors agreed to implement a two-year pilot program enacting Laura's Law in Marin. Through AB 1976, all counties are required to have AOT. BHRS changed the model slightly and incorporated AOT positions with the STAR team. We now have an Assisted Outpatient Treatment program in place. We are pleased that those who have been referred to 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 is funding a pilot program to improve health outcomes and reduce system costs for individuals with alcohol use disorders that have frequent contact with the criminal justice system. The pilot program provides Supported Transitional Housing for 8-10 adults with at least four alcohol-related referrals to the criminal justice system in the previous 12-months. While in supported transitional housing, participants are provided linkages to evidence-based treatment and offered assistance in securing permanent housing. Since the program's inception, nine participants have been stably housed. 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 cycle and improve outcomes for individuals and communities.
Helen Vine Recovery Center
Buckelew Programs operates Helen Vine Recovery Center, a licensed 26-bed non-medical withdrawal management and residential substance use treatment program, with recovery-oriented services for people with substance use disorders as well as co-occurring mental health conditions. At Helen Vine Recovery Center, individuals access individualized programs, including counseling, education, 12-step meetings, wellness and life care tools, relapse prevention, community mentors, and connection to ongoing treatment services. In addition to self-referrals, law enforcement refers to Helen Vine to connect individuals to care, rather than to jail or emergency rooms, to improve health outcomes and reduce system costs.