Review of Mental Health Services for Homeless Adults in Santa Cruz County

Of the estimated 3300 homeless people in Santa Cruz County, between 30% to 35% are mentally ill. Mental health professionals state that an additional 10% to 20% of homeless individuals are undiagnosed but have mental/emotional problems, which interfere with acceptable social behavior.

The following services are available to mentally ill homeless adults: A. Santa Cruz County Mental Health Clinic Services B. River Street Shelter C. Page Smith Community House, a transitional housing shelter D. Mental Health Client Action Network E. County Homeless Person Health Project F. Homeless Community Resource Center G. Santa Cruz Community Action Board Shelter Project H. In-patient psychiatric unit at Dominican Hospital I. Suicide Prevention Service of the Central Coast J. Adult Protective Services K. Community Clinics

There are no standards in use to measure the adequacy of community resources to assist mentally ill homeless adults in need of treatment.

According to mental health professionals, lack of affordable housing for all low- income people in this county makes it very difficult if not impossible for mentally ill persons to find housing. Review of Mental Health Services for Homeless Adults in Santa Cruz County Page 5-23 2001–2002 Santa Cruz County Grand Jury Final Report

Locating housing for mentally ill people is exacerbated by the public’s lack of understanding of their capabilities under treatment to exhibit acceptable social behavior.

Many people are reluctant to have mentally ill persons living in their communities.

Mental health professionals believe that lack of stable housing adversely affects the condition of the mentally ill person.

The County Mental Health Division has Care Services Coordinators who reach out to the homeless mentally ill by linking them to shelter, and other types of assistance that can help prevent the need for admission to the acute psychiatric unit. These Coordinators also help clients pay their rent to avoid eviction, sometimes by helping them obtain bank loans.

Housing of some kind is essential for a successful outcome in the treatment of adults with chronic mental disorders.

The Homeless Persons Health Project (HPHP) has been operating with great success over the past ten years. It is supported by a demonstration grant whose purpose was to refine methods, which are affective in reaching the homeless people in a community. The Program has received plaudits for its creative approach of providing outreach services to improve the health of homeless individual and families.

The staff from HPHP report that one of the principle problems with treating mentally ill homeless people is locating them, and encouraging them to recognize and take advantage of the opportunity to use medical and psychological treatment resources available to them.

Puentes, a collaborative pilot project between the Homeless Persons Health Project (HPHP) and County Mental Health Division, is an integrated service program that emphasizes housing, employment and integration into the community. The program currently serves 30 homeless persons. The program has been successful in identifying, contacting and obtaining mental health care for homeless individuals previously unable or resistant to obtaining available mental health services available to them. Puentes also works to prevent formerly homeless persons with psychiatric disabilities from losing their housing and returning to the streets. HPHP has recently submitted another grant request to expand their services to 60 persons.

Mental Health Client Acton Network (MHCAN) is a non-profit agency operated by and for mental health clients. MHCAN’s approach is based on the principle that users of mental health services are uniquely capable of reaching out to others who need mental health services. Employing this philosophy, the agency provides the only consumer-operated self-help drop-in activity center in Santa Cruz County, which a staff member described as “a safe environment in which mental health clients can socialize without fear of the discrimination and stigmatization so prevalent in society as a whole.” The center offers peer counselor training, support groups, art and writing classes, and has a computer lab. The center also provides opportunity for social networking and advocacy. MHCAN is a valuable source of information, guidance and support for adults with a history of mental illness (currently about one-half of MHCAN clients). For the past four years MHCAN has published a Newsletter for the Page 5-24 Review of Mental Health Services for Homeless Adults in Santa Cruz County 2001–2002 Santa Cruz County Grand Jury Report California Network of Mental Health Clients and put on workshops for Peer Mutual Support at the California State Client forum. MHCAN staff also makes presentations to police departments and local churches, and serve on the County’s Quality Improvement Committee. They have formed two work groups in partnership with professional providers; one to create jobs for consumers in all contract agencies of County Mental Health; the second to work on community acceptance of apartments dedicated for use by mental health patients.

Page Smith Community House (PSCH), which is operated by The Homeless Services Center, provides transitional housing for homeless adults, some of whom are mentally ill. During an 18-month period of residence and participation in community living, residents are prepared for independent living. They must meet requirements such as remaining clean and sober and to actively seek employment. While at PSCH, the client has a private room and shares two bathrooms and one kitchen/living room with four others. There are eight units, with a total of forty residents. As reported by PSCH to HUD on April 4, 2002, 90.6% of PSCH graduates have made a successful transition to employment and housing.

In addition to the PSCH, The Homeless Services Center operates the Homeless Community Resources Center, which the homeless mentally ill can access. The center offers two meals per day, showers, telephones, lockers, laundry facilities and access to the nighttime shelter program called the Interfaith Satellite Shelter Program, a program that has existed for many years. In the Interfaith Satellite Shelter Program, the Homeless Services Center works with more than thirty different churches on a daily rotation. Each night seven churches support fourteen homeless persons, all of whom have been screened and are transported to the churches. In winter the Armory is used for the overflow.

Many of the programs supporting the homeless mentally ill are funded by grants, which generally last no more than three years.

Mentally ill homeless people have a need for transportation for such things as conducting a housing search or job search, going to a job interview or going to a job for the first couple of shifts, and going to medical appointments.

Many mentally ill homeless people are dependent on Social Security income. They are eligible for discounted monthly Metro Pass costing about $30.00. But they have to be stable, have their life and money management organized to accomplish this each month. Even with a bus pass, it takes hours to get from one part of town to another, and it’s difficult to socialize and attend events using only public transportation.

HPHP spends $600 a year on Metro passes to give to people who do not have a monthly pass and need to attend health related appointments. HPHP spends approximately $800 per year on taxicab fares for people who are too sick to take public transportation for special needs and HPHP staff person is unavailable to drive the client in the staff person’s own car.

HPHP uses trips to baseball games, concerts and other such events to motivate the homeless individual to want to earn money through employment. Transportation is needed for this endeavor. Review of Mental Health Services for Homeless Adults in Santa Cruz County Page 5-25 2001–2002 Santa Cruz County Grand Jury Final Report

Use of a van from the Santa Cruz County Fleet Service would better serve the transportation needs of the homeless population.

Using the County Fleet Service is more economical than paying HPHP staff persons mileage for using their own cars.

Many individuals have not or will not apply for Medical or Social Security Disability allowance because of distrust of the system. This makes it difficult to obtain mental health care without these entitlements.

The Santa Cruz County branch of the National Alliance for Mentally Ill worked with the Santa Cruz City Police Department’s Homeless Resource Officer and fifteen of its police officers to train them in Crisis Intervention. The organization plans to extend the training to all 500 police officers in Santa Cruz County.

All of the agencies contacted by the Grand Jury Committee reported a much greater need for their services than they can presently supply. Conclusions