Christin Evans is a small business owner who became interested in the persistent challenge of addressing homelessness outside her front door. She has partnered with homeless advocates and has campaigned for solutions to end homelessness for more than five years.
When I met Samantha—not her real name—she was one week sober. She had undergone detox and was about to exit the hospital. I was called in by a concerned friend because Samatha’s hospital had not secured a residential treatment bed, the next step in her journey to stay away from heroin and cocaine.
As an advocate for people experiencing homelessness, I am familiar with the on-the-ground realities and the political fight to create real solutions to the surging homelessness crisis. Every day, I meet folks like Samantha who struggle to obtain housing and treatment. San Francisco’s Linkage Center, which is essentially a glorified drop-in resource center, runs most of the time at capacity. Its stated aim is to provide linkages to shelter and linkages to treatment assessments, but San Francisco has very few treatment beds available.
In spite of this stark reality, Gov. Gavin Newsom wants to put more Californians under conservatorship—which, by necessity, means ordering the most marginalized populations into treatment. His “CARE Court'' concept, rolled out as part of a package of budget priorities to address homelesseness statewide, grabbed headlines and was promptly lauded by several city mayors, including our own London Breed. (“CARE” stands for Community Assistance, Recovery and Empowerment.) Newsom’s aim is to use California’s courts to mandate treatment for people experiencing homelessness who are unwilling or unable to seek mental health or substance use treatment on their own.
Most experts will tell you California doesn’t have adequate resources and beds for those that are already under court conservatorship. As Jessica Lehman, executive director of Senior and Disability Action recently told me, “San Francisco does not have enough care beds and housing options for people already conserved, let alone for people with mental health disabilities who seek treatment and support.”
Anyone who seeks treatment for mental-health and substance-use issues faces a nearly insurmountable number of barriers, especially for those individuals living on the street. Meanwhile, both the city and state are digging out of a significant affordable-housing deficit which took decades to make, and our fractured healthcare system has continued to fail to care for those suffering from mental health and substance use disorders.
A recent UCSF and Tipping Point study estimated that, in San Francisco alone, there were 6,296 homeless people with serious mental health disorders, more than three times the number of available mental health treatment beds. I believe that Newsom’s goal is to perpetuate a narrative of service resistance to distract from the acute lack of mental health services, drug treatment beds and affordable housing for those who can’t afford the market-rate alternatives like the Betty Ford clinic.
When Gov. Newsom announced the CARE Court process last month, the whole purpose of which is to mandate treatment, he used a media bullhorn to send a loud message that people experiencing homelessness aren’t staying off drugs because they are resistant to treatment. But is the problem really that people are refusing treatment? Or are they being refused treatment?
The governor’s latest move builds on a narrative “moderate” Democrats have been pushing out for a while—that homelessness is a result of individual failings rather than a systemic failure. Newsom’s CARE Court is only the latest political theater—it pretends to do something without doing anything at all.
Samantha’s story illustrates this perfectly.
Upon helping her out of the hospital, the first thing I did was talk to the head of San Francisco’s Homeless Outreach division, Mark Mazza. He confirmed that it's the hospital’s responsibility to secure a placement before discharging her, and I should start with the social worker they’d assigned Samantha. But I soon learned that the hospital’s social worker was brand new in her role, and she didn’t even know where to start. After calling around, we found a San Francisco substance use treatment program that agreed to an intake assessment.
But the treatment bed would only be offered with strings attached. Because the intake officer assessed that Samantha needed a higher level of care, the program made it a prerequisite that she secure a referral for mental health services too. This is what’s referred to as “dual diagnosis,” meaning Samantha needs both mental health and substance use treatment, preferably under the umbrella of a single program.
Several days after being discharged from the hospital after undergoing medical detox, Samantha still had no treatment bed available to her. To make matters worse, she had been instructed to try to stay away from “triggers” that will lead to relapse, but the only beds for people experiencing homelessness are at shelters in the Tenderloin, which Samantha identifies as having triggers everywhere.
Through the support of some distant family members, Samantha remained safe in their home until we were able to get her assessed for a mental health referral. But the city’s referral to mental health came in the form of a list of phone numbers. As Samantha’s volunteer support team, it was still our task to cold call through a list of mental health services ourselves to find someone who will take her on an outpatient basis.
Before we are able to secure a mental health clinician for Samantha, the treatment bed that had been offered a few days before was withdrawn. The facility’s intake officer suggested Samantha go seek care at another facility, and the officer gave us the names of three names with capacity for dual diagnosis treatment.
To be considered for any of these alternative facilities, Samantha had to complete a six-page application requiring four things: a signature from a primary care doctor, a TB test, MediCal documentation and proof of income. Each requirement created new obstacles. She lacks a primary-care physician, so we had to secure one. We were told this application usually takes people about a week to complete, but because Samantha did not have a safe place to sleep that night we returned to looking for short-term measures.
We secured her an overnight bed at an urgent care facility more experienced at treatment placement, and they were able to refer her to a two-week treatment facility—described to us as “the waiting room”—while she awaited a referral to a 30- or 90-day program.
In Samantha’s case it took the full time commitment of a volunteer social worker and unpaid advocate, with critical assistance from a distant family member, to get her safely placed in a temporary half-measure. The resources are few and far between and difficult to access for those who want them. To be clear, it would have been practically impossible without a phone, without transportation and without professional connections and advocacy for Samantha to navigate this bureaucratic labyrinth on her own.
Elected officials like Gov. Newsom, Mayor Breed, state Sen. Scott Wiener and Supervisor Rafael Mandelman may talk about conservatorship as the way to make progress in addressing homelessness. All that while, Samantha has waited more than necessary to match to a residential treatment program which will give her the appropriate support she will need to help her cope with her mental health and substance use struggles. It’s been five weeks now.
Until the politicians in charge start leveling with the public that the real solution is to allocate more resources, we will fail again to make real progress towards ending the mounting homelessness crisis.
Follow Christin on Twitter at @christinevans
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