Jo Ann Rebane: Doing the math on mental illness and homelessness
May 14, 2018
Editor's note: This is the third in a series of columns discussing the impact of mental illness on the issue of homelessness in western Nevada County.
Understanding any social problem depends on understanding its related numbers. Changes should not be made until it is known what the numbers are and mean.
Prior articles have discussed why there are so many mentally ill homeless and described what is known about the costs of dealing with them. Today we'll look again at Nevada County and then some remedies.
Using 469,000 as an estimate of the number of homeless people in California with 30 percent of them mentally ill, that is 140,700 mentally ill homeless residents. If a low average figure like $15,000 were spent to individually respond to, care for, and maintain those 140,700 mentally ill homeless, the statewide cost would be over $2 billion annually.
According to the Economic Roundtable, League of California Cities and the California Association of Counties Report on Homelessness, Los Angeles County spends $1 billion each year on 150,000 homeless, 45,000 of whom are mentally ill. Of those, 4,500, the top decile, are severely mentally ill and/or disabled on which about $72,000 per person is spent on average, or $324,000,000 annually. This leaves L.A. County with about $4,646 per person to spend for all other services for the remaining homeless including the mentally ill whose condition is not severe.
According to Health and Human Services Agency Director Michael Heggarty, Nevada County began to implement a "minimal but compliant" Homeless Management Information System (HMIS) this January as required by participation in Continuum of Care (CoC), a HUD program.
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But there's a wrinkle — our Health and Human Services Agency must comply with the CoC requirement, but funding is not guaranteed from year to year to carry out the mandate. The HMIS will track homeless individuals who contact or receive services from seven public and private agencies.
According to Mr. Heggarty, "our CoC is not currently collecting cost data per service/contact, though it is a field that providers are being shown/trained on within HMIS." The focus now is getting these first participants trained on the HUD required elements, leaving providers the choice to track costs or not.
Using the L.A. County figures for costs, we estimate that of the approximately 500 homeless who reside in Nevada County, about 150 suffer from mental illness and about 15 are severely mentally ill, costing us more than $1 million annually for law enforcement, jails, homeless services, general relief, food stamps, feeding programs, paramedics, public health, mental health, private hospital, emergency department, outpatient clinic, etc.
If it costs Nevada County $15,000 per person to manage the remaining 135 mentally ill persons, that bill would be more than $2 million. None of these estimates include housing costs or after care.
Since the state legislature created today's humanitarian crisis in our cities and counties — that include the unintended result of assumptions that didn't pan out, assumptions that didn't pencil out, assumptions that weren't carried out, and assumptions that couldn't be carried out for lack of funding — it's my opinion that the state legislature bears primary responsibility to fix the current mess. The Legislature should look at the suggestions of those who have dealt with the unintended consequences of the Lanterman-Petris-Short Act (LPS) and have tried to make it work for 50 years.
The California Hospital Association agrees and states "the criteria in California's LPS laws must be updated to incorporate current medical science regarding mental illness; correspond more closely with the Medi-Cal definition of 'medical necessity' and provide treatment before unnecessary social, criminal justice and/or medical consequences occur."
They endorse the LPS Modernization Act of 2016 – AB 1300 (Ridley-Thomas) and believe that it would protect hospitals and emergency departments, and thus keep these limited resources available for other, critical life-saving services. Apparently no funding mechanism was attached to this proposed legislation.
State Senators Wiener and Stern announced SB 1045 this February to expand "conservatorships to help the homeless who are severely mentally ill or have severe drug addiction and have repeated commitments, or exceptionally frequent use of emergency medical services." The bill was introduced as "intent" language to enable the Senators to consult with local governments, service providers, and advocates to figure out new structuring of conservatorships to help those most needing shelter and recovery and to be a tool which counties could elect to use.
Retired Judge Paul Seeman comments, "Many of these people routinely use social and emergency services and find themselves in law enforcement custody, effectively converting a health issue into a criminal issue. By allowing greater flexibility to conserve these extremely disabled individuals — who are unable to make decisions for themselves — we can keep people out of the criminal justice system and focus on their health and well-being." The Legislative Counsel's Digest summary of SB 1045 does not contain any mention of funding.
Gov. Brown recently signed AB 210 (Santiago) a data sharing law which allows "… counties to establish a homeless adult and family multidisciplinary personnel team with the goal of facilitating the expedited identification, assessment, and linkage of homeless individuals to housing and supportive services to ensure continuity of care." The bill requires counties to develop protocols to share information confidentially. Apparently no funding mechanism was attached to this enabling legislation.
League of California Cities and the California Association of Counties Report on Homelessness is a comprehensive study of homeless issues. Of particular interest are descriptions of the data collection methods and links to various online homeless management information systems used by six different counties to track all public and private agencies' assistance costs to specific homeless clients including private hospital emergency department usage, service calls to homeless encampments, and related police and fire incidents. This report should be read and understood by everyone who is concerned about the magnitude and costs of attempting to make the current system "work," or who recognizes that something is not working and needs fixing.
Counties will need funding help to implement even an off-the-shelf homeless management information system. Funding will be needed to coordinate and train personnel in the many public and private agencies and programs which currently deal with the homeless in each county. The Legislature can surely find the money to do this.
Next week will wrap up this series on the mentally ill homeless and urge specific action from the state, cities, and counties.
Jo Ann Rebane is a member of The Union Editorial Board. Her views are her own and do not represent the views of The Union or its editorial board members. Contact her at firstname.lastname@example.org.