Homelessness Solutions Must Address Mental Illness, Addiction

A third of Los Angeles’s homeless population suffers from mental illness and/or drug addiction. Housing solutions will only go so far to provide relief.


Los Angeles Daily News

By Elizabeth Chou

LOS ANGELES -- Officials with Los Angeles’s homeless services agency on Monday stuck to the characterization that just under a third of the people counted as homeless struggle with a serious mental illness or drug addiction, but they added that a deeper conversation about the needs of this segment of the homeless population is warranted.

That figure is frequently used by some advocates to deflect concerns from some members of the community who resist the idea of permanent or temporary housing projects. Those who have worries about such projects often express fears that building them would attract people experiencing mental illness or struggling with drug addiction into their neighborhoods.

But a Los Angeles Times analysis of the Los Angeles Homeless Services Agency’s own homeless count data, that was released Monday, pegged the portion of LA’s homeless who are affected by mental illness and drug addiction at 67%. The story’s headline also stated that the figure supports “the public’s perception.”

Heidi Marston, the agency’s acting director, acknowledged that a larger percentage of the homeless population report being affected by mental health and drug addiction issues than is typically reported.

But she added that not all of those who say they are affected by mental illness, for example, necessarily fit the U.S. Department of Housing and Urban Development’s definition of someone experiencing a “serious mental illness.”

That federal definition is reserved for people who experience long-term or chronic mental health ailments and may not include those who experience mental illness conditions in an episodic manner, or are suffering from trauma, such as depression, that is related to a circumstance in someone’s life.

Additionally, the data from the homeless count survey, despite its frequent use to shape policy and support funding allocations, is viewed only as an imprecise measurement of what is going on in the streets.

Marston said the information about who is experiencing mental health and drug addiction issues is self-reported and vulnerable to problems of “subjectivity and bias.” Meanwhile, the agency is trying to be “careful and responsible on how we report that information out,” she said.

Marston also acknowledged that a separate national study done by the California Policy Lab at UCLA, which she said was done with a more “clinical lens,” suggested mental health was a “concern” for 78 percent of those who are unsheltered across the country, and drug use or addiction was a “concern” for 75 percent.

That study looked at a different set of data pulled from a much more comprehensive questionnaire known as the VI SPDAT assessment that looks at someone’s physical and mental health “vulnerability.” Even with this survey, there can be problems of “bias,” Marston said.

Marston acknowledged Monday that much energy and public conversation has been placed behind efforts to make the construction of housing a priority. Such projects include permanent supportive housing, which is touted as including on-site, wrap-around services aimed especially at those with the most difficulty staying housed, such as people with a serious mental illness and substance use issues.

To me, part of the reason there has been a focus on housing is because the gap is so great,” Marston said. But she added, “there is a third of the population who we know needs more than that.”

The challenges faced by people on the street who are experiencing mental illness or substance use issues “does need to be an important part of the conversation,” she said.

But she said that talking about such topics in a “broad-brush” way “has the potential to impede progress when it comes to siting shelters -- housing. We have to be sensitive about how we talk about the issue, not hide it. There’s a right way to have the conversation.”

Marston also acknowledged Monday that “there is a big gap right now in the level of mental health treatment facilities” that are available, but efforts are underway that they hope to be able to expand.

The wider definition of mental illness and substance use, and the boost in LAHSA’s numbers, appeared to strike a chord with some, including those who work to provide services to people experiencing homelessness.

Jose Salazar, program director for Tarzana Treatment Center, said that it is easy to accept the idea that more than just a third of people experiencing homelessness suffer from a mental health or substance use illness, especially when driving around the city.

Organizations like Salazar’s have seen the need to address the mental health and substance use issues of homeless people grow, along with the larger homeless population.

And while the plan always has been to tackle the issue from many different angles beyond providing permanent housing, choices needed to be made because “we have a finite amount of money.”

The problem has been, “Are we devoting enough resources to one pot or the other, and do we have enough resources to go around? Because the problem is not small -- the problem is very, very big,” Salazar said.

The need to make choices has left other responses, some of them more immediate such as emergency shelters, lower on the priority list.

Ken Craft, CEO of the San Fernando Valley-based Hope of the Valley, said his organization supports permanent supportive housing solutions.

But he also said he worries about what happens in the meantime.

“To keep clients on the streets for months and years while we work (through) the challenges and bureaucracy of opening permanent housing can do a huge disservice to those experiencing homelessness,” he said.

The longer one remains homeless and on the streets, the more susceptible they become to illness, injury and mental illness,” he said.

He also praised the “pivot” that Mayor Eric Garcetti took to put more funding into emergency shelters, with his “A Bridge Home” program that tasked each council district to stand up a temporary shelter site as a way station of sorts between being on the streets and being placed in a more permanent form of housing.

For medical doctor Absalon Galat, who is on the front lines of the ongoing crisis, the re-framing of LAHSA’s numbers could create an opening for better conversations about a topic that has long been misunderstood -- and that carries a huge stigma.

The broader definition helps bring to light “what I see out on the street when we do our street medicine.”

Many people treated by the county “multi-disciplinary” team that he leads in the San Fernando Valley are dealing with life-threatening ailments, but it can be hard to treat people who are living on the street, and it is difficult to find them a safe place to stay in the meantime.

Dr. Galat said that at this point he is wondering if instead of just doing outreach and enticing people to treatment facilities, that it would make more sense to “try to provide more care out on the street.”

This idea of meeting people where they are -- “It’s a very, very small movement here in Los Angeles,” he said. “There are very few practitioners, people who are doing it on a consistent basis.”

Galat said he could not help thinking this could be a possible solution, among others.

“People are not going to get housed pretty soon,” he said. “We’re just seeing them get more sick out on the street the longer they stay there.”

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