There’s No Health Without Home

Stories that caught our attention this week

Tents pitched under freeway in Oakland, CA
One of many homeless encampments around freeways and other public land in Oakland, California. Photo: Xenia Shih Bion.

It’s no secret that the cost of living in California is high. The lack of affordable housing and the widening income gap have destroyed what KPCC’s Matt Tinoco calls the “California Dream of an affordable middle-class paradise.” As a result, the state with the mightiest economy in the nation is in the grip of a homelessness crisis that has so far outstripped the ability of state and local governments to cope with it.

According to the 2018 Annual Homeless Assessment (PDF) published by the Department of Housing and Urban Development (HUD), California had the nation’s highest rate of homelessness, Essential Coveragewith 59 of every 10,000 individuals experiencing homelessness — nearly triple the national rate. HUD estimated that California accounted for 30% of all people experiencing homelessness as individuals in 2018.

In some parts of California, homelessness is so prevalent — and solutions so far behind the problem — that residents have taken it upon themselves to organize around the needs of homeless neighbors. Tinoco reports that in Los Angeles, despite local governments’ model efforts to address homelessness, some residents have begun tackling the problem in their neighborhoods themselves. When a group of neighbors in Los Angeles began donating socks, food, and other necessities to nearby homeless people, it led to the formation of the SELAH (Silver Lake, Echo Park, Los Feliz, Atwater Village, and Hollywood) Neighborhood Homeless Coalition. Before long, SELAH volunteers were trying to help homeless neighbors navigate Los Angeles County’s limited homeless services. “In the neighborhoods SELAH serves,” Tinoco reports, “there is nowhere for homeless people to go if they want to access public services. If a homeless person calls and asks where to go, they’re typically referred to access points that take more than two hours to walk to.”

Governor Newsom Swiftly Prioritized Homelessness

Soon after he was sworn in, California Governor Gavin Newsom made it clear that confronting the homelessness crisis is a top priority for his administration. During his first annual State of the State address, Newsom called homelessness a public health crisis and said, “Too many on the streets are suffering from bipolar disorder, schizophrenia, or paranoia. Many of them are self-medicating with drugs or alcohol as a consequence.”

To address underlying causes of homelessness — like mental illness, substance use disorder, and lack of housing — Newsom established the Commission on Homelessness & Supportive Housing led by Sacramento Mayor Darrell Steinberg. In a press release from the Steinberg Institute, a nonprofit mental health group founded by the mayor in 2015, he called homelessness “California’s most pressing humanitarian, public health, and economic threat.”

Under Steinberg’s leadership, the city of Sacramento implemented Pathways to Health and Home, a Whole Person Care (WPC) pilot that coordinates health care, behavioral health, and social services for Medi-Cal beneficiaries at risk of or currently experiencing homelessness. The California Department of Health Care Services (DHCS) oversees 25 pilots across the state, all of which serve vulnerable patients on Medi-Cal who are frequent users of emergency and inpatient services. Nearly all the pilots explicitly target people who are homeless, or at risk of becoming homeless, with the goal of improving their health outcomes. The five-year pilots are federally funded, and Newsom is adding $100 million of state money to the strategy.

Placer County was among the entities selected by DHCS to implement a WPC pilot. See these compelling stories to learn how the program has helped chronically homeless people get back on their feet.

Putting Navigation Centers on the Map

The Sacramento Bee reports that Newsom also proposed allocating $500 million for navigation centers, which are homeless shelters that provide supportive services like medical care, addiction treatment, and long-term housing assistance. San Francisco city planners created the nation’s first navigation center in 2015 to help people with severe mental health, drug, or other problems who have been living on the streets for at least a decade.

It’s worth reprising Kevin Fagan’s June 2018 article in the San Francisco Chronicle describing navigation centers as places that “let homeless people come in with their partners, pets, and belongings, stay 24/7, and get unusually intensive counseling for housing, drugs, mental illness, or whatever else they needed to get stable.”

While this model of care is relatively expensive — a bed in a navigation center costs about twice as much as a bed in an emergency shelter — it appears to be working. San Francisco reports that 57% of the nearly 3,000 people who have used its navigation centers have gotten housed, and Seattle and Austin are now copying the model. Newsom says he is willing to prioritize spending for long-term solutions to California’s homelessness crisis. In his State of the State address, the governor said, “We need to… focus on prevention, rapid rehousing, mental health, and more permanent supportive housing — because while shelter solves sleep, only permanent housing solves homelessness.”

In addressing California’s housing shortage, Newsom is distinguishing himself from his predecessor “by holding cities accountable for building affordable housing,” CALmatters’ Laurel Rosenhall reports. The administration has already sued Huntington Beach for failing to comply with state housing laws, and state officials vow to hold all cities accountable.

In a state where nearly 30% of renters spend more than 50% of their income on housing, increasing the supply of affordable housing is critical. “If we want a California for all, we need to build housing for all,” Newsom said.

How is homelessness affecting the health of your community? Tweet at me with #EssentialCoverage or email me.