“It just seems to undermine a lot of the principles of disability rights, the right to self-determination, the need for services to accommodate people with disabilities,” said Lili Graham, an attorney with Disability Rights California. “And there’s this coercive component because it’s within the mandate of the court.”
But Hull is also optimistic. If there is any chance that CARE Court can help, she would welcome the change.
“Sometimes there are a lot of things you don’t like and you have to do it,” Hull said. “So yeah, if it’s a chance for someone to be housed and get the word out, I’m all for it.”
Newsom’s administration poured $12 billion into homelessness and mental health programs last year – with another $2 billion proposed this year. But the state still faces severe shortages of behavioral health workers, treatment programs and housing. And Hull’s most recent help-seeking experience illustrates the hurdles that CARE Court will have to overcome to ensure that Hull, and others with similar experiences, can break the cycle of homelessness and successful treatment.
A slow process
When Hull realized hospital staff were going to send her back to the streets, she called her sponsor in a panic. He called the Coalition on Homelessness in San Francisco.
This is how Hull first met Christin Evans, owner of the Booksmith, an independent bookstore in San Francisco, and also a volunteer with the coalition. Evans stepped in as a defender to help Hull find a place to stay.
Hull has a paid social worker appointed by the city. But with a heavy workload, Evans said, the city’s social worker isn’t always able to give Hull as much time as she needs.
Across California, the behavioral healthcare industry faces a labor shortage, and it is expected to grow. A 2018 study from the University of California, San Francisco found that by 2028, California will have 50% fewer psychiatrists and 28% fewer psychologists, licensed therapists and social workers than neededdue to retirements and attrition.
The pandemic has only exacerbated that shortage, said Dr. Le Ondra Clark Harvey, CEO of the California Council of Community Behavioral Health Agencies. And Newsom’s administration estimates that 7,000 to 12,000 people will qualify for CARE Court each year, adding to that workload. All of these people will, by definition, be high-need cases.
“As the system currently stands, we’re already struggling,” Harvey said. “We need to be able to have reliable, well-trained workers within this CARE justice system to make it a success. »
Without Evans’ volunteer support, Hull said she would have been lost.
“I would be downtown, going to case manager after case manager, praying there was an opening somewhere, praying I was safe, sleeping in the doors,” Hull said.
Evans was able to take action. She started by convincing the hospital to keep Hull for a few more days – days that Evans spent trying to find accommodation.
She could not place Hull in an emergency shelter in the Tenderloin, where Hull knew the heroin dealers. Sober for a week, Hull didn’t want to be tempted to use drugs again.
“The options for her for emergency shelter were really limited,” Evans said.
She found a drug treatment program that agreed to do an initial assessment, but not right away.
In the meantime, the hospital discharged Hull, who was able to stay with her godparents over the weekend. It wasn’t a long-term option, as they only let Hull stay with them when she’s sober and undergoing treatment.
However, when it came time for the program to conduct the initial assessment, staff determined that Hull needed more care than it could provide. She wouldn’t find a bed there. So Evans started again, looking for a place that could provide both addiction and mental health treatment for Hull’s dual diagnoses.
“We started doing cold calling, basically,” Evans said. “We were informed that there were really no readily available dual diagnosis beds for her to go to that night.”
To enter the dual diagnosis programs, Hull had to fill out a five-page application, get tested for tuberculosis and get a referral from a primary care doctor, which took several days. Hull spent those nights with her godparents and in an overnight urgent care facility.
Finally, she entered The Avenues Transitional Care Center. But it was only temporary.
She had to wait a few more weeks until a bed was opened at Baker Places Inc., which operates a 90-day treatment program in San Francisco. The whole process took about a month.
“I really believe that in her case, she’s not service-resistant,” Evans said. “The system resists serving it.”
california faces a shortfall of nearly 5,000 psychiatric beds for short- and medium-term care, according to the RAND Institute, as well as nearly 3,000 long-term care beds.
Last year the the state budget included $2.2 billion to create or acquire residential treatment facilities, including pensions and retirement homes for people with mental health problems. This year’s proposed budget includes an additional $1.5 billion for short-term housing for people exiting homelessness and entering behavioral health treatment programs.
But Michelle Doty Cabrera, executive director of the County Behavioral Health Directors Association of California, said all of these facilities will need continued funding.
“These are buildings. These are not the people to work in buildings,” Cabrera said. “We still haven’t increased funding at the state level to support the expanded services that would be needed to accompany these buildings.”
Governor’s proposed budget includes $65 million to implement CARE Courtincluding $39 million to facilitate county court proceedings, $10 million to fund a support program through the state Department of Aging, and $15 million to provide county governments with training and technical assistance.
It does not specify any additional funds to increase services for new CARE Court registrants. But that includes an $11.6 billion proposal for county behavioral health departmentswho are responsible for providing services to people on Medi-Cal – an increase of nearly 50% over the previous year’s budget.
Health and Human Services Secretary Dr Mark Ghaly said in an interview that it was about prioritization.
“Our objective [is] on prioritizing this population,” Ghaly said, “not only making sure they are no longer out of line, but that they are on the front line and getting these services as a priority.
Shortage of housing
Hull does not know where she will go when her treatment program ends in early July. Evans fears that all the work done to get Hull sober and stabilized will be undone if she returns to homelessness.
The shortage of affordable housing remains a huge problem in California, especially for people who often need on-site services to help them stay in stable housing. Nearly 14,000 homeless people voluntarily sought mental health services last year, but only half were placed in housing, according to a survey conducted earlier this year by the County Behavioral Health Directors Association of California.
For the other half, there were simply not enough affordable options to meet the needs of people with complex behavioral health needs.
“We kind of fell victim to the boiling real estate market in California,” Cabrera said, noting that the state has lost many residential treatment facilities in recent years. “We ourselves have very limited resources to meet the housing needs of our clients.
The CARE Court legislation, as currently written, does not require the county to provide housing, only that it provide a list of options and provide assistance in applying for them. There is no guarantee that the accommodation will actually be available.
Hull is trying not to think about what will happen to her in July, “because I don’t want to fall into a depression,” she said.
She will be 31 in September and she is still far from her goals. Sitting in the cafe at San Francisco’s Civic Center, she said she knew that ultimately it was up to her to get there.
“At the end of the day, the government has this and they have that,” she said. “That’s really up to you to fight for.”
She turned her face to the golden dome atop City Hall.
“But the fight shouldn’t be that hard,” she said.