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It’s one of San Diego’s most overwhelming challenges: What to do about homeless folks who abruptly scream at strangers or openly suffer with debilitating depression – yet seem unwilling to seek help.
San Diego County officials responded to that particular part of the homelessness dilemma with a major program that aims to treat and house hundreds of these vulnerable San Diegans
A year ago, county supervisors pledged to try to move 1,250 homeless San Diegans with serious mental illnesses into new apartments over the next few years.
County supervisors promised to treat and provide supportive services to hundreds of people and work with cities across the region to subsidize their rent.
It was a significant commitment. Advocates have long criticized the county for not doing enough to address the region’s growing crisis.
It’s called Project One for All. It has helped get dozens off the streets since county contracts were first expanded early last year and drawn praise from even some of the most skeptical local advocates.
But the much-celebrated initiative has hit some snags in its early months. Confusion has sometimes plagued its implementation.
The manager of a downtown-focused homeless outreach team whose contract was beefed up last year with the influx of Project One for All resources in mind told me he wasn’t sure where to take clients to get Project One for All housing vouchers. He later learned his team had actually been following the correct process unknowingly.
If Project One for All succeeds, county leaders predict San Diego County, which has the nation’s fourth-largest homeless population, could dramatically reduce homelessness.
To do it, they’ll have to overcome a tight housing market and connect homeless clients considered among the most difficult to get off the streets with the resources they need to avoid returning there.
And they’ll have to cut through bureaucratic roadblocks and coordination challenges popping up as they build a complex program that demands collaboration between a chorus of players across the region, from nonprofit agencies to landlords.
“We’ve got a lot more work to do but at least we’ve got a good start on focusing on trying to deal with the most difficult homeless population we’re going to deal with,” said County Supervisor Greg Cox, who proposed the program with Supervisor Ron Roberts.
For years, mayors and City Council members have received the bulk of the complaints about San Diego’s homeless population.
That’s changed as San Diegans across the region confront more homelessness in their neighborhoods.
Roberts and Cox, who represent San Diego and South Bay communities, decided early last year they needed to do more.
“A lot of what we were anecdotally hearing and seeing told us, ‘We’ve gotta step up the game plan here,’” Roberts said.
So last February, they proposed investing millions of dollars the county receives from the so-called millionaires’ tax into a program to aid homeless people countywide who have a serious mental illness. They envisioned a program similar to Project 25, a partially county-funded initiative that’s won accolades for getting about three dozen homeless folks off the street. It saved millions that would have otherwise been spent on things like emergency room treatment for the chronically homeless.
County supervisors kicked off Project One for All with votes to bolster various county contracts to serve 1,250 people with a serious mental illness such as bipolar disorder or schizophrenia.
The county’s since gotten commitments, mostly from the San Diego Housing Commission and the county’s own housing authority, to supply 1,100 housing vouchers for the program. It’s hoping Oceanside, National City, Carlsbad and Encinitas each step up to contribute more.
And it’s worked with several county contractors to add more slots for homeless folks to receive treatment and intensive case management before and after they move into permanent homes.
Advocates have cheered the county’s pledge, including the head of a federal agency that coordinates homelessness efforts. They laud the increased commitment to homeless folks and the innovative use of state mental health money.
“Project One for All feels like a great example of a county using mainstream mental health resources to be a key engine for trying to reduce homelessness among people with mental illnesses,” said Matthew Doherty, who leads the U.S. Interagency Council on Homelessness.
The county’s efforts have brought some early success. The county and housing authorities placed 95 clients in permanent housing through the end of last month. Another 145 were searching for homes, and many had moved into temporary housing while they looked.
Rose, who asked that I not use her real name, is one of those who’s navigated the program. The 64-year-old told me she had for years spent stints on the street, in short-term homes and hospitals before she moved into a downtown apartment last month.
Rose is open about her struggles. She said she has dissociative identity disorder and has often fallen into anxiety and depression. She’s also been saddled with chronic pain, a colon condition and other physical ailments.
A recuperative care nurse referred Rose to a Project One for All provider following a hospital stay last year.
Rose now lives in an apartment decorated with her crochet projects and filled with furniture and other amenities provided by the Community Research Foundation’s Senior Impact program. She said her health is improving and she’s more upbeat. A team that includes a psychiatrist, a nurse and a case manager is assigned to keep regular tabs on her needs.
“I still feel like I’m dreaming,” Rose told me in December.
Life still isn’t easy, though. Rose told me she’s still working through the trauma of years on and off the street.
Social workers who’ve aided formerly homeless clients say a transition process is common. It takes time to adjust to life in a new home.
The county and its contractors will have to help Rose and hundreds of others as they transition – and for the long haul.
“Most of the work happens after they get housed,” said social worker Bridget Kiefaber of nonprofit Community Research Foundation, who’s leading the team working with Rose.
In San Diego, a housing voucher is far from a guaranteed ticket off the street, a reality the county is facing with Project One for All.
It can take months before a homeless person jaded by life on the street will agree to enroll in services. Project One for All requires homeless clients to enroll in treatment services, which can give some pause.
It’s not that they want to remain homeless, it’s that many have learned to survive on the street and aren’t quick to trust those offering help.
County officials have acknowledged the need to increase outreach and to plan on weeks and months of interactions with particularly vulnerable clients.
So on a Wednesday in January, county mental health clinician Sally Dunn visited with more than a dozen homeless folks in Presidio Park and the Midway area. She wasn’t immediately assessing whether they’d be eligible for Project One for All but said referrals to other programs might lead some down that path.
Dunn handed several folks forms to get free ID cards they’ll need to access services and gave another a referral for a clubhouse in North Park where she might get additional help.
But Bernie Miles, the manager for the North Park clubhouse program run by Episcopal Community Services, confessed some confusion about Project One for All.
Episcopal Community Services’ goals under its county contracts are two-fold. The nonprofit serves adults with serious mental illnesses at its Friend to Friend clubhouse in North Park and it conducts outreach downtown in hopes of connecting more homeless people with services, including those tied to Project One for All.
Yet Miles, who oversees both efforts, told VOSD that he hadn’t received a detailed briefing on how to connect his clients despite the fact that his group holds a contract to do just that.
“We didn’t talk about the specifics,” Miles said.
After I shared Miles’ story with county officials, a county Health and Human Services Agency official contacted him to explain the path to a Project One for All voucher. Miles learned his team had been appropriately referring clients through the process – even if they hadn’t known they were following it.
The county has scheduled a meeting next week to discuss the Project One for All process with outreach workers.
Susan Bower, director of integrated services for county’s Health and Human Services Agency, said she wasn’t sure why Miles hadn’t understood the process.
“It really highlights for us the need for ongoing training,” Bower said.
The fact that agencies can’t directly link clients to Project One for All through the regional database that’s been set up to connect homeless folks with services may have added to the confusion.
To get a Project One for All voucher, clients must enroll with one of three agencies who hold county contracts to provide the program’s wrap-around services or visit a county-affiliated clinic.
Then there’s the fact that many of the vouchers, while approved by housing authorities, haven’t been doled out yet.
Bower is confident the county and its contractors can work through these issues in time.
They’re hiring new staffers and still need to ink multiple contracts to help homeless clients navigate San Diego’s housing market and work on treatment programs.
“Any time you do anything this big it takes a little time to get it (going) full on,” Bower said.
In about a year, the county and various cities could apply for significant cash to build housing for chronically homeless people who have serious mental illnesses through a $2 billion bond approved by the state Legislature last year.
Rick Gentry, chair of the regional group coordinating San Diego’s approach to homelessness, said San Diego wouldn’t have been well-positioned for that application just a couple years ago.
He believes regional efforts since, particularly Project One for All, are likely to help San Diego pull in more money.
“We’re moving more and more into what we need to be,” Gentry said.
Cox and Roberts say more success with Project One for All could also set the stage for the county to throw more resources at the region’s mushrooming homelessness problem.
“What I’m hoping is we can enjoy some success and I think that success would bring expanded efforts,” Roberts said. “I think that’s what we have to do. We have to show people that if we spend some money we’re making something positive happen.”