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AREAS\Homeless Programs\Staff Reports\update on homelessness march 2005.doc
Council Meeting: March 22, 2005 Santa Monica, California
TO: Mayor and City
Council
FROM: City Staff
SUBJECT: Update
on Implementation of Strategies to Address Homelessness in Santa Monica
including Recommendations to Allocate $10,000 to Support the Securing of a
Building in Los Angeles for a Proposed Regional Psychiatric Urgent Care and
Sobering Center Facility; Adopt a Resolution in Conjunction with the Westside
Council of Governments and Direct Staff Regarding any Appropriate Modifications
to City Policy or Law.
.
Introduction
This report provides
an update on implementation of strategies to address homelessness in Santa
Monica including recommendations to allocate $10,000 to support the securing of
a building in Los Angeles for a regional Psychiatric Urgent Care and Sobering
Center facility; adopt a resolution in conjunction with the Westside Council of
Governments (COG) and direct staff regarding any appropriate modifications to
City policy or law.
Background
The current policy framework regarding homelessness was established in
1991 with adoption of the Homeless Task Force Report, refined in 1994 with
Council adoption of the Public Safety Initiative and reaffirmed numerous times
in the intervening years – most recently earlier this year. This framework sets forth the goal that
homeless people in Santa Monica’s community be encouraged and supported in
their efforts to get off the streets and into programs, housing and when
possible, employment. While, recognizing
homeless people’s need for basic supports and supplying substantial funding for
those supports, the City has called for such supports to be linked with the
continuum of care to ensure that people actively move out of homelessness
rather than continue to live on the streets.
Continued alignment with this policy framework is an important goal for
the City and its service providers.
In spite of the significant achievements made by homeless persons
availing themselves of Santa Monica’s network of
services, the impact of homelessness in Santa
Monica remains a top community concern. Balancing homeless people’s needs for space,
food and sanitary facilities with the larger community need to preserve public
open space for all to use and share has been a key policy and operational
challenge for the City. As in
communities across the region and throughout the country, homeless people
congregate in parks and other public spaces with their personal
belongings. Charitable groups continue
to come to Santa Monica
from outside the community to distribute food outdoors and outside the
continuum of care framework. Some
homeless individuals, particularly those plagued by mental illness and
addiction, do not abide by the laws and regulations that govern behavior in
public spaces. Such unlawful and
anti-social behavior continues to arouse fears and concerns about the safety of
public parks and other public spaces. On
the other hand, many community members remain very sympathetic with the plight
of the homeless.
Complaints to the City about objectionable behavior focus on people
aggressively panhandling near restaurants; prolonged and heavy use of some
parks by people who congregate there with all their belongings and drive others
away; people using public restrooms for bathing and washing clothes; people
roaming alleys at night noisily gathering cans and bottles from recycling
containers; people sleeping or lying in parking structures, alleys and benches;
people lying on sidewalks often obstructing pedestrians; and people leaving
property unattended in public spaces.
In the citywide resident satisfaction survey conducted by Goodwin Simon Strategic
Research in January 2005, homelessness once again emerged as the top resident
issue, with 39 percent of residents identifying “too many homeless” as the most
important problem facing Santa Monica
in response to an open-ended question. This is a significant
increase of 14 percent from the 2002 survey. Another 6 percent said the
main problem is that there are too few services for the homeless, about the
same proportion as in 2002. In a separate question asking how serious is
the problem of homelessness in Santa
Monica, 74 percent of respondents rated it as
serious.
In other homeless-related questions, 33 percent said the City spends too
little on services for the homeless, while 17 percent said the city spends too
much. Ratings regarding the enforcement of laws against overnight camping
in parks and downtown doorways and aggressive begging or panhandling were
weighted more to fair/poor than excellent/good. Negative ratings were
higher among those with higher incomes and those dissatisfied with other City
services. Those most concerned about homelessness as an issue for the
city, according to the survey, are people who have become residents in the last
four years, persons aged 35-49, men under 50, and persons living in the
downtown (zip 90401) and Wilshire-Montana area (90403). A full
report on the findings from the citywide resident satisfaction survey can be
found on the City’s website.
At the January
11 and February 8, 2005 Council meetings, Council discussed and directed
implementation of a range of strategies to address homelessness in Santa Monica. This report provides an update, possible next
steps for Council consideration and recommended actions in areas
including: Sobering Center/Psychiatric Urgent Facility; the
Chronic Homeless Pilot Project; possible ordinance or policy changes; Westside
Council of Governments (COG) and advocacy efforts.
Discussion
Staff has gathered information on a
variety of possible measures which could address the community’s concerns and
homeless people’s needs.
Sobering Center/Psychiatric
Urgent Facility: One of the
contributing factors to homelessness, particularly among the chronic street
population, is drug and alcohol abuse.
According to the data available through the City’s homeless services
database (ClientTrack), 25% of homeless persons seeking services in Santa Monica self-report a
substance abuse problem. Service
providers report that the actual rate is closer to 50%. The U.S. Department of Health and Human
Services estimates that nationwide, 50% of homeless adults experience substance
abuse. For half of those, alcohol is the
substance of choice.
The residential components of Santa Monica’s continuum
of care are currently not equipped to deal with chronic inebriates while they
are still intoxicated. Many of them are
simply transported to local hospitals and use expensive emergency room
services. The absence of a “sobering center” where people can be safely taken
by Police and Paramedics while they are still inebriated coupled with intensive
services designed to steer participants toward sobriety, has been identified as
a gap not just in Santa Monica’s
continuum of care, but across the entire Westside.
At its January 11, 2005 meeting, City Council directed staff to move
forward with the development of a sobering center on an expedited basis and
expressed an interest in a regional approach, including the potential to
include a sobering center in a County-operated psychiatric urgent care center
on the Westside. Further, the Council
established the following goals for a sobering center.
- To slow or stop the cycle of chronic
alcoholics going in and out of detoxification centers, jail and emergency
rooms;
- To divert this population off the
street and into treatment programs;
- To significantly reduce the
uncompensated costs, time constraints and personnel burden to healthcare,
law enforcement, fire and paramedics, and judicial infrastructure caused
by homeless chronic alcoholics;
- To give people who routinely live on
the street an opportunity to create a stable mainstream lifestyle;
- To link with the criminal justice
system to promote treatment as an alternative to incarceration;
- To develop a program which does not
draw additional homeless persons to Santa
Monica from other jurisdictions.
Since the January meeting, staff from Community and Cultural Services,
Police, Fire and the City Attorney’s Office have been working with the Los
Angeles County Department of Mental Health (DMH), local hospitals, and
non-profit service providers to examine the potential for both a regional
out-patient psychiatric urgent care center and sobering station, and to begin
planning for the possible development and implementation of co-located
programs.
Planning efforts have included a thorough review of current
best-practice models of sobering centers.
The models reviewed include free-standing sobering centers (not
co-located with mental health programs) in Santa Rosa,
Escondido, Santa Clara
County (San Jose)
and Santa Barbara; and sobering centers linked
with psychiatric urgent care in San Francisco
and Santa Cruz. In addition, models of court-linked programs
that offer serial inebriates a treatment option as an alternative to
incarceration were studied, including San Diego, Santa Clara County (San Jose),
Sonoma County, and Escondido. In San Jose, a free standing
sobering center was opened in 1995 – however it was closed in 2003 due to
declining use by the Police and the need by clients for medical treatment which
could not be met by the center. However,
a court-linked drug treatment program in Santa Clara
County (San Jose), was instituted in 1997. This program provides one year of treatment
as an alternative to incarceration and involves coordination between all
sectors of the criminal justice system.
Sources estimate the program saves Santa Clara County
$1.8 million per year.
A literature review indicates that, given the frequent co-occurrence of
substance abuse with mental health issues among the chronic street population, the
linkage of a sobering station with psychiatric urgent care would yield the most
immediate and seamless model of intervention, increasing the likelihood of
engaging participants in on-going treatment and ultimately housing. Incorporating the criminal justice system
through outreach and alternative sentencing has also been a valuable tool for
engaging serial inebriants into the continuum of care in some communities. In other counties, where misdemeanor
offenders may actually serve jail time, such programs appear to have been
successful. In Los Angeles County,
where misdemeanors are seldom sentenced to jail time, the dynamics are very
different because criminal prosecution does not pose the same threat.
Planning efforts also included a survey of local hospital emergency
rooms to determine how many emergency room visits could have been redirected to
a psychiatric urgent care and/or sobering center, if those facilities would
have been available. During the week of
February 14 – 22, emergency room staff from Brotman
Medical Center,
Saint John’s Hospital,
Daniel Freeman Marina
Hospital, UCLA and Santa
Monica/UCLA completed surveys regarding 100 individuals who were brought to
their emergency rooms for the purpose of psychiatric evaluation or
hospitalization. Overall, 34% were
homeless (80% at Santa Monica/UCLA); 41% did not require inpatient psychiatric
hospitalization (and thus could have been taken to an urgent care facility);
and 33% would have been appropriate for a sobering center.
The findings of the survey validate both the need for a psychiatric
urgent care facility and a sobering center.
At this time, County
DMH is working with a
regional provider to secure funding through the Mental Health Services Act
established by Proposition 63 for the operation of a psychiatric urgent care
facility. It is anticipated that
services could begin as early as October, 2005.
An available site at 10000
Venice Blvd., directly across from Brotman Medical Center
has been identified, and Exodus Recovery, the non-profit provider, is
negotiating with the property owner to secure the 10,000 sq. ft. building. Exodus Recovery estimates that they would not
need the entire facility for urgent care, thus making it possible to co-locate
or integrate a sobering center in the same building.
Exodus Recovery needs $30,000 for an initial payment to secure the
building. Under the terms of the lease, monthly payments would not begin until
September, 2005. DMH is in the process of identifying approximately $20,000 in
funding for Exodus Recovery to secure the building, which is highly desirable
given its size, location, ample parking and compatible zoning. City staff recommends that the City Council
allocate $10,000 to be granted to Exodus Recovery contingent on their receiving
the County funds or the equivalent from other sources to meet the shortfall for
the initial payment.
Between now and September, City staff will continue to work with DMH,
other county agencies, and service providers to refine a sobering center
program, identify the provider (possibly the CLARE Foundation), develop
operating protocols and budget, resolve
legal and liability issues, and identify funding sources. Potential funding sources could include local
hospitals that will benefit from lower utilization in their emergency rooms,
public funds (County, other local jurisdictions or the federal government
including Medi-cal reimbursement for eligible clients), and private
foundations. Tenant improvements for
both the urgent care center and sobering center will be developed and
implemented.
Finally, City staff will continue to explore ways to involve the
criminal justice system in the continuum of care. For example, protocols for the sobering
center could include a “cap” on the number of repeat visits, after which
inebriates would be arrested, charged, and taken to court, where treatment
could be offered as an alternative to incarceration. However, as noted above, one significant
barrier to this model in Los
Angeles County
is the fact that typically, the LA County Jail does not hold persons for
misdemeanor violations for longer than 48-72 hours. The review of the literature for court-linked
sobering centers does indicate that the prospect of longer incarceration—90-180
days—motivates some inebriates to choose treatment.
Chronic Homeless Pilot Project
Update: Another service delivery approach continues
to focus efforts on individual homeless people who are gravely mentally ill and
therefore unable to improve their own lives without significant support. Many communities across the region and nation
are turning to models which actively engage and specifically target the most
gravely mentally disabled and long time homeless people – with the goal of
getting them housed with support services to sustain them in permanent
housing. This entails reconfiguration of
services, ensuring the availability of housing and effective, coordinated use
of public health and law enforcement resources. For the past eight months, City staff
(Human Services, Police, Fire, Housing), service providers (OPCC, CLARE, St.
Joseph Center, Step Up on Second) and the County Department of Mental Health
(Edelman Mental Health and Countywide staff) have developed a pilot project to
more effectively target services to those chronic, most difficult to reach and
“service resistant” homeless people who have been on Santa Monica’s streets for
an extended period of time. The goal of
the pilot is to reach these chronic homeless people with a well coordinated,
strategic, interdisciplinary and sustained effort - and get them off the
streets permanently. To date, 19 people
have been enrolled in this pilot project, 11 are off the streets, and all have
a service plan.
A secondary goal of the pilot project is to understand more about the
service delivery systems and processes that enable, and unfortunately sometimes
constrain, the ability to achieve substantial and sustainable outcomes for the
gravely disabled, chronic homeless population; and, to integrate this
understanding into new approaches to service delivery. Lessons learned from the Chronic Homeless
Pilot include:
- Individual Needs:
The situation of each client is unique.
- Multiple Systems: The prevalence of co-occurring
disorders, the severity of the individual’s health, substance abuse and
mental health issues, past negative experiences with service delivery,
public benefit and criminal justice systems, records of arrest, poor
credit, lack of traditional social supports (e.g., family), creates a
complicated path out of homelessness with numerous points for a person to
lose contact with the systems designed to serve him or her. This complexity requires sustained
intervention from multiple service delivery systems: law enforcement and
criminal justice; public health, mental health and social services;
private non-profits; and personal social networks such as friends and
family.
- Need for Informed Consent: The ability and
willingness of individuals to give or withhold informed consent for
providers in these multiple systems to share information is critical.
- Communication: Communication between these multiple
systems of service delivery is critical, and often requires providers to
rely on personal contacts with colleagues, spend time on weekends or
evenings following up, and work with multiple staff within a particular
organization to identify the key person with whom to collaborate.
- High Level of Staff Expertise: The level of intensity
required, and the need to sustain the intensity over time, requires that
higher level staff step-out of their normal routine of service provision
to expend extraordinary efforts to coordinate services for one
individual. At current staffing
levels, this could mean that the level of service to other clients will
decrease.
- Timing and Planning: The succession and timing of events in
the path out of homelessness is critical.
Planning elements of the path out of homelessness ahead of time,
for example, ensuring the availability of key staff from one delivery
system to take the “hand off” from another system, can increase the
probability of a successful outcome at the key moment an intervention
becomes possible.
- Role of Law Enforcement: For many, the first event
in the path out of homelessness is interaction with law-enforcement. Police can play a crucial role in making
the linkage with outreach and services.
Sometimes, an arrest and incarceration can be the precipitating
incident for a psychiatric assessment and subsequent care.
- Courts: The criminal and civil court systems can
also play a key role. In criminal
matters, offering services as an alternative to incarceration can be
effective. Civil matters, such as
the process for placing persons on a 72-hour hold, or into a
conservatorship, can be key ways to initiate and sustain treatment and
contact with service providers.
Existing laws vary in the effectiveness of their application toward
positive outcomes.
- Cost: Staff are assessing the costs involved
in this intensive and focused approach to service delivery for the most gravely
disabled. It is clear that most of
these gravely disabled people will require a lifetime of support to
maintain housing and remain off the streets. However, based on studies in San Diego
(1997-98) and elsewhere, it is also clear that these chronically homeless
people use a disproportionate share of police, paramedics, hospital and
other public resources – costly resource use which is reduced when people
are in treatment and housing.
The successes and lessons from the pilot effort have led participating
agencies to agree to continue and expand the pilot in the coming year. One of the challenges will be to
institutionalize the lessons learned by developing policies and procedures
across the multiple systems of service delivery. A second will be to make sure that the
existing resources in Santa Monica’s
continuum of care are deployed with maximum effectiveness toward meeting the
needs of this population.
Possible
Ordinance or Policy Changes: Changes in policy and law may help address
problem behaviors which impact the entire community. Staff from various City departments,
including the City Attorney’s Office, Police, Community and Cultural Services
and Environmental and Public Works Management continue to review City
ordinances for effectiveness and enforceability, consider revisions or new
ordinances as appropriate, and assess the enforcement of ordinances to ensure
public safety and the balanced use of public spaces. Key areas of focus include threats to safety,
camping and other high impact use of public facilities. Parks and community facilities are intended
for shared use by the entire community.
Behavior which tends to pose safety threats or monopolize public space
forecloses shared use and undermines public safety and welfare. Therefore, staff have focused the following
areas:
- Abandoned property:
Current
City law prohibits
leaving unattended property on City sidewalks for more than 10
minutes. This prohibition may be
extended to all public parks and open spaces and that extension would
serve the need to ensure security in all public spaces in the post-9/11
environment. Also, current practice
includes storing abandoned property for 90 days. This amount of storage time can probably
be reduced. Increased enforcement
may, however, require an additional storage facility.
- Lying or Sitting on Sidewalks:
The Los Angeles Municipal Code prohibits sitting or lying on
sidewalks everywhere in the City. Santa Monica has a
parallel law applying only to the City’s more crowded public space, the
Third Street Promenade. Otherwise,
blocking sidewalks is prohibited only if less than four feet of width is
left clear. A provision similar to Los Angeles’
ordinance could be considered.
However, care would be required to avoid the risk of adopting an
anti-loitering law because such laws are unconstitutional.
- Overnight use of car in park and beach
parking lots: Current local ordinance prohibits being
in a car overnight – except to enter or leave a parking lot – in downtown
parking structures. This ordinance
could be extended to park and beach parking lots throughout the City.
- Use of freeway underpasses and off
ramps: While the City’s current prohibition
against camping on public property extends citywide, the City could
explore developing a law specifically applicable to someone being present
in these locations – since they are a dangerous place to be and such a law
may be useful as these locations are not technically City property.
- Vehicular camping:
The Council previously previously declined to prohibit vehicular
camping on City streets. However,
residents continue to lodge complaints.
One serious concern is that passenger vehicles lack sanitary
facilities. The Council may wish to
revisit this issue.
- Pier and Memorial Park Showers: Public showers are available at
Memorial Park and under the Santa Monica Pier. The Memorial Park
showers are open from 6:00 am to 9:00 a.m. and serve approximately 20 to
25 homeless people per day. The Pier showers are open from 5:00 am
to 9:00 a.m. and serve about the same number. The showers, while
originally intended to supplement park gym use or Pier and beach use, have
become an amenity for homeless people. Individuals tend to congregate in front
of the facilities before they open and after they close. The
presence of homeless individuals has attracted food distribution programs
to Memorial Park. Park Rangers and/or Police are called to intercede
and manage problems that occur in these locations.
The SWASHLOCK facility located at Olympic and 5th Street (linked to the
local continuum of care which assists people in getting off the streets and
into housing and services) will be expanded and improved in the coming
months. It contains showers, restrooms,
lockers and washing machines. It is a
more appropriate resource to be offered by the City than the free standing
shower facilities at Memorial Park and the Pier. Restricting the showers at Memorial Park to
gym users and closure of showers under the Pier may reduce the number of
homeless people who congregate at those locations.
Westside
Council of Governments (COG): The Westside COG has begun collaboration on
regional strategies to address homelessness.
Following COG discussion in November 2004, staff formed a regional
working group including all the Westside Cities and representatives from the
County, Congressman Henry Waxman’s office and service providers to outline
steps for joint regional efforts to address homelessness including potential
use of the federally owned Veteran’s Administration (VA) property in West Los
Angeles. On February 17, 2005, the
Westside COG devoted substantial time on its agenda to discussion of
homelessness and how the cities might successfully cooperate. After an initial presentation from Supervisor
Zev Yaroslavsky, each of the COG cities (West Hollywood, Culver
City, Beverly Hills, and Los Angeles) agreed to
bring a resolution to its City Councils for collective action. The resolution (See attachment) calls for
creation of a regional year-round shelter (including pursuing capital,
operating and program funding) and continued advocacy to both secure funds and
needed legislative reform to realize this vision. Better use of the VA property is a
centerpiece of this effort. The proposed
resolution represents the policy framework for joint action and is complemented
by formation of a subcommittee of the COG, in addition to the staff working
group, charged with developing next steps.
Advocacy: The programmatic efforts and local policy actions described above endeavor
to assist homeless people and manage the impact of homelessness on the general
community. It is important that the City
continue and expand its legislative and policy advocacy efforts to ensure that
the mental health, public health, criminal justice and other levels of
government do all they can to address and end chronic homelessness across the
region and nation. Towards that end,
specific issues to be addressed include the following:
- Mental
Health: All effective laws must
be employed on behalf of homeless individuals that suffer from chronic
mental illness. Life on the street is not acceptable for the healthy and
certainly is not viable for those with serious mental illness. Laws such
as the Lanterman-Petri-Short (LPS) may preclude the involuntary detainment
of people who are seriously mentally disabled. The language of LPS, as well as its
interpretation and implementation, have continued to allow many chronic
homeless and gravely disabled people to remain on the streets of Santa Monica. Passed over thirty years ago, LPS is a California law that
states that people rendered incapable of making rational decisions - no
matter how psychotic or delusional - must be an immediate danger to
themselves or others before being placed in treatment. Moreover, even when they are permitted,
interventions are usually limited to short inpatient stays. More recently, Laura’s Law (AB 1421),
fashioned after New York’s proven “Kendra’s Law”, was enacted in
California to make sustained and court-mandated assisted outpatient
treatment available – with a progressive eligibility standard for those
who do not meet LPS’s restrictive dangerousness threshold for inpatient
hospitalization. However, this
vital assistance will only be available in Los Angeles County
when a full implementation program is established and funded. While the new Mental Health Services Act
funds (Proposition 63) will provide a 15% increase to the Department of
Mental Health’s operating budget, use of legal tools such as Laura’s Law
must be a priority.
- Criminal
Justice System: It is widely
known that no one committing a “quality of life” offense goes to jail in Los Angeles County due to actual or perceived
operating funding shortfalls. And yet often approaches like the SOS
(Streets or Services) program motivate individuals to choose an
alternative rehabilitation program rather than jail time. The County must
redirect resources to utilize now empty facilities rather than turn
offenders back on the streets either without consequences for their actions
or the skills they desperately need to survive in society. As described earlier in this report, a
review of best practice programs in other communities clearly demonstrates
the important role of court mandated alternative sentencing programs. However, these court mandated programs
will only work if the alternative of serving time in jail is real.
- Enforcement
of Public Health Laws: In spite
of several years of joint planning
with hard working and committed Department of Public Health staff,
enforcement of County and State health regulations regarding outdoor food
distribution is not a priority for the County. This hinders City efforts to ensure that
outdoor food groups are in compliance with health laws. County implementation
of health regulations requires consistent application of public health
enforcement resources.
Should
the Council concur, these advocacy issues will be an important focus of efforts
in the coming months.
Budget/Financial
Impact
Funds ($10,000)
to support the securing of the building that would house the psychiatric urgent
care facility and sobering center are in account #01202.544390.
Recommendation
City staff
recommends that the City Council; 1)
support securing a building for a regional psychiatric urgent care facility and
sobering center with an allocation of $10,000 contingent on receipt of County
or alternative funding for the balance required; 2) provide direction regarding any
appropriate modifications to City policy (e.g. specified public restroom closures or limitations on use) or
law; and 3) adopt the attached COG resolution.
Prepared by: Barbara Stinchfield, Director of
Community and Cultural Services
Attachment: COG Resolution