Bramson: Home is where the health is

Recently, on a trip down to LA, I found myself in a cab talking to the driver about homelessness. This happens to me a lot, but in Los Angeles, home to nearly 60,000 unhoused residents, almost every person you meet has come into some sort of contact with the crisis. A personal experience, an opinion on what’s wrong and what should be done, or just a simple observation of the current state of misery they’re seeing on the streets daily.

As we passed by a row of tents on the way back to LAX, the cab driver mentioned a story in the Los Angeles Times he had just read about a bigger percentage of people with mental health issues living outside. He said it made sense to him from what he saw driving around town every day. It was Reagan’s fault, he believed, for shutting down all the mental hospitals back in the 80’s. He didn’t seem to think anyone was working on any solutions right now, either. It’s just getting worse and worse, he said to me. I have heard such sentiments quite a bit lately.

As I sit here writing this column on World Mental Health Day, I get how he and many others might have formed this set of opinions. It’s a fact that over four decades ago, California dismantled its primary system of care for people with severe mental illness. But with its many failures clear and documented, the shuttering of these dingy hospitals and psych wards was actually celebrated as a victory for patients who had suffered for years in institutions that simply didn’t help people get any better. At the time, there was also a faint promise of something else yet to come: treatment and care in community and focused on the recovery of the person to help the individual served lead a more healthy, productive life.

But that solution just wasn’t ready back then and, as a result, thousands and thousands ended up without support, safety and a place to call home.

Fast forward to today and we are now hearing the calls growing louder and louder to implement new laws for mandatory treatment and to compel people into care. Born out of some mixture of fear, fatigue and sympathy for the same few folks struggling on the same corner just to survive each day, it’s understandable why politicians, business leaders and the general public are calling for such actions. But make no mistake: putting energy into these efforts marks only a return to failed policies of the past. Moreover, it won’t help our community get any better.

While in a very few cases, in some of the most extreme situations, aggressive interventions might be warranted, the fact of the matter is that there are simply much more effective things that we can do right now for the majority of the homeless people dealing with mental illness. Back in 2004, the Mental Health Services Act had already identified a set of programs and best practices with proven results that emphasized client-centered, family focused and community-based services that are culturally and linguistically competent and are provided in an integrated services system. The bottom line was that with right treatment and support, recovery from mental illness is feasible for most.

Locally, we’re finally seeing those programs at work in the permanent supportive housing (PSH) system. PSH actually delivers on the broken promise made long ago to create real homes for people to live where they can receive access to whatever on-site services and treatment needed. The results so far have been astounding, with over 92% of all Santa Clara County residents in PSH remaining stably housed for a year at more. With a permanent place to stay, people are actually able to address their mental health concerns, reduce the usage of costly emergency services, and continue to grow and thrive. The best news is that thanks to the work of county and city leaders, thousands more of these apartments are on the way.

Beyond PSH, we should also continue to explore how we can partner with behavioral health departments and mental health organizations to reduce the number of people who fall into homelessness. Preventing people with mental illness from ever ending up on the street makes so much sense and can be accomplished if we look to make sure those upstream systems have the outcomes and resources to pair care and housing together for every patient before discharge. Both professionals and patients alike agree that this is the right prescription for success.

With the noise of the crowd, limited resources and a constant push to deal with the direst issues in front of us, it’s easy for anyone to panic and scramble for some way out, quick fix or silver bullet. Instead, we’d do better to remember what others have said and proved before: housing is a medicine and housing is a cure.

San José Spotlight columnist Ray Bramson is the Chief Impact Officer at Destination: Home, a nonprofit that works to end homelessness in Silicon Valley. His columns appear every second Monday of the month. Contact Ray at rbramson@sbcglobal.net or follow @rbramson on Twitter.

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