The Homeless Chronicles. Part 11

This is #11 in a multi-part series about homelessness. Previously we noted that

• Homelessness changes depending on your definition, from very narrow to very broad.
• There are three main groups of homeless people – (1) people who chose to be homeless, (2) people whose disabilities create/contribute to homelessness, and (3) people who experience a major negative event which propels them into homelessness.
• The life style homeless basically want to be left alone. The temporary homeless are looking for help to return them to their normal life. The chronic homeless have such disabling conditions they are the most difficult to reach and to help.
• In recent years, a greater percent of the homeless are coming from the temporary group, fueled largely by the high cost of housing in relationship to their income.
• The commonly used federal survey under –estimates the number of homeless. In reality, there are over a million homeless people nationwide, 250,000 in California and between 10,000 and 15,000 in Orange County.
• There is wide diversity among California counties in the percent of the population who are homeless. Orange County at 0.22% (22 homeless people for every 10,000 residents) is mid low range with an average of 0.39% for the State.
• There is wide diversity among California counties in the percent of the homeless population who are unsheltered. Orange County at 58% is mid low range with an average of 65.3% for the State.
• There is wide diversity among California counties in the percent of the homeless who self-report being mentally ill. Orange County at 28% is mid range with an average of 29.5% for the State.
• The percent of homeless in Orange County who self-reported being mentally ill increased by 133% from 2017 to 2019, an increase unparalleled in the County’s history and in any other California county.
• Neither changes in language nor methodology account for the dramatic increase in mental illness among OC’s homeless. In addition, analysis of commonalities among counties experiencing high increases could not be found.

Today we’ll get some perspective on two reasons why the number and percent of homeless people in OC who reported being mentally ill increased so dramatically.

Mental Health Care

Not Spending Enough Money

OC has been slow to use the monies available for mental health care for homeless people. In May 2019 OC’s Board of Supervisors approved spending an increase of $85 million for this purpose. According to the Voice of OC...

“For years, county supervisors oversaw a stockpiling of the mental health funds that had grown to $149 million in 2015, separate from another $71 million in reserves for an economic downturn. Last year, as county officials were hauled into federal court over a shortage of homeless shelters, Voice of OC reported the stockpiled mental health funds had reached $186 million beyond the reserves.”

“Supervisor Andrew Do stood before the crowd of activists, homeless people, county officials and city managers and said there was no defense for the supervisors’ inaction in spending the money. “I’m gonna tell you, as a chairman of the Board of Supervisors we don’t have a defense. We don’t have a defense. And I’m going to be the first to own up in that we have failed,” Do said. “To lead requires that we are proactive, not reactive. And we have failed,” he added. “[The] thing that caused us to not be able to spend the money is political paralysis,” Do said.”

In April 2019 the Voice of OC reported data from the California Department of Housing and Community Development showing that OC trailed all other counties in their “competitive funding pool” in requesting “mental health housing grants”. The requests per 1,000 residents were only $4,263 compared to $6,480 in Sacramento, $11.386 in Riverside, $12,521 in Fresno, and $32,046 in Alameda.

Data from federally funded “Whole Person Care” programs shows a similar pattern. The number of “unique enrollees” from January 2017 through December 2018 for the top 5 programs showed OC at the bottom (1.8 per 1,000 residents) compared to 2.9 (Los Angeles), 5.1 (Alameda), 14.7 (San Francisco), and 26.9 (Contra Costa). Among the top 5 recipients of WPC funds, OC had the lowest usage on a population basis.

Effective Feb 2019, “California Whole Person Care Pilot Applications” indicated that among the top 12 applications, OC requested the least amount of money and on a population basis, the least per resident. The average for all 11 counties was $121.11 – OC is merely $9.74. Only two other counties (San Diego, Riverside) were even remotely close. On a per homeless person, OC also proposed to spend the least - $4,528 per homeless person compared to an average of $42,419. Only San Diego proposed to spend an amount even close to OC.

By spending so little money on mental health care for the homeless, did OC’s Board of Supervisors cause the dramatic increase in the number and percent of homeless people who reported being mentally ill? It certainly looks like this is a major contributing factor, especially since the percent decreased for more than half the California counties.

Tumult in Orange County

The past two years have seen great tumult in the lives of the homeless in OC. Thousands of homeless people have been forcefully moved and then moved again. Hundreds of new beds have been made available.

Being homeless creates stressors and the dramatic changes in life circumstances for thousands of homeless people in the past two years undoubtedly increased the stresses. People were forcefully removed and re-located, and for some people this happened multiple times. Anyone who was initially unstable or had borderline issues would find themselves even more stressed.

Summary

From 2017 to 2019 OC had a dramatic increase in the percent of homeless who self-reported “serious mental illness”. Among 32 counties OC’s increase (+133%) was the highest, and many more times the average change (2.4%). Changes in language and methodology should be ruled out as possible causes of the increase, as should the increase in the number and percent of homeless people who are unsheltered. Nor are there any obvious commonalities associated with the 5 counties showing an increase of 15% or more that can account for the change. One possible explanation is the comparative under-use of mental health funds by the County in the past few years. The most logical explanation is that the tumult in OC during this period put additional stress on this already “at risk” group of people, enlarging the number who considered themselves seriously mentally ill. Without the back-up of adequate mental health services, the percent of homeless people self-reporting serious mental illness grew disproportionately.

About the Author

Dr. Jim Gardner is the former Mayor of Lake Forest. A Clinical Psychologist, he is a former University Professor and Department Head. He authored several reports about homelessness.