On Tuesday, November 12, 2002 the California Department of Mental Health arranged for individual Commissioners to visit and learn about mental health programs in the Los Angeles area. Commissioners visited the Mental Health Association's The Village, U.S. VETS' Villages at Cabrillo and the Sheriff's Twin Towers Correctional Facility. In addition, the California Department of Mental Health hosted a stakeholder forum on Tuesday afternoon, which several Commissioners attended. A brief summary of the forum discussion is included in these Meeting Minutes.
Presenters who attended portions of the meeting were:
November 12, 2002
The California Department of Mental Health invited stakeholders from throughout the California mental health system to join individual Commissioners for a facilitated discussion. Commissioners who participated in the forum were Michael Hogan, Dan Fisher, Henry Harbin, Larke Huang, Stephen Mayberg, and Nancy Speck.
After giving a brief overview of the Commission's charge, structure, and activities, Dr. Hogan opened up the floor for comments and input. Participants voiced concerns and recommendations about a number of topics, including:
Commissioners encouraged stakeholders to remain interested and involved in the Commission's deliberations and eventual recommendations. The stakeholders of the mental health system will be the "foot soldiers of change" who can help implement many of the recommendations generated by the Commission.
Discussion participants from California included:
|Beverly Abbott, California Institute for Mental Health
Kathy Barger, Fifth District, Board of Supervisors
Douglas Barton, Orange County Health Care Agency
Gale Bataille, San Mateo County Mental Health
Catherine Blakemore, Protection and Advocacy, Inc.
Esther Castillo, Yolo County Alcohol, Drug and Mental Health Services
Jennifer Clancy, United Advocates for Children of California
Bill Compton, Project Return: The Next Step
Kita Curry, Didi Hirsch Community Mental Health Center
Betty Dahlquist, California Association of Psycho-Social Rehab. Agencies
J.R. Elpers, California Institute for Mental Health
Rega Floyd, Barbour & Floyd Partners
Maryann Fraser, Prototype's Women's Center
Sandra Goodwin, California Institute of Mental Health
Ray Guevara, Consumer
Carla Jacobs, NAMI of California
Kathy Jett, Alcohol and Drug Programs
Pearl Johnson, Los Angeles County Department of Mental Health
Diane Koditek, Kern County Mental Health
John Landsverk, Child & Adolescent Services Research Center
Evelyn Lee, Richmond Multiservice Center
Jay Mahler, Contra Costa Mental Health Department
Susan Mandel, Pacific Clinics
Bob Martinez, Cultural Competence Center
William Martone, Association of Community Human Service Agencies
|David Meyer, Los Angeles County Department of Mental
Elizabeth Pfromm, Los Angeles Child Guidance Clinic
Alicia Ping-DiFiora, Hathaway Children and Family Services
Darlene Prettyman, The Anne Sippi Clinic Riverside Ranch
Mary Rainwater, The California Endowment
Mark Refowitz, San Diego County Mental Health
Ambrose Rodriguez, Los Angeles County Department of Mental Health
Patricia Ryan, California Mental Health Directors Association
Bruce Saltzer, Assoc.of Community Human Service Agencies
Al Scaduto, Los Angeles County Sheriff's Department
Carroll Schroeder, California Alliance of Child & Family Services
Rusty Selix, California Council of Community Mental Health Agencies
Marvin Southard, Los Angeles County Mental Health
Darrell Steinberg, California State Assembly
Lynda Terry, Department of Aging
Richard Van Horn, Mental Health Association of Los Angeles
Kenneth Wells, University of California at Los Angeles
Sally Zinman, California Network of Mental Health Clients
November 13, 2002
Panel Presentation: Housing Opportunities for Persons with Mental
Chair Michael Hogan convened the meeting at 9:40 a.m. and introduced the expert panelists. Tanya Tull opened the panel presentation by providing an historical overview of homelessness, including the development of a separate system of programs for homeless people. She commented that America has come to view the existence of homeless people - including those with serious mental illness - as inevitable and acceptable. She emphasized the importance of permanent housing, noting that without the existence of permanent housing, emergency shelters and transitional housing perpetuate and prolong the homelessness state. Ms. Tull described several models for addressing the needs of people who are homeless: "Housing First," services-enriched housing, and neighborhood-based services coordination.
The Housing First philosophy is premised on the beliefs that (1) permanent housing should be the central goal of those working with people experiencing homelessness; and (2) by providing permanent housing assistance immediately and up-front, providers can significantly reduce or eliminate the time people spend in homelessness. Housing First includes:
Services-enriched housing is a model where services coordination is available to low-income individuals living in an affordable rental property. Typically, a care manager facilitates access to services and resources for residents, including people with serious mental illness. As Ms. Tull explained, this model is simple, adaptable, non-duplicative of existing services and cost effective. Services-enriched housing can work with a variety of housing types and tenant populations.
Finally, neighborhood-based services coordination consists of a central point of contact for services coordination which is available to all residents in a neighborhood. This model connects residents to existing services that meet the full range of needs within the neighborhood population (e.g., families, elderly residents, residents with disabilities).
The next panelist, Carol Wilkins, also called attention to the shortage of available affordable housing for persons with mental illness, referring to one study that found people on Supplemental Security Income (SSI) - on a national average - needed to pay 98 percent of their SSI benefits to rent a one-bedroom apartment in 2000. To combat this issue, Ms. Wilkins recommended implementing some combination of the following strategies:
Ms. Wilkins also described the model of supportive housing. Supportive housing is housing that is permanent (not time-limited), affordable (tenants pay around 30 percent of their income) and independent with private living space. Through supportive housing, a broad range of flexible services and supports are available to help tenants reach their own goals and meet the obligations of tenancy (e.g., pay rent). However, services are voluntary for tenants and not a condition of participation in supportive housing.
Ms. Wilkins cited promising outcomes from several studies of supportive housing, including: (1) Eighty percent of tenants (including those coming directly from streets and shelters) were able to achieve housing stability for at least a year, (2) emergency room and hospital visits dropped by more than 50 percent, (3) use of primary care and services to address substance abuse problems increased, and (4) there was increased participation in work and employment services. The largest study - nearly 5,000 individuals in a supportive housing project sponsored by the City and State of New York - revealed that the cost of homelessness for persons with serious mental illness in New York was more than $40,000 per year. Approximately 86 percent of those costs were incurred by the health care and mental health systems, not the shelter system. The study also demonstrated that the cost associated with creating and operating supportive housing was offset by savings in other public systems (e.g., shelter, psychiatric hospital, Medicaid outpatient and inpatient services, prison, jail, veteran hospital).
Ms. Wilkins commented that, while effective solutions are available to solve the problem of homelessness, creative and successful projects are often financed through a patchwork of funding and typically use money for purposes that were not officially intended. The lack of a flexible and streamlined funding makes it difficult to replicate effective strategies. Calling for strengthened partnerships at the federal, state, and local levels, Ms. Wilkins offered several policy recommendations to the Commission:
Tim Cantwell shared information about U.S. VETS, the largest private organization in the country dedicated to helping homeless veterans. The organization and its extensive housing operations are a result of partnership between a nonprofit corporation and a for-profit limited liability company in California. The Department of Veterans Affairs (VA) is also a critical partner in the arrangement, serving as a funder, service provider and/or tenant that stages its own facility operation.
U.S. VETS operates facilities around the country and currently houses nearly 1,300 veterans nightly. After projects under development are complete, this capacity will grow to 3,000 veterans. The partnership has locations in Inglewood, Long Beach, Ventura, and Riverside, California, Honolulu, Hawaii, Houston, Texas, Phoenix, Arizona, Las Vegas, Nevada, and Washington, D.C. Mr. Cantwell provided mental health prevalence data from its Inglewood location. Approximately 34 percent of the residents of the Westside Residence Hall have mental illnesses, including bipolar disorder, PTSD, depression, and schizophrenia. Of those residents with mental illness, 80 percent were also being treated for substance abuse.
Mr. Cantwell described the philosophy of U.S. VETS public/private partnership. The partnership is based on the belief that it is necessary to: (1) engage the private sector around development, management, and financing of housing, (2) involve the business community to make jobs available, (3) partner with nonprofits to provide the services that would promote reasonable tenants and employees, and (5) work with the VA to provide clinical interventions. Thus, the for-profit real estate company secured, financed, built, and delivered the properties used by U.S. VETS. The non-profit was established and financed from a line item of the housing corporation's budget. Without this type of flexible financing, the nonprofit and U.S. VETS success could not have happened.
Mr. Cantwell urged the Commission to:
During the brief question and answer period, Commissioners inquired about ideas for structuring partnerships between real estate companies and service providers, strategies to enhance capacity and reduce fragmentation among the thousands of homeless service provider organizations, incentives for mainstream public housing systems to connect with the mental health and social service systems, and lessons that can be learned from the VA, which has combined resources to secure more than 7,000 transitional and permanent living situations for veterans in the last reporting period.
A copy of each panelist's presentation is available on the Commission's web site, www.MentalHealthCommission.gov.
The public comment period was held from 11:15 a.m. - 12:15 p.m. Chair Hogan welcomed members of the public who were scheduled to present comments and encouraged others to provide information and recommendations to the Commission via the web site. Individuals who spoke and submitted written testimony were:
Steve Beschoff, California Coalition for Mental Health
November 14, 2002
Dr. Hogan opened the period for public comment at 9:35 a.m. The Commission heard from the following individuals:
David Wanser, Texas Commission on Alcohol and Drug Abuse in Austin
Chair Hogan requested that Commissioners approve the draft minutes from the October 2-4, 2002 meeting. Commissioner Townsend moved to accept the minutes and Commissioner Lerner-Wren seconded the motion. The minutes were accepted unanimously with two edits requested by Chair Hogan.
During the work session, the following Subcommittees provided brief updates on their activities: Children and Families, Criminal Justice, Evidence-based Practices, Consumers, Housing, Older Adults, Interface with General Medicine, Employment, Medicaid, and Rights and Engagement. Several subcommittees will report their findings to the full Commission at the December meeting: Criminal Justice, Evidence-based Practices, Suicide Prevention, and Co-Occurring Disorders.
Adjournment and Next Meeting Announcement
Dr. Hogan thanked all presenters and adjourned the meeting at 11:35 a.m. The next Commission meeting will occur December 4-6, 2002 in Arlington, Virginia.
I hereby certify that, to the best of my knowledge, the foregoing minutes are accurate and complete.
Michael Hogan, Ph.D.
These minutes were considered and approved by the Commission at its December 6, 2002 meeting and any corrections or notations incorporated into the text.
Last Modified 12/06/02