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Homelessness and Mental Illness within Sonoma County
by Paula A, Jenna C, Dom R, B Louie, A Semenza, K Cruz
Wednesday Dec 6th, 2017 7:51 PM
Our research teams decided to look into the homeless mentally ill within Sonoma County. Specifically, the resources and programs that are avaliable to this vulnerable population.
Homelessness and Mental Illness within Sonoma County

Paula Albertolli, Jenna Cooper, Kelly Cruz, Bryan Louie, Dominic Rosales, Andrew Semenza
Sonoma State University Fall 2017

Abstract

Homelessness is an issue that pervades the United States today. Available statistics show that around 600,000 Americans experience homelessness at a given time and that number is steadily growing. In Sonoma County today, the ever increasing population and problem of homelessness occurring throughout the county is an issue. Within the scope of homelessness there are several factors that lead to this social problem. Among this already rising population of homeless, the individuals who are mentally ill are even more vulnerable. Many variable factors cause homelessness, but the overall goal was to highlight where the mentally ill homeless ultimately end up. This vulnerable subpopulation of mentally ill homeless seems to have fallen through the cracks of society. The overall goal of this project was to bring awareness to the how the mentally ill homeless population is hyper marginalized. How this subgroup is marginalized within Sonoma County was researched and analyzed which led to the discovery of inadequate programs and lacking resources county-wide. Possible programs and solutions were discussed leaning towards conclusions that providing short term programs as well as long-term programs are key in mitigating homelessness. Ultimately, these results provide supporting evidence that confirm current scholarly research tied in with these events.

Introduction

The purpose of this research paper is to bring focus to a continuing problem within Sonoma County: Homelessness and Mental Illness. While these two demographics may seem different, they both contain a large population within Sonoma County that at many times can spill over into each other. While previous research has found that homelessness can lead to mental illness and vice versa, the new question that our Sonoma County finds itself with is: How do we best serve this population and what are we doing now to serve them?

It is important to know what services Sonoma County currently provides for the homeless and the mentally ill in order to assess their effectiveness in helping mitigate the problem. We must also brainstorm strategies to increase the efficiency of these programs, and listen to those who work with these services to understand the difficulties associated with this specialized population.

Due to current events, this subject recently took on a new dimension with the devastation within Sonoma and Napa County from the wildfires, specifically the Tubbs Fire. As a result the homeless population increased substantially over night and in turn the subject’s importance has as well. This tragic event as a result only forced the already marginalized group of the mentally ill homeless to further marginalization.

Literature Review

Homelessness is an issue that pervades the United States today. Available statistics show that around 600,000 Americans experience homelessness at a given time (National Alliance to End Homelessness, 2016, Castellow, Kloos & Townley 2015). There are a number of factors that contribute to homelessness, such as housing affordability and availability, as well as other contributing factors such as mental illness and drug abuse (Young, 2015). Available statistics show that millions of Americans suffer from mental illness, with a good portion of that number experiencing homelessness as well (Gittleman, 2005). Even with a significant number of mentally ill homeless Americans, there are a lack of adequate and effective programs to aid individuals both long term and short term (Cisneros, 1996, Gittleman, 2005).

Homelessness in America: Overview

There are a variety of factors that contribute to homelessness, such as the current state of the economy, housing prices, and housing availability (Young 2015). Contributing factors also include mental illness and drug abuse (Young 2015, Gittleman 2005). Historically, those with mental illness were taken to psychiatric facilities, but with the 1980’s deinstitutionalization of psychiatric hospitals by President Reagan, those with mental illnesses no longer had places to provide them with long-term care, which is said to have contributed to the widespread problem of those who are mentally ill falling into homelessness, (Young 2015, Cisneros 1996). Nationwide, there is a lack of long-term resources for homeless individuals as well as those who are mentally ill. This lack of programs causes other public resources such as jails and hospitals to pick up the slack with resources they do not have (Chambers et al. 2013, Espinoza 2017a). Jails are not designed to provide long-term mental health care, but jails house more mentally ill individuals than hospitals do (Pickoff-White & Small 2016, Chambers et al. 2013, Espinoza 2017b). This not only puts an undue burden on the healthcare system, but can also potentially worsen the problem; homeless individuals, after visiting the emergency room, are three times more likely to come back with the same problem. Untreated illnesses, including mental illness, have the potential to get worse overtime when not treated consistently and long-term (Chambers et al. 2013).

Homelessness & Mental Illness in Sonoma County

Sonoma County is no stranger to the issue of homelessness or mental illness; available statistics show that around 20,000 of Sonoma County residents suffer from serious mental illness, with a number of them living on the streets (Espinoza 2017a). In 2016, Sonoma County homelessness surveys showed that approximately 3,000 residents are currently homeless all throughout the county (Hart, 2016). The average demographic of homeless individuals in the county are mainly white, single, males over the age of 25 (Kallen, 2016). According to survey data, the average homeless individual in Sonoma County experiences long-term homelessness, with 53% of respondents being homeless for a year or more compared to 8% of respondents who became newly homeless in the last month (Kallen, 2016).

Homelessness is caused by many factors, and while across the board there are similar factors that contribute to homelessness, some are region specific. In Sonoma County, the main causes of homelessness are housing availability and affordability, (Young, 2015). Currently, Sonoma County is experiencing a housing crisis with only one percent vacancy for rentals, this along with the rising cost of rent throughout the county, is causing many residents to fall into homelessness, (Young, 2015). Housing affordability and availability are cited as two key factors in homelessness, but there are plenty of other contributing factors to homelessness. These factors include substance abuse and mental illness. In Sonoma County alone, around 15-20% of homeless individuals are mentally ill (Young, 2015). While these individuals make up a small portion of the total homeless population, they are undoubtedly the most visible in Sonoma County (Young, 2015).

Programs in Sonoma County

In recent years, Sonoma County has come under fire for lack of services provided to the homeless community and Sonoma County is currently operating with a system that does not have the capacity to adequately serve those in need, (Morris 2017). According to NorthBay Biz, around seventy-five percent of homeless individuals in Sonoma County have nowhere to stay and are forced to sleep outside each night (Young, 2015). Due to the lack of services, homeless individuals have become increasingly frustrated by the lack of effort by Sonoma County to provide adequate services.

With the closing of many psychiatric facilities, including Santa Rosa Memorial Hospital’s psychiatric wing, mentally ill individuals are forced to turn to facilities other than homeless shelters to secure their basic needs (Espinoza 2017a, Espinoza 2017b). Homeless and mentally ill individuals in Sonoma County utilize jails and emergency rooms, causing a revolving door effect, (Hart 2016). In Sonoma County, jails alone are the largest psychiatric facility with 40 percent of inmates countywide suffering from some form of acute mental illness (Espinoza 2017b, Espinoza 2016). Using jails as a substitute for mental hospitals is a short-term solution that causes more issues in the long run in terms of lack of treatment and high costs covered by Sonoma County’s taxpayers (Hart 2016, Espinoza 2017b). Due to the absence of mental health facilities, Sonoma County residents with severe mental illness are taken to hospitals outside of the county and after their short-lived stay are released back into the community (Espinoza 2017a). Releasing mentally ill individuals back into the community with no source of help for them, causes many of them to fall into homelessness (Young 2015, Cisneros 1996). Grievances over inadequate mental health and homeless care have been voiced in town meetings and have been met with a lack of response from county officials citing that there is ‘no strategic plan’ currently in the works to combat these issues on a large scale (Rose, 2017).

Sonoma County Improvement Efforts

In response to the lack of adequate programs, Sonoma County has received millions of dollars in Federal funding to remedy ineffective services (Morris 2017, Espinoza 2015). New programs and services have recently become available to Sonoma County’s homeless population. The Empowerment Center, in Guerneville, provides services for individuals that are homeless and those who are mentally ill. This center is funded by the Mental Health Services Act and is a source of long term aid for Sonoma County homeless (Carroll, 2017). There have also been new outreach programs in the works to provide homeless individuals with permanent housing solutions such as the Palms Inn in Santa Rosa, as well as more resources added to mental health and homeless institutions countywide (Hart 2016, Espinoza 2015). Currently in the works is a 4-year pilot program, which will add more preventative care for those that are homeless, at risk of being homeless, and those who have serious mental illnesses. With the help of federal funding, Sonoma County will increase resources at the Santa Rosa Detox and substance abuse facility (Morris 2017). This form of preventative care will not only assist the mentally ill, but will help decrease resource abuses in emergency rooms and jails. In response to the high rate of mentally ill inmates, the county in planning to build a million dollar mental health wing in the Santa Rosa main jail (Espinoza 2016).

While these plans are a step in the right direction, they only help the issue on a small scale; new improvements to institutions can in no way aid the thousands of homeless individuals in Sonoma County and some of these programs are completely out of reach for poor Sonoma County residents, namely homeless individuals and those with Medicaid (Espinoza 2017a). With new facilities and the increased privatization of Sonoma County mental health services, those who cannot afford to pay for these new facilities will have no place to receive treatment for their illness (Espinoza 2017a). Despite plans to increase services for mentally ill and homeless individuals, citizens have still been met with a lack of response by the county, citing that as of August 2017, the county still had no plans in motion to combat the larger issue of homelessness that plagues Sonoma County (Rose 2017).

Methods
Sample

The goal of this research was to find out the types of programs available to homeless and mentally ill individuals as well as understand the experiences and opinions of individuals that deal with this problem first hand. The sample consisted of professionals working in mental health or homeless facilities. In terms of sampling, the sample was the result of non-probability sampling and was purposive in nature. Professionals ranging from EMT’s to mental health facility workers were included in the sample. In total, we surveyed 3 EMT’s, 8 Correctional Officers working in the Mental Health wing of Santa Rosa County Jail as well as a total of 3 facilities within Sonoma County, and a representative from the Board of Supervisors (Sonoma County Behavioural Health Division, specifically from the multidisciplinary Community Intervention Program (CIP). The 3 facilities sampled included: 1 homeless shelter and youth crisis shelter, S.A.Y (Social Advocates for Youth), C.O.T.S. (Committee on the Shelterless), and 1 mental health hospital: Creekside Rehabilitation & Behavioral Health.

Data Collection

Surveys with open-ended questions were used to gauge opinions of professionals that directly encounter homeless and mentally ill individuals. In terms of sampling, our sample was the result of non-probability sampling and was purposive in nature. Five different instruments were used, each instrument was tailored to fit a specific type of respondent: Correctional Officers, Emergency Medical Technicians (EMTs), Homeless Shelters and Youth Shelters, Mental Health facilities and City officials. The survey instruments included questions on respondent experiences with mentally ill individuals and/or Sonoma County’s homeless population. The survey also included information on respondent opinions to get their take on Sonoma County’s efforts in combating this social issue.


Specific surveys were distributed to participants depending on their job description. Correctional Deputies were surveyed using Survey Instrument #1. A total of 10 surveys were distributed to to Correctional Deputies working in the Mental Health wing of Sonoma County Jail.


Emergency Medical Technicians were a subset of the sample, this group received Survey Instrument #2 . A total of 10 surveys were distributed to Emergency Medical Technicians working in Emergency Medical Services throughout Sonoma County.
Homeless shelters were another section of our sample, this group received Survey Instrument #3. A total of 2 surveys were distributed to Homeless and Youth Shelters.

City Officials were another section of our sample, this group received Survey instrument #4 . A total of 2 surveys were distributed to City Officials.
Mental Health Facilities were another section of our sample, this group received Survey Instrument #5. A total of 2 surveys were distributed to selected Mental Health Facilities.

Data Analysis

Data was analyzed by coding for themes throughout survey responses and identifying common patterns in responses. Responses were then categorized and compared to information presented in newspaper articles regarding Sonoma County homelessness and mental illness in order to see whether our findings corroborated or contrasted public opinion on this issue. Themes that were coded for were program and resource availability, current county action.
However, due to the tragic and historical fires that took place, we had to rescind some data. As a result of the fires, the correspondence of the facilities that house the homeless were severely impacted with high volume in the period our interviews were to be conducted, leading to inadequate data.

Results and Discussion

Available research within the county indicated that homeless and mentally ill individuals in Sonoma County utilize jails and emergency rooms, causing a revolving door effect (Hart 2016). In Sonoma County, jails alone are the largest psychiatric facility with 40 percent of inmates countywide suffering from some form of acute mental illness (Espinoza 2017b, Espinoza 2016). Using jails as a substitute for mental hospitals is a short-term solution that causes more issues in the long run in terms of lack of treatment and high costs covered by Sonoma County’s taxpayers (Hart 2016, Espinoza 2017b). Long term solutions to provide care for a mentally ill homeless person would first, help the person and secondly, get them off the street. However, acute solutions are being used to solve a chronic issue. The lack of programs for individuals suffering from mental illness causes other public resources such as jails and hospitals to provide services (Chambers et al. 2013, Espinoza 2017a). Jails are not designed to provide long-term mental health care, but jails house more mentally ill individuals than hospitals do (Pickoff-White & Small 2016, Chambers et al. 2013, Espinoza 2017b). Due to the absence of mental health facilities, Sonoma County residents with severe mental illness are taken to hospitals outside of the county and after their short-lived stay are released back into the community (Espinoza 2017a). Releasing mentally ill individuals back into the community with no source of help for them, causes many of them to fall into homelessness (Young 2015, Cisneros 1996). This not only puts an undue burden on the healthcare system, but can also potentially worsen the problem; homeless individuals, after visiting the emergency room, are three times more likely to come back with the same problem. Untreated illnesses, including mental illness, have the potential to get worse overtime when not treated consistently and long-term (Chambers et al. 2013).

Overview

In Sonoma County alone, around 15-20% of homeless individuals are mentally ill (Young, 2015). While these individuals make up a small portion of the total homeless population, they are undoubtedly the most visible in Sonoma County (Young, 2015).Homeless individuals who experience mental illness seem to be a growing population; this research was guided by an attempt to understand how to best serve this group and identify possible solutions to this social problem. The primary objective of this research was to examine how public services are providing aid for the homeless population suffering from mental illness in Sonoma County and what service providers recommend as a solution. This was operationalized by interviewing those who come in direct contact with the homeless individuals while living in the street or while institutionalized. Findings derived from these interviews focuses only on categories that concern the homeless population and the sub-population of those suffering with mental illness.

Out of the surveys distributed to the following categories: Law Enforcement, Emergency Medical Technicians, Homeless & Youth shelters, City Officials and Mental Health Facilities, we only received a total of 15 surveys back in total out of the 26 surveys that were distributed. This resulted in a 57.69 % response rate overall.

For each subsection, the response rates varied. For Law Enforcement, 8 surveys were received back out of the 10 distributed, resulting in an 80% response rate for this subsection. For Emergency Medical Technicians, 3 surveys were received back out of the 10 distributed, resulting in a 30% response rate for this subsection. For, homeless and youth shelters, 1 survey were received back out of the 2 distributed, resulting in an 50% response rate for this subsection. For City Officials, 2 surveys were received back out of the 2 distributed, resulting in an 100% response rate for this subsection. For Mental Health Facilities, 1 survey were received back out of the 2 distributed, resulting in an 50% response rate for this subsection.

After interviewing Correctional Deputies from the Sonoma county Jail, 911 EMS providers, mental health and homeless facilities about their experience with the individuals who are defined as mentally ill homeless, some findings showcase valuable comparisons among survey groups. It is important to note that the findings in this study are are only opinions and experiences of the people who provide service to the subpopulations as a whole. These findings are not intended to represent with any certainty a solution to the issue, but rather a way to provide some insight and possible solutions in future policy making or social change. Individuals who were most likely to experience contact with the homeless population were recruited for this study. Be that as it may, this sample does not include homeless individuals themselves. The value of using a sample of correctional deputies and emergency medical technicians-paramedics, shelters, and mental health facilities, was that it provided an opportunity to deliberately make familiar what is disregarded about the homeless in today’s society, and to be able to gain some insight from their perspectives. One of the central themes of questioning and analysis in this study concerned the revolving door issue. A problem that costs taxpayers money in transporting a homeless person to the hospital or housing them in jail. The questions asked were focused around what provider’s experience and some suggestions to what could potentially solve the issue.

The goal of analyzing the data is to review what is currently known about homelessness and how to resolve this social issue by coming up with hypothesized solutions from the data. Focusing on what public services are offered was the key element in supplementing the literature. Mostly unstructured Qualitative Data was used to conduct an overall analysis in each category of groups or services that come in direct contact with the homeless population here in Sonoma county, and while shifting a more specific focus on those who suffer from mental illness.

The analysis of this interview data follows the principles provided by the literature researched in lieu of this study. This was an inductive analysis procedure that included the process of gathering and analyzing the data. No additional constructs are being found and the properties of the constructs can be developed from the interview data. However, in an effort to open the interpretive process to a wider variety of subjective viewpoints, several team meetings were held for the analysis of the data.

Although each team member approached the data with their own analytical interests in mind, they shared their perspectives, knowledge, and insights on all aspects of the data, which broadened the scope and depth of this analysis. The team was comprised of six students in the investigative sociology course at Sonoma State university. By interviewing the groups of people who directly and collectively work with the homeless population, including those who suffer from mental illness, they provided exceptional information that constitute the daily life of a homeless person in use of public services. By interviewing these groups, we present how life for the homeless population involves different facets throughout the community and how complex and diverse it can be for them. Some themes emerged in the interviews and questionnaire process amongst the workers who work directly with homeless individuals and were focused on the revolving door issue.

Law Enforcement

Beginning with the Sonoma County Main Detention Facility, the layout of the data is in order of highly structured to less structured in terms of services. Among the correctional deputies interviewed, about half responded that they were trained in identifying individuals with mental illness. They had described how they look for disparities in behavior, and recognize how to communicate efficiently with the individuals suffering for mental illness. The reason only half were trained was because these correctional deputies were part of the specialized mental health team and went through specific mandated training. This information is relevant to the data due to the fact that the county provides specific training for employees in order to provide these services. The participants reported that violent behavior coincided with substance abuse which is one of the generalized problems that seem to reoccur in the jail, and generally speaking that substance abuse and mental illness seem to go hand in hand for most. Some individuals in the mental health unit were in custody due to communicating of being suicidal, while others were medicated. Substance abuse, however, has been proven to lead to mental illness but this data was not applied to our study. It did help to recognize that the issue of mental illness has several components.

In terms of being institutionalized, all of the deputies interviewed expressed that there is a relevant and significant difference in the mental health unit. The availability of programs to assist internees are stratified and organized based on the needs of each individual. Half of the deputies reported that they are willing to spend more time actively listening to the inmates, to evaluate their needs and be advocates of their safety. All the deputies reported that the basic needs for these individuals who would otherwise be homeless and suffering from mental illness were indeed being met, from beds, meals, medications, and even counseling services. Unfortunately, 90% of the correctional deputies expressed that if these individuals were not institutionalized, that 75% or more of these persons would be indeed living in the streets. One deputy said in particular, “they would have nowhere to go.” Again, all deputies who participated in the interview expressed that the main difference that being institutionalized and regulated was, they offered a regimented and stable treatment program. Majority of the deputies reported that with the proper intervention, prevention, and habilitation, the greater number of homeless individuals who suffer from mental illness would not be incarcerated. They truly believed that with the right guidance that these individuals who want to get better could, and that ultimately they do not belong incarcerated unless they have committed crimes.

In terms of the revolving door issue, all participating sheriff correctional deputies stated that they had indeed witnessed a homeless person with mental illness undergo treatment while institutionalized, have success, be released from custody, and returned to jail from a lapse. One deputy stated how an inmate was essentially discharged with the proper medications and instructions to continue taking them but instead ended up taking illicit drugs to self medicate instead. All the correctional deputies agree that jail is not the place for people with mental illness and that these homeless people need other forms of help. Most expressed how more funding or programs should be made available. All expressed the reoccurring theme of a need and idea for a specialized medical mental health hospital. Again, The participants questioned were correctional deputies in the Sonoma county adult detention facility, they provided some helpful insight in perhaps the development of rationalizing framework to conceive a more appropriate institution for individuals who suffer from debilitating mental illness which in turn leads them to become homeless.

Emergency Medical Services

Shifting focus to another structured service that is provided by Sonoma County that comes into abundant first hand contact with the homeless population are the emergency medical service personnel. A more extensive interview involving paramedics and emergency medical technicians (EMTs) helped expose some of the homeless encampments and the frequency of transport and use of resources. The purpose of interviewing this group of people was to stimulate critical thinking and derive opinion based solutions to the homeless issue.

All the respondents stated that over the course of a work month, that an average of about 10 and in some cases upwards of about 20, homeless people have used the emergency service of hospital transportation, in which case while transporting these individuals, they knew several on a first name basis. Some homeless individuals at times are transported more than once a day. All correspondents stated that the age range of these homeless individuals were between 45-60 years old.

Heavily saturated outdoor encampments were stated to primarily be located along the Joe Rodota trail that runs parallel to highway 12 west, and under the 6th street bridge in downtown Santa Rosa that makes up a portion on the 101 freeway. EMS providers discussed that they are not trained to diagnose mental illness but through years of experience they have developed skills that aid in possible diagnosis: “We are trained to have a high index of suspicion but not to diagnose. In my opinion you cannot know for sure if someone has a mental illness because often it is masked with self defense mechanisms or drugs/alcohol. However, those that are currently expressing their illness exhibit a wide variety of characteristics such as but not limited to: paranoia, talking to themselves, catatonic behavior, violence, and irritability.”

Other respondents expressed that mental illness diagnosis is increasingly difficult in individuals with substance abuse: “It can be hard to differentiate between mental health problems and intoxication especially with Methamphetamines.” These passages support the idea that substance abuse is prevalent in the county and may commonly be lumped together with mental health.

Without extensive training to diagnose mental health issues, EMS is limited in the services they can provide for individuals that suffer from mental illness:
“In EMS we are not trained to diagnose an individual’s medical emergency, but investigate the scenario and treat the most appropriate possible medical concern under a list of medical treatment protocols. In short, we assume the worst based on the complaint or presentation, then work backwards. We do have limited training in recognizing behavioral emergencies, but do not have training to help an individual with them other than take them to an emergency room or direct them to their personal physician. We may receive a call for a person who states they feel depressed and would like to commit suicide. The only training, we do have, is to transport them to an emergency room as a possible 5150 (legal document that states a person is a danger to themselves or others). Another scenario would be a schizophrenic homeless person whom is not compliant with their medications and is behaving erratically or dangerously in a public area. Often times they can violent for no perceivable reason, verbally abusive to themselves and others, and will speak about things that are not considered logical or reasonable. Often times they display deep paranoia.”

These participants help emphasize the prevalence of homelessness in Sonoma County. All correspondents expressed the problem of substance abuse seems to frequently reoccur. Leading to the possible inquiry of a deeper analysis of the correlation of substance abuse with mental health and homelessness. Some opinions expressed when asking what these providers felt would be an ideal solution were insightful and allowed for their perspective to shine through. These are the people who see a side of society that most of us turn a blind eye to on a day to day basis. The biggest problem all correspondents seem to remark on was the lack of a safe home. A paramedic stated “They all tell me it takes months to get a bed off the streets. I think this would go a long way to help them get back on there feet. I also think that since that is optional, to include daily managed prescription med assistant could assist them with the mental desire to get and stay clean and sober. I understand that this treads on personal choice for health care but a lot of these people are not in a clear state of mind to do so.”

When asked about if the county they work for seems to do enough for the homeless population before the tragic fires, all correspondents answers seemed to be an honest ‘No’. All in all, they felt that more could be done to provide aid for the mentally ill homeless individuals and that any resources for mental health in the county seem to be significantly underfunded. They stated that there are plenty of resources for the homeless population but accountability and responsibility in wanting to get help to help their mental health was key. As a result, it seems that with proper funding, the advancement of newer studies, the addition of new programs that have a history of successful results, we could significantly help the social problem. All correspondents stated the same response as the correctional deputies and the literature results, that 75% or more of these individuals would continue to remain homeless if not in temporary housing, facilities, the hospital, or jails. The possibility of having a long term mental health facility was a suggestion that many correspondents acknowledged.

The indication of having a long term full time mental health hospital would aim at assisting a person with their care. To provide these afflicted people with the ability to participate in society and to help alleviate the stigma. These individuals are not likely to stay in short term facilities because it is not what they need. Long term mental health care virtually seems to not exist currently. In terms of a possible solution for a public service to provide aid for the mentally ill homeless or those afflicted with substance abuse was that of an EMT stating, “I realize this point of view is extreme and highly unpopular in America but I do have a strong curiosity in the exploration of safe drug sites in a community. Based on some strong data from other countries about the addition of safe drug sites significantly decreasing drug related violence, homelessness, and the spread of infectious diseases, I am willing to at least have the conversation about adding these resources to not only the homeless but other drug abusers as well. Again, these resources have shown how they greatly improved a community’s ability to reduce homelessness that results from drug/alcohol abuse.” This could be a potential resource that could be made available for people to find a safe place for people to go instead of having someone call 911 and have them transported and the associated financially costs it may ensue.

One of the opinions received, one that captured our interest was that of a paramedic who stated, “I feel it is a never ending story with no concrete solution. The difficulty lies with questions like this. There is not one answer or solution for everyone with a mental illness. They all have different needs, different stories, and paths that have led them to their situation currently. Whether it's congenital, drug induced, bad luck, whatever the reason. The solution cannot be a broad spectrum one stop shop to fix them. In all honesty, I don’t believe a large percentage of these people can be “fixed”. I believe they can be supported and attempted to be integrated. But socially normal as we see it, is not possible. I truly believe it is a disease or illness that has no cure.”

From analyzing the data from the Correctional Deputies, I arrived at finding that it was preferable and more valuable for these people in custody to receive the medications they needed to assist them in living a more normal life. With the proper guidance, as opposed to self medicating in the street with illicit drugs, could be a key factor in establishing a more regimented solution. Simply because they can not be incarcerated permanently, that would be incompatible with societal structure. Long term treatment facilities with proper societal reintegration programs are imperative to creating a solution. From analyzing the data from the EMS personnel, the main theme that kept reoccurring with the homeless population focused on substance abuse. Which forces us to connect substance abuse with homelessness, which a lot of qualitative data is available. Overall in finding an answer to our research question, we faced the reality that the public services can only do so much and leave the decision making up the person with mental illness. This creates a cycles that leads these people to fall in the cracks of society and end up in a revolving door that never provides the care that they ultimately need.

County and City Services

The unfortunate timing of the wildfires that hit Sonoma and Napa County impacted our ability to have a face to face interviews with any members of the Sonoma County Board of Supervisors or the Santa Rosa City Council. Thankfully, we were able to receive some helpful information regarding Homeless and Mental Health services within Sonoma County from the Board and the Santa Rosa Housing and Community Services listed within.

Sonoma County contains homeless and mental health services from the Sonoma County Behavioral Health Division such as the multidisciplinary Community Intervention Program (CIP). This program provides services at a facility called the Brookwood Health Clinic, a drop-in health care clinic for homeless persons. While at the Brookwood Health Clinic, assessments are completed to determine the appropriate homeless services necessary to each individual; concurrently, these assessments can also help determine if a person requires mental health care. Other than the CIP, the multidisciplinary Homeless Outreach Service Team (HOST) does proactive street outreach and collaborates with CIP to bring their expertise to unsheltered people with mental illness where they are found.

Typically, when Sonoma County Services refers to someone who is homeless due to mental health issues alone, they are referring to the severely and persistently mentally ill population qualifying for specialty mental health care. Sonoma County Behavioral Health offers a wide range of community housing options for this population—from supervised, unlocked Board and Care facilities, to supported independent living or shared housing with services, to people living in market rate housing. The range of options allows individuals to be moved to a higher or lower level of care depending on their needs.

Further, if severe and persistent mental illness has directly impacted the person’s ability to live independently and the person meets the criteria for specialty mental health care, their eligibility for County mental health services can be established and the Sonoma County Behavioral Health (SCBH) Division will take responsibility for assessment, crisis stabilization, and case management. The case manager will follow and assist SCBH clients whether they are housed or not. This is a very small segment of the homeless population experiencing mental illness, but the services are extensive, crucial, and most often successful.

Currently, under the Affordable Care Act, people who require mental health treatment, but do not meet the criteria for specialty mental health care, are now referred for treatment through Partnership Health Plan to a range of community clinic and private mental health providers. There are lengthy waits at some of the clinics, but there are many private providers whose services can be covered.

Similarly, the City of Santa Rosa’s Housing and Community Services Department Homeless Services Division works closely with homeless service providers such as Catholic Charities and the Community Homeless Assistance Program (CHAP). The City helps to fund these programs and does not provide specific services directly to the homeless, but operates through the funding of the programs.

Both the county and city rely on their respective Police Departments to provide direct support to the homeless and mentally ill; the County’s Mobile Support Team also provides support to law enforcement during a behavioral health crisis. While the police are provided training, it can be argued by the public that this training is not enough to stop potentially deadly interactions. From our survey, the City reported that some supportive services such as funding and better coordination with the County’s safety net and behavioral health programs could go far with aiding the mentally ill homeless population.

Both the County and City presented the impression that Sonoma County is making efforts to address homelessness, but unfortunately it is not enough. For example, the Santa Rosa Police Department’s Downtown Enforcement Team works closely with Catholic Charities Homeless Outreach Service Team (HOST) to coordinate services and shelter for persons experiencing homelessness. Further, the City recently started a Homeless Encampment Cleanup Pilot Program which aims to address the health, safety, and shelter needs of persons experiencing homelessness and living in encampments as well as to mitigate impacts to the surrounding community. With the implementation of this program, occupants are offered services and shelter prior to cleanup of the area, which is a key component of the program.

While the services that both the County and City provide and fund appear to be plentiful, data from the 2017 Homeless Census show that there are more than 2800 people experiencing homelessness in Sonoma County. Out of the 2800, 39% of them reported a psychiatric or emotional condition.

Local Facilities

As the previous data reported, County and City funding and services are quite limited in the assistance that they are able to provide for Homeless and Mental Health Services. With over 2000 homeless individuals in Sonoma County, and almost 40% of them reporting a mental or psychiatric illness, services are scarce, including beds at mental health and homeless facilities. Our group obtained information from Creekside, a psychiatric facility, and Social Advocates for Youth (SAY), a local organization that aids in providing affordable housing for young adults.

For starters, both facilities have incredibly limited beds available for people with Creekside reportedly having 57 beds, and SAY reportedly having 12 beds. The purposes of both facilities is to aid the residents in assistance with re-acclimating into the community. Both facilities have programs that teach the residents social and work skills so they can pursue a career and home independently. At Creekside, residents have varying amounts of treatment time from as short as six months to as long as never leaving. Each resident’s stay depends on their mental illness and how receptive they are to medication adherence. While SAY relies on local and County funds to maintain their services, Creekside receives payment from each resident’s Medi-Cal insurance services so Creekside does not feel the financial crunch that SAY does. Similar to the results found throughout each interview/survey, the main component each agency appears to need is either federal or some other sort of funding stream.

While the group would have preferred to obtain information from multiple homeless and mental health facilities within Sonoma County, the wildfires did not assist with this and only Creekside and SAY responded to our group’s surveys.

Proposed Solutions

While certain county plans are a proposed step in the right direction, new improvements to institutions can in no way aid the thousands of homeless individuals in Sonoma County. However, with some insight in response to the literature along with supplemental information that continues to come into the subject matter, some recommended solutions came forward.

When asking correctional deputies and emergency medical services whom work directly with our focused subgroup population, they provided some considerably strong recommendations. In addressing this problem of the mentally ill homeless population, all respondents felt that the county does not do enough. In learning and confirming that the releasing of mentally ill individuals back into the community with no source of help, essentially forces them to fall back into homelessness, we made an effort to look closer into this. We identified this issue as the revolving door effect, and many of the workers interviewed were direct witnesses to this dilemma.

Many correctional deputies agreed on the solution that the county should move forward with the administrative ideology of providing better mental health services and use the federal money to start the construction of the mental health unit. The unit would have more therapeutic treatment options as opposed to having these people housed in segregation units that have been proven to cause detrimental mental health effects.

The longer these individuals stay in jail and untreated, their potential to get worse overtime is almost guaranteed. The deputies suggested proper intervention, prevention, and habilitation as potential solutions. Correctional deputies provided some helpful insight in perhaps the development of rationalizing framework to conceive a more appropriate institution for individuals who suffer from debilitating mental illness, that should be underway. Unfortunately, due to the fires, the funding for this program may be adjourned until further notice.

EMS personnel provided some opinions and potential solutions to this issue. Due to the heavy correlation of mental health with substance abuse, these workers looked at the homeless individuals with a more clinical eye. The notion of substance abuse could lead someone to homelessness and their solutions were based on a more medical standpoint. A long term full-time mental health hospital would aim at assisting a person with their care. Having safe drug sites for people with substance abuse and homeless issues to go to would alleviate the 911 system and emergency rooms. Providing nurses at these safe detox centers could lead to helping individuals with addiction.

The themes of preventative care and long term care were the ultimate recommended solutions. For further and future research, looking into how these safe havens have worked in other societies would be something to look into for people who suffer from substance abuse, addiction, and mental health. One stand-out place that was not mentioned was that of the Empowerment center in west county. More centers like these could create collaborative groups of non profit organizations to help people who need counseling and housing services.

Also, as our results discussed, Sonoma County contains homeless and mental health services from the Sonoma County Behavioral Health Division. The county offers a wide range of community housing options for this population and are often successful. Under the Affordable Care Act, people who require mental health treatment, are now being referred for treatment through Partnership Health Plan even though waitlists are long. City of Santa Rosa’s Housing and Community Services Department Homeless Services Division works closely with homeless service providers such as Catholic Charities and the Community Homeless Assistance Program (CHAP), who aided in reopening the Palms inn as housing apartments for homeless veterans. Sonoma County is making efforts to address homelessness, but unfortunately it is not enough.

The Santa Rosa Police Department’s Downtown Enforcement Team works closely with Catholic Charities Homeless Outreach Service Team (HOST) to coordinate services and shelter for persons experiencing homelessness. Further, the City recently started a Homeless Encampment Cleanup Pilot Program which aims to address the health, safety, and shelter needs of persons experiencing homelessness and living in encampments as well as to mitigate impacts to the surrounding community. For now, the resources are available, but it is the overwhelming size of homeless population that forces the mentally ill ones to be marginalized.

Setbacks Following Sonoma County Fires

Due to the recent outbreak of fires which has consumed a sizable portion of Santa Rosa and left thousands more of Sonoma County residents homeless, reaching shelters as one of our main data components would be likely unattainable. Not only out of respect to the survivors from the fire, but taking employees away from caring for survivors would be morally wrong. Shelter priorities would be geared towards helping these survivors and asking for an interview at such a time would be taking away focus (no matter how small) away from the survivors. So in response to this, we shifted our focus to interviewing specific mental health facilities and specific homeless shelters (Aurora, Creek Side, C.O.T.S., and Catholic Charities and S.A.Y.) based on their availability, previous calling, time, and or recommendations from our classroom instructor.

Difficulties Obtaining Data Post-Wildfires

During our group’s process of gathering data, devastating wildfires occurred throughout Sonoma and Napa Counties which greatly limited the amount of data ultimately gathered. After the wildfires, all County and City services as well as local homeless and mental health services became impacted and were either unable or unwilling to meet face-to-face for interviews or complete surveys.

For facilities that were to be visited, we were unable to properly attain information from a certain number of facilities listed. For the Mental Health Facilities, Aurora Santa Rosa Hospital did not respond to the requests of our groupmates (Kelly and Andrew); our group sent requests via email as well as leaving them messages. Creekside Rehabilitation & Behavioral Health facility did respond to our request and an over the phone interview was obtained. In regards to the specific homeless shelters, C.O.T.S responded to us. However, a timeline in which the interview could be performed was not specified, but survey guides were taken in order to fill out via email. Catholic Charities responded to Kelly and Andrew and said they would provide a completed survey to us by the end of 11/14/17 and sent back to us via email.

In response to lack of responses by these facilities,two members of our group, Kelly Cruz and Andrew Semenza, attempted to obtain either an interview or survey completed at local organizations Catholic Services and the Committee on the Homeless (COTS). While unable to obtain data from these locations, the group members’ detailed observations of their visits.

Conclusion

As can be seen from the results and data collected, the County of Sonoma and City of Santa Rosa are aware of the homeless and mentally ill populations within Sonoma County. The lingering problem that not only our county faces, but all other counties face is: How do we properly address this population? This question takes on a new dimension due to the recent wildfires that destroyed many residences in Sonoma and Napa counties, especially affluent neighborhoods. With many new homes destroyed, the County faces an exponential increase of depression and mental illness. We don’t have to look too far to see the repercussions of the wildfires with the recent suicide of a well-known dentist in Santa Rosa that killed himself in front of the remains of his home.

The County and City of Santa Rosa have employed short-term solutions in the hope that these will serve the mentally ill population. The Sonoma County Main Adult Detention Facility (MADF) currently is the largest psychiatric treatment facility within the county. While a jail generally holds individuals that have committed a crime, the lack of other programs causes other public resources such as jails and acute care hospitals such as Aurora Hospital in Santa Rosa to provide these services.

The provision of services becomes even more difficult when taking into consideration that according to the 2017 Santa Rosa Homeless Census there are over 2,000 homeless individuals in Sonoma County, and nearly 40% of them reported a mental or psychiatric illness. A main point emphasized by all the individuals surveyed was the lack of federal and state funding to Behavioral Health services which carry the umbrella of providing services to the mentally ill homeless. With the destruction caused by the wildfires however, a majority of funding that would have potentially gone to mental illness and homeless services will most likely be diverted towards the rebuilding of the affected areas, leaving these services to stretch their resources even thinner.

Some counties are trying to find other ways of funding mental health services. For example, in Mendocino County a ballot measure was introduced that would increase sales taxes to fund mental health facilities and services. Measure B, the Mental Health Treatment Act, would impose a half-cent sales tax across Mendocino County for five years, then decline to an eighth-cent tax. If approved, it is expected to generate $38 million for five years, through June 2023, and just under $2 million a year thereafter.

A large point of emphasis with this research project was to find what services are currently assisting the mentally ill and homeless populations. After the wildfires now, the point of emphasis turns now to maintaining what limited resources are available and not forgetting this population as focus shifts to the newly homeless.

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