A bet­ter way to aid lives on the streets?

Los Angeles Times - - CALIFORNIA - STEVE LOPEZ

Bob, a man with bipo­lar dis­or­der, has lived on the side­walk of a busy Ea­gle Rock boule­vard for a dozen years, with his be­long­ings piled up around him.

Just a few feet from his mat­tress, an apart­ment build­ing that was de­signed to help peo­ple just like him is near­ing com­ple­tion. But it’s not clear that Bob will get in.

“We’ll see if it works out,” Bob told me last week.

In Kore­atown, a gent named Khan lives next to the L. A. County Depart­ment of Men­tal Health’s park­ing lot, un­der a tree with dozens of tea bags dan­gling from its branches.

“I chuck them up there,” he said. Then he asked me to get him some hot wa­ter from IHOP so he could brew him­self another cup.

I looked into this and learned that the men­tal health depart­ment has tried to help, but Khan, who says he’s been in that spot for five years, claims his many prob­lems are not

men­tal. So there he lies, talk­ing about all the forces out to get him.

Sit­u­a­tions like these are un­nat­u­rally com­mon in Los An­ge­les, where en­camp­ments have sprouted far be­yond skid row. And it some­times seems as if peo­ple with stan­dard liv­ing sit­u­a­tions who drive by the en­camp­ments have come to ac­cept that other peo­ple, in­clud­ing very sick peo­ple, live on the streets in­def­i­nitely with all their be­long­ings at their side.

Some street- dwellers claim they don’t want help, though in my ex­pe­ri­ence, that’s sel­dom the case.

Oth­ers want help that doesn’t ex­ist.

And mer­chants and res­i­dents in reg­u­lar houses, apart­ments and con­dos un­der­stand­ably get fed up with some of the un­pleas­ant things that hap­pen when peo­ple who live in tents or boxes with­out clos­ets or kitchens or plumb­ing be­come their neigh­bors.

But in­stead of mean­ing­ful so­lu­tions, what we get are dis­jointed ef­forts of­ten aimed at ad­dress­ing symp­toms rather than causes. Case in point: the L. A. City Coun­cil’s cur­rent move to con­fis­cate the be­long­ings of home­less peo­ple.

That might clear a walk­way for a few hours, but it’s in the same league as writ­ing jay­walk­ing tick­ets to skid row schizophren­ics.

I’ve been pay­ing more at­ten­tion lately to the topic of peo­ple liv­ing on Los An­ge­les streets for three rea­sons:

First, I’ve been fo­cus­ing on is­sues of in­come in­equal­ity in Los An­ge­les of late, and hous­ing is a key part of that prob­lem.

Sec­ond, I’ll be mod­er­at­ing a Zocalo dis­cus­sion next Mon­day about what pro­grams and strate­gies keep peo­ple off the streets.

Third, a con­tin­gent of men­tal health ad­vo­cates has been ask­ing me to op­pose a pro­posal to fold the county de­part­ments of men­tal health and public health into the health ser­vices depart­ment to make one su­per- sized con­glom­er­ate.

They fear that this fu­sion of al­ready big de­part­ments poses the great­est threat to men­tal health ser­vices in years, that the new depart­ment will fa­vor meds over more holis­tic men­tal health re­cov­ery pro­grams and that a drawn- out re­or­ga­ni­za­tion will dis­tract from key chal­lenges such as help­ing the chron­i­cally ill home­less pop­u­la­tion. Are they right? I don’t have a de­fin­i­tive an­swer. That’s partly be­cause L. A. County su­per­vi­sors, who voted to move to­ward con­sol­i­da­tion, first con­sid­ered the idea in pri­vate and have since done a lousy job of ex­plain­ing why it should hap­pen or how it would work.

Su­per­vi­sor Mike Antonovich is gung- ho for the change, say­ing it will break down bar­ri­ers and pro­duce a sav­ings. That sounds good but doesn’t mean much with­out more de­tail.

And county health ser­vices Di­rec­tor Mitch Katz, the likely czar of the new three- unit depart­ment, has said it would in­te­grate care for pa­tients who suf­fer from phys­i­cal, men­tal and ad­dic­tion is­sues.

That hap­pens to be a good de­scrip­tion of the most hard- core home­less pop­u­la­tion, so I can’t re­ject the idea out of hand.

And I’m also inf lu­enced by my re­spect for men­tal health ad­vo­cate Mol­lie Low­ery of Hous­ing Works, who fa­vors con­sol­i­da­tion.

In the cur­rent setup, she said, there are far too many bar­ri­ers to get­ting treat­ment and hous­ing for peo­ple like Bob. She’s had more suc­cess, she said, go­ing through the county health depart­ment than the county men­tal health depart­ment.

The men­tal health depart­ment wants Bob, for in­stance, to fill out lots of forms and show that he meets all sorts of cri­te­ria, when the ob­vi­ous thing to do is take him by the hand and give him the first unit in the sup­port­ive hous­ing that’s about to open 20 feet from his mat­tress. I’d like to hear the pro­po­nents of con­sol­i­da­tion ex­plain how to speed that process. Here’s another con­cern: Katz gets gen­er­ally high marks for his work. But the county has not had a par­tic­u­larly proud history when it comes to pick­ing depart­ment heads.

What if Katz gets ticked off one day by a su­per­vi­sor’s im­pe­rial tantrum, or grows weary of a screw­ball sys­tem in which he’s got to ap­pease five kings but no one’s in charge of any­thing? What if he turns tail and runs for the hills?

We could be stuck with a weaker ad­min­is­tra­tor run­ning what would be a su­per- en­tity that han­dles county hos­pi­tals and clin­ics, dis­ease out­breaks, nurs­ing home and res­tau­rant in­spec­tions, and the largest county men­tal health depart­ment in the coun­try.

So I need more ev­i­dence that things will change for the bet­ter if three de­part­ments be­come one.

And to get back to the Zocalo ques­tion, what works to lure home­less peo­ple in and keep them housed is not a mys­tery.

You have to be­gin with the un­der­stand­ing that im­prov­ing the lives of some home­less peo­ple, like Bob and Khan, takes a lot of work.

It took me a full year to earn the trust of Nathaniel, the home­less mu­si­cian I’ve writ­ten about. It took time to un­der­stand his ill­ness and help him past his fears.

Even when our health agen­cies and ser­vice providers in­vest in that kind of out­reach, how­ever, there is nowhere near enough hous­ing. And nowhere near enough sup­port­ive ser­vices, with em­pha­sis on men­tal health treat­ment, ad­dic­tion ther­apy and long- last­ing case man­age­ment.

Un­til the city in­vests se­ri­ously in all of that, en­camp­ments will be with us here in the land of be­low sea level wages and sky- high real es­tate. And con­fis­cat­ing prop­erty or re­draw­ing gov­ern­ment hi­er­ar­chy won’t change that.

I need more ev­i­dence that things will change for the bet­ter if three de­part­ments be­come one.

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