[Hpn] evil never sleeps...
Mon, 22 Dec 2003 16:44:22 -0800
Meanwhile, Back at City Hall
by chance martin
[San Francisco-12/22/03] With most local media blinded by this autumnıs
marathon election spectacle, in the background the City and County of San
Francisco quietly advanced some remarkable new policies, programs, and
program changes affecting the Cityıs 10-15,000 homeless residents. These
changes appear to describe a pattern, and a new and dark design for homeless
policy emerges whose principal components share a couple of common features:
increased "management" of poor and homeless people while rolling over their
rights and putting them at more risk; and spending more City money to
provide less services.
The most ominous change of these, appropriately enough, is CHANGES
(Coordinated Homeless Assessment of Needs and Guidance thru Effective
Services) an admittedly promising acronym and apparently the sole
unduplicated "change" Mayor Brownıs Office on Homelessness managed to create
in the gridlock in eight long years. The U.S. Dept. of Housing and Urban
Development mandated an unduplicated count of every homeless person served
in any community competing for federal homeless dollars by 2004, so the
Mayorıs Office on Homelessness decided to create a costly centralized
The Coalition on Homelessness researched other localities competing for HUD
homeless assistance dollars that have already implemented their
federally-mandated Homeless Management Information Systems (HMIS) to comply
with the 2004 deadline. We also requested public records regarding CHANGES
development and implementation, and surveyed people impacted by this policy.
Our findings raise serious concerns.
Letıs look at the facts. CHANGES requires every homeless person seeking
city-funded services in San Francisco to give up their first name, last
name, date of birth and motherıs maiden name. One might imagine that would
provide enough variables to derive a unique identifier for coding anyoneıs
confidential information into a centralized computer database, but George
Smith and the Mayor Brownıs Office on Homelessness decided to add an extra
wrinkle homeless people seeking city services in high-tech SF must also
give up a digital photo and a biometric fingerprint.
The City has spent over three-quarters of million dollars (that we have been
able to document) to date to enroll less than 2000 clients into CHANGES, and
some sources project the final cost will exceed $1.1 million. And CHANGES
implementation so far hasnıt exactly been very satisfactory from a
management perspective. Still, this represents pretty good value for the
taxpayer, especially since the whole thingıs been administered through the
Mayorıs office... right?
The best cost ratio we uncovered for a federal compliance-ready Homeless
Management Information System was that covering the entire state of Georgia,
identifying 200,000 unique recipients of homeless services for an annual tab
of $600K. Even the uniquely expensive and encumbered bureaucratic hell of
Washington, DC squeezed out $135,000 start-up costs to enroll 20,000
homeless clients, and their HMIS-FY2003 upkeep tallied a thrifty 98 thousand
So we could reason that people living here and paying taxes in this town are
unwillingly underwriting some problematic research and development for a
local software concern... and client confidentiality gets routinely
compromised for enrollees, while homeless folks with psychiatric labels and
symptoms (including lots of military veterans), immigrants with-or-without
cloudy "legal" status, and women and children fleeing domestic violence
avoid such a system for reasons anyone could easily foresee.
Right around the corner, DHS has been busy implementing Care Not Cash for
quite some time. Before Gavin Newsomıs signature ballot initiative became
his signature Waterloo in the courts and at the Board of Supervisors, it was
Mayor Brownıs Shelter Redesign plan: a consultant- and business
lobby-inspired effort hatched under the placid and conveniently
Sunshine-free skies of Treasure Island.
Part of this "outside the box" thinking included some directives for how DHS
dollars go to help support the "management" of what folks at the Chamber of
Commerce and the Committee on Jobs term "San Franciscoıs homeless problem,"
i.e. visibly homeless folks in San Franciscoıs corporate and commercial
Letıs consider 478 homeless and, very recently, former clients of Conard
Houseıs Community Services Program. Conard is a long time local non-profit
provider of mental health services, and they used to offer a pretty
comprehensive range of mental health and social services without a lot of
official referral red tape. Care Not Cashıs ongoing behind-the-scenes
implementation by DHS meant Conardıs homeless program was abruptly limited
to money management and representative payee services only.
Phasing out the Supportive Case Management portion of Conardıs program means
loss of services for people with psychiatric disabilities such as assistance
in landlord and legal matters; hospital and jail visits; and help getting to
the doctorıs office or grocery shopping. And the only referrals Conard can
now accept come from the cityıs homeless shelters, and those homeless people
can only access shelter through officially care-not-cash sanctioned,
city-funded CHANGES intake centers.
This has been a management bonus from DHSıs perspective, since redefining
Conardıs homeless services resulted in rendering a four-month waiting list
for services to fifteen empty slots in short order. Meanwhile, 478 poor
people receiving mental health services in the South Of Market Area were cut
off a homeless assistance program because the City couldnıt collect any
"cash" for this "care."
Central to the reputed wisdom of Newsomıs Care Not Cash nee Brownıs Shelter
Redesign Plan is the assumption that San Francisco is a "homeless magnet,"
rich in free money and services. Cutting homeless folksı welfare checks is
only part of the central strategy to create a disincentive for homeless
folks to stay here.
San Franciscoıs Mental Health Rehabilitation Facility (MHRF, pronounced
"merf") was created for local residents who require long-term acute
psychiatric care. Itıs a locked facility, which means the services offered
there cost out among the most expensive levels of public mental health care
the city can provide. The Dept. of Public Health, the Board of Supervisors,
and the and the public voted in 1987 to build the MRHF. It was created
specifically to return San Francisco residents from out-of-county locked
facilities, eliminating expensive outsourcing as well as hardships on family
members, including many who regularly traveled hundreds of miles to visit
their loved ones.
But in last summerıs annual budget cycle, Mayor Brown and SF-DPH Director
Mitch Katz decided instead that a large budget like the MHRFıs would be
perfect to plunder in order to balance public health care budget cuts.
It hasnıt been an easy time for the MHRFıs displaced residents. According to
one recent state citation for Patientıs Rights violations, the MHRFıs
administration failed to obtain the stateıs approval before issuing written
transfer and discharge notices to 20 patients. The citation charges this
violation displayed "...lack of consideration for itıs residents, families,
and residentsı legal representatives," and the "...violation had a direct or
immediate relationship to the health, safety, or security of the residents."
To date, DPH has denied any such violations have occurred.
Being homeless on these quality-of-life streets of San Francisco is a
challenge by anyoneıs standards. But when you add a psychiatric disability
to the mix, the central challenge then becomes avoiding premature death on
the streets. And the sad truth is that DPH Director Mitch Katz consistently
cut voluntary mental health treatment opportunities, even in years when it
The result of this is evident in the ever-growing numbers of homeless San
Franciscans with untreated mental illnesses. And today Dr. Katz argues
against the need for funding outreach to this population when there are no
services for them.
This means homeless people suffering from mental illnesses who mostly
canıt successfully access the treatment they need decompensate to the
point where their behavior lands them in trouble with the law. Thatıs why
the largest provider of mental health services in San Francisco is the
According to voters, Sheriff Mike Hennessey is one of the most respected
political figures in this town, but incarceration and treatment are vastly
different milieus. Experience tells us how patently non-therapeutic
environments like jail can undermine effective and successful mental health
treatment for homeless people.
Most could probably agree it seems self-defeating to offer both punishment
and treatment under the same roof and expect good outcomes.
So the biggest problem becomes providing accountable case-management
services to help homeless people navigate all the barriers our managed care
public health paradigm erects between them and the help they need and seek.
Who can we identify to charge with this vital social responsibility?
With much public relations hoopla (and not much prior public discussion or
input) San Franciscans recently learned of the newly inaugurated Behavioral
Health Court. For all the official hoopla, the only real function this court
serves is to provide those accountable case management services, while
adding a generous layer of judicial expenses. That, and ensuring folks who
refuse psychiatric medications are now forcibly drugged under Californiaıs
new AB 1421 guidelines. And soon perhaps all those panhandlers Novemberıs
Prop M promised to connect with services will find their way into BHCıs
Experience also tells us that people referred to treatment by the courts
will probably be prioritized over those who are voluntarily seeking
services, ironically creating an incentive for poor people with mental
illnesses to break the law.
So letıs review: the City and County of San Francisco continually whittles
away at any publicly-funded, voluntary mental health treatment and services
for poor people; the City will reverse wide public consensus and even
violate the State of Californiaıs Patientsı Rights statutes to accomplish
this; the only mental health treatment facility in town that doesnıt suffer
from a dearth of resources is the county jail; poor and homeless folks with
mental illnesses canıt get treatment until their symptoms worsen to where
their behavior gets them arrested (or shot); and it has now been determined
for us that the courts will find the elusive needle of an open and
appropriate treatment slot for many of these San Francisco residents in our
dwindling haystack of publicly-funded treatment.
The final point to be made here is that policies and initiatives like those
weıve just described are all predicated on the idea that homeless people and
poor people with profound disabilities like mental illnesses or addictions
should enjoy fewer or different rights than the rest of society.
Former Governor Davis issued an apology last year to over 10,000
Californians with psychiatric and other disabilities who were court-ordered
to submit to involuntary sterilizations. It hasnıt quite been 60 years since
the last mentally ill Californian living in poverty had their human and
civil rights violated by the state in this fashion.
Perhaps we might care to learn from historyıs mistakes, but until commercial
media sees the continuing devaluation of poor and disabled people as a
compelling story, real change doesnıt look very promising.
chance martin, Project Coordinator
A Publication of the Coalition on Homelessness, San Francisco
468 Turk Street, San Francisco, CA 94102
415 / 346.3740-voice 415 / 775.5639-fax