from father Joe’s villages in this series we explore homelessness its causes and solutions to the issue our
guests include experts and leaders in the space as well as folks with lived experience and unique perspectives on
homelessness to learn more about our mission visit us at neighbor.org and follow us on social media at at father
Joe’s Villages last episode we introduced the making Health a priority pillar of care
we focused mainly on physical health and today we’ll delve into Behavioral Health
which includes both mental health and substance use to explore this topic with
me we have Marissa Veron CEO of mallister Institute San Diego’s largest
treatment service provider and from father Joe’s we have president and CEO Deacon Jim Vargas
and Jenny Wilkins our supervisor of Outreach for our Street Health Team
welcome thank you so much for being here good to be here thanks for having us than for having us us can you start by
introducing yourselves and what you do a little bit about your organization sure so uh my name is Marissa thank you so
much for the warm welcome and as you mentioned I’m the executive director at mallister Institute where I have been
serving uh for the last 12 years I started in this journey based on my
grandmother’s own recovery uh 67 years actually as of Wednesday wow I know that
so many of the gifts that I have in this life are because of the recovery that she found and so when I had an
opportunity to join this work I knew that they were going to be very very big shoes to fill but uh shoes that I
certainly wanted to walk the same path wonderful hi everybody my name is Jenny
I am the supervisor of the Street Health Team associated with the village health clinic at father Joe’s Villages I’m also
a certified substance use disorder counselor um and my Street Health Team really brings medical and Behavioral
Health Care out to the streets to the community members that cannot make it into our brick and mortar Clinic um just
establishing relationships and you know helping people Access Health Care wonderful right and let me give you
a sense of Father do Villages just very very quickly the federally qualified Health Center will be focusing it as you
on certain aspects of it is an extremely important element without your health you really are not good for much of
anything else right so we need to really address Health as it relates to those who who are homeless and those who are
suffering from mental health challenges substance use disorder and the like so we’ll talk about that but in addition to
that we work with children we through our therapeutic Childcare Center we work with these kids who come to us there
academically emotionally socially delayed and we know they’re more apt to be homeless in adulthood unless we mitigate those circumstances so we are
work there is very uh very important as well and then we have our employment center employment is very important we
have our vocational training and so through the various disciplines and and marketable skills that we’re able to to
uh share basically with those who we serve then they’re able to go f f go forward and find employment and then
also they have income and self-sufficiency and that’s what it’s all about shelters where you have over a
thousand shelter beds we offer each and every single night and it’s not enough heaven knows we need more shelter
out there in the city and in the county but we’re blessed to have over a thousand beds and it’s not just a matter
of the shelter beds it’s the million meals that we serve that go along with that it’s the showers that we dispense and everything that goes along that we
take for granted that are just Basics right so we’re able to offer that um day in and day out you know 365 days a year
we develop housing at the end of the day housing is what breaks the cycle of homelessness so we’re blessed to be able
to to develop housing and next year this time God willing will’ll be breaking down ground on three three new Endeavors
right I will offer up about 300 units in Aggregate and and that’s really what
it’s all about breaking that cycle but not only um the housing or the shelters that we that we offer but also the
comprehensive services without those Services people W wind up back on on the street so that’s just very quickly what
we offer at father Joe’s Villages we’re blessed that it’s as comprehensive and as holistic as it is and that’s what
makes a difference in the lives of the individuals we serve so of this array of services why
is behavioral health so important why should the Community Care well I as you were mentioning
Deacon Jim just as your health is such a huge component of our ability to
function and move through this world so too is the health of our brains and to say that behavioral health is a separate
component from health I think isn’t really recognizing that our minds our bodies
Our Spirits are all connected and uh for those who are living with brain diseases
really it it’s so clear that we need to be able to help people get to a point
where they can be living their best lives where they have the tools and the medications that they need to be
successful and what are you finding Jen out there on the street I mean as behave
as it relates to that behavioral health and in and the substance use disorder I mean we we know that more and more
people are admired in those situations a lot of people in fact ask me they assume that that’s what throwing throwing
people onto the streets and that really is in San Diego that really isn’t the one number one cause we know the number one cause it’s an economic one it’s
extremely expensive to live here in San Diego right now having said that if you’re on the street for an extended
period of time and you’re seeing it day in day out I’m sure then you you coping mechanisms you devel you know you use
coping mechanisms and substance use is one way of doing that right um you know if you if you’re not suffering from
mental health challenges when you fall onto the streets in time you know you develop some of
them and so so tell us about that I mean the conditions of the street are are so rough right now we’re seeing
so much suffering and so much substance use there’s overdoses there’s uncontrolled mental illness um and
people are constantly um experiencing toxic stress right and using substances is really a
normal coping skill for abnormal circumstances right can you imagine just being on the street unsafe always having
to watch your back you don’t have four walls to keep yourself safe inside of and using substances becomes this the
only reprieve for that toxic stress you know again a normal coping skill for
abnormal circumstances what kind of challenges do you see people are facing in terms of addressing their behavioral
health I know there’s a lot of distrust kind of in the system or you know in in
when they come in contact with the folks that you’re working with how do you how do
you how do you start working with them what does that look like yeah so our Street Health team does go out onto the
street um and deploy into the community five days a week um and we do have a
medical provider with the team but providing Healthcare is not necessarily the first or the main objective um
because the conditions as we’ve been talking they’re rough right now um you know as Diego becomes increasingly more
unaffordable the unhoused population is growing um and with the ordinances and
the constant encampment sweeps people are being displaced and their things are getting thrown away um and there it’s no
wonder that there is a hesit hesitancy or you know a a resentment so to speak
or you know they don’t want to engage because most of the people they’re in contact with are causing them more harm
than good um and so that’s the beauty of our street Health team is we’re not out
there with our own agenda we are out there to express compassion um you know
we’re we’re asking questions we’re building trust we’re building Rapport and we’re asking them for permission to
serve them we’re we’re asking them how can we help you and we’re letting them tell us and we’re letting them be the
experts in their own lives so you make connections and you
meet our neighbors where they are I think one of the most important components that we can even start with
and some grounding principles are a recognition that folks who are using drugs are are doing so because it has
served a purpose for them and we may have judgments about whether the value
of the choices are good bad but really at the end of the day part of humanizing
this is remembering that it is serving a very very distinct purpose and I think
even as a basis for treatment when we can approach uh folks like that it’s so
much easier to actually start to problem solve and to listen and to have them be
the authors of their own care I was recently doing a panel to a lot of folks
who are very powerful but not necessarily in the streets and I said to them you know imagine this if I were
starving absolutely starving but I had a shellist sh Bish allergy and you offered
me a plate of shrimp and I said no thank you I can’t it will make me sick we
would definitely not conclude that food is not the answer to ending hunger we
certainly would not blame me for not eating the shrimp and so I think those
sorts of just moments of remembering that maybe what we’re offering out there
isn’t always what people want but they do have a sense of their own use the
times that they’ve been able to string together some days of sobriety and I think unlocking that potential in folks
out there is really such an important component of any care we provide and
addiction is so complex like you’re saying abstinence isn’t necessarily the answer for everyone what other kinds of
options are out there well I love that our toolbox is growing I think for a
long time abstinence-based care was the only care that was available and by all
means there are folks who are living with Decades of sobriety and who that
has worked and right for whom it will continue to work and there’s other people that in the confines of an
abstinence only program or with that as the expectation it’s exacerbating shame
it’s causing them to never walk in the door right and we’re seeing what is it,
1300 overdose deaths I think if we’re looking at what our choices are and it’s
abstinence only and people die on the streets because they can’t meet those expectations we start to evolve what we
can do and we’re really lucky now that we have medications available we have interventions like contingency
management is a Statewide pilot right now uh which is really one of the only evidence-based treatments for uh
stimulant use disorder and of course there’s always the therapies and in group and
individual Family Support there’s so many different components and and like you were saying Jenny it really comes
down to finding the right services that someone identifies and that they know that they
need that’s that’s absolutely excellent I mean the the just meeting them where they are
right and then and just that that is making such a difference because it’s not judgmental right and it’s providing
not a cookie cutter approach but it’s recognizing that everybody’s situation is unique their circumstances their
backgrounds their trauma they all come into play I mean if we expect sobriety from everyone then we’re
really reg relegating a number of them to to the to remain on the streets and to Deaths you use that 1300 uh figure
and that’s the general population right but within the homeless population right they’ve been out of the 600 individual
deaths on the streets in this past year 300 of them have been because of drug
overdosis fentanyl especially right and so you know that’s not what we want we
need to reach these people we can’t we can’t help them I’ve said before we can’t help them if they’re dead right we
have to meet them where they are so we can help to keep them alive and then show them that they can really live
right because there is a better way obviously so they can prosper you opened up so many Segways
for a good conversation um and one of the first things that I wanted to comment on is you had mentioned like
there used to be the only option was abstinence based programs and you’re you’re absolutely right so I personally
I am in recovery I’ve been in recovery for eight and a half years now but I was struggling
with I was struggling with substance use for 15 years um
and that that was it it was either I was using and I was hanging out with people that were supporting my using or I had
to go into treatment and face abstinence and deal with all of these underlying
issues without the use of substances and there was no in between and I wasn’t
ready to stop using because like you said using was a coping skill for me it
was providing me something it was providing me some comfort it did something for me and I wasn’t really
ready to give it up you know but now today we have harm reduction uh treatment programs like we do at father
Joe’s Villages our transformative Recovery Services Program it’s our outpatient program it’s low barrier and
abstinence is does not it’s not required to be involved in this program so our
counselors our our group therapy it’s literally meeting our clients where they are at no matter where they’re at in
this stage of change and we’re saying hey I see you I know it’s hard I know
it’s difficult but I am going to walk through this with you I’m G to support you through wherever you’re at and we’re
going to get through this together you know because not everybody wants to stop using some clients can continue to use
but they can use in a way where they’re still able to to hold a job or pay their
bills or they’re they’re not getting arrested or you know they are able to have you know healthy relationships and
that’s okay if you can do that while still using I’m going to support you in that if you can’t do that and you do
want to quit using I’m going to support you in that too but no matter where you’re at I’m going to hold your hand and I’m going to walk you through this
and that’s the key of harm reduction it’s those connections it’s those
relationships it’s I see you I’m here for you let’s do this particularly as
using drugs is becoming cheaper and more dangerous there’s a lot of talk about fentol Deacon you mentioned that tell us
a little bit what about what fentol is and why it’s so dangerous so panol oh wow excuse me let
me start over words pentanol is harder to say than
shrimp uh so fentanyl is a synthetic opioid and like you mentioned it is
cheaper than many of the drugs that we’re seeing it has largely displaced heroin in the street market um
unfortunately it is not the only substance that’s out there actually meth
is still the number one drug of choice that we see and really what’s also Rising is poly substance use folks who
maybe have fentanyl in their drug Supply that they didn’t know but also some
folks who are choosing that as the ideal high and what they’re hoping to pursue
and so when you were talking about you know safer use and harm reduction I think there is this growing public
sentiment and stigma around harm reduction where it’s kind of this dirty word but really at the very very core of
it is meeting someone where they are and seeing them as a human being and valuing
that they have agency in their lives and as much as it’s walking alongside
someone it’s also walking just half a step ahead of them and surrounding them
with a community that maybe maybe they’re not ready to start using or I’m sorry to stop using but they’re in the
presence of people who are successfully doing it and they see a model and they think hey all these years I thought I
could never have that but people are still opening their arms to me and they’re still telling me to come back
and maybe if I do quit I won’t lose every person I’ve ever known all of the
people that are surrounding me I you know I feel so alone all of my family members don’t want anything to do with
me but here we are just a smidge of a step ahead and really using those
principles of Attraction and and hoping that it really is the off-ramp to getting someone you know the healthy
happy life that they dream of and they do have dreams you’re absolutely right and you mentioned Jenny trans
transformative Recovery Services and over this past year already it’s been, 1600 services that that the uh federally
qu qualified Health Center has dispensed right think about that and within that it’s our medication assisted treatment
the use of suboxin to wean people off of those obio substances right and so that’s that’s exciting when we when we
walk with someone we’re able Maybe and Just a step ahead I like that Marissa and and and we a they finally there’s
that break right in the dam almost where where finally you know they want to just off the air you mentioned to me just a
young man in his 20s right and was it just this morning Jenny that you encountered him and what did he say to
you you know so we’ve been working with this young man for about a year um early 20s living unsheltered on the streets um
and he’s grown very near and dear to the street heal team we all see him when we Embrace him we give him hugs but he has
been struggling with use of fent for a long time and literally just this morning we’re out in the community and
we we run into him and he said hey I am ready to I’m ready to start subox in I’m ready to give it a shot W you know he’s
planning to go see his family for Thanksgiving um and he was like I I
don’t want to be using so he was ready to start today right so is suboxin is
that part of the mat treatment then correct so it’s medicated assisted treatment it’s one of the it’s ppan
orphen um which is an antagonist which helps
people um it desades against the withdrawal effects from the opioids in the system
and so it helps people move through um the withdrawal symptoms um without using
right and that kind of speaks to again that recovery looks very different for
everyone you know and treatment looks very different for everyone so maybe if it’s if you’re going from using heroin
to using maybe Canabis or from using fentanyl to getting on the mat treatment
so everybody’s story is valid and everybody’s looks different it is but I
I think the story that you told just about the 20-year-old gentleman does also underpin the importance of access
and you know you’ve been working with him for a year and today is the day that he wants to make a change and spend
Thanksgiving with his family Thanksgiving is on is on Thursday and so so if we miss him in that moment the
motivation that he has today circumstances may change and so we
have to make sure our doors to treatment and to medication assisted treatment are
as wide as humanly possible Right Same Day Access is so important because we
cannot miss that moment it’s we have to strike when the iron is hot especially with people living unhoused unsheltered
on the street like you said there situation can change in an instant right you know I’m ready now so let’s get them
the help they need now because tomorrow they could be moved we might not be able to find them they could have whole
another issue going on and you know tomorrow will not be the day and I have to give a huge shout out to your F
federally qualified Health Center because I remember even early on in the days of medication assisted treatment
you all were some of the first who are willing to do same day inductions and to do induction that a lot of providers
felt were unsafe because people were not housed but I think you’re prioritizing
keeping people alive um and recognizing that you know people who have the
resources to stay clean for some amount of time that is so important and we have to continue to support them but we also
have to reach deeper into the folks who don’t have the resources to even piece
together a safe place to keep their medications and so just thank you so much for that it’s been a huge game Cher
especially for our adult detox program which as I’m sure many of us in the
community know as one of the most impacted resources that we have right in fact in fact we don’t have enough detox
77 beds for a population of 3.3 million in the entire County can you imagine so
we need we need more detox beds that’s we’re focusing on that Marissa all right at father Joe’s Village is we need more
detox beds and maybe we can partner in that regard right for the going forward I mean again people are dying right they
they’re dying on the streets and so that’s an important important element as well tell me more about the tools that
you have to keep folks alive I know you have some new vending machines that father Joe’s correct we do we have
vending machines with 247 access um and what the Community member needs to do is
is just input a little tiny bit of information and they’ll get a unique identifier code and they can use that
code any time of the day or night to access products like um nxone or Naran
um we have fentanyl testing strips so people can test their substances to see if fentanyl is in it we have xylazine
testing strips so they can test it for xylazine um you know and that’s so important because people need to be
aware of what they’re ingesting and the risk they are taking when they are choosing to use um we also have wound
care kits um what else do our vending machines have well the wound care kids
by the way are extremely important as it relates to xylazine especially right I don’t know if you want to talk about that but that’s and xylazine we we
should describe zyline I mean that’s just new on the market as well when I say new on the market it’s been around but I mean it’s finally hit San Diego we
knew it would and it’s been now in the last few months and I’m that’s really concern to me xine because as we move
forward that’s something if you have open wounds you can wind up with amputations as a result so those wound
care kits are are so important did you you want describe XY well I’m actually really curious so we’re we’re not seeing
a ton of xylazine show up yet I know there’s talk and awareness within the community of people who use drugs um but
we’ve actually not had any cases yet I’m I’m wondering if it’s because our Outreach hasn’t been targeted and it’s
or if it’s just not made it to San Diego Jenny are you and your team seeing it out there yet
um I I I I want to share that there was an organization that took a drug testing
kit out into the community recently and out of a hundred samples there was 68 that were positive for xylazine and this
was unbeknownst to the people that supplied their drugs for the testing so it is out there and I just think that
people are are not aware they’re not aware and that is why it is so important to have our Outreach workers going out
into the community dispersing these xylazine testing kits um we also have xylazine information that we’re
providing and we’re having these conversations and saying hey you may not know it but your drugs may have this in
them so this is how you can test it this is how you can educate yourself and this is how you can learn about it um and
then we have those conversations and we continue to talk about it and a lot of the people they will community members
will sit and they’ll engage in those conversations because they want to know they want to be aware they don’t want to
die they don’t want to die right right and so this the drug game is always changing we have to change our
tools and our approaches to it as well you know um and that goes with harm
reduction as well that even though it’s supported by addiction specialists and even the CDC some people have trouble
grappling with it and what would you say you know to community members who maybe misunderstand it or who are trying to
deepen their understanding of it I feel like I’ve maybe already said a
little too much on this topic so um you know again I I want to bring it
back to my own personal experience um I can understand why some people may have
a hard time getting past like oh it’s enabling you know um but I want to share
that I personally I was not ready to stop until I had made that decision and
I was ready to stop right um and so people are going to use no matter what
so like you said it’s so the main objectives of is let’s keep people alive and let’s keep them healthy so if you’re
going to use use in a more safe way so that you can stay healthy and have a better chance at at making some
decisions that are going to improve the your circumstances right um you know I
again I used for 15 years and and that space is such a lonely tormenting um
space to be on not a single day did I wake up and not want to stop using I
just did not know how and there was nobody supporting me through that I really truly believe that if I would
have had someone who I could talk about like my internal conflict with you know
I felt like a hypocrite because I was using but I wanted to stop and I had nobody to work through those things with
and if someone would have been that in that space with me kind of you know affirming my strengths and believing in
me when I didn’t believe in myself I really honestly believe I could have reached recovery a a lot sooner than I
did you know there was a lot of trauma there was a lot of um risky situations
there’s a lot that that I went through that I I believe I probably didn’t need to if I would have had somebody
supporting me in that space I the story that you just shared is something that we hear a lot at mallister and we’re so
fortunate that part of our recovery oriented culture is that we hire so many
folks who have gone through not just mallister but other programs as well and
it’s been a a slow moving cultural shift in embracing harm reduction but I think
the turning point for so many people who have long-term recovery is realizing
that maybe if there had been a compassionate person who had helped me
develop a little bit of confidence or who accepted me for exactly where I was
then maybe I would have had a few years less out there and and you can’t go back
and rewrite history but I think it does help to bring together the lived
experience in a way that is not stigmatizing to someone who is not in
the same place but is really evolving and realizing that you know this disease
is one that grabs your brain that you want a substance more
than water and more than food it is so powerful and I think until
you know I don’t know how that Community Education Works that we really start to understand how strong of a grasp a drug
has on someone but I think a starting place is realizing that I don’t think anyone who picks up a drug for the first
or second time wakes up and thinks hey I’d like to be an addict right I’d like
to ruin my life and all of the close relationships that I have I’d like to lose my job no one wakes up and
that and so I hope at least one of the starting points for our community is
real compassion around the the depth of how what a hold substances can have on
your brain and then the change in that brain chemistry actually and that’s the key and I think a lot of people don’t
recognize that that you’re really not yourself in a sense anymore right and so
that’s an important element yeah and on that line um Callister was one of the
first programs in the country to actually allow women to live alongside their children while receiving treatment
and one of the things that we see are mothers acknowledging that the grasp of
drugs was so strong that even their maternal instincts were captured and
having services that can help them you know accept the shame move
forward hear from others that there are ways to repair those relationships that
there’s skills that they can learn ways that they can make amends it is so
powerful and I think the thing I hope the most that people will hear whether you’re using or you have a family member
is that recovery is possible it there are thousands millions
of people who are living happy lives wonderful lives in recovery who thought
it may never be possible for them and yet it is it is and so the medication
assisted treatment is great but the therapeutic aspect needs to be there as
well the therapy has to be there because there’s so much Brokenness in the whole process that you just described right and that’s where me I know father Joe’s
Villages and and and the health center the mental health services that are offered you know day in and day out part
of it through the street Health but then also now brick and mortar is so very important with this one-on-one therapy
or or group therapy I mean that’s an important element right with that in the in the absence of that medication assist
treatment can just go so far right because you’re still mired in that psychological aspect of it right so that
and that and you know I mentioned housing before you know when you try yes we try to help individuals but we need
to get them into housing because having to trying to cope with all this while remaining on the streets it’s extremely
difficult right so that’s an important there’s so many aspects of this and that’s that’s so very critical you had
you had story that you were sharing yeah it did um you know to the the naysayers
or the people that have a hard hard time believing in harm reduction I I have a really powerful success story that I
wanted to share with you all um I had a young woman who walked into the clinic
one day and she wanted to start counseling uh she was using methamphetamine intervenous multiple
times daily um she had a history of sexual trauma uh PTSD body
dysmorphia um there was a lot going on um and she was not ready to quit but she
would see come see me Faithfully once a week sometimes twice a week and we would
sit together in this space and we would talk through all of these challenges she
was not motivated to go to treatment she did not want to stop using she had
resentments against the the fellow the 12-step Fellowship she was just not at a place where she was ready to move
through the stages of change but we worked together week after week and
eventually she comes to me and she says you know what Jenny I’m tired I’m ready
to go to treatment and I could have I jump for joy you know internally I was
celebrating and I was just so excited we got her into Residential Treatment a couple days later she successfully
graduated from that treatment program she is now in a sober living and she’s
going to outpatient she just got her she passed her certification exam for to be
a peer support specialist and she is doing amazing H my heart just bounces
out of my chest um and yes she has this wonderful support network group of um
people in sobriety that she has you know built along the way but the the coolest
thing is is you know who she still reaches out to when she has a challenge or when she’s going through something is
is me she’s reaches out to her primary care provider at the Village Health Clinic because we have been through this
whole journey with her um and it’s just so beautiful you know this this young
woman who came in broken and alone and scared um never thinking that she could
have a life that meant anything is now just killing it you know um and and it’s
because we worked with her we met her where she where she was at we never pushed we never rushed we never ever
judged we just sat with her in that space you know and we believed in her when she couldn’t believe in herself and
now she’s just doing amazing great feeling huh so proud proud of you a beautiful story and
you gave her that time to develop those healthy coping skills to build a small
community so that when she was ready to take the jump there she had a community around her was beautiful is beautiful
thank you than for sharing that such a great message of Hope from all of you can can you tell us a little bit about
how folks can access mallister or if they need help with resources abely so mallister I have to start by just saying
that we’re one of 36 amazing providers here in San Diego and I say that because
it’s so important to know yes we do provide a lot of services I happen to think we do some of the best care uh but
really there are a lot of doorways to walk through and for mallister we have 26 different programs that span all the
way from esand to Sedro and just about everywhere in between and we really
pride ourselves on the fact that we have Services across the age Continuum across
different levels of care uh so that we can help folks move from withdraw
management to residential to outpatient and sober living and that’s in recognition of the fact that change the
significant doesn’t happen overnight but we really want to be there through each and every step for the people that we
serve and uh to that end we have a founder and CEO who is so singularly
committed to access that she actually gives out her personal cell phone number I have her personal cell phone number I
do and I you know not a lot of people are as good of a care coordinator as Jean mallister so I am going to provide
her phone number here that’s okay area code 619
987 6393 and she really does take calls from 6 to 11
W thank you that’s and tenny knows as well I can tell it’s great thank you so
much for being here again this is obviously such an important topic to not only our organizations but to our
community at large so thank you for your time thank you it’s been a pleasure to be with the two of you by the way thank
you and with Maggie of course and thank you to our listeners we’ll see you next time thank you for
joining the conversation today our next episode of our neighbors helping neighbors podcast will Air in 2 weeks in
the upcoming installment our Spotlight will be on investing in children pillar of care how are you going to get
involved this year Remember You Can Make a Difference by volunteering donating and taking action today at neighbor.org
we’re all neighbors helping neighbors and together we can do better thanks
everyone
