In this episode of the Neighbors Helping Neighbors podcast, we delve into the critical intersection of behavioral health and homelessness. This episode explores the complex challenges faced by individuals struggling with mental health and addiction while navigating life without stable housing.
Join us as we discuss how these issues are intertwined, the barriers that exacerbate them, and the innovative solutions being implemented to provide comprehensive care. We’ll hear from expert guests, including Councilmember Raul Campillo of District 7 and Dr. Carla Marienfeld, MD, FASAM, DFAPA, Clinical Professor and Medical Director at UCSD. Together, we explore the role of government in addressing these challenges and the life-changing impact of integrated behavioral health services in helping people rebuild their lives and regain stability and hope.
Available now on Apple Podcasts, Spotify, and YouTube. Subscribe to stay informed and be part of the solution.
Podcast Transcript: Behavioral Health & Homelessness
welcome back I’m maggie the host of neighbors helping neighbors the podcast from father Joe’s Villages this is a
series where we explore homelessness its causes and solutions to the issue our
guests include experts and leaders in this space people with lived experience and unique perspectives on homelessness
father Joe’s has been a Beacon of Hope for 75 years and if you’d like to learn more about our mission visit us at
neighbor.org and follow us on social media at father Joe’s Villages
today we’re talking about Behavioral Health what it is the barriers faced by our neighbors in need and how the community is fighting back showing compassion and addressing these complex issues join me in welcoming our distinguished guests Dr Carla Marienfeld addiction and Psychiatry expert from
UCSD and council member Raul Campo from District 7.
with me always is my co-host Deacon Jim president and CEO of Father Joe’s villages to explore this topic
welcome thank you for being here oh it’s great to be together absolutely welcome thank you thank you thank you let’s
start by taking a minute to introduce yourself and telling a little bit about the scope of your work excellent uh well
I’m Raul Kio I represent San Diego city council district 7 and uh I’m the chair
of the economic development and intergovernmental Relations Committee very long name lots of things underneath
it but one of the things that falls underneath it is our relationship for the city of San Diego to other governments the state government the County Government Federal Government and we know that Health and Human Services has traditionally been a county and
state government issue and the city typically has land use and policing powers and other things like that I’ve
been using that office to focus on how we can help mental uh health issues be solved quicker uh in a in a city that
really hasn’t focused too much on it so being the chair of that committee has been an honor and transitioning its uh
its uh efforts towards helping people who are suffering from mental health issues wonderful thank you and and I
find you’re the right person for that position by the way so I’m glad you you’re on it thank you I I wanted to be
that chair and this is my fourth year being it so yeah wonderful um wonderful I’m I’m very
honored to be on this committee my name um is Carla marienfeld I’m a clinical professor of Psychiatry and so my
background is as a psychiatrist and helping to care for people with um General mental health problems and then
I also did Fellowship training in addiction Psychiatry and I also did specialization in addiction medicine
which are related um areas and so that gives me um a unique focus on the
overlap of both addiction and substance use problems that people have as well as
the often co-occurring mental health problems that they have um I also run a
small Clinic an outpatient clinic um that treats people with substance use disorders and co-occurring psychiatric
disorders I run our addiction Psychiatry clinical Fellowship training program and I’m also involved in several research
projects looking at helping people with substance use disorders wow wonderful and that’s why we were excited to have
you with us by the way wait we delve into it that’s what we’re all about I
think I think I’m aware of a lot of the problem and it’s great sort of thinking about the ways I might go about treating
it from a medical perspective as well as how um the city and other organizations
Community partner organizations can all work together to really tackle it from all angles right these are the three
people to have at the table this is perfect go ahead well and I’m as Maggie
said I’m the co-host and I’m also the president CEO of f G’s Villages let me just give you a little bit of background
about what we do and what we’re about 75 years Maggie mentioned and U we have a federally qualified Health Center one of
our pillars within we have four pillars within our organization that’s one of the key pillars because we know there’s an intersection of health and
homelessness or poor health and homelessness and housing as well and so being able to really meet people
where they are and help them not only in their Prime with their primary care but especially with the behavior behavioral
health issues that they have on the mental health side on the substance use side it’s absolutely critical and I
frankly I believe that at this point in time unless we are laser focused on that in our community we really really won’t
be able to get our arms around this homelessness situation 40% of those who are on the streets who are homeless have
some level of mental health challenges some have them when it throws them into onto the streets some develop it because
they’ve been chronically on the street and then similarly on the on the substance use side you know we have about 40% also who suffer from substance
use um and and and the combination of the two sometimes and so anyway that’s very great key we’re going to get into
that aspect of it that’s what this segment is all about but in addition to that we have a dental CL within our federally qualified Health Center again
if you were to visit us and you was to visualize the wall of smiles that we have the before and after restorative
Dentistry they just tell the message right who’s going to get that job who’s going to get that apartment right and um
so that’s our fqac but in addition to that we help our children we have children literally from when they are
born up to 18 years of age we have a preschool program and we have after school programs for school age kids as
well mentoring and tutoring and the like and we know that the kids who come to us because they are academically
emotionally and socially delayed if we don’t mitigate those circumstances they’re four times more up to be homeless as adults right so that’s very
key so we must break that cycle we don’t want them to be the future adults who are homeless we have our shelter system
almost a thousand beds that we offer father Joe’s Villages various locations and and they also have diversity in the
shelter because we have some that are sober living we have some for families we have some that are low barrier
because we know to expect sovietyurii
living that’s necessary as well they can’t be a one-size fit tall and that’s what we’re all about not having a one-size fit tall making sure we tailor
our programs and our resources to the needs of the individual because everyone
has its own circumstances and then so that we could be most effective and most sufficient with those precious dollars
that we have whether they’re public dollars or private dollars and then we have um turning the key that’s our
initiative to develop housing at the end of the day that’s what breaks the cycle of homelessness is a house right and or
the council member especially knows St Teresa of kakado villa that 14 stories 407 homes that that we opened two years
ago over 500 people who have either been taken off the streets or have been kept from falling out to the streets that’s
what breaks the cycle of homelessness but not just a home but the comprehensive Services those wraparound
Services which help them to retain their homes and prosper and so that’s kind of
a whirlwind of what we’re all about of course their million meals we serve a year on a yearly basis I mean I can go
on but this is but and I’m excited because today’s segment has to do with Behavioral Health and as I mentioned we
must be laser focused on this as a community in order to truly work through this issue that we have in San Diego
that we call homelessness right so with that well let’s start with what is behavioral health and how does it
intersect with homelessness well there’s a lot of ways of looking at how you think about
whether um somebody is healthy from a behavioral stand point right so we can talk about mental health um you know are
there things that are going on in your life that allow for you to be able to
live and be um and uh you know meaningfully participate in your life um
and sometimes we think about Wellness as well as a psychiatrist we also look at
some of the diseases and disorders that people can have that can impact their
mental health so sometimes there’s stressful situ situations there’s you know all of the different issues around
housing and poverty and Trauma experiences and other um huge stressors that people go through that affect their
mental health and for some populations there’s additional challenges trying to manage all of that because they have an
underlying depression that makes it that much harder or an underlying bipolar disorder or a significant anxiety
disorder sometimes people’s trauma experiences lead to PTSD which is the
posttraumatic stress disorder that some people can have as a response to um to
these significant traumas that they have and and that would be characterized by its own symptoms and and impairments and
functioning in addition there psychotic Spectrum disorders where people really have trouble organizing their thoughts
sometimes and their thoughts can be really disorganized they can also have symptoms of where of delusions where
they think um things are true that other people would not agree and they they
strongly believe that these things are true they can sometimes hear or see things that aren’t there as well and so
there’s a whole spectrum of ways in which things that we think of the brain as controlling can impact us to where we
would have something to the level of a disease where it impacts our functioning so much that it makes it that much
harder and so when you have that going into the other stresses that make
somebody prone to to homelessness um the it’s it’s that much harder and it
can be that much harder to um come out of and and I think what you said earlier
in your introduction was really helpful that that bir directional relationship sometimes there are all these things
that happen that lead somebody into being unhoused but also the stress of
being unhoused also or the traumas that you might be exposed to or you know the
life of of living in that way can also influence um development of of these um
problems as well and so then it’s that much harder and so if you don’t think about them together in that
bidirectional way it’s hard to make progress on them sometimes that’s how they self-medicate as in they
self-medicate I should say in order to deal with their circumstances as an example yeah I I don’t love the term
self-medicate because I don’t always think of these behaviors sometimes as being adaptive I think that sometimes
people don’t always have the skills or they haven’t learned other ways to try to manage or have the other supports
they need to manage these things and so so I I definitely understand that idea of trying to self-treat and trying to do
something to change how you’re feeling or what you’re experiencing um but I don’t know that
that misusing substances is is really best thought of as a medication right
but it’s definitely uh an attempt at trying to cope or manage with these difficult situations
can you say more about what impact homelessness could have on somebody’s Behavioral Health and
for those who are housed the um the impact that mental health or substance
use disorders can have on maintaining housing stable housing well it’s a complicated
relationship and I think there’s a a really um important movement towards housing first um really Meeting those
basic needs that people have can kind of provide that that very basic Foundation
that they might need in order to then begin to address and manage some of the other things that they’re dealing with
um there have been some studies that have shown that housing first can be really helpful and then there have been
some other studies that have sort of mixed outcomes with it and I I think that that speaks to the complexity and
how interrelated these things are and so um so I think that you know in a simple
way I think of it as as um really trying to Target at the same time these basic
foundational things that are so important for a living you need food you need a safe space to be um you need
Shelter From the environment around you um but just focusing on that or just
trying to address the depression or just trying to address the psychosis without meeting the basic needs neither of those
alone are sufficient is is how I understand that absolutely that’s true that’s true what are you seeing in the
community Deacon and council member what are you seeing in your communities in terms of folks suffering from behavioral
health issues well what I certainly see is that it’s people who are housed and
unhoused who are suffering from mental health issues I think that it’s important to understand the stress of
the cost of living in this San Diego region really saps a lot of that positivity
that naturally exists in a community and a lot of young people a lot of older people are saying this is not tenable
for much longer so if you already have a hard life imagine it being just a little
bit harder and it’s you know stress is not linear it’s exponential a little bit more weighs a lot heavier on your
shoulders than the previous pound of stress so I’m seeing a lot of people who are housed saying I might not be housed
next year uh so they have to make economic decisions of uh what is it called uh rationing
it’s like am I going to pay for electricity am I going to pay for my prescription am I going to pay for rent am I going to let the mold that’s in my
my bedroom am I going to pay to fix that it’s like well that’s immediate health need so you have a lot of people who are
making what is a rational decision right in front of them with not a lot of good options and that is what a lot of housed
people are facing that then become housed especially as we see seniors principally growing and growing as a
percentage of the unsheltered population because the cost of living for them might be fixed but their prices are
going up now I think that that is uh what what that tells me is how do we how
do we put money in their pockets so that they can afford and make choices which is freedom for them and reduces stress
and how do we give them options because it’s not just about having money you know one of the things about having housing is there’s not a lot lot of
options so there’s still a lot of stress we need to provide people with options for housing uh so that they can say I
have uh what’s best for me I think the thing the Deacon pointed out about all the services that father Joe’s provides
is we have options if you suffer from this particular problem in your life we
have an option for that and that creates less stress that is worth its weight in gold quite frankly and so I’m seeing
those things not just in homeless individuals but in housed individuals as well yeah it’s interesting that point
it’s an excellent point you you you surface council member the stress I see the stress being felt by the young
people the young people who are you know getting getting out of college as an example not being able to find that
first apartment um I mean you and it used to be I’m a baby boomer by the way
so when you talk about seniors I I can relate right and I’m blessed in many ways but but there are people who are
boomers or the baby the baby boomers who are falling onto the streets especially in a market like ours because it’s so
expensive to live here but I’m also seeing at the other end these kids coming out of college and they think
used to be if you got a college education hey you’re set right you’re going to get a job you’re going to find an apartment and you go you know the
American dream in a sense and it’s harder it’s become harder and harder to to recognize and realize that American
dream and and I see that stress also at the opposite end for the for these kids right and as a as a result it throws
them off track is what it does right and they have their own host of issues that then they uh they with which they
contend as well it’s interesting it reminds me of of conversations when we talk about depression sometimes we talk
about this foreshortened sense of the future this sense that when you’re depressed it’s harder for you to to
think ahead to think that there could be good things or that there’s good experiences and I think um we hear about
that a lot as well and people who um are are struggling with really huge acute
stressors it’s hard to see that there could be better things in the future and then like what you said this young
generation in particular um doesn’t have that like guarantee of the American
dream that they have faith in that they’re going to be okay and so again you have this sort of foreshortened
sense of being able to look forward and and kind of use that to keep moving down a path when it gets tough or difficult
because you have some sense that there’s something good at the end and so I think bringing it back to that combination of
of Behavioral Health um and and um uh the stressors that unhoused people have
it’s it’s that combination of well you know your your situation is making it
harder for you to see that then if you have this co-occurring depression that makes it harder to see that and then you
sort of have all of these stressful circumstances that you don’t have options to think about what can I do
there really you know you can’t see that there are options um that I think also is a really difficult place where people
can feel sort of paralyzed and and and I like what you said earlier about all the
different levels of care because not only do you need different levels of care but you need different options
within those levels because each person is unique um and if I can bring it back
to one more thing you said you know meeting people where they’re at is is really critical because if you don’t see
people um for their unique situation and try to address the things
that are pertinent for them to succeed then it’s going to be really hard for for a lot of people to to rise up
because a one-size solution is only going to help a you know a certain small portion of the population and when you
help that small portion of the population it can affect the the whole as well and that’s what we find as well
right so so it’s a get great segue to a conversation I had with the council member you’ll recall tail end of last
year may have been December or so because I meet with the council members individually uh periodically right just
so that they know what work up to and I like to know what what their concerns are as it relates to homelessness so I
had that that meeting with the council member and I told them something I had been weighing on my heart for at least a couple of years right you recall and
that and that was that it just people are more and more people are dying on the streets I made reference to it
before right and and and because of substances because of overdoses fanol is wreaking havoc xylazine now as well
right so and you know we need to help you know there can be hope there’s always hope if the person help the
person stay alive then there’s always hope right and so I said to him that I
was interested we were interested in starting detox focusing on detox because there aren’t enough beds here in the
city of San Diego two beds right in the entire County including those two beds 78 beds nowhere near what we need and
those beds don’t go to the population we serve and so have been weighting on me I said you know I really want us to focus
I want to repurpose some some beds um and but he took it to heart and three
months later I hear from him and I said by the way remember that conversation you had with me um I’ve been putting
together some legislation and you know it led from there to you presenting at
the city council in early July and getting that passed and that’s going to help tremendously in being able to stand
up behavioral health clinics that can focus on detox can focus on mental health challenges and I I just can’t
thank you enough for that well you bring up the legislation in July I I think back to the uh Town Halls that I had in
my community because I always do four town halls in January February with the different neighborhoods in my district
and I brought up that number that you taught me and taught my constituents you know there’s only there’s only two
Medicare uh medical eligible there’s only 75 to 78 beds in the entire County and that blew their mind um but when you
seeing my Community member saying oh that needs to be fixed just gives me back the the uh sense of urgency that my
constituents want to see it done too so you know you taught me I went and preached it out and they said oh yeah
that’s something we want to see you tackle so it it’s actually full circle and that’s how government should work learn from the experts go communicate
with the community back take their feedback and desires and actually put pen to paper and make a law on it so
that’s the way it’s supposed to happen and is it a beautiful when it does by way and it’s going to be even beautiful when this is up and running come the
first in the first beginning of next year we can’t wait right it’s going to it’s going to be a game changer for those who are going to go through the
program and as I mentioned you help that population and who gets healthier the entire Community right I mean it’s it’s
a no-brainer right and so we’re excited as to be about that I I was going to say you know there’s one other thing right we’re talking about seniors we talking
about youth I think just middle-aged families that also have that stress one of I think like I just and here’s the
social repercussions of that lack of choice as more and more people in the public realize that it’s harder and
harder to achieve the thing you thought your children could or that you could for them you know it starts to Fall by
the wayside taking a risk and in starting new business uh charitable giving volunteer hours in your community
cuz you’re thinking I don’t have time to spare I got to take care of my family because the risks out there are bigger
than they used to be and what we start to see is social the social fabric starting to tear and so if we take care
of our most vulnerable in the way that father Joe’s is doing and the with the resources that they’ve been asking for
us that the public has been asking for us that that sense of we’re accomplishing things starts to alleviate
in the community and people start to feel more comfortable in their own settings with their own families and start to do the things that create a
positive Community like being a volunteer like giving to charity like helping out philanthropy so there’s
reverberating economic repercussions by not helping the most vulnerable and why
not help the most vulnerable who are suffering and then we start to see over the course of 10 to 20 years oh actually
that boosted a whole bunch of other social indicators it’s it’s one of the best things about helping those who need it the most I agree I agree in fact when
you know we’ve been hearing in the last two years every single month non-stop actually for the last two years that
there are more people who are falling into homelessness that are being helped out of homelessness we hear that on the
news month in and month out it was I think of September last year I turned to my team and I said you know what the
public is becoming so disheartened I could tell by the types of questions I was receiving from the media itself and
from others I said I want us to put out some stats on the good things that are happening it’s not to negate that that’s
a reality yes the reality is that for every 10 who are placed into housing 13 are falling into homelessness right now
right that’s the reality but the real there’s part of the reality is that there’s a lot of good that’s happening
right and if not because of that good not just on the part of Father Joe’s Villages but across the board then the situation will be worse so we came up
with what we call a compassion in action report that we make public every single month as well and it talks about you
know the number of our hous who are placed the numbers who are help through the behavioral health clinic and the like I mean because otherwise people
lose heart to your point right and and that doesn’t help across the board tying that into addiction you know we know
very well that the negative consequences of substance use disorders and addiction can motivate you very much in in the
moment but the things we know from behavioral um from psychology and and um
positive psychology in particular is that the things that sustain recovery are the things you gain long term right
so the the benefits to your relationships the the benefits to building Community um the benefit it’s
overall to your well-being when you don’t engage in some sort of behavior is really what sustains it long term and so
I think it it makes sense I love the framework of thinking about using this as a way to make us all part of a better
Community but um but I think what you’re doing of the compassion and action and
putting out there all of the gains that is what helps people stay committed to doing it and to maintain those choices
and behaviors that everybody’s benefiting from because other what will happen is if people feel that we just
going down a hole then who wants to contribute who wants to volunteer who want it’s to your point right I mean you
have to feel as if no this is making a difference things are happening right and so it’s I mean you could always wallow in things right but but there
there’s so much stuff that is happening in the Miracles I call the Miracles that’s the focus that’s what keeps us going at father Joe’s Villages right so
so tell us tell us a little bit about the actual different types of therapies that you utilize that we utilize
ourselves actually at our within our Behavioral Health Clinic we have a team a mighty team of five at
this point and we’re expanding that we’re going to at least double it next year that’s because the need is
absolutely there and they go you know this group therapy and and the individual therapy and medication that’s
utilized as well so boxin and the like but you being you being the doctor you being the psychiatrist so why don’t you
speak to us about that there’s there’s a lot of different therapies that we can think about and and there’s different
therapies like you mentioned so there’s different um individual Therapies and group therapy approaches that we can use
things like cognitive behavioral therapy um adaptations of acceptance and commitment therapy adaptations of
dialectical behavioral therapy there’s all these like fancy terms there’s um a lot of things that that have an Evidence
base for being helpful but the challenge is implementing them and actually
letting people have access to all you know there’s mountains and mountains of scientific journals that show the
benefit of all of these things but it doesn’t mean anything if you can’t implement it in a setting where people
have access to it and can um use those kinds of things and so um so I think
that’s what’s really great I’m I’m also so impressed with how quickly these changes are happening particularly with
the detox and how once you know somebody realizes this is a good idea and sets their mind to it you know you can
implement it and so so we have all these therapy approaches and then we want to think about the settings and and where
and how can people access them and so um I think the detox facility is hugely
needed in our community it’s an important Gap um that’s really being addressed I often though will say that
detox itself isn’t really treatment detox is kind of getting you into a place where you’re safe enough
physically uh medically to participate in treatment and receptive enough and receptive you know if you’re if you’re
in severe withdrawal and you can’t even stop vomiting you’re not going to be able to talk to somebody about you know
what you think about substances or or even have a conversation about medications that you might want to think
about taking um and so so that’s an important entry point um to safely
stabilize somebody to participate in treatment but then what’s amazing about father Joe’s is like you said we have
all these options and different things and so from there it it’s paired with this sober living facility and that
people have different um accesses and so now we sometimes called those recovery
residences right so that you have this safe place without um easy access to
substances and that in of itself is a therapeutic environment and so that’s part of the treatment um then we can
think about these group therapies and individual therapies you can think about different intensities of programs so
sometimes um I use the analogy of of an antibiotic if if you have a raging infection and you take an antibiotic
once a month you’re you’re not going to make very much progress on your infection infection right so if you have a really severe substance use problem
and you see a doctor even once a month which is hard to even get once a month in some clinical settings but even that
it’s hard to really make much progress on something that’s causing you problems you know 16 hours a day every day of the
week um or more and so um so we have these different levels where people can
access these treatments at different intensities that are appropriate for them um I mentioned some of the
different therapies that we can do that can be in kind of individual settings or group-based settings and and groups are
really powerful because uh the peers the people who are in the group are part of
the therapeutic intervention and it can be a much more powerful thing when you
know your buddy who’s sitting here with you says something to you that really hits home in a way that somebody else
may not be able to and so so group-based therapies are really powerful and then
we have a lot of medications that um have come a long way recently particularly for alcohol use disorder um
particularly for opioid use disorder and even to some extent now with methamphetamine use disorder where um
I’m involved in a trial right now where we’re testing a medication combination for methamphetamine use disorder um
that’s really shown some some good promise so medication wise we’re starting to have things in areas that we
never really did before Dr Mariam Feld you have all of these interesting treatment options what are the barriers
that our neighbors in need are facing I think that there’s a number of different barriers so we we talk a lot about
access to care what does that mean well it can mean obvious things like you know it’s hard to pay for or insurance
doesn’t cover the things that you want it to cover um it can also mean not
accessing care because there aren’t enough providers there aren’t enough doctors of the right area or field or
therapists or you know other professionals who help in these areas um it can mean accessing care like
Transportation I don’t have a way to get there or it’s very very far away from from where I am um so there’s a number
of different things when we talk about access to care there’s other barriers around not knowing that there’s care out
there um we talked a little bit about not being able to see well into the future and be hopeful a lot of times
there’s this misunderstanding that um we don’t have effective treatments for addiction and substance use and mental
health disorders when in fact we do have very good treatments um that are similar
and when you look specifically at substance use disorders our treatments are very similar to outcomes for other
things so if you look at um outcomes for high blood pressure or diabetes you know
these are also diseases that have um kind of flare ups and they get better
and they get worse sometimes Lifestyle Changes make a huge difference in the
disease progression sometimes medications make a huge difference in the disease progression sometimes they
just get better and worse on their own um and so when you look at substance use disorders and mental health disorders
it’s like that as well there’s this waxing and waning there’s a role for changing the situations and the
so-called lifestyle factors in your life there’s a role for medications so all of
those are are things to think about um to know that there’s treatment out there
um because I think sometimes that’s a huge barrier that that people think or that there’s treatment out there for you
um for your particular problems um we haven’t mentioned the the term stigma um
but stigma plays a big role in people um wanting to acknowledge if they are struggling with their own mental health
issues or if they are struggling with a substance use disorder there’s very clear studies that people who come to
Health Care settings with either a mental health or a substance use disorder get treated worse often um and
their outcomes often aren’t as good because of that and so so it it disincentivizes somebody from wanting to
share that they may need help in those areas because they’re worried it might affect how they get treated and how they
might access care in other areas so there’s there’s a number of barriers I think also you know some of the
treatments that we have are not great fit for everybody some of the medications for example have side
effects that are hard to manage or some of the medications may make people feel
um what they might describe as like numb or or removed and they don’t like that sensation either they don’t necessarily
want to be struggling in the way they have been struggling but you know the alternative may not be great and so so
some of the treatments aren’t perfect and that can be a barrier in it of itself um but we also want to make sure
that people know that there are a wide variety of treatments and so um so I think a lot of the barriers can be
addressed through through understanding education and really tackling that access to good quality Care um but the
huge barrier before we were talking about with detox two beds I mean nobody had access to that hardly so so I think
that’s a big I would add to what you were saying before about barriers Deacon you know very well some of the folks
that we serve our neighbors in need they will are often you know preoccupied trying to find where their next meal is
going to come from you know they are unable to leave their items for long enough to or leave their pet for long
enough to go seek care so that’s a real barrier scene in our population as well well it is it’s an excellent point Maggie the a third of those who are on
the streets won’t access care in a traditional way the way we would right brick and morar and so they just won’t
and so they they their health situations just become worse and worse and worse so
two in 2019 we started deploying a Street Health Team and you fast forward to today that Street Health team is now
5 days a week mornings and afternoons in fact we have three teams that go out to various locations in order to again meet
people where they are and start the most important thing we start doing is building relationship because that’s
what it’s all about and and we’re now deploying psychiatric clinicians as well so they’re going out there into the
community right for for all the reasons we’ve been we’ve been discussing and and in building that that relation those
relationships so that in time we can get people draw them in for better services
that they with it’s shelter and meals and the like um and so that’s an important element right again and it’s
it’s not in a judgmental way it’s more so if you have issues with substance use
well we have medication assistant treatment right soon we’ll have the impatient detox center right so what do
you need now let’s start helping you in in your particular situations and then
get you better and better help right what do you seeing council member out there as when you think about those on
the street and you think about Behavioral Health and and I know you and I have spoken about how this has impacted us personally in our own lives
with our own families right and it’s heartbreaking and and there’s so many people out there in the public who have
been touched by this some way some way or another I mean I think it’s rare to find someone who hasn’t been touched by
us somehow right and so what are you hearing from your constituents what do
you what you know what what are your thoughts on what else do we need out there from a policy point of view
you know I I oftentimes go back to the economics of what creates homelessness I
will always say that the um the best solution to homelessness is a good job
with Healthcare benefits uh and uh in particular if it’s a union job with good
healthare as well um I think that uh the problem of mental health the
problem of addiction the problem of uh any number of disorders that we’re
seeing in the unsheltered population we’re seeing it in the housed population too and so uh we can create these
resources for everyone and make sure we have enough set aside for folks who are unsheltered because they are the most
likely to die from these problems and always remember that they’re at the greatest risk um I think that uh a lot
of families are dealing with it in the way that my family dealt with it and 10
years ago um 10 years ago my brother Alex died from an opioid overdose 14 years ago broke his leg in a
freak accident was prescribed oxycodon and wasn’t managed correctly
gets rolled off the prescription and he turns elsewhere and that is the heartbreaking story of hundreds of
thousands of people um and little did we understand it at the moment um now it’s not so much oxycodon and pills like that
now it’s more fentanyl is laced in all sorts of things and so um I’m what am I
hearing I’m hearing people cry out and say how are we going to one stop these poisons from being in our community two
how is government going to uh provide options for my family um that is not
giving someone a home but it’s a detox bed you know that’s the thing too I say to my my constituents I’m like you we
know each of us knows 75 people who might need detox right now and if they don’t have the bed there for them when
they come beg for it you know what do we hear from a lot of people they say oh people don’t want help they’re they’re
satisfied with their life I’m seeing a lot more people who are far from satisfied begging for help but it’s it’s
like we got so many people to help we can only help so many so um that’s why I love partnering with Father Joe’s that’s
why I love working with the city of San Diego staff uh with my staff uh got to give a shout out to Carrie Shaw and my
staff who’s worked with so many of you to get things done um but um that that’s
what I’m hearing out is a cry for help uh and it it I I say to myself you know
if a person had a reliable job with Healthcare they could have turned to their own doctor instead of relying on the city to figure out something with
Father Joe’s Villages if we can create the environment for good jobs I think
that we’re going to see a natural decrease in the suffering that we have uh and that’s going to allow people to
pay for their rent pay for their medications store up hope uh and um I I
think that the city government we can do small legislative changes that have big land use implications like they do for
the detox center but man do we need to make sure that the local economy is running well that’s what makes the
students at UCSD who say hey I came here for four years but it’s too expensive to stay here I’m going somewhere else or I
I can’t or I got to rent an apartment with four people the economics of the the environmental economics really do
um make that Major Impact so that than the few that do have
significant uh genetic uh hormonal physiological issues that doctors can
care for they can focus on those people instead of people who on the whole wouldn’t go into that situation but for
the lack of economic uh success they can achieve yeah first of all thank you for
sharing about your brother those types of testimonies are how we humanize this issue and grow compassion so thank you
so much of course what kinds of policies or initiatives are you advoc advocating for directly to increase access to these
Services well right now we are seeing a full fledged push from the state to have
municipalities cities and counties address them I’d say from the city point of view uh we are always doing
everything we can to be a pro housing City so that we can get access to state
grants uh and other cities don’t get them so that we can have uh rent restricted affordable housing so that we
can have permanent support of housing so that the Housing Commission which is an arm of the city of San Diego uh deliver
on that and have that that funding again it comes back to funding and economics um and now we’re looking at the state
saying um they’re going to the governor has been very clear that he is going to
reward cities that deal with homelessness in a particular way and cut back funding from places that don’t um
and that I think that there’s a place for the state government saying we we’re
going to reward folks that um are trying to deal with this in any number of ways
um I think there’s been a lot of complacency at levels of government that say Ah that’s that City’s problem and
I’ll say you know the city of San Diego makes that point a lot we have 18 municipalities in the
