Community Care Plan

Robert Hickey
November 2015

Paid for by Hickey for City Attorney 2016 7185 Navajo Rd. Suite P San Diego, CA 92119

Community Care Plan

Homelessness in San Diego is not just a policy issue, and the statistics do not convey the urgency we should all
feel when discussing the problem. It is a daily struggle of life or death, sickness or recovery, suffering or relief.
In my conversations on this topic, one story in particular stood out to me as an example of what homelessness
means, both to the individuals directly affected and also their families and loved ones.
I met a father of a young man I will call Andrew. Andrew was diagnosed with bipolar disorder in high school
and he struggled to stick with his treatment. Shortly after graduating, he became addicted to heroin. Gerry,
Andrews father, got him into rehab a total of six times over the course of two years. Eventually, Andrew refused
any further treatment.
"The sickness took over," said Gerry, Andrews father. He struggles about what happened to Andrew next. "I can
barely recognize him. He can't use drugs in my home and he can't steal from us, so he stopped coming around."
For the past three years, Andrew has been living on the street. His friends from high school tell Gerry when they
run into Andrew.
"What I hear scares me," says Gerry. "But I know that there is always a way out. He's not the only one in the
family who has struggled with these issues. The hardest part as a father is that I cant control whats happening."
Gerry checks jail and hospital records often. He has no choice but to trust that there is a system in place that will
rescue Andrew before it's too late.
"I don't know when Andrew will hit bottom, but I pray that when he does, someone is there to take his hand at
that moment and show him the way to recovery."
Each person living on the street has a unique story. The commonality is that they are each in a state of crisis. They
depend upon the community to be there with the right support at the right moment. How do we create a network
between government agencies, law enforcement and service providers, that reaches to people like Andrew at the
right moment with the appropriate resources?
In my meetings in the community about this subject, two things became clear.
First, we must focus on improving communication between everyone involved. We need clear and open lines of
communication between service providers, law enforcement, City officials and policy makers. Most importantly,
those living on the street need to know that help is available at every possible opportunity.
Second, we need to utilize tough love strategies. Service providers and law enforcement alike repeatedly pointed
me towards research showing that mandatory drug treatment produces similar success rates to voluntary
treatment. There is amazing hope in that fact, because it means that people like Andrew have a chance for a better
life, whether they choose to begin that process themselves or are pushed into it.
I believe that the Office of the City Attorney is uniquely positioned to tackle these issues and provide the
guidance and leadership we need to make a difference. I welcome your input, advice, and accountability as we
embark upon this effort to lift up our community.

Robert P. Hickey

Community Care Plan

Reducing Homelessness for Better Quality of Life
As San Diegos economy grows, it is even more critical to meet the needs of San Diegos most
vulnerable. The City Attorney plays a critical role in solving homelessness and building a
stronger quality of life for all.
Step 1: Renewed Focus on National Best Practices to Solve Homelessness
Implement data-driven solutions through coordinated intake assessment. Further
implementation of the Homeless Management Information System (HMIS) will ensure
service providers are working together on systemic solutions and more effectively
directing scarce resources to better serve San Diego homeless.
Increase outreach with local landlords to identify housing units for chronically
homeless veterans with VASH Vouchers. The Department of Housing and Urban
Development and Veterans Affairs Supportive Housing joined efforts to move Veterans
and their families out of homelessness and into permanent housing.
Further implement the Housing First model of providing supportive permanent
housing to the chronically homeless. Housing First is a proven best practice that is
the most effective method for solving homeless while reducing social services costs
associated with emergency healthcare and law enforcement. There should be additional
investment in successful programs that are founded in best practices such as the San
Diego Housing Commission and City of San Diegos HOUSING FIRST Action Plan. This
plan calls for a significant investment and includes successful housing best practices
such as permanent supportive housing and Rapid Rehousing to find homeless
solutions.
Step 2: Close the Gaps in the Justice System to Stop the Cycle of Addiction
The City Attorney must work closely with law enforcement to increase
participation in drug treatment programs to stop the cycle of addiction. Prior to the
passage of Proposition 47, there was a greater incentive to participate in these
programs. The City Attorney must work collaboratively with local law enforcement, the
San Diego Housing Commission, the San Diego City Council, and the Mayors Office to
find systemic solutions that incentivize drug offenders to seek treatment and find
permanent and transformative solutions. As in SIP we must work with the court to
create increased punishment for repeat offenders in need of treatment to incentivize the
addicts to participate in programs or face a deterrent amount of jail time.
Expand successful recovery programs like the City of San Diego, Serial Inebriate
Program (SIP). A nationally recognized program, SIP allows individuals who have
multiple misdemeanor offenses for public intoxication to receive supportive transitional
housing and mental healthcare services in lieu of incarceration. Successful programs
like these that are managed through law enforcement can reduce levels of incarceration
while empowering individuals to change their lives. This program should expand to

Community Care Plan

include those repeatedly arrested for being under the influence of controlled substances
such as cocaine, methamphetamine and heroine.
Dedicate a position in the City Attorneys Office to work exclusively on homeless
issues. A dedicated position will help increase collaboration between the City and
other public agencies and will help deliver must needed systemic solutions faster.
Improve communication between service providers and law enforcement to
improve enforcement of City ordinances while more effectively providing
recovery services. There must be enhanced collaboration between law enforcement,
service providers, and the City Attorneys office to increase outreach and better
connect our communitys most vulnerable to needed recover services.

Serving the Chronically Homeless

In 2015, the San Diego Regional Task Force reported that San Diego has over 5,700
homeless individuals living within City limits and 36% of unsheltered homeless were
determined to be chronically homelessi individuals who have been homeless for more than
one year or who have been homeless more than four times in the last three years. Research
has shown that chronically homeless individuals use a disproportionately larger share of public
resources.
According to the United States Interagency Council on Homelessnessii, chronically homeless
people represent 10% of the total homeless population nationally and consume an estimated
50% of available resources, including: emergency medical services, shelters, mental health
support, law enforcement services, and detox facilities. This makes it even more critical to find
permanent supportive housing for chronically homeless.

Community Care Plan

Continued investment in Housing First. To solve homelessness, the City of San
Diego, in collaboration with San Diego Housing Commission (SDHC) and County of San
Diego, should continue its investment in housing first solutions for chronically
homeless. The SDHC Housing First Plan, released in 2014 in collaboration with the City
of San Diego, aims to rapidly provide chronically homeless individuals with permanent
supportive housing and calls for an unprecedented investment. Its a 5-point plan that
(1) Renovates the historical Hotel Churchill to create 72 affordable studios for homeless
veterans and youth aging out of the foster care systems
(2) Awards up to $30 million over the next three years to create Permanent Supportive
Housing that will remain affordable for 55 years
(3) Commits up to 1,500 federal rental housing vouchers to provide housing to
homeless individuals and families
(4) Invests up to $15 million from the federal Moving to Work rental assistance
program to acquire a property that will set aside 20 percent of its units for Permanent
Supportive Housing for homeless San Diegans
(5) Dedicates 25 of SDHCs own affordable units to temporarily provide furnished
apartments for homeless individuals and families. SDHC is one of the first public
housing agencies in the nation to commit affordable rental housing that it owns for
this purpose. Since implementation this year in January, the SDHC was able to
assist 26 families into the SDHC owned units. Along with housing, the SDHC was
able to fund the Achievement Academy which provides employment and financial
education to those in the program. This successful addition to their housing program
has led to three families securing employment or other sources of income to be able
to pay full rent.
Continued Investment in Rapid-Rehousing and Transitional Housing for Specific
Populations. In addition to permanent supportive solutions for chronically homeless, it
increases investment in Rapid-Rehousing resources, a proven method to assist
individuals and families who have found themselves homeless due to unexpected
circumstances including job loss, domestic violence, or medical problems.

Community Care Plan

Continue Efforts to Build Coordinated Intake Assessment and the Homeless

Management Information System (HMIS) for Data-Driven Solutions. Currently, the
homeless service providers in San Diego use the Coordinated Assessment and
Housing Placement System (CAHP) to share information with each other. This shared
data allows providers to see when an individual last entered a facility and which facility
they entered. This system helps identify how long the homeless individual has been on
the streets and makes note of any physical or mental health needs. It also assists
providers determine the most appropriate housing to meet those individuals needs. The
HMIS ensures that all providers are using compatible software and provides them with
real-time data to enable the delivery of housing and critical services to the homeless. It
also meets the recommendation of the U.S. Department of Housing and Urban
Development to use a single system as a best practice.

These are the type of services and programs the City should continue to invest in. As
the City improves the gaps between law enforcement and service providers, the City
Attorneys Office will be better equipped to bring homeless in off the streets and into
transformative programs.

Community Care Plan

Close the Gaps in the Justice System to Stop the Cycle of Addiction
The voter approved Prop. 47 reduced certain felonies to misdemeanors including possession
of methamphetamine, cocaine, heroin, and concentrated cannabis. As a consequence, the
effectiveness of Drug Court and other rehabilitation options has been reduced since many
would-be participants now choose to face minimal jail time rather than undergo intensive
monitoring and rehabilitation treatments. Anecdotal information from court staff reported by
SANDAG states that referrals to Drug Court are substantially less than the previous average iv.
It has also been recently reported that Prop. 47 creates a virtual get-out-of-jail-free card for
narcotics abuse offenses" v. After the passage of Prop. 47, completion of drug treatment
programs have been reduced as drug violators are faced with the choice of an extended drug
treatment program or a very short jail sentence. Through the deterrent of extended jail time for
repeat offenders, we must bring back these incentives to better connect homeless San
Diegans in need to recovery services.
Expand successful inpatient programs to improve drug treatment results. There is
a need for more emphasis on substance treatment as an alternative to incarceration.
Several studies have been conducted on outcomes of compulsory treatment versus
voluntary treatment and the conclusion is that there needs to be an expanded use
mandated programsiiii. Many of these studies, including a study done by the National
Institute on Drug Abuse show those patients who were legally compelled to treatments
reported better outcomes than voluntary patients vii. Without the expansion of successful
inpatient, compulsory programs, individuals experiencing substance abuse will continue
in and out of the criminal justice system without needed treatment.

Community Care Plan

Expand successful recovery programs like the City of San Diego, Serial Inebriate
Program (SIP). The SIP strategy arrests individuals who have at least four
misdemeanor offenses for public intoxication. These individuals are offered supportive
transitional housing, mental healthcare, and substance treatment in lieu of incarceration.
In the wake of Prop. 47, the SIP program needs to be expanded to further, under the
influence of controlled substances for instance, to address substance abuse among the
homeless population. The United States Interagency Council on Homelessness
research of San Diegos SIP reported that in community-supported treatment reduced
the use of EMS, ED, and inpatient resources by individuals repeatedly intoxicated in
public, and there was a significant increasing trend in acceptance of treatment among
individuals facing longer jail sentences.

Expand Community Court to include treatment programs as a condition for case

dismissal. Community Court is a diversion program for first-time misdemeanor
offenders. The program offers individuals the option to complete 16 hours of community
service through Alpha Project or Urban Corps in exchange for a dismissal of their case.
The Community Court should expand to offer individuals the option to receive medical
and psychiatric evaluations followed by relevant treatment programs in exchange for a
case dismissal.
Improve communication between service providers and law enforcement. In the
last few years, the City has invested heavily to provide interim beds for targeted
outreach. Connections Housing provides 223 housing units, both interim housing and
permanent supportive housing. This program plus the 350 beds at St. Vincents are
replacing the temporary tents the City used for nearly 30 years to transition to providing
year round shelter. The City has made available over 50 beds per night to be used for
outreach. However these beds are being dramatically underutilized. There must be
enhanced collaboration between law enforcement, service providers, and the City
Attorneys office to increase outreach and better connect our communitys most
vulnerable to needed recovery services. This will not only allow for enforcement of City
ordinances but will empower those served to transform their lives and take the first step
to recovery.

Conclusion
There is no quick fix to homelessness. This will take a joint effort between all of the key players
in the criminal justice system as well as the service providers who do an amazing job serving
this population. The Office of the City Attorney is uniquely positioned to tackle these issues
and provide the guidance and leadership San Diego needs to make a difference.
We must focus on improving communication between everyone involved. We need clear and
open lines of communication between service providers, law enforcement, City officials and
policy makers. Most importantly, those living on the street need to know that help is available
at every possible opportunity.
Equally important, we need to utilize tough love strategies by expanding programs like
community court and SIP to encourage more utilization of available services.

Community Care Plan

http://www.rtfhsd.org/pdf/2012-WeALLCount.pdf

ii

United States Interagency Council on Homelessness (2004), The 10-Year Planning Process to End Chronic
Homelessness in Your Community, A Step-by-Step Guide
iii

http://digital.turn-page.com/i/593130-2014-15-fiscal-year-annual-report-activity-updates

iv

http://www.vera.org/sites/default/files/resources/downloads/PLCSUMM1.pdf

http://www.sandag.org/uploads/publicationid/publicationid_1932_18922.pdf

vi

http://www.washingtonpost.com/sf/national/2015/10/10/prop47/

vii

http://www.vera.org/sites/default/files/resources/downloads/PLCSUMM1.pdf

viii

https://archives.drugabuse.gov/NIDA_Notes/NNVol20N6/Treatment2.gif