The federal government on Thursday gave $3.1 million to an unusual program that combines housing with treatment for the mentally ill homeless in San Diego County, and joins the new social program with academic study to determine its usefulness.
"We're taking everything we know how to do right now, everything we know from earlier research, and putting it into this program," said Richard L. Hough, a San Diego State University sociology professor and a principal investigator in the study.
The innovative program will find 180 homeless mentally ill people on San Diego's streets and put them into guaranteed space in public housing. Half will get intensive one-on-one support services, called case management, to help them function better in the world. The other half will get traditional, less intense case management.
Another 180 mentally ill homeless will receive the two different types of case management, but no housing.
The idea, said county Mental Health Director Areta Crowell, is to find the best plan for mentally ill people who often become homeless because their bizarre behavior gets them evicted.
Currently, the only housing help offered to the chronically mentally ill is in residential treatment programs, where they aren't allowed to stay permanently, Crowell said.
"We've spent a lot of time putting people into programs where the treatment and the housing were all together, and when the person improved then they had to leave the housing. That doesn't make sense," Crowell said. "So we've really cut through all that and said, 'OK, if we can get permanent housing, how much support does it take to help the people stay there?' "
Official notice of the grant came Thursday from the National Institute of Mental Health, which is headed by a former UC San Diego professor, Dr. Lewis Judd.
The program will be a cooperative effort among the county, the San Diego Housing Commission, SDSU, and San Ysidro Health Center, which already works with the homeless mentally ill in downtown San Diego.
It is one of six grants awarded under a joint homeless initiative between the National Institute of Mental Health and the Department of Housing and Urban Development. The San Diego grant is the only one on the West Coast, and received about 20% of the total funding available in the initiative's first year, county officials said.
The San Diego program is unique in the nation, those connected with it believe. In the past, programs aimed at the homeless mentally ill worked on improving treatment programs or finding housing, but not both together, Hough said. It also involves an unusual coalition of public agencies and academia toward a common goal.
Furthermore, the level of case management that the program will contain for 180 of the participants is more intense and flexible than traditional case management, Hough said.
The caseworkers, provided under contract with the San Ysidro center, will have a very low number of cases to handle, about 15 per person, Hough said. That compares with 30 or 40 under traditional case management.
They will help participants find mental health care and get a job, urge them to take needed medication regularly and help with any other problems of daily life. Participants will not be forced to take medication to control their schizophrenia or other conditions, but will be urged to do so, Hough said.
The approach will be flexible and caseworkers available 24 hours a day, to prevent the problems that occur when the mentally ill are completely cut loose from help, Hough said.
"In the normal situation, they come in, they get assessed, they're given some medication and maybe they're in the hospital for a day or two--if they're lucky--and then they're back out on the streets," he said. "Then they stop taking their medication, they start acting out, and the whole cycle starts over again."
But the project is an experiment, Hough noted, so organizers' hunches that this approach is best might prove wrong.
"If we throw all that at them, it's expensive, so the question is, does it work? If it fails then we have to go back to the drawing board. But it should work," he said.
Crowell hopes that if researchers find the new method saves money over picking up and hospitalizing the mentally ill, they will help mental health departments persuade budget makers to fund such programs everywhere.
"I can't have any assurance that we'll get more money, because we've had lots of proof that we needed more services for the mentally ill and we haven't had them, but one has to keep trying to make the case," Crowell said.