Proposition B would let San Francisco borrow up to $390 million to carry out infrastructure and other projects, like upgrading health care facilities, creating homeless shelter, repaving roads and renovating Harvey Milk Plaza, the Castro neighborhood spot honoring the city’s first openly gay supervisor, who along with Mayor George Moscone was assassinated in 1978.

Listen to a summary of what this ballot measure would do.

Support

Mayor London Breed and the full Board of Supervisors support the bond measure, which they describe in the official proponent argument as a “critical investment” in public health and safety infrastructure.

Other supporters include numerous local groups such as NICOS Chinese Health Coalition, Self Help for the Elderly and the San Francisco General Hospital Foundation. State Sen. Scott Wiener backs the measure, as do the Alice B. Toklas LGBTQ Democratic Club, Harvey Milk LGBTQ Democratic Club and other political groups.

Cost

If voters pass Proposition B, San Francisco may sell general obligation bonds to investors and use the funds for civic projects. The city would repay bondholders, with interest.

If all bonds were issued and sold, projected repayments would total $737 million, according to an analysis by the city controller. The city would fund repayments with property tax revenue, at an estimated rate of $6.90 per $100,000 of assessed property value.

Proposition B wouldn’t increase overall property taxes; it would replace taxes tied to a previous bond measure once they expired, after those bondholders were fully repaid. Moreover, landlords could pass half of their tax costs to tenants in the form of rent increases.

Opposition

The San Francisco Briones Society, a Republican group, opposes Proposition B. In the official argument against the measure, the group says the city should address issues like homelessness using its existing revenue rather than “burdening tax payers with additional debt.” Up to about 13% of the maximum bond revenue would pay for renovating and acquiring homeless shelters.

The San Francisco Apartment Association, which represents landlords and property owners, also opposes Proposition B. The group would like to see property taxes fall, rather than stay level due to a new bond measure, the group says in a paid argument.

What would it do

Most of Proposition B’s bond revenue would fund improvements at health care facilities, split almost equally among community health centers and hospitals.

If the sale of general obligation bonds produced the maximum expected revenue, about $71 million would pay for renovations at the Chinatown Public Health Center, which serves primarily low-income, uninsured, elderly and recent Asian immigrants in languages they understand. That would cover ventilation system upgrades and enable on-site mental health services. It would also fund the facility’s first major seismic upgrade since it was built over half a century ago; the center is one of San Francisco’s most earthquake-vulnerable clinics. During the construction work, services would move to the Chinese Hospital about two blocks away.

Additionally, $28 million would go toward acquiring property that would become the new site for the City Clinic, which provides treatment for HIV and other sexually transmitted diseases to youth and low-income residents.

Two hospitals would together receive $66 million in critical repairs and renovations, including fire-safety upgrades: Laguna Honda, which provides medical and rehabilitation services, and the Zuckerberg San Francisco General Hospital and Trauma Center, which handles 20% of the city’s inpatient care. The facilities would also get $40 million for seismic retrofits. At Zuckerberg hospital, the money would go to expanding mental health services.

The rest of the bond revenue would fund various other projects.

Public spaces would get $71 million in improvements. Of that, $41 million would help revitalize downtown by improving pedestrian areas and access to transit near Powell and Market streets. About $25 million would go toward Harvey Milk Plaza, enhancing accessibility for people with disabilities, upgrading the elevator at Castro Muni metro station and adding fixtures and landscaping. The remaining $5 million would improve infrastructure and recreational spaces at public parks.

About $64 million would pay for upgrading street traffic signs, redesigning arteries and sidewalks, repaving streets and adding roadway lighting.

Lastly, the city would use $50 million to acquire, construct and improve shelters for people experiencing homelessness.

An oversight committee would annually hold a public hearing on the fund’s implementation and report expenditures to the mayor and the Board of Supervisors.

Campaign finance

As of Oct. 7, the “Yes on B” campaign committee had raised $624,544, according to data from the San Francisco Ethics Commission. Contributors included health care organizations, with the greatest backing coming from the San Francisco General Hospital Foundation, which supports and funds the Zuckerberg hospital, at $100,000. Donations of $50,000 each came from Sutter Health, a nonprofit health care provider in California; Hudson Pacific Properties Inc., a real estate agency; and Diane Wilsey, a major Republican donor and the owner and chief executive officer of A. Wilsey Properties Co.

The “No on B” campaign committee had raised $172,000. The main contributor was the San Francisco Apartment Association Political Action Committee, which donated $50,000.

History and context

Over the past decade, San Francisco voters have approved three bond measures focused on bolstering public health facilities, including by upgrading outdated buildings.

Many of today’s needed improvements to health care facilities and infrastructure are described in the city’s latest 10-year capital plan, adopted last year, but Proposition B would not address them all. Proposition B’s architects excluded the renovation of the Silver Avenue Family Health Center, in the city’s southeast, from the measure’s funding targets because its cost projections exceeded earlier expectations, city staff explained at a public meeting in June.

The measure initially omitted the relocation of City Clinic, but drafters included it following community protest. 

Votes needed to pass

As a bond measure, Proposition B requires at least 66.67% “yes” votes to pass.

However, if voters this November approve California Proposition 5, which would reduce the threshold for passing housing and infrastructure bonds, Proposition B would need only 55% “yes” votes to pass.

Click here to return to our full voter guide.

The post Proposition B — Bonds to Enhance Health Care Facilities and Public Spaces appeared first on San Francisco Public Press.

The Homeless Outreach Team’s years-long staffing woes and decisions to redirect outreach workers to special projects have left them less time for their core mission: building trust with unhoused people and helping them get case managers, social services, temporary shelter and permanent housing.

In perhaps its highest-profile special project, the team worked to prepare the downtown area for the Asia-Pacific Economic Cooperation summit in November by removing visible evidence of homelessness. This meant prioritizing unhoused people in that zone for the city’s scarce shelter beds. The summit was widely considered an opportunity for Mayor London Breed to redeem San Francisco’s image after years of bad press. Breed is running this year to keep her seat.

The mayoral race is heating up, with candidates sparring over homelessness and making it a key issue in their campaigns. It is a critical issue to San Franciscans, surveys show. Nearly 40% of residents said homelessness was the city’s worst problem, and over 70% said it was among the top three problems, a 2022 survey by the San Francisco Chronicle found. It was also a top issue for more than half of respondents to a February poll by the San Francisco Chamber of Commerce.

The Homeless Outreach Team’s field work volume has dropped precipitously from its zenith during the COVID-19 pandemic, when the work entailed many brief interactions to help people weather the citywide shelter-in-place order.

Some service providers and homelessness advocates said they approved of one of the team’s special projects, the Street to Home program, which has placed 58 people in housing.

Even targeting high-priority areas, like downtown during the summit, wasn’t necessarily bad if it included offers of shelter, said Christin Evans, a member of the city’s Homeless Oversight Commission.

But it “needs to be done also in a way that the people with the highest needs are getting the resources that they do need, as opposed to moving them along,” Evans said.  

And when scarce resources are used for political reasons, it can damage trust-building between the team and unhoused people, providers and advocates said.

The Homeless Outreach Team could end up doing even less field work if officials follow through with plans to reduce its budget by $3.5 million over the next two years. The cuts might land on its neighborhood-based teams, further reducing or eliminating outreach outside the city’s downtown core, said Emily Cohen, deputy director of communications and legislative affairs at the Department of Homelessness and Supportive Housing.

Joe Wilson, executive director of Hospitality House, said it would be a bad idea to cut outreach, especially in the wake of the U.S. Supreme Court’s recent decision in City of Grants Pass, Oregon v. Gloria Johnson. The court ruled that cities may enforce bans against sleeping or camping in public spaces, even if no shelter is available, and issue fines — causing many to worry that governments will prioritize policing over providing housing or services.

“The Grants Pass ruling clearly opens the doors to outright criminalization without any pretense of offering support,” Wilson said. “It’s even more imperative, even more vital, that we invest in outreach and connection and getting people connected to needed resources.”

The San Francisco Public Press asked the Department of Homelessness and Supportive Housing who, at City Hall, had decided to shift the team’s work priorities.

“HSH, in partnership with other city departments is responsible for deciding priorities and determining special projects,” spokesperson Deborah Bouck wrote in an email.

Waning outreach and possible political motives

The Homeless Outreach Team’s interactions with unhoused people peaked shortly after the pandemic touched down in San Francisco, when Mayor Breed issued a citywide shelter-in-place order to slow the spread of the novel coronavirus. Engagements numbered 14,664 in April 2020 and have been trending down ever since. They fell to their lowest level this April, the most recent month for which the Department of Homelessness and Supportive Housing provided data, with only 1,808 encounters.

The rate of engagement soared during the pandemic because many interactions were brief, with the team on the streets talking to as many people as possible, distributing masks, educating on basic public health and helping people move into hotel rooms repurposed as homeless shelters.

In recent months, time-intensive special projects have meant less time for other outreach work, reducing the team’s overall interactions with unhoused people.

The team met its contractually required 35,000 engagements last year. Data for 2024 shows that the team’s engagements were about 7,900 through the end of April, the most recent month for which data was provided. If the downward trend continues, the team will likely miss this year’s target.

But the workers have many targets, said Bouck, of the homelessness department — not just those related to outreach. “There are 23 service objectives that HOT is evaluated on, and encounters is one of them,” she said, referring to the Homeless Outreach Team.

In its new prioritized work, the team placed 58 people in housing through the Street to Home program from its inception in June 2023 through this March, during which only one person left the housing, The Frisc reported. The program takes people directly from the streets into permanent supportive housing, where they generally can access case managers and social services. Service providers and homelessness department staff said Street to Home has helped some people who have struggled for years to come indoors.

For the Asia-Pacific Economic Cooperation summit, aka APEC, about a dozen team members targeted their field work in zones where event activities would take place: near City Hall, the Moscone Center, the Asian Art Museum and the Embarcadero.

That month, the team continued general outreach throughout the city. But some of its other work, sending staffers out in response to phone calls from the public requesting help, stopped almost entirely. Those dispatches numbered 65 in October, then eight the following month, rising again after the summit concluded. In the team’s work notes about how it responded to phone calls, staffers wrote, “Due to APEC assignments not able to dispatch.”

Critics were troubled that the team’s other work might be affected by political motives.

“It just seems like a ridiculous diversion of effort and kind of classic,” said Jennifer Friedenbach, executive director of the Coalition on Homelessness, referring to the Homeless Outreach Team’s work at the November summit. She called it the latest “example of HOT being politically diverted into other jobs instead of focusing on their existing clients.”

For example, she said, the team has often shifted its work toward areas of the city where there were upticks in complaints, to the detriment of unhoused people elsewhere who had already been promised resources. Friedenbach said the Homeless Outreach Team “has a lot of really strong staff” but that when it changes priorities before following through on earlier commitments, it can end up “disintegrating trust with folks.”

When the team is not dispatched or cannot find those who call for assistance — which occurs in most cases — callers are left to fend for themselves or find help elsewhere.

As the Homeless Outreach Team’s engagements have generally declined, encampment clearings, also called sweeps, have increased. Outreach team members help with clearings by offering shelter and other resources to the encampment dwellers whom city personnel displace.

Breed has been a vocal proponent of clearings, saying it’s not healthy or safe to camp on the streets. She submitted an amicus, or friend-of-the-court, brief in support of clearings to the Supreme Court as it deliberated the Grants Pass case.

Unhoused people, their advocates and service providers have long criticized clearings for reducing the visibility of poverty instead of addressing its root causes, and for further destabilizing people experiencing homelessness.

Looming budget cuts and staffing woes

Cohen said past staffing troubles had contributed to the Homeless Outreach Team’s decreasing field work.

Turnover has been high, according to a 2023 city audit. Heluna Health, the nonprofit hired to run the team, has struggled to keep the team at least 90% staffed at all times, as required by its city contract.

The situation improved by this summer. The team was 95% staffed as of July 2, Bouck said.

But looming budget cuts, which Breed has proposed and the Board of Supervisors may approve this month, could slash the team’s ranks, Cohen acknowledged. That would put social services further out of reach for San Francisco’s less visible unhoused people, in particular, those who tend to steer clear of downtown, such as seniors and families living in vehicles.

One of the outreach team’s roles is to help people navigate the city’s complex services system, said Lydia Bransten, executive director of the Gubbio Project, which gives food, medical assistance and places to rest to people experiencing homelessness. If the team’s budget was cut, she wondered, then what would the plan be for providing that type of hand-holding? Police don’t have the time to do it, she said.

Unhoused people “with chaotic behaviors are the ones who need the most help, and it takes skill” to help them, Bransten said.

‘Outreach from what, to what?’

Several service providers said thinning outreach was just one of many structural problems with the city’s homelessness response system.

One of the bigger problems, they said, was that the city doesn’t have adequate services and housing to offer people in the first place.

Amber, an unhoused woman who declined to give her last name, recalled positive experiences with a Homeless Outreach Team member when she was pregnant five years ago, but said that today the team doesn’t have “too much shit to offer us.” She said she was told last week that she wasn’t eligible for single-room-occupancy housing because of her dog.

Vinny Vizgaudis and Max, who didn’t provide a last name, also described difficulties accessing housing that met their needs.

Max said he has been cycling through prison and probation since he was a teenager, because of substance use. He and his girlfriend were trying to get into shelter but he said the outreach team recently told him that there were no available spaces for couples.

Vizgaudis said he could not stay in a congregate shelter due to his post-traumatic stress disorder, but that when he tried to work with the team to find other options, none were available.

“They told me that I have to get lucky, that I have to basically win a lottery,” he said. “They have to have a room open on the day that they come to service my area and maybe I might get it.”

Because of past negative experiences, he doesn’t interact with them much, he said.

In the meantime, Vizgaudis and Max are shuffled from place to place as city workers conduct clearings.

Wilson, of Hospitality House, said the Homeless Outreach Team is the most responsive of the city’s field teams. But “what we need is something on the end of outreach,” he said.

“Outreach from what, to what? That’s the unanswered question,” Wilson said. “We don’t have the resources available for the people who need them, and even for the people who are trying to get them.”

Madison Alvarado reported this story while participating in the USC Annenberg Center for Health Journalism’s 2023 Data Fellowship, which provided training, mentoring and funding to support this project.

The post Homeless Outreach Declines With Street Team’s Shifting Priorities, Staffing Woes appeared first on San Francisco Public Press.

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The first time Keith B. walked through the door of Rypins House, a residential treatment home for older adults run by the Progress Foundation in San Francisco, he thought to himself: “Where is everyone?”

A former luxury car salesman and behavioral health worker, the 60-year-old had spent years cycling in and out of institutions — detox centers, hospitals, homeless shelters. They were usually crowded and noisy, with lots of yelling. He was always on alert, afraid people would steal from him. Keith lives with bipolar disorder and took to self-medicating with street drugs back in the 90s. But as he aged, he wanted a calm space to sort his life out. Start making plans to get a hip replacement. Acquire his real estate license. Go back home to Philadelphia.

Keith came to Rypins House in August last year after a drug relapse that left him on the streets of San Francisco for four days, unable to sleep. He first sought help from the Dore Urgent Care Clinic, another Progress Foundation facility that offers a place for people to stay and get help for a few days when they’re in a crisis. It’s a gentler, cheaper alternative to an emergency room visit. From there, he was given a bed for up to six months at Rypins, a butter-yellow Victorian house in a neighborhood far from the Tenderloin, where he doesn’t owe drug dealers money and has a better shot at staying clean.

More than 1 million California adults like Keith — and 19.4 million Americans — live with both a serious mental illness and substance use disorder. In fact, roughly half of all people with severe mental illness are thought to also have a co-occurring substance use disorder. Traditionally, treatment programs target one of these populations or the other. Progress Foundation is one of the few across the country serving people who have both — so-called dual diagnosis patients. What’s especially unusual is that two Progress homes are reserved for people 55 and older.

One of his first nights in the house, Keith was sitting in the living room all by himself watching ‘Coming to America.’ He put the movie on pause to go to the bathroom and when he came back, nobody had sat in his chair or taken the remote control.

“It just hit me like, ‘Wow, I’m really in a peaceful, quiet environment,’” he said. “I’d almost gotten used to the chaos of the street and institutions. They’re not good places to heal. This place doesn’t feel like a program. It feels more like a home.”

Rypins House: A respite from the storm

Progress Foundation was founded in 1969 on the belief that recovery is possible at any age. It began as an alternative to medical models that largely rely on hospitalization and clinical treatment. Instead, it employs a social rehabilitation approach, and has created a variety of programs to meet people’s needs at different stages. Nurse practitioners rotate between the programs, and clients can take medication they administer themselves. All of the programs provide clients with a home-like environment where they can learn independent-living skills.

“Our clients are constantly being told, ‘You’re gonna be ill the rest of your life,’” says Progress Foundation Executive Director Steve Fields, who has led the organization since co-founding it. “We’re trying to show them a pathway out of thinking so narrowly about themselves. We’re saying, who knows where you can end up? You may have episodic crises, but that’s not your definition. We can work with you on a recovery plan because we believe that you can reach a level of functioning in the community.”

Rypins House and the Foundation’s ten other residential programs — each tailored to a different need — all attempt to address a huge problem in the mental health system: the lack of places people can go after they’ve been treated for a crisis. Fewer than 50% of patients discharged from a hospital following emergency mental health treatment are seen by a therapist or other provider within seven days, according to data gathered from health plans, and that number drops below 30% when it comes to Medicare patients.

There simply isn’t enough capacity to meet the need, says Tom Insel, a psychiatrist and former director of the National Institute of Mental Health. This is due to a shortage of beds, workers and safety net services as well as residential treatment programs. “The problem isn’t just people entering the hospital. It’s how they leave. There’s no practical plan for most people when they are discharged,” he says.

Progress Foundation is funded primarily through county health departments, and in San Francisco, that means it prioritizes clients who come from the inpatient unit at Zuckerberg San Francisco General Hospital as well as nursing homes that serve patients on Medicare or Medicaid. The agency also receives referrals from the jail system, as well as people like Keith who come from other Progress programs. This is the Foundation’s attempt to create a true continuum of care — a system that can help address the needs of patients at different stages and with different needs.

“We don’t see addiction as being something separate from mental health,” says Jim Roberts, director of residential treatment, supported living and permanent housing. “If anything, we see some of these substance abuse issues as a symptom and behavior of their mental health.”

The Progress Foundation’s wide network

Dore Urgent Care Clinic — where people can stay up to 23 hours to avoid unnecessary hospitalization — is on one end of the spectrum. On the other end are the foundation’s transitional programs where people can stay for between three months and one year.

There’s not much research on the benefits of longer stays for people who have dual diagnoses, but a 2001 study showed that while people in short-term dual-diagnosis programs tend not to remain long in the programs or fare very well, those in long-term programs did better: They were more apt to reduce their substance use and less likely to become homeless afterward.

The foundation also has a handful of cooperative living apartments and three independent living apartment buildings. Clients need to be enrolled in or applying for Medi-Cal, and to be San Francisco residents in order to receive the more intensive services. Undocumented immigrants are now eligible too, since, as of January 1, a new state law provides Medi-Cal to all low-income residents, regardless of immigration status.

The program is a bargain, Fields says. He estimates that a bed at a Progress residential treatment program costs around $300 per day compared with $1000 to $2000 at a hospital — or more.

The foundation’s homes for seniors are especially important since older adults throughout the country are the fastest-growing age group experiencing homelessness, according to an October 2023 report from the U.S. Department of Health and Human Services. In California, most older adults on the streets had never been homeless before age 50, when life circumstances such as an illness, a work accident or a cut in their work hours cost them their home and left them priced out of the market. In the San Francisco Bay Area, adults over 55 are estimated to make up half of the homeless population.

The co-ed program for seniors started nearly 40 years ago with six beds at Carroll House in San Francisco’s Bernal Heights neighborhood. Shortly after, to keep pace with demand, Rypins House opened with six more beds. As far as Fields knows, they are the only such programs in the country for seniors with dual diagnoses.

Both are almost always full, and the need continues to grow. In the first 11 months of 2023, an estimated 316 people over 55 died of an overdose in San Francisco, 42% of all the overdose deaths, according to the San Francisco Medical Examiner. Overdose deaths are rising rapidly among older people all across the country.

Progress Foundation takes a harm reduction approach. Clients are encouraged — but not required — to be sober. The location of Carroll House in sleepy Bernal Heights, a place where people can’t easily buy drugs or alcohol, is ideal for sobriety. Keith, for one, hopes to start attending AA meetings again. It’s part of the individualized plan that he’s created with the staff, reflecting a core belief at Progress Foundation that clients take ownership of their recovery.

“We’re there to provide guidance and support,” Roberts says. “We treat the clients themselves as the expert, and collaborate with the individual we’re serving to meet the aims they’ve defined for themselves.”

That doesn’t mean they’re on their own, however — staff members are available 24/7 if clients need them for health problems or other needs.

During the daytime, group meetings take place, tailored to the needs of the clients living in the house at the time. On the Friday I visited, the group met in a cozy living room at Rypins House, surrounded by books and a piano. Led by nurse facilitators from the University of California San Francisco, clients brainstormed ways of getting social support. Keith said he was going to get a library card to read autobiographies, and that he wanted to start playing chess again.

Staff encourage these kinds of activities as a way to develop social connections. They also help clients connect to case management, psychiatry appointments, housing, and more — everything they need to be independent. As part of its contract with San Francisco County, Progress Foundation must help a minimum of 80% of clients to move to a lower, less intensive level of support identified in their treatment plan, a number they have consistently met, says Fields. But it’s complicated.

“Am I happy with all of the choices as time goes on that are available to people? No,” he says. “At least they’re not in the hospital.”

In the past year, only two out of 32 clients from the seniors program were rehospitalized during the course of their stay; the rest were able to make it through and enter one of a variety of housing choices when they left the hospital.

Some of those include traditional apartments, single room occupancy hotels, and board and care homes, which are slowly disappearing. There’s also Hummingbird Place, a psychiatric respite center that will work with clients to find a path to permanent housing after they leave. It’s a huge challenge, given California’s sky-high housing costs, especially for those who don’t have Social Security. And the age of the unhoused is rising in California.

Fields worries that as people move between different programs and facilities, each operated by a different organization, no one person or agency is looking out for people at all stages and taking responsibility for their progress.

“Who’s responsible for John Smith, who may enter the system at the emergency room, go to Progress Foundation’s acute diversion, then Rypins House for six months, and move on to a supportive housing program run by another agency?” he says.

What’s needed, he says, is essentially a system-wide super case manager, who can follow a person through all levels of the system, no matter which program they’re in.

Staff at Rypins and Caroll try to set clients up for success by helping them learn how to navigate living with roommates — odds are, they’ll have to do so in the future for financial reasons.

Rebuilding a life

Andrea Q came to Progress Foundation after living in a single room occupancy hotel in the Tenderloin, where she stopped taking her bipolar disorder and anxiety medications because there was nobody to hold her accountable. “That’s the first thing that went out the window,” she told me.

Then the 62-year-old relapsed with her husband, with whom she’s been using substances and off for 30 years. In June last year, she overdosed — and almost died after injecting a combination of Xanax, methadone, and fentanyl. Her heart stopped beating — only to be revived with a shot of Narcan. It was the wake-up call she needed to come to Carroll House.

“We’ve pretty much had it with that life. I can’t tolerate any kind of drugs anymore. It would be like a death sentence,” she says. “I wanted somewhere I have to be held accountable.”

These days, Andrea spends most of her time developing a routine outside the house that she can continue once she leaves — like swimming at a nearby pool and being part of a writing group. She gets Social Security and hopes someday to move with her husband, who’s in another treatment facility, to “a nice place” outside San Francisco.

For now, Andrea likes being around people her own age who won’t mind hearing about her osteoporosis. She enjoys the camaraderie with her roommate the most, an older Latina woman who dyed Andrea’s bob hot pink — and in the process, dyed a patch of her own hair when she touched her temple with a stained hand.

With their matching pink hair, they sat with their housemates on a Friday evening in August to dine on Andrea’s cheese and tomato quesadillas. Eating together builds community and encourages responsibility, and clients take turns making meals. Cooking can be challenging for Andrea, and sometimes provokes anxiety. So she keeps it simple — quesadillas or ravioli.

These two senior homes are in high demand, especially in the spring. When beds open up, program staffers go to hospitals, jails, and other programs to interview potential clients. One thing they let prospective residents know is that staying there means learning to navigate conflict.

Just ask Andrea. One night not long ago, one of her housemates didn’t show up for dinner. He came into the kitchen a bit later and declined Andrea’s offer of a quesadilla. He made a bowl of Ramen instead, and spilled it all over the microwave.

“Are you going to clean it up?” Andrea asked.

“How?” he said. “What do you clean it up with? Water?”

“No, with paper towels,” Andrea said. “You know how to clean up.”

“I’ll do it in a little bit.”

He sat at the table in his flannel shirt and slurped the noodles, saying little. Andrea was irritated, but said nothing more. Then the man took his bowl to the sink, tore off some paper towels, and wiped the microwave clean. Andrea thanked him, a tinge of pride in her voice.

“Good for you,” she said. “Good job.”

Reporting for this story was supported by the California Health Care Foundation and the National Institute for Health Care Management.

The post After the Crisis: Unique Program Helps Older Adults Grappling With Both Addiction and Mental Illness appeared first on San Francisco Public Press.

The friend, a mother of two in her 40s, had suffered from longstanding intimate partner abuse, later to lose her home in the 2018 fire that destroyed most of the small mountain town of Paradise, Calif.

Now living in government-funded transitional housing, the woman has been looking — in vain, so far — for a long-term residence. Her federally subsidized housing voucher is to expire in June.

Victims’ advocates worry that domestic violence survivors can end up homeless, and sometimes shun emergency the shelter system and instead brave days and nights outdoors. “Many women survivors prefer to stay in their car rather than in a shelter,” Giannola said. “They feel safer.”

But many survivors will be helped by a recent California reform prohibiting landlords of apartments that accept government rent subsidies from using credit history in the application process, so long as prospective tenants can offer alternative evidence of their ability to pay. While the change does not focus on domestic violence victims, abused women could be among the greatest beneficiaries.

[ Read also: Our series on coercive control and family abuse ]

As of last January, California landlords accepting Section 8 vouchers or other housing subsidies may not use credit reports when screening tenant applications. A law authored by state Sen. Susan Talamantes Eggman, a Democrat from Stockton, allows applicants instead to provide pay stubs or bank records as evidence that they can pay their portion of the monthly rent.

In proposing her bill, SB 267, before the Senate Judiciary Committee, Eggman said research shows that credit scores are unreliable tests of whether tenants can pay rent in time and in full. A couple of outstanding medical bills, for instance, can lower credit scores.

Supporters say the reform is a lifeline for those who leave partners while having poor credit or no money because of financial abuse. That financial instability can cascade on all parts of their lives and makes it hard to get back on their feet.

Giannola shared her own history as a domestic violence survivor at two webinars this year, organized by leaders of a UCSF Benioff Homelessness and Housing Initiative statewide study.

The researchers surveyed more than 3,200 adults experiencing homelessness across California, and did in-depth interviews with 365 people for one year, concluding in November 2022.

The study, co-funded by the Blue Shield of California Foundation and the California Health Care Foundation, found that nearly two-thirds of respondents struggled to find housing because of poor credit or eviction history, problems often directly resulting from violence in the home.

It found that one in five unhoused women fled home to escape violence and escalating abuse by an intimate partner.  More than 40% of them said they continued to experience violence after leaving their homes.

The shortage of domestic violence shelters leaves women exposed to additional violence in homeless encampments, the study found.

“That system is completely overwhelmed and people are winding up in encampments,” said Dr. Margot Kushel, the initiative’s director and co-author of the report. “There are only so many places you can hide when you are vulnerable.”

Outside and at risk

Angela Garcia, 32, said that since she and her drug-addicted ex-husband separated, she has been couch surfing with friends in the East Bay. For a while, she pitched a tent along the railway tracks near the Hayward Public Library, surrounded by other unhoused people and vulnerable to theft. “I would sometimes get back to my tent after a bathroom break only to find my clothes gone,” she said.

Chris Richardson is chief program officer of Downtown Streets Team, a 15-year-old statewide nonprofit organization many of whose workers are themselves unhoused or at risk of homelessness. The organization provides supportive services and resources to people living outdoors or in temporary shelter. Many team members are low-income people who have experienced intimate partner violence.

Team members who have experienced such violence are reticent to come forward. “They will talk about getting arrested, about prison time,” Richardson said, “but not about their domestic abuse because there is a lot of stigma and shame around it.”

Dr. Anita Hargave, an assistant professor of medicine at UCSF, who contributed to the report, said intimate partner violence could affect people across many economic strata, but especially the poor. In the study, 73% of participants said relatively modest amounts of financial support — even monthly subsidies as low as $300 to $500 — would have kept them housed for at least two years. Even more respondents, 83%, said a lump sum of $5,000 to $10,000 would have saved them.

Some survivors attest to the security that would come with a little financial independence.

“I was terrified to survive on my own,” said Susan Lenzi, 61, a San Anselmo resident, who recalled having struggled with drug addiction and several abusive men.

Without a place of her own, Lenzi’s life spiraled downward until Marin County officials threatened to take away her 6-year-old daughter, Natasha, who was raped by one of Lenzi’s boyfriends.

Lenzi, then 23, decided to leave the girl with her own parents in Mill Valley, checked herself into a rehab facility and then into a domestic violence shelter. The shelter staff helped her find transitional housing, a key to her recovery from addiction.

Supportive services gap

The UCSF report made several policy recommendations including more domestic violence shelters, better coordination of shelter and social service intake systems and access to permanent housing.

But women’s and children’s rights advocates worry that California might not make much progress toward those goals anytime soon. The state is likely to face a huge budget shortfall in the coming fiscal year, estimated at $38 billion by Gov. Gavin Newsom, and $72 billion by the Legislative Analyst’s Office.

The state also faces a 45% reduction of federal support through the Victims of Crime Act, which funds service providers that work with domestic violence, sexual assault and child abuse cases. In California, the Office of Emergency Services distributes the money to about 400 programs.

The California State Association of Counties says it expects Congress to cap the grant program nationally at $1.2 billion in the fiscal year beginning Oct. 1, a reduction of about 37% from current-year funding. The federal grant is the primary funding source for crime victim services in all 50 states and six U.S. territories. It is drawn from fines and penalties levied on people and corporations convicted of federal crimes. No taxpayer dollars are used.

According to a March 12 statement from the National District Attorneys Association, without immediate congressional intervention, critical service providers face severe cuts, or even closure.

For California, the reduction is nearly $154 million, said Grace Glaser, policy manager in the Sacramento office at ValorUS, a nonprofit organization that offers support services for crime victims nationwide. “We need $262 million to sustain current programs,” she said.

Marissa Seko, family violence intervention unit manager at the Oakland-based Family Violence Law Center said her organization uses “some of those federal funds to stabilize the situation of domestic violence survivors to help them relocate to a safe place.” She added: “That money can be critical to prevent a survivor from becoming unhoused.”

ValorUS, the California Partnership to End Domestic Violence and seven other women’s and children’s rights groups are placing their hopes for continued funding in the Crime Victim Service Stabilization Act, a bill co-authored by Assembly members Eloise Gómez Reyes, D-Colton, and Jesse Gabriel, D-Encino. Last month, the Assembly Public Safety Committee passed the bill, AB 1956, unanimously.

The bill is the state’s equivalent of the federal Victims of Crime Act. It would require the state to fill funding gaps in essential crime victim services when federal funding decreases more than 10% in any year. The support groups are asking the state for $200 million.

“California stands by victims of crimes,” Reyes said in a statement, “and we are committed to ensuring the safety and well-being of these survivors who deserve consistent and reliable access to healing services.”

Other reforms

In addition to Eggman’s bill banning landlords from using a person’s credit history as part of the application process for housing, at least two other state laws passed last year could provide reprieve for domestic violence survivors in accessing affordable housing.

The Safe and Inclusive Housing Act, Assembly Bill 1418,authored by Tina McKinnor, D-Inglewood, made California the first state to ban so-called crime-free housing ordinances and nuisance laws that some municipalities adopted in the 1990s, allowing landlords to exclude or evict tenants with criminal histories. Because even a 911 call could be considered an indicator of criminal activity, “the ordinances made it more difficult for victims of domestic violence to call law officials,” said Max Griswold, a researcher at RAND, a policy think tank.

Another new measure that favors domestic violence survivors is Assembly Bill 12, authored by Matt Haney, a Democrat from San Francisco. It caps security deposits at one month’s rent, regardless of whether a unit is furnished. In the past, landlords were allowed to charge up to three months’ rent. The law kicks in July 1.

Local reforms also could help. San Francisco voters in March approved a $300 million bond measure to increase the supply of affordable housing. Of that, $30 million is targeted to domestic violence survivors.

Deciding to give back

East Bay resident Ariana Severs, 30, fled her ex-husband after he “beat me to a pulp” within a year after their marriage. He then threatened to buy a gun to shoot her.

Remarried and with two children, Severs works as a direct-service lead with the Downtown Streets Team. The job, she says, is helping her to heal.

Natasha, Lenzi’s daughter, is now a stay-at-home mom looking for ways to help others. She said she might go back to counseling at women’s shelters once her children are grown. She briefly worked at the one in San Rafael to which she had fled in her late 20s.

“The two years I worked at the shelter were so empowering,” she said. “I want to tell my story to help other women.”

When Giannola left her abuser and took her two young children, then ages 1 and 4, with her, her credit history was messed up. She was forced to file for bankruptcy. She knew what it was like to be unhoused, having lived most of her childhood and early teens in trailers, cars and tents with her parents and four siblings. “That’s all we could afford,” she said.

She is remarried and has two more children, one adopted. Until recently, she worked as a case manager for a nonprofit organization in Chico that helps Paradise fire refugees get housing. She sees her advocacy for the homeless and domestic violence survivors as intimately connected.

“Providing survivors with safe housing,” she said, “breaks the cycle of violence.”

This article was produced with the support of the USC Annenberg Center for Health Journalism’s 2023 Domestic Violence Impact Fund.

The post Recent Policy Reforms May Help California Domestic Violence Survivors Stay Housed appeared first on San Francisco Public Press.

Bystanders might wonder how to summon help from the city — and what will happen if they do.

We created a flow chart to answer those questions, though it does not capture all possible outcomes. Scroll down or click here to find it.

Cases traverse a tangle of pathways, through handoffs between dispatchers and myriad public workers. The person in crisis might spend days or weeks tumbling through the criminal justice system or health care facilities. They might get a reprieve from the outdoors in a sobering center or a communal recovery setting, where they can access food and information to help them seek social services. Their path depends on many factors, like the availability of the Street Crisis Response Team, what the bystander tells city personnel and whether responders can calm them.

Often, the person returns to where they started: the streets.

San Francisco emergency dispatchers can receive tens of thousands of calls per year about mental health incidents, including suicide attempts. According to a recent study by a city working group, there were nearly 13,700 recorded involuntary psychiatric detentions in the fiscal year that ended in 2022 — a conservative tally as the analysis did not include some facilities in San Francisco. The study found that African American residents were detained at disproportionately high rates, and unhoused people were frequent users of psychiatric emergency services.

(Click the link below the chart to see a version that allows you to zoom in.)

The San Francisco Public Press spent months investigating how people can be detained involuntarily due to mental health crises and what happens to them afterward. The psychiatric detentions are commonly called “5150” holds, a nod to the section of state code that defines the criteria for this intervention. We examined hundreds of pages of call records, department procedures and training documents, and interviewed staff at numerous city departments directly involved in crisis response to map the city’s system of care.

A single phone call about an incident can trigger responses from multiple departments. Major responders include the Department of Emergency Management, Fire Department, Police Department, Sheriff’s Department, Department of Homelessness and Supportive Housing, and Department of Public Health.

People witnessing a crisis generally request help by calling either 911, the city’s emergency line, or 311, for general services and assistance. Dispatchers do their best with the information the caller provides to quickly determine whether the distressed person poses an immediate danger to themselves or others.

Calls about mental health crises often ping-pong between 911 and 311 as details emerge, said Burt Wilson, president of the union chapter that represents the city’s emergency dispatchers.

Many unhoused people carry weapons to defend themselves at night, and they might struggle with drug addiction or be mentally unstable, Wilson said.

“I don’t know how you differentiate, on the phone call, who to transfer to 311 and who to transfer to the police,” Wilson said. “Most of the 311 calls end up coming back to our call center because 311 just has to say a certain trigger word like, are they ‘aggressive?’ And then it comes right back to us.”

The Department of Emergency Management dispatches police in cases of calls about people threatening violence or wielding weapons; that doesn’t include people who are merely yelling, said Officer Robert Rueca, a spokesperson for the San Francisco Police Department.

But what qualifies as “violence?” The Department of Emergency Management could not say.

“‘Violent’ is not something we have a concise definition for,” a spokesperson said. “It will vary based on circumstances and the level of information the reporting party is providing.”

And a “weapon” is broadly defined as “anything that can be used as a weapon,” according to department guidelines. For many types of small weapons, such as pocket knives, possession alone is not considered a threat.

If a person is in severe crisis, police and medical personnel can put them on a 5150 hold.

But involuntary hospitalization can be harmful, said Sarah Gregory, a senior attorney at Disability Rights California. The organization advocates for community-based services for people with mental health disabilities, as an alternative to forced stays in hospitals or psychiatric wards.

Gregory called it a “traumatic” experience when someone “who’s already having a mental health crisis calls for help, and then receives a response that takes away the person’s rights.”

“Client after client says, ‘I came out of there worse than I went in,’” Gregory said, referring to places where patients were involuntarily detained.

When a person in mental distress is not an immediate threat, the call goes to medical personnel like the Street Crisis Response Team, Fire Department or paramedics. The crisis team is one of many created in recent years as San Francisco and other cities have shifted away from a law enforcement response following high-profile police killings, including those of Mario Woods, Tony Bui and George Floyd, in which the officer was convicted of murder.

The San Francisco Police Department “would never be dispatched to a medical call” even if the Street Crisis Response Team or an ambulance were unavailable, said the spokesperson for the Department of Emergency Management. The police were the crisis team’s backstop in its early years, but that stopped in June 2022, they said.

The team uses de-escalation strategies to calm a person in distress, like speaking softly, asking questions to get to know them, and offering snacks or water. When the person regains composure, the team might connect them to treatment or follow-up care with the Office of Coordinated Care, Homeless Outreach Team or Post Overdose Engagement Team, the spokesperson said.

The team might also simply leave the scene once the person is no longer in distress.

People who engage with the city’s crisis-response system might benefit most from having long-term case managers who can help them fully resolve problems with their health or living situations, said Mark Salazar, chief executive officer of the Mental Health Association of San Francisco. The organization provides case management and peer support services at courts, jails and Zuckerberg hospital after someone is released from a 5150 hold.

“But the shortage of support and funding is really a challenge,” Salazar said. “Without having continued support after being 5150’d, or [receiving] forced treatment, you’re just setting up someone for more failure.”

Support for people struggling with their mental health

San Franciscans struggling with their mental health can call many local and national hotlines. To learn about the resources that are available, and potentially speak with counselors, reach out to the organizations below. 

Mental Health Association of San Francisco: Talk to a peer about your feelings and get information about available mental health services.

• Warm line is open 24/7
• Call or text 855-845-7415

San Francisco Behavioral Health Services: Find local mental health or substance use services that meet your needs.

• Clinicians are only available Monday-Friday from 8 a.m. to 7 p.m., and Saturday-Sunday from 9 a.m. to 4 p.m.
• Behavioral access helpline is open 24/7
• Call 415-255-3737 or 888-246-3333

Harm Reduction Therapy Center: Speak with someone if you are experiencing homelessness and seeking peer counseling or harm reduction services.

• Community helpline is open Monday-Friday, from 10 a.m. to 8 p.m.
• Call 415-863-4282

San Francisco Night Ministry: Speak with counselors trained in trauma-informed care, interfaith spiritual support, suicide prevention and crisis management.

• Care line is open every day from 8 p.m. to 2 a.m.
• Call 844-467-3473

Mobile Crisis Team: Speak with clinicians who can help someone experiencing a crisis. The team may visit the person to assess whether they meet the criteria for involuntary psychiatric detention, and they can request support and transportation by paramedics or police.

• Helpline is open 24/7
• Call 628-217-7000

SF Suicide Prevention Hotline: Speak with a counselor if you or your loved one are considering suicide. Counselors can provide referrals for mental health, HIV and addiction services.

• Hotline is open 24/7
• Call 415-781-0500 or text 415-200-2920

Other resources

California Peer-Run Warm Line

• Warm line is open 24/7
• Call or text 855-600-WARM (9276)

California Suicide Prevention Lifeline

• Hotline is open 24 hours
• Call 988

Crisis Text Line

• Crisis counseling is available 24/7
• Text HOME to 741741
• Visit their website to connect via online chat or WhatsApp

Like many media organizations, the San Francisco Public Press is experimenting with artificial intelligence (A.I.) tools that aid the creation of images for use in some stories. Nearly all our visual content is produced by humans.

The Public Press is part of the Mental Health Parity Collaborative, a group of newsrooms that are covering stories on mental health care access and inequities in the U.S. The partners on this project include The Carter Center, The Center for Public Integrity and newsrooms in select states across the country.

See our related article, The Often Vicious Cycle Through SF’s Strained Mental Health Care and Detention System

The post You Report an Unhoused Person in a Mental Health Crisis. This Is What Happens Next appeared first on San Francisco Public Press.

Uncertain what to do, we dialed 311, San Francisco’s non-emergency helpline. Seventeen minutes later, a red van arrived, carrying members of the city’s Street Crisis Response Team. Jay told them he was schizophrenic. The paramedic recognized him from previous calls and greeted him. Looking at Jay’s digital records, a member of the group realized his prescription had been refilled about two weeks prior, but Jay didn’t remember picking it up.

As they spoke, it became clear that Jay had previously been placed under involuntary psychiatric detention, also called a “5150 hold.”

That fall day, Jay asked to be detained again.

[ Read also: “You Report an Unhoused Person in a Mental Health Crisis. This Is What Happens Next” ]

That was how he had gotten a dose of Benadryl, one of two medications he used to manage his condition, he said. Benadryl is among the antihistamines that can help control anxiety. Schizophrenia requires lifelong treatment, even when symptoms have subsided.

“They give me my pill with a 5150,” he said.

The paramedic bristled. “That’s a lot of resources just to get one pill.”

Jay was one of thousands of people last year who fell into San Francisco’s complex, reactive, strained system for treating severe mental health and drug-related crises. As with many of the people who enter that system — including those who are unhoused or are detained without their consent following a call from an alarmed observer — Jay had received temporary care, entailing multiple involuntary psychiatric holds, that failed to address his long-term problems. That left him back on the streets to fend for himself or, with the help of passersby, try again to get the help he needed.

Since the start of the COVID-19 pandemic, much of the public discussion about homelessness and mental health in San Francisco has focused on the people who desperately need care, but who reject it. Jay’s story diverges from this common narrative.

“When’s the last time you were at Gen?” the paramedic asked, referring to the emergency room at Zuckerberg San Francisco General Hospital and Trauma Center, the facility in the city with the highest number of beds for people on 5150 holds.

“Today,” Jay said. He had gone there seeking medication, then waited in a hallway for four hours before staff gave him a dose of Risperdal, an antipsychotic that he did not usually take. It had not been effective.

Who responds to mental crisis calls

Emergency service providers may not legally turn people away. For many San Franciscans, this is their only option for accessing medical care.

City officials have made recent efforts to improve the crisis care system. A few years ago, police might have been dispatched to Jay’s call and that would divert them from situations they might be better trained to handle. Today, the city routes mental health-related calls to other teams instead when there is not an immediate safety threat, said a spokesperson with the Department of Emergency Management.

One alternative is the Street Crisis Response Team. It was created in late 2020 and aims to offer trauma-informed care to people facing mental health crises or minor medical issues, potentially reducing unnecessary emergency room visits.

When team members arrive on the scene, they address the person’s immediate needs first — for example, food or a warm blanket — and might connect them with other services and take them to a shelter, sobering center or health clinic.

The many units that respond to the city’s increasingly visible street-level crises cost millions of tax dollars each year: The Street Crisis Response Team’s budget will be $12.3 million for the fiscal year ending in 2025; the Homeless Outreach Team’s budget for the same year will be $8.9 million; and the Homeless Engagement Assistance Response Team was authorized last year to receive one-time funding of $3 million.

City dispatchers must decide which team to send — they might send more than one — relying on the caller’s description of the scene. Calls about mental health crises often ping-pong between 911 and 311 as details emerge, said Burt Wilson, president of the union chapter that represents San Francisco’s emergency dispatchers.

“It’s a huge amount of resources,” Wilson said.

Involuntary detention’s disproportionate impacts

Dispatchers received at least 24,000 calls about mental health crises or attempted suicides in 2023, including calls from bystanders as well as police, based on a Public Press analysis of government records. In many cases, responders couldn’t find the people in crisis.

In the most serious instances, crisis responders put people in 5150 holds, named after the section of California’s Welfare and Institutions Code that defines this procedure. The law permits police and trained medical personnel to detain someone for up to 72 hours if their mental health disorder is making them a danger to themselves or others, or it leaves them unable to provide for their basic needs.

The city recorded nearly 13,700 psychiatric holds for the year that ended June 2022 — but that figure, the most recent available, captures a fraction of the total situation. The number was calculated in a report by a city working group, which found that not all hospitals reported detentions and that the available data did not allow for robust analyses of patient characteristics like race, gender or housing status.

Some people were put on 5150 holds multiple times at Zuckerberg hospital. Using data from that facility in its analysis, the working group found that 425 people received at least two psychiatric holds, 86 had at least four holds and 13 had eight or more. African Americans, despite making up only 6% of the city’s population at the time, accounted for over 42% of people detained four or more times.

Most people who received emergency psychiatric services from the hospital, including 5150 holds and voluntary visits, had experienced homelessness in the prior year.

Numerous service providers told the Public Press that people are more likely to cycle repeatedly in and out of crisis-care facilities when they don’t have access to preventive or non-emergency care, because small problems can become larger ones that require hospitalization.

Experts said also that it’s vital for people to receive culturally competent care — for example, when the health worker speaks the patient’s language or knows which medical guidance will conflict least with social norms.

Underfunded care system

San Francisco has seven designated psychiatric facilities with a total of 187 beds for patients on psychiatric holds, according to the California Department of Health Care Services, which approves facilities for this use.

But not everyone on a 5150 hold gets a bed. The crisis care system is notoriously underfunded, with inadequate capacity and staff. When no bed is available, someone is detained in an emergency room for up to 24 hours.

The 2023 passage of state Senate Bill 43 might further strain the system. The law modified the eligibility criteria for 5150 holds for the first time in decades, making it possible to detain people gravely disabled due to substance use. In response, San Francisco has acquired additional beds. Many other counties are waiting to implement the policy, saying they need more guidance and resources from the state to comply.

Meanwhile, Proposition 1, a separate package of state policies that voters approved by a razor-thin margin in March, could add treatment beds to the system, including those for 5150 holds. The proposition forces counties to redirect a large portion of their mental health spending to housing programs, many of which must benefit unhoused people and veterans. A coalition of mental health organizations and disability advocates opposed the ballot measure, fearing it would cause cuts to vital community-based programs. 

Among its many mandates, Proposition 1 authorized the sale of $6.4 billion in government bonds. Of the total bond revenue, $4.4 billion is slated to pay for building behavioral health facilities. Gov. Gavin Newsom, who campaigned for Proposition 1’s passage, has said it will enable adding more than 11,150 behavioral treatment beds.

For people who are able to get beds, their problems are far from solved.

“There’s a perception that if you put someone on a hold, something good will happen for them, like something miraculous,” said Dr. Maria Raven, chief of emergency medicine at the University of California, San Francisco. People might think that an intervention by psychiatric workers would set in motion a process that leads to long-term treatment or, for those experiencing homelessness, permanent housing, she said.

“That doesn’t really happen,” Raven said. Instead, “you just put someone where there’s a bed.”

[ Read also: “Mental Health Advocates Call for Voluntary Treatment as Spears Conservatorship Ends” ]

Back on Market Street, the Street Crisis Response Team was trying to find help for Jay in this overburdened system. As they made phone calls to locate a facility that could fill Jay’s medication, one team member tried to comfort him with snacks and water, which he was hesitant to accept.

“Every time I drink something, bad stuff happens,” Jay said.

“You can drink it,” the paramedic told him calmly. “We’re not going to leave you.”

After about 15 minutes and at least four unfruitful calls to multiple agencies, the paramedic suggested that the outreach workers try the Westside Crisis Clinic. They checked its operating hours but found conflicting information online. A call revealed that it was closed for the day.

“It’s very unfortunate that the city runs on banking hours,” another team member said.

Finally, the team found a bed at the Dore Clinic, which provides psychiatric urgent care. Jay could stay there for up to a day. He would have a bed and access to a shower and a phone. That would enable him to call his sister, who could pick him up and help him obtain his medication.

“You can get all your meds tomorrow, something that we can all look forward to,” the paramedic said.

Like many media organizations, the San Francisco Public Press is experimenting with artificial intelligence (A.I.) tools that aid the creation of images for use in some stories. Nearly all our visual content is produced by humans.

The Public Press is part of the Mental Health Parity Collaborative, a group of newsrooms that are covering stories on mental health care access and inequities in the U.S. The partners on this project include The Carter Center, The Center for Public Integrity and newsrooms in select states across the country.

See our related article You Report an Unhoused Person in a Mental Health Crisis. This Is What Happens Next

The post The Often Vicious Cycle Through SF’s Strained Mental Health Care and Detention System appeared first on San Francisco Public Press.

Read this story in English.

Cuando Karen Rodríguez llegó a San Francisco tras huir de su país natal, Colombia, con su marido y su hijo de 6 años, Juan, la familia se alojó con la madrina de su hijo. Sin embargo, cuando tuvieron que marcharse dos meses después porque el contrato de alquiler no permitía alojar a más personas en la vivienda, recurrieron a dormir en el auto que tenían.

Como la familia era recién llegada, Rodríguez y su marido carecían de permiso de trabajo, lo que les dificultaba en gran medida encontrar empleo y poder pagar el alquiler.

Desde entonces, han estado alternando estancias en su coche y en hoteles pagados por el ayuntamiento y Fe en Acción del Área de la Bahía, una red de organizadores comunitarios de varias congregaciones religiosas. Juan tiene necesidades especiales, por lo que un refugio de emergencia sería traumático para él, dijo Rodríguez.

La familia Rodríguez es una de muchas familias de migrantes recientes que buscan refugio y una nueva vida en San Francisco, y que se encuentran en situación de calle sin tener una solución sencilla.

Los proveedores de vivienda en San Francisco, los defensores legales, los grupos religiosos y los propios migrantes advierten que no hay suficientes viviendas temporales como para dar cabida a la creciente necesidad, y que el sistema de respuesta de la ciudad no está equipado para manejar las complicaciones que surgen en la intersección entre la falta de vivienda y la migración. Los proveedores de vivienda afirman también que la ciudad subestima y subrepresenta intencionadamente la necesidad que existe.

Aunque los representantes de la ciudad dijeron que el Departamento de Personas sin Hogar y Vivienda de Apoyo está tomando medidas para reasignar fondos para abrir un refugio para familias y acelerar el ritmo al que las familias salen del refugio y acceden a una vivienda de más largo plazo, no fueron capaces de proporcionar un periodo de tiempo o instrucciones sobre qué deben hacer las familias que duermen en la calle mientras tanto.

Una necesidad profunda y pocos datos

La idea de que no hay suficiente vivienda temporal para estas familias entra en conflicto con el inventario de albergues de la ciudad, el cual es una plataforma en línea que tiende a mostrar un 7% u 8% de las vacantes que hay en los albergues para familias. No obstante, Hope Kamer, directora de política pública y asuntos externos en Compass Family Services, una organización sin fines de lucro que se ocupa de las familias en situación de calle, afirma que esta cifra no es un fiel reflejo de la necesidad que hay.
“Las familias vienen a nuestro punto de acceso a las 4:30 de un viernes y dicen: ‘No tengo dónde ir el fin de semana con mis dos bebés'”, dijo, calificando la necesidad como “profunda”.

A menudo, se rechaza a las familias porque no hay lugares disponibles en los albergues.

Eso fue lo que le ocurrió a Álvaro Tovar, su mujer y sus dos hijos pequeños cuando se presentaron recientemente a un punto de acceso a albergues, donde se evalúa si las familias reúnen los requisitos para recibir servicios, explicó Tovar. El personal le dijo que tardarían dos semanas en inscribirlos en la lista de espera, y más tiempo en conseguir camas. Le aconsejaron que comprara una tienda de campaña para su familia mientras esperaban.

“Eso me rompió el corazón porque, en primer lugar, no teníamos dinero, no conocíamos la ciudad. Perdí toda esperanza”, dijo Tovar en un evento de la comunidad el 7 de marzo que realizó Fe en Acción del Área de la Bahía para llamar la atención sobre la necesidad de refugio para las familias.

Kamer explicó que el refugio en Buena Vista Horace Mann, un gimnasio escolar que funciona como albergue nocturno para familias, recibe hasta 10 llamadas al día de organizaciones comunitarias que buscan camas para familias que no tienen dónde alojarse, muchas de las cuales el albergue no ha podido aceptar.

Laura Valdez, directora ejecutiva de Dolores Street Community Services, la organización sin fines de lucro que gestiona el centro de albergue para familias en Buena Vista Horace Mann, declaró al San Francisco Standard en diciembre pasado que la ciudad instruye a la organización para que no contabilice la cantidad de familias que rechaza.

Emily Cohen, subdirectora de comunicaciones y asuntos legislativos del Departamento de Personas sin Hogar y Vivienda de Apoyo, dijo que no tenía conocimiento de esa instrucción. Más bien, dijo, el departamento quiere que la gente vaya a los puntos de entrada al sistema de respuesta para personas en situación de calle para crear una lista de espera centralizada del albergue.

En los últimos seis meses, esa lista de espera ha tenido constantemente unas 200 familias, dijo Kamer. Explicó que en Buena Vista Horace Mann, el departamento evalúa la ocupación del albergue a las 5 de la tarde, antes de que los papás y mamás hayan regresado de trabajar y, por tanto, subrepresenta la necesidad.

“Esta falta de voluntad para captar la magnitud completa del problema significa que no hay rendición de cuentas ante estas familias y que, a su vez, no hay presión pública para construir la cantidad de albergues que necesitamos”, dijo.

Las mismas familias inmigrantes se han unido para ejercer esa presión. En colaboración con Fe en Acción del Área de la Bahía, las familias han exigido al Departamento de Personas sin Hogar y Vivienda de Apoyo que garantice alojamiento en el mismo día o que se proporcione un vale de hotel a cualquier familia que acuda a un punto de acceso; que acelere la transición del alojamiento de un albergue a una vivienda de largo plazo; y que haga un control en línea que le permita a las familias comprobar qué posición ocupan en la lista de espera de un albergue.

El grupo se reunió frente al ayuntamiento el 12 de marzo, el día en que el supervisor y candidato a alcalde Ahsha Safaí presentó una resolución no vinculante en la que pedía a la alcaldesa London Breed y al Departamento de Personas sin Hogar y Vivienda de Apoyo que respondieran a las necesidades de vivienda de las familias migrantes. La Junta de Supervisores celebrará una audiencia sobre la resolución el 22 de abril, según el personal de Fe en Acción del Área de la Bahía.

Otras barreras para encontrar vivienda segura

Además de la falta de camas en albergues, las familias migrantes se enfrentan a otros problemas cuando intentan navegar el sistema.

“Para muchas familias, el sistema de respuesta para personas en situación de calle en San Francisco es el primer punto de contacto con servicios sociales en Estados Unidos; es más, el sistema carece fundamentalmente de los recursos necesarios para proporcionar la atención informada sobre trauma y la navegación legal que necesita una familia que acaba inmigrar a San Francisco”, dijo Kamer.

Vanessa Bohm es la directora de los programas de Bienestar Familiar y Promoción de la Salud del Centro de Recursos Centroamericano, una organización sin fines de lucro que ayuda a inmigrantes latinx y a las familias con menos recursos del Área de la Bahía de San Francisco. Bohm explicó que hace 15 o 20 años era más fácil que la gente consiguiera hospedaje o trabajo a través de la economía informal o a través de conexiones con personas que conocían en el área. Hoy en día, no está tan segura de que sea así.

Silvia Ramos, gestora de casos y facilitadora de grupos de apoyo para el programa de bienestar familiar del Centro de Recursos Centroamericano, dijo que muchas familias llegan a San Francisco con trauma del viaje que emprendieron y que se sienten desplazadas al entrar en un sistema al que les es difícil adaptarse. Cuando las familias llegan sin ningún lugar donde alojarse y la ciudad no tiene camas disponibles, Ramos busca en albergues en Oakland o en otras ciudades cercanas y le enseña a la gente a utilizar el sistema de transporte rápido del Área de la Bahía (BART).

Muchos proveedores explicaron que navegar estos sistemas puede ser aún más difícil para las personas que no hablan inglés o que proceden de entornos culturales diferentes.

El papel del sistema judicial de migración

A la vez que buscan tener acceso a una vivienda, las familias también deben preocuparse por el proceso de asilo y el tribunal de inmigración. Sin embargo, los proveedores se han dado cuenta que hay una falta de conexión entre los sistemas de respuesta legal y para personas en situación de calle, y los grupos que ofrecen otros recursos como atención médica o alimentos.

“No hay ayuda gubernamental para conectar el sistema de respuesta legal y el sistema de respuesta para personas en situación de calle”, dijo Kamer. “Los proveedores de atención directa están averiguando cómo hacerlo”.

Milli Atkinson, directora del Programa de Defensa Legal para Inmigrantes en el Centro de Justicia y Diversidad del Colegio de Abogados de San Francisco, dijo que los casos de asilo de la mayoría de las personas no se deciden hasta dentro de años y que a menudo se preocupan más por cubrir necesidades inmediatas como la vivienda o la comida.

“Muchas personas se pierden en el sistema, simplemente porque no tienen la capacidad mental de resolver todas estas cosas a la vez, y primero atienden a sus necesidades básicas”, dijo.

Sin embargo, tener representación legal durante el proceso de asilo ayuda a los migrantes a obtener un permiso laboral, lo que les permite ser más autosuficientes.

La inestabilidad de vivienda puede afectar los casos de inmigración de otras maneras. Uno de los mayores obstáculos para las personas en situación de calle, según Atkinson, es que el sistema judicial se basa en gran medida en tener todo por escrito y en papel por lo que la comunicación se realiza principalmente por correo tradicional. La expectativa es que las personas mantengan al tribunal al corriente del cambio de domicilio.

“Si el tribunal te envía por correo información sobre tu caso y no la recibes, es culpa tuya”, explica.

La llegada de migrantes

Los proveedores de vivienda, los defensores legales y el Departamento de Personas sin Hogar y Vivienda de Apoyo contaron como anécdota un aumento en el número de personas que buscan servicios y que huyen de Latinoamérica debido a los disturbios políticos, la pobreza y otros tipos de violencia.

Atkinson dijo que en los últimos años, su organización ha visto un mayor número de migrantes procedentes de países como Nicaragua, Colombia, Perú y Cuba. Como la cantidad de países que viven inestabilidad política en los últimos años ha aumentado, la cantidad de personas que llegan a la frontera también ha incrementado, dijo.

Dado que San Francisco es una ciudad santuario, las preguntas sobre el estatus del migrante o refugiado durante el proceso de entrada coordinada (un sistema que se utiliza para determinar qué recursos se pueden solicitar) son limitadas. Esto dificulta decir qué porcentaje de la reciente oleada de familias que buscan refugio son inmigrantes, dijo Cohen, aunque señaló a forma de anécdota que ha habido más personas de Centro y Sudamérica que llegan en busca de ayuda.

Los datos de la ciudad muestran que la cantidad de hispanohablantes y personas latinx en situación de calle está en aumento. El porcentaje de hispanohablantes en el sistema ONE de la ciudad, que monitorea a las personas que reciben asistencia del Departamento de Personas sin Hogar y Vivienda de Apoyo, aumentó a más de una cuarta parte de la población de personas que reciben apoyo del departamento en 2024. Además, de 2019 a 2022, hubo un aumento del 55% en la cantidad de personas latinx que carecen de un techo, según los datos recopilados en ese momento determinado en 2022, que es un recuento bianual de la cantidad de personas que se encuentran en situación de calle.

La historia de Leslie

Una vivienda segura y estable les permite a las familias migrantes prosperar.

Leslie, que pidió mantener su apellido en privado, huyó de Nicaragua en noviembre de 2019 con su hija y su pareja cuando el país se enfrentó a un aumento en la violencia política lo que provocó que tanto ella como su pareja perdieran sus empleos.

“Había una guerra y mataron a mucha gente. Había mucho caos por todas partes y la economía ya estaba en mal estado”, dijo al señalar que no tenían qué comer. “Así que nos fuimos en busca de un futuro mejor”.

Cuando llegaron, Leslie se enfrentó al maltrato de los familiares con los que se alojaba y se vio obligada a mantener a su hija, que tiene autismo, en su habitación para protegerla del acoso.

“Sentí mucha frustración, mucha desesperación; no sabía qué hacer”, dijo.

Al final, Leslie, su pareja y su hija se marcharon. Cambiaron de domicilio al menos tres veces; pasaron de un albergue a la casa de una amistad, y luego a un hotel financiado por la ciudad. Fue allí, donde dejó de dormir en el suelo y donde empezó a sentirse más cómoda. Leslie empezó a ver a un terapeuta y a recibir atención médica, y aprendió cómo inscribir a su hija en la escuela.

Sin embargo, Leslie no sabía cuánto tiempo iban a poder quedarse, lo que le causaba ansiedad; además, había otros problemas.

La terapia “me abrió los ojos al maltrato que estaba sufriendo a manos de mi pareja, así que decidí dejarlo”, dijo. “Aquí no tenía familia ni amigos. Solo tenía a mi hija”.

Con la ayuda de Compass Family Services y servicios prenatales para personas en situación de calle, Leslie pudo finalmente solicitar una vivienda permanente para ella y su hija de 7 años de edad. Se mudaron en septiembre de 2023.

“Ahora que hemos encontrado una vivienda estable, ella se siente segura, las dos nos sentimos seguras”, dijo al señalar que la estabilidad es buena para su hija.

La seguridad le ha permitido a Leslie hacer prácticas profesionales en un preescolar y formar parte del Consejo Asesor de Familias de Compass Family Services para compartir sus experiencias sobre cómo ha navegado la vida sin un hogar en San Francisco. Haber vuelto a la escuela le ha hecho sentirse útil.

“Me hace sentir que tengo un futuro mejor aquí”, dijo y señaló que no estaba segura de si tendría que dedicarse a limpiar inodoros de por vida en Estados Unidos. “Realmente me llena de vida y me encanta estar con los niños. Me encanta aprender”.

Madison Alvarado realizó este reportaje a través de la Beca de Datos 2023 del Centro Annenberg sobre la Salud de USC, el cual proporcionó formación, tutoría y financiamiento para la realización de este proyecto.

Traducido al español por Andrea Valencia a través de Linguaficient, una empresa local que ofrece servicios lingüísticos profesionales. Valencia interpretó nuestra entrevista con Leslie, una hispanohablante monolingüe. Yesica Prado, periodista de San Francisco Public Press, interpretó nuestra entrevista con Karen Rodríguez.

The post Proveedores de ervicios opinan que SF subestima la necesidad que hay a pesar de que cada vez más familias migrantes buscan acceder albergues appeared first on San Francisco Public Press.

A separate, possible $20 million outlay could help unhoused families cover rent for a limited time, the department’s spokesperson also said at the Board of Supervisors Rules Committee hearing. The funds must be approved in budget negotiations this summer.

But these new measures would fall short of serving all the families in need, the spokesperson acknowledged.

“There’s these huge communities of people fleeing violence, persecution, gangs, all these things, trying to survive and we’re basically telling them, ‘Sleep on the streets,’” said Supervisor Hillary Ronen, who chairs the committee and represents District 9, which contains the Mission District.

Migrant families have joined service providers and faith-based advocates in a push for a policy response to the mounting crisis, including increasing access to temporary housing and providing greater transparency about where families are on the waitlist for shelter. Supervisor Ahsha Safaí, who represents the Excelsior, Oceanview and other neighborhoods of District 11, recently took up the issue and wrote a non-binding resolution that called on the city to ensure migrant families would receive immediate shelter, among other services. He then convened Monday’s hearing, in which District 10 supervisor and committee member Shamann Walton was also present, to discuss potential policy solutions with staff from various city departments.

Following the homelessness department’s proposal, Ronen questioned whether the migrant families would be eligible for the rent subsidies that the $20 million infusion would fund. She referenced existing programs that prioritize recipients who have been homeless in San Francisco for many years.

Those programs are “not for the newcomer people that are coming, because they’re going to be really low on the list,” Ronen said.

Families from several countries shared their struggles accessing safe housing and pressed the city to do better.

“I don’t want my kids to end up on streets to relive trauma,” said Luz Mejía, an unhoused migrant from Peru. Her family had gotten a slot in the city’s temporary shelter system, but it had space for only three people so her husband stayed there with their kids while she remained on the streets.  

“We need to respect our kids’ integrity, we need more transparency, more humanitarian effort, and more movement to find permanent housing for families,” said Margarita Solito, a mother of four from El Salvador who works with Faith in Action Bay Area. The organization has helped migrant families pay for short hotel stays, outside of government programs, and raise the alarm about the dire situation.

Supervisors Ronen and Safaí questioned why no one had declared a state of emergency.

Safaí, who is running to unseat Mayor London Breed this November, said Breed had the power to make that declaration, as she had in 2020 to give the government greater flexibility to confront the coronavirus pandemic. Department staff can recommend that she make a declaration.

Immigrant families newly arrived here might struggle to find housing or jobs, experts say.

“The increased number of migrants arriving don’t have the support networks or systems that previous waves might have had,” said Jorge Rivas, executive director of the Office of Civic Engagement and Immigrant Affairs.

The city lacks robust quantitative data on migrant family homelessness, Rivas said. That’s largely because many departments do not ask about immigration status when assessing people for services, in accordance with San Francisco’s “sanctuary city” policies.

But “all the qualitative data affirms that we are experiencing a steady stream of newcomer asylum seekers,” Rivas said.

For example, the number of public school students who are recent immigrants has risen steadily over the past three years, he said, and during this school year it reached its highest level in the last decade, at 1,566 children. Some of those students reported being unhoused, Rivas said. And a waitlist for legal representation by the San Francisco Immigrant Legal Defense Collaborative has ballooned to more than 900 people; typically it hovers at around 100 to 200 people, he said.

The supervisors said community members were raising these issues with them.

“We’re hearing anecdotally that hundreds of people are coming into the Bay Area every day,” Ronen said. She added that one family shelter reported “turning away people every single night. We’re hearing from our outreach workers that they find children sleeping on the streets every day.”

The Department of Homelessness and Supportive Housing will issue 35 new hotel vouchers, each giving the recipient household a two-week stay in a hotel. At the end of the period, the department could extend the stay or the voucher could go to another household, said spokesperson Emily Cohen.

The requested $20 million would pay for up to 100 five-year rent subsidies for families. That could still leave many families on the streets, based on figures Cohen presented at the hearing. As of last week, at least 375 families were waiting for rooms in homeless shelters to become available, she said.

Safaí said he would probably hold a follow-up hearing within the next two months to check on whether the homelessness department had issued the new vouchers and waitlist management had improved.

Fixing migrant family homelessness will require long-term solutions, said Hope Kamer, director of public policy and external affairs at Compass Family Services, which serves the unhoused population.

“I really, really hope that money will hit the streets and the safety net will be supported,” she said.

The post SF to Offer Some Homeless Migrant Families Temporary Hotel Stays, as the Rest Languish appeared first on San Francisco Public Press.

Todos los sábados, Aurelia Ramírez llena una bolsa con folletos sobre servicios locales de apoyo social, compra unas docenas de pan dulce y una caja de café, y camina por su vecindario del Distrito de la Misión, conectándose con personas que viven en la calle.

“Nuestro trabajo es verificar si las personas están bien,” dijo Ramírez, quien se mudó a San Francisco desde México hace 23 años.

Ramírez es embajadora comunitaria de la Oficina de Participación Cívica y Asuntos de Inmigrantes de San Francisco. Dijo que quería un trabajo que le permitiera ayudar a la comunidad Latina – especialmente gente de ascendencia maya de Yucatán, como ella.

“Es triste,” ella dijo. “No saben qué pueden hacer. Especialmente la gente de Yucatán.”

Mientras ofrece café y comida, ella comparte información sobre dónde va para recibir atención médica, servicios sociales, refugio, baños y lugares para lavar la ropa. Dijo que la pandemia causó un sufrimiento profundo en su comunidad y muchos nunca se recuperaron.

“Ellos perdieron un trabajo, perdieron la casa. No tienen dinero. ¿Qué pueden hacer?” dijo Ramírez. “Ya sabes, la gente que vende drogas te la dan gratis la primera vez, pero después tienes que pagar. Eso es el problema. Y ahora algunas personas, ya no están bien.”

De hecho, la tasa de muertes por sobredosis entre los mayas de Yucatán que viven en San Francisco ha aumentado lo suficiente desde la pandemia de COVID-19 como para alarmar a la Cónsul General de México en San Francisco, Remedios Gómez Arnau, quien procesa el certificado de la muerte de los ciudadanos mexicanos locales antes de su repatriación.

[ Leer también: “Proveedores de Servicios Exigen Acceso a Reclusos Latinos” ]

En un día inusualmente cálido y soleado de febrero, Ramírez despertó a la gente de sus casas de campaña y parecieron agradecidos por el café, la comida y la información sobre cuando estaría abierta una clínica dental gratuita.

Instó a los yucatecos a llamar a sus familias en Yucatán desde una oficina en Daly City llamada La Casa Del Yucateco que fue inaugurada por el gobernador de Yucatán, Mauricio Vila Dosal, en octubre pasado para brindar servicios gubernamentales a los yucatecos en San Francisco y sus alrededores.

Varias personas sin hogar le dijeron a Ramírez que lo que más necesitaban son viviendas e ir a un refugio estaba fuera de la discusión porque tenían miedo a la violencia y los robos. Ramírez explicó que cuando las personas que conocen están interesadas en recursos, ellos también enfrentan obstáculos.

“A veces, tienen listas de espera: listas de espera por refugio, listas de espera por ayuda,” dijo Ramirez. “Y ellos no quieren esperar. Quieren la ayuda al mismo tiempo.”

Buscando una vida mejor

En la Península de Yucatán, México, los indígenas mayas enfrentan discriminación sistémica, y acceso limitado a la educación, atención médica, oportunidades económicas, y representación política.

La situación lleva a muchos a buscar mejores oportunidades en otros lugares. Y durante generaciones, han estado emigrando a San Francisco y el Área de la Bahía, según Lydia Candila Chan, directora ejecutiva de la Asociación Mayab, una organización en San Francisco que ofrece recursos comunitarios esenciales, educativos y culturales.

Posiblemente, hasta 70,000 mayas yucatecos viven en la ciudad y sus alrededores, pero nunca ha habido un recuento oficial; es una estimación que Candila Chan obtuvo del Instituto para el Desarrollo de la Cultura maya con sede en la capital de Yucatán, Mérida.

Candila Chan dijo que los mayas yucatecos vienen a San Francisco en busca de oportunidades financieras “para darles a sus familias una vida mejor.” Pero la barrera del idioma puede ser un obstáculo grande para encontrar trabajo porque para muchos el español es una segunda lengua. Más de 500,000 mayas de Yucatán hablan la lengua indígena maya, según el último censo mexicano.

Algunos mayas alcanzaron el éxito y, para muchos, dijo Candila Chan, gracias a sus reconocidas habilidades culinarias.

“Son los mejores cocineros aquí en San Francisco,” ella dijo. “En cualquier restaurante al que vayas, verás a una persona de Yucatán.”

La representación de la población en los restaurantes la hizo excepcionalmente vulnerable durante la pandemia, cuando se cerró la industria.

“El sueño americano a veces les resulta muy triste,” dijo Candila Chan. “Están tan decepcionados entonces cuando sus amigos dicen ‘Vamos a tomar una cerveza y hablar,’ empiezan a empezar más y más. De repente, están viviendo en la calle. De repente mueren. Veo muchos.”

Candila Chan hace lo que puede para ayudar ofreciendo programas que brindan recursos esenciales, así como actividades culturales que unen a la comunidad de una manera saludable.

Más de 250 familias se benefician de la despensa semanal de alimentos de la Asociación Mayab. El centro también ofrece clases y presentaciones de jarana, el baile tradicional de Yucatán, artes y artesanías, capacitación en interpretación maya, y una liga de béisbol que ha crecido hasta incluir ocho equipos y 144 jugadores.

La población indígena no recibe advertencias sobre el fentanilo

Gómez Arnau, cónsul general de México en San Francisco, preguntó al socio comunitario Jorge Zepeda, director de salud latina de la Fundación Contra el SIDA de San Francisco, sobre la tasa elevada de muertes por sobredosis que estaba observando entre los indígenas mayas.

En ese momento, Zepeda estaba consultando con el Departamento de Salud Público de San Francisco para evaluar la salud de las poblaciones latinas en viviendas de un cuarto. Le dijo a Gómez Arnau que estaba viendo la misma tendencia y se dijo al departamento de salud.

“Le dije ‘¿Sabes cuántas personas que hablan español y maya han muerto por sobredosis?’ Dijeron ‘No estamos seguros,’” dijo Zepeda.

Desde enero de 2020 hasta diciembre de 2023, 2,955 personas murieron por sobredosis accidentales en San Francisco, según la Oficina del Médico Forense Principal. De ellos, 456 fueron categorizados como latinos. Pero es imposible obtener tasas de mortalidad de subgrupos de la población latina, ya que las autoridades de salud de las agencias municipales, estatales y federales agrupan a todos los latinoamericanos.

Eso no tiene en cuenta la diversidad de idiomas que existe dentro de sus subgrupos, lo que significa que es posible que información vital, como advertencias sobre los peligros del fentanilo y dónde obtener ayuda para los trastornos por uso de sustancias, no lleguen.

Categorizando a todos los latinoamericanos juntos también lleva otros problemas, según defensores como el Dr. Seciah Aquino, director ejecutivo de la Coalición Latina para una California Saludable. La organización fue parte de una campaña de años para intentar que los departamentos estatales recopilen y desagregaran datos más detallados para las comunidades latinas e indígenas.

“No somos un monolito,” dijo Aquino. “Necesitamos comprender y recibir datos que detallar más en esos subgrupos específicos. Si no lo hacemos, entonces estamos perdiendo datos de calidad que podrían llevarnos a tomar mejores decisiones en términos de los fondos que se asignan a la comunidad, a la región y cómo se distribuyen.”

La senadora estatal Lena González de Long Beach presentó el año pasado un proyecto de ley de equidad demográfica para fortalecer la colección de datos estatales. La Legislatura aprobó el proyecto de ley, pero el gobernador Gavin Newsom lo vetó en octubre pasado, diciendo que era inapropiado porque la Oficina de Administración y Presupuesto de los Estados Unidos estaba actualizando los estándares federales para recopilar información sobre raza y origen étnico.

El 28 de marzo se anunciaron estándares federales actualizados que no tenían en cuenta a las poblaciones indígenas latinas. González volvió a presentar su proyecto de ley el 27 de febrero y está avanzando en el Senado estatal.

Necesidad extrema de concienciación sobre las drogas y servicios de salud

Después de descubrir la brecha en la conciencia sobre el uso de drogas entre los latinos y los latinos indígenas, Zepeda se asoció con Laura Guzmán, directora ejecutiva de la Coalición Nacional para la Reducción de Daños, y el Dr. Carlos Martínez, investigador de antropología médica y salud pública de UC Santa Cruz, para realizar un estudio con financiación del Departamento de Salud Pública de San Francisco. El informe de su estudio, “Unido/xs Contra La Sobredosis,” se publicó en septiembre de 2022.

Descubrieron que la mayoría de los latinos e latinos indígenas de San Francisco que consumían sustancias intentaban llevar a cabo un objetivo específico y sabían muy poco de los riesgos asociados con esas sustancias.

“Sabían el efecto que quería, como seguir trabajando, relajarse o dormir,” dijo Zepeda. “Cuando les preguntamos: ‘¿Saben el nombre de la droga?’ ‘No. Pero puedo obtenerlo de una persona que conozco.’”

Concluyeron que para minimizar las sobredosis y los daños relacionados con las drogas en las comunidades latinas e indígenas, la ciudad debe educar a poblaciones específicas sobre los tipos de drogas, impactos del uso de drogas y conciencia de que las drogas a menudo están contaminadas con el opioide fentanilo, que puede causar una sobredosis letal.

El estudio también reveló una brecha evidente en la disponibilidad de servicios de tratamiento. Dijo que la mayoría de los proveedores comunitarios que prestan servicios a la comunidad latina “no se sentían cómodos” haciendo una derivación a un proveedor de servicios de salud por uso de sustancias en San Francisco porque no tenían la capacidad de interactuar con personas que hablan español o maya.

Zepeda dijo que ha visto un progreso desde que se publicó el informe, incluido que las solicitudes de propuestas para la salud conductual han incluido programas en español y maya recientemente.

Los funcionarios del Departamento de Salud Pública rechazaron las solicitudes de entrevista. En un correo electrónico, el departamento afirmó que ofrece 10 camas en el Managed Alcohol Program para pacientes latinos e indígenas. Y acaba de lanzar una iniciativa que se llama Health Access Point, que da servicios de reducción de daños a clientes latinos a través de un programa liderado por el Instituto Familiar de la Raza, el Mission Neighborhood Health Center y la Fundación Contra el SIDA de San Francisco.

Además, el departamento anticipa que una expansión planificada de 33 camas de un centro de tratamiento de salud mental y uso de sustancias para mujeres que han sido arrestadas, acusadas, condenadas o encarceladas será competente en español.

Necesitan programas culturalmente sensibles

Sin embargo, los proveedores de servicios dicen que la competencia lingüística no es lo mismo que los programas culturalmente sensibles y que son casi imposibles de encontrar para las comunidades latinas. The Latino Commission es la única organización que da ese tipo de tratamiento residencial en San Francisco y solo tiene 10 camas.

La directora ejecutiva de la Latino Commission, Debra Camarillo, dijo que conectarse con la propia cultura es fundamental para la sanación.

“Entramos en recuperación y podemos conectarnos y encontrar un sentido de nosotros mismos,” dijo Camarillo. “Y al encontrar ese sentido de uno mismo y desarrollar ese amor propio, surge un valor que al final entendemos que, como humanidad, como seres humanos, somos sagrados. En eso está lo sagrado.

“Si puedo entender ese lugar y puedo vivir en ese lugar, entonces mis acciones serán diferentes. No voy a tratarte como quizás te hubiera tratado en el pasado. No voy a tratarme a mí mismo y no voy a aceptar un tratamiento que quizás haya aceptado en el pasado.”

Para aumentar los programas sensibles lingüística y culturalmente para las poblaciones latinas necesitan a más médicos latinos, dijo la Dra. Marlene Martin, profesora asociada de UCSF y coautora de un estudio, publicado en el Journal of General Internal Medicine en enero de 2022, titulado “Falta de diversidad racial y étnica entre los médicos especializados en adicciones.”

Los autores del estudio concluyeron que diversificar la fuerza laboral médica requeriría una mayor financiación para las facultades de medicina en comunidades desatendidas, ayuda financiera para estudiantes sin acceso a la riqueza generacional, políticas de pago de préstamos más integrales y programas para exponer a los estudiantes a las carreras médicas.

Martin también es director de iniciativas de adicción en el Centro de Excelencia Latinx de UCSF, que está ayudando a satisfacer la necesidad de un tratamiento culturalmente sensible. Se han asociado con la Coalición Nacional para la Reducción de Daños en la educación sobre el uso de sustancias para organizaciones comunitarias latinas en San Francisco.

Sylvie Sturm informó esta historia mientras participaba en la beca de datos 2023 del Centro de Periodismo de Salud de la USC Annenberg, que brindó capacitación, tutoría y financiación para apoyar este proyecto.

Traducido al español por Cassandra Garibay.

The post Las Muertes por Sobredosis entre los Mayas en San Francisco Muestran la Necesidad Urgente de un Tratamiento Culturalmente Sensible appeared first on San Francisco Public Press.

Lee esta historia en español.

When Karen Rodriguez arrived in San Francisco after fleeing her home country, Colombia, with her husband and her 6-year-old son, Juan, the family stayed with her son’s godmother. But when they had to leave two months later because the lease didn’t allow for extra people in the unit, they resorted to sleeping in their car.

Because the family was newly arrived, Rodriguez and her husband did not have work authorization, making securing jobs and paying rent extremely difficult.

They have since been bouncing between stays in their car and stays in hotels paid for by the city and Faith in Action Bay Area, a network of community organizers from various faith congregations. Juan has special needs, so an emergency shelter would be traumatic for him, Rodriguez said. 

The Rodriguez family is among many recent migrants seeking shelter and a new life in San Francisco, who are falling into homelessness with no easy way to climb out.

San Francisco housing providers, legal advocates, faith groups and migrants themselves warn that there is not enough temporary housing to accommodate the increased need, and that the city’s response system is not equipped to handle the complications that arise at the intersection of homelessness and immigration. Housing providers say also that the city is intentionally under-counting and under-representing the need.

While city representatives said the Department of Homelessness and Supportive Housing is taking steps to reallocate funds to open a family shelter and quicken the rate at which families move out of shelter and into longer term housing, they were unable to provide a timeline or instructions as to what families sleeping on the street should do in the meantime.

‘Profound’ need and poor data

The notion that there isn’t enough temporary housing for these families conflicts with the city’s shelter inventory, an online dashboard that tends to show family shelter vacancies around 7% or 8%. But Hope Kamer, director of public policy and external affairs at Compass Family Services, a nonprofit focusing on family homelessness, said this is not a true reflection of the need.

“Families are coming to our access point at 4:30 on a Friday and saying, ‘I have nowhere to go for the weekend with my two infants,’” she said, calling the need “profound.”

Often, families are turned away for lack of shelter slots.

That happened to Álvaro Tovar and his wife and two young children when they recently showed up at a shelter access point, where families are assessed for service eligibility, he said. Staff told him that it would take two weeks before he could put their names on the waitlist, and longer to get beds. They advised him to buy a tent for his family to stay in while they waited.

“That broke my heart because first of all, we didn’t have any money, we didn’t know the city. I lost all hope,” Tovar said at a March 7 community event that Faith in Action Bay Area hosted to bring attention to the need for family shelter.

Kamer said the Buena Vista Horace Mann Shelter, a school gym that functions as a family shelter at night, gets as many as 10 calls a day from community-based organizations searching for beds for families who have nowhere to stay, many of whom the shelter can’t take in.

Laura Valdéz, executive director of Dolores Street Community Services, the nonprofit that runs the Buena Vista Horace Mann family shelter, told the San Francisco Standard in December that the city instructs the organization to not count the number of families it turns away.

Emily Cohen, deputy director for communications and legislative affairs at the Department of Homelessness and Supportive Housing, said she wasn’t aware of that instruction. Rather, she said, the department wants people to go to entry points for the homeless response system to create one centralized shelter waitlist.

Over the past six months, that waitlist has consistently contained some 200 families, Kamer said. At Buena Vista Horace Mann, the department counts the shelter occupancy at 5 p.m., before parents have returned from their jobs and thus under-representing the need, she said.

“This unwillingness to capture the full scale of the problem means that there is not accountability to these families and there is, in turn, not public pressure to build the amount of shelter stock we need,” she said.

Migrant families themselves have been banding together to create that pressure. Partnering with Faith in Action Bay Area, the families have issued demands to the Department of Homelessness and Supportive Housing: guarantee same-day shelter or a hotel voucher for any family who goes to an access point; expedite the transition from shelter to long-term housing; and create an online dashboard that lets families check their position on a shelter waitlist.

The group held a rally outside City Hall on March 12, the day supervisor and declared mayoral candidate Ahsha Safaí introduced a non-binding resolution calling on Mayor London Breed and the Department of Homelessness and Supportive Housing to respond to migrant families’ housing needs. The full Board of Supervisors will hold a hearing on the resolution on April 22, according to staff from Faith in Action Bay Area.

Other barriers to safe housing

Besides lack of shelter beds, migrant families face other issues as they try to navigate the system.

“For many families, the homeless response system in San Francisco is their first touch point for social services in the United States, and the system is fundamentally not resourced to do the legal navigation and trauma-informed care that a family that has just made an immigration journey to San Francisco needs,” Kamer said. 

Vanessa Bohm is the director of the Family Wellness and Health Promotion programs at the Central American Resource Center, a nonprofit that helps Latinx migrants and under-resourced families in the San Francisco Bay Area. She said that 15 or 20 years ago, it was easier for people to get rooms or jobs through the informal economy or through connections to people they knew here. Today, she’s not sure that is the case, she said.

Silvia Ramos, a senior case manager and support group facilitator for the family wellness program at the Central American Resource Center, said many families arrive in San Francisco with trauma from their journey and feel displaced as they enter a system that is difficult to adapt to. When families show up with nowhere to stay and the city has no beds, she will look for beds in Oakland or other nearby cities and teach people how to use Bay Area Rapid Transit.

Navigating these systems can be even more difficult for people who don’t speak English, or who come from different cultural backgrounds, many providers said.

Role of immigration court

While trying to access housing, families must also worry about the asylum process and immigration court system. However, providers noted disconnects among the legal and homeless response systems, and groups that offer other resources like medical care or food.

“There is no government help coming to connect the legal response system and the homeless response system,” Kamer said. “The direct care providers are figuring out how to do that.”

Milli Atkinson, director of the Immigrant Legal Defense Program at the Justice and Diversity Center of the Bar Association of San Francisco, said most people’s asylum cases aren’t decided for years and they often worry more about immediate needs like housing or food.

“A lot of people get lost in the system, just because they don’t have the capacity mentally to figure all of these things out at once, and they’re going for their basic needs first,” she said.

But having legal representation during the asylum process helps migrants get work authorization, enabling them to become more self-sufficient.

Housing instability can affect immigration cases in other ways. One of the biggest hurdles for people experiencing homelessness, Atkinson said, is that the court system relies heavily on paper and communication is primarily done through the mail. People are expected to keep the court updated on their addresses.

“If the court mails you things about your case, and you don’t get them, it’s your fault,” she said. 

Influx of migrants

Housing providers, legal advocates, and the Department of Homelessness and Supportive Housing anecdotally noted an increase in the number of people seeking services who are fleeing Latin America due to political unrest, poverty and other violence.

Atkinson said that in recent years her organization has seen a greater number of migrants from countries like Nicaragua, Colombia, Peru and Cuba. As the number of countries experiencing political instability in recent years has risen, the number of people seen coming in at the border has also gone up, she said.

Because San Francisco is a sanctuary city, questions about immigration or refugee status during the coordinated entry process, a system used to determine what type of resources people qualify for, are limited. This makes it difficult to say what percent of the recent surge of families seeking shelter are migrants, Cohen said, though she anecdotally noted that there have been more people from Central and South America asking for assistance.

City data shows that the share of Spanish-speakers and Latinx people experiencing homelessness is increasing. The share of Spanish-speakers in the city’s ONE System, which tracks people receiving assistance from the Department of Homelessness and Supportive Housing, increased to over one-quarter of the department’s client population in 2024. Additionally, from 2019 to 2022, there was a 55% increase in the number of Latinx people experiencing homelessness, according to data collected during the 2022 point in-time count, a biennial count of the number of people experiencing homelessness.

Leslie’s story

Safe, stable housing enables migrant families to thrive.

Leslie, who asked to keep her last name private, fled Nicaragua in November 2019 with her daughter and her partner as the country faced increased political violence and she and her partner lost their jobs.

“There was a war and a lot of people were killed. There was chaos everywhere and the economy was already in bad shape,” she said, noting they had no food. “So we left it looking for a better future.”

When they arrived, Leslie faced abuse from relatives she was staying with and was forced to keep her daughter, who is autistic, in her room to shield her from harassment.

“I felt a lot of frustration, a lot of desperation, not knowing what to do,” she said.

Eventually, Leslie, along with her partner and daughter, left. They changed addresses at least three times, moving from a shelter to a friend’s house to a city-funded hotel. It was there, where she was no longer sleeping on the floor, that she began to feel some comfort. She started seeing a therapist and getting medical care, and learned how to get her daughter into school.

But she didn’t know how long they would be able to stay, which caused her anxiety, and there were other problems. 

Therapy “opened up my eyes to the abuse that I was suffering at the hands of my partner, so I decided to leave him,” she said. “I didn’t have any family here and I didn’t have any friends. I just had my daughter.”

With the help of Compass Family Services and prenatal homelessness services, Leslie was eventually able to apply for permanent housing for her and her 7-year-old daughter. They moved in in September 2023.

“Now that we have found stable housing, she feels safe, we feel safe,” she said, noting the stability is good for her daughter.

The security has allowed Leslie to pursue an internship teaching preschoolers and sit on Compass Family Services’ Family Advisory Council to share her experiences about navigating homelessness in San Francisco. Going back to school has made her feel useful.

“It makes me feel like I have a better future here,” she said, noting that she wasn’t sure if she would be cleaning toilets for the rest of her life in the United States. “It really fills me up with life and I love to be with the children, and I love to learn.”

Madison Alvarado reported this story while participating in the USC Annenberg Center for Health Journalism’s 2023 Data Fellowship, which provided training, mentoring and funding to support this project.

Andrea Valencia of Linguaficient, a company that provides professional language services, interpreted our interview with Leslie, a monolingual Spanish speaker. Yesica Prado, a journalist at the San Francisco Public Press, interpreted our interview with Karen Rodriguez.

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