The city of San Jose recently released the 2019 Homeless Census & Survey Report. The report focuses on unhoused individuals priced out of the expensive Bay Area market. While I wholeheartedly agree that we must assist the unhoused who struggle to find affordable housing, we must look at other root causes — mental health issues and drug/alcohol abuse — if we hope to solve the problem of homelessness. The report said that 36% of the homeless in Santa Clara County reported substance abuse issues, while 42% reported psychiatric conditions. Current efforts in the county to address these causes of homelessness are tragically inadequate.
Unfortunately, the city cannot treat the mentally ill without support from the county, since the county is responsible for social services and receives the tax dollars to deliver them. We can — and must — enact more protections for the homeless suffering from mental illness. Individuals mentally ill to the point of being unable to carry out normal life functions, cannot continue to live in filthy conditions, abuse substances, and create existential harm to themselves and the community. California has a tool available to counties to ensure the mentally ill unhoused who have encounters with the legal system get the help they need – Laura’s Law.
Laura’s Law was passed in 2002 to help mentally ill individuals occupying the streets by introducing court-mandated Assisted Outpatient Treatment (AOT). For this legislation to take effect, it must be implemented by a county through a vote of the Board of Supervisors. To date, 20 counties in California have done this, including San Mateo, Alameda, and San Francisco. These counties are achieving a high degree of success saving lives and money. A new evaluation of the AOT program in San Francisco shows 91% of patients saw reduced hospitalization, 88% had reduced time incarcerated, and 74% reduced their use of psychiatric emergency services. Further, the 129 participants were costing a combined $485,000 monthly in city services before entering the program, but with AOT, costs dropped by 83% — saving more than $400,000 per month.
San Francisco also received approval from the state Legislature to use conservatorship as a tool to help the severely drug/alcohol addicted (SB 1045), since this is outside the scope of Laura’s Law. Conservatorships allow for court appointment of a public guardian to temporarily make decisions for people who, through addiction, have become unable to make basic life decisions for themselves. They are now seeking legislative approval for stronger, more flexible conservatorships to help more people get off the streets.
Existing conservatorship law in Santa Clara County was established in 1972. It initiated the first statutes for treatment of severely mentally ill people that qualify as “gravely disabled”. In 2018, California passed SB 1045, which provides for the formation of a 5-year pilot program consisting of bolstered conservatorship policies in San Francisco and Los Angeles. SB 1045 increases the grounds upon which judges can refer individuals to a conservatorship and includes those who are blatantly troubled, but may not qualify as “gravely disabled”. Individuals that fail to qualify as “gravely disabled” often get stuck in a chronic cycle of 72-hour psychiatric holds and become victims of a dysfunctional system. Mandating these individuals into treatment is far better than seeing their mental health deteriorate to life-threatening levels.
It’s past time that we focus on the primary causes of homelessness. This health epidemic has become too grave to ignore, and our community suffers the collateral damage. For all these reasons and more, I urge our county to follow San Francisco’s lead in implementing AOT – Laura’s Law – and seek to join the SB 1045 conservatorship pilot.
Johnny Khamis represents District 10 on the San Jose City Council.
Opinion: County can do more to help solve root causes of homelessness