Dear Friends,

Homelessness has devastating impacts on health: studies estimate that it reduces life expectancy by 15-20 years. While we know the primary cause of homelessness is a lack of affordable housing, behavioral health conditions like mental illness and substance use disorders also contribute to homelessness and are greatly exacerbated by a lack of housing. Stable housing and appropriate treatment are necessities for the health of our neighbors experiencing homelessness.

The San Francisco Department of Public Health (DPH) and the Department of Homelessness and Supportive Housing (HSH) are part of a complex system of care that provides behavioral health services everywhere from hospitals to street corners. People experiencing chronic homelessness are among their highest-need and most frequent clients, but without stable housing, clients tend to cycle in and out of shelter and treatment. As part of our effort to prevent homelessness, Tipping Point is working with the UCSF Department of Psychiatry and public health consultancy John Snow, Inc. (JSI) to research the existing system, identify gaps in services, and recommend opportunities for improvement. Tipping Point’s role will be to identify areas for philanthropy to enhance the City’s behavioral health infrastructure for people experiencing homelessness.

Read on for more about our partnership with UCSF and some of JSI’s initial findings.

All my best,

Daniel

Snapshot: Behavioral Health and Homelessness

Homelessness creates substantial barriers to receiving and maintaining behavioral health care. Meanwhile, experiencing homelessness and housing instability can cause trauma and exacerbate symptoms—more than two-thirds (68%) of people experiencing homelessness surveyed in the 2017 Point-in-Time Count reported one or more health conditions, including chronic physical illness, physical disabilities, chronic substance use, and severe mental health conditions. Among respondents experiencing chronic homelessness, 65% report substance abuse, 63% report psychiatric or emotional conditions, and 45% report PTSD. In our community, the lack of affordable housing and “step-down” treatment beds strains our entire continuum of care. Without lower-intensity placements to exit into, individuals can remain in levels of care not matched to their medical or therapeutic needs while higher-needs individuals must wait to access appropriate beds or placements. Higher costs and sicker people result.

Over the course of six months, JSI studied the San Francisco behavioral health care system, researched national best practices, and convened an Advisory Committee comprised of key leaders in the field from DPH, HSH, UCSF, Zuckerberg San Francisco General Hospital, and community-based providers. JSI interviewed 34 total stakeholders—Advisory Committee members and other local providers—and conducted a focus group of clients at the Hummingbird Place psychiatric respite program. JSI met monthly with DPH leadership to provide updates on progress and findings, and to receive feedback and clarifying guidance. This research informed a set of recommendations for enhancing the system of care. Our vision for the application of these recommendations is as follows:

To know the names and needs of everyone who is homeless with a behavioral health care need, provide wraparound services that promote stabilization and a path to permanent housing, and ensure that systems and services proactively address and reduce disparities among Black and LGBTQ individuals experiencing homelessness.

Our initial research indicates that expanding the supply of residential care facilities (also known as “board and cares”) and treatment facilities, as well as the supply of affordable housing, would add needed capacity to move more people through the system to an appropriate level of care. Improved inter-agency coordination—both data sharing and transitioning clients between services—should improve health outcomes for people with complex behavioral health needs. We look forward to sharing the full findings soon, and working closely with DPH and other partners to implement recommendations that will result in more efficient systems and better health for our neighbors.

Who's Making It Happen

“During the worst days of the AIDS crisis, academia, philanthropy, the non-profit community, and government came together to attack what seemed to be an insurmountable challenge. This is the model we are following now in our effort to combat homelessness.”

— Matthew State, MD, PhD
Chair, UCSF Department of Psychiatry
President, UCSF Langley Porter Psychiatric Hospital and Clinics

Dr. State is a child psychiatrist and human geneticist. Over the past decade his lab has been a leader in identifying genes contributing to neuropsychiatric and developmental disorders, including autism spectrum disorders. He was a faculty member at Yale University from 2001-2013 before coming to San Francisco to serve as the Chair of the UCSF Department of Psychiatry as well as other leadership roles. He was drawn to UCSF by their commitment to bringing world-class science together with compassionate care to all.

UCSF provides care to San Francisco’s most severely mentally ill and substance-dependent patients in acute settings and community-based programs, to those in supportive housing, and those within the criminal justice system. Their work leads Dr. State and his colleagues to believe that advances across several domains—clinical services, education, basic and translational science—will all be needed to combat homelessness and the stigma and marginalization that continues to plague individuals suffering from mental health and substance use disorders.

What We're Reading

Life expectancy differs dramatically by race in San Francisco – Income is one way to measure San Francisco’s inequality; another way is mortality rates. And the two are related. DPH released a new report that quantifies racial disparities in health outcomes and life expectancy.

In a little yellow house, SF supes see model for getting mentally ill off the streets — Supervisors Hillary Ronen and Matt Haney on Tuesday introduced legislation to set aside ERAF money to pay for more residential treatment co-ops in neighborhoods around the city.

Chronic Homelessness Initiative Overview

There are approximately 2,100 people experiencing chronic homelessness on any given night in San Francisco. Tipping Point’s $100 million pledge marks the single largest private investment to address homelessness in City history.

Tipping Point takes a three-pronged approach to our impact goal. See here for more details. If you are receiving this email as a forward, subscribe here to receive this update monthly.

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