Stacy Collinsworth was born in Ohio, drifted to Florida and then west to California. Wherever he stopped, he caused trouble.
"The guy you see in the middle of the street using a halfgallon bottle as a pillow?" he said. "That would be me."
Collinsworth landed in San Diego a chronic alcoholic, blind in one eye and homeless. In 2010, he took 43 ambulance rides, was arrested four times, spent 10 days in jail, three days in the hospital and three days in the county's psychiatric ward. In all, he racked up $103,567 in expenses.
In the first few months of 2011, there were two ambulance rides, three ER visits, one arrest and four days in jail.
Then the turning point: two weeks in detox at a cost of $826.
Collinsworth's name ended up on a list of "frequent users" of medical and public-safety services, compiled as part of the San Diego County United Way's Project 25 initiative that seeks to get the costliest chronically homeless people off the street and into housing. When a case manager told Collinsworth that he was being offered his own apartment, he thought it was a joke.
"I thought it was some kind of a set-up," he said, "when they tell you you've won a new TV, you show up and you get arrested."
For the last few months, he's been living Downtown in a building owned and operated by St. Vincent de Paul. He has a case manager who's available 24/7, he attends AA meetings and is enrolled in a vocational rehabilitation program. He's thinking about becoming a drug-and-alcohol counselor.
In all, almost 150 people have been helped off the street and into housing in the last year, the result of Project 25 and a second initiative focused on Downtown San Diego. That alone is significant progress. But, also, the San Diego Housing Commission, which oversees the city's homeless-services programs, announced earlier this month that it had hired Mat Packard, the highly regarded vice president of development at homeless-services giant St. Vincent de Paul; the Downtown San Diego Partnership, the voice of the largely conservative Downtown business establishment, lured Ryan Loofbourrow away from Sacramento—where he'd been lauded for launching a successful homeless-outreach effort—to head the partnership's Clean and Safe Program; and the long-planned Connections Housing homeless-services center is on track to open a year from now. Smaller, but symbolically significant are the recently-installed modified red parking meters in Horton Plaza that collect money to help move people off the street and into housing.
Amid the progress linger two big questions: What's behind the momentum and is it sustainable?
Underlying each new initiative is a common theme: Doing nothing about homelessness costs taxpayers money.
Measuring the economic impact of homelessness isn't new. In 2006, The New Yorker's Malcolm Gladwell wrote about "Million-Dollar Murray," a chronically drunken homeless man who died on the streets of Reno, but not before running up massive hospital bills. The "San Diego 15"—15 chronically homeless alcoholics whose 18-month total for hospital and jail stays came to $1.5 million—were the focus of an oft-cited 1997 study by James Dunford, a physician at UCSD Medical Center and director of emergency services for the city of San Diego. The study became the foundation for the San Diego Police Department's Serial Inebriate Program—launched in 2000, it gives homeless chronic drinkers the option of treatment over jail. Still, it's taken awhile for the cost-savings argument to resonate on a larger scale.
This partly has to do with not having someone to consistently carry the message.
"I don't think service providers have always done the best job in putting what they do in that context," Packard said. "We're great at talking about how many meals we provide and how many people sleep in our facilities, and kind of the outputs instead of the outcomes."
And there's a newish approach to getting people off the street, known as "housing first." In the old model, emergency shelters were the entry point. From there, a person would hopefully work his way into transitional, short-term housing and then on to a more independentliving situation. But housing first, as its name implies, gets a person into a stable, permanent living situation; once housed, an individual can then focus on the issues that landed him on the street.
In early 2009, the United Way made the controversial hire of former San Diego City Councilmember Brian Maienschein to be commissioner of the Plan to End Chronic Homelessness, or PTECH, which championed the "housing first" model—get someone off the street and into a stable living environment coupled with supportive services; once housed, the person can work on the issues that landed him on the street.
Drafted in 2005, the plan had languished without implementation and the county Board of Supervisors—the overseers of federal and state social-services money—had declined to endorse it. As Supervisor Ron Roberts told CityBeat, "We try to stay out of symbolic gestures. If we're going to endorse something, we're going to do something."
Maienschein, a Republican, lacked any sort of track record on issues involving the homeless. But, like Collinsworth's $826 detox, hiring Maienschein ended up being a turning point. What he lacked in social-services experience he made up for in his ability to sell a singular focus: ending homelessness saves money.
"The old way was not working," Maienschein told CityBeat last week at a press briefing on Project 25's progress. "While there are moral and ethical reasons to get involved, the economic reasons are just as compelling."
He also got the county on board.
"Documents and all that are nice," Roberts said at a Project 25 press conference last year, "but let's get into solution-focused programs."
There are now 35 participants in Project 25, named as such because the initial goal was to get 25 people—the most expensive "frequent users" of services— into housing.
Maienschein estimates that those 35 people racked up more than $4 million in court, jail and medical costs in 2010. For the first six months of 2011, those costs have been cut by 75 percent.
According to the Regional Task Force on the Homeless, there are nearly 5,000 unsheltered homeless people in the county. At least 1,000 of them are Downtown and many meet the definition of being chronically homeless, meaning they've been on the street for more than a year and suffer from mental illness, addiction or a physical disability. They've likely been in and out of shelters and rehab programs.
For three days last September, early in the morning, volunteers working in teams fanned out Downtown to count and survey the homeless population. They counted 1,040 people and were able to survey 737. The information was used to compile a list of people most at risk of dying on the street in order to prioritize who'd get 75 housing vouchers made available through the Department of Veterans Affairs and 50 vouchers administered by the Housing Commission.
As of the end of October, 101 people were off the street, 68 of them in permanent housing, said Matthew Doherty, principal of housing policy and planning for LeSar Development, which coordinated Registry Week, one component of the larger Ending Homelessness in Downtown San Diego Campaign.
A main element of the campaign is a five-year plan with an ambitious goal: getting everyone currently on the streets of Downtown into housing by 2018. For this to happen, an additional 104 supportive-housing units would need to be added annually to what's currently available or in development. To put this in context, only 311 such units currently exist Downtown with another 249 under development.
Further complicating things: "A major funding source for all of those supportive units and transitional beds is redevelopment funds," said Jeff Graham, vice president of redevelopment for the Centre City Development Corporation (CCDC).
The future of CCDC, identified as the lead agency in the plan, is uncertain. Earlier this year, the state Legislature, arguing that redevelopment was siphoning off money that should go to the cash-strapped state, voted to give cities two options: eliminate your redevelopment agencies or make a large payment to the state. San Diego chose the latter, which would require $47 million payment from CCDC this year and $11 million in following years.
A lawsuit seeking to undo the legislative action is pending before the state Supreme Court, and a ruling's expected by Jan. 15. Depending on the ruling, CCDC could emerge unscathed, could be eliminated entirely or could be required to make the payment. Meanwhile, other funding sources for supportive housing are scarce.
"We're starting to ask some members from the private sector, from the business community, to start participating in these meetings," Graham said, referring to the ongoing meetings that are part of the plan to end homelessness Downtown, "because we realized funding-wise, the public sector's just not going to be able to pay for all this, so we really want the private sector to start getting more involved and committed."
In interviews for this story, that's a theme that frequently emerged: It's time for the private sector to get more involved.
Two months ago, Ryan Loofbourrow was hired as the director of the Downtown San Diego Partnership's Clean and Safe program which, historically, has played a reactive role when it comes to homelessness: From power-washing urine and feces from sidewalks to making sure folks aren't sleeping in doorways or aggressively panhandling.
Loofbourrow worked for Sacramento's version of Clean and Safe where he started the Navigator homelessness-outreach program after realizing how difficult it was for some people to navigate the social-services system.
"Just doing the enforcement, just trying to move this individual from place to place, didn't solve the challenge that I had or the challenge that my businesses had," he said.
He's close to hiring his first outreach worker and he hopes to soon have a proper team. But funding that team will likely mean selling the program to Downtown business owners who pay for Clean and Safe services.
"My experience has been that if you put in place measures that are helping the homeless, and communicate how you're doing that and the progress you're making, then you get more cooperation," Loofbourrow said.
Doherty said the California Endowment has agreed to fund an analysis of the Downtown initiative's and Project 25's cost savings.
"Locally, there already is a sense that all of these diverse efforts are showing progress and having an impact," he said. "I think the case will be even stronger when we can really demonstrate the cost-effectiveness."
But recent successes needs to be kept in perspective. Marc Stevenson, Project 25's program manager, said he's been surprised by how many people have stayed housed. The transition from the street to home isn't as easy as most might assume. He's had a number of clients talk about returning to the street.
"That's where they know how to be. Some of them are quite infamous among their friends on the streets. In housing, they may experience an identity crisis and feel awkward at first," Stevenson said. "Some of them were not out there dreaming of being in an apartment when we found them."
But, he added, "we do what we can to make the place a home for them.... We establish relationships and rapport with them and give them as much attention as we can, and so far it seems to make the difference."
Then there's the city's annual winter homeless shelter. Money that funds it will go to the Connections Housing project, which opens next year—meaning this year will likely be the shelter's last.
"Do the math," said Rosemary Johnston, director of the Interfaith Shelter Network. Connections will provide 73 permanent beds and 150 short-term beds. "Those beds are going to be off the table quickly.... The Alpha Project sees more than 800 unduplicated people using the winter-shelter tent, so when you subtract 223 from 800, you get almost 600 people who are not going to be housed and who are going to be out on the street during the winter months, and it's not going to be pretty. We can't afford to close that."