A woman at the Metro Hotel has stepped on a tack-one of those tacks that are supposed to keep wall-to-wall carpeting pinned to the floor but instead have a tendency to go sharp-side up. She tells Daniel Marquez, the residential hotel's property manager, that her ex-husband, who lives in the unit next to hers, had to pull the tack out with a pair of pliers-and that she has called 911.
A short while later, she's being wheeled out the front door on a gurney and to the hospital, which will charge at least a couple thousand dollars for a tetanus shot, a band-aid and a ride in an ambulance.
Marquez shakes his head-he tried to tell her she didn't need to go to the hospital, but, in the end, it's her call. If her misstep had happened a year ago, there would've been a full-time psychologist and two case managers on-site to help the woman put her injury into perspective and save the expense of an emergency room visit.
“We miss them,” Marquez says.
For Tony Phillips, administrative director for the Alpha Project, the social-services agency that operates the Metro, this small example underscores the reality that cuts to social-service programs can end up costing taxpayers more in the long run.
For three years, up until July 2005, the Metro, where a majority of tenants are mentally ill, disabled or elderly, or have moved in straight from the street-some teetering on the brink of needing constant care-received roughly $330,000 from the state annually through a program known as the Supportive Housing Initiative Act (SHIA). That money paid for a staff of 10, who, in turn, helped residents with everything from crisis management and self-care to finding a job and learning basic life skills.
Supportive housing-affordable housing where residents not quite capable of living on their own, and who run the risk of homelessness, have access to a range of services-has, over the past several years, been held up as a model for getting people off the streets.
“Housing is the literal foundation for people living with mental illness to get better,” said former state Assemblymember Darrell Steinberg, who, while in office, authored several pieces of legislation in support of mental health care.
And, though more costly upfront, studies have shown supportive housing to be far more cost-effective in the long run. For example, a 2002 study from the University of Pennsylvania's Center for Mental Health Policy and Services Research, using conservative measures, found that it cost only $900 more per person per year to house someone in a supportive-living facility than to leave that person on the street-$900 included the one-time cost of building the housing.
“If you look at the research,” said Jonathan Hunter, California director for the Corporation for Supportive Housing, “cities and counties argue that they don't have the funding to pay for the services, and the reality is that cities and counties are already wasting enormous amounts of money on homeless people that are constantly cycling through jails and through hospital emergency rooms.”
The Metro was one of 46 projects statewide that received funding during the SHIA program's five-year life. SHIA was deemed a success-a November 2003 evaluation showed participants, many of whom moved from the street into SHIA-funded housing, felt more in control of their lives and better able to function. At the time of the 2003 evaluation, 86 percent of program participants had remained housed. Even though the SHIA program was supposed to remain in place through 2009, funding was cut two years ago. A spokesperson for the state Department of Mental Health said she doesn't see the program being re-funded.
“The ultimate weakness of the initiative was that it relied on state general-fund dollars,” Hunter said.
The program was meant to be a pilot-to “plant seeds for collaboration” at the local level, said Linda Aaron-Cort, who directed the SHIA program until funding was cut.
“The idea was it would provide a way for services to get started and demonstrate their effectiveness,” Hunter explained, “and that then counties and cities would need to pick up the ongoing funding of those services. One of the things that we've learned the hard way from this act is that it just takes longer than three years to figure out what a local funding mechanism could be.”
Piedad Garcia, director of adult mental health services for the county of San Diego, said Alpha Project staff approached her, hoping the county could pick up funding when the SHIA program ended. But, Garcia said, her department-like mental-health departments statewide-was already strapped.
“We had been reducing services, reducing our budget for the past two years,” she said. “So that's why we could not provide those funds.”
Phillips said the Alpha Project also hoped money from the Mental Health Services Act (MHSA) could pay for the Metro's support staff. The MHSA-Prop. 63 on the November 2004 ballot, also known as “the millionaire tax”-levies a 1-percent tax on personal income exceeding $1 million. It's not a windfall by any means-San Diego County is getting $25 million, which will help fund everything from services for emotionally disturbed children and youth transitioning out of foster care to enhancing mental-health services at community clinics. The county's spending plan has been drawn up and is awaiting final approval from the state.
“The programs that have been designed aren't designed to provide services at the Metro,” Garcia said of the spending plan. The focus, rather, is on people who currently aren't housed-getting those individuals off the street and into housing where they'd be monitored by an off-site county caseworker. A handful of tenants at the Metro are currently under such an arrangement, Garcia said.
Meanwhile, the Metro last week took in close to 30 people who had been living in the downtown winter shelter. The shelter was supposed to close last week, but the Alpha Project has committed to keeping it open as long as possible through its own funds and through private donations. The San Diego Housing Commission provided $15,000 to cover one-month's rent for those 30 people. Phillips said a private donor put in another $15,000. The goal, he said, “is to give [them] a buffer of time” to stabilize their lives and save some money. Ideally, they'd be able to pick up the $461-per-month rent after the 60 days is up. Marquez said that, right now, there are only eight vacant rooms at the 193-unit hotel.
Phillips said Marquez and his staff have “gone above and beyond” to keep the place running smoothly after the SHIA funds ran out. Marquez is still upset about a gentlemen he had to ask to leave for persistent disruptive behavior. He said he's not sure whether having an on-site psychologist would have helped the man, though.
“Having services on-site is indispensable,” Phillips points out.
Marquez says his staff, none of whom are are trained social workers, wear many hats-something that's not always easy. Mike Torres, who handles maintenance and security, has become a de-facto case manager since he's the one constantly walking the building and handling maintenance problems that most often stem from an individual's mental illness or lack of life-skills. Torres also facilitates a sober-living support group on Fridays after work, something one new resident, Dave, who's just out of a shelter, attributes to his remaining sober and staying housed.
“I'm proud of myself,” Dave said, before walking over to the Metro's elevator to go up to his room.