Heart Forward LA’s Kerry Morrison Calls for Coalition of Shared Accountability on Homelessness

The last time we spoke, Kerry, you noted that part of the challenge with homelessness in LA is that the US lacks a comprehensive and navigable mental health care system. Has any progress been made on that front since?

Kerry Morrison: I would say, sadly, very little progress has been made. The only thing I noticed from this election cycle is that, for the first time, we heard candidates for Mayor and City Council actually talking about the fact that the mental health system was contributing to our homeless crisis. They actually mentioned the need for substance use treatment. I don't think that was as prevalent a theme four years ago, or even two years ago.

Both Mayoral and the City Council candidates would bring up the fact that they knew mental health system challenges contribute to homelessness, but they didn't know how to address it. They didn't have the language or the right framework to suggest what needs to change.

I was really concerned that today in the LA Times there’s an interesting public opinion survey conducted by Miguel Santana and the Committee for Greater LA, and the voters don't seem to hold the county highly responsible for our homeless crisis. They don't see the connection between what it is that the Mayor or the City Council can do with respect to our mental health system and the role of the County.

That's going to make it easier for the Board of Supervisors to hide, when in fact this is actually their issue. I'm a little dismayed by the election results, especially for Hollywood, with two brand new people coming into this space without a lot of experience in this area. I haven't seen evidence that either Lindsey Horvath or Hugo Soto-Martinez have taken the time to really understand how complicated this all is.

I am heartened by the fact that Karen Bass actually has talked about the fact that she wants to engage in, as she describes it, intergovernmental relations to address our issues. I think she recognizes that as Mayor, she has a lot riding on her shoulders, but she cannot bear this burden alone. She is going to have to rely on policy changes at the county, state, and federal levels in order to make some inroads in this space. 

In that poll, 35 percent of respondents put the Mayor responsible, then the Governor, then a small portion on City Council—the county doesn't even show up.  The poll also asked how quickly voters expected results with the passage of measure ULA, with 19 percent saying they expect to see a difference within a year and 35 percent within two to four years. What do these perceptions of who's responsible and how quickly results can be achieved mean to you in terms of the pipeline of projects and voter expectations?

It's the same trap we fell into with HHH, which was passed six years ago, and in fact, there are thousands and thousands of units under construction right now. HHH has been the whipping boy of elected officials and politicians who criticize the pace at which projects are brought online, but, truly, there was a disconnect between the campaign messaging and voter expectations. Voters approved a bond issue in November 2016 and they harbored the expectation that  somehow  in a year or two, 10,000 units were going to magically come up out of the ground? That’s just not the reality of what it takes to plan and entitle and finance and build housing in Los Angeles, whether it's market rate housing or supportive housing. Now, we are six years into HHH, and it is well on schedule to meet its goal to exceed 10,000 units.  

Measure ULA,  is supposed to contribute, they've estimated, $600 million annually into the city housing plan. One of the reasons I didn't vote for ULA is because I felt that we still had to process the lessons learned from HHH. Was that program properly configured to deliver results in the most expeditious way possible? Should there have been more flexibility on what HHH dollars could have been used for? I did not think we would be ready to see another $600 million coming into the pipeline without knowing exactly what that money was going to be invested in and exactly how it was going to be administered.

I noticed in the poll that the voters kind of have a two-year timeframe, and then after that, if they don't see measurable results, there's going to be a great deal of angst. That's still very quick to try to implement these policies.

You touched on the challenges of disaggregated governance, but could you elaborate on how it hinders a comprehensive approach to homelessness? As an oversight board member on Prop HHH, what's the problem with the City of LA building all this housing and investing all this money?

On HHH, we are citizen oversight members, so we're not there by virtue of having any particular ability to design or put together an actual plan for building housing. We do offer suggestions but primarily we are a body that is open to the public to be observing how the city is processing the HHH planning and going out to the market to bring in bond financing, etc.

I noticed that Rick Caruso said one of his first actions was going to be to fire all the HHH Committee members, as if that is where the problem lies. The problem lies in the actual design of the program from back in 2015-2016, when this was being concocted.

If we are relieved of our responsibility, that's fine. Most of t the money is already encumbered. There's 5,400 units under construction. The city’s Housing Department has an excellent dashboard that documents progress. Over 3,400 units have been completed. We're going to start seeing ribbon cuttings here at a very fast clip, and no doubt the Mayor will show up at each of those ribbon cuttings and everyone will be very happy that the voters invested in this plan back in 2016.

I noticed from the Prop ULA approach that they are recommending a paid body of oversight members. Presumably, that body will have greater input into how the program is actually structured.

One of things that I thought was really interesting in the article that Ezra Klein wrote for The New York Times is he said that authority is fractured in the LA system. Our issue is that we have disaggregated authority with no accountability and everybody can point their finger to someone else. So the city can say, “that's the county's responsibility.” The county can say, “that's not our responsibility.” You can point to the federal government for challenges in how Medicaid is administered, which compromises our ability to fund adequate mental healthcare for people.

I don't know who's responsible for substance use treatment and intervention with the crisis we have on our streets with meth and fentanyl. Nobody seems to be accepting responsibility for that, yet it is an existential crisis playing out on the streets.

It'll be interesting to see how our new Mayor proposes to build a coalition of shared accountability, perhaps between the city, county, and other levels of government. She is going to need to aggressively link arms with others in the region to share the responsibility and to articulate measurable goals that we can hold everybody accountable for, not just the Mayor.

One of other the reasons I didn't vote for ULA was that it was only a city measure. Again, we've given a hall pass to the other 87 cities in LA County. LA city voters have now doubled down with HHH and ULA to bear the burden for providing supportive housing and affordable housing in the city limits of Los Angeles. We still do not see any kind of significant commitment from our neighboring cities.

Speaking of how LA County could pull together the 88 cities in order to build a solution, where might we see leadership coming from, besides the Mayor of LA? Is it a vacuum that anyone's filling?

Perhaps there's some hope in how Governor Newsom has rejected the local homeless plans that have been sent into the state. He's asking for everyone to do better without giving a whole lot more instructions on what doing better looks like.

There is the fact that you've got the governor committed to actually improving this issue. You've got a Mayor elected for whom this has been a front and center issue. You've got an electorate really holding everybody's feet to the fire. Maybe this will be the synergy of the state exercising its muscle and its ability to enforce local housing element policy and deploy funding to regions that are actually making a difference.

Given the new Mayor’s awareness of how Sacramento and Congress work, she could be able to identify a way forward that actually unites the different levels of government to attack this collaboratively. I'm hoping she's having those conversations right now as she is preparing to step into that role.

How would you advise incoming Mayor Bass given your perspective and experience on the issue?

There are two big issues that I would share with the Mayor that she needs to have on her radar--issues that she does not directly control, but seriously impact our crisis of homelessness in Los Angeles.

One is the shortage of psychiatric treatment beds at every level of the system, from an emergency room to what you would call acute care in the hospital to sub-acute care, which is a step down from being in a locked psychiatric facility, to community-based residential care. That’s what we would often think of as a board and care home. The official name is Adult Residential Facilities.

This is contributing to our homeless crisis because people are not hospitalized for a long enough period of time to put them into a position to recover in such a way that they can start to reclaim their life. That's why the board and care system, where we are losing beds at an alarming rate, needs to be front and center for the Mayor.

Board and care beds are intended for people who need a high level of care. People who would not flourish in permanent supportive housing because in permanent supportive housing, you're expected to live pretty independently. You need to be able to buy your food, cook, do your laundry, maintain your apartment, and pay your rent. In a board and care environment, you are provided support with what you would call “activities of daily living.”  Medication is managed. Sometimes the board and care will function as a payee and help a person manage their money. Laundry is provided, bedding is provided as well as three meals a day.

For a population of people who are more seriously mentally ill and cannot live independently, this is a critical part of our housing continuum, but it doesn't show up in our housing continuum. It's not anything that LAHSA administers. It is not anything that the federal government will pay for. It is a type of housing that falls under more of a health umbrella.

In the Housing That Heals movement, for which I give credit to a couple of advocate moms from Northern California for raising awareness, we need to provide places where people are appropriately connected to the level of care that they need in such a way that they can recover from their mental illness.

This is something that I, as a layperson, have struggled with in the last three or four years. What does it mean to recover from mental illness? When we think of the word recovery, we think of recovering from COVID or a heart attack,

The way it has been described to me is that recovery from mental illness means reclaiming your life. It means that your life has not derailed to such a point that you cannot have the expectations of perhaps returning to college or going back to work or getting your children back or moving into more independent living.

The time it takes for people to recover can sometimes be a year or more, and our system does not pay for the requisite time to facilitate recovery. Housing That Heals is an environment where somebody can have access to the amount of time and support they need to reenter their life in such a way that there's less of a fear of revolving door hospitalization or homelessness.

I've been trying to educate people about innovative ways to do congregate housing, which is not really in our vernacular for how we think about housing for vulnerable populations. As much as I'm an advocate for forestalling the closure of any more board and care homes in LA or even better yet, adding to that inventory, which is just not happening, I would agree that our traditional board and care environment is not the most ideal place to live.

If you have visited a board and care home, they either are single-family homes where people will dedicate maybe three bedrooms with two people per bedroom and all services are provided by the homeowner. They can also be a facility of 100-200 people, living usually two people to a room, with a large dining room, etc.

Because of the way board and care homes are funded in California, they are, for the most part, falling apart, suffering from deferred maintenance, and unable to provide the amenities that you would want to provide a vulnerable population, such as healthy food, access to activities, comfy common rooms, etc.

I will take anybody for a tour who wants to see a board and care home. They are providing shelter, but it is not an enriched way to live. We have got to put this front and center on our agenda right now. 

You've told us some of how you would advise our next Mayor on homelessness and Prop HHH, but is there anything else you want to highlight?

Since the last time we spoke, I've been volunteering at LA County Twin Towers every week. I spend time in what's called the Step-Down Unit. It's the inpatient program where the most seriously mentally ill inmates are living, awaiting either to be restored to competency to stand trial or placement at a state hospital.

What I feel like I'm observing there, especially hearing the stories of inmates who keep just cycling back into Twin Towers, is that these are people who have very acute needs for a more structured congregate living arrangement once they are released from jail.

Probably 80 percent of them will say that they will return to using meth in very short order because it’s so prevalent on the streets. It is a way to self-medicate. These are individuals who have nothing to return to. There's no job. Sometimes, there's no family. Sometimes, they might be placed in a program, but they could quickly walk away from it.

I really think it's something remarkable that the Sheriff's Department has done, in conjunction with the Department of Health,  that provides compassionate mental health support in the jail. They are to be commended for this innovation and they are also providing a pathway for inmates who are facing long prison sentences to contribute back in a redemptive way. The first two inmates who were brought into this program wrote a book  about how they approach this job.  The program should be expanded, and my eyes have been opened that there is an acute need for people with serious mental illness for highly structured congregate care that we don't provide. It amplifies what I've been saying about the board and care system.

We're just not talking enough about this different kind of housing. We need to pilot housing that has more structure, more care, and more attention to the needs that people have because of their serious mental illness or serious substance use addiction.

No one is talking about how to pay for it. No one is talking about how to site it. Because it is dripping away at an alarming rate, I don't see how we're going to get ahead of our homeless crisis without addressing that.

Is it a problem of public perception? Voters approved billions for permanent supportive housing perhaps under the impression that PSH provides the services, structure, and supports you’re advocating for. You're addressing those misconceptions through your work with Heart Forward LA, but how do they do it in Trieste?

I remember asking in Trieste, “take me to where your most seriously mentally ill are living.” I remember coming to this apartment building where they actually had taken down some walls and opened up some areas so that there was an apartment in the middle where the staff lived. It was staffed 24/7, and that was like the mothership. Then, there were all these hallways and doorways that led to other apartments.

People living there could come to the mothership anytime for coffee, for somebody to talk to. People had their doors opened. When you go to permanent supportive housing right now, everyone's apartment is closed. In fact, there are these common areas for people to take advantage of, but nobody's using them or they're locked because there's a perception that somebody might vandalize the space.

This is what I really think we need to pilot. If I had a billionaire approach me and ask what would I like to see piloted, I would like to see a large house, with perhaps 15 to 20 people who have cycled through incarceration over and over again because of their mental illness, where they would be able to live as independently as possible, within the confines of a structure that keeps them safe, assigns them chores for a sense of purpose and gives them a roadmap to pursue their recovery. We don't have that now.

Is it because the LA Sheriff's Department is the largest provider of mental healthcare in the county?

The Sheriff's Department, I think, is doing the best they can because they are the last man standing for an issue that is invisible to us. Too often, people end up in jail because they had committed a crime that was related to their untreated mental illness, and then they get stuck there.

They get stuck there because there's nowhere else for them to go. They might be waiting to be placed in the state hospital in order to be restored to competency to stand trial. The judge has ruled that they are so mentally ill that they don't understand the nature of their offenses or what happens in a courtroom, etc. They're waiting to then be placed in a state hospital bed to be restored to competency to be sent back to LA County to stand on trial.

The frustrating part, and I hear this from judges, is that you don't want to put people in prison. There are very few places to place them in the county. I'm hoping with the new Sheriff working in conjunction with the County Board of Supervisors and the Mayor, we can start to shine a light on exactly this issue.

When I go in and talk with people about their lives, invariably I'll hear where their life went off the rails because they could not get treatment at age 18 or 20 or 22. They heard voices and the voices would tell them to do something violent and then they ended up in jail.

This one guy and I talked about how he had a very strong meth addiction and his family had a restraining order against him because of some violence that he perpetrated under the influence of meth. He served his time and was released. He said he walked to Union Station and there were meth dealers everywhere. He got his first hit of meth within an hour of leaving Twin Towers. He got on a bus and headed back up to the Santa Clarita Valley where his family, who still had a restraining order on him, lived. He got arrested and was back in Twin Towers within 24 hours.

It's what we see on the streets. We see people who are just cycling through our institutions without anyone to support them without the resources they need to change the trajectory of their lives. That's a new insight for me.