Director, Behavioral Health, Council of State Governments Justice Center
What is your greatest joy or what are you most proud of in your work?
There are so many things that bring me joy in my work, but I would narrow my greatest pride to two things. The first is the widespread recognition of people who are caught in the revolving door of incarceration, homelessness, and other crisis services use. When I started my career, the prevailing view was that there were people experiencing homelessness on the one hand and people involved in the criminal justice system on the other. Few policymakers realized the extent of the overlap between these systems, which often meant that people with multi-system involvement fell through the cracks. I spent many years using data and stories to make communities aware of people caught in this revolving door. I’m very proud of the fact that today, there are numerous communities across the country that are pursuing collaborative efforts to address the needs of these vulnerable individuals. Rather than viewing these individuals as someone else’s problem, law enforcement and criminal justice leaders, homeless services providers, and health care organizations are seeing them as a shared clientele.
Second, I’m proud of the fact that these same communities see supportive housing and Housing First as a key strategy to assist these individuals. We, as a field, have spent a lot of time and energy and resources to build evidence that supportive housing—in addition to increasing housing stability—also reduces jail recidivism and increases public safety, not to mention shifts health care utilization patterns from hospitalizations and emergency department visits to primary and preventive care. It seems like that investment has finally paid off.
Who or what inspires you to do your work?
I’ve had the luck to work with and know so many great practitioners, public servants, and leaders in the field over the years, and I continue to go back to the things they’ve taught me for inspiration and guidance. There are too many people to name here, so instead I’ll just share some of the lessons that others have taught me and that inform my approach to my work:
There’s no such thing as a throwaway person.
You only resort to coercion when you run out of creative ways to engage people.
Jails can’t solve the needs of the people they have in custody. They have to look outside—to partnerships with other agencies and systems—for those solutions.
Never apologize for being on the right side of history.
We’ve proven that we can house anyone. Our job is to now house everyone.
If we are successful, paint a picture of what America will look like five years from now.
We have so much more knowledge about what works to help people with complex health needs to stay out of jails, prisons, and other institutions and help them live with stability and dignity in the community than we did two decades ago, or even one decade ago. And I don’t only mean programmatic solutions like supportive housing, Housing First, Assertive Community Treatment, crisis stabilization and medical respite programs, jail in-reach, and peer recovery supports, but also whole-system strategies like collective impact, the use of data to identify and prioritize high-need populations, and “surge” strategies like 100 day challenges.
While the last election revealed just how divided America is along political and cultural lines, I believe there are many places where there is common ground, especially at the state and local levels. On issues like the over-representation of people with mental illnesses in jails and the need for a solution to homelessness, there is more agreement today than there was ten years ago. If we can harness that growing consensus and hunger for solutions, I believe we have the opportunity to take these strategies and solutions to scale in the next five years and see a substantial decrease in rates of both homelessness and incarceration among people with mental illnesses and substance use issues.
I also think we are on the verge of a new policy moment, where the focus is not just on de-institutionalizing mental health facilities, re-housing the homeless, or reducing incarceration rates, but rather on maximizing community integration for people with disabilities. More and more policymakers and leaders are realizing the folly of moving people out of one institution only to have them wind up in another or out on the streets. And they are realizing that short-term, stop-gap measures only “kick the can down the road” and that the only true solution is to invest in the array of service supports and housing that enable people with disabilities to remain in the community and out of all institutions for good. I think the FY 2018 Omnibus budget passed by Congress (and the increased investments it includes in housing for people with disabilities, mental health and substance use services, and systems change programs like DOJ’s Mentally Ill Offender Treatment and Crime Reduction Act) may be an indication of this. I’m hopeful that we are on the verge of the true realization of the vision laid out in the Americans with Disabilities Act and the Olmstead community integration mandate.
What is the biggest challenge in your work today?
I’ve come to believe that data is critical to the success of any policy effort. Data is what convinces policymakers to make investments across party lines. Data enables us to know if we are making an impact. And data is, at the end of the day, people, so data also helps us to know if we are reaching the people that need help.
But data is also hard. In order to have data, communities have to invest in the technology, infrastructure, and staffing needed to collect and track it. I think the biggest challenge facing my work today is the lack of reliable and consistent data—whether on rates of homelessness or on the number of people with mental illnesses in jails. Our ability to see measurable reductions in the number of people with mental illnesses in jails (and the corresponding increase in the number of people remaining stable in the community) depends upon the degree to which communities have reliable and accurate data on the scope of the problem. That requires putting an upfront investment in data collection, as well as in the screening and clinical assessment work that make that data complete and reliable. That upfront investment in data collection and quality is not sexy, but it is absolutely critical.
What do you wish everyone knew about homelessness?
I wish that everyone would recognize two things about homelessness. First, I hope that more communities recognize that homelessness and criminal justice involvement among people with mental illnesses are not separate and distinct problems, but twin aspects of a decades-long failure to provide an adequate community-based system of care for people with mental illnesses. And for many people, homelessness and incarceration are simply a matter of which month of the year or what day of the week it is.
Second, I hope more will see homelessness as a symptom or manifestation of a larger problem. While others have framed that larger problem as one about housing markets and housing affordability, I tend to think of it more in terms of public systems and systems failure. After all, for people with mental illnesses and disabilities, the Americans with Disabilities Act and the community integration mandate provided by Olmstead v. L.C. have made it clear that public systems are responsible for ensuring certain protections. When people with mental illnesses and other disabilities become homeless (or incarcerated), this is not only a “market” failure, but a policy failure. While market failures can only be corrected by market tools, policy failures can be corrected by public policies. If we think of homelessness as a policy or systems failure, we can begin to assign accountability to public systems and then give those systems the tools to ensure that none of their constituencies become homeless or involved in the criminal justice system.