No Room to Rest — Series Part 3: The ‘spiral effect’ of homelessness, mental illness and substance abuse

A homeless person's sleeping bag lies on the sidewalk outside a restaurant on Girard Avenue in La Jolla.
(Elisabeth Frausto)

This La Jolla Light series looks at local homelessness, explores the complicated factors that contribute to it and highlights the various viewpoints about potential solutions.

Though many people who are homeless in La Jolla and elsewhere in San Diego County struggle with mental illness and substance abuse, Vanessa Graziano says it’s a mistake to assume which came first.

Graziano was herself homeless in 2014, battling addiction while drifting among Encinitas, Carlsbad and Del Mar.

“It’s a misconception that homeless [people] are usually on drugs and that’s why they’re homeless,” she said.

Living on the streets also leads to mental health problems, she said, resulting from the stress of finding shelter and work and wondering where the next meal is coming from.

After her divorce and the related trauma, Graziano found herself without “a lot of resources” to find a home.

She didn’t feel safe going to a shelter with her 5-year-old daughter, so she lived in her car. Graziano was addicted to prescription drugs, and not having care for that led to other drugs.

“You start numbing yourself and putting yourself in unsafe situations,” she said.

Now sober, she founded Love on the Ground Resources, formally called Oceanside Homeless Resource, four years ago “to create something different,” she said. The nonprofit, funded by private donations, works to build programs for homeless families and individuals based on her assertion that “it’s not the drugs, it’s the trauma” that needs to be addressed.

Nonprofit leader and La Jolla resident Scott Silverman, who among other efforts founded San Diego Second Chance in 1992 to help transition people out of homelessness, estimates that “a good 80 percent of people who don’t have a permanent home are under the influence of something mood-altering” or have mental health issues or both.

As mental health continues to be an issue on campus and in the larger local community and the world, UC San Diego presented a webinar Nov. 28 featuring a panel of experts discussing problems in mental health and ways to get help.

Dr. Jeffrey Norris helps clients of Father Joe’s Villages, a San Diego homeless services nonprofit, navigate substance use and mental health challenges while transitioning out of homelessness. He said mental illness or substance abuse are not the core cause of homelessness, but they can push a person over the edge into homelessness when faced with macro-economic issues such as rising housing costs coupled with income levels that have not gone up at the same rate.

“Mental health and substance abuse can magnify those issues,” Norris said. “People that are struggling with either mental health or substance abuse — or both — have more going on and are more susceptible to larger issues that push them onto the street. Further, their behavioral health issues (which can include mental health and/or substance abuse) are going to get worse because of the stress and trauma of being on the street.”

A homeless person's belongings are placed along Fay Avenue in La Jolla.
(Elisabeth Frausto)

That can lead to a spiral effect, Norris said. “Mental health issues put people at higher risk for ending up on the street. If you can’t go to work for a few days at a time or longer … and lose your job ... [and] you don’t have a cushion [to cover housing costs], you can end up on the street. That is, of course, going to further a person’s depression or other issues and cause people to spiral.”

The stress, anxiety, depression and trauma of homelessness can trigger serious mental disorders such as schizophrenia, Norris said.

“These conditions can be made worse if you have a predisposition to them,” he said. “It can bring on those conditions even if you never exhibited symptoms before. Substance abuse and lack of sleep can exacerbate that.”

When people are on the street for a long time, any behavioral health issues can “really get out of control,” Norris added. Case management and special services are needed to get them into housing and keep them housed.

“We have to start with ensuring people don’t end up homeless and on the street” to begin with, he said.

To do that, rising housing costs need to be addressed and adequate mental health services must be available “so people aren’t on the edge,” he said.

More also needs to be done to reduce the availability of drugs on the street, he said. “We shouldn’t be going after people that are using the drugs but those that are providing them. Meth is incredibly cheap and easy to get right now in a lot of communities and is incredibly destructive in terms of how it makes people act.”

For people already on the street, wraparound services (individually designed to provide treatment, personal support and any other needed services) are key, as is a healthy housing supply, Norris said.

“In my work, what we do that is unique is we co-locate services,” he said. “We co-locate shelter and housing with health care; they are all packaged together. But the need is greater than what we can provide. We can’t be everything to everyone and there isn’t the funding to build to match the need that is there. You have to provide a ton of case management and services for that intervention to be successful. It’s intensive and expensive, but we have to address the crisis as it is.”

Government services

Though all San Diego city shelters offer service options including mental health and substance use treatment, a 150-bed shelter that opened in September behind the San Diego County Health and Human Services Complex and the Psychiatric Hospital of San Diego County on Rosecrans Street in the Midway District is the first of its kind to offer onsite mental health and addiction services, addressing some of the most serious issues facing people on the street.

The plan is to bring in 15 people at a time to assess their needs and connect them with help.

The city of San Diego contracted with the Alpha Project, a homelessness outreach organization, for $4.8 million through next June at a cost of about $77 a bed nightly.

Ionia Honeycutt and Jack Phillips of the Alpha Project chat with Sandi Peterson (right), who had been homeless nine months.
Alpha Project outreach specialists Ionia Honeycutt and Jack Phillips chat in September with Sandi Peterson, 54 (right), who had been homeless for nine months near California and Vine streets in San Diego. The Alpha Project opened a new shelter that day on Rosecrans Street in the Midway District.
(Nancee E. Lewis)

The large tented shelter is one of three the Alpha Project is operating through contracts with the city. Father Joe’s Villages operates a city-funded shelter at San Diego’s Golden Hall, and the new Midway District facility brings the number of shelter beds in the city to 1,666.

Additionally, the city “partners closely with the county of San Diego to provide a variety of mental health services to residents throughout the city, including those experiencing homelessness,” according to city spokeswoman Ashley Bailey.

The city’s Coordinated Street Outreach Program often conducts focused events in areas with large congregations of homeless people, she said.

“During the multi-agency events, outreach teams canvass an area to engage unsheltered folks and connect them to supportive services,” Bailey said. “Access to case management, health education, public benefits, mental health and substance abuse treatment, primary care referrals and access to hygiene kits, transportation and basic essentials are all offered to people in the area.”

Jeff (left), a homeless man, accepts donations from Christopher Schirm in San Diego.
Jeff (left), a homeless man, accepts donations from Christopher Schirm in San Diego in 2021. Schirm says he also has been homeless for most of the past 15 years.
(K.C. Alfred / The San Diego Union-Tribune)

To serve homeless people who use library services, the city also offers mental health service in the downtown Central Library through a partnership with the National Alliance on Mental Illness, Bailey said.

In responding to calls related to people experiencing mental health crises, the San Diego Police Department has licensed clinicians in the Psychiatric Emergency Response Team, or PERT, assigned to patrol units to help police officers interact with and identify resources to aid those who may pose a threat to themselves or others.

PERT clinicians also are partnered with SDPD’s Homeless Outreach Team to provide connections to services, Bailey said.

San Diego County representatives were not immediately available to comment about county-provided services, but a spokesperson directed the La Jolla Light to the county’s web page on Mobile Crisis Response Teams, which “provide in-person support to anyone, anywhere, experiencing a mental health-, drug- or alcohol-related crisis.”

Differing approaches

Scott Silverman
La Jollan Scott Silverman runs an outpatient substance abuse treatment program and offers help to the families of people struggling with addiction.
(Provided by Scott Silverman)

Silverman said he’s “pissed off at the system” and believes a lack of drug testing at shelters creates a “secure environment for [addicts] to use.”

“There’s no ... way we can help people if we’re not willing to” test for drugs at shelters, he said.

Silverman, who had his own experience with addiction and says he once tried to kill himself, is now 38 years sober and has worked with local addicts and mentally ill people for decades.

Silverman runs an outpatient substance abuse treatment program and offers help to the families of those struggling with addiction. Nonetheless, he said it’s a mistake to think drug problems lead to homelessness.

“If that’s true, treating substance abuse could solve homelessness,” he said.

He said there isn’t enough scientific research to definitively state where the problem most often originates.

Silverman said there needs to be a “continuum of care.”

“A housing-first model without supportive services is another shut-up mechanism” that perpetuates the cycle of shelter and release, he said.

“San Diego doesn’t have an exit plan for homelessness. Nobody wants to empower” homeless people to get jobs, Silverman said. Advice like “Stop drinking and go on an interview” doesn’t work, he added.

The solution lies in access to treatment along with sustained life-skills coaching and accountability in drug testing, he said.

Vanessa Graziano founded Love on the Ground Resources after recovering from addiction and homelessness.
Vanessa Graziano founded Love on the Ground Resources after recovering from addiction and homelessness.
(Provided by Vanessa Graziano)

Graziano agrees that access to a breadth of services is crucial but maintains that homelessness is due to a lack of housing and that housing must be the first step.

Many senior citizens and others on lower fixed incomes can’t afford rising rents, Graziano said. The “cost of living is crazy,” she said.

The state defines affordable housing as units reserved for those making no more than 80 percent of the area median income. The median income for a family of four in San Diego is $106,900, according to the state’s 2022 list of income limits for affordable-housing units.

“Affordable housing cost” for lower-income households is defined in state law as not more than 30 percent of gross household income. “Housing cost” commonly includes rent or mortgage payments, utilities, and property taxes and insurance on owner-occupied housing.

Graziano says her nonprofit works with various other organizations to provide housing first, and for the first five days, assess people’s individual needs while they rest and assimilate in their new surroundings.

After five days, a plan is organized to connect the individual or family to recovery services that may include detoxification.

“No one can start the healing process until they have a place where they can lock the door,” Graziano said.

Nearly all of the 300 people served by Love on the Ground are still housed, she said.

“It’s about love and … having a foundation with resources” to help, Graziano said. “It’s about working together.”

Christopher Schirm says lack of affordable housing, combined with mounting medical bills, has helped keep him homeless for most of the past 15 years.

Schirm, who grew up in an upper-middle-class family in Orange County and first found himself homeless at 19 after multiple surgeries, said he now strives to manage his homelessness, mental issues and addictions “without falling into a worse case.” He often sleeps in his car and on friends’ couches in and around La Jolla.

Schirm said his dependence on prescription opiates began after much of his colon was surgically removed and he was prescribed painkillers. His addiction grew hand in hand with depression and suicidal tendencies.

“Even when I wanted to get clean and pleaded with doctors,” he was given other narcotics to manage his pain without long-term planning, he said.

He became distrustful of doctors, he said, and “couldn’t keep down a job and I couldn’t make good decisions. I was struggling against my better judgment.”

He said homelessness exacerbated his addiction and mental illness. “I didn’t know help was available,” he said. “I thought if I admitted I had a drug problem, they’d lock me up.”

Schirm said addressing his addiction was “No. 1,” and then he was able to improve his mental health.

He went to addiction rehabilitation to get sober after calling his estranged parents in suicidal desperation, Schirm said.

Through family friends, he was directed to the Loma Linda University Medical Center behavioral health program for 28-day inpatient treatment.

He’s now five years sober but says there don’t seem to be any further solutions for him without truly affordable housing.

“There’s no such thing as affordable housing in unaffordable areas,” Schirm said. He added that he’d like programs that encourage more homeownership and less renting.

“A home is nice, but the security is better,” he said. “If a home’s not yours, how much security do you have?”

The fourth installment of the series will look at the correlation between homelessness and crime.