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Connecting people to mental health support in San Diego County

 May 22, 2024 at 4:59 PM PDT

S1: It's time for Midday Edition on KPBS. It is Mental Health Awareness Month , so today we are looking at the changes happening in mental health care in San Diego. I'm Jade Hindman. Here's to conversations that keep you informed , inspired , and make you think.

S2: That is long term , non-clinical but supportive housing for people with serious mental illness.

S1: We'll also discuss a program offering hands on help for people experiencing homelessness , and we have a few tips to help you find your wellness. That's ahead on Midday Edition. More than 10,600 people are experiencing homelessness across the county right now. That's a modest 3% increase from last year , according to this year's point in time count. Also , the number of unsheltered people rose nearly 20% , though research says the leading causes of homelessness are income and the actual cost of housing. State and local leaders have been looking to transform how mental health and addiction is handled , particularly in the state's homeless populations. One example is proposition one , which was narrowly passed by California voters in March. Prop one will allow more money for shelter , beds and treatment for unhoused people with severe mental illness. As we near the end of Mental Health Awareness Month , we want to talk about what changes may be coming to mental health care in the county. Joining me now is Luke Bergman. He is director of San Diego County's behavioral health services. Luke , welcome back to Midday Edition.

S2: Thank you so much for having me , Jay.

S1: Glad you're here.

S2: Um , you know , the primary causes of our homelessness crisis are exactly , as you've mentioned , housing availability , accessibility and supply. Housing is not a thing that it is easy and very short order to create lots of supply around. Um , and so , you know , I know that there are a lot of hands kind of , you know , busy at work aiming to address that across various governmental and private parties and entities and partnership. But that's going to take a while. So not shocking to see the numbers ticking up still.

S1: Well , aside from a shortage of homes , there's also a shortage of beds for psychiatric patients. Yesterday , the Board of Supervisors , though , moved ahead with a plan to add around 45 beds and increase psychiatric care in a partnership with UC San Diego Health.

S2: Generally , what we in behavioral health services at the county are working toward is the addition of a substantial number of longer term care beds. So beds that would sit not in acute inpatient psychiatric services , but beds that would be situated within Borden care settings or subacute settings. The category of bed that it's most important for us to build up and where we need the most significant numbers is Borden Care , also called adult residential facilities. And these are places where people with serious mental illness can , uh , can live for years at a time and in many cases for the durations of their lives. While we are focused primarily on building up that kind of capacity. We continue to have urgent need for additional acute inpatient psychiatric beds. Most of the inpatient psych services across this county are full run at about between 99,500% occupancy , which leads to the boarding of a lot of people with behavioral health conditions in emergency departments , which is not good for them , not good for the operations of emergency departments , and which is also , um , suboptimal for those inpatient services themselves. It's very difficult to run a psych service that is therapeutic for patients when the service is entirely full. Adding these beds at UCSD will do a number of things. The the kind of most immediate impact will be in actually creating more optimal kind of volume of patient care across the entire county.

S1: Well , I want to talk about proposition one because proposition one could actually help this situation a lot. It passed just barely in March. But what does its passage mean for behavioral health here in San Diego ? Yeah.

S2: So , so proposition one , um , actually has two very distinct components that were , um , nurtured through two entirely separate pieces of legislation. So SB 326 , um , uh , which , which of course passed and then was packed into one focused on reforms to the Mental Health Services Act , which has been a longstanding source of revenue to support behavioral health care in the state of California. Um , that is driven by a 1% tax on it's called the millionaires tax , 1% tax on any entity or person whose income is , uh , $1 million or more. Uh , the Mental Health Services Act has been , you know , since its passage , which was , uh , about 20 years ago , an incredibly important source of revenue for basic clinical services in the county. Uh , the the department that I run has used the Mental Health Services Act , for example , as a , a fund to to provide the local match for Medi-Cal draw down for , uh , for patients in places like crisis stabilization units or outpatient mental health treatment or inpatient psychiatric care. It's been one of the kind of primary utilities of the Mental Health Services Act revenue. What prop one does , what the SB 326 piece of prop one does is it changes the Mental Health Services Act into what is now called the Behavioral Health Services Act , and that change entails two primary shifts.

S1: Well , let me ask you about that. Let me ask you about that.

S2: To a focus predominantly on housing supports for people with serious mental illness , and no doubt that is incredibly important. We we know though , behavioral health is not a cause of homelessness , it is absolutely the case that people who are experiencing homelessness are more vulnerable to , um , behavioral health , um , uh , conditions , uh , people who are living especially on the street. So people experiencing street homelessness are , um , much more vulnerable to substance use disorder and to mood disorders among the serious mental illnesses , uh , in particular. And so it's really important that we focus on getting folks of behavioral health conditions housed. That is what , uh , the bza component of prop one aims to do. The challenge will be that we still have all of the clinical services that we've been running. We still have to maintain those. So we now have a really significant additional focus that we are more or less mandated to address through prop one , which is to ensure that we are providing housing and housing supports to people with behavioral health conditions , um , in much larger numbers or a much larger proportion. We also have to maintain all of those clinical services. And that's that's going to be a challenge. Uh , we're not entirely certain at this point how that's going to play out , but particularly in the context of the budget deficit at the state , that is going to be a challenge.

S1: Well , I mean , in speaking of challenges , there is time before prop one changes , actually , uh , fully go into effect. That won't happen until 2026.

S2: That is all very much at sort of the early stages of development. I would say , um , we at the county are very much focused on understanding what among our core clinical services we can continue to support , even with the new emphasis on housing , um , that that comes with prop one and , and what it makes most sense for us to invest in with respect to categories of care and housing for people with behavioral health conditions. And here is where we see the shift to housing support maybe being very useful , uh , because we we know that we are suffering dramatic shortages of board and care , in particular , that is long term , non-clinical , um , but supportive housing for people with serious mental illness. And the housing component of prop one seems to to focus on that category of service. And it's one that that we know is really important in the county of San Diego.


S2: I think those concerns are absolutely legitimate. The the change that's happening is really significant. There are in particular worries about the extent to which , um , youth mental health or the , the , the mental and behavioral health generally of , of young people will be something that we can focus on at the same time that we have to shift so many resources towards housing , people who are experiencing homelessness , which we anticipate will mostly be addressing the needs of older people. And so we've in particular heard a lot of advocacy on behalf of , um , uh , of young people and their behavioral health care needs. I think , um , it's possible , um , for their not only to be , you know , the , the sustaining of services for young people , but I think it's possible for there to be service expansion and accessibility improvements over the course of the shift to prop one. But it's it's going to take , I think , a very deliberate focus on making sure that those needs continue to get addressed because I think they are vulnerable to being reduced in the context of of the shift towards housing support.

S1: Um , well , as we've mentioned , homelessness , it is a complex issue. I mean , research has shown that loss of income and the high cost of housing are major factors in the rise of homelessness in California.

S2: I think there are multiple reasons that , um , that the the tension between behavioral health , uh , and housing availability in the conversation , uh , about homelessness has such , um , staying power. I think , you know , one of the significant factors that that maybe is maybe as obvious to lots of people but doesn't get pointed to explicitly very often , um , is that one often hears that tension play out around an emphasis coming from municipalities and municipal leadership on the on the significance of behavioral health as a cause of homelessness , where when often hears from county leadership across the state of California , um , a greater emphasis on housing availability and housing support. And that , of course , maps onto. Which governmental jurisdiction has responsibility for what ? Right. So , um , counties are responsible for behavioral health. And there are instances where it becomes a kind of expedient argument for municipalities to make , to suggest that something over which counties have jurisdictional responsibility is , in fact , the primary cause.


S2: There is a as I mentioned before , there is a quite terrible insufficiency of that. There are 31,000 board and care beds in the county of San Diego. Only 255 of those are accessible to people with serious mental illness. People who are eligible for care within the specialty behavioral health care system. So that is that's point 8% of the entirety of board and care slots accessible to , you know , the population. That is in some ways , you know , most conspicuously quote unquote , problematic among the homeless population. So we know we need to build up a lot more of that capacity. And and that's really important. I would say it's also really important that we carry forward a narrative about what to do that more genuinely reflects , um , the nature of homelessness as a , as a problem. And that , that is the sort of that has these , these two dimensions. One , it's mostly about housing supply. And accessibility. And two , it is absolutely true that people with behavioral health conditions are more vulnerable to becoming homeless. And people who are homeless are more vulnerable to behavioral health conditions than otherwise. But behavioral health conditions do not cause homelessness. And if we really want to make strides in addressing homelessness , it's critical that we don't. Focus exclusively on the possibility that addiction causes homelessness , or that serious mental illness causes homelessness. If those are the focuses that we maintain , we will not solve the problem.

S1: I've been speaking with Luke Bergman. He is the director of San Diego County's behavioral health services. Luke , thank you so much for joining us.

S2: Really appreciate it. Thank you.

S1: Coming up , a program providing hands on support to those experiencing homelessness.

S3: It's really hard for people to engage in ongoing medical care or mental health treatment without having a safe place to stay at night.

S1: More on that when Midday Edition returns. Welcome back. You're listening to KPBS Midday Edition. I'm Jade Hindman. We just heard about the county's mental health services and the potential impacts prop 1st May bring to the region. But at the forefront of these conversations is really what mental health support should look like for people experiencing homelessness. The Substance Abuse and Mental Health Administration found nearly 21% of individuals experiencing homelessness reported having a serious mental illness , but a local program is hoping to address that. Let's see how la mesa is approaching mental health outreach. La mesa has a program called Home. It's the homeless Outreach program that utilizes a de-escalation approach with unhoused individuals experiencing mental health issues. They also use a progressive engagement model to connect people with systems of support. Joining me now is Matthew Smiley , the clinical outreach specialist with the city of la mesa. Matthew , welcome.

S3: Thank you for having me.

S1: So glad you're here. So I want to start with an overview of home for listeners.

S3: That's the Homeless Outreach and Mobile engagement team. And as far as the first part of your question of how people make originally make contact with us , that can happen a few different ways. Probably the most popular way is people can walk into the la mesa Police Department and ask for homeless outreach services. When someone does that , they're not going to be screened for warrants. No one's going to ask them who they are. They're not going to be checked in with police. And many times they're not even going to contact a uniformed police officer. Uh , the person at the front desk will notify me that someone is in the lobby wanting home services. And if I'm available , I'll go out right away and make contact with them. And if I'm in a call , they'll usually pend it for when I am available , either after that appointment ends or kind of when I get some space in the day when I don't have appointments and I don't have people waiting for me in the lobby , I'll also just drive around la mesa , and if I see someone that is on the road or kind of on the sidewalk and they might be experiencing homelessness , I'll typically pull over and try to make contact with them. Um , when I'm first making contact , it's usually very , very basic , you know , do they need food , clothes , water , anything that is going to keep them safe ? So if they need like immediate medical attention , I'm trying to get things like that addressed. And then , um , we utilize an approach called progressive engagement. And without getting too into the weeds , it kind of starts with you solving small problems. At first hunger , uh , closed things like that , and then you can progress on to more complicated issues. Those include , uh , medical necessities , housing , necessities , things like that. And then we also have a hotline that people can call in. It's at , um , (619) 667-1475. And typically I spend most of my day out in the community , so someone will have to leave a message. And if there's a way to call them back , I will. And then , um , for clients that I've already met , uh , they have my cell phone number that they can call me for ongoing appointments and things of that nature. And , um , those are kind of the basic ways that someone can start making contact with home. The way the typical day looks is really different every day. But , um , we usually start with emails and follow ups , things like that , and then I try to make appointments throughout the day as best as possible. Things like going to the DMV to get new IDs , going to the county office , signing up for Cal Fresh and Medi-Cal if they need it , going to doctor's appointments , going to mental health appointments. And one of the things that I really am proud about for the home program , and one of the things that I think makes us different than a lot of other outreach programs or community based programs , is that we can stay with people all day if we need to. So we're not just dropping people off at the DMV. We're not just giving them an ID voucher. We're not just giving them the address to East County Mental Health and telling them to go. We will take the person out there and sit with the person while they're filling out paperwork , while , you know , we'll wait for them while they're in their appointment , and then we'll bring them back to wherever they have to go. We'll kind of discuss how the appointment went , what could have gone better , how they can be supported in a different way. And however long that takes is how long we're going to spend with them. Um , we're we're ready to do whatever it takes because we feel like people , um , just have certain barriers that need to be supported. And. Um , we need to to get people to where they need to go.

S1: I mean , it's it's such a valuable resource that you offer when you approach people who are experiencing homelessness.

S3: I would say the the most common thread is the expense of living in Southern California. Um , the rental market is absolutely brutal , and there's a lot of people that were living inside five , ten years ago that just cannot financially afford to live inside now. And it's really unfortunate when we think about people who are on Social Security and fixed incomes. You know , some of these people are making about $1,200 a month , and rooms for rent can be up to 1500. So it's not really like a budgeting issue or that , you know , these people are so sick that they that they can't make decisions for themselves is that , you know , they're on a fixed income. And the rental market in Southern California has , has kind of passed them by with no option for , you know , the majority of folks that that can't afford market rate rent. Yeah.

S1: Yeah. Well , you know home the program focuses on reducing harm in outreach within the unhoused community. So can you tell me about how you live out that kind of approach ? Yeah.

S3: So , um , the most basic ways we are trying to make sure that people are fed. So , you know , ongoing clients , we're going to make sure that they're getting , you know , some form of calories each day. And you can kind of see how all this stuff is intertwined. The amount of calories that you get can definitely affect the amount of how effective medications are and so on and so forth. And then on top of that , we're always trying to connect people to , uh , primary care physicians and ongoing mental health support , if that's something that they've identified. Many of the folks that I work with receive the bulk of their medical care through the emergency rooms. And those are , you know , overburdened at the best of times and very , very hard to access for my folks at the worst of times. And so them kind of going in and out of the emergency room to get something as simple as a as a refill for their Lasix isn't really conducive to them being successful and being able to engage in other programs in the community. And so I think that , you know , getting people connected to this ongoing and regular care and getting them out of , you know , these emergent medical situations is how we try to reduce harm. And then the other way we try to do that is we try to get people into permanent housing. A lot of people don't know that there is there is no shelter in East County , San Diego. So we need to find some form of permanent housing , long term housing. And so that's the goal for everyone that's enrolled in the program. It's really hard for people to engage in ongoing medical care or mental health treatment without having a safe place to stay at night. Right.

S1: Right. Well , you know , what are some of the evidence backed techniques , home practices.

S3: So the main technique that we use on an everyday basis is called progressive engagement. That's kind of the model that that underpins the program. And um , along with that , some of the clinical interventions we use is motivational interviewing that is , you know , taking into account that at the end of the day , you're not going to convince someone to change. People have to find their own reasons to change. So we use motivational interviewing techniques to help people find their own reasons for change , and then to continue reminding them of that when change becomes difficult. And those are , you know , very basic rapport building clinical techniques. And , um , those are the ones that we use the most because most of our interactions are going to be with brand new people , telling them about programs , walking them through how to get connected to programs , and then when the bureaucracy kind of begins to bog them down , while while connected to these programs , we do the motivational interviewing to remind them of their the reasons that they have come up with why they want to engage in these programs and engage in change.

S1: And speaking of of engagement , I mean , um , research has found that people who've experienced homelessness have a lack of trust in law enforcement. Some have even experienced trauma and encounters with law enforcement.

S3: That place in society probably isn't doing street based case management and homeless outreach. These are folks that have had traumatic experiences with law enforcement , with the hospital system , with the incarceration system , with the health care system. And because of that , that's why we use this technique of of progressive engagement , because we understand that as soon as we meet with somebody , they're not necessarily going to say , yep , I want to give you all my information. I want you to I want to put my life in your hands for you to move me into housing as you see fit. And we try to take that into account. And and that's why we start small with this progressive engagement. And we're helping people. We're letting people know , hey , I can solve this hunger issue when you're hungry every day , I can come by with a bag of food , and you can trust that I'm going to be here. And over time , people will then trust you to solve more complex problems that are being presented. And then kind of when you're talking about how law enforcement fits into that , we really want to make sure that the social workers are doing the social work , and the law enforcement is enforcing laws. And homelessness in and of itself is not a crime. And we want to make sure that we're not addressing that as a crime. If crimes are being committed around in two homeless people , those will be addressed through law enforcement. But we want to make sure that we're not criminalizing the lack of a house.

S1: Well , at least in San Diego , I mean , you you do have this element of the criminalization of homelessness. You know , there is a camping ban , for example.

S3: All these people from San Diego are going to kind of flood into the greater county areas. And I really can't speak to the rest of the county because , you know , I spend my whole day working in la mesa , but I have not seen a huge influx of people that are regularly staying in la mesa due to the camping ban. One of the things about limit the population of la mesa is , is pretty fluid. Um , I think there's 5 or 6 major trolley stops in la mesa. Almost every major freeway passes through la mesa at some point , whether it's the eight or the 94 or the 125 or the 54 , all kind of pass through la mesa. So , uh , even since I started the program in 2020 , we've always had a fairly rotating population of people , which is pretty much remained true. And , um , you know , one of the things that I noticed is that people are going to regularly stay where they're comfortable at. So , um , most of the folks that are regularly staying in la mesa have , you know , they've kind of been there for a while. I'm on a first name basis with them. And , um , we haven't seen a huge influx from the city at this point.

S1: Well , in-home has been around for years.

S3: You know , we still have a lot of the same programs are available when we're talking about , you know , getting connected to long term support. Um , I'd say that , you know , the biggest one is East County Behavioral Health that are available for , for doing like walking , um , walking enrollments. It takes like a day or two , but you can do the process by walking in to start , which is a really huge benefit , as opposed to other programs where you have to call and leave a message and wait for a referral and get a call back. So , um , you know , that's been around since I , since I started the program. And then , um , we still use Jane Weston a lot for people that , you know , want to do walk ins down there and try to get same day medications. But , you know , at the best of times those things are hard to access. And , um , someone can spend hours down at Jane Weston and , you know , they're a really great program that support a lot of people. But it's hard for someone that's really sick to sit in a sit in a room for five , six hours waiting for somebody. Same thing for the East County Behavioral Health , you know , for someone to sit , you know , sit and wait for hours and hours on end is just really difficult. You know , there hasn't really been something created to to kind of streamline that process. So , yeah , that's , uh , you know , getting connected to a long term mental and behavioral health continues to just be a challenge.


S3: And. You know , the dearth of that is really challenging for a lot of the folks on the street. And I think the I think we've done a really good job of instituting some crisis response teams like MCT. And , you know , Peart's been around forever. But , um , you know , that's a that's a really big step. But that's , you know , that's crisis response. That's a one time touch. And what we need is , is ongoing case management.

S1: I've been speaking with Matthew Smiley , clinical outreach specialist at la mesa's home program. And Matthew , thank you so much for joining us.

S3: Thank you.

S1: Still ahead. Tips on how to find wellness.

S4: Mental health awareness also does contribute to normalizing and destigmatizing mental health. For those that experience mental health symptoms to feel like they are not alone.

S1: You're listening to KPBS Midday Edition. Welcome back. You're listening to KPBS Midday Edition. I'm Jade Hindman. As we near the end of Mental Health Awareness Month on the show today , we've been hearing about some of the efforts in the region to connect people in need with mental health support. We now want to have a conversation about strategies for people to help manage their mental health and well-being. I'm joined now by Joanna Savarese. She is a neuropsychologist , clinical psychologist , and founder of San Diego Brain Works. Joanna , welcome to Midday Edition.

S4: Thank you for having me here today.


S4: To help decrease the stigma around mental health , to increase education around mental health , mental health services , and the resources that we have in our community. The mental health awareness also does contribute to normalizing and destigmatizing mental health. For those that experience mental health symptoms to feel like they are not alone , also to give prevention and to to engage in prevention and preventative measures so you don't have to you can have typical daily , you know , struggles that might impact your mood and you can seek help for that. It doesn't have to be. You don't have to seek help when it comes to a crisis. So it's also looking at promoting self-care and wellness as well.

S1: And you mentioned the stigma of seeking mental health treatment.

S4: That is going to be really important to decrease the stigma , to know that everyday people suffer from mental health symptoms. People suffer from depression , anxiety and it is more common. In fact , 1 in 4 individuals globally will experience some type of mental health episode symptom experience in their lifetime. So it's so important for people not to feel alone. Well , when we.

S1: Think about , you know , basic human needs for survival , those things are air , food , water and shelter. But , you know , between pollution and the cost of living in California , many of those things aren't being met for a lot of people. Can you talk about the impact that has on mental health ? Sure.

S4: Well , the financial stress on individuals in California in general has been pretty significant. Um , I mean , renting an apartment , just trying to find housing that's affordable are added stressors. And then you have , you know , people come into a situation , they come into life with a whole host of their own experiences and traumas and coping abilities and stress. And then when you have some additional financial challenges , you have , you know , poor air quality. Um , I always try to tell my clients to go back to the basics. And so , are you eating enough ? Are you sleeping enough ? What is your nutrition look like ? And are you hydrated ? And so just paying attention to those four variables is going to help with just general feeling of wellness. It's going to create , you know , different um , it's going to stabilize your cortisol levels. You're not going to be as stressed because you're going to be , you know , nourished. And so I like to just kind of have clients just start with some of the basics.

S1: Well , tell me , um , what are some , some mental health and well-being tips for the summer as we head into this new season ? Yeah.

S4: So as we head into the new season for summer , we're looking at an automatic increase in vitamin D , right ? So exposure to vitamin D. And so being out in the sun is going to be one of the best ways to just get your vitamin D levels up. So when our vitamin D levels up we tend to have better moods. We have less can have less symptoms of depression less anxiety. And actually when you have more vitamin D exposure , the increased levels can also improve and impact your immune function. So just getting sunlight after May gray and after being in colder climates here in California , the sun exposure is going to give you that vitamin D boost that we all could use right about now. Sure.


S4: Um , it's going to increase your endorphins. It's going to help regulate your hormones , your emotions , your emotion regulation. And you know , walking is really incredible. It's like there's been a lot of research lately on just the impact of walking. So as we get older , our , you know , joints and muscles , the weight lifting is really difficult. So just going out for a walk and getting sunlight is you're already on the way to increased and improved mental health. Um , the other , you know , when when it comes to a summer months , there are a lot of times people , parents , adults that have been grinding pretty hard are feeling pretty burned out. So it really is also important that if you can , to take a vacation , to plan a trip , to take some time off , to pay attention to your body , how it's feeling around fatigue. Your energy levels , your ability to regulate your your your emotions. You know , whether or not you're more irritable , you're getting irritable quicker. Those are all warning signs that you might need a little vacation. You might need to plan a getaway , give you something to look forward to. Um , mindfulness and breathing is also a tool that you can use an inexpensive tool to just be able to pay attention to your breathing , pay attention to your surroundings , and becoming more mindful and spending time in that space is automatically going to decrease your anxiety. It's going to decrease some of your depression. It's going to increase your emotion regulation , decrease your cortisol. Um , and when you have when you are more mindful , when you're are more , um , present , when you are more engaged in your breathing , your body is more regulated , that is really going to help you with that feeling of overwhelm , and it's going to help you manage your thoughts , feelings and behavior and thoughts , feelings and behaviors better. So walking exercise , uh , getting out into sunlight and , you know , putting a meditation or a breathing practice , implementing that into your life is going to get you on your way to a better increased mood.

S1: What are some signs that , uh , someone may need to seek treatment ? Yeah.


S4: So you don't have to be in crisis to seek treatment. So when you start to experience some type of mental health symptoms , um , like depression or anxiety. So maybe you are going through a difficult time or you've noticed an adjustment in your mood , or you've recently had a trauma. Some of the symptoms are an increase and decrease of , uh , in sleeping , an increase or decrease in , um , eating. You might notice a decrease in motivation or not engaging in tasks that you used to enjoy engaging in. Um , sad mood more crying , maybe some additional irritability , uh , feeling anxious. You know , some of the the worry thoughts , the cognitive thoughts that go along with , um , feeling anxious. So , um , just rapid thoughts and constant thoughts in addition to some of the physiological symptoms like rapid heart rate , you know , sweaty palms just not feeling that you notice a shift in your the way that you've been feeling and also in the way that you've been functioning.


S4: And it's very important for , for , um , for parents to sit down with their children before summer starts and set the expectations around summer. So that means , you know , what is everybody going to be doing every day ? What does phone use look like ? What is our social media use look like ? How are we ? How are meals being prepared if you aren't in , um , if you are not in , if you're not home , if you're a working parent , how is the kid being going to eat ? How are they ? You know , so going over a lot of expectations and setting the expectations is going to be really important. That way. Everybody is on the same page before summer gets , you know , too far down the road. Um , the other thing is , is so for kids who have certain levels of dysregulation or they , they really need that structure to function , they really need that structure , that structure to decrease their anxiety , to keep them on track , to get them to their higher performance and higher productivity. Keeping a schedule is also going to be really important. So going to bed at the same time every night , waking up at the same time every night. And because summer is filled with fun and a lot of sleepovers and a lot of junk food , it's also really important that parents are paying attention to what their kids are eating , how often their kids are sleeping , the amount of hours they're sleeping , where they're sleeping , um , and making sure that there are expectations and education around those components as summer approaches. Wow.

S5: Wow.


S4: So I know that it's not New Year's , but for a lot of kids and teenagers , you know , going back to school , high school , middle school , I myself am a mom of four teenagers. And so it's just , again , kind of reflecting on what works during the school year , how the summer was , where maybe some of the growth needs to happen for the. Year for parents and for your children. And so I think that spending time in that space and really having open talks and open communication and reflecting on how the year was and what the new school year is going to bring and what the expectations are around that new school year is going to be really important for the family , and also going to connect the family in a different way. People can , you know , family members can keep each other accountable.

S1: I've been speaking with Joanna Savarese , neuropsychologist and clinical psychologist , also founder of San Diego Brain Works. Joanna , thank you so much for joining us.

S4: Thank you so much for having me here today.

S1: So that's our show for today. I'm your host , Jade Hindman. Thanks for tuning in to Midday Edition. Be sure to have a great day on purpose , everyone.

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Luke Bergmann, San Diego County Behavioral Health Services Director, introduces the new pilot program meant to help with substance abuse or mental health challenges, San Diego, Sept. 27, 2023.
Matthew Bowler
Luke Bergmann, San Diego County Behavioral Health Services Director, introduces a pilot program meant to help with substance abuse or mental health challenges, San Diego, Sept. 27, 2023.

More than 10,600 people are experiencing homelessness across the county right now. That's a modest 3% increase from last year, according to the results of this year’s Point-in-Time Count.

Though research says the leading causes of homelessness are income based and the cost of housing, state and local leaders have been looking to transform how mental health and addiction is handled, particularly in the state’s homeless populations.

One example is Proposition 1, which was narrowly passed by California voters in March. It will allow more money for shelter beds and treatment for unhoused people with severe mental illness.

On Midday Edition Wednesday, we look into San Diego County’s Behavioral Health Services and the ways it could be impacted by Proposition 1. Then, La Mesa's Homeless Outreach and Mobile Engagement (HOME) program shares their efforts to offer support and resources for housing and mental health. Finally, we get some tips on how to manage mental health and well-being in everyday life as we mark Mental Health Awareness Month.


  • Luke Bergmann, director, San Diego County Behavioral Health Services
  • Matthew Smiley, clinical homeless outreach specialist of HOME program
  • Joanna Savarese neuropsychologist, clinical psychologist, founder and clinical director of San Diego BrainWorks