S1: Welcome in San Diego. I'm Andrew Bowen in for Jade Hindman on today's show. RFK Jr visits San Diego to talk homelessness and a policy change in treating underlying mental health conditions. This is KPBS Midday Edition. Connecting our communities through conversation. For years , San Diego's approach to homelessness has been built around a housing First model. That means trying to get people housed quickly and easily without many barriers or preconditions. And once a person is stably housed , then you provide services to treat any underlying conditions , but that that approach could be changing. Last week , Health and Human Services Secretary Robert F Kennedy Jr visited San Diego and unveiled his vision for combating homelessness and addiction in the homeless community , he revealed he unveiled a new vision centered on treatment and recovery.
S2: The principle is simple treatment comes first. Results must follow when we put recovery first. We save lives.
S1: Well , here to tell us more about what this means is Drew Sitton , a community reporter with Times of San Diego. Drew , welcome. Hi.
S3: Hi. Thank you so much for having me , Andrew.
S1: And I'm also joined by Alyssa Horton. She is a reporting fellow and D.C. correspondent with Times of San Diego. Elizabeth. Alyssa , Alyssa , welcome to you as well. Hi.
S4: Hi. Thank you for having us.
S1: So , drew , you were , I believe , at this , are you you were covering this visit from RFK Jr. The visit last week. What exactly did he announce?
S3: So he was at the San Diego Rescue Mission. This is a privately funded , uh , South Bay lighthouse , is what they call it. So the toolkit he unveiled was looking at treatment first , And it was also talking about other things , such as the integration of faith and medicine. A lot of support for having faith based institutions lead the homelessness response effort. And talking about those are the places that are successfully doing things versus the current status quo. Hmm.
S1: And Alyssa , you were also covering this story. This is , of course , a national story. Tell us , you know what you have to add what you took away from this announcement of a toolkit.
S4: Yeah , absolutely. I actually spoke with someone from the National Alliance to End Homelessness. I'm sure we'll get into that more later. But what I've really learned is across the board nationally with people who have worked for years with homeless individuals and those with addiction. Um , the treatment first continues to be widely criticized because of a lack of proof that it's , um , successful across the board. So really , that's that's what I looked at from the national angle. Mm.
S1: Mm. Well , we will get more into that , certainly. But , um , Dru , your reporting notes that the word faith pops up a lot in the federal toolkit. Uh , tell us about the significance of that and how that might change how homelessness is approached. Yes.
S3: Yes. That was something Alyssa found when going through the toolkit was that it's a 37 page paper. This toolkit and faith is mentioned 40 times. So , uh , certainly this homelessness tour that they went on , they started in LA at something called the Dream Center , which was also a religious organization. And when I talked to local homelessness advocates , something that came up is that a lot of the San Diego's top homeless providers are already faith based. Think of Father Joe's Villages is Catholic and but they , you know , don't have barriers to entry a lot of times. And I think the concern would be if you prioritize faith based organizations , some of them will have more indoctrination or more things where you must attend a church service in order to receive some sort of housing. And while the administration didn't say that , I think that is one of the concerns with having a faith based prioritization when it comes to federal funding.
S1: Alyssa , anything to add to that? I mean , does you know the word faith appearing in this , uh , this booklet actually indicate a change in federal policy in terms of funding or , or strategy?
S4: For years , for decades , faith based organizations have been part of the homelessness assistance system. This isn't necessarily a change from that , but this is more leaning on them. Um , the toolkit says that people , um , can find more support if it's through faith based systems. Um , we didn't really see numbers or evidence. And to the people that I spoke with on the National Front. Haven't seen that , but they still mentioned that many are involved in homeless services because it's part of their mission , and they are still adhering to evidence based approaches. Hmm.
S1: Hmm. Well , the Trump administration has criticized this concept of Housing First as an approach to homelessness. And this is , again , the principle that a person who is homeless and suffering from substance use or mental health disorders should be given housing first , and that housing should not come with preconditions like sobriety or participation in a drug treatment program. But once that person is housed , treating the addiction or the mental health disorder , disorder is a lot easier when they have , you know , a bed to sleep in at night. And , you know , if a person is living on the streets or in a shelter , they're less likely to succeed at sticking with that treatment. What do we know about the effectiveness of this policy? Housing first when it comes to ending homelessness? Alissa drew , either of you want to jump in?
S3: So something that came up when I was researching was an early paper from about 15 years ago that was talking about , you know , just when Housing First was beginning. And something that they were saying is that for the most complex and toughest cases , Housing First is showing better responses. I think something that comes with treatment first is that people who want to get help can easily attain sobriety or something like that. They make a homelessness program look more successful because you're filtering out people who are in just really tough cases. Hmm.
S1: Hmm. Elissa , anything to add about the effectiveness of Housing First? Absolutely.
S4: Absolutely. When I spoke to Anne Oliver , the CEO of the National Alliance and Homelessness , she mentioned that there are a lot of reasons why people become homeless. But substance abuse is not , um , typically a it's not a proceeding factor to homelessness. Um , many people start using in order to survive life on the streets , from which she said , and use drugs to self-medicate or to stay awake in scary , uncomfortable situations. And really , that's the emphasis that's been provided for. Housing first is providing a safe space where people , um , don't use drugs as a way to self-medicate. Mhm.
S1: Mhm. The housing is essentially the medicine. Right. Yeah.
S4: Yeah. That's that was what I gathered from. Yes.
S1: Yes. Yeah. And one requirement I think it's , you know , really built into the basics of housing first is that there is housing available for someone. So , um , how is San Diego County doing on that front. True. Certainly.
S3: Certainly. We've been building a lot. I think a lot of the Cal Matters toolkit that looked at our things. Unfortunately , a lot of the housing that has been built is in the above moderate income category , and there's certainly the hope that there will be some sort of trickle down effect where people who are middle class can move into these nicer , newer apartments and then that will free up housing stock for lower income people. However , we are seeing instead of that low , we did see a small lowering of the rents average rent price , but a lot of the newest apartments are having , you know , first 2 to 3 months free , instead of actually lowering the rent as a way to still make the same amount of money but not actually raise lower the rents enough so that they can still raise it the next cycle of the lease.
S1: And for the poorest of the poor people living on the streets with maybe no income at all , you know , they might rely on a government subsidy like a section eight housing voucher. And we've seen that funding for that program stagnate. And , you know , the Housing Commission in San Diego , um , not even opening the waitlist for people to get those vouchers anymore. Um , Alyssa , anything to add about , you know , federal money or resources for actually solving homelessness and getting people into housing?
S4: Yeah , there's many systemic barriers , including people who are on long waitlists or unable to access care because of reductions of Medicaid funded services. Um , there's a lack of available mental health services and addiction treatment. Um , and people don't know about them when they do exist. If you're , um , homeless. They exist. But maybe access to them has been cut off or limited. And that's a major problem that goes for people on the housing first side and the treatment first side. Mhm.
S1: Mhm. Drew , what has been the reaction from local homeless service providers to this new direction , or at least new messaging from the federal government?
S3: I think most of them chose not to be on the record. They're certainly concerns that if they were to contradict the administration , that that might affect whether or not they receive grant funding in the future. Certainly , Father Joe's was one of the few that spoke , but it was with a very a statement that very much threaded the needle of. We do provide detox beds. This is something we've been focused on. We also focus on no strings attached shelter beds and that sort of thing.
S1: And so if the federal government is indeed moving away from Housing First as a model , what does that mean for San Diego , and how would these new guidelines work with state or federal programs to , you know , that might continue to prefer housing first as a model? I guess the question is , does the government have the power to force these local service providers to stop using Housing Force first as a guideline?
S3: I don't know that they could force them to stop using housing first , but if you provide only money to treatment first programs , then that by default is going to change how homeless service providers do approach their work. Certainly , the fact that there's not enough detox beds , the fact that there's not enough 12 to 18 month recovery programs is well documented , so I don't think that many homeless service providers are going to complain if those medical interventions start to pop up more. Hmm.
S1: Hmm. Alyssa , do you think these two slogans housing first and treatment first? Is there a real difference there? Are these different approaches or could they coexist? Could they be kind of both embraced by service providers.
S4: In a way? They could both be embraced by service providers. But I think the important thing to remember , and this was a question asked of RFK junior when he was on stage , um , what is going to be done for the rising number of elderly homeless individuals? And there wasn't a clear answer for that. They were not able to provide , um , a well-rounded approach to homelessness that extends beyond people with , um , drug or substance abuse addiction. So that was an interesting part that is not really addressed in this toolkit. Mm.
S1: Mm. And drew , I imagine after covering this story , you still have some questions. What might you follow next if you were writing a follow up story about this? Certainly.
S3: Certainly. I think even the homeless service providers themselves have questions. There's a toolkit , but they don't yet know where the funding is going to go. How is it going to be enforced? Or is grant requirements going to change? So I think following that , as well as following how our service providers adapting with less federal money overall , and how is that affecting the people living on our streets?
S1: Alyssa , what's the next angle for this story for you?
S4: I think this is about following Medicaid and the work requirements. That's something I've really been looking at lately. Um , new Medicaid requirements require people to work at least 80 hours per month if you're dealing with substance abuse , um , issues. If you're under 65 but are unable to work , those kinds of things are going to be a hangup. And that means , uh , lack of resources , um , to help get out of that situation.
S1: Well , I've been speaking with Times of San Diego Communities reporter Drew Sitton and Times of San Diego Reporting fellow in Washington , D.C. correspondent Alyssa Horton. And thank you both for joining me today.
S3: Thank you for having us , Andrew.
S1: And that's our show for today. I'm your host , Andrew Bowen in for Jade Hindman. Thanks for listening to Midday Edition. Have a great day.
