One case at a time

JAMIE, A 31-YEAR-OLD SCHIZOPHRENIC man wearing jeans and a ripped tie, has been living on the sidewalk outside a Santa Monica homeless shelter for a month. Homeless for about five years, ricocheting from hospital to jail to sidewalk, he is what is known as a “frequent flier” -- among the chronically homeless who cost the city the most in police, fire and hospital services.

If Jamie can be helped, then there is hope for scores of thousands of homeless who are not in such dire straits. That’s why Santa Monica’s Chronic Homeless Project, a 2-year-old program that aims to get as many of the area’s most chronic cases off the streets in any way possible, is so promising.

After the state closed its mental hospitals in the 1970s and the availability of affordable housing shrank, tens of thousands of people began pouring into the streets. Los Angeles largely ignored the problem; it has simply managed the crisis one bowl of soup at a time. This policy is not only inhumane, it is also ineffective and inefficient. The Los Angeles Police Department cites and arrests hundreds of homeless people each year, often the same ones day after day. Local emergency rooms know many of the homeless by name. Santa Monica has a better idea: coax the worst-off and most costly into housing and provide them services there. Ultimately, it may cost less.

In a conference room inside the same shelter days later, Sara Lake, a mental health counselor, is meeting with one of the area’s most neglected and expensive homeless cases, a man named Ronnie Granger. His eyes occasionally shift away from the conversation into the corner of the room.

A 50-year-old African American man, Granger has schizophrenia that was diagnosed only a few years ago. He “self-medicates,” to use the euphemism, drinking up to five pints of whiskey a day. When not in prison or jail, Granger has spent most of the last 12 years on the streets of Santa Monica. Add up how much he has cost the public in police, jail and hospitals expenses, and it’s probably more than $1 million.

For the last six months, though, he’s been living in a program for homeless people with mental illness and drug addiction. It took awhile to get him there; Granger and Lake have met in this same room every week for two years. He has never missed a meeting.

The Chronic Homeless Project began in 2004. It’s for the city’s “frequent fliers” -- 85 of the city’s approximately 2,000 homeless. The worst of the worst. With data from police, fire and local hospitals, officials created a spreadsheet and started tracking down each case, one by one. One 50-year-old inebriate racked up 116 citations and arrests in two decades. A 60-year-old man used an ambulance 10 times in 18 months. Along with local service providers, the city has been trying to place these people in housing, then offering mental health counseling and other services, sometimes in the buildings where they live.

Relatively, it’s inexpensive. According to a 2001 study, providing housing to the chronically homeless may be cheaper than leaving them on the street; at the very least, it’s a wash. Just 10% of the homeless, according to the study, account for the majority of all police, jail and hospital costs. They are often homeless for years, the ones seen on the street every day.

Yet so far only a handful of cities such as Santa Monica have decided to focus on the chronically homeless. One worry is that every dollar spent on the sickest cases cannot be spent on the rest of the homeless. That could be true, but it’s hard to argue with the results. To date, more than half of the 85 people in Santa Monica’s program are off the streets, and another quarter meet regularly with a program counselor. It’s too soon to know how much money has been saved, but anecdotal evidence is that the police and fire departments are getting fewer homeless calls.

What about Los Angeles? Perhaps city and county officials can take a trip west for a lesson or two. Currently, the Los Angeles police and fire departments don’t analyze the calls they get each year dealing with the homeless, making it impossible to create a “frequent flier” plan for the city. Such a census would be a start. Providing help to people like Jamie and Ronnie Granger doesn’t just save money. It saves lives.