Issue 1: Community Revitalization
The Lyric Hotel
For many people with mental illness, staying housed is the most vital issue in their lives. The 1994 Supported Housing Task Force, which looked at the relationship of mental illness and housing in the City and County of San Francisco, found that 30 to 40% of homeless San Franciscans have “psychiatric disabilities” which are severe enough to shut them out of the shelter system. Many of these individuals are forced to subsist on the streets or cycle in and out of jail. Their time spent homeless is not likely to improve their mental health nor does it increase their safety. Many turn to drugs and alcohol, often in an attempt to medicate themselves.
Decline in Services
Unfortunately for needy San Franciscans, there has been a decline in availability of both mental health services and affordable housing to those with the lowest incomes. Cutbacks in funding to Community Mental Health Services have decreased enrollment in mental health programs at a time when demand is growing; the loss of low cost units in San Francisco due to gentrification, urban renewal, and the earthquake of 1989 have strained housing resources for those with psychiatric disabilities. This scarcity produces increased use of hospitals, jails, and shelters, all of which are less effective and significantly more expensive than supported housing.
The Supported Housing
Task Force determined that between 1,500 and 3,000 people with severe and persistent psychiatric disabilities need housing with support services available or on site (Division of Mental Health, Supported Housing Plan, 1995-2000, Sandra Hernandez, MD). The Task Force recommended, as a first step, the creation of at least 500 units of supported housing in five years. A significant fraction of the units already on-line have been created in the Tenderloin, a neighborhood in which many of San Francisco’s social challenges are concentrated.
The Tenderloin is a highly diverse community comprised of seniors, families, single parents, and individuals from various ethnic backgrounds. With the highest proportion of Social Security recipients in San Francisco, the neighborhood attracts the homeless, substance abusers, those with very limited resources, and disabled people, including people whose lives have been damaged by AIDS or cancer. To disabled people subsisting on General Assistance or Social Security, most decent housing in San Francisco is expensive and much of the affordable apartment stock is unsafe and unwholesome, especially in the Tenderloin. The psychiatrically disabled are drawn to this district by the large number of small and substandard housing units operated by landlords who are willing to rent on a weekly or even daily basis.
With roughly only one-third of its residents employed, the median gross household income in the Tenderloin is $8,750, compared to over $50,000 for San Francisco as a whole, according to a North Market Planning Association study. As measured by the San Francisco Substandard Income Criteria, some 70% of Tenderloin residents live below the poverty line, and most of the remaining 30% hover near it. In addition to poverty, residents must contend with the tightest rental market in the nation. Even though residents spend on average 62% of their income for rent, it still only gets them a small space, usually one room. With a city-wide vacancy rate of less than 1%, housing is difficult for poor people to acquire and maintain, adding to the growing homelessness problem in San Francisco.
Located in the center of the Tenderloin, the Lyric Hotel, operated by Conard House, Inc., targets a particularly under-served group: homeless people who have dual disorders, chronic mental illnesses and either alcoholism, drug addiction or HIV. This group desperately needs supported housing to stabilize their lives. Even if these individuals can obtain decent housing, they are most likely not able to retain itwithout substantial support services.
Opening the Lyric
In 1992, Conard House, Tenderloin Neighborhood Development Corporation, the Corporation for Supportive Housing, Community Mental Health Services of S.F., the Mayor’s Office on Housing, and the Shelter Plus Care Program, came together to create affordable housing for 58 psychiatrically disabled people at the Lyric Hotel.
All residents have been referred by the Shelter Plus Care Program, which screens for eligibility and provides tenant subsidies. Prospective residents need to be capable of living independently, which includes maintaining proper hygiene, managing their own medications, doing their own laundry, and obtaining their own meals.
The income of Shelter Plus Care clients must be at least 40% below median income for San Francisco. Tenants are required by HUD to pay 30% of monthly income as rent. Tenants currently pay between $94 and $355, with the typical range being $104 to $204 per month.
In order to assure enough qualified candidates, Shelter Plus Care conducted an “open enrollment” several months before the Lyric was scheduled to begin operations in April of 1997. After initial screening, Lyric staff interviewed applicants to confirm admission criteria and suitability for independent living. So that applicants would stay connected to the program, Case Managers provided ongoing money management, counseling, information and referral, and advocacy while they were waiting to move to the Lyric. In addition, two homeless shelters in San Francisco reserved a number of beds for prospective Lyric tenants as long as Conard House staff provided case management.
Core Case Management
Conard House provides staffing at the Lyric six days a week, from 8:00 AM until 11:00 PM. Five Case Managers operate under the on-site supervision of a Program Director. All services at the Lyric Hotel are optional, and paid for through a contract with the City and County of San Francisco, Community Mental Health Services.
Baker Places, Inc., acts as on-site treatment provider, billing MediCal through the FQHC (Federally Qualified Health Center) Program, for intensive case management, individual therapy, and group therapy. The Baker staff focuses on drug abuse and managing mental illness, with a Licensed Clinical Social Worker, an Intensive Case Manager, and a Case Coordinator. Tom Waddell Health Clinic operates a primary-care medical clinic at the Lyric two half-days per week, and offers programs in primary illness prevention and health promotion.
An integral part of the Lyric’s enterprise involves the relationships which develop between Case Managers and residents. Case Managers work with residents using a non-traditional, culturally competent, approach which de-emphasizes the regulations often associated with social service and mental health agencies. It is not unusual for residents to make use of the staff only occasionally before asking for help and becoming more involved with the program. This casual relationship gives the residents opportunities to discuss, outside traditional models, their needs and concerns. Case Managers then familiarize the residents with available services, make referrals, and aid them in navigating the social service, medical and legal systems. At times, groups of residents with similar concerns meet to discuss issues and to arrive at possible peer solutions. These groups provide opportunities for residents to develop socialization skills, to make friends, and to foster a community spirit which bolsters their self-respect.
Conard House also offers job counseling, training, placement, and work opportunities to Lyric Hotel residents. Residents who participate in the Vocational Program may work as desk clerks or janitors and maintenance staff at the Lyric or one of Conard House’s other hotel programs, or may be employed at one of the two cafes the Program operates, or for the Conard House Messenger Service, which covers the central city.
Since the early design stages, residents of Conard House’s other hotels and prospective tenants of the Lyric were involved in planning committees with Conard staff, Tenderloin Neighborhood Development Center (the project developer), and the architect. Their participation was seen as essential to the success of the Lyric Hotel project.
The Lyric Hotel staff encourages tenant involvement in operation of the project by holding regular community meetings with tenants and staff from all the participating agencies represented. The meetings deal with safety and property management, site enhancements, and with creating a Lyric community.
The Lyric project has transformed an unsightly building in San Francisco’s Tenderloin into a showpiece: spacious, well lit, comfortable, and safe. The opening of the Lyric completed the rehabilitation of the city block on which the hotel sits, a block that now contains a diverse group of San Franciscans of all ages living in modern and attractive buildings.
The Lyric Hotel residents, many of who were homeless for years, can reside permanently in a well-maintained supported housing program. Since all the residents suffer from the sorts of serious disabilities that are exacerbated by homelessness, living in supported housing with a wide range of services is expected to improve their mental and physical health in substantial and profound ways.
Seth Katzman is the director of Conard House Hotel Program and Community Services.
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