6 Things San Diego Could Do to Aid Homeless People with Behavioral Health Challenges

Conversations about people with behavioral health conditions who resist offers of treatment or other care often focus on why they can’t be forced to say yes.  

At Politifest on Saturday, Voice of San Diego asked three experts who work with people struggling with addiction and mental health challenges what can be done.  

San Diego Rescue Mission Vice President Paul Armstrong, Harm Reduction Coalition of San Diego CEO Tara Stamos-Buesig and UC San Diego psychiatrist Aaron Meyer, who also serves as the city’s behavioral health officer, agreed that San Diego County government can and should take the lead on these solutions. 

Here’s a rundown of some of their proposals. 

Create a Priority List for Outreach and Treatment 

One idea was to create a list of homeless people that providers should prioritize for outreach and treatment facing the most urgent health crises and other challenges. That list should be available to all service providers.  

Armstrong said that stakeholders in homelessness and behavioral health services should regularly update the list and use it to ensure people get care. He argued that could allow the county and service providers to more effectively work together to move people off the streets and help them access services.  

“We need a dynamic by-name list that then results in actual care coordination, where we’re working together with the highest needs people getting addressed first,” Armstrong said. 

Addiction Treatment Availability Tool 

Meyer said San Diego should create its own version of a public Los Angeles County website that allows anyone to search for services that meet an individual patient’s needs. Meyer was not speaking on behalf of UCSD or the city. 

The LA County website allows users to search for the treatment they are seeking – from office to residential treatment. They can also look for programs that accommodate any special needs. The site then offers a list of programs across the region with openings that meet those needs.  For now, San Diegans and even health care providers are forced to repeatedly call individual programs to see if they have openings. 

Establish a Drug User Health Hub  

Stamos-Buesig suggested that the region create a 24/7 facility with an array of services where homeless drug users can check in regardless of the specific support they are seeking. 

She said the facility could, for example, provide connections to Hepatitis C treatment for people who want that care but aren’t ready to stop using or to move off the street. Others might go to the facility to be connected to specific programs such as job training or treatment. The facility could give people a safe place to be, to store prescription medications and to receive mail. 

“What I hear over and over again from individuals on the streets is that I don’t have the ability to self-refer into this thing or that thing,” Stamos-Buesig said. “And if I could choose when I could go in this or choose which program I went in, I would do it right away.”

Embed Behavioral Health Workers in Homeless Shelters 

It was a big deal in 2022 when the county agreed to integrate behavioral health services into a Midway District shelter – and that shelter has since closed. 

Armstrong argued that it should be easy for shelter providers like his nonprofit to get county-contracted behavioral health workers to serve their residents on site. It’s not. 

“I should have behavioral health providers lined up to come to my shelter,” Armstrong said. “I should not have to be the one going to find them.” 

Expand Who Can Trigger Involuntary Holds or Assessments  

Meyer wants to make paramedics eligible to instigate so-called 5150 holds, which would allow them to transport patients to a hospital for up to 72 hours of evaluation. Doctors ultimately decide whether to approve the hold.  

Currently, county policy dictates that only police officers or county-contracted clinicians can start this process when they encounter a person who is considered dangerous to themselves, others or gravely disabled.  

Meyer also argued that San Diego families, clinicians, outreach and crisis response workers should be eligible to request in-depth mental health evaluations. To make this happen, Meyer said, the county should establish a process under existing law – state Welfare and Institutions Code 5200 – to allow families and other interested parties to request court-ordered evaluations. These evaluations could lead to longer-term involuntary treatment. 

“Families, outreach workers and first responders should be able to request this statutorily required investigation when someone is clearly in long-term danger,” Meyer said. “But in practice, this process is nearly impossible to access.” 

Connect with People  

Stamos-Buesig said every San Diegan can be part of the solution to behavioral health crises by taking the time to connect with people they encounter who are struggling. 

Stamos-Buesig, who for years dealt with homelessness and addiction, said her path away from those challenges began in 2013 when someone stopped to ask her about hiking. The conversation reminded her of her own humanity and identity rather than her addiction. 

Stamos-Buesig said day-to-day conversations and genuine care can help people become more receptive to changing their lives. 

“I’m asking you to please stop walking by people,” Stamos-Buesig said. “Stop and ask them who they are.” 

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