Sacramento City Council
September 5, 2023

City of Sacramento
City Council - 5PM Report
915 I Street Sacramento, CA 95814
www.cityofsacramento.org
File ID: 2023-01164 9/5/2023 Consent Item 8.

Response to Grand Jury Reports Regarding Homelessness
File ID: 2023-01164
Location: Citywide
Recommendation: Pass a Motion authorizing the Mayor to sign and submit the attached response to the Sacramento County Grand Jury 2022-2023.

Contact: Susana Alcala Wood, City Attorney, (916) 808-5346; Mary Lynn Vellinga, Mayor’s Chief of Staff, (916) 808-7881
Presenter: None.

Attachments:
1-Description/Analysis
2-2022-2023 Grand Jury Report - “Homeless Should Not Mean Hopeless: Homelessness Solutions Elude Elected Leaders”
3-2022-2023 Grand Jury Report - “Mental Health Care for the Homeless: Who Cares?” 4-Grand Jury Response Letter
Description/Analysis
Issue Detail: The Sacramento County Grand Jury 2022-2023 Report included two investigative reports addressing their assessments of local government’s response to homelessness in Sacramento County. The first report recommends that local governments in Sacramento County engage in a more coordinated regional approach in responding to homelessness, and in the region’s efforts to reduce the number of homeless individuals throughout the County. The second report specifically addresses the large percentage of homeless individuals that struggle with mental health issues and various forms of addiction. This report provides a series of recommendations intended to focus a portion of the homeless response to dealing specifically with these individuals. The proposed response letter included as Attachment 4 to this report responds to both reports by assuring the Grand Jury that the City and its regional partners have, and will continue to, devote substantial time and resources toward resolving the issues presented.

Policy Considerations: The Grand Jury is an arm of the Sacramento County Superior Court and is considered part of the judicial branch of government. Penal Code Sections 933 and 933.05 require

File ID: 2023-01164 9/5/2023 Consent Item 8.
that the City of Sacramento submit specific responses to the applicable findings and recommendations in these reports to the Presiding Judge of the Sacramento County Superior Court.

Economic Impacts: None.

Environmental Considerations: This report concerns administrative activities that will not have a significant effect on the environment and does not constitute a “project” as defined by CEQA [CEQA guidelines Sections 15061(b)(3); 15378(b)(2)].

Sustainability: Not applicable.

Commission/Committee Action: Not applicable.

Rationale for Recommendation: The City has continued to proactively address homelessness through a host of programs aimed at both improving access to, and the availability of, housing and shelter as well as services intended to address the specific issues presented by those individuals that suffer from addiction or mental health issues.

Financial Considerations: Not applicable.

Local Business Enterprise (LBE): Not applicable.

SUMMARY

Drive down dozens of busy thoroughfares in Sacramento County, and you can’t miss them.

Men and women, exhausted and defeated, huddled on curbs or jammed into makeshift encampments.

With no home and no immediate future, many numb that jarring reality with drugs or drift toward psychosis.

There are the mothers who hide among the bushes or in neglected cars, shielding their children from the angry streets. To stay awake at night some of these moms ingest methamphetamines, to protect their children who sleep awkwardly in crowded back seats.

Homelessness in Sacramento County has ballooned 253% in the last five years — some experts even contend that number is far too conservative. Among the nearly 10,000 men and women who sleep on the streets each night, between 50% - 80% suffer from a mental illness and/or substance abuse.

2022-2023 Grand Jury Investigative Report
Mental Health Care for the Homeless: Who Cares?

Who are these homeless people relentlessly tormented by mental illness or drug abuse? How do we fix this epidemic among our unhoused men and women?

The County of Sacramento, aided by funding from local, state, and federal sources, holds the major responsibility for the treatment of the homeless mentally ill and drug abusers.

The 2022-23 Sacramento County Grand Jury, after a months-long investigation, found the County’s overall strategy to tackle this responsibility largely ineffective, scattered, and wanting better leadership. Despite millions of dollars, multiple programs, and an almost endless array of boards and commissions, mental illness and substance abuse among the homeless continues to proliferate.

Instead of meaningful progress, the Grand Jury’s investigation observed political infighting among County and City of Sacramento officials, minimal coordination, and very few measurable goals and outcomes. Most glaring of all, the Grand Jury noted the absence of a comprehensive, collaborative strategic plan among the County and its seven incorporated cities to reduce homelessness and treat the mental illness and substance abuse that abounds within the Countywide homeless community.

As its investigation into homeless mental health and substance abuse unfolded, the Grand Jury realized that any findings and recommendations needed to encompass the entire system of service delivery. The system includes the stakeholders, the quality of mental health care and substance abuse programs, housing, resources and program coordination. Other critical considerations include the strategy, metrics and goals, communication, transparent access to reporting of funds and expenses, and accountability. Without such a focus, no significant improvement can be realized because successful service delivery is dependent on each part of the system flourishing together.

As the Grand Jury proceeded with its investigation, it was reminded of a favorite quote often used by the late, great UCLA basketball coach, John Wooden: “Never mistake activity for achievement.” Just because dollars are flowing, boards are meeting, and new policies are being introduced doesn’t guarantee substantive progress is being made.

When it comes to the battle to conquer mental illness and substance abuse among the homeless, the County is clearly “active.” Lots of meetings. Lots of plans. Lots of public concern. Real achievement, however and unfortunately, remains an illusion.

2022-2023 Grand Jury Investigative Report
Mental Health Care for the Homeless: Who Cares?

METHODOLOGY
The Grand Jury spent many hours reviewing documents, searching for helpful data, interviewing people, and visiting locations.

Documents – more than one hundred were reviewed:

Difficult searches for Information on the County web site, often without finding what should be available.
• Media articles (Opinion pieces used only when facts could be verified.). • Web searches for information on how others in the country are addressing these issues. • Fifty-three links to information provided by various entities.

Interviews – 22 in all:
• Elected officials.
• County department leaders and staff.
• Administrators of nonprofit entities.
• Law enforcement.
• Clinicians who provide care.
• Outreach staff.

Direct Observation - through site visits that included:
• Full-Service Partnership site.
• Community Outreach Recovery Empowerment (CORE) site.
• Sobering center.
• Homeless encampment.

2022-2023 Grand Jury Investigative Report
Mental Health Care for the Homeless: Who Cares?

INTRODUCTION
The road to homelessness is filled with variables and yet is remarkably consistent but complicated. To understand the mental health and substance abuse crisis in the homeless, we must recognize their journey from stability to homelessness is a multi-step process including:
• Living paycheck to paycheck.
• The loss of a job.
• Inability to pay bills.
• Reliance on food banks, etc.
• Repossession of the car.
• Electricity and gas shut down.
• Finally: eviction.

These experiences don’t necessarily occur in this order, but they are remarkably consistent events in the life of a person forced to live on the street. Most of these losses are often accelerated by alcohol and/or substance abuse and some mental health impairment.

Mental health and substance abuse are huge factors in the homeless dynamic. Between 50-80% of the homeless are faced with one or both issues. The most common afflictions are post- traumatic stress disorder (PTSD), depression, anxiety, and a small number with psychosis.

Appropriate mental health treatment for the homeless requires a roof where a substance free stable environment can be assured and proficient mental health treatment can be provided.

Government rules and regulations that restrict the ability to provide that roof have not resulted in a decrease in homelessness.

Often overlooked to successfully address mental health and substance abuse issues are issues, seemingly unrelated but directly contribute to these problems. The City, and the County in particular, have made several decisions that have made the problems worse. Some glaring examples include:

• The large inventory of multiple trailers and tiny homes sitting vacant. • The recent attempt to close the Miller Park encampment despite its success in providing basic services and getting people off the sidewalks.
• The closing of the Bannon Island camp near Discovery Park, where elderly homeless were displaced without alternative housing.

The Grand Jury began its investigation with a narrow focus on mental health issues. The relationship between mental illness and substance abuse became clear as the investigation progressed. It is apparent that government action - or inaction - has had a broad impact. The homeless population has increased along with mental health and substance abuse problems. Only treating those who are ill is not enough.

2022-2023 Grand Jury Investigative Report
Mental Health Care for the Homeless: Who Cares?

DISCUSSION
Stakeholder Engagement
Simply put, there are too many boards, committees and subcommittees that are stakeholders in the Sacramento County arena. Community leaders meet while the people living on the street wait. While they wait, their problems worsen. There are more tents on the sidewalks, higher rates of mental illness and drug use, and increased numbers of the homeless, especially women and children.

There are too many stakeholders presumably trying to solve the mental health and substance abuse crisis among the homeless. The Grand Jury identified at least 30 boards, committees, agencies, and entities with hundreds of individuals that include staff, elected officials’ appointees and volunteers.

Most entities have members that are elected officials or their appointees. Lots of boards, lots of committees, lots of staff – more mentally ill and/or drug addicted homeless men and women. The problem is worse.

The most important stakeholder? The homeless themselves. There have been many who participate in planning who say they speak for the homeless. The Grand Jury investigation could not find any actual homeless people who were provided with a way to give formal feedback about how they got there and what it would take to get them back home.

Strategy
A Homeless Action Plan was developed by the former Department of Homeless Services and Sacramento Steps Forward (SSF) and approved by the Sacramento County Board of Supervisors (BOS) in 2018 with total funding of $7.8 million over 4 years.

A Gaps Analysis with a strategic plan proposed by SSF and the Continuum of Care (CoC) Board was approved by the Sacramento County Board of Supervisors (BOS) on June 28, 2022.

There were few people interviewed during the investigation that had any knowledge of the existence of these plans or of the specific strategies they contained. The plans emphasize their check-in with stakeholders in the community. Few of them were aware of these plans or their role in implementation. Nearly all of those interviewed were supportive of a comprehensive plan to address these issues.

There is a perception by those who participate in the multiple advisory boards established by the County, some mandated by state or federal government, that they only serve as a stamp of approval for whatever the County and its contracted entities propose. This perception, as opposed to a ground-up involvement in the development of strategies by the various entities represented on these boards and committees, is disheartening to community participants.

2022-2023 Grand Jury Investigative Report
Mental Health Care for the Homeless: Who Cares?

Fragmentation of efforts occurs as multiple entities pursue the same strategies, redundantly using up precious resources. There are many dedicated, selfless people who work hard to make a difference. They include most of those who are employed or volunteer in the organizations listed above. They are working hard yet not achieving positive County wide measurable results.

There are models of successful strategic plans that provide care to the homeless in California and across the nation. There is no need to start from scratch.

The California State Association of Counties recently published a template for homeless strategic planning. These include the City of Riverside in California and San Antonio in Texas. They all have a process to bring together essential stakeholders to determine and coordinate the best strategies and tactics to tackle these problems.

Lack of stakeholder engagement in strategic planning results in poor accountability and inability to achieve goals.

A recent meeting of several stakeholders resulted in the announcement of aggressive outcome goals for homeless programs. These goals are laudable but fall short of the creation of a strategic plan with the resources to implement. Perhaps these actions are a sign of real progress.

Quality of Mental Health Care, Substance Abuse Programs, and Housing Between 50% and 80% of homeless people have mental health conditions and/or substance abuse issues. “People experiencing homelessness die on average at age 50 years – 27 years sooner than the average person in the US,” according to an article in the Journal of the American Medical Association.

Tracking Progress
It is extremely difficult to assess the quality of mental health care that is provided to the homeless. The simple reason - it is not tracked in Sacramento County.

Process measures are used to assure that certain tasks are accomplished in the process of care, while outcome measures are used to determine if the care provided was effective.

County Behavioral Health Services (BHS) monitors process issues in mental health treatment programs. These measures are not tracked by homeless versus other clients. This is also true for the Sacramento County Mental Health Center (SCMHC), the facility for acute inpatient mental health care.

There are few if any outcome measures for mental health treatment being monitored by the County, either for care provided by the County or for care provided by contracted nonprofit provider organizations. There is no determination specifically for the homeless.

The lack of outcomes data, especially for the homeless, does not allow for an assessment of effectiveness. In several interviews, it was pointed out that treatment for substance abuse is hindered unless the client is in a substance free environment. Very few of the housing programs 2022-2023 Grand Jury Investigative Report
Mental Health Care for the Homeless: Who Cares?

have this requirement, and many specifically prohibit a requirement for a clean and sober environment as a qualifying criterion for housing support funding.

Care Delivery:

The County is responsible for all the mental health care and substance abuse treatment provided to County residents. This excludes those with private health insurance who must seek care with their health plan. Patients eligible for County benefits with mental health diagnoses categorized as mild or moderate receive treatment from contracted provider organizations or Medi-Cal Managed Care Plans. The County provides direct care to those with a diagnosis of severe and/or acute mental health issues when patients are at risk to harm themselves or others.

The services provided by the contracted provider organizations include program navigation, administrative assistance, and treatment for mental health and substance abuse issues.

County Homeless Engagement and Response Teams (HEART) and Sacramento Police Department IMPACT Teams, homeless outreach teams in the County and City, respectively, have been established to personally engage with those living in encampments and shelters. The teams consist of a navigator, mental health professional, peer counselor, and support staff. They do their best to provide services where the homeless reside. The HEART teams have been hampered by lack of coordination and communication with other agencies, especially law enforcement. The HEART teams are not fully staffed. The plan is for five HEART teams, but progress is slow. The current IMPACT team has difficulty in meeting the needs of those they engage.

The outreach teams are directed by the program administrator to go where the need is greatest.

The Grand Jury discovered that elected officials, at times, direct the activities of the outreach teams based on constituent demands and complaints. This is despite the acute need for outreach team services in other locations.

An important feature of any mental health system is the ability to obtain an appointment in a reasonable time period. This is especially true for those with mental health challenges who are homeless. Our investigation shows that often, after intensive efforts by outreach teams to gain trust and for a person to commit to engagement with treatment, the time until appointment exceeds two weeks, and many times up to a month or more. During this interval, the commitment to engagement by the client often wanes, and the commitment to seek an appointment vanishes. An opportunity is lost.

The County has approved and is proceeding with the construction of the County Mental Health Rehabilitation Center, a step-down facility, with 64 beds, in addition to 30 acute mental health inpatient beds at SCMHC. This falls far short of the estimated need by the County for 251 such beds, documented in a RAND study in 2022. The County closing of multiple acute mental health beds in the past has had dire consequences for access to appropriate care by those most in need.

2022-2023 Grand Jury Investigative Report
Mental Health Care for the Homeless: Who Cares?

Administrative Barriers:

While this report focuses on mental health care and substance abuse for the homeless, housing is an important factor. An additional barrier to better mental health and substance abuse outcomes is the housing application process. Clients may be required to go to DMV to obtain a valid ID, but they have no transportation. They must document a permanent address they don’t have, produce a birth certificate, and obtain other documents that may be required, but which are frequently lost in the decline to homelessness. Another obstacle may be the battle to escape an eviction history. They must leave their belongings and go to various locations to build this paper foundation, risking loss or destruction of what few things they possess. All of this prolongs the time they remain homeless, and increases the risk they will remain so.

Coordination of Resources and Programs
In the face of a raging mental health crisis among the homeless population in Sacramento County, no accountable party has emerged to coordinate the abundance of resources available to County decision-makers. Minimal, if any, collaboration exists among County leaders, employees, or providers.

With millions of dollars available to manage the momentous task of appropriate treatment for mentally ill homeless men and women or those locked in the desperate jaws of substance abuse, the County’s approach seems clumsy and inefficient. As the crisis proliferates, the County’s public response fails to match its intensity.

Providers of clean-and-sober transitional housing can provide documentation of successful programs but are denied state and federal funding while the county does little to support their efforts. The County Mental Health Board (MHB), charged with the review and evaluation of the County’s mental health needs, do not have their recommendations acted upon directly by the Board of Supervisors. This uncoordinated approach fails to produce meaningful results.

Funds from the state’s Homeless Housing and Assistance Prevention 3 (HHAP-3) program are not transparently allocated for services and are not tied to best performance or outcomes. Funds from the Mental Health Services Act (MHSA) are governed by a separate board that rarely communicates with the MHB or the CoC. Hospital emergency departments house homeless mental health patients for days — and sometimes weeks — while they wait for mental health bed capacity to open due to a severe shortage of inpatient and step-down unit beds.

Not surprisingly, politics sometimes interferes. Deployment of outreach service teams to homeless encampments are often determined by those elected officials whose constituents complain the loudest rather than where the highest need for services reside. Those same outreach teams, whose mission is to earn the trust of the homeless encampment residents, are often undermined when the encampments are targeted for clearing with little or no notice from law enforcement, especially when cleared by the Sacramento County Sheriff’s Department.

2022-2023 Grand Jury Investigative Report
Mental Health Care for the Homeless: Who Cares?

The County contracts out more than 90-percent of its homeless mental health and substance abuse services, but typically in only one-year time frames. Such short terms create instability in relationships between County employees and providers, and fosters the notion the County is pushing its administrative costs to the providers.

If the adage, “show me your budget, and I’ll tell you what you value,” is true, the County’s general fund budget is not subtle: in the 2022 – 23 County budget, 4.9 -percent of $529.9 million in funds to support mental health is provided directly by the County.

Think what a difference could be made for the taxpayers, the staff, and the homeless if the money available from all sources was allocated in a way that made the greatest difference to solve the problem. If all these entities could put aside their silo thinking, invest in coordination, relate to each other productively in search of solutions, then they can make a difference in mental health for the homeless.

Innovation in Mental Health Services for the Homeless
The homeless have many needs. What will work for some groups may not work for others. This is an expensive undertaking, which cost hundreds of millions of dollars, $529.9 million for mental health care alone in Fiscal Year (FY) 2022/23. The amount specifically directed to homeless mental health services could not be determined.

Treatment and prevention for mental illness and substance abuse issues are not one-size-fits-all.

Many solutions have been tried or are being formulated, such as wrap-around services, outreach services, one stop shops (such as, Community Outreach Recovery Empowerment, known as, CORE), mobile treatment services (treat them where they are), sobering locations, transitional housing, and Housing First.

Innovative programs can be found. For instance, the County has the Crisis Receiving for Behavioral Health (CRBH) referred to as “the crib.” This is a voluntary short-term program that is staffed 24/7 with health care professionals who provide short term recovery and recuperation from the effects of alcohol or drug intoxication. Some are homeless, and this provides a brief respite from the challenges of their lives.

Freedom to innovate helps to address complicated problems. But, innovation is often difficult in bureaucratic organizations. Best practices across the country have been developed and could be applied in Sacramento County. Fostering innovation within and among County entities may provide a way forward for some of the mental health and substance abuse problems associated with homelessness. Organizations that succeed exhibit the courage to innovate.

Improved Communication Among Agencies and Entities
“Alone, we can do so little; together we can do so much.”– Helen Keller.

Successful engagement, enrollment, diagnosis, and provision of homeless mental health and substance abuse services to the homeless will take collaboration and improved communication between law enforcement and the service providers. Law enforcement is responsible for clearing 2022-2023 Grand Jury Investigative Report
Mental Health Care for the Homeless: Who Cares?

homeless encampments while several different organizations provide outreach and these vital services to the men, women, and children who live in those encampments.

When one agency acts without coordination and collaboration with the other, the unintended consequences can be severe. For example, a service provider was working with unhoused individuals in an encampment and the next day the encampment was notified it was being cleared by law enforcement. This led the unhoused individuals to believe the service provider reported the encampment to law enforcement and the unhoused individuals refused future services. Their trust had been broken. Better communication may have avoided the loss of needed services for this group.

Other examples include the lack of referral to the CRBH by County agencies. As a result, those who are inebriated or high in public, but pose no other threat, are arrested and jailed, which results in increased health risk and high cost of incarceration as opposed to these alternatives.

The paltry rates of referral to the Acute Intake Center at SCMHC is another lost opportunity to manage people with acute mental health and substance abuse with an option besides incarceration to protect the public.

Whether this is lack of communication between service organizations and law enforcement, or by leadership in law enforcement to patrol officers, it is still a lack of communication.

Communication between entities does not occur at a level that influences the allocation of resources. We could find no instance where leadership in the MHB, the CoC, the MHSA Board, BHS, and Law Enforcement, ever met together to plan how to martial and coordinate resources in support of the homeless to resolve their mental health and substance abuse problems. The same is true, until recently, of the political leadership of the County and other cities in the region.

Communication among County departments responsible for homeless mental health and substance abuse care and to outside agencies was anemic. The people in these roles are passionate and want to make a difference, but they want to do it their way. To break down the silos that exist in this sphere may improve mental health and substance abuse outcomes.

Improved transparency of communication in all facets of the programs to resolve the homeless mental health and substance abuse crisis in Sacramento County is likely to improve the trust of the community in our government to effectively address this issue.

Transparent Access to Reporting of Funds and Expenses
The Grand Jury could not uncover any transparent report that showed where this $529.9 million was being spent. Instead, this information is embedded in the budget which makes it difficult to determine where the funds are being allocated.

In information provided in the Behavioral Health Services FY 2022-23 Budget Overview, the total Sacramento County mental health funding for FY 2022-23 is $529.9 million, as shown in the table below. Funding sources for Behavioral Health are available at a high level but there are no reports that show where these millions are being spent. 2022-2023 Grand Jury Investigative Report
Mental Health Care for the Homeless: Who Cares?

Behavioral Health Services Budget Overview FY22/23
Revenue Source Revenue (Rounded in millions)
Realignment $165.2
Medi-Cal $139.1
State General Fund $7.6
Mental Health Service Act $145.8
County General Fund $10.9
System Partners and Grants $62.6
Total $529.9

Sacramento County government websites have little data available that allow taxpayers and decision makers to evaluate efforts to reduce homelessness or to judge the effectiveness and efficiency of mental health and substance abuse programs.

A good example that might be useful to identify specific allocations of funds relating to homeless mental health in other counties, including one being used by Yolo County. The following table specifically illustrates the sources and uses of funds being allocated towards the reduction of homelessness.

Metrics and Goals

The Grand Jury could not obtain reporting specific to homeless patients and was unable to identify any specific metrics for homeless service outcomes.

2022-2023 Grand Jury Investigative Report
Mental Health Care for the Homeless: Who Cares?

As a standard practice, mental health providers typically submit process metrics as part of the contract management system, and they are well tracked. These reports are robust and are key to maintaining the quality of documentation provided by non-profits with whom the County contracts.

It was less apparent whether such data collected related to services provided by Medi-Cal Managed Care Plans, which provide mild and moderate mental health services to patients for whom the County is required to care.

The accumulation of this kind of outcome data is not a new phenomenon. In 2003, the U. S.

Department of Health and Human Services developed core performance measures for homeless data tracking that could be adopted for County planning. These are useful today and easily obtained.

It is essential to specifically define achievable goals on a regular basis that are assessed and updated. Transparency is provided when key metrics are regularly updated and published.

Accountability
Accountability for the mental health and substance abuse programs in the County homeless population is lacking. While great sums of tax dollars are expended, the results are disappointing when large homeless encampments persist. A high number of homeless have mental health and/or substance abuse issues, and yet, integrated and coordinated treatment remains inadequate.

The County retains control over most mental health funding for the cities and the unincorporated areas of Sacramento County. They contract with many non-profit providers for approximately 90% of these services which makes it difficult to coordinate and focus on results. County programs often work in “silos” and are focused more on process rather than outcomes.

Interviews with service providers conducted by the Grand Jury reflected their frustration that they were frequently stymied by the County and other government bureaucracies.

There is also a disconnect among County elected leaders, senior staff and those providing services. There are five co-equal County supervisors vying for political points with city leaders criticizing County inaction, which makes it difficult to hold specific people publicly accountable for results.

Authoritative, focused coordination of the resources of all stakeholders is desperately needed in the administration of mental health and substance abuse homeless programs. Successful administrative models within the County that have implemented this strategy include the Executive Director position of Sacramento Regional Transit and the Deputy County Executive position for Public Safety and Justice.

Under normal conditions, the treatment of mental health and substance abuse issues is extraordinarily difficult, but deeply compounded for the unhoused. More than 50% of the homeless population suffers from mental illness and/or substance abuse. 2022-2023 Grand Jury Investigative Report
Mental Health Care for the Homeless: Who Cares?

The following recommendations are not the ultimate solution to the problem. The Grand Jury is hopeful they ideas to improve service delivery and results.

FINDINGS:

F1: The current fragmented system of homeless services fails to serve the homeless and their mental health and substance abuse challenges nor the Sacramento County community and its taxpayers.

F2: The County lacks a comprehensive strategic plan to include the mental health and substance abuse issues that face the homeless.

F3: The current strategic plan, the Homeless Action Plan published by SSF, has not been successful in addressing the mental health and substance abuse needs of the homeless because goals are not quantified, accountability is not assigned, and performance is not monitored.

F4 The County does not have a senior executive position that holds budget and policy implementation authority for all homeless services provided in the County, including mental health and substance abuse programs.

F5: Lack of measurable process and outcome metrics correlated with funding and expenses of homeless mental health and substance abuse programs has resulted in lost opportunities to fund those programs that demonstrate the most success.

F6: Lack of transparency in financial reporting of mental health and substance abuse services and access to other funding for the homeless is not publicly available and reduces public trust.

F7: There are too many boards, committees, and government entities which create waste and redundancy in the planning and distribution of mental health and substance abuse treatment resources.

F8: Mental health and substance abuse issues among the homeless are aggravated by poor government planning.

F9: The outreach teams (County HEART teams, Sacramento PD IMPACT Team) are poorly supported and understaffed which results in lost opportunities to positively engage the homeless to accept mental health and substance abuse treatment and other services.

F10: Poor communication between law enforcement and outreach teams erodes the trust of and negatively impacts the mental health of the unhoused population.

F11: There is a shortage of mental health professionals which continues to exacerbate the inability of the County to meet the need for mental health services for the homeless. 2022-2023 Grand Jury Investigative Report
Mental Health Care for the Homeless: Who Cares?

RECOMMENDATIONS:

R1: The County should complete a comprehensive strategic plan to address homelessness by July 1, 2024, to improve mental health and substance abuse services for the homeless, to include timelines and measurable goals and objectives, building on The Homeless Action Plan, using templates and examples from other communities and organizations such as the California State Association of Counties.

R2: The County should immediately begin to develop and implement an interim plan that incorporates all or some of the recommendations in this report and will result in measurable improvement in the delivery of mental health and substance abuse services in the short term.

R3: The County should appoint a new Deputy County Executive position by January 1, 2024, that holds budget and policy implementation authority for all homeless services provided in the County, including mental health and substance abuse programs, and to the extent possible, authority over other governmental entities.

R4: The County should dedicate funds in the 2023-2024 budget for innovative solutions that may not be supported by the County’s flow of external funding (Ex: more CRBH sites, outreach teams, substance free transitional housing, board and care facilities).

R5: The County should immediately begin a process to establish and track outcome data related to the treatment of mental health and substance abuse for the homeless.

R6: The County should track funding and spending specific to support homeless, including treatment for mental health and substance abuse, and post this information at least quarterly on the County website in a manner that is easily accessible to the public by the end of 2023.

R7: Elected officials should immediately take a more active role to lead, coordinate, and consolidate various advisory boards and committees to assume direct accountability for improved outcomes in mental health and substance abuse prevalence and result in a reduction of duplicate efforts, administrative costs, and inefficiency.

R8: Sacramento County should immediately fully staff a total of six HEART teams and the City of Sacramento should immediately establish at least two additional IMPACT Team within Sacramento PD to increase engagement with County and City homeless encampments and improve access to mental health and substance abuse treatment services.

R9: Law enforcement should communicate at least weekly with all outreach teams to collaborate in decisions as to which encampments to clear and when, and post this information on a shared web site to increase the trust of the homeless and support offered by outreach teams.

R10: A communication plan should be developed to timely inform all stakeholders and staff of goals, actions, and events related to planning and execution of homeless mental health and substance abuse services.
2022-2023 Grand Jury Investigative Report
Mental Health Care for the Homeless: Who Cares?

R11: The County should continue to improve incentives and hiring of mental health professionals to meet the demand for mental health services in the County.

Required Responses
Pursuant to Penal Code sections 933(c) and 933.05, the grand jury requests responses as follows:

From the following governing bodies of a public agency within 90 days:

The Sacramento County Board of Supervisors
County Administration Building
700 H Street, Suite 2450
Sacramento, Ca 95815

The Sacramento City Council
City Hall
915 I Street, 5th Floor
Sacramento, CA 9581
From the following elected official within 60 days:

Jim Cooper, Sheriff
Sacramento County
4500 Orange Grove Avenue
Sacramento, CA. 95841
Invited Responses
Ms. Ann Edwards,
County Executive of Sacramento County
700 H Street, Room 7650
Sacramento, CA 95814

Mr. Howard Chan,
City Manager of City of Sacramento
915 I Street
Sacramento, CA 95814

Ms. Cathy Lester, Chief of Police
Sacramento City Police Department
5770 Freeport Boulevard
Sacramento, CA 95822

Ms. Chevon Kothari,
Deputy County Executive, Social Services
700 H Street, Room 7650
Sacramento, CA 95814

Ms. Linda Budge, Mayor
City of Rancho Cordova
2729 Prospect Park Drive
Rancho Cordova, CA 95670
Ms. Bobbie Singh-Allen, Mayor,
City of Elk Grove
8401 Laguna Palms Way
Elk Grove, CA 95758

Mr. Jay Vandenburg, Mayor
City of Galt
380 Civic Drive
Galt, CA 95632

Ms. Rosario Rodriquez, Mayor
City of Folsom
50 Natoma St.

Folsom, CA 95630

Ms. Porsche Middleton, Mayor
City of Citrus Heights
6237 Fountain Square Drive
Citrus Heights, CA 95621

2022-2023 Grand Jury Investigative Report
Mental Health Care for the Homeless: Who Cares?

Mail or deliver a hard copy response to:

The Honorable Michael Bowman
Presiding Judge
Sacramento County Superior Court
720 9th Street
Sacramento, CA 95815

Please email a copy of this response to:

Ms. Erendira Tapia-Bouthillier
Sacramento County Grand Jury Coordinator
Email: [email protected]

2022 – 2023 Grand Jury of Sacramento County

SUMMARY
Nearly 10,000 unhoused men, women, and children sleep on Sacramento County streets every night. Families crammed into thread-bare tents, doubled up in the broken backseats of aging cars, huddled on sidewalks in front of local stores, state office buildings, and neighborhood churches.

The numbers skyrocket year after year and local government has failed to respond effectively.

This occurs despite spending more than $300 million on homeless services over that period. That price tag does not include the enormous cost of law enforcement, public health, sanitation, lost commerce, or the impact on the quality of life of in Sacramento County and its seven incorporated communities.

This is an endless loop of failure. Leaders in Sacramento County must prioritize a more effective regional approach to solve the burgeoning homelessness problem.

County and city leaders must band together to form a comprehensive homelessness strategy. Too often, jurisdictions work independently or informally together, spend hundreds of millions of dollars, and they fail. The current Grand Jury saw a need to revisit this idea and investigate the feasibility and effectiveness of a comprehensive organizational model.

2022-2023 Grand Jury Report
Homelessness Solutions Elude Elected Leaders

BACKGROUND
The 2022-2023 Sacramento County Grand Jury (SCGJ) initiated an investigation into the strategies, programs, and working relationships between the County and the seven incorporated cities (Sacramento, Rancho Cordova, Elk Grove, Citrus Heights, Galt, Isleton, and Folsom) as they sought solutions to the homelessness problem. In 2017, the homeless population Point in Time Count (PIT) was 3,665 persons. In 2019, it was 5,570; in 2022, it rose to 9,278, a 253% increase in five years.

Local leaders interviewed by the Grand Jury agreed these counts are understated. In addition, deaths among the homeless population have also risen to record levels.

Most funding for homeless programs resides with the County, but the cities experience most of the impact.

In December 2010, the County Board of Supervisors (BOS) and the Sacramento City Council each passed a resolution to form a Joint Powers Authority (JPA) intended to resolve homelessness. A JPA is an organizational model to coordinate homelessness efforts among governments. No JPA was established.

In March 2011, the BOS and the Sacramento City Council passed a resolution to endorse Sacramento Steps Forward (SSF) as a new agency to monitor and coordinate homeless programs throughout Sacramento County. This decision outsourced the management of the homeless problem and abandoned the JPA idea. The SSF Board does not have any elected officials from either the BOS or the City Councils of any of the seven cities. The governance of SSF and the plans it develops lack accountability and effectiveness to respond to community needs.

Twelve years later, the problem has worsened drastically. Despite repeated efforts among elected officials and staff throughout the region to meet and discuss the issue, there is no effective regional authority to implement decisions. Media reports in 2022 continuously pointed this out.

Jurisdictions work in silos to seek solutions within their borders with no real plan for this shared problem.

In November 2022, Sacramento City voters passed Measure O which requires "the City and County of Sacramento to approve a legally-binding partnership agreement" that "would improve the homelessness crisis." The City and County adopted the agreement in December 2022. The agreement represents small steps to address the
issue of the homeless on City sidewalks and
impact the surrounding community. The
agreement does not provide a comprehensive
strategy. It fails to include the other six cities or
entities such as schools, public transportation,
and services agencies impacted by homelessness.

2022-2023 Grand Jury Report
Homelessness Solutions Elude Elected Leaders

Homelessness is a regional problem that requires a regional solution. A new plan must include all seven cities and the County. The 2018-2019 SCGJ recommended a new or restructured governing authority led by elected officials directly accountable to all citizens of the County.

This approach has been successful in other regions of California as will be shown below.

METHODOLOGY
In its investigation, the 2022-2023 SCGJ reviewed numerous documents and conducted interviews:

Documents:

1. Previous Grand Jury reports provided information on narrowly focused efforts addressing narrow aspects while assessing the effectiveness of specific strategies.

2. Media reports on ballot measures and the status of inter-agency cooperation.

3. Correspondence and documentation received from city, county, and agency leadership.

4. Website policy review and assessment for the County and the cities of Sacramento, Rancho Cordova, and Elk Grove.

5. BOS and various City Council meeting agendas, board meeting agenda packets, and board meeting minutes and recordings.

6. Annual reports and PIT counts from relevant agencies in California.

7. Existing ordinances and agreements among governing jurisdictions in the County regarding homelessness.

8. State Assembly bills and State Senate bills.

9. The investigation focused on three cities (Sacramento, Elk Grove, and Rancho Cordova) and Sacramento County.

Interviews:

1. Thirteen individuals in leadership and policy positions in conjunction with a review of materials they provided.

Observation:

1. Members of the Grand Jury, like other citizens of the County, witnessed the ever- increasing population of homeless living on our streets, in parks, on sidewalks, and in other open areas.

DISCUSSION
A Common Refrain
A common theme emerged from the SCGJ interviews with county, city, and non-profit leaders regarding the explosion in the number of homeless in Sacramento County. All believed their organization’s efforts were successful, but expressed frustration with the lack of coordination with other jurisdictions. The SCGJ fails to understand why these leaders believe their organizations are successful while the homeless population has tripled in the last five years.

2022-2023 Grand Jury Report
Homelessness Solutions Elude Elected Leaders

Previous SCGJ reports on homelessness have addressed the lack of coordination and the need for a comprehensive strategy. This will be the fourth SCGJ in the past seven years to recommend the County and cities develop a county-wide approach to homelessness. Findings were made, and recommendations were provided:
• The 2015-2016 SCGJ focused on a comprehensive plan not limited to Housing First (HF).
• The 2016-2017 SCGJ affirmed the issue of insufficient affordable housing in the County and recommended additional coordination to address the issue. • The 2018-2019 SCGJ elaborated further on the extent of the challenge, the increase in the number of homeless, and some of the underlying causes. The Grand Jury identified the entities within the County involved in efforts to reduce homelessness. It was again emphasized there was a lack of an organizational model to coordinate efforts. The sole recommendation from this SCGJ was for the County to identify and implement a different model. A Joint Power Authority was suggested as a feasible approach.

Different Cities Face Vastly Different Challenges
Rancho Cordova has a unique challenge with its proximity to the American River Parkway. The Parkway is managed and policed by Sacramento County; any homeless enforcement or policy change impacts Rancho Cordova. In one example, the County removed a homeless camp only to have it reappear in other parts of Rancho Cordova. There is no governance structure to ensure a cooperative approach.

Elk Grove City leaders describe ongoing efforts to incentivize affordable housing and push developers to expand affordable housing as a part of an overall City plan. Such plan was rejected by the City which recently led the State Attorney General to warn Elk Grove of the need to follow through and expand the plan. Elk Grove is fortunate enough to have sufficient funds and staffing to understand and manage its homeless population, a fact for which city leaders are rightfully proud. Most of the other cities in the County do not have this enviable level of resources.

Sacramento Steps Forward (SSF) and Sacramento Housing and Redevelopment Agency (SHRA).

In 2010-2011, Sacramento County faced extreme economic fallout following the 2008 financial crisis. Tax resources dwindled, housing prices shrank, and homes were abandoned. This created a financial shortfall for the County. In response, the County outsourced the coordination of homeless services to SSF.

SSF is the designated lead agency for the federally-regulated Continuum of Care (COC). SSF uses real-time data, PIT counts, and analytics to develop best practices and recommendations to help enhance programs and services to address homelessness. SSF has the data but no authority to direct or implement solutions. There are no elected officials on the SSF board, so there is no accountability among governmental jurisdictions to propose or implement solutions.

2022-2023 Grand Jury Report
Homelessness Solutions Elude Elected Leaders

SHRA is a Joint Powers Agency whose members include the City of Sacramento, the City Housing Authority, the County of Sacramento, and the County Housing Authority. None of the other cities are represented on the board. Representatives of each of these agencies sit on the SHRA Board. SHRA has an inventory of thousands of residential units throughout the County.

Local leaders and key staff members from the cities of Sacramento, Rancho Cordova and Elk Grove expressed frustration with SHRA's extensive requirements to fund new projects that limit local leadership’s access to SHRA's housing inventory. Some interviewees stated SHRA’s requirements hindered new housing development and did not support a comprehensive response to homelessness. SHRA's mission is to deliver fully operational projects with complete "wrap- around services" to meet the needs of the potential occupants. These requirements are seen as too restrictive by the civic leaders because it often takes years of planning to develop this level of service.

Measure O
Measure O provides conditional enforcement against camping in city limits, allows citizens to bring an action for damages against the City, and limits the City's annual financial support for that measure to $5 million.

Measure O only supports the City of Sacramento. Other cities within Sacramento County have concerns and fear the
problem may be pushed to less affluent and more diverse neighborhoods due to the enforcement of the new
encampment regulations.

None of the requirements in Measure O were to take effect until the City of Sacramento and the County completed and adopted a legally-binding Partnership Agreement on the roles and responsibilities of each.

City and County Partnership Agreement

On December 6, 2022, the County and the City of Sacramento approved the Homeless Services Partnership Agreement. It emphasized jurisdictions would work together to decrease the homeless population. This Partnership Agreement is designed to improve coordination and increase services and programs to meet the unhoused needs and move individuals out of homelessness in the City and the unincorporated of the County. • The County will place all shelter beds into the upcoming Coordinated Access System; some beds may be prioritized based on population served or geography. • The County is opening 200 new shelter beds within 12 months and an additional 200 beds within 36 months in the unincorporated County (County Funded). • The County will operate 200 additional shelter beds in the City jurisdiction, provided the City provides a shovel-ready site (County/City funded).

A Case of Supply and Demand
Real estate prices in Sacramento County, as well as homelessness data provided by SSF, show a severe lack of affordable housing in the County. Many of those interviewed acknowledged this

2022-2023 Grand Jury Report
Homelessness Solutions Elude Elected Leaders

as a primary driver of initial homelessness. Housing costs in Sacramento County nearly doubled over the past decade. Homelessness has inevitably followed.

Sacramento has more unsheltered people than the entire state of New York. The majority of homeless in New York state live in transitional
housing or emergency shelters. In Sacramento,
the opposite is true—the majority sleep in tents,
cars, and doorways.

A lack of housing can be fatal. Homeless deaths
from hypothermia are rising. Eight homeless
people died in Sacramento County in the
unhoused
community
due to
hypothermia
in 2021.

More
recently, two individuals have died from hypothermia, a 74- year-old man and a 66-year-old woman. Analysis of deaths within the homeless community indicates underlying
medical conditions can shorten the life of a homeless
individual by up to a one-third when compared to the
general population.

Best Practices and Successful Models for Homelessness
The SCGJ studied other California counties that successfully coordinated efforts to address the homeless issue. They have formed JPAs through legislation to develop housing trusts. All of these JPAs use a governing board comprised of elected officials from each jurisdiction. This is a critical model of successful JPAs. These efforts reflect the best practices and solutions to homelessness as demonstrated by reductions in the PIT counts.

Solano County
In July 1999. the Solano County Board of Supervisors established a JPA: the Community Action Partnership of Solano County (CAP Solano). This JPA commissioned the development of a five year regional plan that includes all jurisdictions of Solano County. The plan included a strategic process which defines measurable outcomes as a key element. The plan discusses strengths, weaknesses, funding, impacts, and opportunities for better homeless outcomes.

CAP Solano is a governmental agency coordinating efforts across Solano County to reduce homelessness. The decision to develop a regional strategic plan was made by the jurisdictions that realized a regional approach was necessary in order to respond effectively to homelessness.

Solano County is much like Sacramento County in several respects. It consists of seven incorporated cities within the County. The square miles, geography, and climate are similar.

The total population of Solano County is about one-third of that of Sacramento County, but the percentage of homeless per capita is about one-half of that of Sacramento's. CAP Solano has

2022-2023 Grand Jury Report
Homelessness Solutions Elude Elected Leaders

been updated to ensure each of the seats on the Board will be an elected official from each jurisdiction. This change created a high level of accountability among leaders.

Solano County 2022 PIT count showed 1.3% reduction in unhoused citizens. During this same period the Sacramento County PIT count showed a 66% increase in unhoused citizens.

Riverside County
Riverside County is significantly larger yet similar to Sacramento County. Its larger population and incorporated cities resulted in a 35% increase in homeless in the last four years since 2018.

Riverside County presented and authored AB 687 in July 2021.

AB 687 was introduced to develop a JPA, the Riverside County Housing Finance Trust. The Bill authorizes the creation of the Western Riverside County Regional Housing Trust (Trust), a JPA, to fund housing specifically to assist the homeless population and persons and families of extremely low, very low, and low income within the County of Riverside. The Trust helps to create housing opportunities as defined in the Health and Safety Code. The Trust may receive funding from public and private sources and has the ability to authorize and issue bonds. A separate Board of Directors governs the Trust, comprised of elected officials representing the County of Riverside and cities within the County, The Bill passed both the Assembly and Senate Floors in July 2021. The Governor signed it into law in July 2021.

Riverside County 2022 PIT count showed an 8% reduction in unhoused citizens. During this same period, the Sacramento County PIT count showed a 66% increase in unhoused citizens.

San Gabriel Valley Regional Housing Trust

SB 751 authorized the creation of the San Gabriel Valley Regional Housing Trust (SGVRHT) as a JPA among several cities throughout the San Gabriel Valley. According to the SGVRHT, the Trust received $1 million in matching grant funds from the Local Housing Trust Fund program for construction of 71 affordable housing units in the cities of Claremont and Pomona scheduled for completion in 2022. This Trust is in the very early stages of implementation and it is reasonable to expect it will see improvements in outcomes as the organization matures, similar to the experience of Solano County and Riverside County.

San Gabriel Valley 2022 PIT count showed a 2% increase in unhoused citizens. During this same period the Sacramento County PIT count showed a 66% increase in unhoused citizens.

Orange County
AB 448 authorized the creation of Orange County Housing Finance Trust (OCHFT), which is a JPA among the County of Orange and cities in the County. To date, 23 of the 34 cities in the County are members of the JPA. The JPA duplicated much of the affordable housing goals and language found in the other Southern California JPAs, but without direct tax funding mechanisms. The OCHFT and its members plan to create 2,700 permanent supportive housing and affordable housing units by June 30, 2025. As of January 2022, OCHFT began construction of 1,676 units, with another 961 awaiting sufficient funding. OCHFT funded these units by 2022-2023 Grand Jury Report
Homelessness Solutions Elude Elected Leaders

leveraging matching grant funds from the state's Local Housing Trust Fund (LHTF) program to issue deferred payment loans to developers.

Orange County 2022 PIT count showed a 28% decrease in unhoused citizens. During this same period the Sacramento County PIT count showed a 66% increase in unhoused citizens.

Burbank, Glendale, and Pasadena

SB 1177 created the Burbank, Glendale, and Pasadena Regional Housing Trust (RHT) to fund the planning and construction of housing for the region's homeless and low-income people and families. The bill establishes a board of directors and governing structure for the RHT. Its governing agreement requires maximum transparency concerning public funds administered by the RHT.

The combined 2022 PIT count for Burbank, Glendale, and Pasadena showed a 10% increase in unhoused citizens. During this same period the Sacramento County PIT count showed a 66% increase in unhoused citizens.

Housing Trusts
The Legislature supported the counties and created the Trusts to fund housing development for homeless and low-income individuals and families. Local governments can follow these best practices by creating JPAs for a housing trust without state approval. Several bills over the last few years have provided examples for these JPAs governed by elected officials. Although these housing trusts are focused on housing, they represent a first step in the process to develop and implement county-wide coordinated homeless services.

FINDINGS

F1 There is no cooperative, collaborative, and coordinated effort among all eight governments in the County to create comprehensive solutions to this shared problem.

F2 The problem of homelessness in Sacramento County has drastically worsened over the past five years, as demonstrated by the dramatic increases in Point in Time counts.

F3 A lack of affordable housing is the primary cause of homelessness and the most difficult one to solve due to the high cost of new development.

F4 Sacramento Steps Forward does not have any elected leaders on its Board and lacks decision-making authority over the eight governmental jurisdictions in the County, making it powerless to implement needed changes.

F5 The legally binding agreement mandated by Measure O and the Partnership Agreement is a step in the right direction, but it applies only to the City and County of Sacramento.

2022-2023 Grand Jury Report
Homelessness Solutions Elude Elected Leaders

RECOMMENDATIONS
R1 The 2022-2023 Sacramento County Grand Jury recommends that the County and the seven incorporated cities implement a Joint Powers Authority (JPA) to address homelessness by December 1, 2023.

R2 The newly formed JPA should be governed by elected officials who are directly accountable to citizens of the County.

R3 The Joint Powers Authority should develop and manage a comprehensive County-wide strategic plan to address homelessness by July 1, 2024.

R4 The County/City Partnership Agreement should be used as a model for the other six cities as an interim measure pending the creation of a Joint Powers Authority.

REQUIRED RESPONSES
Pursuant to Penal Code sections 933(c) and 933.05, the grand jury requests responses as follows:

From the following governing bodies of a public agency within 90 days:

Sacramento County Board of Supervisors
700 H Street, Suite 2450
Sacramento, CA 95814
Sacramento City Council
915 I Street
Sacramento, CA 95814
Rancho Cordova City Council
2729 Prospect Park Drive
Rancho Cordova, CA 95670

Elk Grove City Council
8401 Laguna Palms Way
Elk Grove, CA 95758

Mail or deliver a hard copy response to:

The Honorable Michael Bowman
Presiding Judge
Sacramento County Superior Court
720 9th St.

Sacramento. CA 95814
Please email a copy of this response to:

Ms. Erendira Tapia-Bouthillier
Sacramento County Grand Jury Coordinator
Email: [email protected]

INVITED RESPONSES
Darrell Steinberg, Mayor
City of Sacramento
915 I St., 5th Floor
Sacramento, CA 95814
Bobbie Singh-Allen, Mayor
City of Elk Grove
8401 Laguna Palms Way
Elk Grove, CA 95758

Linda Budge, Mayor
City of Rancho Cordova
2729 Prospect Park Drive
Rancho Cordova, CA 95670

2022-2023 Grand Jury Report
Homelessness Solutions Elude Elected Leaders

Mr. Phil Serna, Supervisor
District 1
Sacramento County Board of Supervisors
700 H Street, Suite 2450
Sacramento, CA 95814

Mr. Patrick Kennedy, Supervisor
District 2
Sacramento County Board of Supervisors
700 H Street, Suite 2450
Sacramento, CA 95814

Mr. Rich Desmond, Supervisor
District 3
Sacramento County Board of Supervisors
700 H Street, Suite 2450
Sacramento, CA 95814

Ms. Sue Frost, Supervisor
District 4
Sacramento County Board of Supervisors
700 H Street, Suite 2450
Sacramento, CA 95814

Mr. Pat Hume, Supervisor
District 5
Sacramento County Board of Supervisors
700 H Street, Suite 2450
Sacramento, CA 95814

Ms. Ann Edwards, County Executive
Sacramento County
700 H Street, Room 7650
Sacramento, CA 95814

Mr. Howard Chan, City Manager
City of Sacramento
915 I Street
Sacramento, CA 95814

Mr. Jason Behrmann, City Manager
City of Elk Grove
8401 Laguna Palms Way
Elk Grove, CA 95758

Ms. Porsche Middleton, Mayor
City of Citrus Heights
6237 Fountain Square Dr.

Citrus Heights, CA 95621

Mr. Christopher W. Boyd, City Manager
City of Citrus Heights
6360 Fountain Square Drive
Citrus Heights, CA 95621

Ms. Rosario Rodriquez, Mayor
City of Folsom
50 Natoma St.

Folsom, CA 95630

Ms. Elaine Andersen, City Manager
City of Folsom
50 Natoma St.

Folsom, CA 95630

Mr. Jay Vandenburg, Mayor
City of Galt
380 Civic Drive
Galt, CA 95632

Mr. Lorenzo Hines Jr., City Manager
City of Galt
380 Civic Drive
Galt, CA 95632

Mr. Micah Runner, City Manager
City of Rancho Cordova
2729 Prospect Park Drive
Rancho Cordova CA 95670

Ms. Pamela Bulahan, Mayor
City of Isleton
101 Second Street
Isleton, CA 95641

Mr. Charles Bergson, City Manager
City of Isleton
101 Second Street
Isleton, CA 95641

August 31, 2023

The Honorable Michael Bowman
Presiding Judge
Sacramento County Superior Court
720 9
th Street
Sacramento, CA 95814

Re: City of Sacramento’s Response to the Sacramento County Grand Jury

Dear Judge Bowman:

The City of Sacramento provides the following responses to the Sacramento County Grand Jury, consistent with its obligations under California Penal Code section 933.05, to the two Grand Jury reports entitled “Homeless Should Not Mean Hopeless:

Homelessness Solutions Elude Elected Leaders” and “Mental Health Care for the Homeless: Who Cares.”

Grand Jury Report: Homeless Should Not Mean Hopeless: Homelessness Solutions Elude Elected Leaders

A. FINDINGS

F1: There is no cooperative, collaborative, and coordinated effort among all eight governments in the County to create comprehensive solutions to this shared problem.

City Council’s Response to F1

The City of Sacramento agrees that there needs to be a collaborative and coordinated effort among all eight governments in the County to create a regional, comprehensive approach to this shared crisis.

The City of Sacramento would point out that some efforts toward this coordinated approach have already occurred. The Sacramento Homeless Policy Council (SHPC) was launched in August 2021 at the direction of Sacramento City Council and the County Board of Supervisors. The SHPC is tasked with regional collaboration to end homelessness and currently consists of elected officials from Sacramento County and the cities of Sacramento, Citrus Heights, Elk Grove, Folsom, Galt and Rancho Cordova.

In addition, in June of 2022, Sacramento City Council and the County Board of Supervisors, and the Sacramento Countywide Continuum of Care (CoC) Board all The Honorable Michael Bowman
Re: City of Sacramento’s Response to the Sacramento County Grand Jury August 31, 2023

915 I Street, New City Hall 5th Floor Sacramento, California 95814 www.cityofsacramento.org 916-808-5407
adopted the Sacramento Local Homelessness Action Plan (LHAP) which is a three year, cross-jurisdictional unified approach to addressing homelessness across Sacramento County. While the other six cities did not formally adopt the LHAP, staff of each city was involved in the creation of the plan, and three of the other cities (Citrus Heights, Elk Grove, and Rancho Cordova) have staff seated on the CoC Board which adopted the LHAP.

On December 6, 2022, the City of Sacramento and the County of Sacramento entered into a Partnership Agreement that is legally binding and enforceable.

The Partnership Agreement sets forth responsibilities upon both the City of Sacramento and the County of Sacramento such as: 1) including all spaces into the Coordinated Access System (CAS) managed by Sacramento Steps Forward (SSF); 2) joint encampment engagement teams; 3) the addition of a Fourth CORE Wellness Center; 4) increased shelter capacity; 5) increased permanent housing; and 6) increased full- service partnership (FSP) capacity and referrals with a whatever it takes approach – amongst other requirements.

F2: The problem of homelessness in Sacramento County has drastically worsened over the past five years, as demonstrated by the dramatic increases in Point in Time counts.

City Council’s Response to F2

The City of Sacramento agrees with the finding.

F3: A lack of affordable housing is the primary cause of homelessness and the most difficult one to solve due to the high cost of new development.

City Council’s Response to F3

The City of Sacramento disagrees partially with the finding.

A recent study by University of California, San Francisco found a direct link between the cost of housing in California and homelessness.1 Additionally, during the most recent Point-In-Time (PIT) count, forty-four percent of individuals experiencing homelessness surveyed identified a lack of affordable housing as the primary problem in Sacramento.2

While housing affordability and availability certainly are substantial contributing factors to generating an environment where the crisis of homelessness thrives, there are a number of other environmental, structural, interpersonal, and behavioral factors such as lack of adequate mental health care services which contribute equally and often more significantly to homelessness.

1 https://www.ucsf.edu/news/2023/06/425646/california-statewide-study-investigates-causes-and-impacts- homelessness
2 https://sacramentostepsforward.org/continuum-of-care-point-in-time-pit-count/2022-pit-count/ The Honorable Michael Bowman
Re: City of Sacramento’s Response to the Sacramento County Grand Jury August 31, 2023

915 I Street, New City Hall 5th Floor Sacramento, California 95814 www.cityofsacramento.org 916-808-5407
F4: Sacramento Steps Forward does not have any elected leaders on its Board and lacks decision-making authority over the eight governmental jurisdictions in the County, making it powerless to implement needed changes.

City Council’s Response to F4:

The City of Sacramento disagrees partially with the finding.

It is correct that Sacramento Steps Forward (SSF) does not have any elected leaders on its Board. It is also correct that as presently constituted, the mechanism under which SSF operates can result in limited progress to implement the needed responses to address the homeless crisis.

Fact 1: SSF serves as Continuum of Care (CoC) that is funded by the US Department of Housing and Urban Development (HUD). SSF also receives grant funding from the State of California per Homeless Housing Assistance and Prevention (HHAP) grant program which SSF was just allocated $12,333,090.41 in HHAP-4 funds. SSF oversees numerous programs and projects that serve individuals experiencing homelessness throughout Sacramento County per its status as the CoC for Sacramento County.

Fact 2: SSF serves as the operator of the Coordinated Access System (CAS). CAS is supposed to serve as the ‘front door’ to all City and County funded shelters and housing programs. CAS places all those doors and programs under one roof so a perspective client only need make one phone call to be assessed for appropriate services, resources, and placement. The City’s intent in participating in this model was to have a response system in place where all homeless clients need only make one phone call or one contact to be assessed for appropriate services, resources and placement, and ensure that the most vulnerable are prioritized for placement suiting their unique needs.

Fact 3: As designed, SSF was to serve as the administrator of the Countywide Homeless Management Information System (HMIS). HMIS is the largest source of data the community has related to people experiencing homelessness and programs serving them and is nationally recognized as a best practice.

Fact 4: As designed, SSF was to serve as the lead for implementing the Local Homelessness Action Plan (LHAP), the County and City and CoC adopted strategic plan to address homelessness.

The intent was to create a cross-jurisdictional unified approach to addressing homelessness across Sacramento County.

F5: The legally binding agreement mandated by Measure O and the Partnership Agreement is a step in the right direction, but it applies only to the City and County of Sacramento.

City Council’s Response to F5:

The City of Sacramento agrees with the finding.

The Honorable Michael Bowman
Re: City of Sacramento’s Response to the Sacramento County Grand Jury August 31, 2023

915 I Street, New City Hall 5th Floor Sacramento, California 95814 www.cityofsacramento.org 916-808-5407
The City of Sacramento would add that it stands ready and willing to collaborate and partner with the other cities in Sacramento County in addressing homelessness as the City has done with the County.

B. RECOMMENDATIONS

R1: The 2022-2023 Sacramento County Grand Jury recommends that the County and the seven incorporated cities implement a Joint Powers Authority (JPA) to address homelessness by December 1, 2023.

City Council’s Response to R1:

The City agrees with this recommendation.

Recently enacted state requirements (AB/SB 129) for funding the region’s homelessness response will require significant analysis of the potential for a regional response, which includes the creation of a JPA. In addition, working with members of the Sacramento City Council, Assemblymember Kevin McCarty has introduced AB 1086, the Joint Exercise of Powers Act: Sacramento County Partnership on Homelessness.

The Joint Exercise of Powers Act authorizes 2 or more public agencies, by agreement, to form a joint powers authority to exercise any power common to the contracting parties, as specified. Existing law requires the agreement to set forth its purpose or the power to be exercised, among other things.

This bill would authorize the County of Sacramento and the Cities of Sacramento, Rancho Cordova, Elk Grove, Citrus Heights, and Folsom to enter into a joint powers agreement pursuant to the act to create and operate a joint powers agency, named the Sacramento County Partnership on Homelessness, to assist the homeless population, to coordinate homelessness response, and to develop and manage a comprehensive strategic plan to address homelessness within the jurisdiction of its member cities and county. The bill would set forth the composition and voting procedures of the partnership’s board of directors. It would require the partnership to comply with the regulatory guidelines of each specific state funding source received.

This bill would make legislative findings and declarations as to the necessity of a special statute for the County of Sacramento and the Cities of Sacramento, Rancho Cordova, Elk Grove, Citrus Heights, and Folsom.

Also, additions made to State’s 2023-24 budget, include entirely new requirements of regional collaboration for jurisdictions that receive Homeless, Housing and Prevention (HHAP) funding. This work will be memorialized into a regional plan that requires (among other conditions): “Identification of roles and responsibilities for all participating jurisdictions regarding outreach and site coordination, siting and use of available land, the development of shelter, interim, and permanent housing options, and the The Honorable Michael Bowman
Re: City of Sacramento’s Response to the Sacramento County Grand Jury August 31, 2023

915 I Street, New City Hall 5th Floor Sacramento, California 95814 www.cityofsacramento.org 916-808-5407
coordination and connection to the delivery of services.” This work will be done collaboratively with the City, County, CoC and cities, and will inform alternative organizational approaches, which may or may not include the formation of a JPA.

In addition, it is important to point out that this approach has been tried, with limited success. In the spring of 2011, the Chair of the Board and the Mayor of the City of Sacramento sent joint letters to all of the Mayors and City Managers of the cities in Sacramento County to meet on April 27, 2011, and discuss a new model for homeless service planning and management through a JPA. Unfortunately, the other cities did not indicate a desire to participate in such an endeavor. However, the City of Sacramento remains ready and willing to work with its partner agencies.

R2:

The newly formed JPA should be governed by elected officials who are directly accountable to citizens of the County.

City Council’s Response to R2:

See the City’s response to Recommendation No. 1. The City agrees with this recommendation. The Joint Exercise of Powers Act authorizes 2 or more public agencies, by agreement, to form a joint powers authority to exercise any power common to the contracting parties, as specified. Existing law requires the agreement to set forth its purpose or the power to be exercised, among other things.

In analyzing the new conditions imposed by AB/SB 129, the roles of elected officials in the structure of a JPA (R1), would be considered.

R3: The Joint Powers Authority should develop and manage a comprehensive County- wide strategic plan to address homelessness by July 1, 2024.

City Council’s Response to R3:

See the City’s response to Recommendation Number 1. The City agrees with this recommendation.

R4: The County/City Partnership Agreement should be used as a model for the other six cities as an interim measure pending the creation of a Joint Powers Authority.

City Council’s Response to R4:

The City of Sacramento agrees with this recommendation and has already implemented this Recommendation by entering into the Partnership Agreement with the County of Sacramento on December 6, 2022. The City of Sacramento and County of Sacramento have also subsequently enhanced the agreement by agreeing to Collaboration Protocols that provides further guidelines to the Partnership Agreement which addresses training and data sharing, outreach and services, shelter and respite centers, funding, and planning and accountability.

The Honorable Michael Bowman
Re: City of Sacramento’s Response to the Sacramento County Grand Jury August 31, 2023

915 I Street, New City Hall 5th Floor Sacramento, California 95814 www.cityofsacramento.org 916-808-5407
City and County staff and leadership meet regularly to ensure the effectiveness and implementation of the Partnership Agreement.

Grand Jury Report: “Mental Health Care for the Homeless: Who Cares.”

A. Findings

F1: The current fragmented system of homeless services fails to serve the homeless and their mental health and substance abuse challenges for the Sacramento County community and its taxpayers.

City Council’s Response to F1:

The City of Sacramento disagrees partially with the finding as it pertains to the efforts being undertaken the City.

On July 1, 2021, the City of Sacramento created the Department of Community Response (DCR) as a stand-alone department. DCR consists of two primary divisions.

The Homeless Services Division handles numerous agreements that provide services and programming for families and individuals experiencing homelessness. Since its creation through June 30, 2023, programs funded through this division have managed to assist 5,607 people in moving off the streets of Sacramento – many of which moved on to permanent and positive temporary/transitional housing. The Community Outreach Division deploys social workers and outreach specialists who perform outreach to households experiencing homelessness and connect them to services.

The DCR Community Outreach Division currently consists of fourteen neighborhood resource coordinators, two program specialists, and one manager – all of whom provide outreach and support services to people experiencing homelessness every day. In addition, the DCR Community Outreach Division Manager works on a daily basis with County staff pursuant to the Partnership Agreement and Collaboration Protocols.

As the Grand Jury notes that the County of Sacramento is “responsible for all mental health and behavioral substance abuse treatment,” which is one of the primary reasons the City pursued the Partnership Agreement with the County. Per the terms of the Partnership Agreement, there are to be eight County staff working alongside twenty- seven City DCR staff. The terms of the Partnership Agreement call for there to be additional staffing with the addition of CalAIM staff by the County. In addition, two County clinicians are to provide regular service to City-established shelter and safe ground sites/programs. Further, City of Sacramento and County of Sacramento staff and leadership meet are to meet on a regular basis to ensure the effectiveness and full implementation of the Partnership Agreement. Ensuring that there are more mental health services provided to the homeless population by the County and partner provider agencies is a principal goal under the Partnership Agreement. The City remains ready and willing to partner with other cities and agencies in the region to pursue this fundamental goal.

The Honorable Michael Bowman
Re: City of Sacramento’s Response to the Sacramento County Grand Jury August 31, 2023

915 I Street, New City Hall 5th Floor Sacramento, California 95814 www.cityofsacramento.org 916-808-5407
F2: The County lacks a comprehensive strategic plan to include the mental health and substance abuse issues that face the homeless.

City Council’s Response to F2:

This finding is directed to the County of Sacramento to which the City of Sacramento does not believe this finding requires a response from the City. The City supports any efforts at a regional strategic plan to address the mental health and substance abuse issues that so significantly impacts the homeless population.

F3: The current strategic plan, the Homeless Action Plan published by SSF, has not been successful in addressing the mental health and substance abuse needs of the homeless because goals are not quantified, accountability is not assigned, and performance is not monitored.

City Council’s Response to F3:

The City of Sacramento disagrees partially with the finding.

As proposed, the Local Homelessness Action Plan (LHAP) is a cross-jurisdictional unified approach to addressing homelessness across Sacramento County. with the following quantifiable goals and assignments which includes:

Improving staff knowledge and skills in both housing crisis response and behavioral health care systems, improving and increasing timely and direct access to behavioral health care supports in locations where they are staying and at service locations, Improving and increasing timely and direct access to prevention and homeless services for people engaged in behavioral health services, and Improving and increasing access to mobile crisis response and multi-disciplinary supports for people with more complex or severe needs. All of these activities are led by Sacramento County Behavioral Health Services, and are to be monitored by all entities supporting the LHAP.

As presently constituted, the mechanism under which SSF operates can result in limited progress to implement the needed responses to address the homeless crisis, particularly as it relates to the growing magnitude of mental health and substance abuse, needs of the homeless population

SSF serves as Continuum of Care (CoC) that is funded by the US Department of Housing and Urban Development (HUD). SSF also receives grant funding from the State of California per Homeless Housing Assistance and Prevention (HHAP) grant program which SSF was just allocated $12,333,090.41 in HHAP-4 funds. SSF oversees numerous programs and projects that serve individuals experiencing homelessness throughout Sacramento County per its status as the CoC for Sacramento County.

F4 The County does not have a senior executive position that holds budget and policy implementation authority for all homeless services provided in the County, including mental health and substance abuse programs.

The Honorable Michael Bowman
Re: City of Sacramento’s Response to the Sacramento County Grand Jury August 31, 2023

915 I Street, New City Hall 5th Floor Sacramento, California 95814 www.cityofsacramento.org 916-808-5407
City Council’s response to F4:

This finding is directed to the County of Sacramento to which the City of Sacramento does not believe this finding requires a response from the City. The City supports any County efforts to simplify the provision of services that address the mental health and substance abuse issues that so significantly impact the homeless population.

F5 Lack of measurable process and outcome metrics correlated with funding and expenses of homeless mental health and substance abuse programs has resulted in lost opportunities to fund those programs that demonstrate the most success.

City Council’s response to F5:

In review of the Grand Jury’s Report, section “Transparent Access to Reporting of Funds and Expenses” (pages 10-11) in conjunction with this finding, the City of Sacramento believes this finding is directed to the County of Sacramento to which the City does not believe this finding requires a response. The City supports any efforts at a regional strategic plan to address the mental health and substance abuse issues that so significantly impacts the homeless population.

F6
Lack of transparency in financial reporting of mental health and substance abuse services and access to other funding for the homeless is not publicly available and reduces public trust.

City Council’s response to F6:

In review of the Grand Jury report section: “Transparent Access to Reporting of Funds and Expenses” (pages 10-11), the City of Sacramento believes this finding does not require a response from the City as this finding is directed to the Board of Supervisors.

The City supports any efforts by the County that improves transparency in reporting of funds and services provided to address the mental health and substance abuse issues that so significantly impacts the homeless population.

F7 There are too many boards, committees, and government entities which create waste and redundancy in the planning and distribution of mental health and substance abuse treatment resources.

City Council’s response to F7:

The City of Sacramento agrees with the finding.

There are many excellent efforts and programs, both in the private provider sector and the government sector that could be strengthened and enhanced with a strategic, unified, regional approach.

The Honorable Michael Bowman
Re: City of Sacramento’s Response to the Sacramento County Grand Jury August 31, 2023

915 I Street, New City Hall 5th Floor Sacramento, California 95814 www.cityofsacramento.org 916-808-5407
F8 Mental health and substance abuse issues among the homeless are aggravated by poor government planning.

City Council’s response to F8:

The City of Sacramento disagrees with the finding.

As written, the finding is somewhat overstated and therefore could be disputed that it is not supported by any reputable scientific study, whether, medical, sociological, or psychological. There are many excellent efforts and programs, both in the private provider sector and the government sector that could be strengthened and enhanced and made much more effective with a strategic, unified regional approach.

F9 The outreach teams (County HEART teams, Sacramento PD IMPACT Team) are poorly supported and understaffed which results in lost opportunities to positively engage the homeless to accept mental health and substance abuse treatment and other services.

City Council’s response to F9:

As to the City of Sacramento PD IMPACT Team, the City of Sacramento disagrees partially with the finding.

It appears that the Grand Jury has a misconception of the role of the Sacramento PD IMPACT Team, which is not related to the types of outreach described in this finding.

However, on July 1, 2021, the City of Sacramento created the Department of Community Response (DCR) as a stand-alone department. DCR consists of two primary divisions. The Homeless Services Division handles numerous agreements that provide services and programming for families and individuals experiencing homelessness. The Community Outreach Division deploys social workers and outreach specialists who perform outreach to individuals experiencing homelessness and connect individuals to services.

The DCR Community Outreach Division currently consists of fourteen neighborhood resource coordinators, two program specialists, and one manager – all of whom provide outreach and support services to people experiencing homelessness every day. In addition, the DCR Community Outreach Division Manager works on a daily basis with County staff pursuant to the Partnership Agreement and Collaboration Protocols.

Since
its inception, DCR staff have been able to engage with over 6,000 people living outside in the City of Sacramento, and in that time, approximately fifty percent of those ended up in emergency, transitional, and permanent housing.

Additionally, on August 1, 2023, City Council updated the Homeless Protocol. Please see Item 4 of the August 1, 2023, City Council meeting. 3 3 See http://sacramento.granicus.com/GeneratedAgendaViewer.php?view_id=22&clip_id=5631.

The Honorable Michael Bowman
Re: City of Sacramento’s Response to the Sacramento County Grand Jury August 31, 2023

915 I Street, New City Hall 5th Floor Sacramento, California 95814 www.cityofsacramento.org 916-808-5407
F10 Poor communication between law enforcement and outreach teams erodes the trust of and negatively impacts the mental health of the unhoused population.

City Council’s response to F10:

As to the City of Sacramento PD IMPACT Team, and outreach efforts of the City’s Department of Community Response, the City of Sacramento disagrees partially with the finding.

It appears that the Grand Jury has a misconception of the role of the Sacramento PD IMPACT Team, which is not related to the types of outreach described in this finding.

However, the Department of Community Response Outreach Division has been around since at least July 1, 2021. DCR Community Outreach Division staff work with the Sacramento Police Department on a routine basis. On October 18, 2022, the City of Sacramento created a Citywide Response Protocols and on November 28, 2002, the City of Sacramento created a sidewalk and critical infrastructure guideline. 4 Lastly, in
effort to coordinate and communicate effectively, DCR hosts a weekly meeting which includes crucial representatives from city law enforcement partners including Sacramento Police Department, Code Enforcement, and Park Rangers.

F11 There is a shortage of mental health professionals which continues to exacerbate the inability of the County to meet the need for mental health services for the homeless.

City Council’s response to F11:

The City of Sacramento agrees with the finding.

B. Recommendations

R1
The County should complete a comprehensive strategic plan to address homelessness by July 1, 2024, to improve mental health and substance abuse services for the homeless, to include timelines and measurable goals and objectives, building on The Homeless Action Plan, using templates and examples from other communities and organizations such as the California State Association of Counties.

City Council’s response to R1:

This recommendation is directed to the County of Sacramento, and so no City of Sacramento response is required. The City supports any efforts at a regional strategic plan to address the mental health and substance abuse issues that so significantly impacts the homeless population.

4 See Sacramento City Council 12:00p.m. meeting (Homeless Workshop) on June 27, 2023; which can be accessed here:
http://sacramento.granicus.com/GeneratedAgendaViewer.php?view_id=22&clip_id=5618.

The Honorable Michael Bowman
Re: City of Sacramento’s Response to the Sacramento County Grand Jury August 31, 2023

915 I Street, New City Hall 5th Floor Sacramento, California 95814 www.cityofsacramento.org 916-808-5407
R2 The County should immediately begin to develop and implement an interim plan that incorporates all or some of the recommendations in this report and will result in measurable improvement in the delivery of mental health and substance abuse services in the short term.

City Council’s response to R2:

This recommendation is directed to the County of Sacramento, and so no City of Sacramento response is required. The City supports any efforts at a regional strategic plan to address the mental health and substance abuse issues that so significantly impacts the homeless population.

R3 The County should appoint a new Deputy County Executive position by January 1, 2024, that holds budget and policy implementation authority for all homeless services provided in the County, including mental health and substance abuse programs, and to the extent possible, authority over other governmental entities.

City Council’s response to R3:

This recommendation is directed to the County of Sacramento, and so no City of Sacramento response is required. The City supports any efforts at the county level that will serve to streamline the provision of funds and services to address the mental health and substance abuse issues that so significantly impacts the homeless population.

R4 The County should dedicate funds in the 2023-2024 budget for innovative solutions that may not be supported by the County's flow of external funding (Ex: more CRBH sites, outreach teams, substance free transitional housing, board and care facilities).

City Council’s response to R4:

This recommendation is directed to the County of Sacramento, and so no City of Sacramento response is required. The City supports any efforts at the county level that will serve to streamline the provision of funds and services to address the mental health and substance abuse issues that so significantly impacts the homeless population.

R5
The County should immediately begin a process to establish and track outcome data related to the treatment of mental health and substance abuse for the homeless.

City Council’s response to R5:

This recommendation is directed to the County of Sacramento, and so no City of Sacramento response is required. The City supports any efforts at a regional strategic plan to address the mental health and substance abuse issues that so significantly impacts the homeless population.

The Honorable Michael Bowman
Re: City of Sacramento’s Response to the Sacramento County Grand Jury August 31, 2023

915 I Street, New City Hall 5th Floor Sacramento, California 95814 www.cityofsacramento.org 916-808-5407
R6 The County should track funding and spending specific to support homeless, including treatment for mental health and substance abuse, and post this information at least quarterly on the County website in a manner that is easily accessible to the public by the end of 2023.

City Council’s response to R6:

This recommendation is directed to the County of Sacramento, and so no City of Sacramento response is required. The City supports any efforts by the County that improves transparency in reporting of funds and services provided to address the mental health and substance abuse issues that so significantly impacts the homeless population.

R7 Elected officials should immediately take a more active role to lead, coordinate, and consolidate various advisory boards and committees to assume direct accountability for improved outcomes in mental health and substance abuse prevalence and result in a reduction of duplicate efforts, administrative costs, and inefficiency.

City Council’s response to R7:

This recommendation is directed to the County of Sacramento, and so no City of Sacramento response is required. The City supports any efforts that will serve to streamline the provision of services to address the mental health and substance abuse issues that so significantly impacts the homeless population.

R8 Sacramento County should immediately fully staff a total of six HEART teams and the City of Sacramento should immediately establish at least two additional IMPACT Team within Sacramento PD to increase engagement with County and City homeless encampments and improve access to mental health and substance use treatment services.

City Council’s response to R8:

The City agrees with this recommendation. As with most local governments, the City is suffering from severe recruitment issues and funding requirements that would make compliance with this recommendation difficult. However, as indicated above regarding the SPD IMPACT Team, the Grand Jury is operating out of a misconception of the outreach responsibilities of the Sacramento PD’s IMPACT Teams. It is the DCR Community Outreach Division and a third-party contractor, Hope Cooperative, that perform outreach services to individuals experiencing homelessness. Second, the City of Sacramento and the County of Sacramento are in a Partnership Agreement which calls for County staff to assist with mental health and substance abuse treatment services. These services are already in effect, and the teams are already coordinating and collaborating with Sacramento Police Department and its Impact Team. Finally, the City believes that this recommendation is directed primarily to the County, as the County has greater resources to specifically address these types of treatment services.

The Honorable Michael Bowman
Re: City of Sacramento’s Response to the Sacramento County Grand Jury August 31, 2023

915 I Street, New City Hall 5th Floor Sacramento, California 95814 www.cityofsacramento.org 916-808-5407
R9 Law enforcement should communicate at least weekly with all outreach teams to collaborate in decisions as to which encampments to clear and when, and post this information on a shared web site to increase the trust of the homeless and support offered by outreach teams.

City Council’s response to R9:

The first portion of this recommendation has already been implemented. Please see Sacramento City Council meeting on August 1, 2023 at 12:30p.m., Item 4 and the Citywide Homeless Response Protocol is attached hereto as Attachment A. The second portion of this recommendation will not be implemented because it is unreasonable, as it would impact the safety of Sacramento PD employees, as well as the ability of the City to effectively achieve their desired outcomes.

R10 A communication plan should be developed to timely inform all stakeholders and staff of goals, actions, and events related to planning and execution of homeless mental health and substance abuse services.

City Council’s response to R10:

The recommendation has already been implemented between the City and County. The City of Sacramento and County of Sacramento Partnership Agreement, Collaboration Protocol includes an entire section on communication between the City and County. A copy of the Collaboration Protocol is attached hereto as Attachment B. Such collaboration is displayed by the co-deploying outreach teams, as well as the county clinicians who are holding office hours at all city-funded programs to conduct assessments and enroll those living with behavioral health issues into comprehensive services which use a “whatever it takes” approach to get and keep clients permanently housed.

R11
The County should continue to improve incentives and hiring of mental health professionals to meet the demand for mental health services in the County.

City Council’s response to R11:

While this recommendation is directed to the County of Sacramento, and so no City of Sacramento response is required, the City supports the implementation of this recommendation by the County.

S i n c e r e l y ,

Darrell Steinberg, Mayor
City of Sacramento