- [Announcer] Production and distribution of City Club forums on Ideastream Public Media are made possible by PNC and the United Black Fund of Greater Cleveland Incorporated.

(upbeat music) (bell ringing) - Hello and welcome to the City Club of Cleveland, where we are devoted to conversations of consequence that help democracy thrive.

It's Friday, August 12th, and I'm Nicole Braden Lewis, chair of the Lutheran Metropolitan Ministry Board of Directors and proud member of the City Club.

I am honored to present to you the second forum in the City Club's behavioral health series, which takes a look at the continuum of care for mental health and substance abuse in our community.

Last month, the City Club hosted a conversation that took a bird's eye view of behavioral health.

Today we will take a deeper dive.

Focusing on one of the most medically vulnerable populations, the unhoused.

Lutheran Metropolitan Ministries Men's shelter at 2100 Lakeside is the largest shelter in the state of Ohio, serving up to 365 men per night with an additional 30 to 60 beds available at partner sites.

We know that homelessness and behavioral health profoundly influence each other, often in reinforcing ways.

The unhoused are at greater risk for high blood pressure, asthma, infectious disease, and other chronic conditions.

The experience of being homeless also increases the likelihood of depression and anxiety and can exacerbate existing health issues, including behavioral health issues.

Without safe and reliable housing, things like access to treatment and critical follow up care become a more difficult challenge.

So what are the opportunities and gaps that exist in the continuum of behavioral healthcare amongst our regions unhoused?

Joining us on stage to discuss are Billie Gilliam, clinical Director of Homeless Services at the YWCA of Greater Cleveland.

The YWCA has multiple homeless initiatives and centers, including independence place for young adults, many of whom have aged out of foster care, Cogswell Hall, a 41 unit, permanent solution to homelessness, and the Norma Herr Women's Center, a low barrier shelter for women.

Jennifer Harrison, director of Behavioral Health, Housing and Employment Services at Frontline, which provides 24/7 crisis and trauma services to Cuyahoga County.

Frontline operates the largest continuum of clinical and social services for homeless persons in the state of Ohio.

And Chris Knestrick, executive director of the Northeast Ohio Coalition for the Homeless, which aims to break the cycle of homelessness in northeast Ohio by eliminating the root causes of homelessness through organizing, advocacy, education and street outreach.

Moderating today is Kabir Bhatia, reporter at Ideastream Public Media.

If you have questions for our panelists, you can text them to 330-541-5794.

That's 330-541-5794.

You can also tweet questions @thecityclub and City Club staff will try to work them in to the second half of the program.

Members and friends of the City Club of Cleveland, please welcome me in.

Please join me in welcoming our esteemed panelists and Kabir Bhatia, Kabir.

(applauding) - Thanks very much.

Good afternoon.

- [Audience] Good afternoon.

- Okay.

I've missed that for the last two years, doing that.

So, welcome everyone, and to just jump right into things, we're going to start, we've all been discussing this for a while here, Jennifer, talk a little bit about right now, county is strategically planning everything, the budget, they're looking at the continuum of care.

Where are the gaps that you are seeing when it comes to the continuum of care in this case?

- Yeah, I first wanted to quickly thank the City Club for hosting this important series for the sponsors and the partners in the community who made this possible.

Not every community has conversations like this and so, I really just wanted to take a moment and be grateful for the fact that all of the players are in the room who really influence the systems of care for our most vulnerable members of our community.

So thank you for being here and for your partnership and sponsorship.

I think that many lessons have been learned over the course of the global pandemic, which was in Cleveland, superimposed upon the opioid crisis, about the gaps and also the strengths of our system.

One of the things that I am particularly excited about in terms of the strategic planning process, which is being headed by the Office of Homeless Services and the Homeless Services task force, is the opportunity to use data in a new and different way.

I think that data is really gonna be the key to us creating a more streamlined, more effective, more evidence-based, practice aligned system of care for our system.

So, I think part of that conversation is gonna be to figure out what are the indicators of the health of our system, the health of the participants that we serve, what are the measures of quality, whatever the measures of success for us as a system for the provider organizations and then of course for the individuals we serve.

- Interesting, Billie, you were, when we were discussing this, you were saying you're able to do housing services.

What is the data telling you though about beyond that?

Because you're having trouble getting people beyond that long-term care, that sort of thing, especially with COVID hitting.

- Yes, definitely.

And again, I wanna wanna appreciate Jennifer for going first 'cause she can remind me to thank everyone for allowing me to be in this space, to be able to advocate for individuals who cannot necessarily always advocate for themselves and being part of this process.

And I think for everyone, for just being here and being ready to do the next step.

Now the gap that I see is in services that allow people to sustain their housing, right?

So individuals, we can get them to that space, but there's a series of wraparound services that they need longer than what we're always able to provide that allow them to maintain their housing, right?

So, an individual can get sheltered, but can they sustain shelter?

Do they have the problem solving skills?

Are there the behavioral health or substance use treatment assistance in order to help them maintain that level of care, even in terms of family, when individuals reunite with family, we usually work with just women singular at Norma Herr, but when they're reuniting with family there's not a lot of services that are connected well enough to allow them to sustain their housing.

- In you're finding, and I think Chris, you're finding this too, that your staff is having to do a lot of these things and that's not what they're there for in a lot of cases.

And I think the quote from you was that you're not case workers, you're one-on-one workers.

- Yeah.

When I think about this conversation, and I think about this work, I think about a 75 year old woman that I met living in a bus station last night in a wheelchair.

Or I think about the young man that overdosed under the bridge on the west side of Cleveland, or I think about the person that has so much trauma and is currently sleeping on a porch of a house that they once lived in and they have so much trauma that they carry that, they don't feel like going to one of the shelters is an option for them.

And those are the people that our outreach staff is working with one-on-one.

And I really think some of us successes we've seen, and I think COVID has shown us and has exasperated the mental health and behavioral health on the streets of Cleveland for folks that are unhoused in a way that we are still beginning to understand.

But I think some of our work has, and the work that needs to happen is really to begin to, to really work side by side with individuals and enter into their reality of where they're at, right?

And accompany them into places to be able to get therapeutic care in our community.

You know, I think so much of our system has been, you know, go to this appointment here or show up here.

And I think we don't fully understand that that's really an impossibility for so many of our people, right?

And so, how are we thinking about embedding care into, whether it's the shelter system, whether it's in the street outreach, whether it's in a deeper level, is I think really some of the work that needs to happen.

And I would say the other thing that COVID has shown us is that, you know, the therapeutic model of de-congregating shelters, like has been very successful in getting people access to care.

I think of people that, you know, would've never gone to frontline if they weren't, you know, in a room kind of able to process and be on on their own.

And then being able to be connected to services from there.

Because if they're walking the streets 24/7 trying to find a place to eat, just simply trying to survive, like the idea of getting to an appointment is really difficult and I don't, you know, and so, I think there's, those are some of the gaps and also some of the opportunities that we have moving forward.

- How do you embed something like that on the streets?

- Yeah, I think there are great models.

I think there's some of that work is happening already at Frontline, but I think there's great models of having a psychiatrist like embedded in industry outreach work at a deeper level.

I think there are street psychiatrists work happening all over our country.

And I think, you know, same thing with, you know, like medical street outreach teams that are also connected to behavior health and really coupled with some type of care kind of navigator or peer navigator to be able to really get to places and and get access to hospitals and the care they needed in hospitals.

- When you're trying to get people into hospitals though, you find a lot of times that's problematic.

It's not possible financial barriers, that sort of thing.

How do you get around that?

- There are, one I wanted to actually just thank the hospital systems for the care that we do get to have, let me just start there.

- I'm not trying... - But I still them.

- Not trying to dump on the hospital systems, but you know, there's always gonna be issues.

- But I already, especially with COVID and the confounded with what they've had to deal with is even harder now, right?

In order to have individuals get the care they need for a population that's so transient, right?

And we're really good, like at this like acute compassion acute empathy thing, right?

We can handle the moment situation, it's when we're asking for chronicity compassion, chronicity empathy.

When we're looking for things to say, let's not just look at the situation that's happening with the individual, how about the system that's maintaining the situation that's happening with the individual?

And I think that's where we tend to falter a lot because even in the hospital they see an individual that's stable, right?

But this individual is not necessarily stable in the shelter environment, you know, and they see the individual, what we see is a exponential impact that happens across the board.

So one person's psychotic episode triggers and it becomes this impact that the entire staff is impacted by.

So, there are barriers in making sure that the care is consistent, I would say.

And even just, it's not always just about, usually what I'm working with the hospital is like, is this person going to kill someone else?

Is this person going to kill themselves?

Those are usually the extremes, but it's, it's not just that they're not always psychologically safe for themselves and or others.

So that's where there's a barrier in order to handle that population that we're not really called to handle in the shelter.

'Cause we're trying to get individual's housed and get to the next step.

- True, true.

Are you finding the same thing at Frontline?

- We are, I think that with the introduction of the behavioral health urgent cares that the centers spoke about in the first part of the series, I think we're slowly adding more pieces of the puzzle to our continuum, but I think we have a long way to go.

We have an under-resourced and very overwhelmed system, particularly after COVID that's trying to grapple with the demands of arising need for services at all levels, at the acute level, at the chronic level.

So, when I think about, you know, the situations that we encounter in the permanent supportive housing space, we have individuals who are in behavioral health crisis and who need some more options rather than just a 24 hour, you know, stabilization period in an emergency department.

They need some sort of an intermediate space to go.

So I think that, I think that we're slowly working on strengthening and making sure that people aren't falling through the holes of that safety net continuum of care.

But that's really what we're seeing as a need in our space as well.

- When folks come to any of your facilities and they've interfaced with police who are trained in CIT talk about, I know that's a related topic, talk about how that's a benefit or you know, it's a problem when that's not been the case when CIT isn't there because I imagine that's going to make it even more difficult to deal with the issues that they're experiencing and get them into something long term.

This is for any of you.

- Well the utilization of the CIT from Cleveland Police Department, the only problem I see is that they don't already have a relationship for the most part developed with the guests that stay with us, that reside, right?

And so, there's not this consistent ongoing understanding between the guests and whoever police officers providing the services.

What we've done at Norma Herr is develop our own CIT team, right, we had initially police officers, then we moved into security professionals who were contracted in.

And it really is not fair to security professionals who are paid, contracted in at $10 an hour who worked at Walgreens yesterday and now they're working at a place today in an environment that's so very different, from what they're acclimated to and it's so challenging.

So we end up learning that it was better to look at individuals who have a certain temperament and who we can train in the same type of model that the police are trained in that provide that level of service on site.

And it has definitely been successful in terms from my perspective, I see incident rates going down dramatically in-house.

So I'm very happy and excited for the team who assisted in putting that together.

- But not everybody can do that, right?

- Yeah, I think.

- Put together their own team, I mean.

- Yeah, but I think that's a model that we should be looking at in our community.

I mean I, you know, I don't know if it's appropriate to have the police officers that are entering into behavior health crisises.

I mean, I don't know if that's their role.

I think we have trained amazing social workers in our community and medical staff that would be more appropriate to be able to deal with a mental health crisis that's on the street, whether it's in public square or a particular house.

And so I think some of our work, and I think you'll, I think there's another City Club coming up to talk about this is like what does a care response model look like in our community?

We've seen successful models throughout the country of non-police intervention around mental health crisis.

And I really think that that's, you know, I think when I think of like when you know someone is a threat to themselves or others and we, you know, and there was a probate out for someone for to hospitalize one of our clients that we work with that, you know, oftentimes it's, you know, we're the ones that like are the in between to work with them, to get them into care.

It's, you know, and so I would really, I think it's a challenge that we have to look at is that like how can we imagine a CIT team that doesn't involve, you know, the policing.

And I think, you know, clearly there's reasons that, you know, sometimes police might be involved in something, you know, criminal activity or whatever.

But I think that definitely it's easy.

It should be a no-brainer to say that, you know, if we have people sleeping on RTA stations that don't have housing and are struggling with their mental health, like police are not the appropriate people to deal with that, right?

Like it should be, it should be mental health work, it should be outreach workers, street outreach workers, I would say peer to peer people that have been there before.

And that would be, and I think that's a challenge in our community.

And I think those conversations are happening and I think they need, you know, they should be happening and we should be really moving towards that direction.

- What's it gonna take to make that happen?

Is it ARPA dollars?

'Cause we're talking about ARPA dollars these days.

What do you, you're smiling, what do you think?

- I do think it's a system mindset change, you know, and I completely agree in terms of the police are not always the most appropriate.

To me that is a really last resort that I want the police to be called.

A, because their job is to enforce the law, right?

And so I get that, I understand that, but then there's so many, so much context associated with what's happening with a particular guest at that moment who is having some sort of crisis.

And that's not, and that's the main reason why I wanted us to make this shift at Norma Herr simply because now when they come, their comfort circumstances that are significant versus being annoyed because this person's stole this person's shirt, you know, so the the goal for me is to utilize the police only when we absolutely have to.

I don't think it's impossible, honestly.

I do think it's a mind shift.

And I do think we have to find individuals who can sustain and not just, it's not just an issue of training, you know, it's also an issue of the culture of where you work and whether or not you see it as, you know, having preemptive relationships.

To me, crisis intervention begins at the moment of relationship.

You meet a person, you connect with the person, that's crisis intervention.

It's preemptive.

You start there and then you recognize those individuals who might be high utilizers of crises and you build relationship with them.

And so that way when a situation does happen, the team has a better chance at redirecting or at least allowing or suggesting other services for the person to provide.

And we know who to navigate those people to in the shelter 'cause they've all have relationships with various different CIT members.

- [Kabir] Yeah, that's a good point.

- I also think part of our response as a community is exactly what Billie said in terms of redefining a crisis.

So what is a crisis?

I know that from Frontline's perspective operating the 24/7 mobile crisis team, there are real acute crises that we need to police assistance with.

And so part of the opportunity that we have ahead of us with strategic planning, with thinking differently is to think differently about how we partner with police.

I know that we have several co-responders who are social workers and they accompany the Cleveland Police to intervene in mental health situations so that the appropriate response is given.

So yeah, I just think that that is a real opportunity for our system to think differently about how we partner with the criminal justice system.

- Not to put them on the spot, Metro Health is here and you were saying Metro Health has done a lot of this good, maybe not so much on CIT, but a lot of work during the pandemic with helping to get people into long-term care, that sort of thing.

- Yeah, I mean, a huge shout out to Metro Health and their team of doctors responding during the pandemic.

I mean, there is no doubt.

(applauding) You know, from mass testing to vaccinations to, you know, meeting a need when, you know, as urgent as being unhoused during the pandemic.

There's no doubt that Metro Health Hospital has stepped up and, you know, is continuing to think about like what are their next steps in care for the unhoused community.

You know, going back, I do think that there is, you know, I would lay out a challenge to the hospitals also, and it'd say that like no one should ever be discharged from a hospital into homelessness, right?

Like that no one should ever be discharged into the hospital into homelessness right?

(applauding) Whether it's from a behavior health case or you know, primary care that, and we see that oftentimes that people are, you know, our people are going to the hospital and then, you know, a couple hours later they're out discharged and living back on the street.

And so, but I think like, yeah, I think there's, you know, having a system and I, I'm also excited about the strategic planning that the continuum's undertaking and thinking about these issues and the gaps because it, I think it's, you know, no one agency is solving all these problems, right?

It's a systems response from the work of permanent support of housing that Eden's doing to the care that Frontline's doing to the emergency shelter work that Norma Herr's doing to the street outreach work and the advocacy work that we're doing.

Like, you know, this problem is so important and so great that we will have to work together to solve it.

- One group that's within the unhoused, a lot of times, we talked about this, the LGBT community, a lot of times that's someone said, oh boy, in the audience, if you couldn't hear.

A lot of times they maybe have extra difficulty in finding the place that's right for them or they're not listened to.

Women of color a lot of times seems are not listened to in this, how do we get around those barriers?

Is it the mindset changes you suggested or is it more than that?

Must be more than that.

- Okay, there's no- - Any of you.

- I'm happy to take it, but- - No, no, I really believe, you know, that's such a, there's so many services needed in that area, and it's just, you know, we're in such, you know, weird political spaces in terms of trying to find our way, you know, in this and trying to, what's the word I'm looking for?

And trying to find the right services and support for individuals because we're not talking about somebody sometimes who is just, who's unsheltered.

We're also talking about someone, I'm thinking about a young lady right now who was beaten at home because she was transitioning from, you know, male to female.

And so, there's the trauma associated with that, right?

There is this shifting in the political climate and people making changes and in what was normal 15 years ago, it's different today from what what we're seeing.

And so, being able to maintain that while providing care is so difficult and just having the services that, you know, we had a lady, we had a couple individuals who were killed not that long ago.

And it was so hard working through that and trying to get training in for not just the staff but the guest going, "Hey, how do you take care of yourself, you know, when you're out there, how do you do this?"

And you know, and it's too bad that you have to leave, actually have to put the care on the victim, you know?

It shouldn't have to be that way, but it kind of, that's kind of where we are right now.

But being able to provide that level of support and understanding sometimes when people are displaying this aggressiveness that we might see it's rooted in trauma and rejection.

- And, you know, I mean, I think there's no more important issue right now.

You know, Cleveland is the epicenter of black trans murders, right?

You know, we hear about a trans person being murdered in our community almost every year.

And so I think there's no better, no more important conversation of like, how are we building both homeless system that is trans affirming, right?

And that has services that are specifically geared towards the trans experience.

I think we've, I think a huge gap is like, I'm not, I don't know if we're sure, like where do we refer, you know, a trans person living on the street to be able to get trans affirmative behavior health services, right?

You know, and I think, you know, I people, you know, I don't, no one, you know, people aren't discriminating, but they're not trained to be able to work with, you know, the people that we're serving.

And so I think there's a huge gap.

And another challenge in our community is like stepping up and providing trans affirmation behavioral health services, particularly for people that can't go to the private, you know, and are on and need it to be, you know, low income people that need those services.

You know, I think NIAC has done some work, you know, trying to build like a trans affirmation trauma care in our community at the shelter level and have done some trainings around that.

And I think, you know, it's, I think, you know, transphobia exists everywhere, right?

And both exists like within our agencies that we need to eradicate and dismantle.

But you know, the folks in the shelter systems also have a lot of transphobia, right?

And so, you know, even if they're greeted at the front door with a really trans affirmation person, they might, you know, they're fellows that stay in the shelter with them or in their PSH building that might not be that way, right, and so, how are we taking a holistic approach to be able to like, not only train our staff, but really, you know, the work is also like working in the community.

And in our case, it's the community of people that utilize their services.

- Getting the right person to have the relationship, as you all mentioned with the guest.

I think the way you put it was that you have people assigned almost, different guests to different staff members.

That seems like that's going to be the next major hurdle when it comes to helping folks who are LGBT, who are coming in for services.

What do you think?

- I did wanna mention that Frontline received some, some funding from United Way, and my colleagues can speak to this much more specifically than I can, but that there are efforts in our community to focus on the particular needs of that population and support them and their navigation through the homeless system and through the behavioral health system.

So that important work is underway in our community.

- That's very good.

I think that we are about to question time.

So we're about to begin the audience Q and A.

And I'm Kabir Bhatia, reporter at 89.7 WKSU Ideastream Public Media.

I'm moderating today's conversation on the continuum of behavioral healthcare among our regions unhoused.

Joining us on stage here at the City Club are Billie Gilliam, Clinical Director of Homeless Services at the YWCA of Greater Cleveland, Jennifer Harrison, director of Behavioral Health, Housing and Employment Services at Frontline.

And Chris Knestrick, executive director of the Northeast Ohio Coalition for the Homeless.

We welcome questions from everyone, City Club members, guests, and those joining via our livestream at cityclub.org or on the radio broadcast at 89.7 Ideastream Public Media.

If you'd like to tweet a question, please tweet it @thecityclub.

You can also text them to 330-541-5794.

That's 330-541-5794.

And our staff will try to work it into the program.

So may we have the first question, please?

- Hi, this has been very interesting.

My question is for Mr. Knestrick, first off, can you tell us, I'm sure it's hard to have statistics on this, but how many of the unhoused, what percentage of the unhoused in this community in Cuyahoga County, let's say, how many of them primarily have behavioral health problems and what kind, you know, what diagnosis, if you know, like bipolar, et cetera?

But I have another question too.

It's Northeast Ohio Coalition for the Homeless, and I know, and of course the title of this form is on the unhoused, and I noticed there seems to be a shift in terminology from homeless to unhoused.

And so what is the reason for that shift?

Thank you.

- Yeah, I might actually leave it to some clinical people to answer the first question.

I don't want to put you on the spot.

But I think we, in the whole scope of behavioral health services, right, I think it would be, I would venture to say that a large majority of people experiencing homelessness are also, you know, have like our in need of behavioral healthcare.

Like I think our whole society is in need of behavioral healthcare to be honest, after a pandemic and everything else, you know, we've seen.

(applauding) But I, you know, I think like, you know, language is important, right?

And how do we like show dignity to people and dignify people in the language we use, right?

And so, and I think one of the mantras we do at work is like, you know, people aren't problems to be solved, they're people to be ventured with and cared for and accompanied.

And so, you know, I think the word unhoused for me also, like housing is the solution to homelessness and unhoused I think doesn't lay, like no one is homeless because they made a bad decision in their life, right?

Like there are systemic reasons in our community why, you know, one statistic I do know is like why like around 80% of the people that enter into our homeless system are black, specifically black in our community, right, it speaks to systemic racism and injustice that is historical.

And so, you know, I think when we use the word unhoused, I use it because I think it's the burden of our government.

I think it's the burden of our systems because housing is a human right and should be provided to, right?

It is not, so I use it that way, right?

Like they're unhoused because our community needs to come up with a way to provide housing in our community to people because it is a human right.

So that's why I use unhoused.

I think also like people experiencing homelessness and people-centered language first is always really important.

But I think unhoused specifically puts the burden on our community and our civil society to respond to that crisis.

- Part I would add, I so appreciate that because I completely agree that when people speak to homeless, they're speaking to the person, from my perspective, when we speak to unhoused, it's the circumstance.

And I think that systemically we do have, it bears a responsibility back on us to make sure that we solve that circumstance as opposed to looking at the individual going, oh, so we push it back over to them when we speak of that's a homeless person, right?

Versus that's an unhoused person that we now have a responsibility to make visible.

Because I've always said that, that the population is as invisible.

You know, people try not to see, you know, what's in our face every day.

Now in terms of mental health, you know, we'll see the diagnostics of bipolar disorder and the schizophrenia and all those type of things, I do think they're probably a little bit hotter than they need to be.

I will say that the underlying manifestations of multiple issues, it's usually a traumatic experience, right?

PTSD to me is far more pervasive than we're given it credit for, it is far more pervasive, you know, but it's easy to say and you're gonna see people of colors when they get that diagnostic of bipolar disorder, borderline personality disorder.

Very rarely will you see, oh, this is PTSD, so what's happening in this individual's life?

And it's so, it's done so often.

I've only seen a few actual real bipolar individuals in my whole career, you know?

And that is like, that's a different soapbox.

I'm sorry, lemme get off.

That's a different soapbox 'cause it's just such a thing for me.

But PTSD is what we don't tend to deal with the way we need to be.

And that's more, again, a systemic issue versus looking at a person and say, oh, that's bipolar, let me treat this, just the symptoms and not the underlying issues that's causing the manifestation of these symptoms.

- How do you do that?

Oh, go ahead.

- Yeah, I was just gonna address the first part of the question, which was the prevalence of severe mental illness.

So in the general population, about five and half percent of us suffer from severe mental illness, in the homeless population, unfortunately, or the unhoused population, thank you for, words matter, yes.

In the unhoused population, of course that number is over represented to the tune of about 20% of someone who is in a shelter or sleeping on the streets or in something that is not meant for human habitation.

About 20% have a severe mental illness and a significant proportion of those also deal with a co-occurring substance use disorder as well.

So, a lot of barriers.

- And those are all gaps in this continuum that need to be looked at.

We have a next question here.

- Good afternoon, my name is Merle Johnson, I'm a member of the state Board of Education and one of the gaps that I didn't hear mention was the school attendance gap.

I'm wondering what kind of relationships do you develop with the schools to help students with their attendance?

I taught 40 years and I know that I was in Cleveland, we had thousands of students who were unhoused.

And I'm wondering, how do you develop relationships?

Because the state law says that if you're absent a certain number of days, you'll fail.

And so how do we keep our unhoused young people from failing when it's not really their fault sometimes when they can't get to school?

- That's for any of you.

You must have people that come up against this all the time.

- Yeah, you know, Project ACT in our community from CMST is the group in our community that really works with folks that are going to school to be able to continue to get access to school.

I know that, you know, I think federal law requires that you're able to continue to go to the school that you were going to before your experience of homelessness.

And I know there's a lot of, they do a lot of work too with transportation with the families in our community to be able to get them attendance.

I, you know, our, we don't see a lot of school age children like living unhoused in our community, you know?

I think the family shelter system also works really closely with Project ACT to make sure the people that are coming into the system have access to transportation.

But clearly, you know, I think one, something we're seeing is like family homelessness is rising again in our community.

And I think we're fully, not fully like understanding the economic impact of COVID on after some of the emergency ordinances are no longer in our community and what that'll do to our family system.

I think it will be a really rough school year for many families in our community.

And then just to name, I think a place for me would be really upset if I just didn't name that.

Like, I think there's a really important conversation around mental health and youth and young adults in our community and like the need for specific services for young adults, both that are still in school and then have, you know, graduated or moved on.

- I think that question also underscores the interdependence and how inextricably intertwined our systems are.

So, gaps in the education system are reinforcing to, you know, gaps in the homeless service system, the behavioral health system.

So, I think that we need to strengthen all of our systems because we have that recognition that we are all interconnected, we all are dependent on the success of the other systems.

- [Kabir] Could- oh, go ahead.

- The one thing I wanted to add to that is the, at least from my perspective, like I'm not in schools, but what I do know is that there's not the strongest mental health that exists within the classroom setting.

So here's, and why do I mention that?

So, it's not just an individual's experience who's experiencing homelessness or unsheltered who suddenly cannot go to high school or go to school anymore.

When I look at the number of young people that now exist at the shelter, it is, it's shocking.

It's shocking to see someone 19, 20.

Like sometimes people think that there's this series of decades of events that happens that allows an individual to be unsheltered and are used to having a mindset that this is a person who's probably in their fifties to sixties.

Not that that's old cause it's me now, but, but, but that's what the population looks like.

And that's not the case.

We're talking about young, young adults, you know, and that is disturbing.

So when you ask an individual, how far did they go in high school, when, not high school, how far do they go in school?

Excuse me.

We're not just talking about people who dropped out at maybe 11th or 12th grade.

Sometimes these individuals stopped at ninth and eighth, you know?

So that tells you that it's bigger than just the fact that they've lost housing.

There's other issues at play that didn't get addressed along the way.

- If you get them stable though, wouldn't that be an avenue to then eventually they can maybe go back, get that GED or go back to school if they're young enough?

Isn't that something that would be amazing to get some of these folks to be able to do that?

- Amazing is the word so, miraculous.

Go ahead.

- I would just say that I think, you know, the why and a place for me at the Y and the, you know, our community has really come around to try to begin to think about and work with young adults, you know, and youth homelessness in our community, right?

And that work's been led by a place for me Sisters Of Charity, Frontline and Eden.

And they, you know, I think it's, you know, there's work being done to put in a youth drop in center that is specifically geared and will meet, you know, will work to meet some of the needs of young adults experiencing homelessness in our community with specific kind of informed care for young adults, right, including behavior health services and stuff.

So I think, you know, the work that our community has done around ending youth homelessness in our community is, you know, I think deserves to be commended and, you know, that work needs to continue.

And I think the, what's been really great about that work is we're we do it from an intersectional approach, right?

It's all these questions that we're asking, right?

Like, you know, like what is behavior health and racism and LGBTQ community and young adults, like how does that all come together and how do we serve them?

And I think some of the most powerful work has been led by folks with like young adults with lived experience in our community.

And I think that that's really powerful.

- They must be the most effective when it comes to one-on-one, going to interface with people who are going through this now, something they did five years ago.

- Yeah, and something I would stand by is like people, the people that have lived through, been unhoused and have lived experience are the ones that have a lot to teach us about ending homelessness.

- You used the term drop in by the way, for education and then earlier you could maybe have a drop in for mental health services just out on the street.

Where would you, where do we put these things, old storefronts, old churches, libraries?

What are your thoughts?

If you could go to city council, county council and tell them this is what we should do.

- I mean there's, I mean I think we should put it in communities that they, that like in this case, the young adults like are working to pick a place and have a location that they want to choose in Ohio City.

I think we should be really wrapping our arms or supporting their decision to put it where they want to put it, right, because they know where their people are.

And then I think another challenge is like having a community that wraps around them and supports them, right?

Like I think we, you know, NIMBYism is real in our community and it happens for many different reasons and you know, making sure that we're like bringing the whole community together to support, you know, particularly these young people, but also like all, you know, any folks that are vulnerable in need of services, like, you know, I think that's really what we need to do.

- Good point, good point.

You have some applause there.

And we have another question.

- Yeah, thank you.

My name is Jim Reesing, I'm a board member at Frontline.

First of all, you're all amazing and inspiring and it makes me wonder what I'm doing with my life and, you know, I'm extremely grateful and thankful for everything that everybody in this room does.

It's really amazing.

So, thank you.

My question is about police intervention and you guys talked a lot about how do we substitute, you know, behavioral health professionals from, you know, with, I'm sorry, substituting police with the right professionals and mental health crises.

And I wonder if you could talk about that a little more.

Like what really would need to be true to make that more effective?

Is it education and communication and coordination or is it availability of resources or something else?

Like what would really need to happen there to make that more effective?

- I mean, I would say really all of that to be perfectly honest.

You do have to have team members, right?

Who are willing and able and compassionate to be able to walk into a system, into a crisis, you know, and to be able, part of the training, I know for the CIT at the Y is a, the recognition of symptomology, first of all, what do things look like?

So that way words like disrespectful aren't used, like oh, they're being disrespectful or words like aggression.

Like well what is this person actually experiencing?

What are you seeing, right?

So being able to train individuals in symptomology and not just that.

So none of the people in the CIT team are mental health professionals, however, they are trained at recognizing symptoms, right?

They don't have to be mental health professionals to know how to do that, right?

They just have to be educated so that way when someone is declining, they send out a little warning and say, "Hey, check on miss such and such, here's what I'm seeing", right?

So there's gotta be individuals who are willing to pay attention, right?

To be trained in those symptoms, recognizing how to work within themselves in terms of what's happening to you when you're having a intervention, a situation happen with a person.

But it has to be preemptive to me at the point of relationship when you spoke to what needs to happen in terms of where people need to go for, I think people, we need to be able to go in more.

I think we count on people to reach out and I think that's unrealistic, you know?

That we have to reach in and go places we're not always comfortable going, you know.

And provide services for individuals that otherwise would not receive those services.

So, I do think it's an issue of funding for sure, but in training and recognizing that this is a process that will get better and develop over time.

The CIT team at the Y is, I love 'em and they're phenomenal, but they're still developing and we're still polishing this model.

- Good point.

We have a question here.

- Yes, good afternoon.

- [Kabir] Good afternoon.

- We have text question that's come in.

If we know the root causes of homelessness are systemic, like racism, redlining, mass incarceration, what are some systemic solutions that our city or county could provide to help support the gaps?

- Well, that's no small question.

- I was gonna say we need another hour for that.

- You know, I wanna highlight, 'cause it, it made me think of it when you said that the early learning center at the Y, right?

So, individuals who may be at the brink of being unsheltered, right?

If we provide these services, and this is to me important about being preemptive, we provide these services ahead of time, right?

Wrapping ourselves around the family, not just providing academic work for these young ones, but also surrounding them with social and emotional support and providing that same support for their families.

It's increasing the strength of their safety net, right?

So if an individual have a safety net, they feel more at ease with walking through systems, you know, and it helps forge relationship throughout their, you know, academic career.

But what's happening is, in the very beginning, people they go to school, they don't have the services of a kid, acts out or is challenging, they put out of the classroom, that kid gets used to a suspension and it all you see is a transition that's going to possibly end up in a person who is unhoused because of all these circumstances that can happen at a very young age.

So if we can systemically, now the question, my response is not satisfied that entire question, but at least it provides, 'cause I don't like bandaid's, we do a lot of band aiding, you know, but provides at least an early response to a potential circumstance.

- That's a good, good way to put it.

Anyone want to add anything?

- I, yeah, I also think that some of the response, a lot of the responsibility and the work will happen at the system's level with the evaluation of the system using data, disaggregated data, to identify where are the policies and procedures supporting unjust practices in the systems.

And I know for example, the ADAMHS Board, you know, just recently published its own strategic, mini strategic plan to focus on areas of diversity, equity, and inclusion.

So I think a lot of that work is being replicated at other levels and will certainly be included in the office of homeless services upcoming strategic plan as well.

- You know, I would just comment like, you know, on the systemic level, I think, you know, our community needs to really come together and I think it really comes down to housing, right?

Like I think we see the redlining and the historical, you know, prevention of building generational wealth in our black community, and that's, you know, really why, you know, the reason, one of the main reasons why 80% of our system is black in our community.

And I think, you know, we've recent, you know, declared racism as a public health crisis, and I think we really need to be moving towards like what are the big picture stuff?

We have this new influx of money that's coming to our community that offers huge unique opportunities to solve some of these systemic issues and, you know, robust packages inverted into affordable housing in our community.

And, you know, I think some of it is also like continued to move, you know, the city council just passed pay to stay, you know, which is a huge, I think-- (applauding) Win, but I, you know, I think we also need source of income protections in our community to prevent, you know, discrimination in our community.

And then, you know, there's no doubt the intersection between mass incarceration and housing sanctions is so obvious.

So like the next, you know, we need to be moving to fair chance housing so that people that are, you know, returning from incarceration are able to access housing.

And I think those, you know, those are big systemic issues that I think, you know, the money that's coming in our community can solve.

And I think it's really up to us and our leaders to make sure that it is put towards that direction.

- Good point, good point.

We have another question here.

- Hi, this is Lu.

You guys all know Lu is infamous for very strong questions which may crash the party.

(laughing) So, in today's situation here we know healthcare system, especially mental health and about the people without stable housing are two big stigmas in the whole society.

So now you are trying to put two broken systems together.

That's why we are having this party here.

So the question is not only for the panelists, it's also for everybody here.

If we all know these two systems are broken very badly to increase the unhoused population in the community, but unfortunately we can only get a government's help once for a while, maybe decades.

However, the local effort here, CIT in a shelter is a good idea.

But unfortunately poor way to carry that out, I'm the proof of it.

The problem here is all of you sitting here please think about this as a question for you too.

Will you really put your mind and effort into that?

Don't forget, even the United Ways had to withdraw lots of funding into homeless programs a few years back.

So there are lots of mistakes we go along the way to create the gaps we have today as big as Grand Canyon.

So, for example, today's a panelist, we don't see any true representation from the unhoused with mental health issues themselves to tell you why they cannot get the service, why they have no way to reach to outreach to the good idea Billie mentioned that here we have to do in reach.

Lots of good ideas here, but the question is how will we bring all these things as important lessons when we leave this- - [Speaker] Party.

- Party?

(laughing) Thank you.

(applauding) - It sounds like you've all been issued a challenge.

So, what are your thoughts?

We have about two minutes.

You have so many ideas.

We can't fit them all into two minutes, but it seems as though this once in a lifetime, the funding you were just talking about a few minutes ago, that might be an avenue to solve this.

Some of this.

- You know, just to speak to lose frustration over the systems, I do understand.

I understand that.

I do think that, you know, we spend a lot of time dealing with symptoms.

I don't think, and Chris has spoke a lot about that today.

We don't put those fundings and these idea sets and these changes of cultures over systems that maintain them, right?

So we can keep putting bandaid's on things, but it doesn't change the wound, you know?

So if we don't deal with those issues of systemic racism that causes these things and allow ourselves to relieve the oppression of others by acknowledging our own privilege, then we're gonna continue to see this happen.

- What are your thoughts, Jennifer?

Chris?

- Well, I think Lu said it well and that we're all here and that we all have a personal responsibility and some of us have organizational or system level responsibility.

And so that is the question is where do we go from here?

How do we come together to solve the very complex issues facing the homeless system and the behavioral health system?

- Yeah.

(coughing) Sorry.

I have to say this, I think like we need to love more.

Like, we just, like to really basic cores, like Billie said it, like the reaching in is an act of love, right?

Telling someone to go somewhere else is not like a form, you know, is not a form of love.

And I think like, you know, from a systems approach, like the force like building policies based on love and the people that, and not based on, you know, like capital or other reasons, but how do, like what would, what would, how would love require us to spend ARPA dollars is like a good question and I think could be fundamental in how we think about that money and to solve some of these systemic issues.

- Yes, ARPA and love, everyone can mediate on that.

Thank you so much, Chris, Jennifer, Billie for joining us here today at the City Club.

Today's forum is the second forum in the City Club's behavioral health series in partnership with Metro Health, with additional support from Sisters of Charity Foundation of Cleveland and also from the Woodruff Foundation.

We would also like to welcome guests at the table's hosted by Eden Incorporated, Frontline service, Lakewood Congregational Church, the Legal Aid Society of Cleveland, the Living Water Association, Northeast Ohio Coalition for the Homeless, Ohio City Incorporated, Sisters of Charity Health System, the Woodruff Foundation, and the YWCA of Greater Cleveland.

Thank you all for being with us here today.

Coming up next week, Wednesday, August 17th, the City Club will be joined by Nan Whaley, the Democratic candidate for governor of Ohio.

And then on Friday, August 19th, the Cleveland Metro Parks CEO, Brian Zimmerman will discuss what is next for our region's Emerald Necklace.

Tickets are still available for each of those forums and you can learn more at cityclub.org.

That brings us to the end of today's forum.

Thank you once again everyone, to our panelists and thank you members and friends of the City Club.

I'm Kabir Bhatia and this forum is now adjourned.

(bell ringing) (audience applauding) - [Narrator] For information on upcoming speakers or for podcasts of the City Club, go to cityclub.org.

- [Announcer] Production and distribution of City Club forums on Ideastream Public Media are made possible by PNC and the United Black Fund of Greater Cleveland Incorporated.