It was one of the sentiments many families felt as the pandemic dragged on, with one lockdown after another: kids struggling emotionally, possibly heading for a major mental health reckoning.

Now, the last time Windsor-Essex schools were closed because of COVID-19 was in January of 2022 — and it would seem students are about to embark on a school year with no threat of online learning hanging over their heads.

But does the return to normal mean the outlook of our teens and children has also stabilized, or are there long-term effects on the mental health of a generation that are still being felt?

Danielle Campo McLeod, mental health lead for the Windsor-Essex Catholic District School Board, says kids are resilient but it can take awhile on the heels of an unprecedented time. 

“We are building back and putting the supports in place to help them build back, but we’re definitely seeing the effects across the board from JK all the way to [Grade] 12,” said Campo McLeod.

Danielle Campo McLeod is the mental health lead for the Windsor-Essex Catholic District School Board. (Sanjay Maru/CBC)

Jodie Nolan agrees, adding one key issue she’s found is a lack of focus.

“Students are having a really hard time regulating themselves with their attention and emotional regulation,” said Nolan, who specializes with student well-being for the Greater Essex County District School Board. 

“And sleep is a big concern. A lot of students, every room I go in, 50 to 75 per cent of the students JK to grade 12 say they don’t sleep at night. Anxiety is on the rise and the lack of focus is really challenging.” 

‘We’ve lost that ability to small talk’

When it comes to socialization, Campo McLeod says times of isolation over the past few years have dramatically affected students.

“I think one of the most alarming things that I’ve witnessed is that we’ve lost that ability to small talk. If you think about in COVID, we waited for our classrooms to load, right? And so when you walk into a classroom … we don’t see that small talk happening with the kids. So that just organic connection was really lost.”

Most students return to classes across Windsor-Essex, Ont., this week. (Ben Nelms/CBC)

Nolan points directly to the boards’ youngest learners who haven’t had any opportunity to socialize.

“So many of them came in even into Grade 1, unable to cooperate with their classmates and their independence wasn’t there even toileting skills and things like this,” she said.

According to Nolan, students were happy to be back at school last year without interruption, and can build off that normalcy and momentum this fall.

What about teachers? How are they feeling?

As for teachers for the teachers Nolan’s spoken to, they’re concerned about focusing on emotional regulation based on some of the behaviours they encountered last school year, she says.

“To really help students to thrive, feel safe, and get to know each other before they dive into the learning.”

Campo McLeod says a primary goal for the teachers she’s connected with is to regulate anxiety while listening to students’ voices — and providing them the tools to have difficult conversations.

“Just supporting our teachers and our students to really meet those needs of everyone, knowing that the supports are there to kind of walk alongside them as we all kind of navigate this new territory and being able to have that ability that it’s okay to talk about it when you’re having issues or that they know where to go or even what to call it.”

Jodi Nolan specializes in student well-being for the Greater Essex County District School Board. She spoke with Windsor Morning on Sept. 1, 2023. (CBC)

Nolan says she’s hopeful the pandemic won’t have long lasting effects on how teens and children cope with life.

“I’m really hopeful, actually, that they will come out in the end more resilient. So we as educators realize we’re not equipped, we’re not all trained in mental health, but now we are becoming trained in the ways that we can help ourselves and help our students.” 

Specific lessons such as mindfulness curriculum and breathing strategies are being taught, says Nolan, so when students feel anxious and stressed they have tools in the moment to regulate their nervous system and calm down their bodies. 

Windsor Morning9:14Kids Mental Health

It will be the first September in 4 years with no doubt about whether classes will be happening in person. Even though COVID-19 is still around, we seem to be past all the uncertainty. Is that allowing for the mental health of young people to bounce back? Windsor Morning guest host Peter Duck spoke with the people keeping an eye on this for local school boards.

According to Campo McLeod, this fall is an exciting opportunity to focus on mental health and wellness, and providing that education. 

“It’s encouraging to think that one day these will be our adults, and talking about mental health and wellness is just part of their everyday vocabulary. And so that makes me really excited for what’s coming.”

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Linda Hause says a recent shopping trip to her local Walmart in Edmonton was a painful experience.

Hause, who suffers from multiple sclerosis, says sometimes her Walmart has no cashier lanes open, requiring her to get assistance at self-checkout. But she says that on this occasion, the self-checkout attendant declined to help.

“They didn’t seem to understand that I had a disability,” said Hause, who was driving a mobility scooter at the time. “I felt that maybe they thought that I was just being lazy.”

Determined to finish her shop, Hause says she climbed out of her scooter to scan her 40 items — and paid the price.

Linda Hause of Edmonton, who has multiple sclerosis, says she was in pain after she had to pay for her items at Walmart at self-checkout without assistance. (submitted by Linda Hause)

“I was in fairly excruciating pain. It was mostly in my back, but my legs were sore as well,” she said. “I just came home and went to bed with painkillers.”

Hause is one of many shoppers raising concerns about the lack of cashiers in some stores as the number of self-checkouts increases.

She says that ideally, Walmart should always have a cashier option, so people who need assistance are guaranteed to get it. 

“That way, I don’t have to ask for help,” she said. “It’s demeaning.”

Divisive issue

Self-checkout continues to be a divisive issue, with many shoppers embracing it and others, not so much. CBC News interviewed several people who said during recent visits to major retailers, they were frustrated to find cashiers weren’t available — only self-checkout. 

“I’m disappointed,” said Canadian Tire customer, Bob Valcov of Gatineau, Que. “It seems like they don’t really want my business.”

Bob Valcov of Gatineau, Que., says he’s boycotting his local Canadian Tire because during several recent visits there were no cashier and only self-checkout lanes were open. (David Ellis/CBC)

Valcov says he stopped shopping at his local Canadian Tire in June, following several store visits where only the self-checkouts were open and no staff members were available to help him. 

“What I resent is being made to work for the company, being made to do stuff for them,” he said. “[Checkout] is normally a service that, throughout history, they provide to you.”

Self-checkouts on the rise

However, times are changing.

VideoMining, a U.S. market research company, analyzed shoppers’ checkout habits during 1.2 billion trips to more than 1,000 U.S. grocery stores in 2022. 

It found that self-checkout made up more than half (55 per cent) of all customer transactions, a big spike from 2017 when the machines accounted for about one third (36 per cent) of transactions. 

“For the first time we saw a majority of checkout happening at self-checkout,” said VideoMining CEO Rajeev Sharma.

The study also found that self-checkouts made up almost half (48 per cent) of all registers in the stores. In its 2017 study, they accounted for only 34 per cent. 

Convenience vs. customer service

Sharma says retailers like self-checkout because it reduces labour costs, and that customers are increasingly drawn to the machines to avoid long lines at the cash register. 

“The number of traditional checkouts that are open is shrinking,” he said. “If you make a short trip of a few items, you don’t want to get stuck in a line for a long time. So this really is a big convenience factor for many people.”

Sharma says he expects self-checkout use to grow, and notes that some retailers are experimenting with an all-self-checkout model. 

But retail expert Liza Amlani says ditching cashiers is a risky venture, because shoppers remain divided over self-checkout.

Retail expert Liza Amlani says stores that offer only self-checkout are making a risky move, because some shoppers dislike the machines. She said finding the right balance is critical. (Pelin Sidki/CBC)

“We know that many of them don’t want self-checkout, but a lot of them do. So this is where finding the right balance is critical,” said Amlani, with Retail Strategy Group in Toronto. “The customer experience is one of the top measures of keeping people coming back into stores.”

Canadian Tire told CBC News that because its stores are independently owned, they each create their own checkout policy. CBC was not able to reach Valcov’s local Canadian Tire for comment. 

Walmart said it determines staffing based on the needs of each store, and that employees are available at all stores to help customers at self-checkout. Walmart says it’s looking into the case of Hause, the customer who says she was denied assistance.

“Our associates are expected to help as needed,” said Walmart spokesperson Stephanie Fusco in an email.

But Amlani says customers shouldn’t have to ask for assistance.

“This is an added friction point that does not need to exist,” she said. “You have to at least have one [cashier] available for the customer, so that they can check out in a meaningful way.”

WATCH | Self-checkout theft causes problems for retailers, shoppers: 

Self-checkout theft has more stores asking for receipts

​​Self-checkout theft is a growing problem for many Canadian stores, and some have started checking shoppers’ receipts to try and prevent it — despite backlash from customers.

Shoppers Drug Mart policy to offer both

Retailer Loblaw, which owns pharmacy chain Shoppers Drug Mart, says its policy is to offer customers both self-checkout and cashier options at all times. 

Even so, Sheldon Rayman of Brampton, Ont., says that sometimes, there are no cashiers to be found at his local Shoppers. 

“Instead of [self-checkout] being an additional convenience or an additional level of service, it seems to be a downgrade of service,” he said.

In shoppers drug mart yesterday. Cashier asked if I’m paying cash or plastic.

She would only accept cash and forced credit/debit users to use self checkout

—@miltonal57

Jocelyn Winterburn says she’s now avoiding her local Shoppers in Vernon, B.C., after she was told she had to use self-checkout during a visit to the store in January. 

Winterburn worries self-checkout will lead to job losses. “I believe in customer service,” she said. “Why do they want to replace everybody with machines?”

In an email to CBC News, Loblaw offered Rayman and Winterburn an apology, and said that it has contacted their local stores to resolve the problem.

“We are disappointed by the experience these customers have described,” wrote a Loblaw spokesperson in an email. 

In 2019 and 2021, CBC News reported similar complaints from Shoppers customers that they weren’t offered a cashier option. Both times, Loblaw told CBC it expects stores to always give customers a choice when checking out. 

WATCH | Some Shoppers customers say they were pushed to use self-checkout: 

Shoppers Drug Mart accused of forcing customers to self-checkout

Shoppers Drug Mart is accused of forcing customers to use self-checkout rather than a counter clerk during the pandemic. But a retail analyst predicts that people will return to counter service once the pandemic ends.

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In March 2022, John called the police to his home in Mecklenburg County because his 16-year-old son Paul was experiencing a violent behavioral health episode.

John and his wife began fostering Paul and his two younger siblings when Paul was 12 and later adopted all three children. John said child welfare services had been involved in Paul’s life from a young age, and the boy had several behavioral health diagnoses, including ADHD, a disruptive behavior disorder and an attachment disorder. A child with an attachment disorder struggles to form healthy relationships, and they can have trouble regulating their emotions.

“His behavioral issues became apparent really quick, but we were trying to commit to taking care of him and loving him and keeping the kids together,” John said.

EDITOR’S NOTE: Due to stigma attached to mental illness, this article assigns the pseudonym Paul to an adolescent who has experienced psychiatric hospitalization. His father is identified by his first name only. NC Health News verified their identities and reviewed relevant medical records with the father’s permission.

These violent episodes were not new for Paul. When they happened, John said Paul would scream and throw things, sometimes for more than an hour. No one could calm him down. That March day also wasn’t the first time John had called the police to help with his son. Two years earlier, John said he had to physically restrain his then 14-year-old son when he tried to attack other family members. 

After that, John remembers thinking, “If this happens again, we’ve got to find somewhere else for him to live — because we have two other kids… And if this keeps happening, it’s obvious that whatever we’re doing with [Paul] isn’t what he needs, like he needs more help than we can provide.”

At 16 years old, Paul is now over 6 feet tall and 200 pounds, and John said he can no longer intervene. John also says that Paul started using opioid pills and smoking marijuana, which John believes has negatively affected his son’s behavior. So this time when the police came, the parents asked that their son be taken to Atrium Behavioral Health in downtown Charlotte. 

“We don’t feel safe. We don’t know what to do. We really need treatment for him. Please help us,” John remembers telling hospital staff as he explained the violent episodes at home.

But Paul told the hospital staff that he was fine and said he didn’t know why he was there, John said, adding that Paul has learned what to say to get out of situations. The next day, John said hospital staff called and said that Paul was ready to be discharged and he needed to come pick up his son. 

John told the staff no. He insisted they find a psychiatric treatment facility for Paul. He reiterated that he didn’t feel his family would be safe if Paul came home without some kind of treatment. 

“A different person from the hospital was calling me every day, like, very angry, saying ‘I can’t believe that you would leave your kid here. You need to come get him,’” John recalled. 

When John refused to pick Paul up from the hospital, he said that hospital staff threatened to call the county department of social services and file a child abandonment case. A few days later, someone from the county department showed up at John’s door.

There have been stories like John and Paul’s playing out across the state for some time, child welfare advocates say. A lack of outpatient mental health treatment options and services for children with complex behavioral health issues puts families and hospital emergency departments in a hard spot when it comes to finding care for these kids.

Lack of treatment options

In recent years, more people have sought mental health care, particularly in the wake of the pandemic. For many in crisis, the first stop is in their local emergency room. 

“Because of a lack of resources outside of the walls of our hospitals, behavioral health hospitals and emergency rooms are out of space — to the point of it being a crisis,” an Atrium Health spokesperson told NC Health News in an emailed statement. “Too often, behavioral health patients are ready to be discharged — only to have nowhere to go, and hospitals are forced to house them until a bed opens in a residential type facility or a parent or guardian picks them up.

“There are rare instances when, as a last resort, we need to engage the … social services to intervene to help connect families with social and community resources. We recognize this may create challenges for some families, but it is a necessary step in some cases to ensure those patients in immediate need have support in accessing resources and services,” Atrium’s spokesperson wrote. 

Hospital staff being left with no other option but to call their county social services when a child needs help is “an indictment” of North Carolina’s mental health system, said Corye Dunn, an attorney and the director of public policy with Disability Rights NC.

“It’s not because their needs are intractable but because our system is not set up to meet those needs,” she said. “Then it creates this adversarial relationship, where the parents don’t trust the care providers and the care providers don’t trust the parents. Parents are painted as uncooperative or undermining the care planning because they insist that the child’s care meets a reasonable standard.”

Though it’s difficult to quantify just how often this scenario occurs, Dunn said it’s a problem across the state in rural and urban areas. She added that people often hear about the issue of children in mental health crises and think the solution is to create more inpatient psychiatric beds. 

“But the problem is we don’t have any supports — even when there is inpatient treatment offered,” Dunn explained. “The lack of community-based support is . . . allowing kids to go into crisis because they’re not getting what they need at a lower level of intensity. And then on top of that, the lack of community-based services means that it’s very difficult to discharge from an emergency department or a [psychiatric residential treatment facility] or a psychiatric hospital because there’s not an adequate community-based safety net for kids or adults.”

Dunn said that the state’s six LME-MCOs are the groups responsible for managing behavioral health care for those with the most complex needs and for ensuring that there is an adequate network of services available. 

“I think we have to ask ourselves why those services don’t exist,” Dunn said. 

Why hospitals refer to social services

When a hospital calls a department of social services, they are making a dependency referral as defined under North Carolina statute 7B-101, explained Sen. Sydney Batch (D-Raleigh), who is a family law attorney and child welfare advocate in her work outside in the state legislature. The hospital is telling social services that a parent or guardian is unable to take care of their child and does not have an alternative child care setting. 

Other scenarios where this statute could be applied is if a parent was in a coma, entering substance use treatment or a psychiatric hospital and no relative was available to take the child, Batch said. 

“So the key with dependency is the parent is unable to care for the child,” Batch said. “And in this situation, as you can imagine, the parent is unable. They can’t control the behaviors. There are a lot of issues with regards to mental health, and a child needs a higher level of care than the parent can provide.”

Batch says she gets similar calls from clients in these situations. She had a client tell her that their child tried to stab them, and now they sleep with a lock on their door and they don’t feel their other children are safe. Meanwhile, the hospital emergency department said that the child was “medically ready” to be discharged.

“I do have empathy for the hospitals because they are now the dumping ground of the mental health system,” Batch said.

It can be particularly challenging if a parent has private insurance. Private payers don’t cover in-home intensive services or therapeutic placements at the same level as Medicaid, Batch explained. Medicaid often provides more services and better coverage for children with behavioral health needs. Every child that enters the foster care system automatically receives Medicaid coverage, which could open up more placement and treatment options.

“And so the only choice that the hospital frankly has at that point is to call social services to say, parents can’t pick the kid up and you’re going to have to intervene,” Batch said. “And at that point, DSS should call the parents and try to come up with some alternatives to help the parents navigate a very complicated and broken siloed mental health system that we have in North Carolina.”

Foster families need more support

But even with Medicaid, Paul lacked the appropriate support until he went into crisis and his father fought for help. 

John said Paul had intensive in-home mental health services during the pandemic, but because of social distancing protocols, he claimed the workers never came to their home and only met with Paul over Zoom. John said he always felt like they were just going through the motions and checking off boxes in their care of Paul.

Later, when John discovered Paul was using substances, he tried to get his son help. But unless Paul was actively intoxicated, failed a drug test or was in crisis, the local substance use programs said they couldn’t help, John recalled. He said everywhere he called suggested the same handful of programs that were always full, and no one had any new ideas.

Then, as John argued with Atrium’s staff about finding long-term treatment for his son, he said he started calling private and public facilities looking for a treatment placement for Paul. Some of the private facilities were “eye wateringly” expensive, John said, with price tags of $15,000 a month out of pocket.

John held off on picking up Paul from Atrium for two weeks until a placement was found at an in-state psychiatric residential treatment facility. Now, more than a year later, Paul is living in an intensive group home, and John said his son is doing really well. There’s a possibility that he’ll even be able to live at home again soon.

The county department of social services did open a case. In the family’s paperwork, it says the reason was because the parents refused to pick up their son from Atrium Behavioral Health. The social worker’s written plan for the family was simply to keep in touch with the hospital and the department of social services and follow medical recommendations for Paul’s treatment. 

“It’s very toothless. The hospital and DSS makes these threats towards you. The hospital says, ‘We’re calling DSS.’ And if you’ve never dealt with that before, that sounds really bad. And then you find out later that’s the only play they’ve got,” John said. “Then when DSS gets involved and finds out that you’re a responsible parent trying to get help for your kid, they back off.”

Disability Rights’ Dunn argues that the community has a legal obligation to provide support for children with prior social services involvement — even long after they are adopted. 

“I think there is this optimistic notion that if we just recruit more foster parents or adoptive parents, more families to support children, that that is enough. That is important, but it is absolutely not enough,” she said. “We should expect that kids in general — and particularly kids with DSS involvement — may need treatment on an episodic or ongoing basis. So waiting for them to go into crisis as a way to decide how you’re going to hand out services is cruel.”

Attention from state lawmakers

Problems in  the foster care system  have garnered gut wrenching news stories, including reports about large numbers of children in custody with mental health issues, children boarding for weeks in emergency departments, sleeping in social service offices and being sent out of state for treatment. 

North Carolina is one of only nine states in the country that has a child welfare system that’s directed at the state level, but administered by county governments. Of those nine states, North Carolina had the lowest per child investment across all public funding sources in that system, according to a report generated by DHHS in 2018. 

Annual per child investment in child welfare across peers (states with state-led county-administered child welfare systems). Graphic courtesy: NC DHHS,

“There is an urgent crisis of children with complex behavioral needs who come into the care of child welfare services. Each week, at least 75 of these children are sleeping in child welfare offices or emergency rooms because there is nowhere else for them to go,” said a DHHS  spokesperson in an email to NC Health News. 

“North Carolina has long underfunded its child welfare system, ranking last in per-child funding among peer states with decentralized child welfare systems,” the statement continued. “NCDHHS continues to work with lawmakers to make significant, critical investments in the child welfare system that are as urgently needed as policy improvements. NCDHHS is grateful for NCGA’s $5.7M annual investment in kinship subsidies to ensure more children move into a safe and stable home, and we know that greater investment is needed to address our full system.

Departmental leaders have asked for a total of $47.5M to strengthen specialized behavioral health treatment options in community, residential and inpatient settings for kids. The department asked for $20 million to support child welfare and behavioral health workers across the state and another $12.5 million for services to foster care families. 

State lawmakers included several provisions in their latest state budget proposals to help address some of these problems, but not at the level that’s been requested by DHHS.

The Senate budget proposal includes $15 million in additional funds to support new and enhanced Medicaid services for children receiving foster care services. The Senate budget includes the creation of a work group to identify “innovative Medicaid service options” to address gaps in care for foster youth. Work group tasks include: 

• identifying models of community evidence-based practices that support a foster child returning to the child’s family. 
• diverting higher-level foster care placements.
• identifying short-term residential treatment options to serve children with high needs, which could divert a child away from a psychiatric facility placement. 

The Senate budget proposal also orders the state health department to issue a request for proposals for a single statewide specialty insurance plan for children in the foster care system and their families. A bill that would create this single statewide health plan for children and families involved in the foster care system has been discussed for years. This year’s bill has already passed the North Carolina Senate, but it has been at a halt in the state House of Representatives since early March.

The Senate proposal includes a provision of $750,000 in fiscal year 2023-24 to fund the development and implementation of a trauma-informed, standardized assessment for every child entering the foster care system. This screening is intended to assess the trauma experienced by children in the child welfare system. The Senate proposal would require the assessment to be completed within 10 working days of the referral for children ages 4-17. Currently, there is no standard assessment for kids entering foster care. 

Meanwhile, both chambers propose that foster care funds be used to provide financial support to kids who are in a permanent family placement, who are eligible for legal guardianship or who are otherwise unlikely to achieve permanency. 

The House budget proposal would appropriate $2 million in recurring money for the foster care permanency initiative and add $5.1 million in recurring dollars in fiscal year 2023-24 and $10.2 million in recurring funding in fiscal year 2024-25 to support increased payments to relatives caring for a child in foster care and to support child welfare staffing and administrative costs.  

State lawmakers are hashing out the differences between their budget proposals now, and in the coming weeks they will share their consensus budget plan with the public.

This article first appeared on North Carolina Health News and is republished here under a Creative Commons license.

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Each morning, Denise wakes up in her bed at 40 Prado Homeless Services Center and starts her day’s routine.

First, she waits for an opportunity to use the shelter’s shower that accommodates people with disabilities. That’s followed by another wait in the breakfast line, before she spends the rest of the morning tackling her daily cleaning chore.

After lunch, Denise, 73, said, the day slows down. Because of her physical limitations and age, she’s permitted to stay in the dormitory area and lie down during the shift change in the middle of the afternoon.

“I almost never sleep,” Denise said of the rest time. “Then, ta-da! It’s time to get ready for dinner. There’s nothing you can do.”

She may socialize with other residents in the evening, and then it’s off to bed around 9 p.m.

The next day, the whole cycle restarts again, just as it has since Denise started staying at the shelter several years ago.

Homeless for the past seven years and more than 100 spots down on the waitlist for housing, she doesn’t see her living situation changing anytime soon.

It’s problem that’s becoming increasingly prevalent for vulnerable San Luis Obispo County seniors, as the realities of an aging population collide with a lack of affordable housing.

“I’m 73 years old,” said Denise, who used a pseudonym due to privacy concerns. “I’m not moving anywhere — this is my last move.”

40 Prado homeless services center in San Luis Obispo. David Middlecamp dmiddlecamp@thetribunenews.com

Senior homelessness rising with cost of living

Denise’s struggles with SLO County’s high cost of living date back to her arrival on the Central Coast almost two decades ago.

Originally from Cleveland by way of Arizona and Sacramento, Denise said she’s had health issues from a young age. Born with spina bifida and dropped at the age of 3 months, she has dealt with mobility problems all her life.

After 20 years working as a costume designer, Denise said a job-related back injury effectively ended her ability to work. That’s when she visited San Luis Obispo on a four-day trip and decided to move here.

Arriving in 2005, Denise said she was able to obtain a Section 8 voucher due to her disability within around three months of her arrival.

The voucher allowed her to live in Arroyo Grande for the next 11 years, she said. But that all changed, she said, when her landlord kept raising rents to keep up with increases in the value of the voucher.

“He got mad, and he’s started throwing people out,” Denise said. “His excuse was he needed to renovate my mobile home.”

Out of options and homeless, Denise said she tried living in Arizona again, but eventually returned to San Luis Obispo County due to California’s higher Supplemental Security Income. Since returning, she’s primarily stayed at 40 Prado, working with case managers and searching for housing opportunities.

Jack Lahey, homeless services manager at 40 Prado, said around 25% of the shelter’s population is comprised of people over the age of 55, a figure that has crept upwards over the past few years.

The Department of Housing and Urban Development’s guidelines do not prioritize housing seniors in subsidized housing, despite the increased chance of medical vulnerability, Lahey said.

Lahey said seniors are also more likely to score lower on HUD’s Vulnerability Index, a metric that determines risk and prioritization needs for homeless individuals, because that metric does not account for age.

“The oldest person on our by-name list is 82 years old, and they scored a 2 out of 17, which by our criteria … (means) there would be no housing intervention provided to that person,” Lahey said.

Lahey said at 40 Prado, seniors are generally given preference for beds over other younger clients, who may be more physically capable of staying unsheltered.

As part of that prioritization, one of 40 Prado’s five family shelter rooms was converted into a living space for senior and medically fragile women, Lahey said.

Since Lahey joined CAPSLO in 2021, senior homelessness has been a growing issue, and now, the system is straining to accommodate the heightened demand for services, he said.

“We’ve been saying, ‘Oh, this silver tsunami is coming,’ but it seems like now it’s here and we’re in it, and we haven’t really done too much to address it,” Lahey said.

Jack Lahey is Director of Homeless Services at CAPSLO, working at 40 Prado homeless services center in San Luis Obispo. David Middlecamp dmiddlecamp@thetribunenews.com

High cost of living takes heavy toll on seniors

Denise is far from the only senior in San Luis Obispo County experiencing or at risk of homelessness.

According to the San Luis Obispo County 2022 Homeless Point in Time Count Report, senior homelessness is on the rise here. Between 2019 and 2022, the share of people aged 51 to 60 experiencing homelessness grew from 15% of the unhoused population to 26%, while the share of people over the age of 61 grew from 8% to 18%.

Those increases in senior homelessness coincide with rising costs of living and an increased demand for affordable senior housing of every type, SLG Senior Care senior placement specialist Sue Gibson told The Tribune.

Gibson said there are around 110 senior living communities and care facilities in San Luis Obispo County — 86 converted homes with around six beds on average and 24 larger care facilities — and prices at these facilities are almost always out of reach for people on a fixed incomes.

“I probably get at least three to five calls a week, with people that have $1,200 to $1,600 a month income and are in need of assisted living,” Gibson said. “There’s calls every single week (in which) I have to say to people, ‘Unfortunately, there is nothing for you, you’re going to have to stay at home with family.’”

Sue Gibson, SLG Senior Care senior placement specialist, said the prices at senior living communities and care facilities in San Luis Obispo County are almost always out of reach for people on a fixed incomes. Laura Dickinson ldickinson@thetribunenews.com

In Denise’s case, she gets around $1,200 each month in Social Security and SSI benefits. She also receives Supplemental Nutrition Assistance Program benefits, though she said the amount received has recently dropped from more than $200 to around $23 after increased COVID-19 funding for the program ran out.

Gibson said San Luis Obispo County is not yet a part of California’s Assisted Living Waiver program, which would permit seniors to use their Medi-Cal benefits to obtain assisted living.

However, that’s far from a cure-all for this problem anyhow, Gibson said. In counties where the program has already been implemented, it’s only added a few beds, and waitlists can be years long.

For seniors such as Denise who are already several years into a wait for housing vouchers or a place to call home, Gibson said this delay can be extremely damaging to their health.

Homelessness makes consistently staying on medications far more difficult, causing many seniors to go unmedicated and unable to deal with conditions such as high cholesterol, which is common in the lower-quality nutrition often found at shelters and on the street, Gibson said.

Mobility, sight and hearing impairments are also common among homeless seniors, largely due to the physical stress of inconsistent sleep and constant movement, Gibson said.

Likewise, cognitive function is worsened by prolonged homelessness, including conditions such as dementia and Alzheimer’s, making care even more difficult, Gibson said.

Denise, who is gluten intolerant, said she has lost nearly 40 pounds in 2023 between hospitalizations for bronchitis and subpar gluten-free food at the shelter.

An air cleaner and walkers in one of the dorms at 40 Prado homeless services center in San Luis Obispo. David Middlecamp dmiddlecamp@thetribunenews.com

Housing efforts still far behind demand

Efforts to improve housing options for seniors in recent years have accelerated in San Luis Obispo County, but there is still a significant lack of housing that’s affordable to fixed-income seniors.

Elaine Archer, director of housing management at the Housing Authority of San Luis Obispo, said the marginal, 1-2% increases in fixed-income sources such as Social Security and SSI have not kept pace with local rents.

“I think what compounded the issue is that during COVID-19, when the real estate market really took off, it became attractive for people to sell their longtime holdings and cash in on their capital gains,” Archer told The Tribune. “A lot of what has been affordable homes for seniors got sold.”

Seniors are most likely to live in single-family or one-bedroom homes, as most do not live with their immediate family. And that type of housing is almost never available in San Luis Obispo County, Archer said.

Archer said the last time she conducted an analysis of HASLO’s waiting lists in February, more than 1,800 people were waiting to get into one-bedroom units.

She estimated more than 50% of those applicants were elderly or disabled, and demand for one-bedroom units was double that of two-bedroom units.

Building more affordable housing for seniors presents some unique design challenges, which led HASLO to include a requirement of making all ground-floor units adaptable for wheelchair users, Archer said. The organization’s senior affordable housing units almost always include an elevator, she said.

“When we build multifamily (housing), I’ve asked our development team to dedicate as many units as we can to the one-bedroom category,” Archer said. “We’re a retirement community — Morro Bay, South County — people retired here, and we don’t have enough one-bedroom units across the board.”

People’s Self-Help Housing, another of the county’s largest affordable housing providers, has also seen demand spike in recent years, CEO Ken Triguiero told The Tribune.

Triguiero said for every one-bedroom, senior-specific unit People’s Self-Help Housing produces, there are around six seniors on the waiting list. To meet demand, the county needs at least 3,500 units, he said.

Despite the organization’s efforts to increase affordable housing for seniors, applicants on the list are still experiencing waits of around five years, Triguiero said.

“We’re trying to understand the demographics of the folks who are telling us they need this affordable housing,” he said.

As a means of meeting demand, People’s Self-Help Housing is targeting fewer of its projects to one group of people who need affordable housing, instead opting to build more adaptable, generally applicable units, Triguiero said

Similar to HASLO, many of People’s Self-Help Housing’s new multifamily projects that feature one-bedroom units place those units on the ground floor and are built with Americans with Disabilities Act-compliant doors that can accommodate wheelchairs and walkers, Triguiero said.

“If we’re not providing all the accessibility in a new project, we’re at least thinking in the future (that) we might want to convert those, and so we make them ADA-adaptable,” Trigueiro said. “As a senior goes in there, and then lives there over time, they might experience a disability, (and) we can convert that unit pretty easily.”

What’s next?

As it stands, Denise said she doesn’t believe she’ll be housed anytime soon.

Having lived alone all her life, she said she’s not interested in living in the kind of collective housing that most homeless service providers use to place clients in transitional housing.

That limits her options and has been a sticking point in getting her out of the shelter, she said.

She said she’s “frustrated beyond belief” with the lack of progress toward housing she’s made in recent years, and is sure the feeling is mutual with her case manager.

“Now it’s a waiting game — I’m on the list, and if a whole lot of people die, I’ll get an apartment,” Denise said.

This story was originally published June 11, 2023, 5:00 AM.

Related stories from San Luis Obispo Tribune

John Lynch is a housing reporter at the San Luis Obispo Tribune. Originally from Kenosha, Wisconsin, John studied journalism and telecommunications at Ball State University, graduating in 2022.

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Cleveland Recovery and Crisis and Recovery Center on Washington Street.

Theresa Lutz is desperate to find help for her grandson but everywhere she turns, there are closed doors.

She said the 27-year-old was diagnosed with bipolar disorder and has struggled with his mental health since he was a teenager. Recently he spent time in jail after repeatedly calling the emergency number in an effort to seek help and was charged with misuse of the 911 system.

“The magistrate will tell you he does not need to be there, but there’s nowhere else for him,” Lutz said.

Since his release, he’s been living with her, and she and his mother have been trying to find a mental hospital who will accept and treat him but without any success.

“When he goes into one of his meltdowns, he seeks help,” she said. “He has been to various rehabs for his mental health condition.”

Lutz said his most recent episode was triggered by the death of his close friend, and it sent him into a downward spiral. As an adult, he has to seek help himself, and privacy laws sometimes inhibit family from helping or knowing any details of their loved ones’ care.

She said he went to what is now called Cleveland Crisis and Recovery Center, a small facility on North Washington Street. According to the Partners’ website, “Cleveland Crisis and Recovery Center is home to a “behavioral health urgent care,” where citizens experiencing a mental health or addiction crisis can go for help, instead of waiting in the emergency department.”

The facility is open 24 hours a day, year round, and according to the website, while it specializes in mental health and addiction crisis, medical professionals are on staff to ensure medical stability.

“The behavioral health urgent care treats an average of 50 people per month, and more than 90% of people evaluated at the urgent care choose to receive treatment in some type of community-based behavioral health service,” it states.

Lutz said that has not been their experience and her grandson has repeatedly been turned away.

Story continues

“But if it’s mental health, they don’t do anything for you,” Lutz said. “It’s above their level. He was turned down for it.”

A message left with the facility was not returned.

Calling for help

Lutz said her grandson, who doesn’t want to be named to protect his privacy, will call police or the ambulance and when they take him to the crisis center, she said the police will see him be turned away.

“They’ll evaluate him and say he’s too acute,” she said.

They have tried Kings Mountain Hospital’s adult behavioral health unit, but she said they also will turn him away because he does not abuse drugs or alcohol.

His mother, Meredith Lutz, said he has actually sat in the parking lot drinking beer in an effort to receive help.

“The charge nurse has come out and said he doesn’t meet our criteria,” Theresa Lutz said. “He’s not on drugs.”

His mother said Shelby Police have been phenomenal and have done more for them than designated mental health agencies in the county.

“Police have sat down on our porch and talked to [him],” she said. “The police department has helped us.”

The two women are attempting to gain guardianship so they can better help him access services and get care. Right now, because of privacy laws, they can’t discuss any of his care with providers.

Revolving door

Theresa Lutz said he currently receives some psychiatric services through Monarch and Phoenix who are with Partners Behavioral Health, but the visits are all done virtually which she says isn’t adequate.

His grandmother said in April, he called Partners’ mobile crisis line at 8 a.m. when he was having a manic episode, and the police came by twice. She said they are supposed to send someone out, but they got no response. It was raining and when he didn’t get a response from Partners, he wanted to be taken to the crisis agency or the hospital. She said he was so manic he got out of the car and walked in the rain to the hospital.

Finally, his mom said at 12:30 p.m., Partners finally called back, and she said she was told a psychiatrist hadn’t come out because of the inclement weather.

“I asked what’s a good day to commit suicide? A beautiful day?” Meredith Lutz asked.

She said she feels like he’s regarded at the hospital as the boy who cries wolf for seeking help so often.

“He’s been there so much. He’s not got any drugs or alcohol in his system, he’s going for mental health. They will let him go in three hours,” Meredith Lutz said.

With his blessing, his family has had him involuntarily committed. The police picked him up, took him to the hospital and had 72 hours to keep and evaluate him.

“He asked us to do that,” Theresa Lutz said.

She said they kept him for less than an hour.

Cost of care

Theresa Lutz said they have sought help outside the county, but in order to be admitted to a facility he would need to be on Medicaid, and he doesn’t qualify for full Medicaid.

The cost of receiving care is thousands of dollars they can’t afford. Most treatment facilities out of the county cost around $5,000 a week. She said he stayed at Frye Regional Medical Center in Hickory for three days, and the bill was $3,500.

She said he works for awhile and then loses jobs.

“It’s not fair to those who can’t afford it to not be able to get it,” Theresa Lutz said.

She said millions of dollars are raised for cancer, and millions are spent on a new justice center in the county, at the community college and toward other things in the city, but nothing is going towards mental health.

His mom said they are working on getting guardianship so they can help him apply for disability.

Theresa Lutz said recently, while she was sick, she sat in her house for four days and went down the list of mental health agencies in the county and called every one.

“And at the end of the day you’re back at the first number you started with,” she said.

She said they pass her on to someone else. Some don’t return her calls. She has pages of a notebook filled with where she has recorded phone calls to different agencies.

‘Dropped through the hole’

Last month, in desperation, Theresa Lutz attended a Cleveland County commissioner’s meeting and read a letter Meredith wrote about the fight to get her son help and the lack of mental health resources in the county. She said none of the commissioners responded or contacted either one of them later.

“I’m just trying to reach any outlet,” Theresa Lutz said.

She said he calls 911 because they are the only ones who show up and show him concern.

“You keep calling them because no one else is answering your call. We’re trying to get help for him, and nobody cares,” she said.

She said it’s hard enough for her, and she can’t imagine being in a manic state attempting to get help.

“It makes me crazy,” Theresa Lutz said, wiping away tears.

At night she thinks about who she can call and what more she can do. She said it takes a toll on her to not be able to find help and as depressing as it is for her, she can’t imagine how it feels for him.

“This is the frustration families with mental health have,” she said. “I’m trying every avenue I can to push it to the surface. Too many people are getting paid to do this, and there’s not any help.”

She said she thinks of people who don’t have advocates, including veterans, and how easily they end up homeless.

“They’re just dropped through the hole,” she said.

The women want to see a facility in the county that provides mental health and psychiatric care.

“We can’t be the only ones in Cleveland County going through this,” Theresa Lutz said. “It needs to be brought to light how insufficient the mental health system is in Cleveland County.”

Reporter Rebecca Sitzes can be reached at rsitzes@gannett.com.

This article originally appeared on The Shelby Star: Family struggles to get mental health care

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Former prison chaplain Rev Herro Blair Jr has questioned Jamaica’s penal system, wonders if churches are really prepared to deal with mental health, and lamented a lack of empathy.

In an interview with the Jamaica Observer, Blair Jr argued that self-righteousness is to be blamed for the attitude of Jamaicans towards individuals who suffer from mental health problems, which sometimes cause them to commit crimes.

“The options for some people are beyond their own handling. They can’t handle what they’re going through. The ordinary man on the outside says, ‘No, he should not have committed this crime or no, he should not have killed his wife.’ But the truth of the matter is that the mental state of the individual is what leads that person to often commit the crime,” Blair said.

“And that is why the Bible describes dealing with the whole man. The whole man is not just a spiritual man and not just a physical man, but also a man whose mental state has to be dealt with. We’ve lost our empathy, not realising that we, too, can go through the same situation,” he continued.

There is an issue to be dealt with, says Blair Jr.

Blair pointed to reports of increased mental instability among Jamaicans over the last two years, and told the Sunday Observer that the issue has crept over into 2023.

“So, there is an issue there to be dealt with. If a lawyer goes to court and says a man committed a crime because of a [mental] situation, it needs to be addressed, certainly. We, the Church, are not perfect either. From the pastors down to the members, we all go through our own situations and we have to deal with them.”

At the start of the year, Prime Minister Andrew Holness implored Jamaicans to take care of their mental health and to seek help if overwhelmed, depressed, or unable to cope.

The advice came from Holness in his address to the nation on New Year’s Day.

GULLOTTA … inmates are hostages captured among different agencies which are supposed to deal with their trials and them serving time

“Find someone to talk to. We Jamaicans tend to think of ourselves as tough, ‘tallawah’, able to take on and defeat challenges greater than ourselves. However, over time, this tough attitude has led to an ineffective response to personal and social trauma in our lives,” he said.

Further, Blair said that oftentimes, Christians tend to deal with their problems by using prayer only.

“That is not the way to deal with it. There needs to be ways that we can identify and deal with our mental capacity, our mental state,” he said.

“Even me as a pastor going through a divorce and saying to myself, ‘I never planned to get divorced. I never planned to be here. I’m a pastor.’ But then, it happens and you have to face the realities of life; the loss of children, the loss of a wife. It drives you to do things you didn’t even think you would do,” Blair went on.

Meanwhile, Carla Gullotta, executive director of Stand up for Jamaica (SUFJ), said it is necessary to acknowledge that having mentally ill inmates in prison continues to be a concern.

She said the case of Noel Chambers, 81, who died in a facility after a 40-year wait for a trial highlights the urgent need for change.

“Inmates are hostages captured among different agencies which are supposed to deal with their trials and them serving time. The Department of Correctional Services may be an insufficient executor, but fundamental focus has to be on justice system and its lack of accountability. Mentally ill inmates cannot be fit to plead and need to be diverted to community mental health care and for a modern forensic psychiatric facility to be built to provide treatment for the most severe cases,” she told the Sunday Observer.

“The Department of Correctional Services is simply not equipped to deal with mentally ill inmates and as such, it is up to the courts to uphold the human rights of these persons by ordering that they be removed from prisons and be provided with the mental health services that they need. Prison is no place for someone who is mentally ill. Prison needs to become the place where inmates are still considered as human beings and use the serving time to learn a better life.”

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