Welcome to The ONEder podcast. This is your host, CCB. And today's conversation is following a path that we've been taking recently, talking about behavioral health and the people and the places that are providing support to behavioral health. Our guest today is Dr. Brian Greenberg from LifeMoves. And I'm going to say I'm going to call him Dr. B since I'm CCB, but you can call him lots of different things in his practice and he's going to share a little bit more about that with us. So welcome. Dr. B, Tell us a little bit about yourself.

Dr. Brian Greenberg: [00:00:44] Thank you. My name is Brian Greenberg. I'm a psychologist, trained in addiction treatment for 18 years. I was at Walden House, now Healthright 360, kind of overseeing programs and services there. That's kind of high-volume, low-cost substance abuse treatment services and for the last 17 years, I've worked in the field of homelessness. Obviously, there's a big overlap between recovery services and homeless services. Not a perfect overlap by any stretch, but again, it's kind of that high-volume, low-cost service where you try to drive scale, effectiveness and cost efficiency. So, kind of my whole career has been kind of the confluence of driving those three things scale, growing programs to serve a lot of people, and effectiveness and cost efficiency, how inexpensively we can do it so that we can serve more people.

CCB: [00:01:48] So you talked about the overlap of terms. And I'd love for you to help us understand the terms. Mental health and behavioral health are used sometimes interchangeably. And there are some differences. And if you could help us understand that, that'd be great. Yeah.

Dr. Brian Greenberg: [00:02:07] I think from 30,000 ft, the way to separate them first is primary health care from behavioral health care. And we all know what primary care is. People have a primary care physician or a specialty physician. And then under behavioral health care, we like to divide it between mental health care and perhaps serious mental illness or even milder forms of milder challenges anxiety, depression, stress disorders like post-traumatic stress disorder, as opposed to substance use disorders. Now, it's kind of a false dichotomy because substance use disorders we do see as a mental illness, as a form of mental illness. But regardless, under behavioral health care, are mental health services and we separate these two in our homeless service provision, oare mental health services, as opposed to addiction or recovery services.

CCB: [00:03:09] Okay. Thank you. You at LifeMoves are definitely working on interim housing and the support services. And you have that, that third leg of the stool, if you will, is access to resources. But to start us off, there's a term “housing first” and can you help us with a definition or a kind of a history of that particular initiative?

Dr. Brian Greenberg: [00:03:41] Sure. I think “housing first” in terms of shelter services means several things. At the front door, people coming in it means very low barrier to access to shelter or what we call interim emergency housing. Housing that is not permanent, but it's designed to get people off the street and transition them to permanent housing. And “housing first” at the front door means very low barrier to access. So, at the site I'm at now in Redwood City, you're allowed to have basically any kind of pet that's safe. So you can have up to two dogs, people have rabbits, people have reptiles, whatever they had out there on the street or in their car, cats. So that's one example of low barrier. Another low barrier is that we try not to make people homeless or deny them access, for engaging in the behavior that made them cause their homelessness in the first place. So, we deal with people with substance use disorders. People might come back under the influence. We don't really tolerate illegal behavior on site, and we don't tolerate any behavior that is unsafe for others. So, for people struggling with their own recovery, as well as any aggressive behavior, people throwing their weight around. But as long as you can be safe in the community, we welcome you. So people with serious mental illness, people maybe with a bipolar disorder that's difficult to control, in a manic or depressive phase, people with schizophrenia who may have, be having auditory hallucinations or may be delusional, people that use drugs, we try to open our doors to everyone, with the exception of people who cannot be safe in this community. So that the communities are designed to not only be safe, but to feel safe for the most vulnerable residents as well as our volunteers and staff.

Dr. Brian Greenberg: [00:05:54] So that's at the front door. And then “housing first” means that you don't have, I mean, look, 12-13% of Americans have a serious alcohol use disorder. Most of them are not homeless. So, this is you know, what we're trying to get people to understand is they need to be respectful tenants, responsible tenants. But you don't need to necessarily be completely abstinent. Abstinence is the best thing, we work towards that. But what we really want to do is make people great tenants and get them into housing. So to each their own. We have onsite drug treatment in, in many of our emergency interim housing sites seven days a week. And the one I'm in. So we encourage people to engage in recovery services. But the ultimate goal is to get people into housing and that “housing first” that you spoke of means you don't need to have everything perfectly aligned to get into housing, but you do need to be a safe and responsible tenant.

CCB: [00:07:07] So I was, at One Workplace we have been working with LifeMoves in supporting the placemaking that to, to afford the folks new housing. And I was interested to hear more about Safe Parking, the program, if we're talking about “housing first” and how do we get people in.

Dr. Brian Greenberg: [00:07:29] Yeah. So there's, as people that live in the Bay Area or almost any densely populated urban setting realize, we have so many individuals, couples and families living in oversized vehicles. It's a super challenge. Many of these households don't consider themselves homeless, even though they're not hooked up to the five things that homes are hooked up to - water, sewage, electricity, natural gas or electronics. So, our safe parking lots are designed to give people a safe place to park, get engaged if necessary, in any services needed to exit homelessness or exit their vehicle. And especially for families, you know, RVs on the street are not an ideal place to raise your children. So, when we open a lot, what we did in Redwood City, what we're doing in San Jose, is we try to prioritize seniors, the geriatric population and families with minor children first, and then open it up to the general public. But as cities begin to enforce their ‘no overnight parking of oversized vehicles’ ordinances, we're trying to not shift them into the next city, but give them a place where they can be safe, 24/seven 365 and work on that next step.

CCB: [00:09:00] Oh, my goodness. One of the things that we know that we all are feeling is post pandemic, the anxiety has ratcheted up across the entire population. And are you seeing, and we also know that there have been lots of economic challenges as a result of work reductions, are you seeing greater demand for your resources, for your services?

Dr. Brian Greenberg: [00:09:29] Our wait lists are huge, both for families and single adults, we separate our populations by families and single adults. Um, one of the silver linings of the pandemic is we'll never probably build another congregate shelter where you sleep 20 or 40 people in a dormitory or barracks style. Now, every household has their own locked door, their own HVAC, their own window, their own five electrical outlets, their own desk. Families have multiple rooms. Most of our places have ensuite bathrooms. So, we're bringing people in that otherwise would not or may not have accessed shelter. So, yes, our waitlists are huge. Um, you know, and it's really what's driving it is the cost of housing, right? I mean, in the Midwest, rents are a dollar a foot a month. In, on the West Coast, in the Bay Area, rents are about $350 a foot a month. Right? The home I grew up in, in Cleveland, sold during the pandemic for $84,000. That's kind of a rounding error in the Bay Area. So, you know, your payments are three, $400 a month on a home like that. And it's a decent home. It's only 800ft², but it's a it's a three bedroom, one and a half bath, bungalow. But that's how much homes are in many neighborhoods in the Midwest. So you know, there's been pressure on the rental market and on the sales market. Those both ballooned during the pandemic, especially in the Bay Area. So, yes, our waitlists are larger, and it's largely tied to the price of housing. You know, people in California, in the big cities, in Santa Cruz, San Francisco, Oakland, San Jose, Seattle, Los Angeles. There's no more mental illness or addiction disorders here than anywhere else. So, the increase is largely driven by the cost of housing.

CCB: [00:11:36] Wow. Um. Okay, so we're curious about, about placemaking and what types of places are more desirable. And we know that you've done everything from the tiny house to ideally larger facilities for families. And how did, how does your thinking, how does place fall into your thinking? Where does it fit?

Dr. Brian Greenberg: [00:12:09] So in the Bay Area and on the West Coast in general to build housing, permanent housing at prevailing wage or union wage, the cheapest studio is really about $650,000, right? A 600 square foot studio, a very small studio and is about $650 and very few communities are doing it for that cheap. So the price of housing, the developing of housing here is just outrageous. It's very expensive. What we're doing since the pandemic, is modular units, right? So it's not built with sticks. It's prefab, it's trucked in. You can build these transitional units, they could be permanent, but we use them as transitional units, for about a third of that cost or a quarter of that cost. Again, depending on whether there's an ensuite bathroom sink, shower, toilet, depending on whether that's down the hall, depending on land and infrastructure costs, but about a third of that. So that's, when I began this talk, I talked about scaling. So one of the ways we scale is to decrease the cost, the cost per door, and so that we can serve more people. Because we want to visibly and dramatically impact homelessness, right? And if we try to build a $700,000 unit for every period person experiencing homelessness, it would be generations right, before we get all these people off the street because we still probably have more people entering homelessness in many communities than are exiting homelessness.

CCB: [00:13:56] Okay. I'm going to take a little pivot here. And you’ve referenced the large demand that you have, the huge waiting list, and there are staff members who support all of your activities. And are you challenged to find staff members? I went on the website and saw that there are a large number of openings. How is, how is that that demand?

Dr. Brian Greenberg: [00:14:27] So yeah, that's a great question. So we're in a, our business is labor intensive, right, both in terms of keeping everyone safe, again, the most vulnerable residents safe, and in terms of service provision, all of our facilities are staffed 24 over seven, 365 by our staff. We don't contract out with security as other providers do. We'd rather have our people that are, go through an extensive training, staffing our facilities. So, while our retention is good, while we grow, we do have a hard time keeping up with full staff. So, it's very expensive to live in the Bay Area. You have to be committed to this work. We have a great benefit package. We have a competitive wage/salary, but it's very hard to to secure labor. It's easier in downtown San Jose where there's more, there's, there's some more inexpensive housing than it is in Mountain View by Google or in other parts of north Silicon Valley where, again, rents are $350 a foot. And it's very, so many of our staff live in multigenerational families. During Covid, people were afraid to come to work and when they came to work, they were afraid to go home because they didn't want to infect their parents or grandparents or children. So, it's eased up since the pandemic has eased up. But it's labor is, you know, our, we're only as good as our workforce. So, we invest in our workforce. We're choosy, but we have certainly have open positions.

CCB: [00:16:16] Oh, I was just talking with someone from the University of Washington Behavioral Health Services this week, actually. And they were talking about the huge demand for people involved in that, in this particular profession, across the United States and how they're, they're scrambling opening a new training facility, teaching facility, but recognizing very clearly. So we have the added challenge of cost of…

Dr. Brian Greenberg: [00:16:46] Yes, you know, we train about 30 or 35 graduate students who provide mental health services maybe 20 plus master of social work students, and 15 plus psychology graduate students, people getting their PhD or SciD in graduate work in psychology. And that does three things, right? It gives us a well, it first of all, they provide mental health services, and it gives us a recruiting tool as they as they graduate. But it also trains people to work in this field. So, it's a, it's a very large training program. It's all philanthropically funded. And so, it's very expensive. But it really serves multiple purposes.

CCB: [00:17:30] That's fantastic. Um, on your website and I'm going to say on the, on our website, when we publish this podcast, there will be links to the LifeMoves website and any of the organizations or businesses that you're referencing. So, you know, we certainly want to make links for people to get more information if they're interested. But on your website, you have the five-year strategic plan, which is, you know, solid and and I'm going to say simple, which is lovely. But one major portion of it is collaborative partnerships. And you just kind of referenced the philanthropic support that you receive. But tell us, what's the challenge and how does it work? How does the financial model work?

Dr. Brian Greenberg: [00:18:15] So about 55% of our funding comes from government sources. It could be the Veterans Administration, county government, city government, state and federal. About 45% is philanthropically driven. So that money has to start over anew from zero every July 1^st, our fiscal year. So, we rely on the support of the community. I think that since Covid, since things shut down, people are more aware of the unhoused on our streets, in our libraries and our parks, and people want a solution to that. So, people do lean in to that because it's so prevalent now. So, 45% of our budget is philanthropy. Many of our philanthropists, certainly not all, begin as volunteers. Prior to Covid, we had about 11,000 volunteers a year. So as people become familiar with our work, I think that they're driven to contribute in other ways, whether that's in-kind donations or cash donations, in addition to their talents and time. But yes, we're a part of the community and each shelter, whether it's in north, near San Francisco in north San Mateo County or the Mid Peninsula: Palo Alto, Redwood City or downtown San Jose. They're strongly supported by the people in the immediate hood.

CCB: [00:19:47] Well, one of the major drives at One Workplace since we're in northern California from, from Monterey/Salinas, all the way up to the border is volunteering in our communities. And no, we are involved in that. And I'm going to point out on your website the numbers of locations that you do have so that we can drive a little bit more traffic if at all possible, and encourage, you know, listeners to get involved. And if this isn't the right organization to get involved with, if LifeMoves is not it. There are lots of other places and lots of other services that, you know, people can find. So. we we're hugely encouraging of that kind of participation. Um, so I'm going to round up with, you know, more specific, some of the work that, that we've been doing with, with Life Moves and want to say - what's the forecast for, you know, for continued building given the fact that you have the, you get the resources from the places where you do,? How do you plan out?

Dr. Brian Greenberg: [00:20:59] So let me say that during the pandemic, we opened up in Half Moon Bay on the west side of one, that's on the coast, for people not familiar with the Bay Area. We opened up in Mountain View very near Costco, kind of the Google neighborhood where we're building in Palo Alto, um, and the southern end of the city, near San Antonio Road, that's in process. That's going to house both 24 families and about 64 single adults. So, singles and families in the north, north Santa Clara County, but particular all those people in Palo Alto that live in San Francisquito Creek, live on the Caltrain corridor, are in those RVs across from Stanford, for the first time there'll be a place for them to be. We're going to be opening up, we're building now at the corner of Monterey and Branham in in San Jose. It's going to be over 200 doors. So we're scaling right now. These facilities won't be available for maybe ten, 12, 14 months. Um, you know, once the infrastructure is in, the modulars are very quick to connect, but it looks like nothing's getting done. Nothing's getting done. Then in, in a month or two, everything's set up. So, they're very interesting to watch develop. But we're continuing to scale our services. In the next week or two, we'll be opening up a large Safe parking site for oversized vehicles in Santa Teresa light rail, in a lot that's underutilized in west San Jose. So we're scaling constantly.

CCB: [00:22:43] It's just so aggressive. You're exhausting me with everything that you're, that you're working on. Just the conversation around it. And I want to say the it's it's so rewarding for us to be able to work with organizations like LifeMoves, along with all the other customers that we work with,clients that we work with. But we, when we see immediate change, immediate resource taking place, it's definitely it definitely gives us a little extra boost. We're coming to the end of the conversation. So I want to say, gosh, Doctor B, thank you so very much for sharing with us. Is there any last message that you'd like to share with our listeners?

Dr. Brian Greenberg: [00:23:22] I just think that there's a way for every individual, or service organization, or faith-based organization, or family to get involved, whether as an individual or as a group, whether as a volunteer or as a tutor of young children, as a mentor to adults, whether you're skilled or unskilled, there's a way for everyone to get involved in resolving this issue. I think we've all had it with people sleeping on the street. That shouldn't happen in one of the most affluent parts of the planet. And there's a way for everyone and every household and every group to lean in. And please check out our website to learn about opportunities.

CCB: [00:24:11] So you saying that, is going to make me say again on the website, we'll have links to all to life moves and everything that Doctor B's been talking about. The ONEder Podcast is available on all streaming services. And thank you so very much for spending time with us today.

Dr. Brian Greenberg: [00:24:28] Thank you. I appreciate the opportunity.