Practicing Harm Reduction with Pattie Wall

By Pattie Wall, HAC Executive Director, and Drew Tillman, HAC Staff Attorney II

On one level, HAC is a legal aid agency dedicated to helping unhoused and unstably housed clients get access to public benefits and stable housing. On another level, though, the agency is a collection of interesting, creative, and thoughtful people. Below is the second of two installments speaking with HAC’s Executive Director, Pattie Wall, who has been at HAC for almost 30 years.

Drew: Over the last decade or so, there’s been a huge increase in the number of people that are unhoused, and it’s obviously become a big political issue. Was there a moment when you noticed that a shift was taking place – both in terms of the reality on the ground for the people experiencing it and in terms of the political climate around the issue?

Pattie: That moment is right now. I’ve been marching around for some months saying “Everything old is new again.” London Breed wants to drug test welfare recipients. We already did that, London. You’re late to the party and it’s unconstitutional. Or the Gavin Newsom proposal, Prop 1, where he says we’re going to take money out of the Mental Health Services Act, which is currently being used, sensibly, for mental health services, and we’re going to build some housing with that and that’s going to solve homelessness. No, it’s not. I think even Gavin could do better.

The anti-homeless sentiment is very, very, very high right now. Cities and counties are responding to business improvement districts and business owners by trying to reduce visible homelessness. They’re closing encampments in Oakland and Berkeley, whether or not they have a place for everybody to go. It doesn’t really matter – they just decided those encampments must be closed. What else are they doing?

The CARE court.

The goddamn CARE court, FFS. So, CARE court provides no new resources for what it’s intended to do, which is to get homeless disabled people into housing. There’s no new source of funds identified in the CARE Act to give people housing. Nobody’s building housing in Berkeley or Oakland for this group of people. Also, the counties that have implemented it so far have very few enrollees. I just think it was, like, a vanity project.

On the left, it seems like the view is that the solution to homelessness is simply more housing. On the right, there’s this view that we need to address the mental health and drug crises. Aren’t both sides correct, though? Don’t we need to address all these things? I’ve seen situations with clients where they’re just not able to sustain housing because of their mental health or drug use issues.

As long as it’s not coercive. I mean, I want people who want treatment to go to treatment. I do not want people to be forced into treatment because (A) that’s a violation of their humanity, not to mention civil rights, and (B) it doesn’t work when you force people to go to treatment. It just doesn’t work. In fact, a lot of treatment just doesn’t work. And people get sober in a million different ways. Some of them go to programs, some of them don’t go to programs. Some of them learn to manage their substance use in a way that hardcore 12-steppers would frown upon.

I think that you have to go back to the ‘70s when there was a giant disinvestment in public funding for housing for all people, but particularly people who are low income. And after that disinvestment, homelessness happened. Also, when I started doing this work, there were SRO’s [single room occupancy hotels] in Oakland where a person on SSI could go in and pay rent every month, and those don’t exist anymore. So, part of it is disinvestment in affordable housing for people and part of it is no new housing stock. Like, I’m a “definitely-yes-in-my-backyard.” Build a lot of it that people can afford.

Including market rate housing?

No. You can build market rate housing if there’s a market for that, but it doesn’t work to build exclusively market rate housing here in the Bay Area where there are many people who cannot afford it. I mean, there are people working at HAC who can’t afford market rate housing based on what they’re paid to work here.

So, you support investing more in mental health services, you just don’t want the provision of those services to be coercive.

I don’t think there are enough mental health services. People who don’t have any insurance at all have zero access right now – except the ER. And then there are people who have Medi-Cal and their access to treatment is totally rationed. And then there are people with private health insurance like us where even our access to mental health resources is rationed. Because: insurance companies.

I’m a firm believer that mental health treatment works. I’ve seen it work miracles in people’s lives. But for our clients to get access to a therapist in this county, you practically have to threaten suicide. You have to say that you’re actively suicidal or homicidal to be prioritized for that kind of one-on-one treatment. And so, we teach people at the outset of mental health treatment to not be candid with what’s actually going on. We teach people to be duplicitous in order to get into treatment.

HAC’s Evolution

In terms of HAC’s programs, how have they changed over the years to respond to this evolving and expanding crisis?

I think it started with the work of the outreach team, so [HAC Manager Attorney/Outreach Supervisor] Heather Freinkel and that gaggle of people who are my faves. They’re amazing. They do outreach in the community in Oakland and in Berkeley, among people who are actually living outside. I think their work changed HAC’s awareness around the encampment stuff in a really good way. They’ve informed our understanding and made us more interested in what we could do for our clients that would help them get into housing.

And then out of that exposure grew our sort of accidental operation of Almost Home, an eight-bedroom Safe Haven house in Berkeley. It’s an amazing little program where people get plucked right out of encampments and put into a transitional household where they get their ducks in a row for a few weeks or months and then move into permanent supportive housing.

What are the metrics that you think about when you consider HAC’s success and whether or not we’re doing a good job?

So, there are of course all the contractual obligations that we have with funders: we’re going to do X number of SSI cases per advocate per year, and all of that stuff – which we actually do very well with by the way. But the first thing I really ask myself is: Are we being kind to people? That is the most important thing to me. Are we treating the people who come through our doors with humility, openness, willingness to be in that moment with them? Radical compassion. That’s really where it’s at for me. So, if we’re doing that, then all of the other stuff is kind of a bonus.

What’s something that you want to see HAC do in the future that we haven’t done yet?

Well, I want a medical clinic, of course. I’m never going to stop talking about it.

I think that we’re going to be doing some more stuff in the housing realm. We’re submitting an application to the City of Berkeley and a church in West Berkeley. The church owns a four-unit apartment building, and they want somebody to manage it. The city will provide the subsidy so that people can pay rent, and HAC will provide a set of services and interventions that will help people stay housed.

I think that our pitch to the city and the church is going to be that we want to serve people over the age of 62 who are currently homeless and help them get in-home supportive services so that someone can be monitoring their activities of daily living and helping them with things like cooking or cleaning or getting to appointments. Also, we want to create a little community inside the building, so that people feel like we’re in it together and we can talk to one another candidly about what are the problems and how do we solve them.

Is that going to work for everybody? No. But is that a sort of radical departure from the way it usually works? Yes. So, we’re positing a more high-fidelity model of case management than currently exists in housing. What people get when they receive a Shelter Plus Care certificate [in terms of case management support] is of a much lower intensity than what we’re proposing.

It’s a higher touch model.

Yeah. Plus: hilarious. Four old people – my age – trying to get along.

You could make a sitcom out of it.

Yeah. So, I’m confident that we can submit a competitive proposal. This housing has already had one organization that operated it and the city was unhappy with the way that it went down. So, it’s vacant now, it’s recently renovated, it’s ready to go. Let’s get some people in there and make our sitcom.

OK, before we go, let’s end with one more softball. What’s one thing that people might not know about you?

I’m a very skilled knitter.

Oh yeah? What kind of stuff do you knit?

Right now, I’m working on some cat toys, but in general, I like stuff that’s on the smaller scale. I like knitting for babies and kids.

Well, there’s, like, three babies coming to HAC soon.

Already have my plan for that.

That’s kind of a dorky thing to be unknown for. I went to a demonstration in New York City once, right after I started working at HAC, when the Pope was visiting Saint Patrick’s Cathedral. Many women in the protest line bared their breasts for the Pope. I feel particularly proud of that little moment.

Well, that seems like a perfectly good note to end on.

I think it’s going to be dull and we’re going to have to revisit it.

[Part 1 of this interview was published in April 2024.]