 Okay, we're live. This is Think Tech Hawaii, if you didn't know. And it's Aloha United We Stand, if you didn't know. And it's 12 o'clock. Well, it's kind of a running 12 o'clock. My apologies. 12 o'clock Rock. That's Sherry Coffey. He's a clinical director. We need to know exactly what that means. Of IHS, and IHS is one of the most important, you know, organizations, institutions in the state of Hawaii right now. The Institute for Human Services. And it is saving not only its own constituents there on Nimitz Highway, but all of us. Sherry, tell us say hi and tell us what you do. Hi Jay, thanks for having me. So gosh, I've been at the Institute for Human Services now just about five years. And in that time, what I have done as the clinical director is basically provide leadership and support for what is considered the clinical side of the house in a great big emergency home shelter. We have an administrative staff. We have our operations staff who basically run the shelter on a day-to-day basis. IHS, of course, is open 24 hours a day, 365 days a year. So we have a very large operational staff. And then we have our clinical teams. And clinical teams or clinical staff at IHS basically means about nine different kinds of case management. And the clinical staff at IHS are basically under the direction of about nine coordinators that are just below me. And then about 40, 45 staff who would be paraprofessionals, bachelor's level, master's level, nurses, and a psychiatrist or two also as part of the mix. All trained, all professionals. Absolutely, yep. You said nine, nine categories. Is that nine categories of why? Is this administrative division or is that division of how you characterize homeless? That's a good question. I guess what that would be referring to is roughly we have nine scopes of service. So there are several different. We're fortunate to be funded and to be chosen to be funded. And so the... And one of the funders is the Loa United Way. That's correct. That's why we're here together. But the other side of that coin is the more diverse your funding, the more diverse your services and scopes of service need to be. So we have a lot going on. So we basically have nine or so programs that are under my direction. And I have a wonderful team. I miss often having direct contact with the clients that we serve, because really most of my time and energy is really spent working directly and administering directly to an amazing group of clinicians and case managers and nurses and psychiatrists. And we make beautiful music together. So I'm really grateful to have the opportunity to share in detail what it is that we do. They talked to you about their services to render and the conversations they have. Yeah. And you learn from that on a larger level. I guess you learn what really troubles people out there. What has I think been part of the secret of our success at IHS has been that I feel strongly that teams should cross pollinate. So it is always the case that members from one team within IHS are also bridging onto another team and et cetera and et cetera. And that way processes are much smoother rather than people being kind of only knowledgeable about their department or their processes. Everybody is a generalist at IHS. Any staff that works with me at IHS needs to be a generalist, which means they need to know a little bit about what everybody is doing, because it's a very ambiguous and a very confounding population to serve. And so any time that we have the ability to have an homeless individual in front of us who might be motivated and ready and capable at that time of making change in their life, whoever our staff are at IHS, they need to be able to direct that individual in the right direction. You know, I'd like you to come back over and over again so we can examine exactly what you and they learn about this population. Could we have to analyze? These are people who are in our community like it or not. And, you know, in our lifetimes in the last 20, 30 years, there's been a remarkable increase in homeless. Not only here, but really all over America. In every city, I mean, San Francisco is a really good example. But in Europe too. And to a lesser degree, but possibly on the same track, is countries in Asia. And I asked you before the show began, what causes this? We're in a time now where homelessness is part of humanity. It wasn't before. What happened? That's a really good question. Oh, a deep question. I think we're fortunate to live in a beautiful island culture. And I think we're fortunate that our host culture continues to be very visible and that the host culture is still tangible for us. Native Hawaiian host culture. Correct. And I think one answer to your question is that the things that have sustained indigenous cultures and made it the case that indigenous cultures continue across the planet to have core values and core understandings of what living in balance looks like. I think that as a society and as a world community, we are just for so many reasons getting further and further away from those basic tenets that we still see represented in host cultures, which speak to balance, speaks to inclusion, speaks to charity, kindness, generosity. That's correct. And again, inclusion. Everybody had a place at the table. Everybody's identity mattered. Everybody had a role to play. Everybody was important. And so when you look at a homeless population, it's an incredibly complex and diverse subset of human beings. But one of the things that they have in common is grief. Grief about what? Most homeless people have lost an incredible amount of things that the rest of us take for granted. They've lost relationships. They've lost careers. They've lost limbs. They've lost their health in general. They've lost their health in general. Of course, their dignity. It's still there. So this is a grieving for that loss, those losses. When I facilitate our new employee orientations each month at IHS, we have almost 150 employees at IHS. So we're constantly bringing new folks into the mix. And what I tell the operations crew as I'm kind of orienting them to what they're about to do, relative to working in an emergency homeless shelter, is that culture and ethnicity are important things to observe when working with any marginalized or special population. But really the culture that I'm telling them to pay attention to is the culture of grief and the culture of PTSD. Because those are the two threads. Maybe an answer to your question, that is a common... PTSD? Like in the military PTSD? Yeah, PTSD. You're talking about it in a larger context. It's not just military guys who've been injured psychologically in war. You're talking about people who never went to war. Certainly vets. Yeah, I'm talking about the trauma that is a part of living as an unsheltered homeless person. It is one of the reasons why IHS understood that the City and County's implementation of SIT-LI laws was logical. Because if you look at folks camping on sidewalks, what you see are children. And you also see vulnerable, elderly, mentally ill adults. And so what I hope a coherent society does is makes a decision that that's not okay. And the reason it's not okay for children to be homeless, unsheltered on a sidewalk is because there's drug addiction and drug abuse and prostitution. And it's not a good place. So PTSD is the result of being a victim of crime, of being vulnerable to chronic medical conditions that just keep coming back. Yeah, it's not a fun existence. It's not what you were raised to expect. It's traumatic to find that your life isn't working the way you thought it would. That's correct. But we talked before about living in a complex world, more complex all the time. And technology makes it complex. And maybe some of the complexity that hurts people, that makes them homeless, that shows them that they can't cope. It makes it impossible for them to cope. This complexity, it's a problem. And I think you're right to say that the complexity makes for mental illness and there's a relationship between mental illness and homelessness. And it's all this kind of, I give up kind of thing. Or I don't even know what I'm doing kind of thing. But the other point I wanted to mention, going back to Daniel Ellsberg, because he is my model back in Manhattan in the 60s I guess. He was a psychologist and analyst. And in those days, I grew up there then, in those days there were analysts on every street corner. There were social workers and psychologists and psychiatrists on every street. Everybody you knew was engaged in some way. And you could go on your Tuesday at 3 o'clock weekly meeting or whatever it was. And you could talk to that person and tell that person your inner thoughts, concerns, successes, failures, whatever. And that person was safe. I wouldn't repeat what you said. That person might offer you advice. That person would help you find your own strength. But that went away. There's no more Daniel Ellsberg. There's a few psychologists in the state, a few social workers, but I think they work for the government mostly. Well, I'm one. I have a private practice. Okay, well, I want to find out about that. But my thought is that if we had friends that we could talk to, tell them our most innermost thoughts and try to call it friend therapy, we'd all be better off and there'd be less mental illness in the world and less homeless. I agree. What you're referring to is kind of two things. People being isolated and also disenfranchisement. So kind of on the interpersonal level, it's being isolated from other human beings. And on a social level, it's being really disenfranchised from greater society and not really having the ability to participate or compete in society. Unique to Hawaii, I think, and maybe this is in relationship to what you're noticing. Asian and Pacific Island cultures, it is very common that you have multi-generational households. I think we see this on the mainland as well, but I think it's perhaps more represented here because of the mix of cultures that we have. And so one of the things that causes people to become homeless is when the relationships in those intergenerational homes breaks down. You intermarry, meaning you bring new people into the fold and it's very expensive to live here. The cost of housing could be a whole show in and of itself. So you have a lot of people cohabitating and so there's a lot of breakdown of those relationships and those are often the reasons that people give for why they're coming to our front door or why they're presenting to an emergency room needing help because they're homeless is because the cost of living creates a situation where people will cohabitate and people don't always get along because everybody doesn't have good communication and coping skills. So I think that that's a part of the equation that doesn't get talked about much. And I'm not talking about domestic violence. Of course domestic violence would be a level or a point on the continuum where you would expect that people would move out. Cultural violence. Yeah, yeah, that could be it. Cultural trauma. And of course there's folks from the mainland. It is not a myth that folks from the mainland flock here. Of course they have no support system. They have no... But in general, Jay, you're right. One reasonable assumption you could make about any homeless individual is that they have burned bridges and that they really truly lack the kind of support system that the rest of us might take for granted in the event that a tragedy struck and we needed that level of support. They do not have it. And in many cases their primary relationship is no longer with their family or their people, but it's with drugs. Drugs are a relationship. Primary relationship is with a substance and not another human being. I want to talk to you about this whole day and all night learning so much. That's Jerry Coffey, clinical director. He supervises the entire clinical operation at IHS, the Institute for Human Services. It wouldn't take a minute just to recover from what he was talking about. I'm going to come right back. Hi, I'm Steven Phillip Katz. I'm a licensed marriage and family therapist here in Hawaii and I'm the host of Shrink Wrap Hawaii, which is on Tuesdays at 3 o'clock. Have a great summit. Take care of your mental health. Hello, this is Martin Despeng. I want to get you excited about my new show, which is Humane Architecture for Hawaii and Beyond. We're going to broadcast on Tuesdays, 5 p.m. here on Think Tech Hawaii. Aloha, my name is Josh Green. I serve as Senator from the Big Island on the Kona side, and I'm also an emergency room physician. My program here on Think Tech is called Health Care in Hawaii. I'll have guests that should be interesting to you twice a month. We'll talk about issues that range from mental health care to drug addiction to our health care system and any challenges that we face here in Hawaii. We hope you'll join us. Again, thanks for supporting Think Tech. Jerry Coffey, one of our directors, a very caring man. He's not a woman. He wrote a piece and he circulated around some of the other directors. It was about this Hawaiian notion, going back to his own father back in 1900 or so, where you pass by a Hawaiian house and they offer you food. Right. Or water. Or water. And you sit at their table. I don't know if that happens so much anymore. Maybe they're not even in a position to do that for you. I remember Oz Stender gave a talk for us a few months ago and he said when he was a kid, well, they had nothing. Right. And anyway, the point being that deep in the Hawaiian culture is this thing about generosity and helping people for no reason. Just to be kind and generous. Because it's the thing to do. The thing to do. It's part of the culture. Right. It's what you do. And I think we have lost that or we are losing that and we really have to focus and try to regain that. Not only on an individual household level, but on a community level. Right. But let's go to... Are you aware of the meaning of the word nanakui as a place name? Oh, why? Nanakui in Hawaiian means to look down. And the reason why nanakui, as I understand this story, is that it is such a dry place that back in the day when Native Hawaiians were traveling by foot through that district, because there was so little water, the residents of nanakui did not have water to offer. And so out of the shame that they felt, that they could not extend that very common expected human giving, they would look down in shame and avoid eye contact. And to this day, nanakui continues to have that name. And in reaction to that, the elementary school, Nanaikapono, was specifically the name that they chose for that elementary school, which means to look at with righteous conviction. Wonderful. Isn't that a great story? It is. It's a great story. Think, Tech, we got it all. So, Jerry, we wanted to talk today about the medical problem. And you have a medical, what is it? A medical halfway house kind of thing, where you recover people who are homeless and who have been in institutional medicine and need help in order to extract from that and have a more reasonable medical life. Talk about it. For many years, the Institute for Human Services and Queens Medical Center have had a very symbiotic relationship. In a given week, myself and our nurse, Elizabeth Glenn, we will clear anywhere from 5 to 10 or sometimes 15 hospital referrals just out of Queens Medical Center alone. That would be referrals of individuals coming into our emergency shelter from emergency rooms, from inpatient hospital beds, and also from psychiatric beds. Of course, we receive referrals from just about all the other hospitals as well, but because Queens carries the state of Hawaii on its back, the majority of homeless individuals are expedited to Queens. What we notice... Medicine is more expensive when that happens. Of course. If you have regular medicine screening and checkups and whatnot, it's not nearly as expensive as you take every problem to the emergency room. That's exactly right. And where do most homeless people go for their primary care? To the emergency room. So what I just noticed, and in regular dialogue with Queens, I'm on a first-name basis with practically every social worker and some of the ER docs and certainly the psychiatrists in Queens. There was a very distinct subset of homeless individuals with chronic health conditions that we kept seeing cycle through our shelter and the street and the hospital. And these were folks who, as is often the case, have cellulitis, which is a condition that's associated with diabetes. Cellulitis can become infected, and the therapy for taking care of infected cellulitis is very long and entailed. Doesn't go away right away. It doesn't. It's a serious chronic bacterial infection. It is. And you can lose limbs, and many homeless people that you see with amputations are for that reason. When folks like you and I go to the hospital for our IV antibiotic, which is the prescribed treatment for severe infections, when we are medically cleared to leave the hospital, we may not actually be done with our course of IV antibiotics. So what would happen is you and I would go home and we would take all that expensive stuff out of the hospital room with us, our little buckets and our tissues and all that stuff we paid so much for, and we would have follow-up care. We would have follow-up appointments at an IV infusion center. And maybe if we had a really hot rod health plan, our infusion would come to our home and we would have four to six weeks of... The function of high-tech antibiotics to deal with the bacterial infection. Correct. Homeless individuals don't have that option to go home to some place to complete that course of treatment. And often, having been in a hospital before receiving that treatment, we'll leave the hospital AMA, knowing that this is an infection that has been resolved mostly. It's clean. I've had a few weeks here. I feel nourished. I feel better. And, of course, there is a relationship, perhaps, with drugs and alcohol. And they will leave the hospital. And so there never really is any resolution of that chronic health condition. It can be life-threatening. It certainly can. Let it go and go. And this particular diagnosis is not the only one that we see coming into our medical step-down house. There are others. But I want to back up. And so the name of these two homes, so what IHS has done is we've contracted the Medical Center and also Castle Hospital. They purchased beds. These beds are in two homes. One home is in Kalihi. And the other home is located in Makiki. Each are eight beds apiece. And folks are discharged then from Queens or Castle Hospital into these two medical step-down houses when the alternative for them would have been just to go back to the street. IHS is sort of managing this, yeah? Absolutely. We are responsible for 100% of the operation of the two homes. What happens when folks are released from the hospital, just like if you or I were released from the hospital, there would be home health supports that we would need. And our health plan would pay for those. And the hospital discharge planners would arrange for those. And so what IHS has basically done is we've created two homes. We call it Tutu Burt's house. Claude Dutille, who was the gentleman who founded IHS. His wife was Alberta. And her nickname was Burt. And Claude, of course, has passed on. But Burt is still very aware of what we're doing. She's not directly involved. She's on the mainland, actually, but she keeps up on what we're doing and we love her and we keep her posted. And so we thought, let's name these houses after Tutu. So Tutu Burt's house. Perfect. So when those individuals leave their hospital and they come into either of these two homes, all of the skilled, which would be nursing, and non-skilled services that they would require in order to be maintained in that environment, it's all provided by home health agencies and paid for by their insurance. There are three winners. Actually, there are four winners in this scenario. And it has been incredibly successful and we have had amazing positive outcomes. One winner, of course, is our client. During the time that they're in the house for a period of four to six weeks, we are able to link them to housing. That is something that they maybe have not. Yeah, you have an opportunity. You really work closely with them now. That's exactly correct. They're captive. Yeah, that's exactly correct. Quite literally in some cases. They also win because for many of those people, it could be the first time in their adult life, having come out of a 30-day or a 90-day hospital stay into our home, it might be the first time that they're clean and sober for the first time in a really long time. So it's an opportunity for them to move on those stages of recovery from contemplation to action. There's pre-contemplation, contemplation, action, and maintenance. That's how people recover from addiction. And so we're really getting them at a point when they might be ready to be in action. The other winner in this equation are the hospitals. I have the people around that are going to listen to them. My thing about they should have someone to talk to. They need to talk to that guy in New York City that you remember from earlier. When I hear the debate about Obamacare and I hear people who may or may not understand the real costs and realities of medical care in the United States and health care, I become very frustrated. Hospitals are suffering. I've seen some go out of business. Queens and Castle have struggled to have adequate reimbursement for our sickest and most vulnerable and most chronic utilizers of emergency rooms. That's federal reimbursement. Correct. And inpatient hospital beds. So for a large facility like Castle or Queens to be able to expedite an individual out of an inpatient bed to a lower level of care and despite the fact that they're paying for that, insurance companies are not paying the bill for people to come to Tuberts House. The hospitals are so motivated to move those individuals along that they're willing to pay for that themselves because the cost associated with bringing them to our medical step down house is a fraction of what that hospital is eating on a daily basis. An inpatient hospital day can be anywhere from $15 to $2,500 a day. Right. And the hospital... The hospital has no choice. You know, if the absence of a step down house, you just know you can't put them on the street. And so here's the other winner. The other winner is IHS. We are able to address a housing need for our most vulnerable, homeless individuals. So it's been a wonderful opportunity. Part of their services during the time in the house is we have a case manager, Tiffany. She's amazing. She's dedicated 100% to the folks who come to us from those facilities to try to get them a housing subsidy. In some cases, she's getting them their picture ID, helping them to get their birth certificate, and just doing all those initial steps that are required to get people linked back to benefits and then eventually to housing. Are the two houses sufficient for the number of people who could qualify? Um, no. They're not. What are you going to do about that? We have, uh, since the day we opened Tuberts One and McKee... Here's a picture of... ...in Kalee. Yes, there it is. Yeah. It's beautiful. We've been approached by insurance companies. We've been approached by every other major hospital on the island. At this point, it's just kind of a capacity issue for IHS. Of course, we staff the homes 24 hours a day. We provide all of the food. We often will find that we need to make the homes ADA accessible. Oh, sure. Because that's the population that we have. And there's a little cost for us in that. There's cost for us in all of that. You know, one of the difficult things about running an emergency homeless shelter and programs related to that is that we need to be staffed 24 hours a day. Most emergency homeless shelters do not staff up 24 hours a day. Close up at sundown. Correct. But IHS, we're open all day, and I think we have good outcomes because we have access to our clients. So if I wanted to go to third step down house, what would I need? What would you need? Well, gosh, that's a great question. Like anything having to do with homeless population, what we would need is a landlord or a property manager who was open-minded and sympathetic and willing to partner. We've been fortunate. We have several facilities outside of our emergency shelters. Some of those nine programs I was referring to. But first we would need somebody who owns a home to come forward and offer their home. And we use a rental kind of. Correct. Of course, IHS would become the tenant and we would pay the rent, obviously. And again, to the extent that we would need to make modifications, we do good work, we do quality work. The home that you just saw, we buffed out both kitchens, we buffed out both bathrooms. This was a landlord in Kalihi that's smiling from ear to ear. Does it improve the quality of this property? Considerably. So yeah, we need partners. But I have to say... You have a cookie cutter kind of thing going on. But before we close, we have to close. I just want to say, you can respond, but you missed one. You missed a beneficiary. The taxpayer. Well, the public, the community, all of us need, for example. That's right. And we really appreciate that. You're welcome. Thank you, Jerry. Jerry Coffee. I thank you every day.