Homelessness

Understand the homelessness crisis from the inside-out—what drives it, what perpetuates it, and why nothing seems to help.

It’s like like a scene from the slums of India, Nigeria, or Bangladesh. But these are American citizens, living on the streets in America’s most prosperous cities: San Francisco, Los Angeles, Seattle. It’s emotionally jarring: how is it possible that in the wealthiest nation on Earth, people are living in these conditions? How is it possible that more than a half million Americans are sleeping on the streets, in tents, and in emergency shelters?

Governments have mobilized billions of dollars to “solve homelessness,” but there are more tents on the streets than ever.

These are important questions. But despite immense visibility and public attention, it seems as if mass street encampments will be a permanent feature of the urban landscape.

This video is about how to understand homelessness—what drives it, what perpetuates it, and why nothing seems to help.

I. THE NARRATIVE

In order to understand what’s happening with the homeless, it’s important to first understand the stories we tell about homelessness.

In West Coast cities, there is a single dominant narrative—which we could call the “hard times” narrative—that capitalists, landlords, real estate developers, and systemic racism have conspired to put people on the streets. They’ll say that homelessness is a manifestation of income inequality, that a homeless encampment under a luxury condo tower is evidence of capitalism’s moral and economic failure.

This narrative is effective for three reasons:

First, it creates the impression that homelessness is essentially random—the product of chance or raw probability. The subtext here is that “it could happen to anyone” or “you’re just a paycheck away from being homeless.” And, if homelessness can happen to anyone, there is no connection between behavior and outcomes. It removes any sense of “fault” or “responsibility” from the equation.

Second, the narrative suggests that homelessness is a form of social injustice. They cite high rates of homelessness among African-Americans, Native Americans, and LGBTQ, and argue that this disproportionality is, by definition, the result of discrimination.

And finally, the narrative establishes the premise for a policy of unlimited compassion. If homelessness is random—or, even more so, if it’s a form of social injustice—a good society will act immediately to fix it. To help make their case, activists, officials, and the media can deploy a range of affectively-loaded images: people on the streets, people in tents, people suffering. The first human instinct is to say: let’s get them indoors.

II. THE HOUSING HYPOTHESIS

Which brings us to part two: the housing hypothesis.

Cities like Seattle, Portland, San Francisco, and Los Angeles have all settled on a single solution to homelessness: provide housing with no preconditions. It’s a policy called Housing First and the basic idea is that homelessness is fundamentally a housing problem—and, therefore, housing is the solution.

The man who invented it, a psychologist called Sam Tsemberis, has earned the support of the national media and been called “the man who solved homelessness.”[mfn]McCoy, Terrance. "Meet the outsider who accidentally solved chronic homelessness." The Washington Post. Published May 6th, 2015. https://www.washingtonpost.com/news/inspired-life/wp/2015/05/06/meet-the-outsider-who-accidentially-solved-chronic-homelessness.[/mfn] In the past twenty years, the Department of Housing and Urban Development has spent billions on Housing First programs. Los Angeles recently passed a $1.2 billion bond to build 10,000 housing units for the homeless. And California Governor Gavin Newsom recently said that “doctors should be able to write prescriptions for housingthe same way they do for insulin or antibiotics.”[mfn] Newsom, Gavin (GavinNewsom). “Doctors should be able to write perscriptions for housing the same way they do for insulin or antibiotics.”Twitter. Published February 21, 2020.[/mfn]

But here’s the problem. We’ve actually put the housing hypothesis to the test, we’ve gathered the evidence, and it’s pretty clear that Housing First has failed.

First, cities can’t build their way out of the homelessness crisis. In Los Angeles, their $1.2 billion Housing First program has been plagued by construction delays, cost overruns, and accusations of corruption.[mfn] Uranga, Rachel. “FBI probe into Councilman Huizar widens.” The Eastsider. Published January 4, 2019. https://www.theeastsiderla.com/news/news_notes/fbi-probe-of-councilman-huizarwidens-lawsuit-seeks-to-block/article_5441eddc-db57-597b-a4f8-6e999676808c.html[/mfn] They will likely build less than 5,000 total units—while there are more than 59,000 homeless in Los Angeles County. They won’t even make a dent in the problem.

Second, the most progressive cities—which provide the most services and tolerate the most “quality of life” crimes—have shown a strong “magnet effect,” with large numbers of homeless migrating into those cities. In Los Angeles, 35 percent of the homeless migrated to the county after becoming homeless somewhere else, including 19 percent who migrated from out of state.[mfn]“2019 Greater Los Angeles Homeless Count Presentation.” Los Angeles Homeless Services Authority. Published June 17, 2020. https://www.lahsa.org/documents?id=3437-2019-greater-los-angeles-homeless-count-presentation.pdf [/mfn] In the City of Seattle, the number of migrants is an astonishing 51 percent.[mfn]Applied Survey Research. “City of Seattle 2016 Homeless Needs Assessment.” City of Seattle. Published March, 2017. https://assets.documentcloud.org/documents/3480319/ City-of-Seattle-Homeless-Needs-Assessment-March.pdf [/mfn] In effect, migration will always outpace Housing First.

Third, in the big picture, the cities that spend the most money on Housing First have failed to reduce overall rates of homelessness. Los Angeles, San Francisco, and Seattle each spend more than $1 billion a year on homelessness, counting housing, healthcare, and law enforcement costs. And yet, since 2011[mfn]Office of Community Planning and Development. “The 2011 Annual Homeless Assessment Report to Congress.” U.S. Department of Housing and Urban Development. Published November 2012. https://www.huduser.gov/portal/sites/default/files/pdf/2011AHAR_FinalReport.pdf [/mfn], homelessness has increased[mfn] Office of Community Planning and Development. “The 2019 Annual Homeless Assessment Report to Congress.” U.S. Department of Housing and Urban Development. Published January 2020. https://www.huduser.gov/portal/sites/default/files/pdf/2019-AHAR-Part-1.pdf [/mfn] 15 percent in LA, 24 percent in San Francisco, and 25 percent in Seattle. It’s just not working as a strategy to reduce homelessness within their jurisdictions.

III. THE REALITY CHECK

Now this all leads us to part three—and a question: what have the West Coast cities got wrong? A lot, actually. As it turns out, policymakers have misdiagnosed the problem and, consequently, formulated the wrong solutions.

First, let’s revisit the dominant narrative on what causes homelessness—which, officials tell us, is economic misfortune, lack of affordable housing, racial discrimination, and bad luck. But there’s a major omission here. While there is an element of truth to all of these supposed causes, they’re missing the two most dominant causes of all: drug addiction and mental illness.

This, unfortunately, has become a taboo. Merely mentioning the connection between homelessness, addiction, and mental illness will be met with fierce resistance from activists and reporters. But the facts are quite simple: according to a UCLA study, 75 percent of the unsheltered homeless have a substance abuse disorder and 78 percent have a mental health disorder.[mfn] Rountree, Janey, Nathan Hess, and Austin Lyke.” “Health Conditions Among Unsheltered Adults in the U.S.” California Policy Lab. Published October, 2019. https://www.capolicylab. org/wp-content/uploads/2019/10/Health-Conditions-Among-Unsheltered-Adults-in-theU.S.pdf [/mfn] In San Francisco, the Department of Public Health estimates that there are more than 4,000 people in the “perilous trifecta”—being homeless, addicted,and mentally ill simultaneously.[mfn] Rufo, Christopher. “Plot Twist.” City Journal. Published March 10, 2020. https://www. city-journal.org/progressive-narrative-on-homelessness [/mfn]

And there is another element that is forbidden to say, but well documented: the homeless are nearly 100 times more likely to commit crimes and get booked into jail than the average citizen.[mfn] Abt Associates Inc, et. al. “The Applicability of Housing First Models to Homeless Persons with Serious Mental Illness.” U.S. Deprtment of Housing and Urban Development: Office of Policy Development and Research. Published July 2007. https://www.huduser.gov/portal// publications/pdf/hsgfirst.pdf [/mfn] The logic is fairly simple. According to city and federal[mfn]Kilmer, B. et al. “What America’s Users Spend on Illegal Drugs: 2000-2010.” Executive Office of the President of the United States. Published February, 2014. https://obamawhitehouse.archives.gov/sites/default/files/ondcp/policy-and-research/wausid_results_report.pdf[/mfn] data, virtually all[mfn] Applied Survey Research. “2019 San Francisco Homeless Point-in-Time Count & Survey.” Housing Instability Research Department. Published January 1, 2020. https://hsh.sfgov. org/wp-content/uploads/2020/01/2019HIRDReport_SanFrancisco_FinalDraft-1.pdf [/mfn] of the unsheltered homeless are unemployed, while at the same time, those with serious addictions spend an average of $1,200 to $1,800 a month on methamphetamine, heroin, fentanyl, and other drugs. With no legitimate source of income, most homeless addicts support their habit through a “hustle” such as theft, fraud, prostitution, and other property crimes.

And this brings us to the deepest failure of Housing First: it does nothing to address these underlying human problems of addiction, mental illness, and despair.[mfn] The Council of Economic Advisers. “The State of Homelessness in America.” Executive Office of the President of the United States. Published September 2019. https://www. whitehouse.gov/wp-content/uploads/2019/09/The-State-of-Homelessness-in-America.pdf [/mfn] According to a wide range of studies, Housing First programs do nothing to reduce psychiatric symptoms, reduce drug consumption, or even prevent overdose deaths. In fact, in one recent study in Ottawa, Canada, Housing First participants were five times more likely to die than a control group that was simply left on the streets.[mfn] Cherner, Rebecca, et al. “Housing First for Adults with Problematic Substance Use.” Journal of Dual Diagnoses, Vol. 13, No. 3 pp. 219–229. Published April 17, 2017. https://doi.org/1 0.1080/15504263.2017.1319586[/mfn] In other words, enormously expensive Housing First programs sometimes produce worse outcomes than doing nothing.

IV. THE STATE OF PLAY

The irony, though, is that despite these obvious failures—none of the major West Coast cities have reduced homelessness at all—they’re all doubling-down on the same policies that got them here. On the surface, this doesn’t make sense. If something isn’t working, change it.

But there are three critical reasons that these cities find themselves trapped in the status quo:

One, ideology. The narrative about capitalism, racism, rents, and homelessness is extremely powerful—and resists any contradiction. Go to a city council meeting in Seattle, show them the evidence about addiction and mental illness, and see what happens. It subverts their narrative about homelessness and even their own identity as compassionate people. It introduces moral ambiguity: how much of addiction is chance? How much is choice? If a homeless person is committing crimes to feed an addiction, what is their responsibility? The answers to these questions are deeply uncomfortable, so most activists and reporters in these cities will simply stick to the script—and paper over the failures of the current policies by saying “there isn’t enough funding.”

Two, institutions. Remember that homelessness is now a billion-dollar industry in the major West Coast cities. There is now a large network of nonprofits, consultants, developers, service providers, and city employees whose livelihoods depend on the homeless. Most of these individuals are doubtlessly genuine in their desire to help people, but these institutions are not incentivized towards successful outcomes. In Seattle, for example, this so-called “homeless-industrial complex” spends nearly $80,000 per homeless person per year—and has consistently failed to reduce the number of people on the streets.[mfn] Stiles, Marc and Coral Garnick. “The Price of Homelessness: The Seattle area spends more than $1 billion a year on this humanitarian crisis.” The Puget Sound Business Journal. Published November 16, 2017. https://www.bizjournals.com/seattle/news/2017/11/16/ price-of-homelessness-seattle-king-county-costs.html[/mfn]

Three, policy. Despite a dramatic rise in tent encampments, open-air drug markets, and property crime, policymakers have sought to “decarcerate, decriminalize, and depolice” major cities.[mfn] Rufo, Christopher. “Chaos by the Bay.” City Journal. Published April 14, 2020. https://www. city-journal.org/san-francisco-experiment-in-lawlessness[/mfn] In San Francisco, for example, the District Attorney has committed to ending all homelessness-related “quality of life crimes,” including public camping, drug possession, prostitution, and low-level property crimes—all under the theory that enforcing these laws is a form of oppression. But this new policy of mass decriminalization has just concentrated the problems and fed into a sense of greater lawlessness. As one public worker told the San Francisco Chronicle: “The alleys are filled with people who are high as a kite, and they are basically controlled by two drug dealers and a pimp."[mfn] Matier, Phil. “SF homeless tents, once seen as problem, now seen as path to coronavirus social distancing.” San Francisco Chronicle. Published April 12, 2020. February 19, 2020. https://www.sfchronicle.com/bayarea/philmatier/article/SF-homeless-tents-once-seenas-problem-now-seen-15193812.php[/mfn]

V. THE FUTURE

These three obstacles—ideology, institutions, and policy—are formidable.

But the real tragedy in these places isn’t the ideology, the institutions, or the policies—it’s the impact on the homeless themselves, who are left to languish in the streets.

If you spend time with the activists and journalists and policymakers in these cities, they talk almost incessantly about compassion. But compassion can’t be measured by intentions; it must be measured by outcomes. And on that count, these places fail, dramatically. They speak the language of compassion, but have created a system of enormous cruelty. The tents, the drugs, the overdoses, the deaths: all of these are symptoms of personal despair and deep political pathology.

There is the possibility that the addiction epidemic will gradually subside and alleviate what’s happening in the West Coast cities. But for things to change through governance, there will have to be a dramatic shift in how people think about homelessness.

The dominant narrative will have to be broken apart; the institutions must be reformed or refigured; and the policies will have to be reoriented towards order, recovery, and accountability.

It’s not easy, but that’s what it will take to alter the tragic fate of more than 100,000 people sleeping on the streets of the West Coast’s major cities.