Having spent decades researching the needs of the homeless and mentally ill, I continue to marvel at how outrage and fear never seem to lead to the political will to make better and more effective social policies.
Public mental health physicians are heroes in choosing to work in a woefully under-resourced system that is overburdened with patients who need much more than an occasional 10-minute “check-up” visit with a psychiatrist. But it is the patients who ultimately pay the highest price in a society that stigmatizes and shuns them. A healthy recovery is difficult to achieve living without a home and depending on a system that is broken.
Beginning in mid-March, massive sweeps of subways and highway underpasses eliminated 239 of the 244 encampments known to city authorities. Of those who were awakened, only five agreed to go to a shelter, an indication of the dangers and discomfort of crowded shelters. This scenario unfolds in cities across the country.
Having watched such clearings, I am left with a sense of futility as camp residents helplessly watch as their worldly belongings are dumped into garbage trucks, then make plans to regroup elsewhere.
As for solutions to homelessness, the research evidence is irrefutable. An approach known as Housing First has challenged traditional shelter-based policies by offering immediate access to independent housing for homeless people with serious mental illness. Housing First is not “just housing”, it includes a variety of support services necessary for stable living in the community.
Until relatively recently, Los Angeles tended to tolerate the homeless as long as they were herded into downtown’s Skid Row and other encampments largely out of sight. San Francisco’s tolerance level was extended to allowing homeless encampments located near luxury hotels and shops.
Even before the pandemic, however, such hands-off approaches had become untenable, with many cities and the state of California seeking to finance and build affordable housing to address what was becoming an “uncontainable” problem as homeless people camped out on beaches, in parks, and on the streets of affluent neighborhoods.
And yet, the heavy hand of the bureaucratic status quo had to make its presence known. Converting and refurbishing hotels into modest but livable accommodations required changes to zoning laws and expediting building permits, as well as finding developers willing to use their capital funds to purchase the hotels and then renovate them with federal and state funds.
The election of Mayor Eric Adams in New York City and the rise of new Governor Kathy Hochul was cause for optimism followed by familiar disappointment as state and city leaders announced modest increases in housing finance.
However, even that surge in political will dissipated as sweeps of camps and surveillance of subways became the movement of political leaders outraged by the tragic murders that took place.
In short, the response to California’s homelessness has been toward housing rather than shelters, a policy moving in the right direction despite bureaucratic hurdles. The response to New York’s homelessness has been dominated by shelters and the vast network of jobs and expensive building leases needed to keep the system viable under a “right to housing” mandate. Most American cities are pursuing a hybrid of these two disparate responses. Time will tell if pandemic-driven funding increases will actually open doors to permanent housing for the homeless, and now is the time to act.
In the meantime, we know that a person experiencing the anguish of mental illness and homelessness is not destined to murder a stranger. And we know that providing stable permanent housing with loving support can set in motion positive life changes. Public funds are better spent in realizing these goals than in activating police departments to use force and coercion to “handle” the homeless rather than end their ultimate deprivation.