Opinion: Outrage and fear about homelessness never seems to lead to the obvious choice

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.

Political leaders like New York City Mayor Eric Adams decry the plight of the homeless and promise more and better shelters and permanent housing. But the city’s initial response was an all too familiar reliance on police tactics, such as sweeps of encampments and the subway system.

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.

Multinational studies, including “gold standard” randomized trials in the US, Canada, and France, show that Housing First ends homelessness for 75-95% of people with mental illness by providing immediate access to housing along with 24/7 support. services to ensure your needs are met — mental, physical, and instrumental (food, transportation, money management, job training, etc.). Costing less than a bed in a shelter, jail or hospital, Housing First’s success depends in large part on your attention to building that hard-earned trust.
The Covid-19 pandemic came just as the number of homeless Americans was rising, especially in Los Angeles and New York City. Oddly enough, this terrible disease made possible a major change in homeless services, as unused hotel rooms filled with thousands of homeless people moved from overcrowded shelters and camps to counter living conditions.” superspreaders”.
The differences between these two cities, New York and Los Angeles, could not be greater. New York offers a legally mandated right to shelter and spends billions each year on a massive network of shelters and supportive housing (the latter reserved for homeless people with serious mental illness or other disabilities).
One can only wonder how many homeless families and individuals could receive subsidized housing and rent with these funds considering that a bed in a shelter in New York City costs more than $3,000 a month. To paraphrase Malcolm Gladwell, it is sometimes easier to manage homelessness than to end it.

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.

Beginning with Project RoomKey and later morphing into Project HomeKey, the state under Gov. Gavin Newsom embarked on a concerted effort to house the homeless, whether in “tiny houses,” approved tent cities, or apartments in new or remodeled buildings.
Despite its tragic impact, the pandemic literally opened the doors to empty hotel and motel rooms. Giving the homeless a respite not only from Covid but from the many tribulations of life on the street, a glimmer of hope emerged from the viral scourge.
In Seattle and some California cities, there was political will to convert hotels to housing, and the Biden administration committed additional funds through the CARES Act.

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.

Formal audits and budget calculations revealed that a staggering amount of California’s designated housing funds have not been spent due to local political leaders’ risk aversion and rising construction costs. Unspent federal funds present a frustrating dilemma for housing advocates in many parts of the US.
Where are we now? Some progress has been made in creating new housing units in California, but the need far outstrips supply and the gap is widening. In the summer of 2021, the New York City Department of Homeless Services moved more than 9,000 residents from hotels to the overcrowded shelters they came from, despite continued funding from FEMA.

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.

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