California governor Gavin Newsom recently announced his administration’s plan to spend more than 1 billion taxpayer dollars to combat homelessness. The Californians footing the bill deserve to know if their investment will abate the crisis, or if this is yet another waste of their hard-earned dollars on the policies that precipitated it in the first place.
As most are doubtless aware, California has a poor track record of dealing with its homelessness problem. The state has spent billions of dollars buttressing a morass of social-service organizations, sometimes called the “homeless-industrial complex,” with little appreciable decline in the rate of homelessness to show for it. In a 2018 report, the Department of Housing and Urban Development found that California had the nation’s second-highest rate of homelessness per capita, and its highest rate of “unsheltered” homeless persons.
But even as the reality on the ground fails to match their utopian vision, state officials continue to regurgitate the same tropes about homelessness, mental illness, and addiction that have become de fide oaths for social-service professionals: A commitment to the “Housing First” philosophy, a dogged insistence upon providing “community based” mental-health services for even the most seriously ill, and an allergy to the enforcement of norms and standards for service recipients. It’s the same recipe that has failed other states and cities with serious homelessness problems.
In California, there seems to be little discernible relationship between the amount of taxpayer money spent on combating homelessness and actual declines in its incidence. While recent data show modest improvements on a statewide level — the same HUD report found that homelessness in California fell by 1.2 percent from 2017 to 2018 — the figures in individual municipalities where the crisis is most acute paint a bleaker picture. San Francisco’s homeless population has grown by at least 17 percent since 2017, even as the city’s government spent an annual $300 million on services for the homeless. Los Angeles County, with the second-largest homeless population of any county in the United States, spent $600 million on services for the homeless from summer 2018 to summer 2019, only to see a 12 percent increase in its homeless population over that span.
Major cities in California are awash in familiar pathologies: A sea of used heroin needles, piles of human waste, and a precipitous spike in crime and disorder. The homeless, while more likely to be victimized by one another than to victimize the broader community, have wrought considerable violence on their non-vagrant peers. Anthony Miele Jr., a 35-year-old from Ventura County, was sitting across from his wife at a steakhouse with his five-year-old daughter on his lap when a homeless man with paranoid-schizophrenia wandered in off the street and stabbed him to death in April 2018. Last November, a mentally ill homeless man dumped a bucket of scalding fecal matter on a passerby in Los Angeles. The victim, hauled immediately off to a nearby hospital, later told reporters that she “was soaked,” by the content of the bucket, which “was coming off my eyelashes and into my eyes.” Angeleno Albert Davtyan nearly died in December 2018 after being attacked at random by a homeless man, who pushed him into oncoming traffic. Davtyan was hit by a truck and suffered severe pulmonary and skeletal injuries.
There’s no denying the dire consequences of the status quo for both the unsheltered homeless and society at large. Californians are not only forced to trek through mounds of human waste interspersed with sidewalk-encampments as they walk city streets, but must also live with a reasonable, if remote, fear that the untreated mentally ill living on the street will lash out violently.
Newsom’s new budget proposal and an associated executive order provide California taxpayers with reasons for both optimism and dismay. One positive development was the executive order’s exhortation to make use “of vacant and decommissioned hospitals and health care facilities” to provide “shelter for individuals who are homeless” on “a short-term emergency basis.” While there is a dark irony in California’s retooling dissolved state mental facilities to serve as shelters for the often-ill homeless population, the impulse to build “shelter” — any shelter — is a step in the right direction for a state with a higher proportion of “unsheltered” homeless than any other in the nation. Although a decision to make use of brownstone hospitals located in rural areas will aggravate certain ideologues in the “Housing First” movement — who insist that the state has an unqualified obligation to provide shelter and services for the homeless in the city in which they reside, with no behavioral prerequisites or strings attached — it is an appropriate use of state land for a population that desperately needs shelter.
Newsom would do well to look to Colorado for a brownstone model that has proven successful. The Centennial State revivified an abandoned state tubercular sanatorium on a 100-building, 530-acre rural campus and turned it into the “Fort Lyon Supportive Residential Community,” which is dedicated to “recovery.” While the campus requires that residents abide by sobriety rules if they wish to remain, the homeless can enter and leave the program voluntarily, and they direct most of their day-to-day lives themselves. Life on the campus includes self-improvement courses, counseling, and medical services, as well as client-directed rehabilitation programs. Residents are offered the chance to work in on-campus jobs to offset the costs of maintaining the aging facility. The facility has been a boon to the local rural community, which was damaged by the closure of its predecessor in 2001.
The results have been impressive. In an extensive August 2018 report from the Colorado Legislative Audit Committee, the state compared residents of Fort Lyon with residents of Housing First–style “permanent supportive housing” units. Comparing the costs incurred by both populations a year before and after their enrollment in the two programs, it was discovered that a sample of Fort Lyon enrollees saved the state 18 percent in total health-care and criminal-justice costs, while the costs incurred by the PSH group rose by 4 percent in that same window. While one might quibble with the sample size (30) used in that section of the document, the report is full of evidence of the Fort Lyon program’s success, including data on the entire population served there. Once described as a “throwback to the dark days” and met with skepticism by certain advocates at its inception, the project has significantly outperformed expectations. James Ginsburg, a homelessness advocate who runs Fort Lyon and previously ran five “Housing First” programs, remarked upon “an argument that Housing First proponents make, that everything should be done in vivo. That you shouldn’t take people out of their environment.” While he affirmed the merits of that aim for some homeless people, he claimed that “for heavy substance users, in vivo is counterproductive. Your vivo is killing you.”
Governor Newsom seems to understand that removing the despairing homeless from that ruinous “vivo” might be a necessary step toward abating California’s current crisis. But while he appears willing to buck certain orthodoxies of the Housing First crowd, he also seems to accept some of its ruinous premises. One incomprehensible portion of the governor’s budget is the so-called Community Care Collaborative Pilot program. In explaining the program, Newsom’s office released a statement detailing the governor’s plan to allocate more than $350 million over six years “to implement efforts in three pilot counties to place individuals with mental health needs, specifically those designated Incompetent to Stand Trial, into stable placements in the community instead of state hospital placements.” The fetishization of “community” services for the severely mentally ill — even those found incompetent to stand trial — is a leading cause of the state’s homelessness problem. The man who dumped steaming-hot feces on the female passerby, for instance, was on the streets in the first place on account of his discharge from state care after being deemed incompetent to stand trial for another crime.
Indeed, deinstitutionalization and “Housing First” are sister philosophies, based on the same assumptions about social-service provision. The United States Interagency Council on Homelessness admitted as much in its description of the Housing First ideology:
Housing First is, and always has been, about changing mainstream systems. The approach emerged as a reaction to traditional mental health treatment modality, which thought that the way to address the needs of people with psychiatric symptoms on the street was to get them into psychiatric treatment, typically at an inpatient facility. Housing First was about changing the mental health system’s paradigm to recognize that housing is foundational to mental health recovery.
Housing First’s role in changing mainstream systems should not stop with the mental health system. Housing is just as foundational to addiction recovery and psychical well-being as it is to mental health. The new frontiers of systems change are to engage the substance abuse treatment system and the mainstream health care system around housing.
It might well be a noble goal to help the homeless to secure permanent housing where and when possible. But the ideological lodestar of the Housing First movement, which seeks the complete demolition of intensive forms of mental-health and addiction services, takes a worthwhile goal for some and makes it an unworkable one-size-fits-all solution. Some homeless people with addiction and serious mental illness require more structure than the basic “housing” model proffered by the Housing First crowd permits.
For the sake of his state and its homeless, one hopes Governor Newsom recognizes as much and can point the state in a more reasonable and humane direction.