There have been plenty of “what we’re getting wrong about homelessness” lists over the years, and apparently our leaders aren’t reading them because the homeless population has dramatically increased over the last decade. I have come to realize that the problem wasn’t that these articles weren’t influencing policy — in fact, the problem might be that they are. As a former homeless drug addict that lived in the Tenderloin and on Skid Row in Los Angeles, I feel compelled to weigh in.
The biggest issue I have noticed was these articles represent homelessness as a monolith of purely economic origin. The truth is people become homeless for radically different reasons, and homelessness due to poverty shouldn’t be conflated with much of what we’re witnessing in the streets of San Francisco. The city has been at the helm of radical leniency toward antisocial and self-destructive behavior, which has been devastating for those that are homeless due to addiction, mental illness, or both. And the strategy of essentially providing them hospice care to slowly kill themselves in front of us over the last few years has become an utter disaster.
For those that are a danger to themselves or others, four walls and a kitchenette is nothing more than an oversized coffin.
Homeless drug addicts that are usually homeless because of their addiction, and nearly half of the homeless in San Francisco self-report drug abuse. These people don’t deserve assisted suicide via neo-harm-reduction (our current strategy), nor do they deserve long prison sentences; they deserve comprehensive care that we hope we are on the verge of providing. For those that are severely mentally ill, they too deserve a dignified level of care, but instead we provide them little more than the freedom to wither away in the public eye. And although there are plenty more things we’re getting wrong, I’ll focus on the two most critical misconceptions specific to San Francisco. These are the two most important things our city is getting wrong about homelessness when it comes to drug addiction and mental illness.
Housing alone can’t solve the majority of homelessness in San Francisco
This is a tough concept for some to grasp, and will likely get the most pushback from the devout housing-first fanatics. If someone is homeless, it implies that they are without housing; so the obvious solution is to provide them a house, right? This is somewhat correct. To solve homelessness in San Francisco, every homeless person will need to be provided a place to live. But a large number of our homeless people are severely addicted to drugs or mentally ill, or both, so that place needs to be a medical treatment program. Once detoxed, transitional supportive housing with psych care, addiction treatment, life skills training, and job placement would set these people up for prolonged success. And with incremental steps toward self-sufficiency, they could get a second chance at a life worth living. A free studio apartment can’t cure severe mental illness or addiction, but it can help a homeless person that has simply fallen on hard times — and I’m all for that. But for those that are a danger to themselves or others, four walls and a kitchenette is nothing more than an oversized coffin. In fact, 44 people died from overdose in San Francisco’s permanent supportive housing system last December, and another 30 in January. Activists often say it’s safer for homeless drug addicts to be housed, and this is true, but what they’re leaving out is that it’s only safe if they’re housed in a recovery environment that doesn’t enable their deadly disease. One would think that most of San Francisco’s overdose deaths in 2023 happened to people living on the street, but the truth is that 74 percent occurred at a fixed address, the majority of which were concentrated in pockets of permanent supportive housing. My colleague Gina McDonald analyzed every overdose death from the county medical examiner and determined that 542 people overdosed in San Francisco permanent supportive housing since 2020. Of those 542 deaths, 121 occurred at the Tenderloin Housing Clinic, a nonprofit that doesn’t require or incentivize addiction treatment. The Salvation Army, one of the only nonprofits that does, had only a single overdose death since 2020.
Given that I’ve purchased drugs, gotten high, and even overdosed in some of these SRO’s, I’m speaking from experience. These homeless addicts, like myself, have a disease defined by the subconscious drive to kill ourselves, and when the “solution” is no-strings-attached housing, none of the root problems are remotely addressed. On top of this, the city’s notorious leniency and resources to help homeless addicts self-destruct attracts many out-of-towners. Even Jeff Kositsky, San Francisco’s former homeless czar, admitted this last year: “San Francisco attracts unsheltered people to our city due to a lack of real enforcement and the many amenities we provide to folks.” Therefore, this approach will never come close to solving the problem.
Which brings me to the second thing San Francisco is getting wrong about homelessness, which I will address in Part 2 of this series.
