Tim Cook, the CEO of Apple, told the graduates of Tulane
University that they should not waste time working on problems already solved.[i]
He suggested they should tackle big issues, like the environment. He could have
suggested homelessness. It is a big problem, unsolved.
This is the richest country in the world. California is the
fifth largest economy in the world. Sacramento County is rife with affluence.
Unemployment is low and thousands of jobs go begging. In this economic boom, we
live with the shame of homelessness, growing 20% or more a year. The city, the
county, the local governments, all are overwhelmed.
Every two years local agencies count the homeless. The 2017
Point in Time[ii]
report identified 3,665 homeless people in our county. They expect the count to
increase significantly this year. Despite government and NGO efforts, fifty-six
percent are unsheltered, living on the streets, along our riverbanks, and in other
encampments.
A recent Sacramento Bee article reported about a survey of
homeless people took at one of the city’s shelters. The results were
enlightening, but not surprising:
·
60% percent had mental health illnesses
·
46% had substance abuse issues
·
86% had a disabling condition.[iii]
Are we asking the right questions? The evidence says that we
are not. One reason well-intentioned efforts miss the mark is that we think of
homelessness as a heterogeneous problem that places people on a bell-curve. We
assume that if we concentrate on the needs of those in the middle of the curve
everything will work out. Evidence from all over the country, however, suggests
that we should focus on the 10% or so that fit on the edge of the curve, the chronic
homelessness. Chronic homelessness doesn’t follow a statistical bell curve. Homelessness
follows a power-law curve. Instead of a bell curve, think of a chart that looks
like a hockey stick.[iv]
In major cities across the country, it is the ten percent, on the periphery,
that is the problem. They are the unfortunate who live on the streets for
years, who use the emergency rooms for major health problems, running up
hundreds of thousands of dollars in bills.[v]
Homelessness is costly! Our medium size city spends thirty
million dollars and more each year trying to address the issue, almost to no
avail. One shelter served 658 people, who rotated in and out during the year,
costing the city more than $5 million to operate.[vi]
The idea was to provide temporary shelter while helping guests search for permanent
housing and jobs. Success is minimal. Would the money have been better spent simply renting apartments for these people?
Nearly 800 people show up at Loaves and Fishes[vii]
each day for a place to rest, and to get what might be their only meal of the
day. Agencies hire “Navigators” to work the streets helping the homeless get
proper medical attention, food stamps, veteran services, and other needs. We are
putting band-aids on gaping wounds. Are we asking the right questions? A
leading advocate for educating government officials about the power-law is
Philip Mangono. He argues that simply running soup kitchens and shelters allow
the chronically homeless to remain chronically homeless.[viii]
We are not asking the right questions.
Local leaders are not ignoring the problem. Sacramento
Steps Forward, the linchpin in the government’s efforts, has an impressive
Board of Directors and staff. Cities staff departments that are responsible for
reducing homelessness. With all of this effort, the problem is getting worse. While
we concentrate on the whole, we ignore the few; the power-law. Yes, we need to
feed the hungry, clothe the naked, care for the sick, and welcome the stranger.[ix]
Nevertheless, we must also recognize that that won’t put a dent in the problem
unless we focus on the chronic few.
Homelessness is a symptom. We need to eliminate the root causes
of that symptom. The homeless have defined the causes for us. We need to listen
to them. We need to change the laws that hamper efforts to solve the problem.
Let’s begin with the idea that in this rich country it is
not ok to have homelessness! We should not want it for anyone and we should
have solutions for it. The courts, however, ruled that it is a First Amendment
right. That does not make it right. Few people can really want to be in that
condition. Too many of us, however, are within one or two paychecks of not
making the rent, the mortgage, the car payment, or school tuition. If a person
suddenly loses a job or other income, they too could be on the streets. Those
people, if they choose, will be back in the mainstream quickly. It’s not likely
that they will become chronically homeless. We need stopgap programs for them,
of course, so that their situation does not become chronic.
Doing the same thing over and over and over, but expecting
different results is the classic definition of insanity. Whatever we are doing
isn’t working and it’s costing millions of non-productive dollars. Yet, our
local leaders want to do more of the same, expecting different results. They
seem to concentrate on the middle of the bell curve rather than the hockey
stick end of the curve. They want to create more shelters for those who don’t
want to use them, spread them throughout the city, and place them far from
centralized services that people need. How likely are people with mental issues
going to fit easily into a shelter cramped with bunk beds 18 inches apart? If
people have substance abuse problems, how likely is it that they will go to a
shelter that requires no drugs or alcohol? If people have pets, how likely is it
that they will want to go to a place that doesn’t allow them? If people have
medical or disability issues, how likely is it that they will want to live in
outlying areas with few if any services.
Governments cannot criminalize homelessness behavior per se:
sleeping in public places for example.[x]
We can, however, make living on the street a bad choice. It’s hard to make that
statement without sounding cruel and mean. But, in fact, we need change: “Current law makes it very difficult to
commit a homeless person to a mental health institution. We see the unintended
consequence of these well-meaning laws. Jails and prisons become mental health
centers but without adequate resources. The tools currently available to the
judiciary fail to meet the challenge of dealing with persons with mental
illness. … Public safety is as much at stake as is the fair treatment of
individuals who have a mental illness.”[xi]
Jails can’t do the job. Even mandatory outpatient counseling is ineffective.
We need to make it easier to commit people with severe mental health issues to
in-patient facilities. We need to build those facilities. The law needs to
change so that the homeless can be sent to in-patient facilities to rid
themselves of drug and alcohol dependency.
The lack of affordable long-term housing is an obvious need.
We don’t have enough housing stock to meet market demand, much less affordable
housing. The NIMBY factor also plays a serious role; people are afraid that too
many lower-priced homes in their neighborhood will reduce their own home’s
value or change the social climate in their area. What to do?
What do we need to change to get people into rehab to eliminate
their substance abuse?
What do we need to change to get people into mental health
facilities, even when they don’t want to go there?
What do we have to do to provide the medical treatment
needed to address disabilities?
What do we have to do to ensure permanent housing for the
chronically homeless?
Local governments can solve the problem. They just haven’t
asked the right questions. Let’s assume that we have 10% chronic homelessness
in our area. How do we provide smart housing for 400 homeless people? Small
homes: 144 square feet with a front porch can be purchased for about $12,000 per
unit. That’s a little less than the cost of running a shelter for one year.
Allow another million dollars for excavation and installing central facilities.
That provides safe, clean housing at a lower cost than running shelters. And, it
gets people off the street. Compare that to many of the shelters that force
people to leave early in the morning, to walk the streets and beg for money and
food. Mangano talked about some cities that bought older apartment houses,
those with one room and studio apartments and gave them to the chronically
homeless for a couple of years. They even hired caseworkers to meet with
tenants each day to ensure that they attended their physical therapy, got their
food stamps, etc.
Homeless people are forced to use the streets and other
people’s lawns as bathrooms. How about purchasing and operating bathrooms and
showers in large trailers, like the U.S. Forest Service does for its firefighters.
The large trailers that can service hundreds of people a day. They cost about
$300,000 each. Five of them would cost one and a half million dollars plus operating
costs, a wild guess, another million dollars per year. These type of facilities
require 24-hour monitoring to ensure that they are not used for other purposes:
prostitution, sleeping, and drug use, to name a few. I suspect that is less
than what it cost to clean the refuse on our streets and in our parks.
Sixty percent of the homeless self-identify with serious
medical issues. How do we take care of them? Do we send them to expensive
clinics and emergency rooms for basic health care? Why? How else could we do
it? Would it be possible to set up four or five “free clinics” around town, and
operate them 24 hours a day? Physician Assistants, Nurse Practitioners, and
Medical Assistants could staff them. That should be doable for around
$1,500,000 less insurance payments from Medicare and Medical.
The solutions cost money; of course, they do. However, when
you consider that the city and county have about $34 million budgeted for
homeless problems and have little to show for it, perhaps they should be asking
different questions.
If we ask different
questions, we often come up with different solutions.
[i] Tim Cook, Tulane University Commencement Speaker,
New Orleans, Louisiana, May 2019
[ii] Point in Time count of homeless in Sacramento County
– Sacramento Steps Forward -2017
[iii] Theresa Clift - Sacramento Bee – May 19, 2019
[iv] Malcolm Gladdell – Million-Dollar Murray – The New
Yorker – February 13, 2006
[v] Ibid
[vi] Sacramento Bee – May 19, 2019
[vii] Loaves and Fishes is a non-profit, self-sustaining
agency dedicated to helping the plight of the homeless, the abused, and others
in need. It receives no government funds.
[viii]
Million-Dollar Murray, ibid
[ix] Matthew 25: 35-40
[x] Martin vs. City of Boise – 9th Circuit
Court – September 2018
[xi] Milton Mack Jr. – Decriminalization of Mental
Illness – 2016-17 Policy Paper – Conference of State Court Administrators
