Those who know of my work designing homeless facilities and my book on the subject have been asking my opinion on solutions to this seemingly intractable problem, reflected recently in the proliferation of sidewalk campsites in San Francisco. My response is that solutions to homelessness exist, and they are both obvious and difficult.
The obvious solution is that we must keep people on the verge from becoming homeless, because once on the streets they experience a dehumanizing and costly downward spiral. Job loss, long-term unemployment, lack of affordable housing options, and gentrification are all contributing factors to homelessness. In San Francisco only 10percentof the substantial funds spent on the homeless is focused on keeping people housed.
The difficult answer is thatwe must build more supportive housing (housing with social services) for the homeless. This solution takes money, political will, focus and coordination.
Public and elected officials in some U.S.cities are willing to tackle the problem and spend money. The last two San Francisco mayors have initiated any number of strategies from Care-not-Cash to one-stop service Navigation Centers. San Francisco now spends nearly a quarter of a billion dollars on homelessness each year. That works out to nearly $35,000 per homeless person, given the latest count. The problem is how the money is spent and how programs are coordinated.
I would characterize the current approach as scattershot. The underlying causes of homelessness are so varied, and the homeless population so diverse, that a myriad of programs have emerged in an attempt deal with the entire spectrum. San Francisco now has 400 separate contracts for services with over 70 different nonprofit community groups.These community organizations provide mental health services, addiction programs, employment training, emergency housing and more. This is in addition to direct services provided by the city and county and the $20 million to arrest homeless people for quality-of-life misdemeanors.
None of this is particularly well coordinated. There is no tracking system that allows all of these disparate entities to know if an individual is, or has been, served or enrolled in programs. The oversight of so many contracts is problematic and it is unlikely that each provides definitive results based on evidence that it is working.
It is common knowledge among experts and practitioners in the homeless field that supportive housing permanent housing with social services on-site is the best approach and is where public money should be focused. As far back as 2002, research by Dennis Culhane at the University of Pennsylvania revealed that the cost reduction forsocial services, hospital visits and emergency responses is so great,when homeless are instead housed, that the latter planmore than pays for itself. San Franciscos budget and legislative analyst recently undertook a similar study, noting that while initially social-service costs were higher, these eventually diminished once people were housed and settled into programs.
This strategy, known as housing first, is not only the most humane approach, it'salso the most economical one. California State Sen. Holly Mitchell has introduced SB1380, requiring the state to move toward housing first, and the San Francisco Chronicle editorial board has endorsed the bill.
Why is housing first successful? When you are homeless, survival is your goal. Finding a meal, a safe place to sleep and a toilet are your priorities, not health care, mental health treatment, substance abuse programs or job training.
In the 1990s, Larkin Street Youth Services, a San Francisco community based organization, began to see an increasing number of homeless youth with HIV and AIDS. At the time, the drug protocol was complex, as several medications had to be taken on a rigorous and regular schedule. These youth were living on the streets, and there was no way to monitor their treatment or ensure they were following the protocol.
Larkin Street realized that until you take the housing crisis out of the equation, the condition of these youth would not improve. In 1997 I designed their Aftercare and Assisted Care facility in San Francisco'sTenderloin district; itincluded housing, social services and a clinic. What happened? Not only did the residents health improve, they transitioned into permanent housing within two years.
But housing first is also controversial. Malcolm Gladwells 2006 article in The New Yorker, Million-Dollar Murray, describes the case of Murray Barr, a homeless ex-marine who was on the streets of Reno for a decade. Murray was an alcoholic, and while he underwent several treatment programs, he would inevitably relapse and return to the streets, and eventually to the local emergency room.
Between police interventions, emergency services and hospital stays, Murray had cost Nevada an estimated $1 million. Had there been housing first perhaps Murray would have lived longer and better, and cost the state far less.
Million Dollar Murray was one of the hardcorehomeless, a relatively small segment of the homeless population, but probably the most visible. He reflects the public perception that the homeless are neer do wells who would rather stay on the streets than get a job and become productive members of society. Although it actually savesmoney, housing first can seemlike we are letting Murray jump the line in front of more worthy individualswho are homeless through no fault of their own.
The underlying reasons for homelessness are many, and rarely is the individual at fault -- so everyone must be viewed as equally worthy of housing. Mental illness is prevalent among the homeless, and we have failed as a society to provide community mental health strategies after California, and then the nation, retreated from centrally funded treatment centers in the late 1960s through the early 1980s.
We incarcerate many and provide little tohelp those released to re-enter society. Many become homeless. Drugs are prevalent, cheap and quickly destructive, often leading to homelessness and acute health problems. A large and growing segment of the homeless population is very young or very old. Many of the young are aged out of foster care and have few options. Others may have been in abusive homes and escaped. Many of the old have severe physical disabilities, little social security and are notemployable.
In many industrialized countries housing is a basic human right, as is education and health care. In the United States we have been uneasy with subsidizing housing for those with low (or no) income. Programs exist, but these are modest and woefully inadequate, given the scale of the problem. We have no problem, however, subsidizing those in the middle class and above: the yearly income tax deduction for mortgage interest, alone, is $80 billion.
Even were the public perception of the homeless to change from those at fault to those at risk, providing housing for them in established neighborhoods is a hard sell. Residents of south Berkeley are enraged atthe notion of the Claremont Hotel adding 45 condominiums on its property, each of which is likely to sell for $2 million. Imagine the resistance were there a proposal for supportive housing anywhere in the area
The first time I designed an adult shelter it was within a warehouse, a poignant example of warehousing the poor. Locals still objected, as it was next to a cemetery and they didnt want homeless near the grave sites of their loved ones.
Here then are a few solutions:
Institute anti-snob zoning
California needs a tougher anti-snob zoning law, similar to the one enacted in 1969 in Massachusetts. That law not only streamlines the regulatory process for development, but may also allow for variances in local zoning codes, to facilitate affordable housing projects. A more conservative approach would simply disallow appeals to city councils, and lawsuits by opponents,if a project abides by current zoning laws. This would reduce the cost of the housing by negating drawn out litigation and by providing assurances that pre-development funds will result in a building.
Every city in California is required to have a housing element -- a development plan that includes affordable housing, shelters and supportive housing. There is, however, little recourse against a city if it fails to enact such a plan. The threat of not receiving funds for affordable housing is ineffective if the municipality sees such housing as a low priority.
Furthermore, the plan requires that a city identify locations where shelters may be created without a discretionary review. All other locations require the same type of review as any other project. Because of the opposition to housing for the homeless, this in essence precludes such housing outside of the specially designated district. Similarly, supportive housing must be treated like all other projects, and therefore without a stronger anti-snob provision, these too will be restricted.
Build smaller projects
While we need more housing, any one project should be modest in scale. Projects of 30 to 40 units are large enough to achieve an economy of scale both for construction and the operation of on-site services, yet small enough to avoid an institutional quality while enabling a cohesive sense of community. Projects of this scale are also more likely to be acceptable to a community. Larger projects, while more economical to building and operate, will encounter increased community resistance and, once occupied, more likely stigmatize the residents.
Use existing buildings
It is not necessarily true that rehabilitating existing buildings is less expensive than new construction, but there can be advantages. If an existing building is viewed by the community as a blight or a nuisance, any upgrade may be acceptable. In Los Angeles both nonprofit and private developers are buying and then converting nuisance motels into 500 units of permanent supportive housing. The city will issue vouchers to support rent and services at these sites.
Manage projects well
In 1994, what is now Erna P. Harris Court, on University Avenue in Berkeley, was converted from a motel into affordable housing for formerly homeless and those of very low income. Community opposition was long, bitter and litigious, but the nonprofit Resources for Community Development prevailed. The project is now an integral part of the neighborhood, in part because it is well managed and well maintained. It is difficult to counter neighborhood fears that unsavory occupants will lead to lower property values and a deteriorating neighborhood. Neither is the case, but only by building more such successful projects can the reality overcome the perception.
Filling the time gap
It will take time to build enough housing for the homeless. What happens until then?
Shelters are a necessary albeit unsatisfactory solution. We must have the beds, bathrooms, meals, healthcare and treatment programs where they are accessible and available. But shelters are difficult places -- seen as unsafe, unhealthy, noisy, institutional and restrictive -- and oftentimes people would rather stay on the street than use them.
Just as housing projects can be too large, so, too, can shelters. Shelter design needs to evolve from huge rooms with hundreds of beds to something less intimidating. The dilemma is how to create a sense of privacy for the occupant while enabling the staff to provide security and control. In the shelters I have designed, there are no more than 10 to 20 beds in a cluster. These smaller dorm-like areas are less visually overwhelming and provide some level of privacy and control by residents, but are still viewable by staff. A cohesive group formed on the street for support and security could occupy a small dorm, something not currently allowed in most shelters. This is only one of many strategies that can make shelters less institutional and more welcoming.
A situation that continuously enables homeless to remain so is untenable. We have all manner of laws, codes and zoning ordinances intended to ensure public health and safety. Tent encampments on public streets are dangerous and unhealthy, both for the homeless and those who live nearby. They do nothing to counteract the underlying causes ofhomelessness.
But we cannot force people to use shelters, and if they view encampments as the only option, many will remain on the streets by themselves.
Some encampments are better than others. Several cities have set aside land for groups of homeless to settle. For some time there was a community of 26 people living in geodesic domes under a freeway near downtown Los Angeles. Portland, Oregon had a self-governing encampment called Dignity Village on city property. Among the advantages are a sense of community and self-determination, both of which are oftenlacking in shelters or when people are living on the streets alone. In addition, the relative concentration of homeless people in such encampments makes it easier for outreach teams to connect them to the services they need.
But these group encampments are also often not clean or safe. While local authorities sanction some, there are rarely infrastructure improvements such as paving, lighting and sanitary sewers. If there are to be encampments, there should also be such improvement, as well as meals, social services and security. Such monitored encampments would be more economical than rousting people from sidewalks on a recurrent basis, and then cleaning up after their eviction -- only to have them settle elsewhere or return. And they would be far more effective in connecting people to services.
There has been much discussion of the small house solution. The idea is that we can manufacture very small dwellings for the homeless. But where would these mini dwellings go? How are they connected to the city infrastructure? The implication is that it is only the lack of shelter that makes someone homeless. But someone with mental illness, isolated in a tiny dwelling, is not likely to be able to live independently.
Were these small dwellings aggregated in a community then there is both the security and independence of a home, but also the support and services that can help them stay in that home. This is the basis of a recent project I designed in Sacramento. The tiny dwelling units are clustered into groups of 10 houses around a court. These courtyard clusters are then connected by a main pedestrian street to the community building that includes social services.
Achieving 'housing-first' solutions to homelessness
The goal must be to build supportive housing -- housing with social services -- and this will take continued political will and money in order overcome neighborhood resistance to such housing.It will also take time.While we work toward this goal, we should improve shelter design, convert existing buildings in marginal use and continue programs already in place, but with renewed efficiency, client tracking among service providing agencies and evidence-based evaluation of these programs.