Housing is Medicine
“You are here to discuss the toughest issue facing us as a society, the most significant moral question of our day: how do we address homelessness?”
These powerful words from Assemblymember David Chiu opened Battery Powered’s expert night on Homelessness: Solutions for San Francisco.
Photo Credit: Misha Vladimirskiy
Moderated by Daniel Lurie, founder & CEO of Tipping Point, we heard from David Elliott Lewis, a trainer with the SFPD and advocate for the homeless, Jeff Kositsky, Director of the city's Department of Homelessness & Supportive Housing, and Margot Kushel physician and researcher at UCSF. Our discussion focused on what it would take to make homelessness in San Franciso a rare, brief and one-time experience. This is what we learned.
Housing is Medicine
The solution to homelessness is housing, Daniel reminded us. And David shared his personal story of experiencing homelessness as a result of a financial downturn, divorce, and depression. Eventually, he got a permanent placement in a supportive housing unit. “Housing saved me,” he said, “but it was the first step in a long recovery.”
Over Margot’s two decades of experience treating homeless patients and researching this issue nationally, she said she can sum up the findings in one sentence: “The single most important thing we can do for people who are homeless is to get them housed. Housing is the best medicine.”
Photo Credit: Misha Vladimirskiy
While “housing is necessary, it is not sufficient,” said Margot, for those with mental health or substance abuse disorders. Supportive housing that combines deeply subsidized housing with on-site services (ranging from case managers to psychiatrists and nurse practitioners) is an evidence-based solution that San Francisco is investing in. In fact, with 6500 units of supportive housing, the highest number of supportive housing units per capita for homeless people in the U.S., many wonder if our city is a magnet for those experiencing homelessness.
The Lake Wobegon Effect
About 31% of our homeless population in San Francisco comes from outside the city. Jeff pointed out that that’s about 65 people a week showing up new to San Francisco homeless. Still, 69% were already living in San Francisco when they lost their housing. Importantly, Jeff noted that “your zip code should not matter when it comes to getting housing and healthcare.”
Margot and David shared that in every city they visit in their work on homelessness, they hear the same belief that their city is a magnet for the homeless, “even in North Dakota!” David exclaimed. Margot calls this the Lake Wobegon effect.
Photo Credit: Misha Vladimirskiy
What’s different in San Francisco is the proportion of our homeless population that is unsheltered, literally living on the streets. 67% of our homeless population is unsheltered, compared to New York City where only 5% are unsheltered. So what is NYC getting right, and why aren’t we doing it? Not so fast, Jeff cautioned. New York invests billions of dollars to implement a “right to shelter” law and ensure sufficient temporary shelter beds. It reduces the number of unsheltered individuals, but it eats away at resources to build permanent affordable housing. San Francisco focuses more on long-term housing solutions.
Is it Getting Better or Worse?
So people aren’t coming here in droves to become homeless. Then why does it feel like homelessness is getting worse? The reality is, the number of people experiencing homelessness in San Francisco has been pretty steady for a decade. But as Jeff pointed out, our city is changing geographically. We’re developing areas like Mission Bay that have always had a large homeless population but where people like you and I didn’t used to live. David suggested that in the Tenderloin, where he has lived for 12 years, it actually is getting worse as this neighborhood is used as a “containment zone” for people experiencing homelessness.
Jeff and Margot noted the rise of methamphetamine use as a factor. “It’s driving a lot of the behavior you see on the streets,” said Jeff. “You may think, ‘That person is schizophrenic or bipolar; they’re actually suffering from meth-induced psychosis.’” And while these people number only a few hundred, they are very visible and very sick.
In terms of addressing the mental health of those experiencing homelessness, Jeff continued, “I don’t think people see all the work that is happening in the city. Much assistance is offered, but the problems are complex.” Margot also suggested that sheer fatigue, the duration of the crisis, is part of what makes it feel like it’s getting worse.
“Homelessness is the intersection of all this unfairness. It’s a result of racism, of economic inequality, of a poor education system, of lack of healthcare, of making housing a commodity when it’s something everybody needs.” ~ Jeff Kositsky
It’s important to highlight where our city is succeeding as well. In the past few years we’ve significantly reduced the number of children under 18 who are experiencing homelessness -- 1600 versus 2600 in 2015 -- and the vast majority are at least sheltered.
So it’s not necessarily getting worse as far as the number of people experiencing homelessness, but neither is it getting better yet. How do we start improving?
A Systems Approach
Data is a big focus of improvement for the city, as San Francisco is still “playing catch up”. Many cities began transitioning a decade ago to a coordinated data system that tracks every individual experiencing homelessness by name and integrates service data across providers so that each person can be connected efficiently to the package of services they need efficiently. Yet until very recently, San Francisco had 15 databases across four city departments as well as 40 organizations with their own databases, most of which did not speak to one another.
Jeff is now leading the integration of all data into one coordinated data and entry system that will allow the city to play an “air traffic control” role, plugging the right people into the right services. This approach has led to great success in places like Houston and West Virginia.
David described innovative approaches to policing such as clinicians riding in police cars or being on call to address psychiatric emergencies instead of police responding to these cases -- a system they have in place in Los Angeles. “Moving from a police response to a public health response is safer and more effective.”
Daniel mentioned the need to reduce the burden of building housing in the city. Tipping Point is experimenting with a lower cost building model that is also quicker. Innovations like this are needed to expand housing capacity. But also policy change that eases the process for building supportive housing
Photo Credit: Misha Vladimirskiy
Our Role in the Solution
Our panelists ended the evening by offering simple but meaningful actions we can each take to be part of the solution for homelessness in San Francisco:
- Attend San Francisco Board of Supervisors meetings (Tuesdays at 2 pm in City Hall). During the public comment period, stand up and say that you encourage the development of supportive housing and you support it in your neighborhood.
- Ask every elected official you meet at every level and every time what they are doing about the affordable housing crisis.
- When you pass a person experiencing homelessness on the street, make eye contact and say hello.
You can also learn more about effective organizations providing solutions to homelessness by attending Organization Night, where you will hear from our 12 finalists. Join us on February 21st to hear from these organizations and learn how we can support them in making homelessness a rare, brief and one-time experience. RSVP here.
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