An abusive relationship landed Angelique on the streets, where she moved around different encampments and shelters more than 14 times in two years. Life on the streets led her to drugs to cope, saying, “Methamphetamine? It’s what you do to keep away the pain, to numb yourself.”  

Video by San Francisco Chronicle 

Eventually, an invitation to a San Francisco Navigation Center helped her get linked to substance abuse disorder counseling and recently, permanent supportive housing.

“Just look at this place. It is so quiet, so clean.”

- Angelique Mayweather,
formerly homeless San Franciscan upon seeing her new supportive housing unit

If you did not have a home yesterday, simply being able to lock your door today, knowing that you will wake up safe in the same place tomorrow, is transformative in and of itself. Only once the immediate crisis of homelessness is resolved can people begin to address their other issues, such as mental health or addiction.

To this end, San Francisco was one of the first major cities to operationalize a Housing First model, offering permanent housing without preconditions to solve the foremost challenge facing those experiencing homelessness.

Photo courtesy of DISH

This commitment to begin with the solution rather than on any number of tangential problems has led the city to create more than 6,500 permanent supportive housing units, which pair subsidized housing with onsite services ranging from case management to healthcare. Nationwide, supportive housing alone can deliver an annual cost savings of $20,448 per housed person, driven in large measure by decreased use of urgent care and emergency costs. What’s great is that supportive housing works for the individual as well: only 3% returned to homelessness across San Francisco. Yet not all individuals experiencing homelessness demand this level of care.

There are youth who have had a dispute with roommates and find themselves homeless. There are families who have become homeless on account of eviction due to rental arrears, many of whom are the mothers and fathers of the nearly 2,500 homeless or marginally housed students of the San Francisco Unified School District. Such households may benefit from a softer touch that includes time-limited financial assistance, mediation, and support that rapidly rehouses them in the private rental market, or with loved ones committed to supporting their continued reintegration.

While the solution to homelessness begins with housing, there is an obligation to balance the right level of intervention with the right people, so that our limited housing supply is maximized and the households it is designed to serve are poised for success.

Our approach will be to open doors and ensure they stay open. While homelessness ends with housing, housing is only the beginning of optimizing the health and self-determination of individuals and families that have experienced homelessness.

Housing Innovation and Advocacy

Supportive housing is a critical part of the toolkit for resolving homelessness. But currently, only 800 units become available in the city annually from new construction or people moving on to other housing options.

While our resources are not sufficient to support building or renovation to create new housing, there are key interventions we can support to open more doors for our neighbors experiencing homelessness:

• Moving On. Some residents of supportive housing may wish to “move on” from this level of support, having benefited from the stability that supportive housing has offered them during their residency. With success demonstrated in other cities, San Francisco, with support from Tipping Point, is testing an initiative that enables people to transition out of supportive housing if they wish, in turn creating a critical vacancy for a currently homeless household ready to begin their path to self-determination.

Photo courtesy of DISH

• Community Acceptance. The passage of Propositions 1 and 2 at the state level as well as Proposition C at the city level will create a surge of new funding to establish more housing for low income and homeless families and individuals, legal challenges pending. There is a significant concern, including from the Mayor, on whether the city will be able to effectively and efficiently spend what amounts to a doubling of resources for the Department of Homelessness and Supportive Housing. Regardless of one’s position on Proposition C, what seems clear is that new affordable and supportive housing cannot be realized with these new resources in a timely manner without neighborhood support.  Advocacy that includes the voices of those who have experienced homelessness can be a powerful tool to build neighborhood support for new projects and ensure that lived experience is part of the decision making process.

• Innovation. We are interested in supporting innovations that lead to more rapid, flexible housing options as well as promising approaches in how services are provided to those in supportive housing.  Creating connective tissue between services and providers to make more efficient use of existing resources is also of interest. Including the voices of those experiencing homelessness in the design and execution of innovations is important.

A Safety Net of Support

People experiencing homelessness often have co-occurring issues such as mental health, substance use disorder, and chronic health conditions that, for some, may initially worsen with moving into housing due to the loss of social networks and familiar environments.

We are interested in coordinated and trauma-informed approaches that provide holistic support to those in need of a safety net once housed. For example, Whole Person Care coordinates physical health, behavioral health, and social services, including housing, to improve the health of homeless and at-risk people. San Francisco is using this approach to  reach individuals experiencing homelessness who are also the greatest users of emergency and urgent care services.

Reintegration and Prospective Pathways

While homelessness may end with housing, it is also an opening for lifelong economic and community participation. People who have experienced homelessness face tremendous barriers to reentering the workforce. Extended periods of unemployment, disabilities, or criminal justice involvement are just some of the many examples that can keep formerly homeless individuals from re-entering and remaining in the labor force.

We are particularly interested in supportive approaches to employment that integrate case management and retention support while targeting career pathways that command a living wage. We are also mindful of the issues facing households that are unable to work due to age or ailment and are interested in initiatives that reduce isolation and advance community cohesion.