☆ Smith and Wolf: Where SJ and SF's Housing First methodology went wrong (2/4)
Image by County of Los Angeles
Bay Area homeless policy advocates Irene Smith and Tom Wolf discuss why they believe CA's extreme Housing First approach (barrier-free Permanent Supportive Housing) harms our homeless neighbors and community. What if local pols pursued “middle ground” solutions instead? Part 2 of an Opp Now exclusive.
Opportunity Now: Earlier, you both mentioned some practical ways California can fight homelessness better—adopting more and larger interim shelters, and uniting local jurisdictions under a larger plan. So what are your thoughts on the Valley's prevailing “Housing First” methodology?
Tom Wolf: Homelessness is as much a public health issue as it is a housing issue, a law enforcement and accountability issue. Think of it as a multi-legged stool; if you take away one of those legs, the stool falls over.
For the last nine years in California, we've taken away one of those legs (interim solutions) by defunding the shelter system. Then, another leg (law enforcement and accountability). So now we're trying to sit on a stool with one and a half legs.
Irene Smith: I can tell you that the homeless advocacy industry has made a wrong turn conceptually. Because when they've asked homeless people about their needs, and they've been told they want P.O. boxes, clothing, etc. But this has been interpreted as, “Oh, they must require housing before getting further help.”
But that logic doesn't stand up. There's a middle ground. It's not a choice between everyone living on the creek side and everyone getting a subsidized $1.1 million home. The interim solution is to immediately build sprung structures and start helping folks up the ladder of housing success.
TW: Agreed. Right now, in San Francisco, we have about 16,000 people in Permanent Supportive Housing. The cost of the rent subsidies alone for those 16,000 people—for the City and County of San Francisco—is $400 million/year. That's not including costs of operation, security, management, etc. And that number's only going to grow as more people enter the system.
ON: And yet, despite the millions of dollars California pours annually into PSH, the data on health and safety is less than encouraging. How do you parse it?
TW: In 2023, it's estimated that 30% of SF's 811 overdose deaths took place in Permanent Supportive Housing. (Overall, since we started really tracking overdose deaths in 2018, 16% of overdoses have happened in PSH. And during Covid, 10% of everyone placed in a shelter-in-place hotel in SF died, but 0% were due to Covid.) 70% of all the overdoses have occurred at a fixed address.
Also, in Los Angeles, Homeland Services Authority is struggling with about a 10% overdose death rate within their Homekey programs, and about a 25% rate of people leaving the housing within a six-month period of time.
You can take someone off the street and address more surface-level health concerns like body lice; but many of these homeless people suffer from co-occurring disorders like substance use disorder, untreated mental illness, heart disease, diabetes, etc. While housing is key—I'm a huge YIMBY myself—we can't make substance abuse services voluntary for people who need them, or allow drug use inside PSH (Senate Bill 1380, passed in 2016). When we do, we're just turning those rooms into really expensive coffins.
ON: We’re hearing that there's “middle ground” solutions that are more data-supported than the Housing First methodology. So where's the disconnect? Why aren't local politicians pursuing them—but instead clinging to costly, failed initiatives?
TW: We're all working towards the same goal: to end homelessness. But I think some people get so close to the problem that they can't see the forest for the trees. While they're looking to reduce harm to the individual experiencing addiction or homelessness, they have to take a step back and consider harms to the broader community. And they must realize that trauma (exhibited in drug addiction, untreated mental illness, etc.) must be properly and compassionately addressed. This is where we benefit from: homeless sweeps, arresting organized drug dealers, arresting shoplifters or people openly using drugs.
Also, I think the pervasive idea that “housing is a human right” has been taken to an extreme level.
IS: As Tom mentioned, I think a lot of folks are still stuck on the Housing First model. There has been a pendulum swing. Initially, around the '80s, we started thinking that structures were the solution to the problem. Now, we are realizing that services are tantamount—and for many, sobriety and addiction rehab. Hopefully, we're getting more toward the middle: providing a variety of different shelters and services for folks in the beginning, and then moving them over into larger group living options or even tiny homes.
Tom Wolf, formerly homeless and in recovery from heroin and fentanyl addiction, is an outspoken advocate—and sometimes critic—about California's policies that have impacted homelessness. He also co-founded the California Peace Coalition and founded the Recovery Education Coalition.
Irene Smith—D3 Council candidate and head of Independent Leadership Group—has lived in downtown San Jose for 35 years and observed the worsening homelessness crisis since 2016. She is also a pro tem judge for Santa Clara County and has been a housing provider for 35 years.
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