What exactly are we trying to solve?
The incuriosity and fuzziness with which people look at the west coast homelessness crisis drives me fucking batty.
Now look, I admit up front that I am also both incurious and wool-headed about this issue, but I work in a fucking restaurant for minimum wage. If you write a book about the fucking homeless crisis or run the city government I expect you to think a little bit harder than the average schmoe on the street, and I think that's reasonable.
One thing that pisses me off about the way people talk about homelessness is that they don't seem to know why it's bad, or what it would look like to solve it. Which I know sounds crazy but hear me out.
Scott Alexander helpfully reviews San Fransicko for me so I don't have to punch any holes in my drywall, but I want... Well, actually I was composing this as I finish Alexander's review, and I got to his utilitarian discussion at the end that cuts to the heart of the matter:
Along with all the problems and preaching, San Fransicko offers solutions. These won’t come as a surprise to anyone who’s read this far: they’re basically the Amsterdam plan presented earlier. Break up open-air drug markets. Force addicts into rehab by threatening prison sentences for noncompliance. Ban camping on streets and force the homeless into shelters. Offer permanent housing when appropriate, but make it contingent on good behavior. Have a strong psychiatric system with ability to commit people who need it, and enforced outpatient treatment when appropriate.
Would these work?
I’m pretty sure they would work well for housed people and the city as a whole. Homeless people would no longer block the streets and assault passers-by; they would be safely out of sight in shelters or in mental institutions. A new generation of tough DAs would crack down on crime. Stores could reopen, and citizens could walk the streets without fear. It’s hard for me to imagine this not working.
I have to admit - I talk a good utilitarian talk on this, but I don’t know if I live up to my ideals. An addictionologist interviewed in San Fransicko heaps contempt on well-off liberals who get the benefits of virtue-signaling while externalizing the costs onto poor people in bad areas:
[You] sit in the suburbs and feel smug about the fact that you oppose the war on drugs and have a Black Lives Matter sign in your yard. But you don’t have homeless people taking a crap on your front stoop every day or [have] all your packages stolen every single day
So I imagine - what if I lived in the worst parts of SF, had people crap on my front steps every day, had all my packages stolen, and (by the bounds of this hypothetical) wasn’t allowed to move to the suburbs, ever? I think I would last two weeks before I sacrificed all of my principles on the altar of “less human feces, please”.
Maybe, as a lefty, I'm supposed to read that and gasp and say, "How can you be so heartless?" or maybe I'm supposed to say, "Gosh, when you get right down to it, doesn't the poor guy have a point?"
But instead I'm going to ask:
Do you have any studies showing how effective those policies are at getting rid of human feces?
I'm not being a smart-ass, I'm genuinely wondering how Alexander didn't notice that so much of the criticism he himself quotes in Shellenberger's book has nothing to do with any of that stuff.
This is the particular quote from Shellenberger that caught me up short:
"An experiment with 249 homeless people in San Francisco between 1999 and 2002 found those enrolled in the city’s Housing First program, Direct Access to Housing, used medical services at the same rate as those who were not given housing through the program, suggesting that the Housing First program likely had minimal impact on the participants’ health."
Did it have an impact on how often they took a shit on a public sidewalk? Did it have an impact on the amount of litter they dumped on streets? Did it have an impact on time spent chasing people around and screaming obscenities? Did it have an impact on how often they injected heroine in the subway? Did it have an impact on how many sidewalks they blocked with tents?
All that fucking soul-searching, all that "Gosh, perhaps to solve the problem we simply must be cruel" and this reluctant commitment to reducing the effect of homelessness on tourists and housed locals, and realizing that, gosh, we might have to sacrifice the well-being of homeless people if that's what it takes, an utter commitment to ignoring anything but the reduction of social harm from mass camping...
And the criticism of DAH is that it doesn't improve the health outcomes of the people enrolled in it?!
ARE YOU FUCKING KIDDING ME?
This kind of goalpost shifting is RIFE within the discussion of west coast homelessness, where opponents of current policies or even speculative ones waffle back and forth about whether or not they give a shit about the health of the homeless or not.
Before all that soul-searching I quoted this is Scott's assessment of Housing First policy:
Conclusion: Housing First seems to work in getting people housing. It probably also helps people use fewer medical services, and it might or might not save money compared to not doing it (probably more likely when treating very severe cases, less likely in areas with high housing costs). It probably doesn’t affect people’s overall health or drug use status very much.
So... Housing first policies probably actually do a pretty damn good job at making the Homeless less obnoxious to tourists and housed people in a number of concrete ways related to litter, camping, public defecation, etc.?
There's good reason to think, pending further research, that they might actually do a pretty good job at reducing some of the problems that, after all that soul-searching, we decided were the only priorities we have?
I'm furious and unhappy at the way Portland is being covered by tent cities, mounds of trash, and grafitti. But I have this utterly baffling conversation with people where they go,
"This camping is shameful, the city should crack down on it!"
"So, get people into stable housing"
"Well, if you get people into stable housing it only puts a band-aid on the problem, they still can have health and behavioral problems that are really important."
And I always go, "Right, but I thought we were trying to reduce camping."
There's this kind of baffling goal-post moving. Alexander has a lot of paragraphs of hand-wringing over whether or not we should accept that sometimes we have to be TOUGH and HARD to really solve these problems, and accept that we may just have to care less about what Homeless people do or want, but he somehow hasn't noticed that he actually has very little data on whether or not Shellenberger's preferred policies work better than what he calls "Housing First" in terms of these metrics.
This is a wild guess and armchair psychologizing, but what seems to be happening is that in cities like San Francisco or Portland, as the problem gets worse, you, as a relatively better-off housed person, start thinking of Homelessness less and less in purely charitable terms with worries about how it effects the homeless, and more and more things like, "I don't like crossing the street because the sidewalk I was going to use is blocked by tents and piles of garbage" and "I don't like how often people chase after me screaming obscenities" and that feels somehow hard and uncompassionate, so you sort of start to assume that the only way to solve these problems is through policies that also feel hard and uncompassionate.
But I'm going to be honest, the case for that strikes me as extremely flimsy and I don't think I've ever seen anybody make it in a very convincing way.
Yeah that definitely seems much more plausible to me.
The Homelessness Problem in Portland didn't really have the capital letters until roughly ten years ago. My mother's neighborhood has been a dump ever since she moved there, it's a weird mix of malls and chain restaurants with incredibly sketchy looking auto mechanics, cheap motels, and dilapidated apartment buildings with low rent and nobody doing maintenance.
When she first moved there about a decade ago, you basically never saw any homeless people in the neighborhood. Then, you started to see a few. Then a few more. Five years ago it started becoming common to run into panhandlers at any hour night or day. Today, Every other block has a tent complex surrounded by heaps of garbage.
There has, recently, been an explosion in the population of homeless people, it is a very temporally limited phenomenon and a lot of people seem bafflingly unable to treat it that way.
In that review Scott Alexander makes a strong moral argument against involuntary institutionalization, and another argument that I think should be made is that the timeline of de-institutionalization doesn't seem to coincide with the timeline of the homelessness spike in any way.
I'm very unfamiliar with the history of de-institutionalization in the USA, but the one quote Scott gives from Shellenberger with a timeframe is this:
The tragic irony is that many of the people who had drawn attention to the poor conditions in mental hospitals had hoped to mobilize the public to increase funding for better care in them, not shut them down entirely […] Idealism and ideology had triumphed over pragmatism and reason. Between 1948 and 1962, the mental health center that reformers had pointed to as the model had not prevented a single case of mental illness or even treated a single individual with schizophrenia or other major psychiatric disorders. As a result, notes a historian, “The majority of lives were little different than they had had while hospitalized . . . and a significant number were considerably worse off.” Some mental health reformers regretted what they had done.
So... I can't help but notice that Homelessness in my mom's neighborhood really started becoming a major nuisance to the housed people around, you know, literally half a century later.
And the thing is, the narrative Shellenberger wants to press is that deinstitutionalization is part of this sort of general attitude of permissiveness and apathy towards mental illness, which allows the mentally ill to run around on the streets and bother people without consequence or hope of help.
But if that's the case, shouldn't the spike in homelessness coincide very closely with deinstitutionalization? Wikipedia has a fairly vague article on the whole process but even if we're quite generous and push the date of deinstitutionalization all the way to 1980 that still leaves a more than 30 year gap between deinstitutionalization and Portland's spike in homelessness.
I really don't know what, in Shellenberger's narrative about what institutionalization does or is for, could possibly result in this kind of delayed effect; if the narrative is 'we just let all the mentally ill people out to live on the streets' you should see a massive increase in problem homelessness pretty much immediately on the closure of the institutions, not decades later in populations that hadn't even been born yet.
If nothing else, putting aside for the moment all the moral arguments against institutionalization, Portland, at the least, was for quite a while able to adequately control the homeless population without needing to use this practice.
Given that the practice is morally disastrous, and if we don't care about that it's also expensive, wouldn't it make more sense to try to figure out how to reduce the impact of homelessness without this tool, given that we provably did so for many decades?
The homeless problem as a serious drain on livability for the housed in Portland is less than a decade old, but over the last few years there's been a massive increase in the homeless population, and if we aren't asking why this happened then to me any argument about solutions is sort of like trying to decide if a bandaid will work on that cut or if you need gauze while Jason Vorhees is currently in the process of hitting you with a machete.