
How Albuquerque helped its homeless population and saved money in the process - danso
http://www.politico.com/magazine/story/2016/12/what-works-albuquerque-homeless-solution-housing-policy-214527
======
gaspar
It is mind-boggling that one of the richest countries in the world and
definitely the most powerful one has such a big problem with homeless people.
My first impression when I came to US 4 years ago and in CA specifically was
the amount of homeless people. I have not seen so many even in my home country
that has a LOT of illegal immigrants. So far I have not seen any progress, at
least in the state of CA. Does anyone know if those people are doing that by
choice, is the system "punishing" the people that made a bad choice maybe in
the past and lost everything, is it something else ? I have heard that it is
very difficult to find a new job once you reach that level, not because you
don't want to, but because of formalities (e.g. no home address, etc). Is that
true ? It is not fair for people to not be able to sleep under a roof or to
not be able to have food and clean water (see Africa), and at the same time to
have so many technological advances and to have so many
millionaires/billionaires that care only about their pockets.

~~~
SomeStupidPoint
It's just a very hard problem to deal with, and places like CA attract
homeless people from other places, because they have good services. The US
lacks a comprehensive national plan to deal with homelessness.

Part of the problem is that even when services exist, they're often fragmented
and hard to administer. That's what led to ideas like "Housing First", where
they've found just providing a home for a year fixes most homelessness
problems (particularly when combined with other services). Having a home gives
them a base to operate from to organize the rest of the services, finding a
job, etc.

Part of the problem is that the US doesnt have a good plan for what to do with
crazy people. We had a lot of problems with long-term institutions, but when
we shut them down, we didn't actually start a new solution. We just left them
on the streets.

Part of it is just social myth that people deserve their caste. If the
homeless don't deserve their place in the increasingly vitrified social
system, then perhaps the wealthy and powerful don't _either_ , and so a large
amount of anti-poor propaganda has been generated in the US by the elite.

~~~
tcj_phx
> places like CA attract homeless people from other places, because they have
> good services.

California's winter weather is more survivable than most parts of the country.

> Part of the problem is that the US doesnt have a good plan for what to do
> with crazy people. We had a lot of problems with long-term institutions, but
> when we shut them down, we didn't actually start a new solution. We just
> left them on the streets.

Institutions were replaced with drugs. In 'Anatomy of an Epidemic' [1], Robert
Whitaker says that before the drugs were available, many people were able to
recover enough to get out of the institutions.

The book makes the case that commonly-used psychotropic drugs take an episodic
illness and make it chronic.

[1] [https://www.madinamerica.com/anatomy-of-an-
epidemic/](https://www.madinamerica.com/anatomy-of-an-epidemic/)

This HN submission was from 2 days ago: _Psychiatrists Must Face Possibility
That Medications Hurt More Than They Help (scientificamerican.com)_ \-
[https://news.ycombinator.com/item?id=13186201](https://news.ycombinator.com/item?id=13186201)

This has been my observation of the system... My friend was doing well until
they got hold of her.

~~~
appleflaxen
Where is the data for the point about making psychotic chronic? Because there
is peer-reviewed medical literature (meaning double-blind clinical trials)
about their effectiveness in reducing symptoms, and "longer lasting symptoms"
would have been a reportable adverse event that could/would have been seen.

Additionally: to advance this model, you have to think that the people caring
for these individuals (both families and doctors) are either unable to see
that the treatments make it worse, or that they see it but are motivated by
something other than the patient's best interests. My uncle had schizophrenia.
In my experience, neither of these were true.

Finally: these symptoms are chronic and intractable by nature, if you talk to
people that have them. Look at the homeless people who are clearly mentally
ill: they react to things we can't see all the time; not episodically.

Asking iconclastic questions like Whitaker does is important; we need to have
a discussion about it and make sure we're not completely off base, but when
you look at a persons total ability to function and their global quality of
life, antipsychotic medications are helpful.

~~~
SomeStupidPoint
Just to comment on a case I know personally: the person had semi-regular
psychotic episodes, a few per quarter, but every day meds to prevent them
definitely made him less smart and... "there" on the good days (in addition to
stopping episodes). That's how he was treated until about 20, when he managed
to convince a doctor he should just have an as-needed supply of fast acting
ones.

I know it's anecdata, but my experience is that there are a fair number of
borderline cases where they can't hold it together sporadically, but the meds
definitely lower the quality of the "good days" to fix that. Sometimes there's
a fast acting med that can work; often there's not and patients are faced with
a stark choice.

I think we see a lot more homelessness in that group of people than we should,
because we basically trap them there after one or two episodes, even though if
we fixed it and got them some help (usually better coping techniques;
occasionally meds), we'd see a lot less homelessness.

I do think that meds have become a substitute for real coping technique
teaching, and that in many of those cases, the caregiver isn't making the
optimal choice for the patient, because they're optimizing cost or time
invested, rather than long-term quality of life.

There are obviously things like hardcore schizophrenia where that isn't the
case, but even for more sporadic delusion disorders, it can be.

~~~
tcj_phx
Thanks for sharing your anecdata. I also replied to that comment:
[https://news.ycombinator.com/item?id=13206356](https://news.ycombinator.com/item?id=13206356)

> I think we see a lot more homelessness in that group of people than we
> should, because we basically trap them there after one or two episodes,

yes, this exactly: the system "traps" its patients with medications that do
not address the cause of their psychotic presentations.

My friend just needed sobriety, but all she got were tranquilizers and other
"bad prescriptions". She briefly escaped from her court-ordered medications,
but then she got an SSRI which destroyed all the progress I'd made with her.
See my comment history.

------
tomsthumb
This and the similar initiative in Utah are the kinds of governmental problem
solving I really like to see. More effective services for the populace in the
form of helping people better their lives while at the same time benefitting
society at large and being less expensive than traditional approaches. I count
myself reasonably liberal, but these type of solutions have largely popped up
in traditionally conservative places, which is a pleasant surprise and makes
me take another look at my understanding of the spectrum.

~~~
ianai
I think this has more to do with the nature of Albuquerque than
republican/democrat. This as someone who grew up there. I now live in Las
Vegas. The two cultures are very different. There's a lot of hostility in LV
in a general sense that isn't there in Alb.

~~~
tomcam
I'd like to hear more about this.

~~~
Avshalom
Albuquerque is deeply Catholic. Catholicism, Latin American Catholicism in
particular is very big on social/economic justice, charity, 'works theology'

Albuquerque (NM as a whole really) is quite poor and it's a lot easier to
convince poor people to help poor people.

~~~
mcone
I lived in Albuquerque for nine years (2003-2012). The Catholicism is
certainly part of it, but it's more complicated than that.

One gets the feeling that it's a more egalitarian city than other US metro
areas. I didn't feel like it was that racist of a city, certainly nothing
compared to Pittsburgh, where I now live.

And there are very few establishments that are designed exclusively for the
wealthy. The Frontier restaurant near UNM is a great example of what I'm
talking about. You would regularly see news anchors, professors, doctors, etc.
dining there in the same room as people who were homeless.

~~~
komaromy
> And there are very few establishments that are designed exclusively for the
> wealthy.

This is an excellent description. Some people still flaunt their wealth, which
is true everywhere, but I feel a sense of the city belonging to everyone that
lives in it.

Of course, that's my view as a fairly well-off white male who's never
experienced anything close to homelessness. People from different
circumstances may have different opinions.

~~~
ianai
You can still find those places in Alb and the rest of NM. They have a hard
time establishing a real presence though, as there really aren't so many
people there. It still needs more industry/business. Something to pull the
average income up and employ everybody.

------
devoply
Most problems that have hard line solutions, i.e. drugs and crime, have much
cheaper alternatives which are usually much less hard line and much more
humane. This also includes a lot of hard line management theories about how to
get the most work out of workers. Better and more humane treatment of people
usually leads to better and cheaper results... and better overall outcomes.
These are usually arrived at by idealists and dismissed by rationalists and
supposed realists.

------
coldcode
Hopefully next year the Federal and State money won't vanish. This is the kind
of problem best solved locally, but it still requires money from somewhere.

------
snarf21
This is such a hard problem to solve and there will only be less and less
money for it. It is a good approach to start helping people to help
themselves, rather than saying "we'll help you AFTER you fix your hardest
problems yourself.". This makes no sense and doesn't work. As shown here and
in other cities ([http://gladwell.com/million-dollar-
murray/](http://gladwell.com/million-dollar-murray/)), leaving homeless until
they get so bad that they need ambulance and ER services is VERY expensive.

In our local town, the major hospital group did an experiment. They took a
look at the top 50 patients that used the most of their ER and other services.
They hired people whose job it was to make sure they stayed on track, got them
to appointments (rides and public transport are big issues), made sure they
stayed on their meds and followed treatment plans. It was a great success.
They used ~70% of the resources that they used before. BUT, the hospital made
lots of money on the use of those services, the experiment cost the hospital
almost $1M!! It was not continued as hospitals exist to make money not help
people.

So let's say a city takes a stance to be progressive and helps their homeless
and (largely) gets them back on their feet. Pretty soon everyone in the
surrounding areas hear about all the help and services and now one small town
is dealing with all homeless that can get to this town. Smaller towns only
have so much money to invest in an effort such as this. Additionally, what all
jobs can you find to give all these people at $9/hour? There are only so many
things you can have them do before you start cutting municipal jobs to create
work and putting others on unemployment.

I saw a program several years ago where people that came into some of these
programs, were set up with social security disability (especially those with
mental issues and substance abuse issues) and give them a home base to get
other program support. At least this uses federal resources and doesn't put
such a strain on the local municipal budgets and resources.

This is a completely solvable problem but it takes a tremendous commitment of
will. The other issue is that homeless don't vote. It is a problem that has to
get fixed because it is the right thing to do, there is little political gain
or public outcry in most cities. It is more expedient to work on issues like
creating blue collar jobs and healthcare because of the public opinion payoff.
Just my two cents.....

------
ilaksh
Can we really not afford to provide very small homes (like tiny home villages)
to all of the homeless (rather than just the most likely to die)? I think the
biggest issue people would have with that is that people might take advantage.
Certainly some would. But would there be so many that we couldn't sustain it,
or that it would not match the benefit of having very few homeless?

It seems like there is just a very tiny amount of money available for these
types of efforts. I really wonder why that is.

~~~
Broken_Hippo
the biggest fear with some of this is that we tend to build public housing and
then it turns into some sort of slum with heavy police presence. While I agree
tiny housing is _usually_ better than no housing at all, I fear for what it
will become in medium to larger cities.

If there is a way to mix in these small properties into an area and have
mixed-sized housing, I think this would help the issue greatly - but the
logistics and politics to make neighborhoods such seems too high of a bar in
most places.

~~~
internaut
What I notice (since we're talking about 'Projects' it seems relevant) is that
there is a very low take up of the Tiny House concept among the black
population which mostly inhabits social housing schemes similar to the
Projects. The next smallest group is working class whites but this group is
still influential in the movement.

This is curious because a self built Tiny House is very affordable. You can
build one of these for less than 10k:
[https://www.tinyhomebuilders.com/images/products/simple-
livi...](https://www.tinyhomebuilders.com/images/products/simple-living-tiny-
house-exterior-1.jpg)

This is important because any social housing policy designed to decrease
poverty requires a large amount of 'buy-in' or goodwill by the residents or it
shall fail.

There is of course the question of land for THs, but that thorny issue has
already been overcome by most Tiny House people in a variety of ways I won't
list here, although I admit it is a serious concern.

I went in search of a black person who lived in a Tiny House. She had
immediately understood the nature of the question and said a bunch of things
on the subject, what stood out is that you might be able to sell the idea of
being frugal, minimalist, eco-friendly, outright home ownership i.e. autonomy,
practicality and economy to the majority white population that makes up the
Tiny House movement e.g. poor students and downsizing retirees, but selling
the same ideas to the black population is a very difficult sell.

[http://tinyhousetrailblazers.com/2016/07/where-are-all-
the-b...](http://tinyhousetrailblazers.com/2016/07/where-are-all-the-black-
people-in-the-tiny-house-movement/)

She said while many of the whites are coming from the suburbs i.e. been there,
done that, the American Dream for blacks remains to have a big house with its
associated trappings. That is when they know they have 'made it'. It follows
that a re-imagining of the American Dream is necessary for the black
population, just as has been happening for the people in the Tiny House
movement, but different.

Where I don't concur with Miss Pearson, is that I think this is regression.
For individuals it is a good adaption, yes, but the net affect on a society is
indeed regression. Big Questions need to be asked about why that's happening.

