This is great news! A close friend tried to give his parents, wife, doctor and me (each individually) the legal ability to do this if he went off the rails.
When he went off the rails, the authorities absolutely refused to do anything, even after he started talking about shooting up a local synagogue.
We eventually got him care, but only after he was fired, divorced, homeless and went from $100,000s in savings to $100,000s in debt. (The spending was on non-medical things. He had health insurance at the beginning of this, but eventually stopped paying for it).
The healthcare workers said this was pretty much the best case outcome because of current law.
It honestly sound like a weird scheme to provide free treatment the homeless, while sounding though. Still I question whether forcing treatment upon people is a good idea, and it would be much better to make it freely available before people become homeless.
The correct answer is both are needed, for overlapping but not always identical reasons.
There are a lot of drug addicts in homeless encampments, and they are often a menace to other people and to themselves (the drug addiction often going hand-in-hand with mental illness.)
Article says that if they refuse, they are put into conservatorships. I suspect that's going to be the most common outcome of this system.
Many homeless already have problems with banks, the criminal justice, healthcare system and other institutions. This is just going to add an extra institutional problem keeping them trapped in homelessness.
There are two types of homeless: (a) there are the temporarily homeless, who have lost their homes due to unaffordability (lost job, unforseen expenses, etc), may be fleeing domestic abuse (#1 reason for women with children), or some other temporary condition that prevents them from acquiring or maintaining housing; and (b) there are the permanently homeless, who have lost their jobs due to mental disease and/or drug use. (Note that the use of mind-altering substances causes physiological changes to the brain, so drug use frequently leads to mental disease.) Most of the (b) group chooses (to the extent they are able to exercise choice) to remain unhoused, because shelters and housing forbid narcotics, alcohol, and other contraband.
Right now, we operate under the ridiculous presumption that members of the (b) group are capable of acting rationally and in their own best interests. This is objectively false, but since this is the presumption we are forced to pretend is true, we can't force them to into treatment, however bad they may need it, unless they are at risk of inflicting imminent physical harm to themselves or others (but in this context, physical harm doesn't mean any harm typically arising from drug use...)
The proposal lets us force the members of the (b) group into treatment/rehab, however much they may refuse. And this is important, because people who are mentally ill will refuse treatment, until they get treated, at which point they recognize why they need to be treated, and will generally choose* to remain under treatment and to accept housing.
There is at least one more category, (c) those who are temporarily or permanently homeless by choice. It's not common, but some do prefer the nomadic life and have no desire for a permanent address.
We should take care not to assume that everyone in the "permanently homeless" category is there because of some sort of mental illness or drug addiction, forcing them into unwanted and unnecessary "treatment" until they agree to conform. Not wanting to be housed is not, in itself, a mental illness.
IMHO the only thing that could potentially justify forcing someone to accept treatment (or confinement—their choice) would be if they are manifestly a danger to others. In other words, the current situation without this proposal, except no use of force is justified against those considered a danger only to themselves and not others.
You're right there is a group C, but those choosing a nomadic life are probably not the ones in tents right at a major city intersection.
I am a 'live and let live' person and generally not bothered by the sight of homeless people (besides sympathy for their plight), but it has all started to get out of hand in California.
Yes but ... In my county the census of homeless persons counted only 17% of chronically homeless who primarily attributed their situation to mental health. By comparison half of chronic homelessness was blamed on lack of money, i.e. the cost of housing. Treating their mental health conditions may not solve their overall problem.
That’s just one county out of several in the Bay Area. Your study is also just a survey. There’s a good chance a mentally ill person will not consider themselves mentally ill.
Nationally the percentage range from 60-80% of chronically homeless as mentally ill depending on the study.
That's consistent with the data here: 70% of them are mentally ill. But it's not considered the primary reason they are homeless.
If you prefer to blame homelessness on mental illness, you need some kind of explanation for why homelessness has tripled in ten years, and why it's highly correlated with rents and anticorrelated with vacancy rates.
Because Reagan and the Kennedys made it so that you need direct consent from the mentally ill person for treatment. Otherwise, nothing can be done. Mental illness prevents many people from being able to hold down jobs and be independent when they are not getting needed treatment. You can't rely on the mentally ill to provide you with the real reason why they are homeless. That's a near useless survey.
80% of the homeless recover. It's mainly the mentally ill ones that stay chronic.
You need to cite authoritative sources on that. Mental health is a significant contributor but not necessarily a root cause. Most studies I have seen show that housing costs are the determinative factor. [1] Treating people is the right thing to do but won't end the problem.
There are several more papers that back the mental health angle. The key issue in the United States is that we need to have the consent of a mentally unwell individual before we can give them the psychiatric help that’s needed to get them off the streets
That paper isn't telling us anything new though. It's not telling us that mental health predicts homelessness, only that the homeless are disproportionately mentally ill. I'm mentally ill and make six figures as a software engineer. SWEs are disproportionately AD(H)D but it's not seen as a problem.
From what you linked:
"A qualitative study highlighted the basic human needs that often take priority over seeking psychiatric care. Access to adequate nutrition, water, shelter, and protection from the elements are the reality homeless individuals encounter daily, and these issues take priority over psychiatric needs, which are often not addressed until a crisis occurs."
Forcing the homeless into psychiatric care without their consent is skirting around why psychiatric care is currently inaccessible. People die rationing insulin, something tells me Uncle Sam isn't going to provide bipolar people on the street with free lithium. Plus people have good reason to distrust their doctor, a non-zero portion of homeless people ended up there after being prescribed Oxy and getting addicted to opiates. Substance abuse is driving most of the disparate health outcomes, and is a mental health issue but more importantly a public health one. The US as evidenced by the lack of a pandemic response does not care much about the public health.
I have good insurance. And supportive parents. I found navigating my diagnosis and care difficult, and I don't live on the street. I feel as though some of the commentators here have never experienced poverty nor can they empathize at a basic level with the struggle. It just seems as though psychiatric wards are meant to disappear these people since we can't disappear the underlying problem: commodification of shelter, water, food, knowledge.
It’s not telling us anything new because we already have the answer supported by several other studies. Their mental illness is so debilitating that they cannot function and they need professional help. That help is now being offered and you’re expressing doubt? As you’ve pointed out yourself they have no one and they don’t have “good insurance”. What’s the alternative, keeping the status quo? Imo this is best scenario. Like the Drug War, we’ve tried the Reagan Kennedy experiment with the mentally ill for decades, and it has failed. It’s time to move on.
As a former homeless person myself and not someone from an upper middle class background, being more proactive with the mentally ill makes total sense.
Btw chronically homeless people tend to experience schizophrenia more often than ADHD. It’s much easier to be high functioning with ADHD compared to the mental illnesses that the homeless tend to deal with
Fear of being involuntarily institutionalized is the single biggest reason most of the homeless populations (around here at least) refuse to seek any assistance, despite institutionalization not really being a thing around here anymore.
The voluntary aspect of this plan seems to be incredibly foolish to me, and I suspect it will not be accepted at high rates.
Here's to hoping it helps anyway, even if I am not so hopeful myself.
Some of this fear may also be part of their illness. I have worked with incarcerated mentally ill people, and paranoia is (somewhat unsurprisingly) a symptom many ill people who have committed serious crimes suffer from.
That said, I don't particularly want to be involuntarily committed either — it's a frightening thought, especially for those who have been involved in the justice system, where basically nobody cares about you as an individual. You'd want to have some kind of public awareness campaign so people (including potential patients) can see that they're not the asylums of years past. Play up the "spend the day playing checkers in the day room and getting better" part, play down the part where they don't get to leave until the nice people running the place decide enough progress has been made.
Getting back to inmates, I spent some time reading feedback form entries about how various inmates felt about their new tablets. I took an excerpt from one and sent it to a couple of product managers — the guy had written up his test cases and findings so professionally they were sure it had come from one our our QA teams. I guess we know what he did on the outside... One of the more paranoid inmates ranted about how his tablet was watching him, tracking his movements, etc., but then complimented us on the selection of movies — I guess I know why he briefly overcame his paranoia and accepted the tablet (they're not mandatory).
> You'd want to have some kind of public awareness campaign so people (including potential patients) can see that they're not the asylums of years past. Play up the "spend the day playing checkers in the day room and getting better" part, play down the part where they don't get to leave until the nice people running the place decide enough progress has been made.
As long as the "don't get to leave" part remains true your "public awareness campaign" sounds a lot like propaganda to me. This sort of thing is why people don't trust the system. You need to be up front about the restrictions, and persuade people (especially the prospective patients) that it's worthwhile anyway.
> Newsom told the San Francisco Chronicle that there was no more time to debate people’s civil rights when communities were faced with “people with their clothes off defecating and urinating in the middle of the streets, screaming and talking to themselves”.
That's pretty much what I saw when I lived in, and traveled to CA.
IMO: A major contributor to homelessness in CA is the absurd cost of living.
I'm with Newsom on this one. There's nothing compassionate about leaving the mentally ill in a pile of their own feces. If someone is competent enough to argue their rights to a court then that's one thing but the vast majority of homeless people in California are in desperate need of rehabilitation or care.
This doesn't seem entirely fair. My right to refuse medical treatment now depends on my housing status?
I live in California and I recently tried to help a friend get mental health treatment. We were refused because they were already at capacity and simply couldn't take on any more people. They even admitted she obviously needed help, but there was nothing they could do.
The obvious solution is to increase funding for public mental health services so they actually have enough resources to help people in need. At the moment, people who want treatment can't even get it, so it's very confusing when the state seems to think forcing treatment upon homeless people and undermining fundamental human rights is some kind of "solution".
I definitely worry about edge cases. This is the sort of law that seems ripe for unintended side effects/consequences.
It doesn't seem hard to imagine someone living on the street/in their car in the Bay Area and not having housing, but having a job and feeling trapped. That trapped feeling makes them not quit the job or move to another area, for fear of being in a worse position. I worry there are more people in this type situation than we know. I wouldn't want people like this to be put into an institution.
I don’t care. You can’t live in the park. That’s not a valid lifestyle choice.
We should expand systems to prevent homelessness in the first place but once that point is reached “no thanks” is no longer an acceptable response to offers for help.
> that point is reached “no thanks” is no longer an acceptable response to offers for help.
On this path lies a terrifying dystopia. For example, I find smoking and eating ultra-processed food an incredibly invalid lifestyle choice; doctors agree with me. Should we also mandate forced smoking addiction treatment and diet watching?
The terrifying dystopia is already here. Try walking or taking a bus from King Street Station to Third and Virginia in Seattle without seeing human excrement and tarp shelters. The area is completely unusable.
Try eating a sandwich for lunch in Pioneer Square, or in Denny Park.
That I don't feel safe traveling through my own city because it is overrun by mentally unstable people is unacceptable. Neither they nor I should live like this.
We have rules and norms in a civilization. When we ignore real problems like mental health everyone suffers and those norms break down. I am not in favor of adjusting our norms to include "well you can't use public spaces because we don't care about mental health".
We have laws prohibiting smoking indoors in public places. When your actions affect the lives of others, that's when they are subject to potential legal/judicial intervention. Certain segments of the homeless population have become a significant public safety issue in many parts of California, that is what is driving this.
Leaving the extremely mentally ill/drug addicts to essentially rot and die on the street is not a solution for anyone. I'm not saying all homeless people fall into this category, but this is the segment that is driving this change.
You are incorrect. We don't provide mentally ill people with even basic treatment, most particularly in cases where they are too sick to recognize the need themselves. Instead, we walk around people on the sidewalk as they suffer psychotic breaks.
I support this proposal 100%.
It will not solve the housing crisis in California, because it's largely driven by high prices. But it will help us restore basic decency in our treatment of fellow citizens who badly need help.
> Americans will do anything to avoid providing people with housing.
Including resorting to $60K per year tents. [1]
But we could steelman the argument for proposals like this one: you could see homelessness as a problem of loneliness, addiction, mental health issues and unstable families. This might be more realistic compared to seeing it as merely a housing issue.
The fact that governments spend money on tents and 'temporary solutions' doesn't disprove my assertion that we refuse to build safe and stable housing for all our citizens.
Most homeless people in America are people who has some form of mental illness or have suffered from some traumatic event. In any case just giving them a home won't help much, those homes would quickly become drug dens.
A better solution is to provide them with shelter, community, mental help, education, and generally good care. This is actually even harder to do than just throwing houses at them.
But there is also merit to giving housing to people who are homeless but not mentally ill. Many European countries do this.
Are you sure it's not true? Perhaps they should be more specific in that the majority of "long term" homelessness is due to mental illness or drug addiction.
Usually, when people refer to homelessness, they are talking about the people living on park benches and pushing around shopping carts or sleeping off their last high sprawled out on the sidewalk. Most of these people need mental health care. Not just a home.
My understanding in San Francisco is the majority of (visible) unhoused fit the GP description as those who are not mentally ill do make extensive use of shelter services and other avenues to be off the street. Whereas those with mental illness or drug issues do not.
I don't see a problem with that. Sure it's trashy and sure I'd appreciate it if I didn't have to pay for it but a) the alternative is drugs on the sidewalk b) who am I to tell others how to live?
Remember that virtually every homeless individual started out as a homed individual. To inhabit a home, you need an income to pay rent, you need food, and you need utilities somehow for a bare minimum existence. If you're making the choice to spend your income on drugs rather than rent every month, you're going to quickly return to homelessness and we won't have solved your problem.
If you're proposing giving people free rent, food, and utilities indefinitely, that starts to get uncomfortable as it edges toward slavery.
But they are responsible for large portion of the quality of life issues impacting local residents.
I feel like the homeless issue is a case of two sides talking past each other. Homeless advocates (and the "industry") are doing their best to support the "down on their luck" individuals. These folks are capable of holding down a job (maybe with some support), but might struggle to afford rent. The "homeless industry" is heavily focused on helping them. Meanwhile, local residents are complaining about the decline in quality of life from having individuals with drug and mental health issues living on their doorsteps. These types of homeless are very resistant to the services provided by the traditional "homeless industry". When you see a significant amount of tax revenue going to homeless services, but the guy living in a tent down the street is getting no help, it can be very frustrating. Hopefully this measure is the first step towards solving that issue.
But probably the source of a large portion of the antisocial behavior that cities are trying to deal with (e.x. human feces in subway escalators that cause constant breakdowns in the escalators that aren't actually designed to be defecated into).
Is there something particularly attractive about an escalator to someone who needs to poop? Or is it just that there is so much pooping all over the place that some just ends up in the escalators?
As one who rarely defecates in escalators in subways I'd only be speculating, but I would imagine that at night, when the subway is closed, they afford more privacy and protection from the elements than the street.
The east cost for the most part doesn't have these problems or at least not to the same extent (with a couple exceptions for Philly and NYC both of which are nowhere near as bad as cities in CA/OR/WA)
This isn't an American problem. This isn't even a liberal/conservative problem. This is a west coast problem.
Yes, homeless people want to live near wealthy people who don't mind being surrounded by the homeless. Most large cities in the US have this, but sunbelt ones typically are more conservative and therefore harsher on the homeless. There are of course many other reasons why homeless leave too. Harsh summers, car dominant culture are obvious ones.
But that's simply not true. Much of the Southeast US is considered a temperate climate, and homelessness is not an acute problem like it is on the west coast. Miami, while humid, doesn't often get above the low 90s and has one of the lowest homeless-per-capita rates of cities in the US.
The entire European Mediterranean region has similar weather to the Western US and doesn't have the same homelessness issue. Lake Tahoe, Chicago, NYC, Vancouver hit freezing in the winter and do have homelessness.
I think it's easier to permit homelessness when people don't freeze to death or become heat casualties, but the causes are way more complex than the weather being nice year round.
It strikes me that the dysfunction stretches across state and country borders. The issues you see in San Diego and San Francisco are the exact same ones you see in Vancouver.
I'm in Massachusetts now, and as a west-east transplant I'm amazed at the stuff that just works. Cycle paths get built, housing gets built, state social and health services are extant and useful. I'm sort of at a loss to explain the difference.
The fact that CEQA applies to all levels of government in California makes it easier to throw sand in the gears.
Similarly there is too much good government sometimes, too much accountability makes it hard to accomplish anything. Too little means corruption is hard to root out. There is less accountability in the east overall in bureaucracy - any state not hit hard by the progressive revolution of the early 20th century seems to be better at doing thing.
I see more community focused expectations of behavior on the east coast (There is more of an expectation that everyone ought to behave a certain way, and do certain things in certain places).
There are other cultural differences too, east coast residents in my first hand experience tend to be more apt look the other way at penny ante corruption (the stereotypical "I know a guy.." culture), which somewhat perversely makes government more flexible work better. Generally the less moral imperative government has, the better it works.
I realize these are probably not popular opinions.
perhaps the same reason that it's really hard for me to view SF as a "real city" after living in NY for a few years. Even with all the money moving around in the bay area, so little of it actually makes its way back to the built environment.
NYC in many ways is "America's Only Real City." Seems like every other major city went for the 'burbs in the postwar period and ended up kneecapping their growth.
We have a similar problem with bark beetles in pinyon pine trees in the southwest. The theory I heard is that when winters don't get cold enough, too few of the beetles die off, and many pinyons can't handle the additional parasite load. The trees die and huge swaths of forest burn up.
If something even slightly threatens the capitalist dogma, it has to be reduced to a performative half measure. From healthcare, to housing, transportation... etc.
There has been a rise in homelessness and people becoming disillusioned by the tethers of society, to the point that people are voluntarily retreating into cities and wildernesses to live freely off the land.
Homelessness (particularly voluntary) is an existential threat to capitalism because it reduces the productivity of the working class. This in turn diminishes the gains of the proletariat, who need workers and purchasers of their goods and services (such as houses).
The title story seems like a scary way for the system to force people into becoming productive members of society. In the system's eyes, these people are useless, unwanted wastes of space, so they are going to force them into treatment so they can "lead normal lives," a euphemism for turning them into productive cogs in the proletariat's capitalist machine.
healthcare/housing/transportation are good for economic growth and "capitalists."
the issue is more that the landowner/rentier class are still the most politically vocal, and anything that upsets the status quo for them gets an insane amount of pushback.
Former public defender here: laws in CA already have rehabilitative programs. LA and San Bernardino County already have fairly large rehab programs for drug offenders (aka "diversion").
Diversion is actually the preferred process for first-time (non-dealing) drug offenders. However, repeat offenders are not entitled to diversion, and due to capacity constraints, must generally surrender their spot to first-time drug offenders (the best analogy I can think of is Disney's Lightning Lanes vs Standby Lines), because first-time offenders are more likely to benefit from diversion than a repeat offender for whom diversion clearly did not work.
There are simply too many drug users for the rehab programs to handle. It's not a matter of just increasing the budget for rehab, because more than half of the drug-related offenders are repeat offenders who have already gone through rehab and relapsed.
I am familiar with the current system and its failings. This is why I believe that the only real solution is to have start doing real rehabilitation in the prison system.
If an addict or mentally ill person is repeatedly harming others or breaking laws, the only solutions are rehabilitation or incarceration. The problem is that we are failing to rehabilitate and following that, we are failing to incarcerate.
I don't see how a parallel judicial system of "care courts" solves this fundamental problem.
If you were familiar with the current system, then you would know that "diversion" isn't just a parallel judicial system, it includes rehab as a fundamental part of the process. Or in other words, the solution you claim to want is already part of the system.
If an addict or mentally ill person is repeatedly harming others..., the only solutions are rehabilitation or incarceration. The problem is that we are failing to rehabilitate and following that, we are failing to incarcerate.
Non-violent addicts are eligible for diversion, which means a separate judicial process that includes rehab. But only first-time drug offenders are entitled to diversion in lieu of incarceration. A person cannot be forced to rehabilitate: they must choose to rehabilitate. If rehab fails, it is because the addict has failed, not the system.
Violent offenders are generally not eligible for bail, and are not eligible for alternative sentencing options like diversion, home detention, half-way housing, or early release. They are simply incarcerated in jail, prison, or a mental hospital. We are definitely are not failing to incarcerate these individuals...once they commit violent crimes. The problem is that we simply can't incarcerate them until they commit a violent crime because homeless rights advocates have convinced judges that these types of individuals shouldn't be incarcerated because their too mentally ill to understand what they did is wrong. (Yes, the very thing that makes them more dangerous is also the grounds for not doing anything about it until someone else gets seriously hurt.)
Addicts (even violent offenders) can participate in rehab in prison. If they are eligible for it, want it, and there is space in their local facility's program. They cannot be forced to participate in rehab.
Mentally ill individuals who cause harm go through the process of "civil commitment" whereby they are committed to a mental hospital for treatment and remain for at least the duration of the prison sentence they would have served for the crime if not mentally ill. Depending on the extent of their illness, and the role it played in their violent actions, they may remain committed for significantly longer than they would have if they had served time in jail (and may even remain committed indefinitely).
Laws do prohibit this. You can't force prisoners to take medication.
I have worked in housing units filled with mentally ill inmates and as one might imagine it's not a therapeutic environment (though at least they are somewhat shielded from predation by the general population).
I don't think it's a good idea to simply criminalize homelessness. That's not really the right way to get them help, and it gives them a criminal record that employers will see.
Many things associated with homelessness are already criminal. It is is not clear to me how this changes anything for the better.
Instead of charging them with a crime in a real court, and mandating rehab programs or incarceration if they don't cooperate, we will charge them in a "care court" and mandate rehab programs or incarceration.
When he went off the rails, the authorities absolutely refused to do anything, even after he started talking about shooting up a local synagogue.
We eventually got him care, but only after he was fired, divorced, homeless and went from $100,000s in savings to $100,000s in debt. (The spending was on non-medical things. He had health insurance at the beginning of this, but eventually stopped paying for it).
The healthcare workers said this was pretty much the best case outcome because of current law.