I've heard that in Europe there has been a lot of success with criminalizing public intoxication and camping, providing free drug rehab, and making participation in that drug rehab mandatory or else you go to jail.
Well, those places are doing different things, for a start. So you still need to pick one.
For example, Singapore will execute you for possessing drugs (legally, for trafficking, but their standards for proving that are... very easy for a prosecutor to meet, let's say). So they have a very low rate of drug abuse, which no doubt makes the problem of homelessness easier to deal with. And you can't really implement that sort of a system with a vague wave of the hand and "do whatever they're doing over there". You need a critical mass of people to say "actually, yes, we do want to hang druggies."
An important point for both criminals and homeless crazy people/drug addicts is that leaving them on the streets imposes a lot of costs on the world, but an individual hospital or state agency or city agency's budget doesn't have to pay those costs, whereas those budgets have to cover the costs of taking them off the streets and putting them in jail or in an institution.
wrangling a building full of psychotic adults is very different from wrangling a building full of sane adults.
You say cameras in locker rooms. Okay, you put those up, on day 1 you see one person shitting in a corner while a second person pins a third person to the wall and demands money and a fourth person shoots up drugs in another corner. When you try to talk to any of them about it they ramble about the CIA and the aliens and the simulation, and honestly their paranoia in this case isn't completely wrong, you *did* put up cameras to watch them, after all. Maybe you *are* the alien feds. The next several days are much the same. The security and janitorial resources required to keep up with this are orders of magnitude higher than a youth hostel.
> The Soviets understood that if people don't have shoes, the solution is not that the government redistributes money. It is that the government builds a shoe factory and makes shoes.
We have a market economy in which people use money to buy things, so giving people money does suffice for most things.
> SF has a huge budget. Why cannot they build?
The Bay Area is where anti-growth coalitions have been most dominant https://whorulesamerica.ucsc.edu/local/san_francisco.html They hate developers and made it nearly impossible for them to build things, and those restrictions also make it practically impossible for the government to build things.
Muho Nölke used to live in a homeless encampment in a japanese public park before he got appointed as abbott of Antaiji. He met his wife in that park IIRC. His description of his homeless life in Japan sounded nice.
Plus, new government policies are virtually always messy and inefficient. When you avoid giving specifics, you get to dance around that fact, which hardly seems fair. The implementation problems become more obvious when you get into the details.
Cruel and draconian policies will be executed no more competently than kind and gentle ones; we shouldn't let people pretend otherwise.
Depends. One cruel and draconian option is to announce an end to police resources for investigating the killing of homeless people. Vigilantes would change the incentives for homelessness. With some surveillance this would double as a way of identifying all the vigilantes while they're only killing those we've already given up on, and we could always go back on our word and prosecute them for murder.
I'm not saying this is a good idea, mind you. Just pointing out that the idea-space is vast.
And what we have now isn't? It at least has the merit of being a different clusterfuck. But it allows the well-to-do to escape seeing the consequences of their behaviour, so morally worse perhaps.
Isn't the answer to "who killed this homeless person?" usually "this other homeless person"? I don't think vigilantism is involved much, if at all, and stopping police investigations wouldn't make much of a difference to the numbers of homeless people getting killed.
"Figures from the Los Angeles Police Department show that people experiencing homelessness are roughly twice as likely to be victims as suspects. According to the city’s open data portal, which goes back to 2010, unhoused people have been victims in about two-thirds of homicides in which someone was identified as homeless (417) versus suspects in about a third (215).
Tellingly, an LAPD public records request for data since 2017 shows, if you remove homicides where both the victim and suspect are homeless — likely leaving more of the oft-sensationalized “stranger danger” cases — the proportion of houseless victims to suspects tilts further: 171 to 51, more than three to one.
The public-records request data confirms a rapid rise in annual totals of homicides involving a “homeless/transient” victim and/or suspect: from thirty-eight in 2017 to forty-four in 2018, fifty-two in 2019, seventy-one in 2020, and 106 last year — likely an all-time high. Going back further, to 2010, the portal’s data shows a similar recent spike: for 2010–19, the total homicides including a homeless victim and/or suspect was 364. Already this decade, it’s 268.
Two agencies shared numbers with me that seem to confirm a recent surge: In Denver, a police spokesman notes, fifteen of the ninety-six homicide victims in 2021 were homeless. In San Diego in 2020, Lt. Andra Brown notes, unhoused people were victims of four and committed three homicides; last year, they were victims in eight but committed just one."
Killers who are not themselves homeless persons seem to be criminals already, going by this case:
"The suspect in the three fatal shootings of homeless people in Los Angeles was identified as a man who was already in custody after being arrested earlier this week in connection with the murder of a San Dimas resident who was shot during a follow-home robbery, authorities announced Saturday."
This is not but reminds me of wet streets and rain.
Yes of course right now vigilantes don't do anything, because they'd be prosecuted. If you talk to people affected by homelessness, however, you stay to think that one out of every hundred or thousand might be willing, were there no enforcement, to solve the problem.
>Isn't the answer to "who killed this homeless person?" usually "this other homeless person"?
"[T]wice as likely to be victims as suspects" suggests that it isn't, no?
Anyway, that aside, a few recent murders of homeless people in Southern California that got media coverage turned out to have been done by thrill-killers who presumably thought that it would be easier to get away with.
Of course, that could just be these cases getting more media coverage because they are at first mysterious and senseless, as distinct from "homeless person A and homeless person B got into an argument at their encampment, whereupon B stabbed A at their mutual encampment in front of a bunch of witnesses who knew them both," as the latter case would be resolved quickly without a lot of sleuthing.
Just pointing out that just because a homeless person is twice as likely to be a victim as a suspect doesn't mean that the killers aren't usually other homeless people. Even if we know all the killers, there's likely to be less than the number of victims, because a lot of people who kill are relatively likely to commit more murders. But in reality there's going to be a lot of cases where no suspect can be identified.
There seems to be a little bit of fiddling with the figures - yes, if you take out all the cases where the homeless person A was murdered by the homeless person B, then you are left with the homeless people murdered by the non-homeless. That may or may not be higher proportionately, but there doesn't seem too much wiggle room if, in San Diego in 2019, there was one homeless murderer and eight homeless murder victims but in 2020 there were three homeless murderers and four homeless murder victims. *Something* caused that jump up in homeless murderers: homeless victims from 1:8 to 6:8
How much of these numbers boil down to when a homeless person is killed the PD has no clue who did it, and never learns?
Skimming that article I see the numbers for how many people died (easy to measure) and how many suspects were homeless.
What I DO NOT see is how many suspects (let alone convicteds) actually were non-homeless.
Big surprise that, as per usual with Jacobin, you can't even tell if they are deliberately hiding this data or simply so stupid they don't even realize that it's THE most important number...
Implementation =/= no longer implementing. Implementing a return to a long-ago previous policy such as 'if we catch you being shifty in our town the police will beat you with clubs' is different per sec than informing all the armed Americans who are sick to death of problems like this that the police will no longer be implementing the fairly recent effective ban on mob justice.
Messy, inefficient implementation of policies that protect the law-abiding citizenry and any unintended victims will eventually have recourse may be superior to the status quo for many people. The impact classes are totally different: parents, for example, probably care a lot more about their children not being harassed or dodging needles on the street than they care about the drug-addled ward of the state dumping the needles to begin with. If kind and gentle policies do nothing for normal people, they will eventually give up on them and vote for the cruel and draconian that does.
Also this is clearly a commentary on "damn liberals" calling anything that actually has an impact "cruel and draconian," like maybe not having open air drug markets where people commit slow suicide in public parks.
People committing slow suicide in public parks is more of a nuisance or a depressing eyesore than an actual danger to the "law-abiding citizenry," isn't it?
No. Junkies leaving used syringes in the parks that my nephews might want to play in is, in fact, an actual danger to them. I do not want my nephews getting Hep-C (or anything else) because they stepped on something that a junkie couldn't be bothered to clean up. Yes, I have helped pick up other people's used sharps in public parks.
I realize that I'm stereotyping by presuming these are typically left behind by junkies and not diabetics, but I think I can live with that.
In fairness, the risk of any given diabetic having hepatitis or other needle-transmissible illness still seems high enough to be worth taking seriously.
I'd be curious as to how many Californian homeless persons are originally from California? Surely there can't be *that* many naturally-occurring crazy people per capita, and if there are, that's a sign of something much more worrisome.
Minimum-security jail sentences might be the most humane short-term option for people who can't look after themselves, and if most people cease being homeless within a year then clearly incurable mental illness is not what's keeping them on the streets.
1- ALWAYS have a drug problem, at best severe alcoholism, most frequently polyaddicts including at least one of cocaine, opiods, or amphetamie-class stims.
2- Are substantially below average at mental function in at least some way even while sober
3- as a result of the above, literally cannot handle taking care of themselves. Whether you consider them responsible for their own behavior or not, there are people who just cannot handle life.
SF has a major problem because housing costs raise the threshold of how hard it is to take care of yourself. Once you end up broke and homeless once, you fall into the visibly obvious problematic homeless attractor. That happens more often when it is more expensive to support yourself.
Remember that still, MOST homeless people are in a temporary situation that they get out of, with or without state help, with or without friends or family. Not without no help, just that ~80% of people who experience homelessness in their lives manage to get out of it.
I'm in favor of providing as much help as we can to the people experiencing homelessness and prosecuting opiod distribution with extreme public brutality
I think that you have to go pretty far along the fascism axis before you make a difference. If you are advocating for rounding (some) homeless people up and killing them (which would both be in your bounding box and also objective-limit effective, but at a price a damn liberal like me would not be willing to pay), then instead of vaguely gesturing at it, please state it outright.
If you had something short of that in mind, please clarify why you think it would change the behavior of homeless people where current disincentives fail.
My cruel and draconian policy is "yes we will criminalise persistent homelessness and the more mentally ill you are, the longer your sentence".
Since nobody wants to build asylums any more because of stupid Hollywood shit like "One Flew Over The Cuckoo's Nest", my new prisons will be called "prisons" but they will in fact be asylums to treat the mentally ill homeless, hopefully get them stabilised, and enable them to have a roof over their head, food, clothing, bathing facilities, and some kind of routine before they get turfed back out on the streets. If there isn't a plan in place to support the person once released, that's an extension of the "sentence" so they won't be turfed back out to live on the streets while we flail around to get them some kind of halfway house or accommodation.
Needless to say, there will be strict inspections to make sure the 'prisons' are not hellholes and that the government money is being spent effectively. I will go all-in on being a horrible cruel draconian by permitting charitable bodies -including, gasp! religious and double gasp! even Christians - to be involved, particularly in the post-release "help people get jobs, accommodation, ongoing support and treatment, half-way houses, assisted living, whatever they need" phase.
Staff will be properly trained and properly paid, but nobody is going to get rich off this. There will be no 'private nursing homes where one nurse is looking after a hundred patients while the owner buys their second luxury home' arrangements. However many we need to provide a decent ratio of care will be hired. Anyone who thinks they can have a side hustle smuggling in drugs, booze, porn, or exploiting the inmates will go for a long trip on a slow boat to China.
(That may or may not be a metaphor).
Maybe some of the inmates are in such a state that they can never live independently, even with support. Well, they'll be our lifers.
Yes, I am willing to get the "You Fascist Monster!" medal of honour from the damn liberals and bleeding-heart progressives for my bold policy initiative.
This creates a really tantalizing incentive for some of the more ambitious Christian organizations: to declare lack of faith as mental illness. After all, only a crazy person would reject Christ and thus embrace the Devil, right ? It is our duty to bring these poor benighted souls to the Lord !
I wouldn't mind this if the inmates had 24/7, guaranteed, uncensored Internet access. (Except in the specific cases of people where doctors *seriously, specifically* think *unfiltered* Internet might make their condition worse.) I think with the modern world being what it is, the lack of Internet access is one of the most prima facie inhumane and torturous aspects of forced instutionalization *or* regular prison. It cuts you off from, potentially, some of the most meaningful human contacts in your life. The fact that it's limited even for lifers/long-term mental patients is I think an archaism as much as anything — people treat it as if it's like "not giving them a free TV set", as opposed to what it really is, potentially cutting them off from their loved ones forever.
I don't think the internet needs more crazy people on it.
Loved ones can write letters to stay on contact. If they're too lazy to do that, they were probably going to dump their mentally ill loved one eventually anyway.
Medals aside, how are you going to pay for this? And where is the political will to actually do it, and do it right (no hellholes), and *fund doing it right* going to come from?
We're already throwing tons of money, depending on what country you are from, at it. Why not take some of the $848 million San Francisco is allocating to homelessness support services and build, staff, and run one prison/asylum with it?
"The proposed budget allocates $846.8 million to HSH in FY 2024-25 and $677 million in FY 2025-26.
With ongoing Our City, Our Home funding, HSH’s budget has more than tripled since the first year of the Department’s operation.
92% of the proposed two-year budget would be appropriated to homelessness response system services, including 60% ($916.6 million) to housing. Housing costs go towards subsidies and services that keep households who have exited homelessness stably and successfully housed as well as new units."
The running costs are going to be the largest chunk of change we need, but if they can afford to throw hundreds of millions each fiscal year at the problem, they can afford to stump up fifty million to keep one prison going for the year each year (I have no idea if it would cost fifty million, but I'm thinking about having decent facilities and plenty of qualified staff).
'More than tripled'. Take a gander at that and think about it for a bit. Started in 2016/17 with a modest budget of $224 million, now proposing to spend $847 million in 2024/25. I'd be ashamed to look my diabolic stony-hearted fascist monster compeers in the face if I couldn't make a go of one lousy little asylum in its own grounds with fifty million in my hot little hands to do it up right.
I support this plan. It happens to be a lot like the plan I was going to lay out, but decided to read some of the comments before doing so. So maybe I'm just biased towards ideas that seem similar to the ones I'm already thinking about.
"Too far along the fascism axis" seems to include anything that gets clean streets and no open air drug markets when Xi Jinping isn't visiting. Is it a timing thing: it's okay for a week or two, but not for months or years?
It's unclear to me if you think gassing the hobos is the only thing that will make a long-term difference (and is of course wildly unacceptable), or if you're jumping to a grossly uncharitable example just for the fun of it. Forced relocation to comfortable but not downtown housing is probably too far along the fascist axis too.
Where, even vaguely, is the acceptable liberal line that doesn't let a small minority of anti-social people inflict themselves on the innocent citizenry with virtually no recourse? Is there one?
I believe that there are a large number of liberals who are not progressives or communists. People who can think. People who can make tradeoffs. People who can hear an idea without emotional hysterics when a word they don't like is used.
I have to say "I believe" (instead of "I know") because I have not heard from anyone who meets this description in a long time. Social media makes it worse. I bet there were always emotionally unstable people within the left, but those people had no way to publish anything I might read until the internet made it easy.
I miss the reasonable left. I wish I could hear from them. I know many of them are now small-R republicans.
Several comments throughout the thread seem to think any form of relocation is unacceptable so I still think it fits my frustration with that above comment. I figured the cleanup was some sleight of hand.
Well for starters I'd say we don't need to criminalise being homeless, we just need to criminalise committing crimes.
The problem isn't the crazy people who walk around muttering or the homeless who sleep in their car for a couple of weeks, the problem is the crazy or homeless people who actually commit crimes which harm others. Right now the criminal justice system seems to default to giving them some soft sentence, hoping that this is somehow going to cure them, which it doesn't.
Drastically increasing prison sentences for "minor" offences would have two good effects. The criminals who are making semi-rational decisions will be much less likely to commit crimes. And those who are irrational can be safely confined and forced to take their meds.
If this sounds inhumane then I'm perfectly willing to work on making more humane prisons into the bargain.
How about starting by scaling up production of those GPS tracking anklets already being used for some types of parole? Seems like simply being able to find previously-arrested individuals again, on short notice, would open up a lot of useful options, and "wear this unusually sturdy wristwatch in case we need to contact you again" doesn't seem like the sort of thing that's too heinously excessive to apply for a first offense.
>There are an infinite number of ways that semi-psychotic homeless people can miss appointments. The half-life of these people’s contact with the medical system is a month or two. So they’ll miss their appointment and get off the drugs. The police aren’t going to start a nationwide manhunt for a psychotic homeless person who’s indistinguishable from all the other psychotic homeless people.
sounds like: This is a lossy system. My knee-jerk reaction is that it needs redundancy. In addition to the locator beacons, what I would add is:
- The half-life for losing contact with the medical system is a month? Schedule appointments once a week _even at the cost of making the appointments lower quality_ . Do perfunctory, perhaps automated appointments.
- Since these people are homeless, have at least their prescriptions held at the pharmacy, _not_ in their tent. Use some flavor of ID - fingerprint, retinal scan, whatever to match patient to prescription at the pharmacy, rather than having them have to keep ID in their tent.
This is all in the interests of keeping as many of them as sane _as possible_. Now, there are large chunks that this won't solve:
Medications with side effects bad enough that people stop taking them, even when they have them.
Expensive housing. That is a huge problem way beyond just the mentally ill homeless, and a whole separate discussion, and a lot of approaches have been tried and have failed.
We have a winner. GPS tracking anklets are very old technology at this point. The technology is dirt cheap. It's really insane that we don't use them more.
"The problem isn't the crazy people who walk around muttering or the homeless who sleep in their car for a couple of weeks, "
No, the problem is crazy people who walk around muttering and shouting and screaming and shitting on the street and threatening people, and the homeless people who sleep in their cars permanently and use facilities that weren't designed for long term living.
This is a really obvious and sensible solution that Scott seems to have almost deliberately ignored in service of making this problem seem intractable. This is actually a really easy problem to solve and cities like New York have previously solved it before losing the technology in a City of Ember like fashion. Step 1) build enough shelters so that people with nowhere to go don't have to sleep on the streets, 2) enforce the law (you can't do crimes or sleep on the street and if you do you'll go to jail), 3) congratulations you have solved the problem most people care about which is not being accosted by crazy violent people who live in the street. We did it folks, and in only a few hundred words.
Step 1 runs against the very obvious problem of "nobody wants a homeless shelter near them", besides politicians implementing Big Brained Ideas (both of the leftist and rightidt variety) making the shelters unworkable even IF they are built
There's a thread down below that talks about privatization of the problem. Perhaps we combine that with "be arbitrarily cruel and draconian". Call it a "last chance" program. If the company can successfully reintegrate you into society, they get paid and the problem is solved. If not, you get drafted in our forever wars and go directly to the front line. Set a fixed timeline for reintegration and define success as the ability to retain a place of residence.
To be frank I'm sick of both the homeless problem and the forever wars, but if we're stuck with both, when life gives you lemons... Damn this is dark.
Random people who don't want to be there, never mind the whole mentally ill bit, are just a dangerous liability on the front line rather than helpful in any way.
Not to mention the expense and difficulty of transporting them there and upkeep in the meantime.
Convicts have been used a lot over the centuries in various roles; untreatably psychotic mental patients less so; any army with the state capacity to conscript mental patients has relied on either ordered formations or complex weapons to some extent.
I considered the liability aspect after posting and my mind came up with: paratroopers. Effectively human weapons turned loose behind enemy lines. Best case you damage your enemy, worst case they defect and become another country's problem.
Indulging the idea further: this seems to potentially be the current play with "asylum seekers" in the US at least according to some sources.
I don't see cost as a real counter argument as it is likely less than a lifetime on government services.
And I have to reiterate how abysmally dark these ideas are and that I'd rather both problems (war and homelessness) be solved more compassionately.
The more I think about it, the more we're really just on track to gladiators.
The US military already have things that you can drop at the enemy from the air to inflict not-very-targeted damage. They call these things "unguided bombs" and they come at just a few thousand dollars apiece, and don't require food or much space when stored.
Ehh, kind of. Certainly, a conscript-based military has to be designed in a different way than a volunteer one, and you do definitely need at least some volunteers (to be commissars/blocking troops, at the very least) but Russia has demonstrated that it can be made to work even in modern times.
I'm not sure they're demonstrating it can be made to work - the invasion seems to be a shambles compared to expected performance, and they're still picking fit young men who they just don't value for some reason rather than incorrigable homeless people off the street - generally the young men have families back home, something to lose, and the general ability to do things.
You said "Random people who don't want to be there, never mind the whole mentally ill bit, are just a dangerous liability on the front line rather than helpful in any way."
Conscripts are "random people who don't want to be there". Apparently they're helpful in the proper framework. They would definitely be a liability if put into a designed-for-volunteers system, and they are definitely always less useful than the same amount of volunteers, but apparently that's not enough to make them infeasible.
Now, yes, chuck insanity into the mix and it gets a bit trickier (although I imagine a well-designed boot camp might be able to mitigate a lot of the insanity prior to deployment), but you explicitly claimed that that wasn't necessary to conscripts' uselessness.
Yup, and even Russia briefly looked at the idea of conscripting their own homeless and said - "nope!". There was some politician voicing the idea early in the war, and reports of isolated cases of this happening, but it didn't really go anywhere.
Well the draconian fascist in me would say that we wouldn't send them to fight the serious wars, just little wars that we start for the purposes of giving the hobos something to do. You can't invade Russia with an army of American hobos, but maybe you can invade Papua New Guinea?
Government interventions are often useless, but "let's solve the problem by privatising it" is even more useless. What happens is that the entities interested in such schemes see $$$$ instead of public service, are more interesting in wringing out the maximum return for the shareholders, and often do worse than the government agencies in the first place.
'Get recruits by emptying the prisons' and 'jail or the army' is a time-honoured practice for militaries, but 'use the homeless' isn't a good substitute. You need people who are minimally competent and trainable to be soldiers, and even criminals need to be more the "robbery" and "juvenile petty shit" than "multiple murders and assaults" types.
It depends on your approach. Prigozhin was having great success with the prison-to-military pipeline (perhaps a little too much success, in fact, which is why he's dead now). The magic recipe appears to be to have a core of loyal (and well-paid) veterans who will babysit the convicts (by shooting any dissenters and wannabe deserters), and to send the convicts into the meat-grinder as quickly as possible. Putin tried to take over Prigozhin's business (after the latter's unfortunate spontaneous mid-air explosion), but (possibly due to the overall corruption level of the Russian army) is not having nearly as much success. His convicts keep deserting, or worse, surviving the meat-grinders and returning to their home towns, to resume committing whatever crimes got them thrown in jail to begin with.
There's a far better option along the same vein: instead of pointlessly butchering them, give them homes in the conquered territories. In fact, you can open that up as an option to everyone, and solve more problems.
I'd have no problem sending them to the front with the promise that if the effort is successful, they would share in the conquest. I think I disagree with giving territory to someone who didn't fight for it.
All of that said, my preference would be for neither homelessness nor war to exist. We're too damn rich of a country to not have asylums big enough to adequately treat the psychotic patients we turn out on the street.
I see where you're coming from, but in my view, they WOULD be fighting (albeit a prolonged lower-intensity conflict), to HOLD valuable territory in hostile conditions. For this to work, I expect you'd need far more manpower than your soldiers can reasonably provide. Perhaps you could give your soldiers rent from the properties for a few decades before transferring ownership to the residents?
I expect the homeless would make poor soldiers, but perfectly adequate settlers.
What I could see working in conservative states (only) is low-cost, tented prison camps, like the WWII Japanese American "relocation centers", i.e. internment camps. These were situated many miles inland, often in remote and desolate locales.
No one has the right to be sustained on other people's dime, i.e. by forcing other people to pay taxes under threat of imprisonment themselves. If you can't survive a low-cost relocation center/internment camp, you can't survive in the modern world. Oh dear, never mind, how sad. Let's move on from emotions, and protect productive society.
Such camps would be extremely unpleasant. So be it. That should be an excellent deterrent. If internees demonstrate the ability to contribute to society - or at least not to be an active detriment - they should have a way to earn their release. If they don't, they should be offered a painless way out: e.g. equip every cell with a ligature point and a length of rope, and confer upon people the discretion what to do with their lives.
Nasty? Yes. Realistic. Also yes. Better than how LA or San Francisco are currently dealing with this? Definitely yes.
'Enslave' is probably overwrought, given that these people wouldn't be actually earning their keep; it's also not in line with my actual intent. If we're striving for a pithy one-word encapsulation of my preferred policy, it would be: 'Exile', i.e. get these people away from productive decent citizens who deserve to be allowed to live their lives unmolested.
Forced labor for the homeless was the traditional solution. But there really aren't a lot of jobs any longer that are economically meaningful if you're both completely without qualifications and actively hostile to the task.
You don't really need it to be economically meaningful, you just need it to keep them busy and (ideally) to help offset the cost.
Many low security prisons are prison farms -- I doubt they're particularly efficient as farms go, but it keeps the prisoners busy and sometimes teaches them useful skills that they can use to go get a job once they're released. If I had to be in prison I'd choose doing farm work over sitting around all day.
Earn their release? Why not put these camps deep in the Alaskan wilderness, fifty miles from the nearest road? Don’t stop anyone from leaving, but make it very clear that nobody is going to be looking for them. Maybe give them tracking bracelets or ankle monitors or something; if they shed those they shed them. If you can get through fifty miles of roadless wilderness and back to civilization you are probably reasonably fit and thoughtful; if you can’t and gambled and lost…well, not our problem. Good day to be an Alaskan buzzard.
Besides, you could argue that you aren’t technically stopping them from leaving. Meet your requirements, or take your chances in the Alaskan bush. If you can find a way to get a buddy with a snowmobile to meet you at the fence…well, it’s public land, nobody is going to stop snowmobile guy from riding through it or you from meeting him.
Reminds me of https://detoxcampcomic.com though admittedly that's a slightly different "undesirable" demographic and involves a lot of supernatural elements.
"No one has the right to be sustained on other people's dime… If you can't survive a low-cost relocation center/internment camp, you can't survive in the modern world. Oh dear, never mind, how sad. Let's move on from emotions, and protect productive society."
I was trying to think how to respond to this, and realized that Scott had already done so, a decade ago:
"But society came and paved over the place where all the roots and berry plants grew and killed the buffalo and dynamited the caves and declared the tribal bonding rituals Problematic. This increased productivity by about a zillion times, so most people ended up better off. The only ones who didn’t were the ones who for some reason couldn’t participate in it.... Society got where it is by systematically destroying everything that could have supported him and replacing it with things that required skills he didn’t have. Of course it owes him when he suddenly can’t support himself. Think of it as the ultimate use of eminent domain; a power beyond your control has seized everything in the world, it had some good economic reasons for doing so, but it at least owes you compensation!"
For the rest, this sounds like the traditional early 19th century solution of workhouses with involuntary confinement, although I don't know that any of them went so far as to include suicide apparatus in each room; that's an innovation. But the general idea is familiar. I would suggest that before thinking about setting up internment camps for people unable to afford housing and/or unwell enough to manage, you ought to look carefully at why those institutions were dismantled in the first place.
Thanks for the link - I'll read it after work/at the weekend. I think the short answer though is that I disagree with this:
"...most people ended up better off. The only ones who didn’t were the ones who for some reason couldn’t participate in it.... Society got where it is by systematically destroying everything that could have supported him and replacing it with things that required skills he didn’t have. Of course it owes him when he suddenly can’t support himself."
I think that a more accurate, but less emotionally cathartic answer is that historically people who couldn't support themselves died. Modern liberals delude themselves that everyone has equal potential. In fact, I think that a small but significant % of people are simply totally unable to add any value to the modern world. Such reasoning is leading European nations, which are largely to blame for welfare states, to effective bankruptcy. Take France, for example:
- government spending 15% points above the OECD average
- welfare spending is 18% of GDP, nearly double the OECD average
- public debt is 112% of GDP, among the highest in OECD
- retirement age remains among the youngest in Europe
- civil service employs 5.7m people
- 5.5% deficit and rising
- no balanced budget for 50 years
That's the model which Democrats are attempting to impose in the US: ever-growing spending to throw money down a black hole. By contrast, I believe in Friedrich Hayek, Ludwig von Mises, Milton Friedman and Thomas Sowell:
• If you tax something, you get less of it.
• If you subsidise something, you get more of it.
• Western countries: (a) tax productivity; and (b) subsidise parasites.
"I think that a more accurate, but less emotionally cathartic answer is that historically people who couldn't support themselves died."
The passive voice evades no end of responsibility, or tries to. If someone who used to be able to support themselves, dies because you paved over all the wild fields and killed all the buffalo, then it isn't a matter of "they died", you killed them. If the claim is that they could have supported themselves by working in the factories you built on the paved-over fields, then you killed them because they couldn't or wouldn't work in your factories.
Which, yes, is the sort of thing our ancestors did to a lot of people. It isn't namby-pamby "modern liberalism" to say that was probably wrong and we shouldn't do things like that.
What I was disputing however was the underlying contention that "someone who used to be able to support themselves, dies because [one] paved over all the wild fields and killed all the buffalo".
My proposition is that, historically, vast swathes of 'useless' people died without being mourned, and that it is an entirely modern conceit that we can throw evolution into reverse and conjure up a society in which we ensure the survival and thriving of the truly worthless (meant objectively, not pejoratively: i.e. people who really do have no value).
I genuinely believe (having worked for 5 years in the UK criminal justice system) that welfare and liberals/left wingers have thrown evolution into reverse.
I'm surprised that most places (?) don't sweep up the homeless, put them on buses, drive them 200 miles away and dump them there to be homeless somewhere else. It could either be made legal or semi-legal, or done completely illegally in the confidence of getting away with it.
This obviously isn't anything like an actual solution, but it's *got* to be tempting to "solve" your local problems.
"Wet houses" for drug users is probably a decent option - essentially a simple shelter where you can get your drugs injected by professionals until you die or you decide to try to fix your life. It's vastly cheaper for society than the homeless financing their drug habits through crime, anyway.
This way, there'd be no need for force - a roof over your head and your drugs is what they *want*.
Completely different populations. Chronically homeless are not the majority of the homeless population, but they are the modal group that people think of when they hear the word "homeless," and they're the ones disruptive enough to normies to constitute a "crisis."
Wouldn't there be rather more room in homeless shelters and housing projects if the ~80-90% that are not mentally ill were induced to leave California and/or get off the streets?
....No? I'm saying the majority of that 80-90% don't interact very much with the shelters and aren't visibly on the streets. They're couch-surfing, sleeping in cars, etc. Those people moving might free up resources in food banks and the like, but shelters are still primarily going to house the same population of chronically homeless they do now.
It's an odd definition of "homeless" to include everyone currently bunking with a neighbour, and if that's true I'd be curious about the source of the statistic.
Th part that's missing is that you do not distinguish between
- things that are difficult/impossible because of the law/convention AND
- things that are actually immoral. (yes vague term, opinions differ...)
You simply elide the one with the other. Let's not do that.
If we do not do that, then the space that opens up is forced confinement that is not "prison". It doesn't occur in a prison, and it doesn't require as much infrastructure (ie is cheaper than) a prison because we don't need things like armed guards and searchlights; a facility placed in the middle of nowhere that's essentially like a homeless shelter today basically does the job. The main additional constraints are limitations on dealers being able to visit whenever they like, and making it not exactly trivial to simply walk out the place, or be driven out.
Now, given the above design is this "immoral" (as opposed to "illegal/unconstitutional"? Well that depends on your mental model of a schizophrenic.
(a) Is the person happier living in filth and squalor than in a regimented environment? The homeless advocates claim no. I don't trust a damn thing they say, but if we go along with this claim, then we are in fact providing the schizophrenic with the housing and structure that it is claimed they desire, so what's the problem? The fact that they no longer have access to street drugs?
The rest of us accept that while we have some flexibility in our lives, we may well have to live in a place that is far from our first choice for whatever reason - school, job, military commitments whatever.
I don't see why this basic fact of life for everyone else becomes an unacceptable burden for the homeless. You can live housed by the state -- out somewhere in Northern California far from the vices of the city and the rest of the population. Or you can live illegally on the street in LA, subject to being arrested for breaking the law in multiple ways. These are much the same choices the rest of us face.
An on-going problem is lack of honesty by advocates. What is the claim that the state owes these people? Housing? Or "housing wherever I want, of whatever form I want, subject to no oversight, with the ability to hurt my neighbors as much as I wish, and with ample access to street drugs"? Because the arguments always claim the first, but then veer off into the second as soon as details are required.
(b) the schizophrenic is not the only person in the equation, there is also the rest of society. The traditional thinking has always been that to take advantage of living in society you are expected to follow social rules; and if you are unwilling to do so then society doesn't owe you anything.
Once again the issue is not "illegal/unconstitutional", it is is this an immoral viewpoint?
The liberal stance has always been "your rights end where mine begin", and this seems to fall into that category, in much the same way that we're willing to ban political entities explicitly committed to ending liberal democracy.
So yes, by all means bring up the issues of law because they delimit what is possible. But don't confuse the issue by claiming that the *legal* bounds of the possible admit for no "reasonable" options beyond those bounds. The law can and has been changed. The constitution is not a suicide pact.
Sometimes hard choices must be made and someone will be hurt no matter what, but cruelty as a goal in and of itself is never a good look. Unless your goal is to sound like a Hollywood movie villain, in which case, great job!
Other reason a homeless person might miss their prescribed social-worker or psychiatry appointment: they have an unrelated physical illness that makes it difficult for them to travel halfway across the city day of, and they aren't allowed to simply communicate with the social worker by email.
I'm curious what the process is like in rural areas that lack a hospital with a psychiatric ward. I live in a remote area where inpatient psychiatric care is not readily available.
Does a rural police officer still have to find a way to transport someone to a suitably large hospital wherever one can be found?
I don't know about the 'States, but in Australia: yes, you'll be strapped down in an ambulance (with IIRC a policeman in the back with you) and driven to the nearest city large enough to have a hospital with a psych ward. I haven't had personal experience with this in places where said large city is more than a day's drive (though I imagine that doesn't happen in the 'States), but my guess would be that you get taken by plane.
This is roughly the case in Canada as well; though the person will first be assessed by a doctor in their local area who can order a 72 hour hold; and at that point the person will be transported to one of the few hundred hospitals designated to involuntarily hold psych patients for up to two weeks (with extensions after that). In very remote communities this can indeed involve plane transport since we have areas not accessible by road; but its rare and in practical terms people with that level of psychosis requiring revolving involuntary admissions aren't staying in those remote communities.
Relative to how Scott described the process above, our definition of "harm to themselves or others" is a lot more literal and less vibes based. We're never admitting a person for whom that isn't VERY clearly true (and not just for involuntary admissions- due to bed you can't really be admitted as a voluntary patient unless you're meeting the criteria that could make you involuntary). However the vibes play out in the opposite direction- if its a huge logistical challenge, a physician in a very remote area is going to try a lot of other options to make things work in their community before signing a Mental Health Act form.
I can see this logistical challenge scenario playing out here in the United States as well. Ambulances, ambulance drivers, emergency physicians, they are all in short supply and I am guessing there would be a tendency to try to avoid the substantial investment of time to transport someone to another region and complete all of these processes.
I think that only really is a thing in really remote Alaskan communities and in that case…if Timmy develops schizophrenia, maybe aided by dank Alaskan weed, he gets hauled to Fairbanks or something by police Cessna.
This also applies to non-crazy homeless people. Rural areas and smaller towns/cities will often have a little capacity for addressing homelessness, such as basement cots in a few churches, but the general answer is to drive/bus them to somewhere with more capacity.
Many small cities are happy not to develop that capacity. They would rather send the problem elsewhere than address it locally. Even if they were willing and able to address it locally, there are strong second- and third-order effects of being within driving distance of a major city and having a reputation for generosity towards the homeless.
In rural areas, such people generally not homeless because housing is much cheaper, houses are much larger, and they or a relative/friend usually have a place they can stay in despite their conditions.
I think you are incorrect, at least if you are speaking from the United States context. In my career I don't deal directly with homelessness, but I sometimes work with people who do. I've consistently heard that homelessness is a significant rural issue, and when it's come up directly in my career, there certainly seems to be an extensive problem in rural Kentucky.
Is this an issue that you track on an ongoing basis? I'm surprised to hear the claim that homelessness is not a rural issue, but perhaps in some regions of the world it is not.
I've only glanced at the articles, but a rural definition of a homeless problem is unlikely to match an urban one. When "in town" refers to a village of a thousand people, even *one* homeless person is a visible problem.
"Difficulty getting to medical services"? Most rural counties don't have bus service, so you're walking if your car doesn't work.
Neither of the links you provided disputes the data Mark linked to. The data from Mark *is* from an organization that regularly tracks this type of data. The claim is not that homelessness is not a rural issue, only that it is not as bad as it is in urban areas.
On Kentucky specifically, from the 2023 HUD Point in Time homelessness report:
"Over the longer period, from 2007 to 2023, the number of people experiencing homelessness declined in 25 states and the District of Columbia. [...] The largest percentage decreases were in Louisiana (42%), West Virginia (41%), Kentucky
(41%), and New Jersey (41%)." Page 18
So homelessness may be a problem in Kentucky, but that problem isn't especially bad relative to the rest of the country (rates of homelessness in KY are below the median for the country), and improving (though the report notes a 20% increase from 2022-2023, which was typical throughout the country).
I am currently in charge of a project to implement mental health crisis response teams in an area pretty much like this (regional city, large rural parts of the county). The police officer transports the person the the nearest emergency department, and, depending on the rules in the area, has to stay with them until they are admitted there, or the person is assigned someone to watch them while in the ED. Then they stay in the emergency department until someone finds a bed for them in an inpatient psych hospital, which could be many hours away or across the state. The hospital then has to arrange transport for them. In the area I’m launching this program, there are no inpatient psych wards for under 18s in the entire county, so the hospital staff have to call around to all the other hospitals in the region until they find them a bed. Kids stay in this emergency department for an average of about five days, waiting. The average length of stay for people in the ED for mental health reasons in this region is 12x that for people with only medical reasons, because of the difficulty of finding beds, and because they aren’t legally allowed to be evaluated until they are sober.
"And anyway, now we’re back to Housing First, the solution that all of these “We Should Do Something About The Mentally Ill” articles treat as their foil."
That seems to happen a lot!
I think it's probably because the Housing First people are right, and it's pretty much impossible to fix somebody's other problems while they're homeless. We keep trying to find ways around that fact, but reality refuses to cooperate.
I mean, "build more housing" will be helpful for people who are homeless for simple financial reasons, but I gather that's a fairly different set of people from the destructive people on the street that people are complaining about, and that those people are often homeless because, in addition to the financial problems, anywhere they try to live, they get kicked out for wrecking the place. So what do you do about that?
Admittedly I guess one answer would be "build *so* much more housing that even such people can afford to buy their own house from which they can't be evicted", but I don't think that's really possible in a city -- the way you build more housing is by building *up*, not by building lots more individual houses that a person could buy. (I guess condos exist, but I have to assume those have *some* sort of provision for dealing with people who wreck the common areas and/or structure of the building itself, right?)
(...hell, even when you own a house outright, you don't have arbitrary legal right to wreck it, right? Building codes exist for a reason...)
My solution, which mixes housing first with being cruel and draconian, is "build cheap kinda-crappy housing in cheap areas instead of downtown San Francisco". This does require overcoming some nimbyism and also some objections of the form "but it's cruel to force people to move 50-100 miles away to single-room tenement apartments", but it does actually solve the main problems.
And it requires interventions at a much higher level of government than is typical for this problem. The state of CA or a hypothetical Greater Bay Area Co-Prosperity Sphere could do this; no city government can.
Certainly if I were redesigning the US I'd take a lot of powers away from local governments and give them to the states. Local governments should do zoning and garbage collection and parks, they shouldn't be running their own goddamn school systems or police forces.
I'd probably break up some of the bigger states as well to get everything at a more reasonable scale.
I'm thinking about a Greater Bay Area Co-Prosperity Sphere, and wondering who would be the equivalent of the Japanese in that case. Would it be tech moguls who think they know best and are going to force their solutions onto everyone else? What about homeless NGOs that force every non-SF city to take Sf's homeless, making it seem like they've solved the problem by making everywhere else worse? Or would it actually be an effective institution run by competent leadership (maybe an AI)? Clearly, we should create the GBACPS and find out.
This creates ghetto towns - which create a new set of issues - and if these locations are not integrated with accessible community services, what's the plan for treating the underlying issues?
The main issues with ghetto towns are just that they're full of dysfunctional people, but those people are going to exist either way. (In this case I don't think it would create whole towns - the actual number of crazy homeless people who harass passerby is surprisingly low, they're just very prolific).
Re community services - seems easier to build those outside of a busy and expensive downtown area anyway. I don't expect they'd be especially well done, but then they're not especially well done now either. I at least don't expect they'd be worse.
who pays for the community services in the ghetto? If the local council isn't receiving rates etc from residents, then you're saying that some other community needs to carry that cost. I appreciate SF downtown needs a solution, but sweeping people up and moving them somewhere else isn't solving the problem, it's just tidying it up for the people living in downtown SF. Supporters of this policy aren't looking for a solution to homelessness/mental health, they're looking for a service to create insulation against a problem being located on their doorsteps. If the problem were dispersed across all communities, the cost is evenly spread across the services required to address it, and the chances of keeping it on the agenda might be higher.
Why is it important for them to be "in mind"? If the mind only furnishes vexation with them, or solutions that are de facto draconian, isn't it better that the taxpayer should stop thinking about them at all, so that homelessness may take an ever-increasing share of the public budget without any pushback?
The goal isn't first and foremost to treat the issues, it's containing and preventing them from being an nuisance to the rest of society. Although, it does allow community services to be concentrated at that location. Seems like the best of bad solutions to me.
Also, it seems to be often the case that the issues aren't treatable. Perhaps things have changed, but I knew a guy who was periodically inssane because he stopped taking his medications...intentionally. Because the side effects were intolerable. He was a professional quality pianist...but couldn't develop a career. (Truthfully, while he was professional quality, he wasn't better than the median for that profession.)
OTOH, most of the time he was an engaging conversationalist, honorable, truthful, and a good enough friend that I tried to babysit him though one of his episodes...but couldn't. He developed paranoid hallucinations.
Note, however, that when he was on his meds he didn't remember the times when he was off them, but only noticed the side effects of the meds.
That's fine. I admire you for expressing this framing. The cost of sweeping up the nuisance doesn't address the pipeline that creates that nuisance, so do you assume that moving the current homeless population to the new location, will mean that next month, you'll expect to clean up the newly arrived homeless people and send them to the ghetto? Do you genuinely expect that the politician that proposes a budget to send community services to ghetto will win votes / donations from tax payers of the cleaned-up communities, to fund the community services that will support the needs of the residents of the ghetto?
If you keep them there involuntarily, that’s just an asylum. If they are there voluntarily, you’re going to have the same issues with treatment compliance.
One largely-missed option is to permit people to build cheap housing. Society has, in its infinite majesty, decided that neither the rich nor the poor are allowed to buy cheap housing, and it's kind of a problem.
I go to a convention in San Francisco every year. A bunch of my friends do crazy stuff like pack four people in hotel rooms. I don't; I look for the terrible hotels where the room is *at most* twice as large as the bed and there's shared bathrooms on every floor. These used to be legal to build for straight-up residence, and they no longer are, but they're much cheaper and frankly only slightly less convenient.
We allow college kids to live in these situations - why don't we allow adults to live in these situations?
There's lots of cheap housing, it's just not in San Francisco. I don't know why the "we should build cheap housing" conversation always seems to start and end in the few places where that's geographically impossible.
Why is it always "We should build more shitty apartments in San Francisco" instead of "We should build more trailer parks in Arkansas"?
Housing is expensive throughout the Bay Area, not just San Francisco.
> Why is it always "We should build more shitty apartments in San Francisco" instead of "We should build more trailer parks in Arkansas"?
Because people want to live in the Bay Area, where jobs and their existing families/friends are located. They don't want to live in Alabama. If you build more trailer parks in Arkansas, they will sit empty.
It should be the other way around. Let's say I own land in California and want to build an apartment building on my land, and people want to rent those apartments. That should be my business, and it's really too bad if my neighbors burst out crying at the sight of an apartment building.
You can't stop people from moving in because of our constitutional right to travel. Which is pretty much non-negotiable, nobody wants to have to show their passport and proof of income to cross state lines. So immigration to major metro areas (in and out of California) will continue. You have two choices: either build shitty apartments for people to live in, or they'll turn your sidewalk into a shitty apartment. Which do you prefer?
There's plenty of perfectly sensible middle class people with good jobs who have left the Bay Area because it's too expensive. If you're choosing to sleep in someone else's doorstep in San Francisco rather than a warm trailer park in Arkansas then... well, that's a choice you shouldn't be allowed to make.
There's housing that is cheap because land and construction prices are cheap. There's virtually no housing that's cheap because it's designed to be minimal. That's what I'm arguing here - "let people have cheap housing, not all housing needs to be high-quality".
If you're in Nowhere, Arkansas this isn't as useful of a thing to be able to do because even a one-bedroom house is pretty cheap. If you're in the SF Bay Area, it is.
> And climate aside, I think a lot of it is the combination of wealth and leftiness in SF. The combination of those two things implies: a) good odds of handouts, b) funded social services, and leftiness implies c) permissive legal environments, but also wealth implies d) high property values. Thus, homeless accumulate in places with high property values, but not through the obvious causal connection.
Actually, a lot of San Francisco's problems date back to a Supreme Court decision that city governments could not limit their public assistance programs to residents of the city. This might have been specifically designed to destroy cities that had generous public assistance programs.
Housing the homeless would remove a lot of the barriers these people have for treating their mental illness since police / social workers now can know exactly where these people are. Which should in theory make it easier to get them to take medication or go in for appointments...
Because San Francisco is on a relatively small peninsula, and other than the park space, it's *already* covered in buildings. And still, more people want to move there, so the value of the land is very high. And construction costs are high.
Now, I have proposed building a series of half-mile cubed arcologies the entire length of Golden Gate Park, but most of the residents of San Francisco whom I know have objected to this idea.
Part of the issue is that even in the places with 'cheap housing' it is still very expensive, which makes the solution of 'give everyone a house' cost a ton. Housing could be significantly cheaper everywhere, even if places like San Fran are the focus because of their exorbitant prices.
I agree, but with a caveat: shared property tends to create problems. Housing projects are a great example of this. Rowhouses work much better, and I've seen tiny single-room houses specifically for this purpose. But that probably runs up against "cheap", again.
The sort of stereotypical example is Wild West boarding houses, where the tenants are just long-term renting and don't own the property. I am personally totally fine with that but I believe it's currently not legal without behaving a lot more like a hotel.
Boarders need to be people who aren't horribly disruptive, though possibly having the option of being a boarder means that fewer people do a serious downhill slide.
To me it seems like some combination of allowing some type of cheaper via less/shared space and some relaxed building requirements but still humane and structurally sound housing, and at least enough asylum beds to house all the worst offenders, makes the most sense.
Singapore executes drug traffickers, regularly imprisons drug users for several years, and also uses judicial caning on drug users, robbers, vandals, and voyeurs.
This is only a very very small selection of cultural differences that make something work in Singapore that would absolutely disgust your average San Franciscan or otherwise urban American. Start caning drug users and maybe a few years later you could have social housing. Don't put the cart before the horse.
You're 100% right. The problem is that most people think we definitely need more housing, but in their heads they imagine more spacious, well-furnished apartments. That's not feasible, or even terribly helpful. The illegality of small, spartan apartments is the issue. We need to permit the construction of cheap, crappy housing, because that's the logical step up from homelessness. We've removed the bottom rung of the ladder.
I don't think that's quite right. Agreed that building any housing will lower the price of housing overall.
But consider as an extreme example: a city where regulation prevents an apartment being listed smaller than 1000 square feet. This is going to place a floor on apartment prices even if a ton of new housing is built. Someone who can only afford to pay $200/month is still going to be out of luck. They will be priced out by people moving from other cities, or by non-residential uses for those apartments, because renting such a place for $200/month is always going to be a loss for the landlord.
There's a crucial dynamic that this overlooks - many people get dramatically worse _after_ they hit the street. When you go from having a fixed home to being homeless, suddenly you lose most of whatever support network you might have had (because they can't find you), your physical health takes a toll, and you're more exposed to bad influences.
There's a crucial difference between:
1. Building housing to keep prices low will help keep people off the streets, and
2. Putting the currently homeless in housing will help them get off the streets.
Both things can be true but with significant differences in details.
If you build more housing for everyone, that significantly brings down the cost of government subsidized housing, usually through 1) reducing competition for government housing units from non-needy people (lowering the amount of gov housing you will actually need to achieve your objective), and 2) by reducing many of the regulations needed to make private housing easier to build, you also reduce the regulations needed to build government housing.
I liked something I've heard Chinese developers did - they offered housing swaps when they were buying land.
If you were a current homeowner, living in an old run down home, they would house you while they were building an apartment tower and then give you several of the new units.
Honestly, this wouldn't work on homeowners in the US (where the old homes are in better states of repair and the residents are vehemently opposed to apartments even if they're nice new amenities). But it might work on landlords as a kind of three-for-one deal in a package where the developer builds 30.
There is an age gap in this. The people in charge lived through the era where we did build enough housing for all the poor people. They were called housing projects with several high rise buildings filled with virtually free housing. They were hell on Earth because it put all the poor people together. And poor people are disorderly.
It's chicken and egg, though: the people who respond best to getting housed are likely to not have been homeless long, or are otherwise stable.
The worst, and the most visible, problem is the "crazy junkies in tents on the streets" homeless and just putting them into housing and then saying "job accomplished" is not enough. They won't take their meds, they may be incapable of independent living, they may trash the place or simply live in squalor or end up with predatory types taking advantage of them.
There does need to be ongoing support and engagement, and that is where people fall between the cracks, as listed by Scott above: miss appointments, can't get new appointments, can't handle the bureaucracy, don't take their medication, are just one more in the caseload of overworked social workers, etc. Putting them in housing is the first step, but it isn't enough on its own, and sometimes it may be better not to put them into housing until they're stable enough to handle independent living.
It's housing first, not housing only. And I don't think there's any way around it. I don't think there's anyone who's better left homeless until they're more stable, because I don't think you can expect anyone to get more stable while they're homeless.
My brother used to work in the Youth Services Bureau, here in Ottawa, so I've heard a decent bit about this. Housing people who aren't capable of living independently is a hard but well-understood problem. It's mostly a matter of money, and if housing wasn't so mind-bogglingly expensive it would be cheaper.
I very much agree it's not housing only, but the trouble is, such programmes cost money, and to trim down costs things like support services will be pared down. So instead of having the community nurse calling every week to make sure the client is managing, that will be once a month, maybe, if you're lucky.
So what seems like an easy quick fix will be to stick people in cheap, possibly government-built, housing and then leave them to sink or swim, and a lot are going to sink.
Housing First is also an infinite money pit, especially if there's no willingness to remove people that refuse treatment and will continuously destroy the housing and terrorize their neighbors.
> pretty much impossible to fix somebody's other problems while they're homeless.
I get this argument, but is it any easier to make someone not homeless when they have other problems? Will they wander away from or destroy their home before their illness is under control? Will they be unable to get a job and resort to begging on the street in order to eat, taking up too much time to do anything else? Will they voluntarily take their meds (or remember to do so) just because they have a roof and a bed? Or do you still need some (probably draconian and invasive) infrastructure at the same time?
Idea: have, after steps 1-5, have private companies in charge of getting the people help. For each person who lapses, goes back on the streets, and gets arrested, the private companies pay a fine. For each person who becomes a successful and functional member of society, the private companies get a large financial reward. This would unlock the ingenuity of the free market to figure out what to do in particular cases, which would probably involve the companies carefully making sure that people figure out the mess with insurance. So basically I'd just have a step 8--funnel them to private companies who are financially incentivized to care for their well-being.
But you need to avoid Goodhart's law: Such a company would have huge incentives to "filter" the easy-to-reintegrate homeless from the problematic ones. One obvious way is for the company to have "reasonable employee protection practices" which somehow always end up classifying the worst homeless as threatening or a danger to the staff and thus excluding them. More extreme, such a company would be incentivized to make people homeless to easily re-integrate them. A scammer could e.g. take children of employees who are leaving for university and first make them "homeless" for a few days and cash in on the rewards. More grey area schemes are certainly also possible.
Idea: they'd have to take the homeless who meet criteria 1-5 at random! Also, if they filter easy-to-reintegrate homeless, that might not be so bad compared to the status quo where it seems even those guys are being failed.
So they have to take on homeless people who has previously assaulted their staff? That seems incompatible with employee protection laws. What if the staff gets a restraining order against a homeless person?
If they are allowed to filter, there will be a race-to-the-bottom where the most successful company will be the one that filters the best (since removing your 5% worst homeless is much more profitable than making the homeless you have 5% more likely to re-integrate. Remember that most homeless people re-integrate quickly if left alone).
Maybe require them to be taken at random unless people assault their staff or commit other crimes to their staff, in which case it's their choice whether to keep them. Alternatively, set up betting markets for individual homeless about how likely they are to have various positive outcomes, and then reward people only for beating the betting markets.
If you can filter homeless people by making them commit crimes against your staff, then the most profitable company will be the one who is hyper-vigilant against anything that could be a crime, and also provokes or fabricates crimes.
(I'm not trying to shit on any market solution: obviously "make the government run everything" has an incentive problem, so does everything. My pessimistic side thinks the only good solution is "have high asabiyya" and people will do what's right damn the incentive.) But I think your proposals thus far have too obvious incentive problems that would be too easy to exploit, because filtering will be so profitable for this specific problem.)
Betting markets are great of course, I'd support that.
Glad we agree on betting markets. Yeah, I think there might be some way around this--maybe have heavy oversight so that people don't goad mentally ill people into attacking staff for profit or allow heavy suits for that sort of thing.
why would filtering would not be hard to prevent if the company has no control whatsoever over who they get?
Like the government makes a contract with the company that says "we will assign 10% of cases to you." then the company gets 10% of the cases as determined by a random number generator picked by the government. How does the company filter then?
> Maybe require them to be taken at random unless people assault their staff or commit other crimes to their staff, in which case it's their choice whether to keep them
OK, so now you've just created an incentive for me to get my most problematic clients to assault my staff. This doesn't sound great.
you could make it that once someone was a selected client, you still get the fine if they arent integrated regardless of whether or not they keep being your client
Whatever legal mechanism allows Private prisons to impression people who previously assaulted their staff should allow these companies from taking on people who assaulted their staff.
This can be problem with studies of ways to reduce homelessness. When you dig into them, you can find out that they recruited solely from among populations who had already been filtered for ability to follow rules and live cooperatively in groups (such as being residents of a shelter that requires things like "no smoking" and "no drug use" and so forth).
The UK tried the privatisation solution with its probation service (the people who help ex-prisoners get their lives back on track). It went horrifically for basically the reasons you outline: writing contracts for these services is nigh impossible.
>Such a company would have huge incentives to "filter" the easy-to-reintegrate homeless from the problematic ones.
This would be an actually good thing. If the "homeless problem" is, in fact, several different problems of different difficulties and which require different solutions, being able to separate them would help a lot.
As long as you have multiple companies in competition you could do something similar to an auction to assign cases. The easiest ones that everyone is eager to take on naturally pay the least, then the reward increases until someone decides it's worth their time.
Good idea really. You should write this up more fully, and push it to people of influence in red-state large cities. (Because I don't think blue states will go for this level of private involvement)
Besides providing an "insurance advocate" as you describe, the company might pay some minor costs for the homeless person (like insurance copays or transit passes), pay for a bit of financial counseling, and so on.
It's not obvious to me what Goodhartian complications could arise, but it strikes me that a trial program could be run, and adjusted or cancelled if Goodhart interferes too much.
And when the private company pays out the reward to shareholders in the form of a dividend, rather than reserves it against future fines and declares Chapter 7?
Social workers have pretty similar incentives in practice - they already want people to become successful and functional members of society, using ingenuity where possible. I like Ethan’s suggestion onto make companies bid on involuntarily-committed people to assist, as a way to combat Goodharting, but I still think the free market’s ingenuity would go towards gaming the rewards rather than improving outcomes. These companies would still try to improve outcomes where possible, but they wouldn’t have the force of the free market behind those efforts - it will always be easier to game the rewards than to solve the problems listed under “threaten people into attending appointments”. These companies will still use ingenuity to help their people, but in the same “where possible” way that social workers would.
what is the normal path that leads to "these kinds" of homeless people? i've been radicalized by the Land Value Tax + UBI Georgist movement. i want to believe that many people who end psychotic could have helped themselves earlier in life, if we didn't have a housing crisis and weren't wage slaves to the landlords.
Realistically schizophrenia is mostly genetic and hard to change.
Best case scenario, you have a loving family who notices when you start to become schizophrenic, you get put in an early detection / "first break" program and put on antipsychotics early on, they work for you, and then you can live a pretty normal life, with your family taking care of you during the intervals when the illness breaks through.
Medium case scenario, you don't have this or the drugs don't work perfectly, you're pretty confused a lot of the time, you get into some government program, you get a free house, you stay there, social services check on you every so often, and you basically do fine with a breakthrough episode once every few years and a lot of negative symptoms.
It sounds like you think maybe the homelessness causes the psychosis rather than vice versa. I think that's not really how things work, although I can imagine that if a previously stable psychotic person suddenly becomes homeless, that might be stressful enough to cause a breakthrough episode.
So if money and available social workers were unlimited, is that medium case scenario what you'd support for the long term homeless with persistent mental health problems and no familial support network?
If so, would this create incentives for comparatively functional people to get classified this way (along the lines of disability fraud)?
If resources were effectively unlimited, I'd provide graded living quarters. A basic one that emphasized "durable, cheap, and easily replaceable". Grading up into nicer quarters that perhaps required a bit of maintenance. First you are moved into the cheap housing, and if you trash it, you stay there. Otherwise after awhile you can move to a nicer place. And at the top someone who acted as a custodian to try to resolve any quarrels. Cameras in the hallways, so any fights you could tell what was happening. Bad behavior, and you get relocated to another dorm where you start over. (But will good mail forwarding!) Even at the cheapest end it's a safe place to sleep, and an address that people can contact you by mail at.
When you get a job and can find a place of your own you can move out, but don't force someone to move out if they don't have some place to go. (Not even if they could afford to have another place.)
Note: This would not be family housing. It would be for individual adults. Children would need separate housing and care.
I looked into it recently, and the schizophrenia research money in the UK is a joke. Like, total annual research budget is around £10m.
Is it the same in the US?
Is it the nature of the aetiology of schizophrenia that a huge increase in funding would likely make no difference? Or is it that it's not a 'sexy' thing to put money into, so it's neglected?
Sometimes the best solution to a resource constraint is to alleviate the bigger fixable problems and then reallocate resources to the smaller problems that can't be fixed.
We have an over-capacity system. Poverty causes crime, homelessness, drug abuse, traumagenic mental illness, and many other problems. Genetically predisposed psychosis is a fraction of the total utilization of these systems I would surely think? We should be able to free up a lot of resources to better manage the unfixable problems, like genetically predisposed mental illness, by dealing with poverty.
Don't get me wrong, your search for silver bullets is noble. It would be great to have a better solution for schizophrenics. But there are viable solutions in the big picture even if there are no silver bullets.
I can only speak from my experience in Canada, and it depends on which services you group together as "these systems", but psychosis is present in a large majority of people regularly utilizing most homelessness services. Some of that psychosis is genetically predisposed like schizophrenia, a lot is drug induced.
Honestly, most of the homeless people with only poverty related issues are not that hard to help. Most don't even need the help of current programs because they have existing social supports like families, and the ones who don't have that still get helped relatively easily once and then either leave homelessness or require minimal interaction with the system. The biggest challenge is just that its hard to get them help quickly when the system is so overcapacity because of all the psychosis, and the difference between getting help in 3 days vs 3 months is REALLY important when someone is first entering homelessness. But over the long term you're left with the people who are the most complicated to help- ie they have severe mental illness or substance abuse issues or some other extremely challenging behavioural issues.
Functionally we've already done all of the reallocating of resources to that latter population, to the point where we probably need to be looking at adding back protected resources for the easiest to help people to get them help more quickly.
That's very fair, but doesn't Canada have a much smaller and better managed homeless population? Some cursory googling suggests 1/3, but numbers are all over the place, admittedly. I've seen estimates between 8 and 171 homeless Americans per 100,000 while the Canada numbers I could find were 53 so I would need to go deeper and sadly I have to work now.
I guess more to the point we would probably just directly measure how many homeless are schizophrenics if we want to know how much that's the issue. But it seems like non-drug-abuse psychosis is <50% of the population (again cursory searching suggesting ranges between 3% and 65%.. ugh.. sadly I have to work)
I did specify my location just incase there were differences, but I would expect the specific subset of the chronically homeless utilizing services to be pretty similar (and for this to not be well captured in easily Googleable stats). Canada does have some advantages (better laws making it easier to treat people with mental illness), and some disadvantages (much less affordable housing). In both countries its also worth noting that the problem is not equally distributed- Southern Ontario and Southern California are much more similar to each other in terms of homelessness than either is to rural Saskatchewan or rural South Dakota respectively.
Anecdotally, some engineers I know who moved to San Francisco but come back to Toronto and Waterloo frequently have said they think things are moderately worse in SF, and some other people I know who travel between Vancouver and Seattle say things look basically identical.
They "predict" it, but that's not the same as causing it. Judith Harris' "The Nurture Assumption" covers lots of things people assumed caused certain outcomes but turn out to merely be correlated.
I suspect they are causes, because of the existence of a correlation combined with obvious reasons they are a cause. Living in a resource constrained environment will logically lead to you being the kind of person who does things they need to do to get by. If your choices are to bully your classmate or go hungry, you are more likely to bully your classmate. In the long term, the more poor you are, the more pressure there is for limited resources, and the more pressure you get put under to be strong, hard, and survive a more vicious pecking order. That's eventually a recipe for mental illness and criminality. Similarly, not being educated will leave you with far fewer apparent economic options that increase the relative value of criminality and fewer critical thinking tools that will help you decide not to be a criminal.
I'm not saying that poverty and lack of education are the only problems, and I don't think ending these would alleviate the need for law enforcement, but these issues are fixable problems that morally should be fixed and (thinking like an engineer) they would reduce the amount of pressure placed on this downstream bottleneck that depends on common public resources if they were fixed for a good decade or so and we consequently had fewer traumatized kids becoming criminals and crazy homeless people.
I'm not sure "mostly genetic" is accurate. Certainly there are genetic "will break" causes, and others that are "will break under stress" (perhaps of some particular kind).
I'd be more likely to guess it was 1/3 genetic, 1/3 physical environment, and 1/3 social. Note that impoverished areas tend to suffer more pollution of various kinds as well as suffering more social stress.
Is there any evidence that alcoholic brain damage works that way? The brain damage typically downstream of alcoholism doesn't seem to resemble actual psychosis all that much, except for the presence of hallucinations in some people with advanced Wernicke–Korsakoff syndrome. Admittedly this is based on some quick googling plus my limited but nonzero experience around people who chronically abused alcohol for decades.
For whatever it's worth, in popular culture the babbling street drunk seems mostly to be viewed as pathetic but not particularly dangerous.
I met somebody who told me she'd fried her brain with too much cocaine and now needed antipsychotics indefinitely. Somebody else told me that'd happened to his son. Philip K Dick wrote that a A Scanner, Darkly was based on people he'd met who fried their brains with drugs. If drugs can cause psychosis, then maybe: homelessness => feel like crap => drugs => psychosis
Huh, I don't see a lot of extreme cocaine addicts, but this doesn't seem to correspond to anything textbook to me. If you fry your brain with cocaine I would expect you to end up depressed or something, but I'm surprised to hear someone ended up psychotic.
People end up with psychosis like symptoms from amphetamine abuse, like Phillip K Dick. Cocaine should do the same. It isn't an effect of long term use, just an acute effect from high use short term. There is a reason most anti-psychotics are dopamine antagonists as you surely know.
lots of rich people do a lot of coke (lot of people - in the service industry for example - do ampthetamine), and they don't end up that bad.
given that base rate it seems reasonable to believe Scott that most crazy people on the street lost both the genetic and socioeconomic lottery at the same time.
None of those people are doing meth or cocaine enough to cause psychosis like symptoms. It's very hard to do, even if you want to do it, but it happens regularly enough that it's notable in the psychiatric literature and a reason psychiatrists think antidopaminergic drugs actually treat the symptoms, rather than mask them.
I don't doubt it that it happens (after all you can get permanent - or maybe just very long lasting, but no one does the follow-up at 5+ years - pyramidal side-effects from psych meds that tinker with dopamine), I just think that it's naive to think that somehow "those people" don't do enough coke yet some random other people do.
Of course usually if rich people have problems they usually don't end up in case reports involving involuntary this or that.
The woman I knew well; her diagnosis was "psychosis which responds to anti depressants". In the mental hospital she believed the nurses were conspiring against her specifically, which is classic schizo stuff, but by trial and error the doctors figured out that antidepressants made her passable. I guess there's not a clean break between schizo and depression.
To your original comment Asahel, an old friend of mine who had a psychotic break traced it to being given weed laced with something (probably amphetamines). Looking back he certainly had some prodromal signs but I could see an event like that (and subsequent hospitalization) pushing him over the edge
"i want to believe that many people who end psychotic could have helped themselves earlier in life, if we didn't have a housing crisis and weren't wage slaves to the landlords."
Well, speaking from my time in social housing, we had (when I was there) at least one client who was schizophrenic. When she was on her meds, she was fine and could hold down a job. When she went off her meds (as she tended to do), she lost her job, ended up at the customer service desk talking a mile a minute about how the neighbours were breaking into her house to smear shit on her kitchen walls and what were we going to do about it (what the department did was routinely send out a pair - with clients like these you NEVER send out one person on their own because of risk of the client coming back with false accusations of assault or robbery or worse, things which have happened - of workmen to change the locks and give her new keys, even though no, the neighbours were not, in fact, breaking into her house to smear shit on the walls). She also liked to accuse the government of spying on her via the council (us) putting cameras up through her toilet.
In short, being a wage slave to a landlord was *not* the problem here.
> “the damn liberals are soft on the mentally ill”.
I agree with your point in the post. I’ll add though that a policy that is adjacent to this is be “cruel and draconian” to the subset of homeless who commit anti-social crimes. If we removed the subset of criminals from west coast homelessness the problem would be still visible but far far less concerning to those of us who live among it.
This is where I land too, but I'm suspicious that there must be some reason we don't do it, the sort of thing I'd learn about if a police officer ever wrote a post like this one.
My guess is that homeless people who stab someone are pretty quickly taken care of (except maybe in SF during the worst administrations), and people are complaining more about homeless people who camp somewhere and litter and yell at people randomly. My guess it that it's hard (or just hasn't been done) to frame a law such that you can put a homeless person in jail for littering so much they destroy an entire park, but don't put a random guy who throws away a cigarette butt in jail (though honestly I am completely unsympathetic to this guy and think maybe a little jail would be good for him).
I would welcome learning more from people in law enforcement.
Never ignore the possibility that the damn liberals actually are crazy. Some of the other policies they have favored from time to time certainly do not seem to take the option off the table.
I am quite certain that some liberals are crazy. But that is not specific to one political point of view. I'm also certain that the news media give excess attention to the more extreme views. And that some people will adopt extreme views just to get the attention.
All fair. But in some places, the crazy wing of one or the other party has gained supreme political control, and one should not forget the fact when evaluating their policy decisions. It's possible that what seems crazy (left or right) is, in fact, crazy. I would suggest that Seattle and SFO might be on the list of such places.
Here in Seattle, people are complaining the loudest about homeless people who steal things. We've got areas of the city where people essentially can't get packages delivered to their porches because they'll get stolen, and all too often can't leave bikes locked up outside because they might get stolen too.
People walking by homeless camps have seen bike "chop shops" there, but the police won't do anything. In the police's defense, on the rare occasions they do arrest homeless people for theft, the county attorney will just drop the charges.
Meanwhile, the second-loudest thing people are complaining about is that several blocks of downtown near the tourist area, and around one of the main bus transfer points, has been taken over for years by an open-air drug market. I've seen many stories of people (mostly women) who've stopped taking the bus because they've been harassed and threatened at that stop.
When I say something needs to be done, this is what I'm usually thinking of.
I assume the "stealing packages" thing is a combination of it being hard to catch them in the act, and normal police inaction/incompetence. We had a (non-homeless) person hit and run a friend recently, got their license plate on camera, and the Oakland police didn't care at all. I don't know why this happens, I assume police underfunding.
Yeah, I'd totally believe police underfunding and undermanning; Seattle Police Department hasn't been able to hire anywhere near enough to make up for everyone who quit since the Floyd protests. But here, I think just a big a problem is how the county attorney keeps dropping charges, which discourages arrests in the first place.
None of this is related to homelessness as such, except that it provides a nice-sounding social justice rationale for the attorney to drop charges. But it's like shako said - we're not really upset at people being homeless; we're really upset at the antisocial things some very-visible homeless people do.
Someone (Peter Moskos? Matt Ashby?) has written about this- its an interaction between the big increase in administrative burden for arrests, and the decreased chances of any sort of prosecution. A police officer who spends 6+ hours doing paperwork just to see the person released without charges before they're even finished isn't going to keep making arrests for petty crimes like theft, vandalism, sexual harassment, etc.
Looking around online, that seems to be a perennial complaint about the Oakland police. Someone explained that hit and run is only a misdemeanor and unless bodily injury is involved, it's not worth the bother.
I lived near Oakland a long time ago, in the golden 2000s, and I remember a public meeting organized by the Oakland police where they explained that they will not investigate petty theft, and in fact any crime less severe than serious assault (especially sexual assault) and murder -- as a matter of policy.
Oakland PD is the D league of police in the Bay Area. It doesn't have adequate funding and the population is the most hostile. So most A tier cops avoid it, while OPD gets rookies and the leftovers. Then there's the fact that they have half the police they should that similar size+crime cities do. Guess how many police are patrolling at one time among 430k people in the crime that Oakland gets? 200? 100? It's 30! 30 officers to respond to whatever mayhem is going on. One officer busy filing paperwork and driving 2 hours to Dublin jail for every 40,000 people...
> Meanwhile, the second-loudest thing people are complaining about is that several blocks of downtown near the tourist area, and around one of the main bus transfer points, has been taken over for years by an open-air drug market.
I find the porch pirate thing weird. America is generally seen as having more crime than Europe. But in Hungary, while I don't consider myself very worried about crime, I find it very much obvious that if you leave something unattended outside in a city, it's going to get stolen, and not necessarily or primarily by the homeless. It would never occur to me to order something and not be at home; if I can't be at home, I order to a pick-up point. And yet Americans have packages left on the porch and expect them to stay there, and it counts as an especially bad area if they tend to get stolen?
Indeed, I've also noticed that American single family houses are often depicted with an unfenced front yard (I guess that's what enables delivery on the porch in the first place?), while in Hungary, everyone's garden is fenced in both the city and the country.
Small town America can be a very high trust environment. I know people who regularly leave doors unlocked, whether or not they are home. Others will leave their cars running while making a quick shopping trip at a convenience store.
The computer monitor I am using right now was delivered to my front door. I was not at home. Amazon called to ask how I wanted to handle that, since it was a brightly labeled computer monitor box. "Just leave it in an apartment hallway?" Yeah, that's fine. And it was fine. I have never gone two days without seeing delivery packages on doorsteps in my hallway. There is no outer lock or even an outer door, just an open hallway. We have never had a single theft.
Rural America is great. We still have farm stands with open money boxes. If I saw anyone trying to rip them off, I'd be plenty pissed, "Dude you want Northies to go away!" The long term benefit far outweighs the one time gain.
Rural America is great. We still have farm stands with open money boxes. If I saw anyone trying to rip them off, I'd be plenty pissed, "Dude you want Northies to go away!" The long term benefit far outweighs the one time gain.
I used to work in very rural West Virginia and I never locked my doors. I know people who would have to really search just to find their house keys and who just left their car keys in their car at all times.
I now live in a sub-division in central Virginia, but it's not a gated community. We have a fenced yard but it's for keeping kids/pets in, not keeping anyone out. There's no lock. We have packages left on our porch (or, if the delivery person doesn't feel like opening the fence and walking up the stairs, outside the gate). No concerns. My wife doesn't like it when I leave the doors unlocked, but I often just forget. Same with my car.
Prior to now, we lived in another medium sized (few 10s of thousands) central Virginia town, but on a main street close to a soup kitchen. We had a lot of poor and/or homeless foot traffic. We were better about locking our doors, but still had packages left on the front porch and never had a problem.
My brother lives in a medium sized town in south-eastern Pennsylvania. Same situation, and they leave their doors unlocked even more often than I do.
My point is that there are still a lot of places where theft and similar crimes are mostly an afterthought. That's not to say they don't happen -- they definitely do, but they're rare enough that people just aren't that concerned.
It's maybe part-culture, part-density. I live in a top-5 US metro, within the main city but in a single family neighborhood. I get stuff delivered to my porch and don't worry about it. My neighbors often leave their front door open. Porch pirates around here aren't homeless people, I think it's a combination of crimes of opportunity and "regular" criminals.
Keep in mind the fact that in America if you trespass in someone's yard, especially with the intention of burglary, the homeowner can shoot you dead, normally without serious legal consequences. Not saying it's necessarily a good thing, but it makes fences less necessary...
That is absolutely not true. Not even Texas allows deadly force against simple trespassers, though I’m sure there are a few cases of rural prosecutors not charging it.
I had my bike stolen, tracked it down via GPS to a bike chop-shop. I called the cops for an escort so I could go get it. Ended up giving up because it was fully chopped to bits. Talked to the cops for a while and they said the city won't let them prosecute the chop shops because then people get mad about them harassing homeless people. Obviously the cops could be lying, but...
I knew a young lady who got punched in the face and given a concussion in the 42nd Street subway station by the Times Square Free Hugs Guy when she told him she didn't want a free hug.
I went and looked him up and found a 2000 word New York Times article about him from three years before that starts off making him sound harmlessly eccentric and eventually makes clear he's a violent loon who has beaten up lots of young ladies in Times Square and Washington Square Park. And I found five or ten other articles about his being a scary nut, plus videos of him being a scary nut, plus there is a Free Hugs character in the "Angry Birds" movie.
Apparently, the number of really scary crazymen on the streets of New York City is under 4 digits. Heck, NYC maintains a list of its 50 scariest street people. If you took just those 50 off to a peaceful lunatic asylum in the countryside, daily life in New York would be less stressful for young ladies.
My suggestion is that states should double their capacity for locking violent nuts up in restful rural surroundings. When they get that done, they can think about doubling the capacity again. Even that wouldn't clear off all the nonviolent homeless drug addicts, but it would improve the quality of urban life for everybody else, including for the nonviolent homeless.
I think the classic description of this issue is "Million Dollar Murray" by Malcolm Gladwell. A tiny, tiny fraction of the homeless population racks up enormous charges at hospitals and prisons because of a never ending cycle of get drunk, aspirate your own vomit, catch pneumonia, go to the hospital ICU, get released, get drunk, aspirate your own vomit and on and on. That was the genesis for Housing First, the idea that you're spending hundreds of thousands on these guys anyway so you might as well give them an apartment and a full time nurse.
Homelessness almost never results in charges that keep people locked up for more than a few weeks or months. Then on release they rapidly revert to their old behaviors.
"you're spending hundreds of thousands on these guys anyway so you might as well give them an apartment and a full time nurse."
Very important to note that the full time nurse is what makes such a programme work, but of course in our world, what tends to happen is that a bunch of cheap housing is made available, the people are dumped into it, and the promised supports never materialise. So the crazy and hapless just degenerate while 'housed' and their problems are not really tackled.
Building a ton of cheap (shabby) housing or apartment blocks, and dumping an entire population of the really hard cases into that, and then leaving them there with no support, is how you get places like the Ballymun Towers which were for ordinary working-class people moved out from inner-city tenements but which deteriorated into bad areas.
"Work first started on the first Ballymun project in 1965 and it was initially planned to include about 3,000 homes – the vast majority of which would be flats in Ireland’s first high-rise, out-of-centre public housing scheme.
A town centre with shops and other amenities was supposed to be built in time for the earliest waves of tenants, but the construction was delayed for years and residents were left without some basic services.
The development was also plagued with failures including lift faults, heating problems and claims Dublin City Council wasn’t keeping up with the general maintenance backlog."
"The Ballymun Flats were built in the 1960s to accommodate the rising population, particularly to accommodate former residents of inner-city areas which were being cleared in the process of 1960s urban slum clearances. Whilst suffering from a lack of sufficient public amenities, several schools served the area (Holy Spirit N.S. and Ballymun Comprehensive), as well as an Eastern Health Board medical centre and a purpose-built shopping centre. The area suffered from many social problems such as drugs and rampant crime. The causes of these social problems, and the subsequent discrimination faced by many people with Ballymun addresses when seeking employment outside the suburb, have been disputed, but Ballymun generally paralleled the experience of many working-class people in the 1960 and 1970s when placed in high-rise locations."
For such projects to work, you need a mix of population which includes stable people, families, etc. and that's tricky, plus the massive investment in support structures. That's expensive, which means it's the part that gets omitted, and then you end up with stories like the Mayfair Hotel as linked above.
This. Not to get too old-school Progressive, but the key is to take them out of their previous environment and society, remove all their links, and pressure them to integrate into mainstream society by example and osmosis. Destroy the old culture and assimilate them into the new. This can't be done if they're still surrounded by the same type of people as before. It'd be like taking a bunch of alcoholics, handing them the AA handbook, and telling them to meet every week in a pub.
>a never ending cycle of get drunk, aspirate your own vomit, catch pneumonia, go to the hospital ICU, get released, get drunk, aspirate your own vomit and on and on.
<morbid semi-snark>
Doesn't each trip through the ICU carry a significant chance of breaking the cycle - with a trip to the morgue?
Yeah. I mean, read "Million Dollar Murray" if you get the chance., Like him or not Gladwell is a talented writer and he's able to pull off the trick of personifying the homeless crisis through an individual in that article quite nicely.
Much appreciated! Is there a non-paywalled version of the article? I saw a summary (power law distribution, dominated by a small fraction of the cases).
"Free hugs" guys (I think they're usually guys) are a global phenomenon, you need not worry that the Angry Birds character is based specifically off the New York one.
I think it would be trivially easy to make ‘being homeless’ not criminal by itself (as you discuss above) but a (massively) aggravating factor in any other crime.
In the UK at least this used to be what happened in effect: lots of people had a justice problem with it. And whether it would solve the problem in practice is doubtful (enforcement, court efficiency, lawfare, prison space). But legally you could produce the system to do it.
"This is your first offense, minor crime, so we'd normally let you off with a warning. But, we can't figure out where you live, so you also get a tracking anklet. If it starts blinking and beeping, head to the nearest police or fire station or public library soon as you can... else we'll have to send somebody, and then you get a night in jail. After about a year, battery will run out and the strap will come loose, at which point you can turn it in anywhere that accepts deposit bottles to get a thousand bucks, cash, as our apology for inconveniencing someone who turned out to be an honest citizen."
It's not just "yell[ing] at people randomly". It's carrying on loud and angry conversations with themselves or thin air, sometimes involving talk about killing people in various ways. It makes the person seem dangerous and unpredictable, and sometimes a passerby catches the person's eye, and then person follows the passerby for a bit, yelling at them specifically (and I think this does happen more with smaller women). Who's to say that they don't have a knife?
This, IMO, is part of why people develop the "completely ignore the existence of homeless people" reflex, and avoid places where that's not physically possible. It's a safety measure. It's dangerous to draw any attention to yourself.
yeah, it bothers me a lot when people moralize about how bad it is that we don't talk to or make eye contact with homeless people on the street. If I did that I'm pretty sure I'd be dead. The people who moralize about this seem to think it's because the homeless don't take up any space in my attention, but it's exactly the opposite - they take up a *lot* of space and I'm terrified.
ETA: being homeless is not actually the crux, and I wish I knew a better term for the kind of person I'm saying I'm afraid of - people who are on the street acting violently psychotic and/or so dirty that there's significant disease risk if they touch you at all.
Most of those people are homeless, but not all of them. And certainly some homeless people don't have those traits and I'm perfectly happy to interact with them.
I actually do make eye contact and at least nod or respond, for the ones that don't seem high or crazy. But I'm not as worried about self-preservation as most people.
I tend to divide the homeless into 2 categories. The first is simply homeless, and may or may not have jobs, but given a bit of help to get back on their feet, they can rejoin society. This makes up something like 60% of the homeless population, and are the people that pilot programs work on, and whom "housing first" would help. And they're not the ones who cause visible problems for non-homeless people. (I say "visible" just as a bleeding-heart reminder that homelessness itself is a problem.)
Then there are the other 40% who have some combination of severe mental illness, drug addiction, or "chronic anti-social behavior" (anything from robbery to shoplifting to shitting on the sidewalk to inability to follow simple rules). These don't tend to last long in shelters (which often have rules like curfews, no smoking, no drug use, and so forth). When given housing, they rapidly destroy it. (I know two people who've worked a job cleaning up afterwards.) This is the group that causes most of the visible problems.
Scott seems to be just glossing over this point. He mentions that most homeless are just homeless for a few weeks. But this is irrelevant, because the homeless that we need policies to handle so they don't cause problems for everyone else are *not* in this category.
When I lived in Seattle I tried to maintain a policy of always acknowledging the homeless and responding to them when they started talking to me. Some of them were sweet, like the guy who said a prayer for me after I gave him a cigarette. Some were rude, but my worst experiences (getting jumped, having someone scream racial slurs and death threats at a friend) started without any input on my part.
Yeah, I've never had any problems myself, either. With a bit of exposure, I think it's fairly easy to classify a lot of them as "safe". But I understand if some people don't want that exposure, or if some people overgeneralize and start treating dangerous ones as safe.
I've done some volunteering involving walking on routes in a group to hand out food to the homeless and engage them in casual chatter. It only happens on routes which are pre-determined to be safe, and the volunteers (walking as a group) develop a tacit sense to predict whether someone will be dangerous to approach.
It's quite an eye-opening experience, and it helps to de-anonymize the homeless and better understand their predicament. There's an underlying social network for the homeless, mapped over the city, that you don't otherwise notice. You can directly see the difference between people who are heart-wrenchingly kind and grateful, and those whose life choices are innately antisocial.
>So realistically what will happen is they’ll be back on the street, a year later they’ll get arrested for some other reason, the police will notice they violated the treatment order, and the judge will try to add an extra year to their sentence for the treatment order violation. Then if their lawyer is really good, he’ll spend his 0.01 minutes on the case arguing that his patient has one of the excuses above, which will always be true. Then the judge will either give them a year in prison or not.
This doesn't seem like a great description. Crime is pareto distributed. The most problematic individuals have hundreds of arrests, dozens of convictions, and no doubt thousands or tens of thousands of victims. That they keep offendings is consistent with the modal punishment for even non-victimless crimes being 0, and the mean being pretty close to 0, as well.
This relates to the sequence listed above. It seems to imagine police evaluating someone in a vacuum. In a reality, the problematic characters are usually already "known to law enforcement" who've interacted with them hundreds or thousands of times, and the people in question already have "known mental health issues."
Many people see that the US has a high incarceration rate, notice that it has victimless crimes on the books, and put two and two together, assuming that the US is excessively draconian in its assignment of crimes and their punishments.
In reality, the US has a lot more crime than other countries, so if anything, the US has an underincarceration problem.
E.g. the US has an incarceration rate 3 times as high as Singapore's, but a homicide rate 55 times as high as Singapore's.
An incarceration rate 4 times that of the UK, but a homicde rate 6 times that of the UK.
An incarceration rate 5 times that of Italy, Belgium, and South Korea, but a homicide rate of 12 times, 6 times, and 12 times those countries.
An incarceration rate 10 times that of Norway, but a homicide rate 12 times that of Norway.
An incarceration rate 14 times as high as Japan's, but a homicide rate 27 times as high. [I'm sure someone's put together a proper article with plots of these].
It seems to be a choice, especially in Progressive cities with high homelessness to allow a small percentage of the population to run rampant, victimizing the public, including crimes like assault, not just littering.
To reiterate, it's not about identifying marginal cases, but about choosing to lock up serial offenders, whether in a prison or an institution.
"don't put a random guy who throws away a cigarette butt in jail (though honestly I am completely unsympathetic to this guy and think maybe a little jail would be good for him)."
Welcome to the Side of Social Conservatism and Darkness, Scott 😁
>My guess it that it's hard (or just hasn't been done) to frame a law such that you can put a homeless person in jail for littering so much they destroy an entire park, but don't put a random guy who throws away a cigarette butt in jail (though honestly I am completely unsympathetic to this guy and think maybe a little jail would be good for him).
It's not hard, it just wasn't legal until the Supreme Court overturned Martin recently. For instance, you have a law against camping in public parks. Then anyone with a tent in a public park gets fined, kicked out of the park, and their tents and stuff confiscated. After a while people don't camp in the park anymore. They find more out of the way places to sleep, which is good for the public because they're more out of the way.
This is why on the West Coast you get public areas taken over by tents and shanties and you don't see that in Central Park: New York isn't under the 9th Circuit's jurisdiction, San Fran and LA and Seattle are. And under Martin, if you didn't have enough shelter beds available to shelter *every homeless person in the city* then you couldn't arrest *any homeless person* for camping in the park, or on the sidewalk. Now that that's gone we'll see some changes.
Huh. Am I reading this correctly that you think the person who throws a cigarette butt on the ground should go to jail? That seems like a pretty wild over-response to me.
But crimes are already crimes and you get sent to jail for them. You don't need an additional policy for crimes by homeless people, that's just criminal justice.
All of these articles about 'the homeless problem' cite a handful of cases where something is stolen or someone is assaulted or w/e. But those could be solved with normal law enforcement.
The 99% of the 'problem' that they're actually trying to 'solve' is just people who it is unpleasant to look at or listen to or smell as you walk around the city.
NY's system is far from perfect but CA could really take a page or two. NY didn't deinstitutionalize as much as other places. Post-COVID there has been a huge shortage in funding and staff, and people have gotten crazier (possibly post-viral brain damage), but the bones of the system are not bad.
There are state hospitals for the criminally insane where all the treatment resistant crazies are warehoused. Regular dangerously crazy people mostly go to private hospitals where they stay a few days to a few weeks, and are provided with a state attorney and access to a judge to petition for release and drug refusal. There are also programs to provide long acting injectables and follow up with patients.
Developmentally disabled people get state funded, privately run group homes, which are generally pretty good. Extending that program to people too crazy for outpatient care but too sane for hospitalization could work maybe.
"What’s your plan for when homeless people finish their prison sentence? Release them back onto the street, then immediately arrest them again (since there’s no way they can suddenly generate a house while in prison)?"
I'm not defending the *rest* of the plan, but isn't that what halfway houses are for? "You live here until you find permanent housing or your probation is up, whichever comes first."
I don't know exactly how this works. Given that there aren't enough homeless shelter beds, I would be surprised if there were enough halfway house beds. I'd also be nervous about any system that privileged prisoners over non-prisoners (ie nonprisoners have to wait years for a homeless shelter bed, but prisoners get a halfway house bed immediately). If you're going to do something like that, just skip the prison and give the homeless the halfway house beds.
Don't get me wrong, I'm in the "just make more housing" camp. I was just pointing out that there's already a system that could ("could") deal with this specific bullet point.
Homeless shelters are already notorious for being dangerous. Many homeless prefer sleeping in the street in a place of their choosing rather than go there. Thus the aggressive homeless crowd out more peaceable ones who would be easier to re-integrate.
A fun fact is that currently the federal government defines homelessness in a technical way that excludes people recently released from prison, so they don’t qualify for programs that help house homeless people (because the current definition uses ‘did you have somewhere to stay for the most recent X weeks as their main criteria, and the person -did- have a place to stay--prison!). I’m currently sitting on a California govt committee that is trying the get this changed.
I noticed many suggestions start with some form of building more housing, shelters, tents, etc. Sounds expensive.
A potentially "arbitrary cruel and draconian" suggestion for how to get this done (apologies if this has already been suggested; I have not combed through all 1000+ comments):
1) Prisoners build more housing, shelters, tents, etc.
2) <arbitrary cruel and draconian part> Tie sentencing directly to work produced. Eg. building something equates with a fraction of one's sentence served. This would require more supervision and skills training.
3) If you want to take this further, you can even tie basic needs like food and shelter to work produced. Then if prisoners aren't capable/willing/too stubborn/etc. they remove themselves by starving.
Pro: shelter built at a fraction of current costs.
Yes, but then you have to build a ton more halfway houses, and as Scott said if you're going to spend that money anyway you can put them in social housing *before* sending them to jail.
Can we look at what other places do? What is eg Salt Lake City’s solution? (Possibly, export the homeless to SF). What about Zurich? Singapore? Edinburgh?
The US in general and SF in particular seems to have this problem unusually bad, so one could reasonably look elsewhere for ideas.
I was going to make the same point. In environmentalism, the answer to "why do we have this problem and, say, the Germans don't" can plausibly be "because they outsourced their production of tetrahydrosomething to us". But with mentally ill people, that's not likely. The base rate of schizophrenia etc should be similar (if not, that would be the first question to dig into), but in the various places in Germany I've lived in and seen, encountering a raving homeless is maybe a once-a-year thing, not a daily occurrence. I don't know what the procedures are like here, but I'm willing to guess they don't qualify as draconian...
In Germany, homeless people have a right to a shelter. (But not a right to a shelter where they can bring their dog or their different-gendered partner, which are common reasons not to use a shelter.) More importantly, homeless people can receive welfare cash (Tagegeld or even Hartz IV) but the city they're in can attach conditions to that, like you get the cash only if you're in a shelter. And where you go to pick up the cash is also a place where various social work programs can find you.
And I don't think psychotic people get released from hospitals that quickly. IIRC an involuntary stay at a locked ward is weeks not days.
I can confirm this seems to work to some significant degree. There are some homeless people I meet in the street (in large cities only) but they seem more like drug addicts than like psychotic people.
I also meet a few psychotic people (so few I can recognize them and could probably learn their names if I cared) but they don't look homeless; they don't stink and they'll frequently have new sets of clothes. So yeah, whatever Germany is doing differently seems to be working, and I very much doubt the differences that I know about (above) are all there is to it.
It could also be that violent people are always arrested right away. Where I live there is a place where there are pretty much always 15 homeless people, but they just sit there or walk around and drink beer. Maybe they are all non psychotic or at the violent people have just all been arrested.
I always just feel bad for them, I think even young women mostly aren't scared to walk around that place.
Yes, my feeling is that in Canada 80-90% of homeless are on the street because of drug/alcohol addiction and maybe 10-20% because of a legitimate mental illness (not caused by prior substance abuse). The 60% of homeless people who have neither drug problems nor mental illness - which someone mentioned as being their estimate for the US homeless population - I am sure does not exist in Canada due to a) a welfare system which pays a sufficient amount that even if you don't work you can still afford an appartment and b) climate.
In particular, different experiences regarding the association between homelessness, crime and mental illness are interesting. In Budapest we have homeless, but the only problem is they stink; they seem far too lethargic to pose any threat. We have some threatening-seeming people, but they generally aren't the homeless. Perhaps our homeless just drink booze, while yours take meth?
Between Scott's past writing on culture-bound illnesses (including schizophrenia as a permanent condition), joking-not-joking about the San Francisco egregore, and Albion's Seed type founder effects, I don't think it's actually that unlikely that the US produces more mentally ill and concentrates them into few areas, with runaway feedback loops related to these.
San Francisco has its share of psychotic homeless people, but I haven’t noticed more here than in other major US cities. What SF does have that some of those other cities don’t is a highly visible concentration of fentanyl-addicted, mostly non-psychotic, homeless people on the streets in the middle of downtown.
In solutions 1 and 2 what matters is not the absolute level of prices but the level relatively to available resources. The average income and the tax take in SF are extremely high compared to any other city. It probably does not solve the first cause as what matters there is not the average income but a bottom 5% income at that can be low in SF relatively to house prices. However if solutions 2 and 3 are not implemented it is because SF government is disfunctional, not because of high prices.
I think also, better enforcement of drug laws. Many of the problematic homeless aren't mentally ill, they're drug addicts, and the US has pretty much given up on enforcing its drug laws.
I think people underestimate how much worse the drug problem is in the US than in other countries. Germany has about 2,000 drug overdose deaths a year, while the US with ~3x the population has over 100,000(!).
Clearly this means that the first step of a realistic solution is deporting all crazies to Alaska, with each state paying a fee per head for the privilege. As an additional bonus it's much harder to get fentanyl there I'd guess.
Minimum fee could be based on making sure the https://en.wikipedia.org/wiki/Alaska_Permanent_Fund stays proportional, and then the lower 48 could be given an option to pay more - however much more they like, according to whatever criteria they like, with some sort of assurance it won't result in discrimination-related lawsuits - to secure higher priority for particularly obnoxious individuals when the overall not-technically-a-gulag system starts running into capacity limits. Would probably still end up at least a little bit less terrible than existing for-profit prisons.
Alaska, being under the 9th Circuit's jurisdiction, is also currently having a major homeless encampment problem. Hopefully with the Supreme Court decision they can start implementing option 5, but in the meantime a good portion of the folks you deport to Alaska will freeze to death with opioids in their pockets and a bottle in their hand.
Notably, last year the Mayor of Anchorage floated a proposal to buy homeless one way tickets to Seattle. I'm still not sure why they didn't actually do it.
If there are not enough homeless shelters, jobs, ... for all then apply requirements to get them.
If you have only room for 10% of the homeless, make the rules strict enough so that only 10% can possibly comply with them. Increase cruelty for the remaining 90%.
Use those 10% as a good example why this policy works because they will have more success stories than the 90%. Ensure funding for another 10% this way.
Repeat until the problem is so small that a solution for the rest can be payed for.
I searched a bit for Switzerland. If you want to know every bloody detail, here is a 50-page English summary of how homelessness is handled in Switzerland.
First of all, my own impression is that it is handled pretty well in Switzerland. The report says that the number of roofless people (living on the street) is about 2,200, which sounds low to me compared to the Swiss population of 9 million. After some severe failures in the 80s/90s(?), Switzerland has adopted a very supportive policy towards drug addicts, and this works very well.* From my own experience, you don't see drug abusers or roofless people on the street, though you sometimes (like, every few weeks) someone in public transport who seems mentally ill or perhaps even roofless.
I have skimmed through the report (no guarantee that I got everything right), and my main takeaway is:
1) There is a good social safety net, especially with financial aids. The regulations are pretty sane. One excerpt:
"The extent to which a person is in need is assessed according to the regulations and principles applicable at the place of support (Art. 2 paras 1 and 2 SocRA). The place of support, i.e. which canton is responsible for paying social assistance, cannot always be clearly determined. In its information sheet 'Local responsibility in social assistance', SKOS provides tools for determining the place of residence of a person in need. If persons with Swiss citizenship are in need of immediate assistance outside their canton of residence, the canton of residence must provide it (Art. 13 para. 1 SocRA). In the event of disputes regarding liability for assistance, the canton in which the person in need resides must provide assistance, at least temporarily, until the legal obligation has been clarified. The canton of residence is also responsible for foreign nationals who are not resident in Switzerland (Art. 21 SocRA). They too are entitled to at least emergency aid. The provisions of SocRA therefore establish the principle that a person in need receives assistance in emergencies, even if they are outside their canton of residence, their canton of residence is unknown or they have no place of residence."
2) The good safety net makes the numbers so small that they can be handled somewhat individually, and officials usually do feel responsible for it. Again an excerpt:
"As far as the assessment of possible measures is concerned, most cantons feel able to judge the advantages and disadvantages of the different offers. It is generally recognised that a certain degree of individuality is essential – even with emergency concepts. There is a need for privacy, which is why emergency shelters that are shared with several people are often only considered suitable to a limited extent."
3) Most rooflessness concentrates in the six largest cities, and those have developed concepts, and invest effort into the problem.
4) As mentioned, there is a pretty good support system for drug addicts.
The report contains a wealth of information and is actually well-written. It also contains some interesting figures, for example a breakdown of what officials perceive as the main reasons of homelessness on page 33/34. If anyone wants to read the whole report, I would quite interested in another summary.
* The drug support system in Switzerland will be put on a severe stress test right now because a crack wave is running through Europe. Crack addicts are much harder to reach with supportive measures than the usual cocaine/heroin/alcohol addicts. It is yet open which European systems can handle this.
When I was at the ACX Zurich meetup, I noticed the city was very pristine and asked some Swiss people how they dealt with poverty. They said "everyone here is rich". Seems like a good solution if you can make it work.
Zurich is a bit of an edge case, since the people who can afford to live in the city are generally rich, and those who can't afford it often live across the border in Germany. That's also the case in Geneva and Lugano with France and Italy respectively.
It certainly helps the social service budget if a substantial fraction of your workers are "guest workers" who have to stay employed or go back to their origin countries.
Switzerland is indeed a paradise (one could argue it has been built thanks to tax evasion and "blood" money which filters into its banks from around the world), but indeed a very safe and clean place to go for a walk. Cost of living is expensive enough to dissuade most homeless people from trying to make a go of it as well, I reckon.
Zurich was quite different from that in the 90ies and it had some interesting policies to deal with the issues. Not always successful in all cases (see eg. the movie "Platzspitzbaby") but apparently overall successful if you see the way it looks now.
Just a list of policies that they used in combination to battle the open drug scene of homeless people at the "Platzspitz park" (also known as "Needle Park" back then):
- be very cruel and draconian to dealers and all others that did not comply with requirements
- take all addicts/psychopaths/homeless to their hometown/village for them to deal with the issue. This didn't solve anything on its own but it ensured that it was no more seen as a "Zurich problem" but rather a "Swiss problem". In addition, the people were taken out of their problematic surroundings.
- offer methadone, other programs and social housing for those willing to comply with certain rules. They got the conservative state to allow and finance these only once it was seen as a Swiss problem.
- offer help on a privately funded basis to some more people with less strict requirements.
I don't know what the actual *policies* are in Edinburgh, but I can say that while it's reasonably common to see beggars or rough sleepers on the streets or in the parks (I guess I see one or two a day, on average?), it's *very* unusual to see people shouting or being randomly threatening.
Salt Lake City tried Housing First but results were mixed; the Salt Lake Tribune described it as "a shrug." They did find that substance abuse was a more difficult issue than other mental illness in many cases. TL;DR: Costs skyrocket, motivation to keep it going does not, when the vouchers run out the people are no better off.
One note I'd highlight from the below links is that Finland had a very successful Housing First program... with a 3:1 subject to staff ratio regarding various counselors, nurses, etc. To make housing first work it's a long-term ICU.
I believe universal health care greatly reduces bureaucracy, which makes the system more navigable and accessible. People are less likely to fall off at points about insurance, paperwork, prescriptions, and in-network locations.
That could be, but universal healthcare is not universal (at least, not if you mean something like the British NHS). Switzerland and Singapore (to use two examples from my OP) both have insurance based systems. They might be less complicated that their American counterparts (could hardly be more so) but I presume there would still be insurance and paperwork to deal with. And even in NHS type systems there will be prescriptions to deal with.
I'm not sure how it works in Israel, but there are markedly fewer homeless people on the street, and they also seem much less threatening. My instinct is to say that stronger families are a factor. Which leads me to think you can't solve this with "light touch" social services. They have to really be involved all the time.
I feel like this article presupposes a lack of experts. Like from an idealized hierarchical standpoint, people should be able to make reasonable requests like deal with homeless people or pollution, and the system should have experts that are equipped to translate said reasonable requests into systematic policy. And we do have experts technically, bunches of think tanks and colleges and advocates have decades of research on how to deal with this stuff supposedly. So the question should be what exactly goes wrong in the expert to policy pipeline. It is logically strange to expect regular people to invent public policy that is better than the people who's job it is to do so in order to be able to advocate for it. And yet it seems like that this is how it should work these days.
I think the problem is something like - all (?) the experts support the current policy, and all the normal people who aren't experts say we should "do something about the mentally ill". The experts can't think of anything to do, so they don't, and then the normal people complain louder. See also the discussion in https://www.astralcodexten.com/p/book-review-the-revolt-of-the-public
Is it that the experts can't think of anything to do, or that they aren't willing to recommend what they can think of?
Those would both look the same to people who aren't closely paying attention, and the existence of some places without the problem (in the recent past! And even some places today!) is evidence for the latter.
There are social pressures preventing experts from suggesting anything at all, because it's a culture-war issue. Proposing specifics in public is an invitation to be attacked by one or both sides, based on criticism of (in preference order):
1) perceived ideological impurity in the actual specifics,
2) anything else the so-called "expert" has ever said or done,
3) anything anyone they're vaguely associated with ever said or did,
4) whatever someone with better demographic credentials is willing to lie about
Yes, and all actual solutions involve messy trade-offs and it's easy to point to the ugly parts in any specific proposal but hard to come up with a better one.
So do you personally believe that the policy we have right now is actually the best possible policy and the only reason regular people should consider these questions is to recognize how intractable the problem is? Cause maybe that is the case.
Well, the ordinary people may also get fed up enough to coalesce around a revolutionary movement of some sort. Which may even solve this particular problem, at the cost of creating a hundred of new exciting ones! So it goes.
Solutions some experts might advocate for, like "build more long term living solutions for the chronically serially mentally ill so that more people can access longer term involuntary commitment", are both at odds with current political trends in the ivory tower and with the public.
California just passed a ballot proposition to fund $6 billion worth of exactly that type of thing so I think it’s difficult to argue that it’s counter to current sentiment.
I think it’s a specific example of “the elite consensus is good for the elite but not good for ordinary people” dynamic that’s playing out in lots of different ways in different places and contributing to the rise of the anti-elite
The experts are paid to implement the current solution, so if they decide to advocate for a different solution they are advocating to put themselves out of a job. (It’s rare for someone to be paid well to be agnostic about the solution to e.g. homelessness)
I think in this case it's just 'the experts know that you can't fix this without spending a lot of money and changing some zoning laws' and the people who want the problem solved are also against those things.
"If your plan is to “lock them up long-term”, keep in mind that (for now) there are almost no institutions equipped to do this. Each state usually has one center with a 3-digit number of beds for the most recalcitrant patients."
I think most people are thinking off something like the California Department of State Hospitals, specifically DSH-Atascadero, DSH-Metro, DSH-Napa, and DSH-Patton. Admittedly these are forensic hospitals but I think that matches their intuition of how some of the mentally ill homeless should be treated: if they've committed a crime and they've got an obvious mental illness, they should be sent away to a secure institution by a judge until they're better. And a lot of the disturbing homeless are committing crimes.
Admittedly, most people don't know enough about the California government to know about DSH but I think that's the kind of thing they're internally thinking of. And I'm not sure we could quickly scale up 2-4 new hospitals but it's not impossible.
California used to have a huge and quite lovely public mental asylum in bucolic Camarillo. Lots of celebrities like Charlie Parker spent time there. It got shut down when lunatic asylums went out of fashion, and is now repurposed as the very nice campus of Cal State Channel Islands.
Interesting, I hadn't heard about Camarillo. This bit from the wiki article (1) jumped out at me:
"Another contributing factor was in 1996, when Governor Pete Wilson empowered a special task force to research reasons for and against the closure of the Camarillo State Hospital and Developmental Center.[2] The task force cited that the facility, which housed as many as 7,266 patients in 1954, had only 871 clients in 1996. The hospitals per capita costs had risen to nearly $114,000, second highest in the state mental health system. These factors prompted the initial closing of one-quarter of the facility's 64 units and later, on June 30, 1996, the hospital officially and permanently closed."
Which makes this sound like primarily an economic issue, which makes sense. When they closed Camarillo, the issue wasn't beds, that wouldn't explain a nearly 90% decrease in patients served, but the $100k price tag per patient (in '96 dollars, now I think it's closer to $200k). That matches what I'm seeing in the budget (2), although I might be misunderstanding it, $75 million on "capital outlays" and $3.4 billion on "State Operations" sure sounds like the costs are overwhelmingly on personnel and managing patients safely, not building more beds.
...it is insanely depressing that $200k/person/year is insanely expensive to keep someone off the streets and yet is still probably cheaper than what SF has tried.
I still think this comes back to moral intuitions. A lot of liberals really, really dislike mental institutions and...yeah, they're not bad in the way liberals think they are but they're also way worse, if that makes sense?
> it is insanely depressing that $200k/person/year is insanely expensive to keep someone off the streets
My reflexive snark is that it may cost more than that to *live* in SF as an ordinary person. Dunno if that's a fact or not, though, but it's not off by an order of magnitude, surely.
I have seen it repeatedly said (but not fleshed out with much detail) that the capacity (beds) of state mental hospitals used to be much higher, and it was relatively common for people to be committed to them for long periods. So perhaps "there are almost no institutions equipped to do this" is a statement about our times. ...
So just going back to "how we did it when I was a boy" -- which people then seemed to perceive to be better -- would require nearly two orders of magnitude higher psych beds -- and associated staffing. In that situation, it might be possible to lock someone up, start them on meds, hold them for the several weeks for the meds to improve their mental state and adjust the prescription as necessary, and only then release them. Even better if during that time a social worker can be connecting them to an adequate array of housing/work/support services/family/etc. so they don't immediately fall apart when then walk out the door.
... The web tells me that the UK has about 24,000 inpatient psych beds with a population that is about 10 times that of Massachusetts. So that's maybe 4 times as many beds per-capita.
I should caution you that I've heard that a lot of places in the USA solve their homeless problem by buying the homeless bus tickets to San Francisco, which works great for them but won't work for San Francisco. Checking other countries avoids this issue.
It is possible that what I have heard is wrong. That is why I put those words in my post.
I find it interesting, however, that of the five non-paywalled citations you gave (Citizen Times is paywalled for me), zero actually address the specific claim. I would appreciate a direct rebuttal rather than pattern-matching me to a bingo card.
I don't live in the 'States (I'm an Aussie) and have little experience with directly researching things there; this would seem pretty difficult. I am also not amazingly motivated, for related reasons - I care about US problems when they risk becoming my problems (cultural stuff that affects the rest of the Anglophone 'Net, for instance, or anything that risks the USA no longer functioning as the lynchpin of the Western alliance system), but otherwise it's frankly not really my place.
Bottom line is: no, I'm not going to investigate this thoroughly enough to have direct knowledge. I pointed out what I'd heard because it's relevant and noted a way to sidestep the issue. If what I've heard is inaccurate, okay, fine. If people don't believe me without me doing such investigation, okay, fine, I don't really care.
I made the second half of the second comment not because I was invested in the proposition, but because the reply itself hit some red flags independent of content - specifically, the full sarcasm is TTBOMK not appreciated here, and per Bounded Distrust/Media Very Rarely Lies (and my skills as a shopper avoiding imitation products) I am immediately suspicious of anyone who goes to great lengths to imply X without actually saying X ("because putting 'butter' on the package of a fat spread will help sell it, any such spread that doesn't prominently say 'butter' can be assumed to be legally barred from doing that by virtue of not actually being butter").
(To be fair, the red flag is not as big for a random commenter (who can tell straight-up lies and largely get away with it) as for somebody big enough to plausibly get sued.)
It's to any large city that actually provides social services. I know it happens at a regional level, but if "Texas to SF" is a thing I'd guess that it's solely because of the culture war.
Fortunately, once they've spent one night in a non-shelter, or sometimes have been in the city for more than 6 months, surveys will count them as "local".
I need an upvote button or something to avoid saying, "This," but having worked and volunteered with social services in medium and small cities: exactly this. The small city's homeless plans beyond a couple of nights are "can we buy you a bus ticket back to wherever your family lives?" and "have the police drop them off at the homeless shelter in the nearest medium city" (which is also where they can catch the bus back to wherever their family lives). In the medium city, we did have out-of-state people with no home, job, or money arrive (bus station again) because they heard the system was better/less overcrowded than where they were coming from.
California is about 40 million people, or a little over 10% of the country in terms of population. Yet their homeless population is grossly disproportionate.
Or Dallas, for that matter. The summer heat is unbearable if you have nowhere to shelter from it, and winters are "generally" mild, but there are enough days with sub-freezing temperatures and howling wind (in that part of the country the two usually go together) to make sleeping in the rough as deadly as it is in Boston.
More likely, people on the margins tend to drift to places where the living seems to be better (or at least, less worse) based on whatever their priorities are. So those places will have more people who've slipped over the edge.
(Though in point of fact, there have been times when the welfare bureaucracy in New Hampshire would give the unemployed free bus tickets to the neighboring Massachusetts. But that was a time when Mass. had very low unemployment and was desperate for more workers, so it's possible that the Mass. Office of Labor and Workforce Development was actively encouraging it. Oddly, it turned out to be easier to relocate whites to Boston than blacks; apparently it was on average easier for a white immigrant to find a friend/relative to crash with than a black immigrant.)
Here is a news story from my home rural state where multiple police officers state that they regularly put homeless people there on a bus out of state. Including buying tickets & managing logistics for them. Unless you think the entire article is fake, including the specific names & pictures of the officers quoted, this does seem to be a pretty real thing
Have you been to Texas? Nobody in Texas thinks Texas has anything that "works better" w.r.t. the homeless. Maybe better than San-Francisco, but that is setting the bar so low you have to dig a ditch for it.
Are you talking about EU? We have universal healthcare and better social security, so there are fewer homeless people in general. For one you are not at a risk of losing your home at the first sight of a major illness. Plus people who are mentally ill are hospitalized and then usually taken care of through some social security systems (depending on the country – some EU states are better at it than this). In mamy countries there is usually some sort of subsidized housing and people get social workers who assist them in daily living. Basically you need to raise taxes (or tax the rich more) and put lots of money into having a coherent, working social security systems, like European countries did.
Raising taxes tends to be unpopular unless that social safety net is already in place. Start by aiming to keep the overall tax burden the same, but shift more of it onto stuff that's naturally easy for the government to measure, because without the government's direct and ongoing involvement it wouldn't exist at all: land-use rights (distinct from structures built thereon), professional licensing, intellectual property, that sort of thing.
Reduced overhead costs for dealing with tax fraud means more revenue for actual useful government services, less hassle for taxpayers, and considerably less deadweight loss across the whole economy due to tax avoidance.
Resultant goodwill can then be leveraged to raise tax rates, if doing so is still necessary, and most of the burden of such an increase would then fall on rich people or megacorps who were extravagantly wasting something which other people could be making more socially-beneficial use of: slums or vacant lots in valuable locations, patent trolls, etc.
- You'd be abolishing the FDA, not the DEA, for this
- You'd want to give them out for free, because they're cheap enough that the government could easily afford this, but homeless people have no money and even a very cheap price would be an obstacle for them.
- Realistically there would be various horrible side effects, but maybe still a net benefit given how bad psychosis is.
The really exciting option would be giving GLP-1RAs (eg semaglutide) free and over the counter for opioid addiction. But this is much harder, both because these drugs are way more expensive, and because there would be a profitable arbitrage operation in smuggling them to normal people who want to lose weight.
OK, why not give semaglutide free over the counter to everyone? I've heard that obesity is a huge public health issue costing our healthcare system tons of money, so that might even save money in the end?
(Yeah, yeah, various horrible side effects, but maybe net good?)
Interesting idea, really. Of course, the pharma companies expect to make (cue Dr. Evil!) BILLIONS OF DOLLARS each year from these drugs, but on a national level, the federal government could just pay them off and it would be a rounding error in the federal budget.
is this a situation where the medication is too good? if there were no antipsychotics to give these people, the ability to demonstrate improvement would be hampered and easier to justify commitment. also the need to keep them off the street would be greater. what does medicating them actually accomplish? (not trying to be unsympathetic to their condition, legitimately curious how much better their experience is medicated vs non-medicated)
I think you've touched on the combined medical/political dynamic. Before we had antipsychotics, people who developed severe mental illnesses were hopeless and it was admitted that the only thing to do was lock them up and care for them as best we could. Hence state mental hospitals. With antipsychotics, a substantial fraction of those people -- with careful support and supervision -- could live freely. So between humanitarian and financial incentives, the state mental hospitals were closed down, but the well-supported slots in community mental health facilities were never funded. Though some of that error is because people still tended to think the bulk of the expense was in the big buildings rather than in the corps of well-trained workers that made it all work.
From what I see in the press, it might be useful for the government to just hand out buprenorphine for free to cut back opioid addiction. But I expect that things aren't as simple as they are made out to be in the press I read.
I think you’re missing the goal of a short arrest (few days). Part of the problem is the homeless are in areas where society doesn’t want them to be. They’re near city downtowns where tourists spend time or near commercial districts or in otherwise nice parks. If you can arrest them for a few days and keep arresting them until they move somewhere else … the goal is to eventually force them to move to the more acceptable areas vs. least acceptable areas. This is obviously not ideal but in the mean time the city gets more tourism, more office rentals, etc. Europeans ruthlessly arrest homeless people who hang out in the touristy areas. SF doesn’t, yet.
Very true. These policies can amount to, "We're going to make your life significantly less pleasant if you don't stay where we want you to stay and live how we want you to live while you're homeless." Which sounds harsh, but doesn't have to be in practice, and certainly makes the cities nicer for most people.
My impression is that less touristy areas are more residential areas and the residents don't like having homeless people around any more than the tourists do (and I'm more sympathetic to them since they have to live there 24-7).
Agreed. People don’t want them in the residential areas or suburbs either and for good reason. But my guess is cities can identify certain areas where they would prefer the tents to set up. Something like industrial areas or run down parks. The key is that city officials should be able to use arrests as a strategy to move the tents/homeless concentrations without having to face a million lawsuits.
Cities used to have "skid rows" where living was really cheap ... and where the police didn't care what the people did because people who had any money at all didn't live there. But those have been either "urban renewed" or gentrified out of existence in most cities.
There are tons of areas in cities that are neither touristy nor residential. In cities that pursue these practices -- at least those with which I have any familiarity -- such places are usually where the homeless are directed.
It makes more sense to send them tp industrial areas for 2 reasons :
1. Industrial areas don't have nimbys. Easy to put up a few barns, bunk-beds and bathrooms
2. Industrial areas can have menial jobs to go around.
Downtown usually the most-dense part of any city by an order of magnitude. So even after adjusting for land-use, more residents are affected by homeless-ness if it exists in downtown than if it did on the outskirts.
If it was that economical to build housing in industrial bits, you'd think someone would already be doing that to sell more apartments. I wonder what's stopping them?
Right: the logical improvement of that strategy is to just keep them in those places with physical barriers. These are the "Sanctuary districts" from DS9, which frankly I think are a much better idea than how they were portrayed in the show.
Look up Marc Dones. He was hired at $250,000 per year to oversee a $140-million budget for the King County (Wash.) Regional Homeless Authority. He had no relevant experience and no related education, and was not even familiar with the area (being from Ohio).
He was, however, the exact kind of person "damn liberals" like. So, while I don't have a specific "plan to do better," I could see--along with many others who are on the Left--he was going to fail. We could do better by doing nothing, but one thing would be to avoid hiring clearly unqualified people. Is that enough a plan to start from?
Say what you will about Jim Jones, but being able to get a bunch of people to pack for the Guyanese jungle and commit mass suicide shows some real leadership and organizational chops. "Leaders" like Dones struggle to maintain the office copiers or inspire subordinates to get their TPS reports in on-time.
I am suspicious that California is doing the best it can possibly do, given that no other place in the developed world (and certainly no other state!) has even close to the same degree of this problem, despite many others having good weather or expensive housing or mental illness or drugs. CA has around 60% of all unsheltered homeless in the country, despite having only 12% of the population. It’s difficult to believe nothing can be done when every place I’ve ever been to seems to have it better under control.
>despite many others having good weather or expensive housing or mental illness or drugs.
This is false. As of 2024, Hawaii is the only other state that approaches California in good year-round weather and housing expense. And Hawaii is obviously far more difficult to reach for your average homeless American.
Honolulu resident here. There's a homeless encampment less than a mile from my home. Last year a homeless woman from that encampment broke into my house, and I interrupted the burglary. She had a history of doing that but I was the first to press charges. The gal was Micronesian, a demographic which often includes people who come on a visitor's visa but don't return. A quick internet search of her name revealed that her two little kids had been put in foster care a few months before the burglary. She required an interpreter during the court proceedings. She wasn't deported and did a short stint in jail before sentencing where she was released for time served.
Is it unreasonable to limit the accrual of unemployable immigrants as a measure to address the homelessness of an urban area?
Micronesia actually has a treaty of free association with the US that grants all Micronesians the right to live and work in the US without a visa, so she would have been there legally. It's diplomatic compensation for being occupied and nuked by the US military.
Honolulu is the cheapest US destination from Micronesia, and I can only assume living in a tent in a park in a safe and prosperous US city is preferable to living in an informal residence on a low lying island that's threatened by sea level rise. I'm not sure what the solution is - Oahu desperately needs more housing and better transit and I think this problem is downstream of that. It's difficult to build things there, though, because of the Jones Act restrictions on shipping and the standard NIMBY factors of zoning and environmental review, with the added wrinkle of every new project being vulnerable to protest as a settler colonialist violation of indigenous Hawaiian rights. Which is kind of the original sin the whole state has to deal with.
The way you wrote it, that's not Housing First, that's Housing Second, after spending a few weeks in an institute, taking medication, talking to a social worker, and visibly appearing better. Such an approach seems a lot more likely to work than throwing a bunch of obviously unstable people together in free housing.
This probably sounds draconian and cruel, too, but in fairness, all these discussions seem to assume that this person is in San Francisco and can *never ever leave for some other, more affordable place.* I get it -- it's tough leaving home, and maybe they'd be leaving friends. But they wouldn't be the only people leaving SF over rent prices, and they'd pretty clearly be among the most rational.
So I dislike articles like this when they say things like "the average wait time for a homeless shelter bed is 826 days" or "cheap apartments in SF are $1000 / month."
I have a friend who was homeless for around a year in another major American city, and he said it was always 100% feasible to get a shelter bed if he wanted one. Indeed, there were several options.
On a different note, I also think that if one were going to go a "cruel and draconian" route, homeless shelters might be able to change policies to better support that and prevent some of the issues you highlight. If it takes 826 days to get a shelter bed, then zero of the typical people you mention who are briefly homeless are getting shelter beds. If all of the people who were homeless for longer were either leaving or in jail, then more of those people probably would get beds. Am I saying this is the policy I favor? No, I agree it's a hard problem and I'm not sure what the right answer is. But things like this need to be kept in mind, too.
"I have a friend who was homeless for around a year in another major American city, and he said it was always 100% feasible to get a shelter bed if he wanted one. Indeed, there were several options."
I've heard the same thing in a number of articles about the recent "Grant's Pass" Supreme Court case. In a lot of cities, there are shelter beds available... for people who want one and are willing to put up with the shelter's rules.
Until the recent Supreme Court ruling, that meant that sometimes a court would say the beds weren't available. Sometimes, the rules were so strict that made sense - but sometimes not, and nobody was confident the court would say any particular set of rules was fair enough the beds could be counted as available.
For the most part I agree, people definitely have a bias towards staying where they are even if it isn't actually in their best interest. But I imagine it is challenging as a homeless person to get a ride to a different city?
Yep, why on earth do we even want a single homeless shelter in SF? They should all be built out in Nowhere, California and everyone should be bussed in there from around the state. If you're poor you shouldn't get the right to free housing in the second most expensive city in America.
At one point, there were something like 600,000 Americans in long-term psychiatric institutions, and that was in a less populous America. Start by locking up 600K and then lock up more. Ah, but where do you put them? The 50 states are dotted with the creepy and picturesque ruins of all the old mental asylums--you can't put them there!
It's true that the current government (states, local and federal) are totally incapable of building and running a vast network of psychiatric hospitals, but don't we want government to do things like build nuclear power plants and also lots of housing? If I'm making an argument for cheaper housing and you say "government can't/won't ever allow more building," am I supposed to say that you have won the argument?
Unless we want to embrace full anarcho-capitalism, we have to believe that it is possible to have a government that can do things that it did in the 1950s like (a) apprehend and detain the severely mentally ill, (b) back and create lots of nuclear power plants, and (c) build abundant housing and infrastructure.
2. People with Down's Syndrome and other developmental diseases
3. People with neurosyphilis
4. People with extreme untreated schizophrenia that you basically don't see since the invention of antipsychotics.
As lifespans increased, we spun off a new type of institution (nursing homes) for dementia. As Down's syndrome tests got better, we started aborting more of those children, and also were able to find more compassionate ways to care for the ones there were. With the invention of penicillin, we cured neurosyphilis. And with the invention of antipsychotics, schizophrenia became a pretty different disease with a pretty different prognosis.
We never had 600K schizophrenics locked up in a world where antipsychotics existed. I agree it would be possible to do this, it would just be a kind of novel plan and start seeming weird once all those people got antipsychotics and were mostly better.
If it turns out that we don't need to lock up that many people, that's great news! But, as an NYC resident, I'm tired of the usual song and dance where an insane person pushes somebody on to the subway tracks, and it inevitably turns out that they have been cycling in and out of custody over 20 times.
All these individuals need to be locked up and if the number is only 250,000 or 400,000, that's fine with me. But they need not to be on the streets.
When the severely mentally ill are allowed to roam free, we all are living in the asylum, and there is no one to protect us from them. And of course, people in poor and more crowded neighborhoods have to deal with the brunt of the disorder.
My impression is that the number of potential subway track-shovers is surprisingly small even in NYC. Taking, say, the 100 scariest loons in NYC off to restful rural lunatic asylums would make a major dent in the number of random violent attacks in New York, making life less nerve-wracking for everybody else.
In fact the number of chronic homeless is relatively small. IIRC a study done in NYC found something on the order of tens or hundreds of thousands of homeless over the course of a decade--but the vast majority were homeless for the period of a day or two, rapidly discovered that life on the streets was no fun, and transitioned themselves onto a friend's couch or mom's basement.
The one who couldn't, in the words of the study's author, had "tenuous" social connections. In other words mom had kicked them out for pawning her tv for crack or they were so mentally ill that their friends and family were simply incapable of caring for them. But they were a tiny minority, small enough to house given relatively modest government expenditures.
I wish I had the source but when I lived in Seattle, I read that about 5% of the homeless use about 80% of the support services. I assume those numbers pertain to dollars and not doctors visits or shelter beds.
I can really see that in my minds eye: a tiny subset of homeless pushing people on tracks in NY; a tiny subset setting fire to their newly built tiny house in SEA.
To my tech-addled brain, this means there's a cheap way to produce massive impact without huge changes to law or spending billions on increasing social services: become very good at spotting these worst offenders and get them off the streets into forced care.
Regular folks win. _Other_ homeless people win even more because there's a lot more dollars available for their support. And the worst offenders are safe and getting the care they need.
It's difficult though because even if essentially all of the 100 scary-homeless-random-crimes are done by people who've been cycling through the system for decades, only a very small fraction of the people cycling eventually commit a scary-homeless-random-crime.
>it inevitably turns out that they have been cycling in and out of custody over 20 times.
Whatever happened to "three strikes" laws?
Maybe the person cycling in and out of custody 20 times is not committing felonies the 20 times, but there should be _some_ way to notice that someone is a hazard to people around them after multiple convictions.
If they are going to get better and stay better, then great, but the whole point of your article is that they won't. If a person is pretty sane while medicated but doesn't stay medicated unless under supervision, putting them under supervision seems like a decent plan.
(in and of itself, at least. I'm not sure about the economics or politics of it, or whether it's morally justified, or whether these places would turn into hotbeds of abuse or something.)
I'd love to see a breakdown of what fraction of the people who used to be in asylums
- can be successfully medicated, and stay on the medication without further effort
- can be successfully medicated, but have a high probability of "falling through the cracks", e.g. administrative snafus that the patient can't navigate past
- can be successfully medicated, but have bad enough side effects that they actively resist being medicated, even if they have the drugs in hand
- can not be successfully medicated with our existing pharmaceuticals
( somewhat orthogonal to these would be what fraction are hazardous to people around them )
My uncle is in more or less this situation, a nursing home for the mentally ill after he stopped taking his schizophrenia medication. You could view it as either a very comfortable and relaxed prison, or as a nursing home where the inmates are not allowed to leave (numpad lock on the door with a code given to staff and visitors but not residents). Seeming weird is definitely not an issue in his case, because everyone who knows him knows this is the only way at this point for him to have some semblance of a normal life.
This is in New York State, and I'm not sure whether the arrangement could be expanded to cover chronically homeless people, but I guess it's a proof of concept. My best guess is that this costs $160,000 per year funded by Medicaid. I'm also not sure how well equipped they are to deal with violence - I assume they are able to handle occasional instances where a resident arm-wrestles a nurse away from doing something, and anything more severe would get handled by the legal system (which is actually functional, unlike in California).
I definitely think more shelters are the bigger deal. I was just thinking that longer periods of commitment (if you have enough shelters that it's viable) means you have longer for social workers etc to be in contact with unhoused people and it's easier to track them etc (so people come to them instead of expecting mentally ill psychotic people to be the ones doing their own self-discipline/paperwork/time management/executive function etc).
Yeah, I’m surprised that Scott doesn’t see the value of longer periods of commitment, which seems like the obvious answer to me. I’m not schizophrenic, but I’ve been on brain pills, and they really do make you feel weird, especially in the early stages, and those growing pains tend to last longer than psychiatrists say they do, in my experience. I don’t think it’s a surprise that a lot of homeless people stop taking their meds when their lives are already so chaotic—it’s a tremendous change (and even more so if you have to deal with extreme side effects). Having an asylum/halfway house kind of situation (with less intense care requirements than a hospital but still meaningful supervision) where they can live for six months to a year as they acclimate to their meds and even out would, I suspect, solve a lot of the problems outlined in this post. It would give them a roof over their heads and a stable address where case workers can find them (and where they could receive mail and paychecks/gov support!) as they get used to being on meds, and they could go through the process of e.g. learning how to independently get their meds refilled while in a stable and more directed environment.
You said in this article that commitments are not long enough for the drugs to actually start working, and that people whose drugs have not started working may go off them because they think the drugs are an Illuminati plot or whatever. Longer commitments for psychosis would patch that (though so would massively-extended-release antipsychotics).
This seemed sufficiently obvious to me that rather than post it myself I did a keyword search in the comments for "period", and got here with minimal scrolling. I do think it's a good suggestion.
Specifically, let's extend the involuntary commitment duration to "however long it usually takes for the desired effect of the drugs to actually kick in, plus a week or so so that they can get used to the full effect". Per the article this is 2-4 weeks for antipsychotics, so go with 4-5 weeks there. May be different for other drugs.
Should probably also expand psych hospital capacity to cover the increased load, but I'm less certain about the exact numbers there. Especially since the goal is to eventually bring the number back down by actually fixing the problem (i.e., making them permanently healthy).
It's definitely draconian, but I'd be comfortable with sentencing chronically homeless + jobless people to a year in out in the country camp. I just don't see many of these people getting better and I think getting them out of the way and giving them a simple life may be an answer. Especially on low cost land in robust basic construction.
Included would be free hot meals, shelter, air conditioning, television, in a refugee camp outside of population areas, eg, like many miles away.
I don't think it exists. In my mind, it would be somewhere between a summer camp and minimum security prison, located a minimum of 50-100 miles from any metro area. Any significant crime there could escalate to normal jail or prison.
The point would be to redirect funds from unrealizable rehabilitations, volunteer organizations, charities, and emergency services into a minimal cost simple existence.
For all of these solutions, it doesn't matter if it exists or not, because with the billions we are already spending on homeless solutions we can make it exist!
I think my plan is "it should be a crime to make things awful for everyone in a busy public area".
For example if someone is on a crowded subway and they start shouting death threats, they should get arrested.
After they are arrested, I am okay with whatever process we implement that makes sure that they don't go back on the subway and resume shouting death threats. If that means we find a miracle medical process that makes them functioning citizens, great. If that means they go to a mental institution, fine. If that means they go to prison, that is acceptable.
Wherever they go, they should stay there until we are confident that letting them free won't lead to them getting back on the subway and shouting death threats. If they are in a mental institution on antipsychotics and are perfectly lucid, but we predict that releasing them leads to an 80% chance of shouting death threats on the subway, then they stay in the mental institution for life. If there aren't any mental institutions with space, then they stay in prison for life.
I am a little bit sad about this but I would rather have nice public spaces than have free crazy people.
I agree with this. My guess is that it's very hard to get police to be around for any given case of threatening and screaming, so most of the time the perpetrators never get arrested. I think this is why the debate has become "arrest homeless people on the grounds that they're probably the kind of people who do this" vs. "change nothing". It seems to me that more/better policing should solve this, but I'm not a police officer and I expect they would be offended by me saying they should trivially be able to do their jobs better.
> A police officer sees a mentally ill homeless person and assesses them as disruptive. Technically the officer should assess whether the person is “a danger to themselves or others”, but in practice it’s all vibes. They bring this person to the ER of a hospital with a psychiatric ward.
it sounds like currently threatening-and-screaming people are considered "disruptive", so they get taken to an ER and then released a few days later?
I wonder if there exists a law-enforcement process that arrests people for threatening and screaming (and isn't just catch-and-release). I suspect that, in San Francisco at least, no such process exists.
If San Francisco does have a process like that and it's simply not able to catch people, then I guess I would advocate for putting cameras in public spaces, so that the police can find evidence of threatening-and-screaming when it is reported. There apparently already are cameras on subway cars but I'm not clear if there are cameras in eg the Tenderloin.
>and it's simply not able to catch people, then I guess I would advocate for putting cameras in public spaces, so that the police can find evidence of threatening-and-screaming when it is reported.
Seconded! Cameras are now cheap (and, frankly, are pretty pervasive anyway). As a citizen: If we are more-or-less under surveillance anyway, we should get _some_ gain, like fewer threatening-and-screaming people at large, from it.
I know the commenters are edgy so I wasn't paying it much mind, but I'm shocked that you agree. Consider it as a Rawlsian lottery: you can have quiet public spaces where no one randomly yells at you, but if you develop psychosis, you'll be deprived of liberty and of the right to refuse treatment that has severe side effects, possibly for life. Would you accept that deal?
I think you're misreading me? I'll explain what I mean by "Ralwsian", sorry if you're already familiar but that seems to be the most likely miscommunication.
Currently, Scott is not psychotic, and you probably aren't either. But there's some risk you'll develop psychosis at some point (around 3% for a single psychotic break, around 0.3% for schizophrenia). This partially puts you behind a "Rawlsian veil of ignorance": you don't know whether you'll end up psychotic or not. (Partially but not fully, because you can use family history to estimate the risk. Scott generally likes contractarianism + Rawls as a way to ground moral judgments.)
You can have opinions now about how you'd prefer to be treated if in the future you become psychotic 1) in general, 2) unpleasantly loud, or 3) dangerously violent. You could in theory declare psychotic!you to be a different person, or to have no rights, but you'll still experience what this person experiences.
At the personal level, this looks like advance medical directives, powers of attorney, savings, insurance. (Not really relevant to this topic, but a good thing to plan for anyway.)
Now scale it up, and imagine a whole society made up of copies of you, all deciding together: each person deciding how they'd like to be treated if they later go [at all/loudly/violently] psychotic is equivalent to all the non-psychotic people deciding on the treatment of all the [subtype of] psychotic people. (Since nobody knows where they'll end up, there's no difference between selfishly deciding what's best for oneself, and deciding what's best for the average person — this is what Rawls is about.)
In this situation, you have a choice between (possibly among other options):
A) Don't bother psychotic people; if they scream, well, being annoying is not a crime; don't give them antipsychotics unless they say they want them or unless they're physically attacking someone.
B) If someone is psychotic and bothers people (e.g. by yelling in public), put them somewhere they can't leave, and force them to take antipsychotics even if they say the side effects are unbearable.
If you pick (A), then you have a certainty of being yelled at in public. If you pick (B), then you have a certainty of having nice quiet public spaces, but a 3% chance of being locked up and forced to take unpleasant drugs, and a 0.3% chance that this will last a lifetime.
I very very strongly prefer (A) over (B), and I expect most people do too! So in this Rawlsian scenario, whether I'm selfish or altruistic, I pick (A).
Now, in real life, people aren't in fact making decisions all together like this. If you put a lot of effort into fighting for the rights psychotic people, and then become psychotic, then your own past efforts will only improve your situation a little bit; and this only has a 3% chance of happening. So if you're purely selfish, then it's not worth it to you. But if you value the welfare of other people, then you can jump from the Rawlsian hypothetical to real life, and treat psychotic people the way you'll want to be treated if you become psychotic.
Yes, I'm serious. A society where you get yelled at kind of sucks, but much less than a society where you get locked up for yelling in public. That's… hardly an outlandish position that people would only hold in jest…
Is this a difference in values, or in expected outcomes? If you don't "remove" people for yelling or committing mild vandalism, there's yelling and mild vandalism, but nothing I'd think of as society ceasing to function (e.g. it's still possible to live, run businesses, and go to school in San Francisco). Do you expect worse consequences? Or do you agree those are the consequences, but think they're worth imprisoning people for yelling in public?
If we do have a difference in values, then yeah there's no point in arguing, we're going to have to fight it out. Realistically, I expect to lose in the short term and win in the long term, with future generations shaking their head at the barbaric mistreatment of persons of neurospiciness or whatever that'll be called in 2424.
The veil of ignorance is some kind of strange disease that seems to hack into certain people's brains and delete the capacity for common sense. "Yes, if may seem like a good idea to jail murderers... but have you considered a thought experiment where you yourself were born a psychotic murderer? 🤓".
Are the drugs more unpleasant than schizophrenic episodes are? Because if they're preferable, even with their side effects, to having schizophrenic episodes, which a lot of schizophrenics in their lucid moments seem to believe they are, then it doesn't seem like an undue burden, from behind the veil of ignorance, to expect schizophrenic people to take them and thus make themselves compatible with society.
There's enormous disagreement. Among bloggers who are frenemies of this blog, Freddie deBoer is full-throatedly in favour of them and ensures as hard as he can that he'll be forced to take them if he wants to go off them during an episode, and @loving-n0t-heyting Tumblr considers them one of the worst fates that can befall a human being and ensures as hard as she can that she'll never be made to go on them again.
I understand that they are not pleasant to be on, and consequently, lots of people stop taking them once the symptoms go away, causing the symptoms to start coming back.
3% is probably high. In addition as Alexander points out it looks like schizophrenia has a large genetic component. From what I can tell it often manifests in adolescence or early adulthood so if you have passed those milestones you are more than likely safe in terms of personal risk.
The other thing is it's not just a question of yelling at people. It's living in filthy, dangerous conditions that will almost certainly result in a drastically shortened life span. Who is served by letting somebody die slowly on the street when they are clearly incapable of taking care of themselves?
These two options are a false dichotomy, there are more. I'd of course choose C): Please, please lock me down if I ever become dangerous to people, I might hurt some kids! I might kill the neighboring little boy's mother! I would rather die myself.
If I just yell a bit outdoors: this is an uncertain area. I'd rather be free I think, but then again I'd probably not enjoy life in the street filth and danger. I'd take the asylum if these are the only two alternatives. Or another case: I knew a psychotic old lady (not homeless, not in danger) who had her apartement smelling of feces so badly that the whole house of 6 flats was unusable for other people. This is a measurable cost for society; she was eventually taken to a nursing home against her will. I plan to prevent this happening to me by investing in a good pile of diapers when I reach her situation. Yet dementia can prevent me from using them; I probably agree that I should be moved to a nursing home too at such a point. It will be very painful and can totally happen to me.
The Rawlsian conclusion should require you to consider "what if I was one of the kids being hurt by the homeless" as well as "what if I was the homeless forced to be locked away".
The problem with the violently psychotic isn't simply "they will yell at you in public", it's "they will threaten you and may indeed assault you".
What are the chances/odds of "get assaulted" versus "get yelled at"? You calculate out the 3% chance of being locked up. I think if I ever got to the point of being an actual danger to others, I would want to be locked up. "Yes well she did murder that guy, but the risk is acceptable because do you want the 3% chance of being locked up if you get crazy enough to go around murdering people?" may be very damn liberal, but I think if it's a choice "get murdered or get locked up", a lot of people would go for "okay lock me up".
There may well be people who would choose "get murdered, I would hate to be locked up for life" and good for them, but for those of us who would rather not be murdered, we get a say, too!
>I very very strongly prefer (A) over (B), and I expect most people do too!
I think analytic philosophy with its methods and cultural practices (thought experiments like the Rawlsian veil of ignorance, making underspecified claims like "x is intuitive") specifically trains people to succumb to these types of cognitive pitfalls. When you look at empirical cross-cultural psychological research like e.g. "The WEIRDest People In The World," what you find isn't that there is some sort of universal convergence to a specific set of values or a way of thinking. What you find is that culturally parochial practices like liberalism or worshipping the sovereignty of the individual are very culturally unique and that the majority of the world does not think in the way the "West" or "Americans" or "people who have received training in analytic philosophy" do.
For example, after the Arab Spring there wasn't a widespread proliferation of liberalism and democracy in the affected Arab countries. But the people there did act rationally and accomplished what they wanted to do - they reinstated theocratic government, constitutional monarchies, military dictatorships, etc, because they thought that was the best way to govern, not because they hadn't considered the Rawlsian veil of ignorance enough. If you ask the stereotypical bad-because-they're-in-the-Western-outgroup Muslim "If you were behind a veil of ignorance, would you really support honor killings?" their answer wouldn't be "Holy shit I never thought about it like that," it would probably be more along the lines of "Yeah, if I was born a whore and acted on it and dishonored my family and went against Islamic teachings, of course I would deserve to be bludgeoned to death." In other words, the stereotypical "bad" Muslim isn't making a mistake or acting ignorantly - they think differently than you do, don't share the same values you do, and are probably perfectly consistent in their support for honor killings and the encroachment of Islam on governmental duties, or any other cultural practice you might deem irrational or unendorsable from behind the veil of ignorance. This hypothetical Muslim example is mostly unnecessary though - in these comment responses you have a multitude of people disagreeing with you that there is anything obvious about what you take to be a mundane and straightforward application of the veil of ignorance to the possibility of someone becoming a psychotic homeless person.
Basically, training in analytic philosophy doesn't grant you this a priori insight into what every rational person, in every place, all across time, would think when exposed to your views, and existing cross-cultural research and historical events where there have been uprisings and revolts don't support the idea that people are coming to some sort of one way of life or one way of thinking that analytic philosophers can outline in their armchair endeavors. If you want to find out whether people do in fact all agree with one of your presuppositions, you have to go out there and ask, not use your failure of imagination or failure of cognitive empathy as evidence that nobody nowhere could ever disagree with you. (Charitably, you don't say "nobody nowhere," you just say "most people" but leave that heavily underspecified. Most people across all of human history? Just most people alive today? Most people in the future? I think making accurate empirical predictions about any of these reference classes is extremely difficult - but oh, here come analytic philosophers ready to chip in that a variety of empirical claims about how people think, speak, or act are just "intuitive" simpliciter.)
idk there's the same lottery for things like "being a murderer". A rule like "If you're in a state where you can't safely interact with others you don't get to interact with them, regardless of whether that state is 'your fault'" seems pretty reasonable to me honestly.
(ETA: and yes, if *I* become violently psychotic or otherwise a danger to the people around me, *please* lock me up somewhere where I don't hurt anyone. This doesn't even feel like biting a bullet, it feels like the obvious prosocial opinion to have.)
I'm curious whether you live in a place with a severe problem with psychotic street people - I think if I didn't/hadn't, all this would seem unnecessarily cruel to me, but as someone who has violent things shouted at them daily, has to ride a BART that reeks of urine and step over human feces during their work commute, and a few times a month gets followed down the street by one of these people, I just want to be able to safely go for a walk in my city.
(also, my coworkers regularly have complaints that a violently psychotic person outside the office building made it difficult for them to get in or out, like, threateningly standing in their way and moving to block them. it is unreasonable for this to be normal in a big city in a developed country in 2024.)
I wonder how much of the urine and feces in public places could be mitigated by simply setting up accessible, vandal-resistant bathrooms, with city government (or a specialized subcontractor) paying for maintenance. If the only toilets in reasonable walking distance are associated with specific businesses, who'd chase you off for scaring their customers... well, you gotta go somewhere.
Another option is to set up accessible normal bathrooms and throw people in prison for vandalizing them.
If we can do vandal-resistant bathrooms, that's great -- but I suspect the usual way to vandalize a bathroom is to smear feces all over everything, and I don't know of a way to make a bathroom that's resistant to that.
First possibility which springs to mind is making every interior surface a seamless mass of sloped and contoured stainless steel, with an automated self-clean cycle involving sensors and spray nozzles in the ceiling. Work out a sensor array that reliably recognizes crud on the walls but can't be usefully tapped into for voyeurism, set a debris-removal algorithm to incrementally escalate from "garden hose" up through various combinations of heat, pressure, increasingly harsh chemicals, etc., and if somebody manages to apply a turd which literal sandblasting can't pry loose, call for help from a human technician.
A given municipality might instead determine that their money would be better spent on something less elaborate, like off-the-shelf "port-a-john" chemical toilets, and go for 'replace' rather than 'repair' when faced with sufficiently extreme vandalism, but then again I've already seen bizarrely over-engineered benches and "bike racks" intended to manage the issue, so "Frank Gehry's Brick Shithouse" could maybe be the right fit for some planning committee's needs.
The reason why we can't have nice things is that public bathrooms are then used for drug dealing, drug taking, prostitution, and makeshift camps by homeless people and petty criminals.
Real people aren't minimum-maximizers like Rawls thinks they should be. Their revealed preferences from their behavior show they care about normal upsides to probabilistic actions rather than solely being fixated on avoiding the worst possible outcome.
I think Rawlsian analysis is mostly useful to stop people from stumbling into admiring setups like, say, Sparta, where a few at the top are glamorized, while the vast majority are enslaved, and often randomly murdered, but the losing side is less readily visible.
Easier math. Some people have a really hard time weighing different moral values against each other, or doing integrals across population demographics, but can intuitively realize they wouldn't want to have their own personal face eaten by a leopard, and then, with some help from Rawls, realize that a vote for the Leopards Eating Peoples Faces party is not actually a vote for a better world.
When it's a technocrat with a supercomputer, working all the angles out to ten decimal places, sure, utilitarianism is probably the way to go. Drunkard at 4 am? Let's try the approach that won't run out of swap space while he's reaching for car keys, and still usually ends up pointed at least vaguely in the right direction.
The utility monster is a standard example. Of course, a near identical criticism can be made of Rawls ( ie a situation where you ask the many to make huge sacrifices in exchange for a slim benefit to the few).
First: Rawls' concept of the veil of ignorance is deeply flawed and I reject the line of argument.
Second: If I weren't rejecting the argument, yes, I would take that deal. Psychotic homeless people suffer terribly and die quickly. I hope that if I ever develop such bad psychosis that I end up on the street, I will be involuntarily confined.
I don't know their specific reasons, but one would be that you can only decide based on your current values. There's no mind of perfect emptiness to consider in the before-time, even when you're consider a case before you're doing that relative to your current values.
(I do think Rawls-like arguments still work decently, but I don't think they're quite as strong as some people take them to be, but it is a decent *baseline* for the start of an argument about how to treat a group which you aren't a part of)
I sort of thought that the point was to bypass values by appealing to self-interest? You don't need to have an empty mind to go from "should I hurt them" to "should they hurt me".
My impression of the police perspective is they feel like there is no point investing time and energy into a case that is not going to go anywhere. Say someone calls up and says "Hey there was a crazy homeless guy yelling death threats". It is totally within their capabilities to take witness statements, get a hold of CCTV footage, identify the offender, patrol known homeless areas looking for him, etc. These people are not criminal masterminds hiding their tracks, you absolutely can find them, charge them, get a bench warrant when they inevitably don't show up for court, go find them again and arrest them etc, etc.
But at the end of all that the public defender is going to say "Look, my client obviously has severe mental health issues, he didn't have criminal intent, your honor should send him off to psychiatric care". And the judge will agree so he gets released to someone like yourself who gives him some pills, and then he gets better, and then he gets released, and then he stops taking his pills, and then he's yelling at people on the subway again and the cop asks himself "Well what was the point of all that?"
I live in Melbourne, Australia, I think this is basically how things work here and everything is fine. We have roughly the same proportion of psychotic people as the US. It's an expectation that if you are not institutionalised, your psychosis is under at least enough control to keep you from harassing other people trying to go about their day.
My vague understanding of the US in general and California in particular is that George Soros is actively recruiting district attorneys who do not enforce the law and that this is encouraged by the "Abolish the Police" nut jobs. It's more a "crime is out of control" than "psychosis is out of control" issue.
I doubt that George Soros is personally behind it, but there is a strong tendency for people with liberal sympathies to vote for such district attorneys. Less well-known is that the conservative side of politics in the US has a strong libertarian streak and *also* dislikes the idea of locking people up simply because they're scary. So the dream is popular that we only need to lock people up if they've committed crimes that they're legally responsible for.
I don't think this is how it works in Australia - possibly there's some state-to-state variation but the current practice to me appears to be "get the NDIS to house and treat mentally ill homeless people at great expense".
The NDIS is a giant clusterfuck but this is not specific to the psychotic population (which is a small proportion of the population served); its problem is that it is staffed exclusively by bureaucrats who take a million years and a billion dollars to approve a client changing their T-shirt. (Source: I'm a medical provider who has to write letters to the NDIS.)
Some chronically psychotic people are provided for by the NDIS (at great expense, but AFAICT no greater than chronically severely autistic people, or stroke victims, or people with spinal cord injuries, etc). These tend not to be the violent ones who are a threat to society; they end up in jail, or in forensic psych institutions like Thomas Embling. A psychiatrist who worked in Thomas Embling once told me it's actually much harder to get out of an institution like that vs jail, because the burden of deciding the patient is no longer a threat to society rests exclusively on the treating psychiatrist, and this is scary for the treating psychiatrist (how sure are you really that this person won't stab someone? 90% is nowhere near enough when it's your career and reputation on the line)
So sometimes the patients actually prefer to get sent to prison, for above reasons, and because the drugs there are better.
From a legal theory standpoint it's simple enough:
(shouted threats) x (witnesses who felt threatened) => number of counts of simple assault.
If he's got a knife or something, upgrade that to assault with a deadly weapon. Hard part is collecting enough evidence to convince the judicial system it's not a complete waste of time. Maybe hire more judges, clear case backlogs, bring back the right to a speedy trial?
I would add: this is not a plan about mental illness. This is a plan about crime and law enforcement.
If some of the people who are doing the screaming-and-threatening are psychotic, that's very interesting and someone should be tracking the statistic, but I don't see it as relevant to whether they should suffer consequences for their actions.
People have twice now attempted to round my plan off to something much larger -- "why do you want to imprison all homeless people?" "why do you want to imprison all psychotic people?" I don't. I want to imprison all screaming-and-threatening people, and that's a small fraction of homeless people, and (I believe) it's also a small fraction of psychotic people.
I have heard many stories of this happening in the Soviet Union, but none about it happening in the US during our era of longer-term commitment. Does anyone know of anything like this?
It was a big news story because it happened in unified democratic Germany. In socialist East Germany, there were huge numbers of politically inconvenient people committed to mental asylums. They weren't even shy about it - socialism was so Obviously Good that refusal to participate in it was openly declared evidence of insanity.
Because it's much harder to get a court to convict someone for a specific crime that they haven't done than it is to get a doctor to sign a piece of paper.
Historically, the rumors were that the enemy that would get you committed was a family member to whom you had become inconvenient for one reason or another.
> Okay, then can you just make it a crime to be mentally ill, and throw everyone in prison? According to NIMH, 22.7% of Americans have a mental illness, so that’s a lot of prisoners. “You know what I mean, psychotic homeless people in tents!” Okay, fine, can you make homelessness a crime?
> (followed by five paragraphs about how your ideological opponents want to imprison people for being homeless)
I don't want to make homelessness a crime. Lots of homeless people are perfectly harmless. I want to make *shouting threats in public spaces* a crime.
Keep in mind that the "strawman" version of criminalizing homelessness per se was just endorsed by the Supreme Court, so it can't be very much of a strawman.
My guess is that many homeless people are the type of people who *would* scream at someone, but it's rare for them to be caught by a police officer in the act of doing this, so most of the time it doesn't get punished. People would like to make things easier by punishing being in the class of people who would do this (homeless), but this seems like a weird rights violation.
The Grant Pass decision didn't rule that laws that criminalize sleeping outdoors were fine - they narrowly ruled that they don't violate the 8th amendment (which, they say, refers to the method of punishment only).
The majority decision states that they can still be challenged on other grounds. For example, they leave open the possibility that fining people for sleeping outside constitutes a disproportionate fee.
As I recall from my read of the opinion, the criminalization would also apply to non-homeless people who camp outside just like homeless. And would not apply to homeless people who stay in a shelter (so, "sheltered homeless"). Thus, it isn't criminalizing a status. The dissent points out that there are more homeless in that town than there are shelter beds, but I don't seem to recall the decision addressing the question of whether it was permissible to criminalize sleeping in parks when there were literally no shelter beds available.
Part of the problem with the 9th circuit precedent that had been overturned, was that it was interpreted to mean that shelter beds were not counted as "available" if the homeless person wanted to smoke and the shelter was non-smoking (as almost all are), or if the homeless person said that the shelter had a "religious atmosphere". The latter was conflated with being forced to attend religious services, but they are not actually the same thing.
A given city can't control how many homeless people enter, so it seems unreasonable to demand that they have enough homeless shelter beds for the current homeless population before they can prevent people sleeping in the park.
I agree. I think the dissent was hinting that they don't agree, but I don't particularly respect the dissent; it was more concerned with sweeping generalities than dealing with the details of law and practice. There was a distinct flavor of wanting a particular outcome in this particular case, and not caring about how they got there.
If we have police move unsheltered to shelters until they're full, and then ignore unsheltered, that doesn't incentivize the unsheltered to do much of anything, but it does incentivize the construction of new shelter beds. That seems OK? At some time in the night, the signal goes out to patrollers that the shelters are full and they have to ignore the unsheltered who aren't otherwise causing problems. If someone complains, there's a simple and correct answer that incentives a solution.
It seems like this ends up as a demand to provide shelter beds for all the homeless people who may ever show up in my town, or I'm not allowed to have public parks and libraries be usable because I have to let homeless people camp out in them.
I think it's fine for a town to simply say "nobody is allowed to camp in this city park and we will arrest you if you do," so that the city park can be used for its intended purpose instead of as an impromptu open-air homeless shelter. I don't think this implies an obligation to shelter as many homeless people as show up and demand shelter.
I think the alternative to allowing the city to do this is not having public parks where kids can be let play on their own or moms can push their strolers.
After checking a bit, let me point out the obvious. What works elsewhere is PATERNALISM.
Once you are in the "clutches of psychiatry", they don't let you go. Upon release you are placed into some sort of housing, your appointments are monitored and a social worker will find you and drive you there. You will be given multiple chances to get a job and/or rehab. Your meds will be delivered to you if you cannot pick them up. They remind you to take them. There will be a social safety net so you are never in a situation where you end up on the street unless you really really try to.
In retrospect, it makes sense: people who are not able to take care of themselves for a time because of a fixable mental infirmity are taken care of by the state, until they can. That's what we do with children already.
I still think you're eliding over all the difficult parts.
"They don't let you go" - okay, so the person is in a locked facility? Placed in "some kind of housing"? Does the housing have locks on the door, or can they leave? What if they do leave? "Multiple chances to get a job", oh, great, with whom? How are you enforcing that they take mentally ill people. What happens when the mentally ill people are less good workers than other people they could hire, or have some kind of crisis on the job, as even the best-treated person might once in a while?
"Paternalism" is a vibe, not a solution, and I think you're overestimating your ability to convert this vibe into a solution that could work once fleshed out.
It seems to work in places like Sweden. There are no locks, but people rarely just disappear into the ether (I assume cold winters make it harder, too). But also, if you go through your list of reasons why people get off the prescription meds, there would be much fewer of those in such a setup. The system helps you (and often gently forces you) to avoid trivial and non-trivial inconveniences. You have an id, your prescriptions/appointments/address etc. are in the system tied to that id (as is almost everything else in a sane id setup). There are government-sponsored useful work projects that help people get on their feet, so there is little competition with "better workers". The system actually cares about you. Taking a mental health day does not mean you get fired.
Not that it's all happy utopia, bureaucracy often backfires in fantastically creative ways.
But I guess at this point we are talking about reforming the whole society into more of a social democracy, a non-starter in the US. Still, the point is that some people need some degree of parent-like supervision at least for a time, and it's up to the state to provide it if they do not have any other support system. Hence paternalism.
Sweden's not just a 'social democracy'. It's a tiny country that was incredibly homogenous for most of its history. It's not that they have a system that 'actually cares about you' , it's that their entire system is closely related in terms of genetic distance. Witness how, the moment migrant populations have started increasing, the 'system that actually cares about you' starts electing far right parties in substantially greater numbers than ever before.
Germany has a lot of these. A typical example of such work would be disassembling broken appliances for recycling, or simple crafts like basket weaving. The work isn't valuable, so these places pay less than minimum wage. In Germany and many countries there are special exceptions to minimum wage laws for such workshops. They have trained staff and good connections to the local health care providers landscape, especially Assisted Housing facilities. I believe these would surely be able to employ psychotic people, at least as long as they take their meds.
And that Wikipedia article says: "In 2021, California banned organizations from paying disabled people less than minimum wage, giving the agencies who employ disabled workers until 2025 to either pay their workers the statewide minimum of $15.50 per hour or shut down."
Seems to me like that's a promising point to address, where a specific policy change could help? If these workshops also give work and inclusion and a little money to psychotic people, as long as they do take their meds?
Seems like a not-crazy solution to me to subsidize those workshops, for state $s to go to make up the difference between how much they're paying and minimum wage, to the extent they're genuinely helpful in preventing very bad societal outcomes. Maybe this proposal is too naive for reasons I don't fully understand?
I'm generally against workfare but maybe this is exception?
Rather than workfare, it might be useful to think of it sort of like a dark mirror of firefighters, or sysadmins, or other crisis-response sorts of roles.
"In a particular type of emergency, there is a very specific thing which society as a whole needs you - yes, you personally - to be ready to do. Until that situation arises, here's some tedious, tangentially related stuff you can keep busy with, but if you screw up the details of that, no one will really care unless it becomes a problem for the one big thing. We'll pay you whether it explodes or not, but be all the more glad to do so if you cleverly succeed at preventative maintenance."
For a firefighter, the emergency is 'people trapped in a burning building.' For a sysadmin, unscheduled server downtime. For somebody with severe mental health problems, relevant potential crisis is a public containment breach of their personal demons. Skills involved there are far less rare and prestigious, and moral hazard is a potential factor, so naturally the pay won't be quite as good... but the whole point of a minimum wage is that even the worst deserve some consistent degree of dignity and advancement prospects, rather than being dragged down as far as the market will bear.
I think California is in a particularly difficult situation, for reasons I outlined in another reply, but I can answer some of your questions for my paternalistic society, Norway, where there are significantly fewer mentally ill homeless people (and not just because they’re doing such a good job).
I don’t want to suggest that Norway has everything figured out. They haven’t. There’s a shortage of resources, and many suboptimal outcomes. But the system does suggest some answers to your questions.
“the person is in a locked facility? Placed in ‘some kind of housing’?”
Yes and yes. Depending on diagnosis. Often both, in turn. You graduate from locked facility to housing. I assume this is common even in California, though, but that it’s a matter of resources?
“can they leave? What if they do leave?”
Yes. As soon as possible (often not soon enough) you get your own apartment, and you’re free to come and go as you wish. Though you don’t get housing unless you’re reasonably safe to allow out into society as an outpatient, and likely to stay. If you leave, with no place to go, and it’s a problem, you’ll probably be identified and helped soon enough, as there’s no big haystack of homeless people for a needle to hide in. Bad things happen, but it’s unusual enough that it seems to spark debate every time.
“Get a job … With whom?” There are protected businesses that exist for this purpose. Bicycle repair shops, fulfillment, simple food prep, light manual labor, etc. Often (not always) businesses that wouldn’t otherwise make sense in a high-cost country like Norway if they were purely profit-driven (e.g. gift-wrapping services) and typically offering jobs that don’t require a lot of customer interaction. Wages and/or other aspects of the business are subsidized, prices are competitive, and customers understand that they may sacrifice some efficiency and sophistication for price and social benefit. These businesses take crises and low productivity in stride (and are rigged to handle it), and no enforcement is necessary.
Because of the scale and nature of the issue in California, the way the culture and economy and politics work, the role of drugs and the criminal justice system, etc, etc, I don’t think California could or should copy that system if they wanted to. And even if they did, it would take a long time, a lot of money, and they’d find it wasn’t perfect.
However, I’m not fond of “it can’t be done” rhetoric, which is very common among experts who know how it’s always been done. (For the same reason, I wanted to ask your clinic director if it wouldn’t be possible to overbook, taking no-shows into account when scheduling, and use good communication and positive incentives, rather than blaming and punishing the patients for the bad finances?)
The older I get, the more often I think “there are no solutions, just tradeoffs”. However, there are usually tradeoffs to be made – especially if you’re willing and able to fiddle with many variables at once, to break out of some local optimum.
I think the general pathway for psychotic homeless people is to get sent to an inpatient ward (which is reasonably secure) a few times, then end up in a CCU (which is probably vaguely secure in that you have to ask the nurses to let you out) and enter SRA (which is not at all secure but someone will notice if you disappear) if they seem stable. If they leave, someone will put a small amount of effort into finding them, and then they'll stay in secure accommodation longer next time. My brother worked night shifts in a SRA house as a disability carer while he was in university and the most traumatic thing that happened was a morbidly obese resident rolling onto and bursting a colostomy bag, so I don't think they're terrible places. I am not sure whether they're cost effective.
California must have inpatient care and forensic mental health. Perhaps it's missing long-stay residential services and supported accommodation in the middle, or missing the ability to send people to those services, or missing government funding for enough beds? Or more probably I'm misunderstanding the system and patients just aren't getting sent to those services for legal or procedural reasons.
Well, I think Sergei is more correct than you think: "paternalism" includes not just "XXX provides you with the resources you need" but also "you must obey XXX in using those resources". It's the opposite of libertarianism.
Saying Psychiatrists regularly commit people on “vibes” doesn’t say much for the profession of psychiatry and degrades the credibility of the writer who is implicitly using his status as a psychiatrist to bolster his case.
“Hey listen to me I’m a psychiatrist…an expert…, but my expertise is basically vibes and you shouldn’t trust psychiatrists’ judgment…except for this article of course”
I didn't say psychiatrists' expertise or judgment was vibes. I said that the commitment process was based on vibes (ie judgment-related factors) rather than a simple clear legal algorithm.
Although I think the track record of psychiatrists in predicting objective outcomes (suicide, homicide, etc) is in fact pretty bad. My impression is that psychiatrists shouldn't claim to be able to predict these things beyond common sense, and mostly don't. The expertise they claim is in knowing how to treat mental illness.
So then one solution to your query is for psychiatrists (or others) to develop better predictive criteria
My question is whether that is hard because
1. It’s inherently a difficult prediction
2. The field of psychiatry doesn’t have the interest or the training to develop quantitative predictive models…they like treating patients… not predicting murder
3. Both
While I accept #1 to a point…I’ve encountered people who have committed violent crimes and there were indicators …so I have trouble believing it’s a crap shoot also
It's 1 - or at least, I sometimes see smart people try to make statistically sophisticated predictors and publish papers which, if you read between the lines, show they've failed pretty badly.
Don't get me wrong - you can easily predict that poor mentally ill people with a past criminal history will commit more crimes. You just can't pick out which ones or when more than common sense would allow.
From the your comments, it seems like more shelters solves so much of the problem that it becomes a qualitatively different problem. Why not put that front and center in the main article?
What will the rules be on the shelter? Will it allow smoking? Drug use? Having visitors at night? Can people come and go at all hours? Can you store possessions there?
No smoking - no drugs - 10 pm curfew - you get one locker - if you stay on the street instead of going here you go to jail. If you're good you can get a 4x7 foot dorm (shared bathroom tho)
Done. Easy. At least as a Step 1 - we can iterate as we go.
The problem is not that this wouldn't work, but is unimplementable. (Moreover, *any* solution is unimplementable because for some reason a plurality(?) of the population wants this "anarcho-tyranny-via-homeless-schizos" status quo so we're at a loss)
Keep building more shelters, each with slightly different (but clearly posted) rulesets, until demand is saturated. Collect data on success rates, complaints, etc.
If a shelter isn't nice enough, then people will choose to live on the street instead.
And it's too nice, then people who are currently just barely paying the rent on their crappy apartment will decide it makes a lot more sense to become homeless so they can live in the shelter instead... so they can spend their rent money on drugs instead.
When a crime is commited, make them wear a GPS tracker which they are not allowed to remove. Now, the social workers can follow them around for continuous administration of meds.
This is only a semi-serious proposal.
But it's at least less draconian than: "lock them all up" ....
"Stealing a GPS tracker monitored by someone with law enforcement on speed dial" is somewhat saner than "stealing live power lines", but only somewhat.
And yet where I live power line theft is a frequent issue. GPS trackers also don't seem to deter car thieves, so obviously there are ways to jam the signal and then disable the units.
Are the people stealing power lines stealing them while they're live, though? Stealing power lines with the power off is significantly less insane.
What I'm getting at is that if any disruption to the GPS signal results in an immediate scream to law enforcement, you'd better have a hell of a getaway car ready in order to pull that off and not get immediately arrested (jamming won't help if the "oh shit" detector is upstream of the tracker, because the jamming will itself result in the scream). RL isn't quite up to the level of that Star Trek episode where a guy breaks his tracking anklet and two seconds later Starfleet beams in with phasers at the ready, but you're still talking minutes if this is prioritised.
Well, I mean, yeah, I did call it insane (I read a bunch of Darwin Awards about this, although I think the curator said she wasn't accepting new ones as fried copper thieves were getting boring).
But TTBOMK those dumb enough to try it don't usually get far enough to get paid, so a "thriving market" still doesn't happen (well, in this case the stolen-scrap-metal market does, but only because there are non-power-line sources of stolen scrap metal - old copper phone lines, copper pipes, and so on, and that's just copper).
This is maybe true in a world where GPS trackers are monitored constantly, removal is prioritized, and consequences are severe, but that's not the world we live in, unfortunately.
People remove GPS trackers all the time. Or sometimes they just leave them on while they go murder people, and that's not noticed until the following Monday because the courts don't observe the monitors on nights or weekends. Obviously this could change, but that's the current state of affairs.
Yeah, my impression is that in our ancient humanocentric era, trackers are mostly useful for people who have successfully bargained with the legal system for more freedom, and thus they have a personal incentive not to mess with the tracker in case it gets found out and the freedom is revoked.
Of course, in the upcoming AI-centric era, our overlords won't have these mere flesh-and-blood limitations.
There is a “NIMBY” angle to this. My European city has a problem with homelessness. I once helped in the day shelter, only to speak and provide soup to homeless from Spain and Romania. They had specifically come to the Netherlands for the better homeless facilities. Makes you kind of hesitant about providing more facilities..
I remember interviewing homeless people, social workers and others when I lived in San Francisco a long time ago, and I heard a lot of reasons why people came to California – including a version of this one about homeless facilities.
A lot of people – especially outsiders, starving artists, LGBT+ not accepted in their own town, people who frequently use and romanticize drugs, anachronistic hippies/beatniks/hobos/hipsters etc. – have a very romantic vision of California. Many of those are probably high-risk for severe mental illness, too, without going into reasons. The Netherlands, particularly Amsterdam, has a similar image in Europe, I think.
In California’s case, however, I heard a rumor that towns and counties across the States (unofficially) dealt with homeless and other “undesirable” people by buying them a one-way ticket to SF or LA, with the promise of a better climate, better social services (at least then), and general California Dreaming. I didn’t confirm it, and am agnostic about it, but I’ve been to some small towns that I could believe that of.
If you’re a place that has a reputation as a good place to be homeless, and if other places nudge (or push) their homeless in your direction, I don’t know that it’s possible to build and staff shelters fast enough, but that’s where I’d invest my first two cents. (But also, physical paper prescriptions, strict appointment hours w/ no-show fines, the insurance system, etc. seems old-fashioned, counterproductive, and designed to fail.)
After reading you, I am surprised by the apparent size and intractability of this problem in the US. I'm European, and extremely critical with almost everything we do (or rather, *don't* do), but we don't seem to have this issue here (perhaps it is the greater social safety net? Definitely not us being good at making housing available). Perhaps there's something to be studied here?
Despite all of Europe's problems with housing, it's still much better at housing than the US is (speaking in broad generalities of course). I can get a nice apartment in Paris for cheaper than a bad apartment in a second tier city in the US. Part of this is that average salaries in Europe are lower, but *entry-level salaries* in Europe are often the same or higher, and that's what's relevant for people at risk of homelessness.
Why are antipsychotic drugs even controlled? It feels like a lot of this could be improved if instead of jumping through doctor hoops to get ahold of them, you could just roll on down to the drugstore and fork over five bucks for a ten-pack.
Are they addictive? Are they societally dangerous in the way that unnecessary use of antibiotics theoretically is?
No. Most medications with side effects are controlled because that's how the government works. Antipsychotics have lots of side effects, including a few particularly nasty ones like giving you permanent tics that will never go away if you take too high a dose for too long.
They have a sedative effect, don't they? Do they have the potential to be used for date rape (as benzos notoriously do), or to keep sex slaves under control? Either would pose at least some issues with fully opening the floodgates.
The issue is the *chronically* homeless camping out in maximally public areas, like around subway stops. Option 1 is to fund a few asylums in big cities, and put the chronically homeless in there for long periods. Option 2 is to give police officers cattle-prods and task them with zapping any highly public homeless, so at least they'll learn to hide in a back-alley or in a hole or something.
I'm only half-joking, by the way. Liberals will say it's utterly inhumane to do things like this but most peoples' willingness to vote for liberal politicians goes down a bit every time they see the homeless. By letting a very small number of people dominate the image of big cities causes severely disproportionate backlash over the long term.
1. Build the mental institutions. Make them reasonably nice, nicer than prison at least, but cheap enough to actually get built.
2. Send mentally ill people *who are convicted of crimes* there instead of sending them to prison. Doctors can recommend people go there voluntarily perhaps, but involuntary commitment is for people who would be involuntarily incarcerated anyway.
3. Incrementally increase sentence lengths for repeat offenders. Rather than have the same person alternate in and out every 3 months because they keep failing to take their meds and commit petty crimes, you identify that this person cannot function in normal society and you let them stay there nearly indefinitely. Maybe the nth sentence is n times longer than it would be for an ordinary jail sentence, or maybe some more mathematically smooth function that took into account severity for preceding crimes too, but something like that.
Some people might describe this as "cruel and draconian", but whether it is or not depends on how nice the facilities end up being. It would probably cost more than just housing said homeless people, but the point is that only mentally ill criminals who can't function even with free housing would end up here. Or maybe if it's too nice then you incentivize homeless people to commit crimes in order to get here (or circumvent that by just letting them voluntarily commit themselves). There are some kinks to work out. But we're already paying to house a lot of these people in jail, so I'm not sure there's that much difference economically.
The signing of this law (https://en.m.wikipedia.org/wiki/Lanterman–Petris–Short_Act) by Reagan and a suite of other laws in the 60s gutted the states ability to confine people long term in the manner that you suggest. Addressing this would be a good place to start for the solutions that you propose.
I think there's a lapse where we put people in jail for homelessness even though they would only be homeless for a week, since the people "who could only be homeless for a week" and "disruptive homeless who commit crimes" is a venn diagram with very little overlap. So you can be cruel and draconian to the latter, and that's fine with me.
Another thing is that the local solution works for most people. You just need to make sure you are somewhat less not-cruel than some non-trivial subset of other places. Even within the subset of nearby places with lots of bleeding-hearts, some (e.g. Palo Alto or Redmond!) are not as not-cruel as others (e.g. San Francisco or Seattle!). You cannot really call the former cruel, but the problem concentrates much more in the latter.
You don't have to worry about "not being nice doesn't work cause if everyone does it...". Sure, it doesn't work in abstract, but in the real world there'd always be plenty of idiots who would then get what they deserve.
I don't understand your last sentence, or what you mean by "the local solution works for most people", but it sounds like you're describing a race-to-the-bottom of cruelty? If every place has to be more cruel than its neighbors, then if SF becomes more cruel than Palo Alto, Palo Alto will become more cruel to keep up, and so on
I think the point is that you don't need to race to the bottom because SF is all the way up at the top, so you can stay one step from the top and still have all the psychotic homeless go to SF.
Of course, this doesn't work for SF, but SF hasn't participated in the race to the bottom for 50 years and it shows no sign of starting now.
What Richard said... I put it in a less charitable and more general form - for any problem where the solution for one actor is "don't be dumb" but it won't work if everyone follows it, the solution /would/ work in practice, because there's no shortage of dumb people in the world ;)
The point is that there will be some place that will not have the resources to expel the homeless, and the homeless will all be driven there, where they can safely be forgotten by society.
A lot of the solution to the social work side of- and to similar welfare policy problems- is:
1. Building more houses, as others have noted.
2. Putting serious money into a simple, streamlined bureaucracy that gives support and money to people. No more "wonder not-for-profits" with shiny brochures. No more debt relief for Pell grant recipients who work for five years in underserved communities on days that start with a T. No more complicated programs designed by well intentioned over-woke shiny eyed do-gooders. Uncomplicated, generous distribution of welfare.
Support includes, in this context most notably and in addition to financial support:
A lot of the reason America doesn't do this is because Americans have convinced themselves that government fails so much that they've let their own state capacity atrophy, and developed the frankly insane belief that NGO's and private companies can handle areas like this with less graft and corruption. The incentive compatibility problems alone boggle the mind.
Thanks for articulating this. I could never really put my finger on it, but my impression of so many things related to “spending for social good” in the US come in the form of fractured individual providers and solutions, be it health care, student loans, homeless services or what have you.
I still don’t really know how to explain it, but your description with the shiny brochures somehow captures my sense well.
I think of the NGOs as the progressive left's answer to the more standard privatization thing, where the cronies of the governor get a sweet deal on some state asset that's being privatized.
> So when people say “we should do something about mentally ill homeless people”, I naturally tend towards thinking this is meaningless unless you specify what you want to do - something most of these people never get to.
I disagree. It's a coordination mechanism for gathering support for a type of policy proposal. Actually working out the details of the policy proposal should probably be left to people with a better understanding of dynamics of the current problem (such as perhaps you). But the general statement should be interpreted as "I think that it is bad that we let homeless people slowly die on our streets, and there appear to be a sizable group of homeless people who would not significantly benefit from simply giving them housing (because they would refuse it or destroy it or simply die slowly in it), and we should collectively come up with a better solution for that group".
I understand that you're probably reacting to articles proposing simplistic solutions or suggesting that the root problem is merely that the Outgroup Tribe has political power. Those aren't particularly helpful. But there are still people who deny that there's any problem, or who deny that there's any problem that can't be solved by building more housing, and those people present an obstacle to experimentation that might let us develop a better way. Coordinating against them is a first step.
I think the number of people in SF/Berkeley/Oakland who deny that there's any problem is quite small. You can't do anything in those places without being directly accosted by the problem.
I don't think it's mostly those people, specifically, I think most of the impetus comes from people who don't see it themselves. But even among the group you mention, I suspect a number of them have either acclimated to the problem, or have succumbed to social pressure to pretend that the problem isn't as bad as they think.
It is a coordination mechanism in the sense that politics where people yell out random issues is a coordination mechanism. A poor one compared to trying to increase the average understanding of the challenges and potential solutions. For every article about a complex topic, that actually proposes any decent plan at all, there's what feels like a thousand that have only heat (your ''coordination mechanism''). And that's not even getting to that an *actually* adequate article would essentially be a series of planning proposals of different ways to resolve homelessness.
Of course, we don't expect people to read that much, but we barely even expect them to read a basic article about a topic before saying they have a strong opinion.
I get the idea you're talking about, but as far as it is a coordination mechanism it is a poor one with lots of side effects to the overall sanity level of society. They refer to the problem but it is already known as a problem — potentially it needs to be emphasized! But honestly that is rarely the issue. Both political parties think there's issues with homelessness, they just don't have the competency to propose a whole-hearted solution or the ability to agree on methodology.
There's definitely areas where this sort of weak coordination scheme was beneficial, like getting worried about pollution. However it quickly drives oxygen out of the room, making so reasonable discussions about planning are choked out.
I'm not saying heat is a coordination mechanism! That's not at all what I'm talking about, and for most of his post, and most of the arguments he makes, that's not what Scott is talking about either.
This is specifically about people saying "I notice this problem but I don't have any ideas for a solution". I maintain that there is nothing wrong with that.
If you think there's something wrong with people saying "I notice this problem and the reason we don't have a solution is the other party are all Nazis", then we agree. And finally I would further maintain that the problem with that is obvious and has nothing to do with not proposing a solution.
I do think that a lot of people's way of talking about topics saying "I notice X issue" is just a minor form of heat. Yes, it isn't anywhere as bad as "I notice X issue and the other people are evil because Y", but it still has the problems of driving out talking about solutions. Especially in carefully considering solutions that have notable trade-offs, I think that when you have a large amount of people *saying* "X is bad" rather than just a general acknowledgement that "X is bad", you have problems.
> This is specifically about people saying "I notice this problem but I don't have any ideas for a solution". I maintain that there is nothing wrong with that.
I also think this is mildly uncommon, or even when this is what is literally said there's the implicit bounds on what they think are acceptable. Having people be.. I don't feel like I have a good word for this.. worked up? The problem is not caring, caring is good, but rather posting about it a lot. Keeping it in mind as part of the background Problems. That sort of thing makes it harder for anyone to make a significant proposal, as it makes the proposal more likely to have heaps of positive and negative attention. Negative attention tends to win out, carving at the rough edges but not necessarily in good ways, but positive attention also makes it harder to maintain self-awareness. If people understood the problems better, then the negative attention would be focused on parts that actually need fixing.
So I think a decent summarization of my complaint is that a lot of people talking about an issue makes it harder for those who actually pay attention to the issue to get anywhere. The attention from so many people makes proposals weaker and harder to produce solutions that are not obvious from the typical commenter's perspective, because that under-educated/under-specialized attention onto the issue weakens it.
I agree it is a coordination scheme and just going "everyone silence" would have its own undesirably large side-effects, but I'm very skeptical of its quality as a way to coordinate and of the side-effects it has on society.
Has anyone read How Big Things Get Done by Bent Flyvbjerg, or The Fifth Risk by Michael Lewis? HBTGD outlines a process for making complex problems simpler (plan slow, act fast). It identifies political risk as a source of compromise against interests. TFR took a look at the disruption that came from the 2016 POTUS transition. These books identify successful projects as well as the blunders (consistent with the problems in your post). The pattern in your example compounds 2 significant problems and touch-points across psychology, pharmacy, policing, crime/law and admin in transport, health and housing. It might be reasonable to expect project management risk in coming up with a solution that caters to each of these elements of the risk profile. I wonder if there are elements of ideas in this thread (eg: using the social impact bond model that @BENTHAMSBULLDOG is describing) with the iterative process that Flyvbjerg outlines. That might be casework patterns that are aimed at supporting homeless people who struggle with mental illness into stable accommodation. If the casework is paused because of people not getting the approval for a free subway pass, then the data collection point that could prompt the caseworker to meet the person with the travel pass before the appointment might remove one of the disruptions from the cycle you have outlined. Small interventions may produce data that allow the social impact to be framed in a way that supports the commercial risk taking that could incentivise risk taking as part of a solution. Flyvbjerg's book has many of examples showing how big complicated projects or problems are broken into smaller components, and then solutions are planned and refined in testing and iteration. Lewis' book shows how these grand efforts fall off the rails without management and with the pressure of political risk. Maybe those who are saying that there is a problem, are willing contributors to an aspect of a solution. Calling for a perfectly designed policy solution, without the iteration might exclude the meaningful engagement that could be provided if it were possible to coordinate the interaction with those people who may have an element of insight. Maybe a small part of a solution could be a rent arrears database which health care providers could access. The access could form part of a risk assessment which might give the health care worker an indication of whether a person may be facing homelessness and could offer intervention resources (I accept that these may not be readily available). This wouldn't help those who are already homeless, but it might a data insight to help address an at-risk-of-homelessness segment of this group.
To the extent the issue is keeping apointments, can we just get rid of appointments?
Like in places with free soup kitchens people go to to eat, can the social workers just hang out in the soup kitchens and meet with them there?
Also can the social workers be given copies of the perescriptions so they can refefel then for the paitents.
Or, if that doesnt work can there be a database of persriptions associated with images and names, so that pharmasits can look up the person's name in the database, see that the image matches how the person looks and give them the medication, even if they lose the perscription?
yeah I'm a little confused by this concept of "losing the prescription" - in my experience, when I get prescriptions they are digitally sent to the pharmacy, and I go to the CVS or Walgreens or whatever that it was sent to and give them my name and date of birth and they pull it up. If it's a controlled substance I do have to show ID but I assume the people Scott is describing do too.
I'm not homeless or in poverty, but I don't see why this would be a matter of privilege - why can't the doctors who work with homeless people also call the prescription directly into the pharmacy?
I thought Scott just meant they lost the actual bottle of pills after filling said prescription, hence the insurance company complaining about the cost.
- Step 3 becomes "Psychiatrist assesses whether patient is capable of living an independent functional life, and prepares report for the court".
- Step 4 becomes "Court holds a hearing to determine if a patient is indeed incapable of independent functional living, relying heavily on the psychiatrist's report".
- Step 5 becomes "If the court finds that the patient is incapable of independent functional living, it designates a family member (if one exists) as the patient's guardian, and they are now responsible for keeping him/her fed, housed, medicated, etc. This does not need to be voluntary. Guardians get wide latitude in terms of how they go about it, but extreme abuse/neglect is criminalised.
- The patient's carer gets paid a reasonably generous state-funded stipend to support them in taking care of the patient.
- Patients who do not have any family (or whose family are themselves incapable) get put in state-owned housing with state-paid social workers filling the role of guardians. But this is a last resort, and even a distant cousin counts as "family" if that's all that can be found.
- Patients who later recover to a point of being able to live independently and functionally can apply to the court to have their guardianship removed.
- Also make it so developers do not have to apply for permission before building (they still have to comply with building codes and regulations and can be inspected/audited to ensure they are), so houses are cheaper.
Why require designating a family member? Being a caretaker of a violent schizophrenic is a lot of incredibly draining work. I don't see why having the bad luck of being related to such a person should result in you having to care for them, especially if it's a distant cousin.
Because family should look out for family. And because other solutions are not working well. My country (Australia) has gone down the route of having a massive new disability insurance scheme that is ballooning in cost and is spending huge amounts - sometimes over a million per year for one person to house violent schizophrenics independently and have social workers come help them with their needs (in groups of at least two for safety reasons). And it's just not sustainable.
So I am not allowed to be estranged from family? What is the definition of "family"? What if the only family lives on the other side of the country or in a different country?
What kind of question is "what is the definition of family?" I already specified that it would extend to include distant cousins. I don't believe that's an insufficient level of detail for you to decide if you do or don't like the idea.
Courts would be able to take account of all circumstances when designating a guardian, so if there is some particular reason why it's just not workable for you to take care of your relative then you can explain that to the judge and he can give responsibility to another family member or, ultimately, to the state if no one suitable can be found.
That said I would not envision living on the other side of the country as a sufficiently good reason to refuse guardianship. We're talking about homeless people, by definition they have no fixed address.
I would indeed prefer to have qualified professionals who opted in to their field taking care of these people en masse than to foist them on their family members who may or may not do the job very well at all.
Having family do it doesn't magically make it take fewer resources, and in fact it probably takes more because there's no economy of scale benefits. The resources are just being spent by families directly rather than taxpayer dollars.
On the contrary, having the government do it absolutely does require more resources. Most things the government does end up being very costly, and disability support is no exception. Sometimes that's worth it if it's something that only the government can effectively do, but if you can find a different solution you should.
It's nice to think that economies of scale would reduce costs but it's not true in practice. My wife does the finances for a mental health disability support provider and the money spent is staggering. And at the same time the providers are constantly on the edge of bankruptcy, and the clients are not experiencing an enviable standard of living (though obviously better than homelessness). You'd save money and probably get better client outcomes by paying a family member $100k/year to look after their own relative.
The cost of the NDIS is getting completely out of control. It will soon cost more than the age pension. And we still have homeless people! Not as many as America, but given the cost of our approach the fact that it is only a partial solution is pretty grim.
I think it does need to be voluntary, though. I am not going to be happy if my psychotic cousin from out of state, who I met five times in my life at reunions, is suddenly *my* problem
I like a lot of aspects of your proposal, though. I suppose what it looks like in practice is drastically increasing the "carer's allowance" that people are entitled to through Centrelink, in recognition of the fact that close family members are often better in lots of ways at caring for their disabled relative than the state
The snag is if a homeless person is acting crazy, then once they are hauled in and kept in a police cell or a psych ward for a while they may recover, like a drunk sobering up under similar confinement. So to a psychiatrist tasked with assessing them, it must sometimes feel like having to open a fridge door to see if the light is on!
There are many places on Earth that have substantially lower density of homeless psychotic people than downtown San Francisco. Actually, any city I have been to, across dozens of countries, has a lower one. There must be a reason for this and I genuinely do not know what that is Theoretically, I can think of the following explanations. 1) The rest of the world has a lower underlying rate of mental illness, by an order of magnitude. If that is the case, then this is the root cause and that is what you should be at least discussing if not addressing. 2) The rest of the world has displaced their mentally ill to San Francisco. This might work for Berkeley or even Austin, but I do not see this as a plausible mechanism for e.g. London, UK and for most other places. 3) They are solving this problem in some ways.
That means that a San Francisco lay person can reasonably write "damn liberals are soft on mentally ill and are not doing whatever literally every other city on Earth does with a small fraction of resources available in SF".
It also means that a San Francisco expert on mentally ill people has an alternative option to admitting that nothing can be done other than tinkering around the edges of their current clearly defunct system - just look what some other places are doing and try to think which of these solutions would work best in SF?
It's certainly *mathematically* possible San Francisco is not doing anything wrong: if in the UK, homeless people are handled locally and in the US they're all sent to San Francisco, San Francisco will have an incidence of homelessness 300x the UK national average and 300x less resources per capita to deal with the problem.
If somehow nobody is shipping homeless to Austin or Zurich or London or Madrid then maybe San Francisco did something wrong to be the place where everyone sends their homeless?
It certainly could be that San Francisco is doing something uniquely wrong. Other explanations could be:
- SF has the best weather in the United States to be homeless
- in other nations exporting homeless people is politically toxic
- in other nations national programs obviate the need to export the homeless
- other cities are extremely cruel to homeless people and so the homeless go to SF
- SF is really nice to homeless people and so the homeless go to SF
Only one of these is plausibly SF's fault. Nobody denies that SF is probably doing something wrong. But your original post is framed this way: "SF has way more homeless people, therefore, it *is* fucking up in some way all the other cities in the world do not." If the argument gets watered down to "SF could be doing something wrong" then, well, sure. But at that point it's much better to figure out what the wrong thing instead of relying on the argument.
1) not true, many places have the same weather, but not this problem
4) this is self contradictory, if something exists everywhere except for one city, it isn't extreme by definition
2) and 3) may be true, but I do not know how large organised homeless export to SF is relatively to the stock of SF homeless and homeless export in other directions. Do you have any data on that?
I don't - I'm not an expert - but neither are you, and you're the one saying that "SF has way more homeless people than other cities => mathematically, SF therefore must be doing something wrong." That's the entire argument you've made. I'm not going to try and do a process of elimination on every other possible alternative explanation to rescue your argument for you.
I do not use the word "mathematically" lightly and I did not use it here. In any case, I appreciate there may be a set of unique and implausible circumstances that make SF such a unique magnet for homeless and/or crazy people and that can not be influenced by that administration.
Most of those points, while theoretically plausible, are factually untrue and just go to show that SF *is* actively doing something wrong, on top of whatever the state of California is doing wrong. (Comparing it to other states with very different weather is probably unfair.)
Maybe it's partly the ratio of the population of the country to the population of the city? London is the biggest city in Britain (by far), but SF isn't even in the USA's top 10 (by some counts, anyway).
I think some of it is also a product of time. The "housing first" people have one thing right, in that one of the pipelines into being one of the "visible problem homeless" is spending too much time as one of the "invisible good homeless". Perhaps we've let our safety net decay for so long that we've had a greater proportion of people move from the good category to the bad one, while other countries may have had better ways of dealing with the good category, thus reducing their future numbers of the bad category.
And climate aside, I think a lot of it is the combination of wealth and leftiness in SF. The combination of those two things implies: a) good odds of handouts, b) funded social services, and leftiness implies c) permissive legal environments, but also wealth implies d) high property values. Thus, homeless accumulate in places with high property values, but not through the obvious causal connection.
Unusually for Scott's posts, he doesn't link to any of the pieces he's responding to, so it's a little hard to say how fair he's being. The most recent piece I've seen is Freddie Deboer's (https://freddiedeboer.substack.com/p/well-i-dont-know-about-this-involuntary), which doesn't seem so much like a "we should do something" argument as a "ideological opposition to involuntary institutionalization is foolish" article. And it does seem like he has a point: solving the problems with involuntary institutionalization, problems Scott thoroughly details, is going to be hard enough *without* a widespread belief among young progressives that these problems shouldn't even be solved because the project is wrong to begin with. I'm curious to know if Scott has a position on the moral merits there, or if he thinks it's pretty much irrelevant as long as the practical problems are so daunting.
I think they should at least be given an implant with antipsychotic drugs before being discharged. That should keep them from being psychotic for the next year.
> If your plan is something else that will solve everything with no tradeoffs, then you owe it to your readers to explain what that is.
How about this modest little proposal: free government-provided fentanyl, as much as you want, whenever you want, no strings attached. Fentanyl is super-cheap to make, or so I hear, so I'm sure it'd cost less than what we're currently spending on the homeless problem. There'd be a certain "adjustment period" at first, but I think we'd rapidly reach a new equilibrium with much less bother all around. Plus, it might put a lot of drug dealers out of business, so it's really killing two birds with one stone, as it were!
In addition to the obvious ethical concerns, most of the people who have become addicted to opioids in the US during the "opioid crisis" are neither homeless nor psychotic. This would hit those people at least as hard.
The point of this article seems to be to emphasize the intractability of the homelessness situation, which it does a great job of, but I still wonder if it would be prudent to not emphasize mental illness so much. Could it be that drug use, not mental illness, is the key factor? Would stricter drug laws help alleviate these issues? Repeat for housing access, etc, etc. To believe that mental illness is the key factor in homelessness, wouldn’t you have to accept that cities with unusually high rates of homelessness also have higher rates of mental illness to others. I would guess that this is probably not true.
What about Fairweather Lodges? (https://en.wikipedia.org/wiki/Fairweather_Lodge). Psychologist who invented and tried out the idea wrote a book about it and how surprisingly successful it was. Tried to interest hospital administrators in the idea -- sent them a description of his program and its results, offered to do pretty much anything, including come to their area and spend as long as needed, at no charge, to help the hospital set up a trial program. Nobody was interested. I, like anyone else, find it hard to believe that a household of homeless people with no staff in residence could work, but I don't think Fairweather was lying.
I can't imagine this being solved without a truly enormous investment, like, Manhattan Project plus some, into mental health support at every level of acuity:
- for the most severe cases or people who are incorrigibly violent, permanent institutionalization
- for people who simply do not take their meds, assisted living complete with nurses making sure people take their medication (under the threat of permanent institutionalization)
- for people who actually take their meds until life happens, Free Houses (TM), or, at the very least, free meal tickets redeemable at centers where they can also be followed up and provided their medication so they don't just disappear from the system.
The price tag on this would be enormous, like, actual whole percentage points of GDP at the national level or whatever polity is trying to implement it. I don't think any polity would be willing to pay for it.
Do other countries require Manhattan Project levels of investment to deal with it? Even within the US, poorer red states have fewer homeless people (to a significant extent because housing is cheaper because it's easier to build).
Society already houses the mentally ill, in prisons and jails. Involuntary commitment takes place in the form of prison sentences.. Maybe it would make sense to try to return to the old standard pre-1950's and try to operate dedicated asylums again.
It relates to a problem I see in the criminal justice quite often. What should you do with someone who punches a stranger every couple of years?
I see quite a few people like this, they clearly aren't mentally healthy and they aren't dangerous criminals. It would be Draconian to give them life imprisonment the 4th time they punch someone but I am also not sure you can let someone be free if you think there is an 80% chance they will punch a shop assistant in the three years after their punishment.
How many random people do you get to beat up before we stop letting you do it? As I get older and less able to respond effectively to an assault by a crazy guy or just a thug who likes hurting people, I find that I prefer a smaller number of people we let you hurt before we decide that the best place for you in our society is inside a cage with the door locked.
Isn’t the usual story that there was a large “deinstitutionization” effort during the Reagan administration that led to a large increase in homelessness? If that’s right then it seems strange to say that there’s no feasible way of keeping large numbers of people institutionalized longer. Where were they all in the 1980s? Granted that was a few years ago so maybe the capacity has eroded, but it seems like if we managed to do it then then it’s surprising to hear it would be so radically unworkable now.
It happened around the time chlorpromazine was discovered - the first antipsychotic. Prior to that, schizophrenia or "insanity" meant you lived in an institution for the rest of your life, plus or minus a few wild therapies like giving you insulin until you passed out, deliberately infecting you with malaria, or a frontal lobotomy. (And electroshock, but this is actually somewhat effective and still used today in some recalcitrant cases)
Definitely. Effective medications are a big part of the reason that deinstitutionalization wasn't worse. And it makes me wonder if intensive therapy in a residential setting, a 21st century asylum, is perhaps viable from a resource consumption perspective.
I don't think it was Reagan; he may have finished it, but I'd thought it started as a left-wing movement after some horror stories about asylums got publicized.
This is largely true. People point to Reagan largely because he passed the strictest laws at the national level to force de-institutionalization, but the process started much earlier in individual states (and other countries also deinstitutionalized!) The movement was sort of like modern criminal justice reform in that it was largely grounded in left wing ideology, but the immediate cost savings appealed to conservatives who pushed it through.
However I would point out that early deinstitutionalization was actually pretty successful because there were a lot of people in institutions that really should have been managed in the community. Each round of deinstitutionalization this became less true. By the time Reagan made it so that almost nobody could be institutionalized, all the low-hanging fruit had been picked and the only people released were people who really should not have been.
> Most (?) homeless people are only homeless for a few weeks, and 80% of homeless people are homeless for less than a year.
I worried about this statistic, too, because it's difficult to know exactly what they mean by "most" when counting people who are only homeless for a few weeks. Do they mean anyone who was homeless at any time during a year, or a decade?
> On a single night in January 2023: There were 143,105 homeless individuals with chronic patterns of homelessness. That is nearly 22 percent of the total population of homeless individuals.
So, what's "total" and what's "chronic"? But they had a link to their source:
> On a single night in 2023, roughly 653,100 people – or about 20 of every 10,000 people in the United States – were experiencing homelessness. Six in ten people were experiencing sheltered homelessness—that is, in an emergency shelter (ES), transitional housing (TH), or safe haven (SH) program—while the remaining four in ten were experiencing unsheltered homelessness in places not meant for human habitation.
> About one-third (31%) of all individuals experiencing homelessness reported having experienced chronic patterns of homelessness, or 143,105 people. This is the highest number of individuals experiencing chronic patterns of homelessness counted in the PIT count since these data were frst reported in 2007. Two-thirds of individuals experiencing chronic patterns of homelessness, or almost 93,000 people, were counted in unsheltered locations. This is also the highest number recorded.
So I don't know where that "80%" or "nearly 22%" came from. 143105/653100 is 21.9%, but why didn't they just say so? I suppose the second article did the math and rounded, and then Scott rounded again, but why is the original article's math different? There's a definition:
> Individual Experiencing Chronic Homelessness refers to an individual with a disability who has been continuously experiencing homelessness for one year or more, or has experienced at least four episodes of homelessness in the last three years where the combined length of time experiencing homelessness on those occasions is at least 12 months.
But that "with a disability" has to be a mistake, right? Either they're defining the wrong term, or used the wrong definition. (Or the entire thing is compromised.) And it still doesn't actually define "chronic"; I wonder if they just asked people "would you say you are experiencing chronic patterns of homelessness" and recorded the answer.
Here's some tidbits:
> Nearly half of individuals who experienced chronic patterns of homelessness in the United States were in California (47% or 67,510 people). California accounts for nearly six in ten of all unsheltered individuals experiencing chronic patterns of homelessness in the United States (57% or 53,169 people).
> Los Angeles had, by far, the largest number of individuals experiencing chronic patterns of homelessness in the country (30,442 people or 21% of the national total). New York City had the second largest number of individuals experiencing chronic patterns of homelessness, 4,548 people (or 3% of the total). In Los Angeles, more than 8 in 10 individuals experiencing chronic patterns of homelessness were found in unsheltered locations, while in New York City, less than one-ffth (18%) are unsheltered.
In Britain, we used to send people away “for a stay in the countryside”, a euphemism for being detained in a mental asylum effectively. Once there getting people to take their anti-psychotics is no problem, and while you describe the detention as draconian and cruel, expecting seriously ill schizophrenics to be able to navigate a modern society seems more cruel to me, and simultaneously imposes their behaviour on the rest of us. There’s a nice summary of the history of the asylums here: https://beyondthepoint.co.uk/a-history-of-mental-asylums/
Overall, this post strikes me like most written by policy experts in that it says, “oh solving X is impossible I assure you”, then disregards the obvious solution because it’s beyond the pale to their sensibilities. In other words - not impossible, I just don’t want to
> Overall, this post strikes me like most written by policy experts in that it says, “oh solving X is impossible I assure you”, then disregards the obvious solution because it’s beyond the pale to their sensibilities. In other words - not impossible, I just don’t want to
Ah, yes, like when you ask someone to take care of a problem like, oh, a sink full of dishes, and they say that, "well, the sponge is due for a cleaning and I should look up the latest discussion of how to do that on reddit, and we don't have the good dish soap only the old stuff which doesn't do quite as good a job, and I might need to toss stuff in the trash and we only have one extra trash bag so I should go to the store first, and I think my right arm muscles are weirdly overdeveloped so I'm going to do all the scrubbing with my left hand, which takes 3 times as long and it's before my bedtime, that is if I'm going to get in an hour of meditation tonight..."
They disreagrd the obvious solutions because they have a vested interest in status quo. People don't give up power, prestige, influence, money, excitement etc if they are not forced to.
Theft is a year of prison? Is that applied? My main source of information about the US is people living in San Francisco so I may be heavily biased here but at least in SF it does not seem like everyone gets arrested.
> “You know what I mean, psychotic homeless people in tents!” Okay, fine, can you make homelessness a crime?
I think the “you know what I mean” would be psychotic people who are a danger to themselves and others, not homeless people. And I would be interested in what commitment would look like for these people could look like - not sure it would be good, but not just prison, new institutions focused on treatment with pathways to release once on anti-psychotics for some period of time?
Anyways, disappointed by this straw man in an otherwise informative post.
As many have said, the real issue people are concerned about isn't those without places to live being present in public spaces per se, it's a small minority engaging in anti-social behavior (whether induced by drug addiction, mental illness or general misanthropy) that make the lives of everyone else around them, and the immediate surrounding environment, significantly worse. There's an overlap between these two groups, but that's incidental. Indeed, punishing homelessness as a proxy for anti-social behavior is unnecessarily cruel when we can just focus on the anti-social behavior.
Most of the people who threaten and harass others, create public nuisance, or physically ruin public spaces, are absolutely identifiable, especially over time. They're repeat offenders. It's ridiculous that we should be constrained from dealing with known perpetrators just because it's impractical to "catch them in the act".
All your points about the impotence of the current system to deal with this are well taken. But I'm not sure why it's so impractical to formally advocate what many urban municipalities do informally - roust anti-social perps away from highly trafficked, desirable areas where they infringe on everyone else's quality of life, to less populated areas where their presence would incur a much smaller social cost. I don't think anyone really believes there's an absolute entitlement to inhabit a specific public space regardless of one's behavior. I'd love to hear the counterargument.
You could say that the differential policing of the Tenderloin neighborhood in San Francisco represents a version of this. Skid Row in LA, etc. The complaint you hear in these cities boils down to how ineffective these "containment" policies are.
Everyone knows there are some parts of a city where anti-social behavior is simply not tolerated, and others places where it's allowed to proliferate with impunity. Thats why smug, fatalistic dismissals of the rising concern around this reek of bullshit and deflection. It's always been a political choice, not an inevitable feature of urban living.
"I asked the clinic director why we had such a punitive policy, and she said that without the policy, patients would miss so many appointments that the clinic couldn’t make money or pay staff."
Could this be fixed by not being so rigid with appointments and overbooking things? Like, let's say 75% of clients miss their appointments. If you book 4 people at the same time, then on average 1 is going to show up. Of course sometimes more than 1 shows up but then maybe you could tell them to wait or tell them to return another time.
Obviously this is far from magically respectful of their time, but at least as an alternative to punitive policies it seems like it might be worth having.
You can be draconian too, and have any homeless people disturbing the peace (begging, screaming etc) whipped (or something more palatable to modern voters - like broken bones or killing them - I suppose) for second offenses, and of course heavy disciplinary action to the person responsible for them
I was a community mental health worker in the UK in the noughties. My employers were supposed to be the carrot, but we ended up being the stick. We would visit people on the NHS mental health books, and “support” them to remain living in their rented accommodation, some of which we owned, and promote independence including employment. Sounds good, right? So why the scare quotes? Well, most of the clients had been referred to us while being detained in hospital, consequently the clients’ issues were skewed towards psychosis. Was that the plan? I never got to the bottom of this. But some features/bugs of the programme made us a bad fit for this client group, regardless. (1) The role required no qualifications - our company emphasised “lived experience” of mental health issues, which in real life meant personal experience of mental health problems up to and including bipolar (but not schizophrenia), or experience as a carer.
(2) Promoting independence & employment - this was not an extra, it was integral to our funding, we had to bid for the tender every few years and provide evidence that we were improving employment outcomes for our clients. This leads me to believe the programme may have been designed for unemployed depressives, but other features don't fit with this e.g…
(3) Our role as landlords - landlords have a “duty of care” to their tenants in common law: providing fire extinguishers and the like. Rightly or wrongly, the company interpreted this very broadly, meaning we had to inspect client properties to ensure they weren't using the flat in a dangerous way e.g leaving the gas on. But we went further still - one client was a hoarder, there were boxes everywhere, and my boss believed this was a fire hazard, so we threatened to evict him and he relapsed. This problem was exacerbated by…
(4) Gender issues - most of our clients were male, but I was the only male member of staff. The hoarder (male) was the tip of the iceberg, but most of our clients’ flats were were in a poor state, albeit not unusual for a single man, sadly, but the bar for “unacceptably messy flat” was set by females, so we had to badger our clients to tidy up, and if they didn't comply…
(5) Relationship with mental health services - we were dependent on the NHS and social services for referrals, therefore we had to show willing by snitching on our clients. Fair enough if the paranoia was flaring up, but as I say “duty of care” was interpreted so widely that we were under pressure from management to report clients who weren't doing the washing up, because this was evidence they were relapsing. Cue more visits from CPNs, Social Workers, etc. To be fair to my managers (why?) even if we had maintained client confidentiality ruthlessly, we had so many written records that only the seal of the confessional would have protected us if a client had ended up in trouble with the law.
I hope by now you can see why I used scare quotes - this “support” was often the exact opposite and made clients no better, or sometimes worse. There were good days - busking with a client on World Mental Health Day was the highlight. But the funding stream was Supporting People and it most definitely didn't do what it said on the tin.
Two takeaways - firstly, this project to the outside world probably looked liberal and wishy washy if you want to lock everyone up, but the popular image of psychosis is what it is, and any “liberal” project is going to be influenced by this as well in real life. Secondly, while I was there David Cameron became PM and The Age of Austerity swept us away - I was sad, but I reflected that a poorly funded state would at least have fewer resources to badger the mentally ill.
Probably a naive question. Why this is not a problem (or at least not to the same extent) in Europe ? I guess there are less cases but if schizophrenia is mostly genetic, shouldn't the cases per capita be similar?
Could drugs like fentanyl be a significant exacerbating factor for mental health problems? Europe seems to have less of this (evidence: according to the Economist Europe only has 10% of the US's drug deaths https://www.economist.com/europe/2023/11/16/fentanyl-kills-thousands-every-year-in-america-will-europe-be-next - sadly paywalled after the first couple of paragraphs, but I couldn't find anything else that got to the point so succinctly, though there are lots of articles worrying that some clown will think of importing fentanyl to Europe).
It should be noted that large scale psychiatric institutions that could hold a significant population existed throughout the 20th century but were abandoned mostly because the damn liberals turned against them. One Flew Over the Cuckoo's Nest and all that.
The only solution is to bring them back in some form maybe like psychiatric halfway houses.
A little from column A, a little from column B. The anti-psychiatry movement, as represented over on this side of the pond by the likes of R.D. Laing, wanted to do away with such institutions and indeed the very notion of "mental illness" which they perceived as a stigma attached by society to those who dared to be different. To be fair, there were also genuine cases of neglect and even abuse in such institutions.
So close down the asylums, let the patients go home, and instead provide 'care in the community'.
This coincided happily with Thatcherite/Reaganomics where such large institutions were often located in spacious grounds and/or prime locations, and the covetous eyes of the "privatise everything and sell off the family silver" types in government fell upon them as being money troves that could be sold off for development.
As for "care in the community"? That never worked out as hoped for by the optimists, and indeed the term became a jokey reference to "that guy is nuts". True, at that time we hadn't achieved the pitch of raving drug-addled people defecating in the streets and living in camps, we just had the "nutter on the bus" to be the stereotype.
Would "Just go back to how it was handled in the 1950s, because despite the well known disadvantages is was still better than the current system" be sufficient details?
There's a great article, against (most of?) the "be draconian" options, "Homelessness and the issue of freedom" by Jeremy Waldron[1]. It's not specifically about the mentally ill, but all homeless. Essentially, he argues that while opposition to draconian treatment of homeless is usually made on left-wing grounds, such as compassion, it is also unconsionable purely on right-wing grounds, that is, on the basis of the value of freedom . It's not just a polemic, but a thorough and clear treatment - he's a philosopher.
His basic argument (and this may be a poor summary) is that freedom is situated - to be free to do something entails there being somewhere that you are free to do it. And that things most of us take for granted - freedom to sleep, urinate etc - are still important freedoms., and depriving people of them is unconsionable:
"Moreover, though we say there is nothing particularly dignified about sleeping or urinating, there is certainly something deeply and inherently undignified about being prevented from doing so. Every torturer knows this: to break the human spirit, focus the mind of the victim through petty restrictions pitilessly imposed on the banal necessities of human life. We should be ashamed that we have allowed our laws of public and private property to reduce a million or more citizens to something approaching this level of degradation."
'Even the most desperately needy are not always paralyzed by want. There are certain things they are physically capable of doing for themselves. Sometimes they find shelter by occupying an empty house or sleeping in a sheltered spot. They gather food from various places, they light a fire to cook it, and they sit down in a park to eat. They may urinate behind bushes and wash their clothes in a fountain. Their physical condition is certainly not comfortable, but they are capable of acting in ways that make things a little more bearable for themselves. Now one question we face as a society – a broad question of justice and social policy – is whether we are willing to tolerate an economic system in which large numbers of people are homeless. Since the answer is evidently, "Yes," the question that remains is whether we are willing to allow those who are in this predicament to act as free agents, looking after their own needs, in public places – the only space available to them. It is a deeply frightening fact about the modem United States that those who have homes and jobs are willing to answer "Yes" to the first question and "No" to the second '
If anyone objects to these quotes, please do read the rest of the article, which deals with possible objections much more clearly than I am likely to be able to.
Declaring something "unconscionable" doesn't get you very far if you don't have any other plan for dealing with the problem. He can be frightened or disturbed all he wants, but other people aren't going to tolerate mentally ill homeless people taking over public property.
I mean, yeah, in the US we pretty-much do tolerate that. People leave for the suburbs or do business with private companies to provide "public" spaces that don't let homeless people sleep in them as a result, but (for example) our local downtown library typically has a dozen homeless guys sleeping in chairs.
So in the olden days there were many fewer mentally I’ll street homeless and also it was easier to keep people involuntarily committed. But also antipsychotics weren’t as good.
It sounds like you’re saying we couldn’t just go back to how it was in the old days because the meds got better, so now people just get all better and it feels unfair to keep them in institutions (but then they go off their meds)?
If you've ever visited Europe you'll probably notice that there are far fewer homeless people on the street, and almost no psychotic homeless people. So clearly for all the problems outlined, there are solutions that work. I'm guessing its some combination of: more spending on community mental institutions, more spending on social workers, free medicals services, less restrictions on forcing people into treatment. But I have no idea. Anybody have any insights?
It is baffling to me that this isn’t better covered, but Sam Quinones (author of the excellent Dreamland, on opioids) spent a long time in homeless encampments around the country talking to homeless people. In his opinion the number one reason homelessness skyrocketed is because one of the precursors of meth became poisonous. Basically the US worked with Mexico to ban the import of some important chemical precursor, so the drug makers had to find an alternative, and the alternative leaves a residue in meth which causes psychotic symptoms. So many people who were addicted to meth but could keep a job and home went overnight to being unable to do so. He said he heard this story over and over. He’s a very credible source, but weirdly I’ve never heard anyone else talk about it.
I'm going to express my scepticism at the reliability of drug addicts. Just like everyone in prison is innocent, I'm sure that "the problem wasn't that I was addicted to meth, the problem was they changed the formulation".
'Hearing this story over and over' is just as much leaning in the direction of "the junkies used this as an excuse" as it leans in the direction of "meth suddenly became poisonous".
To be clear this is something that isn't just coming from the meth users themselves, but other homeless people surrounding them, people providing social services, and health care providers treating them. The shift is REALLY hard to miss if you're even casually exposed to people who use meth.
That being said the specific mechanism of a residue in the meth from the new production process is just a theory, and its likely that at least some of the massive change in presentation we're seeing is just from people doing so much more meth now that its so much cheaper. But the fact that there's been a massive change in the presentation of meth users seems really, really clear.
Mexico banned imports of ephedrine in 2009. That's where it started.
The homeless/psycho/zombie epidemic right now cannot be addressed apart from cutting off the supply of cheap Mexican P2P meth. Which requires closing the border, among other things. You'll never get the left onboard as long as they're all in on open borders. Can't stop migrants: can't stop meth either.
Quinones goes on to explain that in much more detail in *The Least of Us*-- it is WELL worth the read.
Tweakers believing there's some kind of contaminant or that there's a different formulation that's harming them is a tale as old as meth. The fact is, chronic meth use is what leads to psychosis. Quinones is being highly credulous.
I think the idea that we can simply Do Something About The Crazy Homeless People comes from the fact that the problem feels bigger than it used to be. We have moved away from the Pareto frontier, so intuitively it seems like we should be able to move back
We probably can't actually do this for the same reason we couldn't simply choose to revert whatever pushed us from a 1960s crime rate to a 1980s crime rate, we're not sure what the cause is, but it *seems* like we should be able to.
The crime rate didn't get stuck at its 1980s level, it entered a long-term decline starting in 1994, getting back to the 1960s level. Then 2014 & 2020 boosted it up again, but now it's back to declining.
In Soviet Union we used to round up all homeless people and send them off to university to study nuclear physics, so they could become janitors in America after blue jean salesmen took over the country.
In America you would have to prevent not homeless people from abusing the system to get free tuition, so you should randomly distribute people in 3 groups: 1/3 get drafted into the military, 1/3 get regular medication and treatment, and 1/3 go to (liberal-majority) university.
"If your plan is to “lock them up long-term”, keep in mind that (for now) there are almost no institutions equipped to do this. Each state usually has one center with a 3-digit number of beds for the most recalcitrant patients."
Before chlorpromazine became a thing, pretty much every county had a long term mental hospital.
Anyway, the whole thing sounds like a sort of argument for socialism or maybe Social Darwinism.
>can you make homelessness a crime? As of last month, yes you can
This is misleading. First, it implies that the city can arrest people at any time simply because they are homeless, regardless of the time of day or what the person is doing at the time. That is not the case. You cannot, in fact, make homelessness a crime, because it is an Eighth Amendment violation to criminalize status (the original case was re a law that made it illegal to be addicted to drugs). All of the Justices (except Thomas) agree with that. The issue was whether a law making it illegal to sleep in public de facto criminalizes the status of being homeless, if the city does not provide enough beds for its entire homeless population.
Second, it was only in the Ninth Circuit that such laws were unenforceable. The Supreme Court decision did not alter the status quo. (Edit: did not alter the status quo outside the Ninth Circuit, that is)
PS: I am not opening either way on the merits of the law, nor on its constitionality. I am merely clarifying what happened.
"These take about 2-4 weeks to make people less psychotic. But one of their side effects is sedation, that side effect kicks in right away, and heavily-sedated people seem less psychotic. So realistically the person will stop seeming psychotic right away."
I don't think you're right about this Scott. This review - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1413955/ - talks specifically about the fact that studies have found statistically significant improvements in core psychotic symptoms in the short-term independent of changes in excitement, hostility, and agitation.
I don't think Scott is denying that. He's saying that the side effect of sedation is likely to occur regardless of the other things, and that alone will make people "seem less psychotic".
I don't think Scott would've used the word "but" in that paragraph if he wasn't trying to make the argument that it's not actually the antipsychotic effects you're seeing.
He's saying we will see sedation, and thus the person will appear less psychotic from that alone. Even if the person has also experienced something that will add up to "statistically significant improvements" with a large sample size, that can still be less than the effects of 2-4 weeks of treatment, but the side effect can make a small real improvement appear larger.
Interesting. It sounds to me like there's a lot of potential for improvement on #5 and #6 on that list.
Since I can barely figure out how to use the medical system, and usually just avoid it because of the hassle, I find it unconscionable that we expect psychotic homeless people to be able to use it.
What if the government instead set up a central distribution center for free anti-psychotic meds? No paperwork, just give them your name, they'll pull you up in the system, and err on the side of giving out the drugs. Maybe the FDA would complain? Seems worth fighting them on, though
My initial thought was "this is a good idea" because anti-psychotics are so miserable that who would want to abuse them? But from a quick google, maybe there is some risk (e.g. https://bpspubs.onlinelibrary.wiley.com/doi/full/10.1111/bcp.15420), but some abuse doesn't necessarily mean abuse-at-scale. Plus, the cost/benefit might work out regardless.
There will no longer be any judgement-proof people who get in trouble over-and-over. Everyone will have an insurer authorized to do whatever is necessary to stop their charges from getting convicted of any crimes. Is the insurer objectionable in the authority it exercises over you? Switch to another one. No one is willing to insure you with the freedom you want? Sounds like you're the problem and just need to accept such restrictions.
Yes, something like that existed. But now we have many more people, and much more cleverness applied to gaming systems, and it's easy to spread knowledge of how to game systems, and it's probably possible to build a for-profit enterprise based on gaming the system...
"The system" isn't paying out money to be gained by gaming the system. Insurers will pay it out, and they'll derive their revenue from insuring people. I could foresee a failure case where we have inefficiently high restrictions on all of us because our legal system makes too many things illegal (and the insurers effectively restrict us), which wasn't as much of a problem when laws were inconsistently enforced, but that's not a "gaming the system" failure.
“If such magical social services exist [providing housing the day you release someone from prison], wouldn’t it be cheaper and more humane to invoke them before putting someone in prison?“
This bit isn’t quite fair. The system would have the entire duration of the person’s jail term to arrange services/housing for the day they are released. Nothing magical required.
In fact, this could be reframed as “temporary food and shelter (jail) provided during the social service bureaucracy waiting period”. This would make it so the government would save money if they improved the social services bureaucracy because jail probably costs more per day.
How much is the “mistaking sedation for recovery” problem a systematic problem versus an illustrative example here? If it’s actually a major part of this process, that’s the kind of thing policy could usefully target.
Eg a policy of not discharging patients before treatment effectiveness has had time to work given our knowledge of drug effect times. In other words if you get committed with psychosis, you’re defaulted to being in there for 4 weeks.
This is a policy problem, but consider the tradeoffs being faced. If you move from holding someone for 4 days to 4 weeks you need 7x more beds, with 7x more staff, to treat the same number of people. Even if you assume you're not facing a resource constraint of that many staff existing to be hired, and that there is available land to build all those new psych wards, you still have the fiscal cost involved.
I am mostly familiar with the Canadian system, and for psychosis we do tend to keep people admitted for longer than 4 days (I really hope that's an exaggeration on Scott's part!). But we're generally discharging not because we think someone is fully stabilized, but because they're more stabilized than the 20 people waiting for their bed to open up. Psych beds are a REALLY scarce resource and we're trying to ration them as best we can. We already can't find enough people with the skills and willingness to work in these settings just to maintain our existing number of beds, let alone add new ones (which has led to hiring a lot of staff who really should not be working in this setting, or in healthcare at all). You can train people, but its hard to scale that up by much more than say an additional 10% per year, even if you somehow had the political capital to throw nearly unlimited money at it.
"Its hard and expensive" isn't a great excuse not to do it- indeed I really support expanding this capacity! But a lot of things that seem like simple policy changes have hard and expensive real world aspects that come with them.
>"If you move from holding someone for 4 days to 4 weeks you need 7x more beds, with 7x more staff, to treat the same number of people."
Possibly less, and maybe even lower over time.
It seems plausible that a non-trivial portion of the treated population would have multiple 4-day holds in a single 4-week period (possibly in different institutions, but at a system level that should be a wash), so the number of distinct patient-days wouldn't go up as much.
And to the extent that it can actually get more people out of the cycle, the total need should decline. Illustrative example with made-up numbers: if the average patient gets a 4-day hold every month, but would only get a 4-week hold annually (N.B., still a pessimistic assumption!), that's a 40% reduction in utilization.
Yeah, you're correct that second order effects matter here, that people treated longer will have less re-hospitalizations afterward. Now mind you I think your pessimistic assumption of only a 4 week hold annually is actually WILDLY optimistic, but you will see improvement.
In terms of short term readmissions that could be prevented by a longer hold though are probably less than you'd expect.
Many of the problems you describe with getting consistent access to help remind me of the book “The Persistence of Poverty: Why the Economics of the Well-Off Can't Help the Poor” by Charles Karelis, who is a philosopher.
The book (as I recall from reading 15 yrs ago) describes a framing of how the barriers to escaping poverty stack up. It’s like having five bee stings: if you get a salve that makes 1-4 of them not hurt, you still have one that hurts and remain in great pain. Poverty is like this: you have several barriers to earning enough to support yourself, and solving some of them is often not enough to allow someone to hold a steady job.
The barriers to consistently accessing and receiving mental health care sounds very related, perhaps even a special subset of the same issue.
Like the typical reader here, I'm not at all in poverty. But it intuitively strikes me as similar to other aspects of my life. The notion of self-improvement just doesn't resonate with me like it does to other readers of rationalist sites, as I expect any marginal change in my behavior to result in negligible changes in outcomes. But that sounds like rationalization for my own laziness & apathy.
If I may be so bold: harshness with yourself is not a good motivator in the long-term. Look into mindful self-compassion. It helps you face your problems realistically (like if you messed something up) while leaving you in a constructive frame of mind to move forward.
“My own laziness and apathy” is a harsh framing, in my view. This is not about whether or not the framing is factually accurate.
I am not an expert and I don’t really know your situation. I’m just observing how you have described it. If you would like to know more, look up Kristin Neff’s books about this.
Uh, I would be for that bill, that baby-formula threatening bill. What am I missing?
I can't imagine the thought process that would involve making the lives of babies so tenuous as to rely on a single supply-chain ingredient, to say nothing of the pollution that would later make them choke.
So - I should imagine that a bunch of babies died during the infant formula shortage, that I didn't hear about? Or I should imagine that the outsourcing of childcare - the only reason to go through the much more arduous process of formula-feeding over breast-feeding unless you are one of the mothers that are unable to nurse - did not make babies more rather than less vulnerable?
I like play-pretend as much as anyone, so just tell me the correct backscratcher imagining.
ETA: I was a formula-fed baby. Because breastfeeding is what animals and savages do. That was some cool imagining!
I don’t see any other realistic option than to rebuild mental health facilities, loony bins, bit houses, whatever you want to call them. Then mandate things like cameras, audit, and even pretend patients to prevent abuse.
Have some policy that the more times you go through the system the longer your involuntary commitment. So in your scenarios if you fail out x number of times you just stay forever unless some other person vouches to provide you with care.
There are a lot of drug addicts who need someone to stand between them and the giant cliff they’re walking toward.
We can’t just let people die in the streets. I don’t know why this isn’t seen as compassionate to the people with these problems.
I find these discussions very frustrating because homelessness is an entirely self-imposed problem with technical solutions. Everything boils down to stupid regulation.
Here are a few things that (combined) would solve the homelessness problem:
1. Remove all restrictions on housing units in SF. As Scott said, 80% of homeless people are homeless for a few weeks. Why? Because they miss rent! Austin has had _declines_ in rents over the past year. Unleash building in SF and you break the pipeline to homelessness.
2. Develop or get the FDA to allow slow-release drugs. If the issue is these people need to be on anti-psychotics for 4 weeks, then give them a form factor that keeps them on anti-psychotics for 4 weeks without intervention.
3. Move the ~$1.4 billion (yes, you read that right) that is currently being incinerated by the city of San Francisco to non-profits and use that to build 5x the number of involuntary confinement beds for the people who truly cannot be helped. And confine them.
1 won't happen because NIMBYs prefer to keep their views over letting people be homeless. 2 won't happen because regulatory capture. 3 won't happen because of rampant corruption. But these are all solvable without "being arbitrarily cruel and draconian"!
1. Provide ~infinite shelter in a big military style tents with rows of beds an hour outside the city, where land is cheap, people are more spread out. Run a bus line to the nearest public transit or into the city. Make the zoning such that vendors would be able to operate nearby if they wish. Consider making it a special economic zone so that minimum wage laws don't apply and vendors could profitably employ people who stay there. It should have some security and enforce standard laws so that it's safe to sleep there, but not particularly comfortable or private.
2. Enforce laws in the shelter and in public against drugs and being a public nuisance. People that violate that go into the criminal justice system and go to jail.
This all makes a lot of sense. Like a lot of public policy debates, it seems like we're circling the drain going over the same half-baked solutions over and over.
So let's brainstorm. What might be some more effective solutions?
- Make SROs effectively legal again (or some other form of ultra-cheap housing that gets a pass on zoning and whatnot)
- Give homeless mentally ill people GPS trackers and have social and medical workers visit them wherever they are (to some degree, this could even work without the trackers)
- Develop long-term implants for psychiatric medications (or even injectables that last a little longer)
- Develop neuro-stimulation treatments for psychiatric conditions
- Come up with some other longer-lasting treatment
- Expand the housing supply so that less people experience homelessness, which seems like it would be a big risk factor for worse mental health
The only viable solution I see is rebuilding long-term psychiatric hospitals. Many of the patients we’re talking about here are people who really can’t manage their own lives well enough to live independently in a stable way for any length of time. One big argument in favor of bringing back asylums is that they’ve actually been successfully tried before. Yes, it’s a lot of construction, but I think in the long-term it is far easier than creating some giant social service organization to hunt people down and keep them medicated.
I've seen a video about Japan having a non-government solution-- there are cheaply rentable gaming cubicles, so homeless people have somewhere to sleep. I don't know where they get the money for the cubicles, maybe from their families.
So, it seems like there was a time where visibly crazy homeless people weren't taking over all public spaces--where public parks and libraries were very rarely overrun with people with no fixed address sleeping in them, for example. Is there a reason we can't go back to the policies that we had then? What man has done, man can aspire to.
>But most of the time, it’s because some trivial hiccup comes up in getting the prescription refilled, or in getting to the doctor’s appointment.
>Am I just being gullible? Are these people just making fake excuses? I don’t think so.
You don't need to be homeless, lack insurance, be psychotic, or lack determination to get care, to have these problems. Last year I had nasal surgery at a major hospital in a major city. I had family waiting to take me home and ready to pick up my prescriptions for me. The hospital's pharmacy had already closed before they were ready to discharge me (couldn't they have filled it while I was in recovery? Nope!), so they automatically called it in to my regular pharmacy... which was closing in 15 minutes. Tried to call the hospital to have them send a new prescription to a 24 hr pharmacy, and couldn't get a hold of anyone. So no meds for me.
Next morning I woke up, sent someone to the pharmacy, and found out it was closed for Veteran's Day until the afternoon. We tried again to call the hospital, and got nowhere. Operators refused to transfer me, transferred me to the wrong people, or told me to call back Monday. One did text an emergency room doctor, who didn't respond for hours, then refused to act because they didn't think it was important.
When the pharmacy opened, they told me the doctor who wrote it wasn't licensed to write prescriptions in the state, which was false and a database error, but they *also* had been calling the hospital and couldn't get a hold of anyone. Ultimately I was able to email my surgeon directly, and he apparently was checking it on a Saturday when he wasn't working. He got a new prescription written, but it was still over 24 hrs before I got my first dose of post-surgery antibiotics.
It worked out in the end and I had an extremely smooth recovery, but I can easily see how someone else would give up and then end up in the emergency room with a major infection.
Thank you for writing this! Yup, it is _very_ easy to fall through the cracks, even just in the process of getting a routine prescription filled. I've had my own (_far_ less worrisome and time critical) problems in getting a routine prescription refilled (three channels of communications failed thus far...).
"How long are you keeping people there? Remember, someone’s going to come in, start taking antipsychotics, and (if the drugs work) appear significantly saner within 2-4 weeks. Best-case scenario, they’re completely sane. Now what? Do you keep a completely sane person locked in the mental institution forever?"
I found this a rather arresting way to describe anti-psychotic drugs: they make people "completely sane"? A psychiatrist would make this judgment about, say, someone who had been menacing people in the street two weeks prior?
The words “best case scenario” are doing a lot of work there. Certainly, not everyone will be “completely sane”, but some subset of psychotic patients being within the range of a normal, non-psychotic individual while on antipsychotics seems plausible to me
Take the person in the area who not long ago went into his next door neighbor's house and beat his neighbor's son with a bat to the head repeatedly. The child lived but will not now have a normal life according to his father.
This is a stand-in for any other incident you like. The guy who killed his parents and then went on a killing spree of strangers, including a mom pushing a baby carriage. He had many interactions with law enforcement over the danger he represented.
Anyway, these examples are as numerous as the oft-repeated "mentally ill not dangerous" claim, so let's take it as a given those are two opposed facts and it's obvious, which one is the compulsory lie.
To me, the bar for "completely sane" would be if the person, being so very completely sane for a time, would recognize that he needed to be locked away from other people going forward, regardless of his state of mind at that moment. Anything short of that would not be "completely sane" to me.
Again, I said best-case scenario, but I think this is plausible. For example, Freddie deBoer has been very open about his own mental health problems - not quite killing sprees, but pretty extreme hallucinations and some harmful actions he really regrets. My impression is he's now completely normal (well, for a commie blogger) on antipsychotics. He seems extremely regretful of his past actions, but isn't locking himself away because he's fine when he's medicated.
(the people who actually commit horrible crimes are locked away in any case, because insanity defense just shunts you to a mental hospital, it doesn't leave you free)
Freddie is bipolar and not schizophrenia, but I think it's possible (though uncommon) to get this level of success in schizophrenia too.
Sure - but Freddie deBoer did not beat anyone over the head or knife a passerby.
I rarely agree with him but I do think he presents his honest POV. And I really believe that he would say that if he had really seriously injured someone - he ought not to be at liberty to do it again should he fall back into psychosis. Or, alternately, if he had serially assaulted people again and again on the streets or subways of his town, even if no one needed hospitalization.
I grant that he may find this possibility easier to contemplate because he has a good deal of inner mental resources, that are not available to the average crazy person, perhaps, for whom the freedom to locomote may be the principal joy in life.
But I don't think he furnishes a counter-example to his own convictions on this point, at least until the drugs get really, really good and the "refuse to take them" problem goes away.
I don't expect any of this to change, under the current cultural regime, and the only hope lies with understanding the brain someday.
I think that the difference between a psychotic person who is just weird/annoying and one who kills someone is sometimes just moral luck, and not a fundamental difference in the kind of psychosis they have or how treatable it is.
Well, obviously I defer to you as an MD, on the shared propensity for harm.
But the idea of "moral luck" argues for more incarceration rather than less.
And if beds are always going to be scarce even if we were to return to the idea of incarceration, then the severity of the offense seems like as good a place as any to triage.
You are missing the forrest fir the trees. That is OK, It is hard for the fish to see the water.
The problem is a general housing problem. Not a free housing problem, just not enough housing for a sane, capable person working a minimum wage.
The issue is it has becomes so bad, it would take years to build all the missing housing created from the 2008 crisis and bad housing policies even if everyone agreed to go with the right policies right now.
Maybe ship people to China, I Heard they have ghost towns.
I think you are right that this is a genuine problem, and it makes everything else worse, but I don't think this is any of the main problems for people who are currently living on the streets with uncontrolled life-wrecking mental illnesses or addictions. The guy who's currently couch-surfing with a friend or sleeping in his car because he couldn't make rent would be helped by cheaper housing, but the guy who wanders around in public screaming back at the little voices needs an entirely different class of help. Cheaper housing won't do much for him. At the margins, it might make it easier for him to stay on his meds and stay engaged with the social service bureaucracy once he's stabilized, but if he keeps going back off his meds and relapsing, having housing be 50% cheaper isn't going to help.
The best prospect for people at the very bottom is probably allowing something like rooming houses. But those places will (and must) kick out people who are disruptive and dangerous, as a lot of people are in the middle of some kind of psychotic episode.
Well, if you smoked for 40 years and now have cancer, stopping smoking won't cure you.
However, the remedy for society would be to reduce smoking as much as possible. Treating the symptoms is fine, but you also have to treat the source of the problem as well.
Expensive housing causes a bunch of other social problems, but it doesn't cause schizophrenia or bipolar disorder or drug addiction or alcoholism.
We should make housing more affordable because that would have a lot of good effects, but we still will need to deal with people with uncontrolled mental illness who can't or won't maintain themselves on their medications and so become a danger to themselves or others.
> but it doesn't cause schizophrenia or bipolar disorder or drug addiction or alcoholism.
I agree with Nir that simply being homeless can lead to a bunch of other problems. There may not be a direct causal link, but there's a strong correlation. And I think there's a category of psychological damage that most normal people aren't even aware exists, a gaping black pit below us that most of us go our whole lives without noticing, because we're walking on a thin floor built of social connections.
It seems like the basic model here is like this: People with mental health issues are on a spectrum, where some are going to have a mental health crisis no matter what environment they're in, some won't have such a crisis in almost any environment, and some can be pushed into a crisis by various levels of bad environment.
It seems clear there's some level of this going on--just keeping on your medications and getting to your doctors' appointments is a hell of a lot easier if you have a fixed address and a car and a phone and such.
What's not clear to me is how big this effect is. Are there lots of people who were rendered unable to care for themselves due to a mental illness triggered by being homeless (say, being kicked out of their apartment or home), poor, or the victim of a crime? ISTM that a lot of people have PTSD related issues from some trauma, but I don't think many end up unable to hold down a job, or have a psychotic episode, or whatever. But this is a place where I just don't know much and don't trust my intuitions at all.
Speaking as a relatively high-functioning person with PTSD, I think the big problem there is reliability. Sometimes the best solution when triggered is to simply leave the situation, and that's not always possible at jobs. (I wind up volunteering a bunch instead, at places where I'm useful but not necessary.)
And there's also the problem that the medications which work best to relieve PTSD symptoms seem to be alcohol, THC, and opiates. :-/
Also, I don't have any good statistics myself, but in a free clinic I've seen numbers that indicated that victims of childhood sexual abuse are highly overrepresented in the homeless population. I think I recall a conversation where someone with more experience (therapist or psychiatrist) said that CSA, and common circumstances around it like keeping secrets and not being believed, tend to result in PTSD and a reflexive lack of trust in all authority figures. Which is something I can easily see leading to life on the streets, especially in combination with self-medication via street drugs.
2. free public transport system, patrolled by competent cops so it continues to function and doesn't become an ersatz homeless shelter, who are themselves overseen by a well functioning internal affairs department
3. voluntary state or national register for "clinically essential drugs administered to at-risk individuals", which uses fingerprints or iris scanning for identification, has a database which legally cannot be subpoenaed for anything short of child sex crimes or homicide, and which you are placed onto after getting a single prescription for antipsychotics while committed unless you opt out; anyone on the register can get certain meds from a pharmacist without a second prescription unless they've been inactive for five years or more
I live in Australia. We have 1., we effectively have 2. for mentally ill homeless people (I think public transport staff are told to let anyone who's visibly mentally ill but not too distressed through the gates), and I have no idea if 3. already exists or not.
>has a database which legally cannot be subpoenaed for anything short of child sex crimes or homicide
Reminder that some jurisdictions and Australia in particular have highly-absurd legal definitions of "child sex offence" which make this exception at least somewhat swallow the rule. Drawing a cartoon depicting two entirely-fictional children having sex is a "child sex offence" here in Oz (although rarely enforced - I publically confessed to this a couple of years back when attempting suicide, and while the police showed up they didn't do anything other than take me to the psych ward).
I don't really care about the minutiae of whether Lisa Simpson porn is a child sex crime or not. The reason to make special rules for child sex crimes and murders is to avoid the predictable bad press, not because it matters. Such a fingerprint database won't be instrumental in catching many people, because those high-profile crimes are rare and large swathes of people already have their fingerprints taken by the ABF or the police anyway.
Iris scanning would be even better than fingerprints because it's almost useless for forensic purposes.
Re - it being hard for social workers to track these people down, how hard would it be legally to allow police officers to share information with social workers.
Like, to the extent that these people are doing disruptive things, people are probably complaining to the police. Maybe not every disruptive thing they do is arrest-worthy and maybe not every report of an arrest-worthy thing comes with enough evidence to actually make the arrest, ... but would it be illegal for the police to say
"Oh the crazy guy yelling about tiny spiders in the rain is hanging out on Madison Avenue these days? I can't arrest him for doing that but I know that tiny spiders in the rain guy's social worker is Mark, I'll let him know that's where to find him
"you can slightly alleviate some of these problems with long-acting injectable antipsychotics, which can be given at the doctor’s office, but the patient still needs to go to the doctor once every few months."
This was an intriguing side bar which maybe deserves more attention. If we're talking about something that only has to happen every few months, that's not much easier for self-compliance but easier for state violence to enforce. Let's conjure up briefly that every time a police officer encounters someone on the street and obviously homeless they scan them with some means of identifying them like they scan license plates on every car they see. (Yes, I'm going to exercise my prerogative to handwave the ID technology here. Maybe the person has been chipped.) Is this person due or overdue for every three months anti-psychotic inject they've been assigned? If yes then they get hauled in for their next injection and dumped back out on the street by nightfall.
It won't "solve homelessness" but maybe it solves people wandering around with untreated psychosis? How medically practical are these long-lasting injections? Will they really result in people given them behaving better?
Long acting injectable anti-psychotics are really effective and a huge breakthrough, though not a complete panacea. You need a patient to actually respond to them and tolerate them (not all do), and then there's some degree of experimenting to figure out how long you can go between doses without losing effectiveness, and there's variation for different drugs. "Every few months" is something I've basically never seen, but all the points above still stand for a once a month injection which is more realistic (at least with the commonly used injectables in Canada). They're also more expensive than pills which is not the biggest deal, but my understanding is the insurance bureaucracy the US deals with is a pretty big barrier. Missing a dose by a few days is generally fine, but if someone misses for an extended period of time you also have to re-titrate them up to a treatment dose again. There are some additional risks and challenges that come from them being an injectable but they're relatively minor. It can also be challenging to inject them into the muscle properly on a very fat individual, and they have a side effect of weight gain, but I'd say that becomes an issue in less than 5% of cases. But again, overall they are great, and they increase adherence and decrease rehospitalization.
The thing is you can't just handwave away how you get the person in the room for the injection every month. Even in jurisdictions like Canada where you don't have the legal barriers to bringing someone in to get their injection, you need to have available police resources and be able to find and ID the person, which is hit or miss. Using recreational drugs also lowers the effectiveness of the LAIAs (though potentially less than oral meds?), and of course there's lots of drug induced psychosis in non-schizophrenic homeless people, homeless people with brain injuries, etc. And then you still have a homeless person at the end that requires a bunch of supports, just a less psychotic one that's potentially easier to house. But they're a very useful tool, and I'd guess there's a lot of room to expand their use in the US, even if the impact the public notices is likely to be marginal.
The city I am most familiar with spent all its ARPA Covid money on the homeless ($188 million). I am not sure how that played into the ordinary city spending on it but I do know they are trying to figure out how to keep that additional money flowing, in perpetuity, from the locals (taxes and charity) versus federal taxpayers.
Of course it has always had a city budget center dedicated to the homeless, doled out to various non-profits to spend.
Around ten years ago, I'd say, that budget started to really grow. From ten, fifteen million maybe, to 30 million, then up, and mostly up again with a little fluctuation.
This year it has two components: $80 million for "homelessness response efforts" and another $87 million for a neologism - "deeply affordable" housing with what is called "a continuum of care".
This is real money. For its efforts, the city seems to purchase more homeless people, basically.
I don't mean that in an entirely snarky way. I mean, yes, it is obviously true - there is a runaway number of homeless camps and street people, far above what there used to be.
But I think that a lot of the city's voters like this situation.
An open-air insane asylum is not unpleasing to them. It plays into their worldview. It is sort of like a zoo of their favorite people, those they consider most worthy.
All that of course has nothing to do with whether it is humane.
Then too, the people like me who don't care for this status quo, don't necessarily care that much about the "humane" aspect either. For me it is twofold: I don't care for the civic affects, the aesthetics of it, the trash and general mess; and I don't like that the money that might be/used to be spent on other things such as parks or other civic improvements of a vintage kind (or not spent at all lol) is entering this widening maw of homelessness.
Like, I don't really understand why society would expend *so much* on something from which it can expect no benefit. *Something* of course - always has and always will be - spent.
I don't mind if people want to say I'm inhumane, or a monster. But I want it on the record that the opposite view to mine, is no more "humane".
Spend the money to set up free housing that is obviously better than living on the street, but you have to sign away some rights to enter it. I.E., let a social worker make some medical decisions for you, consent to searches to find drugs, the police can return you after curfew until you get a discharge that requires showing a prima-facie plausible plan about where you'll live and how you'll support yourself, etc. Ideally these housing complexes would also have psychiatrists either on staff or who can visit. Then, if you're temporarily homeless, you just get the temporary help you need. If you need longer term care to manage mental illness, it's much easier for you to get it. If you turn down this option and decide to be dangerously psychotic in public, it's socially much easier to give you a draconian involuntary commitment.
>Another homeless person steals their pill bottle thinking it might be opioids; later they will grind them up, snort them, and have the worst day of their lives.
I think this might have been a guess on Scott's part. Quetiapine (Seroquel, or might have a different brand name in the US) is absolutely diverted to be used as a recreational drug for a high, including by snorting it. This is probably most common in prisons and locked mental health units, but it wouldn't shock me if people did it on the street too. I have no idea about other second generation anti-psychotics, but I really doubt it would be "the worst day of their lives", even if it might not give a very good high. Not an antipsychotic, but Bupropion (Wellbutrin) is also commonly diverted and snorted for a high.
The exception here is likely to be Clozapine, where I'd imagine crushing and snorting would have a pretty high risk of wild swings in blood pressure and heart rate that could be pretty dangerous.
I have two small thoughts here, apologies if they are naive or stupid.
1) I don’t necessarily think it is just to lock someone up just because they are a danger to others theoretically. I do however think it is just to lock someone up if they have repeatedly proven they are a danger to others. In my neighborhood in NYC, there are several well known offenders who walk around and randomly accost or attack (for the most part) women. I am not a police state guy - I don’t want to live in Singapore. But if you’ve punched 5 people at random, you should go to jail. I don’t really care if you are talking to yourself, are homeless, smell bad - that’s life. I don’t want to criminalize being weird. I just want to criminalize punching people on the street. I just want those laws enforced. I don’t think this reform requires some major restructuring of our healthcare or criminal justice systems. I do recognize that some well intentioned bail reform policies have probably contributed to this issue.
2) On the general subject of crazy seeming distressed homeless people..why does this not exist in Europe? Obviously I am exaggerating, and don’t know anything about mental health in Europe. But I do know that, walking around anywhere in NYC, including the most wealthy or touristy areas, I am likely to encounter a naked homeless man in clear distress. And when I go to London or Paris, this happens less. Despite not having conducted a rigorous experiment to prove this, I am confident that this problem is much more specific to NY than it is London, Paris, etc. So what are they doing? If it is cruel and unjust, we don’t have to copy them. But I am curious.
Re: Grants Pass ruling allowing states to criminalize homelessness, it obviously sounds dystopian and Kafka-esque if you're away from home, lose your smartphone and wallet and are rendered as having "no choice" but to sleep in public and go to jail.
Though in practice most jurisdictions start with a citation and then escalate to prison on repeat offense.
But lets say it's something more persistent. A wildfire wiped out the nearest set of towns and you have a lot of refugees (as happened with the Holiday Farm Fire in Oregon a few years ago). Every hotel and motel and campground is maximally packed. It's not even legal to allow people to camp on private property in all nearby counties (due to a history of hippies probably going too far). Do we really want the police to sweep these people up into jail for camping out in parks?
One of the interesting parts of the Grants Pass, Oregon case is that homeless shelters did have capacity, but they do not allow drug use in the shelters, which made them unappealing to homeless drug enjoyers who preferred to camp out in public parks and sidewalks.
A reasonably humane compromise is probably that the police cannot start the citation-to-arrest pipeline for sleeping in public unless they can look up on their smartphone that a homeless shelter exists with capacity within a something mile radius. At least that creates a direct public incentive to produce shelters if we want to clear homeless off of our streets.
Walt Bismarck had an interesting solution that’s in the cruel and Draconian camp, but if done properly could arguably be less cruel than the status quo.
“To address this we should build an enormous facility in Western Nebraska to house the homeless and cheaply shelter the ones who can’t take care of themselves (or who have severe mental health issues) while rehabilitating the ones addicted to drugs. Make this a federal mandate and sweep the homeless off the streets, but take care of them in a really nice way so the bougie gals have an excuse not to feel bad about it.”
I've seen "housing first" objections mostly around substance abuse, not endogenous mental illness - as in, that we're enabling people to be homeless addicts. While perhaps some harm prevention groups have lost the plot (e.g. is it really important to provide pipes and foil? does this actually offset a significant danger like needle use?), this still kinda falls into the same category. If you want people off the streets, you need to remove barriers to people being off the streets. Zero tolerance policies are a big barrier.
Here in Denver, hotels were turned into permanent housing for homeless. From my perspective as a citizen, this was a HUGE success. Within a matter of weeks last Nov/Dev, we went from homeless tents and trash piles everywhere none at all. Now I rarely see tents (and then only on the outskirts of town), and the same small bit of visible homelessness that has been here as long as I can remember.
Unconditional permanent housing + aggressive sweeping is an ethical solution, I think, as long as they remain paired. But I'm assuming such a program isn't feasible in SF, given the scale of the problem and housing.
As to other interventions: better anti-psychotics! Easier said than done, but I hope sufficient dollars are being funneled in that direction. Perhaps there should be an org like Givewell but focused on identifying and mitigating sources of societal decay. While the cost/benefit of anti-psychotics can't touch anti-malarial interventions in terms of lives saved, perhaps there is an argument to be made in terms of system level effects.
It *really* matters a lot whether the subset of homeless people you are housing in a hotel is "poor person who lost his job and couldn't make rent" vs "untreated crazy person."
These hotels were purchased by the city and made available to the homeless population, i.e. are no longer operating as hotels. But yeah, I'm sure upkeep (along with community management) is quite a challenge.
I haven't read any comments, so my apologies for repeating other people's points.
First of all, can we all acknowledge the contradiction at the heart of:
"Do you keep a completely sane person locked in the mental institution forever? Or do you let them out, at which point they will inevitably stop taking the drugs and become psychotic again?"
If I need someone who is not myself to keep reminding/ordering/forcing me to take meds without which I would be psychotic, then I am NOT, in fact, completely sane.
To answer the question: "A person who acts sane as long as they take their meds but has to keep being reminded to take said meds" sounds like a great candidate for some kind of halfway house: not as restrictive as an inpatient mental institution, but there's a nurse/social worker on premises and someone goes around all the apartments daily and tells all the residents, "please remember to take your meds today" with the understanding that if you start acting more than a certain level of erratic/psychotic, that means we can't trust you to take your meds on your own and it's back to the inpatient mental facility for you.
As for the bigger picture: I am a Polish-born naturalized American citizen. I love my adopted country, but mentally ill homeless people are one issue where I think my birth country did a much better job, and they did this by being much more on the side of public order rather than a homeless person's right to scream incoherently and pee on a random street corner. "The needs of the many outweigh the needs of the few."
Of course I understand that a ton of $$$$$ would have to be spent on building and staffing a lot of inpatient mental institutions, and I'm happy to pay higher taxes to make it happen. But I think our thermostat should adjust from "is this person an immediate danger to self/others" towards "is this person competent to live on their own", and if the answer to the latter is no, then they go into either an inpatient mental facility or, if possible, some kind of halfway house where they have some freedom but also someone to look in on them regularly and make sure they're coping.
Yeah. This is tough to square with America's broad protection of the individual right to live as one chooses, but I do think we could come up with a better solution, if enough people were able to discuss this calmly and rationally and humanely.
"If I need someone who is not myself to keep reminding/ordering/forcing me to take meds without which I would be psychotic, then I am NOT, in fact, completely sane."
This isn't even limited to psychotic people! I can't tell you how much work I put into making sure my depression patients, who will become horribly depressed if they don't take their depression medication, who know this, who have had it happen to them many times before - continue taking their depression medication. Some people are just really bad at meds in a way that's hard to explain.
There are places in the world where mass homelessness just isn't a problem. One of the most common comments you'll see from people who visit Japan or Singapore, for instance, is how clean the cities are and how they see almost no homeless people. Clearly this problem isn't impossible to solve. Why don't we see what those kinds of places do and mimic that as much as possible?
I do think other places have more sensible approaches, but also Japan just doesn't have the problems we have. Fore example, they have a MUCH lower crime rate. Are their police far more effective? When confronted with a criminal who simply refuses to confess, they get stumped. The police don't have to do the things US police do, because they don't have to deal with the same criminality.
They get like a 95% confession rate, so I think they're not so stumped as all that. They just are able to apply a lot more pressure to get a confession.
I once had a judo instructor, with a jujitsu background, who showed us a technique used by Japanese police to "convince" people to put their hands in a position where they could both be handcuffed. Simple, excruciatingly painful, and apparently leaves no physical evidence behind.
Whenever I think of Japan's high confession rate, that comes to mind.
I can imagine arguments at least as persuasive as this one that it's impossible to e.g. land a rocket, and yet I could ignore them all because I've seen a rocket land.
Similarly, there are lots of cities where homelessness is a very minor problem. How should I reconcile an argument like this, about how some problem is intractable, with data showing that the problem is worsening in some places, and virtually solved in others? Or are my premises wrong, and there are no jurisdictions without a big mentally ill homeless population that aren't doing the maximally draconian thing?
There's a line that goes "these people who claim to be so out of touch with reality that they can't control themselves or be responsible for their actions somehow have the clarity to direct their assault and harassment disproportionately towards people who can't defend themselves". Now, I don't know how much this is true from personal experience. Perhaps some others can comment.
But maybe this is true even *if* they genuinely are psychotic. If it is then the whole hypothetical about making mental illness a crime is a strawman. Assaulting people is already a crime. The only thing you need to disincentivize such behavior is the right to self-defense and existing law enforcement.
In my experience working with individuals with psychosis, it is absolutely the case that someone can both be psychotic to the point of not being able to control their actions while also being able to target people less able to defend themselves. However both of those exist on a spectrum rather than a binary, some psychotic individuals will be completely indiscriminate, and I've actually even seen psychotic patients in hospital manage to focus their aggression on the people most able to defend themselves to try to minimize someone getting hurt by their violence, but not able to control the violence. Psychosis is really not logical or straightforward- for one fun example, lots of patients are able to correctly point out the logical flaws in delusions expressed by another patient, but not apply that to their own delusions.
In general you aren't going to get much change by trying to "disincentivizing" assaultive behaviour from psychotic individuals though; the only options are to treat the person or restrain the person.
> somehow have the clarity to direct their assault and harassment disproportionately towards people who can't defend themselves
That's just animal instinct. Flee before strength; pursue after weakness.
> Assaulting people is already a crime.
A) For the chronic cases, the assault seems pre-determined, so the hope is that we can intervene before any actual assault happens. That seems better all around.
B) By the first paragraph, the people assaulted are going to be the ones least capable of defending themselves.
C) While I am somewhat curious about the dynamics of a modern society where a high percentage of all people carried concealed guns in public, and I do think it's possible that such a society might reach an equilibrium with less public danger than modern America, I very much doubt that moving in that direction would improve things in the short term.
Scott, what a great post. I think one thing I'd like to expand on is the criminal component.
A lot of "draconian" solutions necessarily require the criminal law (because you get minimal returns out of suing homeless or very poor people). In the United States, this means you're activating a *ludicrously* inefficient system to deal with low-level problems. It might be satisfying to a person of a deontological bent that no theft go unpunished, but it's hardly optimal. A lot of "soft on crime" policies in my jurisdiction come from a place of simply not wanting to bother with the time and expense of punishing an instance of shoplifting.
See, prosecutors make "good deals" that include no jail time as a way to get people to admit their guilt and move the case along. If you don't make "good deals" and decide to be draconian, people will fight back: they'll insist on trials for stealing a bag of chips...and nobody actually wants that, because trials have a ton of process. When I get a shoplifting case, I demand security footage (if available). Just getting that to me from the store is often more costly for the store than the stolen bag of chips. If I went to *trial* on a shoplifting case, I'd probably win unless two witnesses appeared for a whole afternoon: the employee who caught the lifter and the cop who showed up when/if they were called. Losing an employee for an afternoon is already a decent amount of time and expense for a victim, to say nothing of the police/jury/judge/clerk resources that get spent. If the plan is to put someone in jail for 60-120 days for stealing a bag of chips, you've turned a case people would normally shrug and admit to into something that is as worth fighting about as a white collar credit card theft. If the plan is to put someone away for 5-10 years for their next instance of loitering because they haven't learned their lesson the previous 128 times, we've turned a low-level misdemeanor into the trial of the century.
Finally and probably most important to your point: the supreme court did recently rule that you can technically criminalize homelessness, but actually prosecuting the "crime" of homelessness might be onerous in the future, since there would be numerous active defenses, everything from "there were no shelters available" to the truly preposterous "oh gosh, this was a big misunderstanding, I was walking back to my house and then a dude came out of nowhere and beat me and threw me in a ditch and that's why i'm in this ditch at 3AM". Trouble is that even if your defense is truly preposterous, you get a trial...
> Just getting that to me from the store is often more costly for the store than the stolen bag of chips.
Right, but that's just one instance and one victim. Repeat enough, escalate, spread to others, and the damage to society exceeds the cost of prosecution, but it's still not in any single victim's personal interest to prosecute.
It's kind of like showing up for jury duty. Or voting. What do I, personally, get out of it? What's in it for me?
I think that's exactly correct, but I think the "balancing" tends to be a political question that varies a lot from jurisdiction to jurisdiction, and that's the point I'm trying to make. Prosecutors are the ones who make decisions about how much this is really worth everyone's time, and often with inputs from victims, if they exist.
I think strictly enforcing the penalties of anti-homelessness laws might be even more difficult than strictly enforcing the penalties of anti-shoplifting laws, simply because the defendants have even less to lose by fighting it out, and might even be more sympathetic to jurors and judges.
In short, my point was that irrespective even of the cost of jail and prison, it's really expensive and onerous to prosecute people, and if you increase the stakes of prosecution, it gets even more expensive and onerous.
"it's really expensive and onerous to prosecute people"
That's a very valid concern, but there has to be some middle ground between "it's not worth the hassle to engage the creaky machinery of the judicial system to prosecute some loser for stealing a packet of biscuits" and "you can commit crime with impunity, just remember to keep your total of swag below the magic figure of $950!"
I see there are actually penalties for shoplifting in California, but if nobody can be bothered to prosecute them, or would rather make "good deals", then what use is "don't steal or you may go to jail for six months!" deterrence?
"Shoplifting in California is normally a misdemeanor offense that carries a maximum potential penalty of:
* up to six months in the county jail, and
* a fine of up to $1,000."
It's not the one guy who sometimes steals a packet of biscuits that is the problem, it's the guy who is robbing stores 178 times, or the organised gangs of professional thieves, all encouraged because "too much hassle to go after a petty crime like this".
"If the plan is to put someone away for 5-10 years for their next instance of loitering because they haven't learned their lesson the previous 128 times, we've turned a low-level misdemeanor into the trial of the century."
Prosecuting people for stealing a packet of biscuits is silly, I agree. However, if this is your 129th time stealing biscuits and you've been given chance after chance and no jail time and you still persist in stealing biscuits, hell yeah go to trial and go to jail.
There comes a point where soft treatment doesn't work any more. If you are not going to turn things around after the first 129 times the judge let you off, you are not very likely to suddenly have an epiphany the 130th time. Giving some people chance after chance is just encouraging crime. If the "good deal" is "you admit you stole this, we don't prosecute you" and the person goes off to continue stealing biscuits with no consequences, how good a deal is that for society at large? "Gosh, why on earth did this last grocery store in the neighbourhood close down, it can't have anything to do with the constant dripping of petty theft going unpunished, no it must be the fault of greedy fat-cat capitalist owners!"
I think what i'm saying is that this is a phenomenon we see across a number of American jurisdictions, from California (which Scott is mostly discussing) to Minnesota (where I practice). The criminal justice system isn't set up to handle the number of trials that you'd create by like, going ham on loiterers and rogues. We'd need a lot more jurors, judges, prosecutors, and defense attorneys. The hypothetical homelessness prosecutions Scott discusses are likely to be more difficult, I'd say.
This was a really interesting comment and helps me think about this problem in a different way, thanks. Is there a good reason we can't treat homelessness like we treat traffic violations? The first N (5? 10?) offenses could be treated as infractions that special administrative courts could adjudicate efficiently. Fines only, no jail time, defendants are pro se by default. After N citation convictions the person is labelled 'chronic vagrant' and there's a criminal trial for serious jail time. Put em in low-secuity Joe Arpaio style internment camps for a couple years (or whatever).
Seems like this solves the "criminal courts are inefficient" part of the problem. Are there obvious problems with this (other than political ones)?
Obviously, any solution here starts with "make it easy and cheap to build more housing." If not for the mentally ill homeless, it should at least result in fewer homeless overall and a much more clear and manageable problem in the chronically mentally ill and homeless.
For the rest, I think the solution is equally "clear." Obviously the acute care system has nowhere to put the seriously mentally ill, nor do the prisons. There are long-term care facilities designed for weeks-to-years stays, but they're rare and underfunded. The solution here seems to make them less rare and less underfunded, though this of course costs money.
That said, I feel like this article is more defeatist than it needs to be. Certainly I can sympathize with a professional who's seen the broken status quo every which way for years, but surely "hey maybe we need to bring institutions back but with a more modern and compassionate approach focused on rehabilitation" isn't too much of a stretch.
You are asking the wrong question and thus getting absurd answers.
Instead of “How can we help these psychotic homeless people” the right question is “How can we prevent psychotic homeless people from harassing members of the public?”
This is good. Nice to get some detail on the systems involved. Too me it looks like some sort of nationalized medicine and efforts to build a ton of housing would help. Tremendously frustrating that the US doesn't seem to have the will/capacity to make big interventions to solve problems.
Wouldn't basically all homeless people qualify for medicaid in their states? I assume it's horrible to try to get through the bureacracy and get any treatment if you're homeless and not very functional and in some kind of mental health crisis, but ISTM that the mechanism for providing/paying for care is already in existence.
The point is, there's already a scheme for paying for their medical treatment. Why do we expect some future nationalized healthcare to be less bureaucratic and more accessible to people with no fixed address and major mental health problems than this federal/state program to provide healthcare to the poor?
There's a fair bit of bureaucracy that could be eliminated by the assumptions that every single person gets a certain minimum standard of care, and that patient billing is unnecessary for that minimum standard. A lot of the paperwork is because only certain types of people and treatment are reimbursable, and there can be finicky minute-by-minute tracking requirements. It wouldn't all go away with a universal system - fraud would still be a problem - but the current gatekeeping requirements are mind-boggling.
IIRC when I applied for Medicaid the process involves proof of address within the state and ability to receive mail at that address. Not sure how a homeless person would handle this.
Medicaid varies from state to state. Mine has removed a lot of hurdles, but others, including I think CA, still have lots of bureaucracy even on the patient side. And that's not even talking about what providers need to do in order to handle Medicaid patients: I've heard of areas (geographic and medical) where the paperwork takes longer than the treatment itself.
Much of Scott's very useful discussion appears to be responding to (or at least addressing) some of the proposals in Freddie De Boer's NY Msg article from a few weeks ago.
Is the problem of unhoused mentally ill people a new thing? Has the proportion of psychotic people increased over time? I suspect some would say yes, due to effects of the modern diet, increased pollution, shrinking church attendance, or some other cause, but I am skeptical.
Isn't it possible that the problem of crazy people on the street has been pretty much constant (or possibly decreasing) with time? We may be more concerned with homeless psychotics now because we have fewer other things to worry about.
It's possible that our anxiety over unhoused psychotics is a symptom of our relentless utopianism, the idea that every societal ill can and must be solved. The problem may well be one that we have always lived with, and we will just have to learn to tolerate, or at least avoid.
I'll point out (without knowing the answer to either) that this is conflating two different questions:
1) Is the number of crazy people going up?
2) Is the *proportion* of crazy people going up?
Exposure to crazy people scales really well. It only takes one crazy person to make a given street corner a street corner with a crazy person on it. If population goes up that one crazy person just services more non-crazy people. So if we have more crazy people in an absolute sense, that might both make it seem like there are more crazy people and not need to be explained by any social problems other than general population growth.
The rise of P2P meth formulations (MUCH cheaper than old meth, and much more likely to cause long lasting psychosis) has definitely caused an increase in the number of unhoused people with psychosis. There are other factors that have made the problem more visible as opposed to bigger (ie someone in an abandoned building being violently psychotic has little impact on others, someone being violently psychotic on a crowded bus has a big impact on others). But the impact is definitely much, much larger than it was 5 years ago
The other piece alongside new meth is fentanyl (also widespread and cheap) causing more frequent ODs, but widespread Narcan meaning that those ODs are often reversed. Each OD presents a risk of brain damage from hypoxia, and some individuals living on the street are very frequently ODing and being given Narcan. Over time you've got a lot of people with brain damage that results in bizarre, often aggressive, behaviour
Is there any value in catching people early in the development of their psychosis, and getting them treatment while helping them avoid homelessness? Seems like that would be the best way to go here if the rewards and difficulty of treating them later on are so low and high respectively - not sure how to do the former, but the latter can be done with enough cheap housing (AKA SROs) and maybe some public housing with social services.
Early intervention programs for psychosis are indeed extremely effective, but there's not a lot of low hanging fruit to pick there since most places have already implemented them; and first episode psychosis is a very small proportion of total psychosis (let alone the psychosis you see in the street). All the benefits of prevention that come from them have already basically been taken advantage of.
21% of homeless people suffered from psychosis and 11% suffered from full-blown schizophrenia. That's 4-7 times and almost 10 times the general population rate.
Schizophrenia comes with extremely elevated risks of hurting others.
Despite how bad psychosis and schizophrenia are, there are great medications for them and depot options are becoming more and more available.
We just have to have the will to get people the care they need.
What are the interaction effects of illegal drug use (specifically amphetamines and opioids, but to a lesser extent things like crack, PCP, marijuana) on the degree of clinical psychosis and “recidivism” into homelessness?
Others may know this literature better than I do, but what is wrong with a simple first step of rigidly enforcing drug possession laws that are already on the books in homeless encampments?
It surely wouldn’t entirely solve the problem of homelessness but it would take the subsection of the homeless population off the street who don’t have the capacity to avoid bad decisions about taking steps towards recovery - whether that’s recovery from mental illness, drug addiction, or a combination of the two.
>Most (?) homeless people are only homeless for a few weeks, and 80% of homeless people are homeless for less than a year. If someone was going to be homeless for a week, and instead you imprison them for a year, you’re not doing them or society any favors.
I don't think this is a good argument, at least from the perspective of "draconian, unprincipled government that is trying to just the solve the problem with minimal side effects".
For example: you can simply make it illegal to be homeless for more than a year. While our current institutions are not well set up to handle the problem, this essay raises a bunch of objections on the basis that defining the problem is intractably hard. I don't think that's true. I think it's pretty easy to define the problem. The vast majority of people are never involuntarily institutionalized, much less repeatedly. The vast majority of people are not homeless for any significant length of time. Those two filters alone would do a *pretty good* job of pinning down the population we're talking about.
If you operated the current system, but people who keep getting re-committed for being homeless and insane over twelve months or longer go to a long-term institution (prison, or something similar to prison but not intended to be punitive), this would largely fix the problem (from the perspective of normies trying not to get screamed at in public) over the course of approximately 1 year. This would represent about a 30% increase in the total prison population in the US.
This is *pretty bad* from a civil rights perspective, which I assume is why the essay is trying to steer away from it, but it's not literally true that it wouldn't work or is somehow definitionally incoherent. The problem is fairly easy to fix, just not in a way that respects the humanity and civil rights of insane vagrants and retains any hope for their rehabilitation. I think it's worth being straightforward about that.
> it's not literally true that it wouldn't work or is somehow definitionally incoherent.
100% this. Just like 3 Strikes for crime, there is definitely a power law distribution for homelessness where some small population of re-offenders is responsible for 90% of the actual problem. It's trivial to identify those people: X vagrancy arrests over Y months and you're a "chronic vagrant" and we just put you in a separate category. Throw em in some low-security internment camp away from population centers. Commit the mentally ill. Simple. It'll cost some money but it's definitely worth it to reclaim our city centers.
The whole advantage of banning homelessness (as opposed to waiting for the homeless to commit specific crimes) is that it's enforceable. A cop can see a person sleeping on the street, realize he's homeless, and arrest him.
"Ban homelessness for more than a year" is much harder. A cop sees a person sleeping on the street and . . . what? Asks "how long have you been homeless?" "One day", the person responds. "Can I see your state documents showing the date you became homeless?" the cop asks. "I can't even consistently poop in a bathroom and you expect me to have state documents?" says the homeless person. Then the cop tries to bring them to trial, the public defender asks for proof that the person has been homeless more than a year, and the cop doesn't have it.
So take fingerprints or other biometrics whenever someone is involuntarily committed, and (while they are being treated) ask them to provide some sort of proof they have a home.
If, at their sanest, they can't, you record that information in their file and make a note. If you involuntary commit someone with the same biometrics twice and there's a previous note at least one year ago (but maybe less than five), you say "okay this person has both been repeatedly involuntarily committed and is persistently unhoused and we have documentation of both, we don't need to put this person back into the revolving door cycle".
Again, I get why you find this sort of thing unwholesome (it is), but I feel like because of that you really aren't applying yourself to figuring it out. It's just not that hard to come up with a metric by which people can be shunted off the cycle of repeated involuntary commitments that you originally described.
Seems overly skeptical. This isn't the unknown frontier of policy- most rich places outside N. America don't have this problem, and pre-1960s America didn't have this problem. Even pre-2000 America didn't have that bad of a problem.
Claiming we need to be "be cruel and draconian” is clearly hyperbole- unless you think the Rest of World is cruel and draconian or that pre-2000/1960s America was such.
Scott over-indexes on mental illness and under-indexes on "response to incentives". Homeless encampments are largely open-air drug markets, where the homeless can ply their wares, get benefits, etc... Would they rather be living at the 4 Seasons? Sure, but if the choice is living somewhere squalid but sheltered with no drugs outside of SF and living in a drug market in SF, they choose the latter. Simply not allowing them that choice will force them to make other arrangements- just as they did pre-2000.
Most mentally ill still respond to incentives and all druggies do. If we shutdown the encampments, they will move on to other, less anti-social living arrangements. They might even move to a more affordable place than SF/NYC!
I'd be happy to vote/pay taxes for more asylums, but Scott is playing dumb here. My wife worked at John George in Alameda- they know *exactly* who the "frequent flyers" are- the people who need to be locked up (who'd it'd be much cheaper to incarcerate than to waste police/emt/medical resources on them on a daily/weekly basis). There's no real issue identifying those who need involuntary help. Are there marginal cases? Sure, but we could resolve 90-95% of the problem without any real dispute among medical experts.
It's not like someone has a bad day, terrorizes a BART car, then gets taken to the psych ER and they say "let's commit him for 10 years". No- they see the same person for weeks/months/years at a time and are completely unable to do anything to help them or society. A simple rule like "the 3rd time. you are taken to a psych ER you get involuntarily committed for 1 year", with escalating commitments on further episodes would resolve much of this issue.
.. and how the problem of homelessness in _general_ relates to the problems of the severe. A reasonable explanation, to me, would be that what specifically ills SF & the other West Coast cities is:
1. High housing costs lead to high homelessness, many of whom have some level of dysfunction but only a small percentage of which are truly disturbing.
2. Those small percentage of the highly disturbed (and disturbing) are highly visible and take up lots of space in the public consciousness.
3. But for authorities, it's difficult to separate the smaller portion of high needs people from the larger population of not-great-but-not-as-bad people who mostly just want to live in tents and keep to themselves, given that the latter still demand some attention.
4. Thus, it becomes a question of state capacity. Cheaper housing would not fix the worst cases, but it would help reduce the local homelessness population so that what resources exist can focus on the hard cases more.
you make a convincing argument for locking them up and never letting them out. if the only solution to their miserable slow-motion suicide is to forcibly corral them so they will keep taking their anti-psychotics, then i guess that's the only solution
What if we built some sort of homeless ghetto in the middle of nowhere and shipped all the most problematic homeless people there? Maybe we just need to bring asylums back.
Your treatment of the "throw them in prison" position seems like a strawman. You don't have to throw them in prison immediately. Police often give warnings well in advance of taking action. A basic policy could be something like:
-First encounter: Warning, explain the new system.
-Next encounter that is more than two months after the first warning: Signature bond.
-If they don't show up in court for their signature bond, a warrant for their arrest, which realistically will only matter if they have another police interaction before they turn up at court to resolve it.
And police have plenty of discretion, they can always give additional warnings. I'm confident that this type of strategy will avoid locking up the type of temporarily homeless person who's about to get back on their feet. I'm also convinced that the criminal justice system is the only way to keep these people in one place long enough for their medication regimen to get established.
That said, the only truly humane and effective solution is to rebuild the asylum system and bring back long-term involuntary confinement. You've explained at length in this article how you can't expect homeless people to stay on their meds or come back for appointments, so long term involuntary confinement seems like the obvious solution. What's your objection? That SF can't build buildings? SF needs to solve that problem in any case...
BTW, what's up with this idea that people should be released within a few weeks, when we know it's very likely that their symptoms are just being masked by sedation? The normal medical standard is that you don't discharge them until you're convinced that they're stable, not just that it's plausible that they're stable. In the rare cases that a patient does become "completely sane" earlier than expected, I think it's completely reasonable to keep them a bit longer to make sure. And if you do release them and see them again a month later, surely you need to take that into account next time?
Am I a housing first advocate? I feel like this was much less of a problem 70 years ago. The big difference is that flophouses have been zoned out of existence. Reviving them would not solve everything, but it might make a big impact.
Not homelessness specific (I'm fortunate to live in a place where crazy homeless people aren't a visible concern), but just generally it feels like no political movement is willing to engage with intractability at all. Everyone just assumes all problems are solvable, easily, but someone is standing in the way. Nobody is willing to settle for the best bad solution or acknowledge tradeoffs. I can no longer engage with political discussion on either side because I find this so frustrating. Some (Most!) policy problems are genuinely hard to solve.
It sounds like a disproportionate hurdle for people in this cycle is consistent use of antipsychotics. Doctors want to give them to people and people want to take them, but minor difficulties spiral with a lack of ability of doctors and patients to easily coordinate. Has anyone tried subdermal tracking, so that an official is able to physically locate the person where ever they may be and physically had them a their medication? Are there subdermal, slow-release anti-psychotics available so that the patient wouldn't even have to think about remembering to take these meds?
How do all of the other developed countries in the world do it? The general tone of this piece is, here are a bunch of practical & logistical barriers that make mass institutionalization of psychotic homeless really difficult. But my understanding is that Giant Tent Cities Of Psychotic Homeless is a uniquely American problem. As a good faith question- what are Britain and France and Germany and Spain and Japan and South Korea and Australia doing differently from us? Do they just have way more hospital capacity for long-term institutionalization? How do they make psychotic patients take their anti-psychotic drugs?
Most people in tent cities are not the hardest cases. It's true that most homeless people will usually have some level of dysfunction, but not usually to the point that they're a serious threat to public order other than just taking up space and making a mess.
For obvious reasons, social perception tends to focus on the worst cases, but it distorts the debate to confuse the hardest cases from a bigger population of people who fluctuate into homelessness on the margins.
To be clear, both things are problems, and very much related, but mass homelessness and hard-to-control-psychos aren't the same thing.
The country I live in has a halfway functional health system, state subsidised housing and a welfare system that should prevent "anybody" from ending up on the streets. This makes the causality very obvious, the only possible first order cause for homelessness ist an unwillingness or inability to interact with the bureaucracy that would provide housing (actual housing, not shelter) - something I can empathise with, I hate interacting with bureaucracy but I certainly would hate being homeless more. "unwillingness or inability" of course comes in the common flavours of mental illness and drug abuse as discussed here.
Which is to say it is extremely hard to "just spiral into homelessness" as you apparently can in the US (?). Once people are homeless however, it seems our instituations are just as helpless / incapable dealing with it. There does not seem to be a good solution other than "prevention".
I don't know how to translate this into American and I am almost certain that you will get the wrong mental image but here is an attempt: I live in one of the largest cities of the country (order of magnitude 1 million people). On Sunday morning I take my daughter near the local train station (local, not the city center) in the hopes of buying breakfast. There is a Starbucks-like affair there that has put some chairs outside. These belong to the place. One is occupied by a clearly "problematic" man with a bottle of hard alcohol (Vodka or equivalent) in front of him. No hiding in a brown bag here. I decide to sit inside rather than sitting outside. Man leaves, we have breakfast, we leave. Police is now there, looking around, man is out of sight, even if he were in sight, what would they be accusing him of, Police leaves. We take a bus somewhere. Hours later, on our way home we come by the Station again. This time from the bus we can see that the police is there again, the very same man is lying on the ground, apparently helpless, police officer is putting on gloves, apparently to feel his pulse. An ambulance is arriving in the background. I think "wow that man certainly wasted my taxes by making the police come twice within a couple of hours".
This is a noteworthy episode in the sense that it does not happen every day. What does happen every day is that somebody will tell you a sob story on the subway asking for the equivalent of a dollar or (this at least is the current meta of that story) something to eat. This is prohibited but I have never seen it enforced.
Tent cities arise wherever you let them arise. I've seen tent cities start to spring up in Australia, but eventually the police get rid of them. There's certainly people who get welfare payments sufficient to pay rent but will instead choose to live in tent cities if you let them so they can spend their rent money on drugs; it's important not to let them have this option.
Dealing with these sorts of people who have complex problems is difficult and the only way to do it is with an appropriate combination of carrot and stick. Sometimes you gotta hold your nose and give free shit to someone who doesn't deserve it, sometimes you gotta hold your nose and be mean to someone who doesn't deserve that either.
If I may offer an overly pat explanation, it's that the US is polarised between people who refuse to ever use the carrot and people who refuse to ever use the stick, which means that neither gets used.
This essay would be compelling if the homeless problem wasn't unique to the West Coast. Nearly every other jurisdiction on the planet has solved this one way or another, so it's not like politicians need to actually break new ground in policy development. It's perfectly fair to make a generic complaint about the issue and expect politicians to decide who to copy.
I think, similar to how some elders require assisted living, some psychotic people require assisted living. It's not pretty or nice, but our world is not pretty or nice. The alternative isn't working.
Let's build a mess of new lower-than-lowest-security class of prison. Homelessness is put on a new tier of crime that doesn't show up on your criminal record at all, and the sentence is six months in this new lowest-tier prison. The new class of prison focuses on rehabilitation, treatment, education, and work programs.
(What's the difference between a prison and a housing project, once we've decided we're not going to -allow- people to be homeless?)
If we as a society have decided we are not okay with them walking outside and living on the streets, the question isn't really about which direction the doors lock from.
If you don't care about freedom, they're probably quite similar?
But seriously, I think freedom is an underrated ingredient. People can perform well in restrictive environments and then completely fall apart when faced with the choices of the real world. I don't think we'd be doing people favors by restricting them more than necessary.
That this is true in the general case doesn't mean it is remotely true in the specific cases involved. Indeed, given where their use of freedom has gotten them, it seems rather generally false for the cases under consideration - where their use of freedom is generally applied to, for example, not take their medications.
That's where the support structure is needed - don't just dump them back out when the sentence is finished. People who can't handle the transition/have no-one like family to help them out? Halfway houses, assisted living, something like that.
People who will be otherwise okay but just need someone to check in on them from time to time, who they can contact f they have a problem? Let's do that, too; that's what the probation service and social workers are supposed to be for after all.
People who just cannot cope without a routine and, if left to themselves, will fall right back into chaos but do okay in the regimented environment? Yeah, then we're looking at lifers, but that doesn't mean that they can't have relatively comfortable lives in the prison; give them little jobs to do, give them privileges, let them be in low-security places where there might be a garden or grounds to tend. Hell, let's try something like day release where they can go into nearby town or visit family, but carefully monitored to make sure they are not going to fall back into addiction, and they return to the prison afterwards:
"In most cases, you can be released on compassionate grounds if there is a family emergency, such as a death or serious illness. You may also be released to visit family at Christmas, or to attend special family occasions such as christenings or communions.
If you demonstrate good behaviour and engage in structured activities in prison, you may be granted day-to-day release to participate in work or training outside of prison during the day. You return to custody in the evening.
You may also be granted day-release near the end of your sentence to build family relationships before your release."
Naturally, if this is abused, then you lose all your privileges and go right back to "locked up permanently".
You and me should get together for our new combined "Yes I'm An Evil Monster And I'm Proud Of It" prison-building schemes 😁
If the only damn way to get anything done is to put people into prison, well okay then let's the hell have prisons. But different levels of prisons. Not so much for the criminally insane but for the 'so addicted and/or crazy they can't function' types. Something along the lines of the Central Mental Hospital (and today I learned the term "forensic patients"):
And if they're not crazy, just in bad circumstances, they go to your low-level prison for rehabilitation. If people/governments won't or can't pay out for hospitals, then let's use the 'law and order' approach and appeal to get institutions that can treat and support such people built, even if we have to call them prisons.
Oh good somebody -did- understand what I was getting at. Thank you.
I was also thinking about multiple tiers of "homeless prison" catering to different needs (probably not every homeless person needs to be kept on their medication all the time) but erased that paragraph because it got overly specific.
But among many other advantages, calling your housing-and-rehabilitation program a prison also lets you route around a lot of housing regulations.
Also clears up emergency responders from dealing with low-stakes crimes and faked medical emergencies by people who are just looking for a bed and a meal.
Hmm... This calls to mind Dante's circle of virtuous pagans (in contrast to the _rest_ of the prison system, and in contrast to the _rest_ of hell...).
You should start by asking why they have the right to put people away even if they haven’t done anything wrong. And if the people who put people away should be the go-to-authorities for deciding what to do.
I have seen with my own eyes people being committed to insane asylums even though they haven't done anything wrong and aren't insane (unless making jokes and breaking social norms is insane). Instead of asking what we should do about them, maybe the first step should be to stop doing that to them?
I do not accept that vibes is a good substitute for rule of law. A lot of the problems are actually caused by misdiagnosis by the so called experts (who are not neutral by any stretch of the imagination), but somehow they have a veto on what we can and should do. People like you talk to THEM instead of the patients. And they talk to external actors instead of talking directly to the patients. Perhaps you say, that's the law,, but if a law is unjust, we shouldn’t follow it. Isn’t that one of the most important lesson of the 20th century?
The experts have a clear and consistent record of opposing everything that works that doesn't give them full control. Maybe you should think of them as being in the control buisness, not the health buisness. They think they can assess whether people are insane or not even without talking to them, just observing them!
The court always defer to the psychiatrists, but why don’t they let the defendants speak for themselves in a court of law? Did you speak to the patients in your case? Or god forbid, did you ask the experts what the patients opinion is, what their state of mind is and so on?
Now go to your favorite forum and ask some experts how to interpret this. Inject your morphine and make sure you get a sanitized version of what I just wrote, so that it is easier to refute it. Strawmen don’t fight back.
"unless making jokes and breaking social norms is insane"
What social norms did they break? "Don't walk on the grass" or "Don't defecate in public, expose yourself in front of a preschool, and rip out copper cabling to sell to junkyards"?
There's a spectrum there, no doubt, but I more and more tend towards "those arguing for drug decriminalisation and 'it was just a joke' about public order offences are the problem".
The social norms they broke were in the category of disrespecting authorities. They have also been falsely accused of breaking other norms similar to the ones you mentioned, but without a shred of evidence.
Arguing for drug decriminalisation is sure to raise the suspicion of paternalistic authorities, since their modus is looking for anything that deviates from the norms. You are supposed to worship the drug laws and if you don’t, you must have something to hide. Probably drugs. That’s their modus. It is based on moralizing, and is a yuuuuuuuge part of the problem.
Moralization has all kinds of externalities, with devastating consequences for those on the receiving end of it. That is one of the reasons (far from the only one) why drugs need to be decriminalised. Fighting moralization is and should be an important priority. It is like an all permeating disease in some countries. If 'vibes' are allowed to determine how we commit people in the age of hi-tech surveilance we have lost democracy. I don't think people realize just how much they are giving away if they allow experts free rein to determine if someone should be committed based on their assessment of the patients 'mind', by using 'vibes. I mean holy shit!
I must also add that astral codex is wrong on some of his premises. This one for instance:
”And everyone would support a magical bill that cleaned the skies with no extra hardship on industry.”
People who benefit in terms of power, privilige, money etc would fight tooth and nails against solutions even if they come ”with no extra hardship on industry”. Assuming that the system is free from corruption is more than a little naive. It is easy to be fooled by the idea that no one would seriously want people to go to prison or insane asylums if they are not criminal or insane, but evidence proves this is just wrong.
My problem with the drug decriminalisation/legislation argument is that there is "nobody except nice people like me who can responsibly use fun party substances and continue to be productive citizens will take advantage of this" reasoning mixed in with "and this will magically do away with criminals gangs" plus a helping of "and so if people do fuck up their lives by being junkies, well tough for them, let Darwin sort them out because they'll overdose, kill themselves off, and the problem is self-solving".
If your anti-authority anti-social pals just fucked up their own lives, the rest of us could cope with that - even if it involved "We are the cosmic horrors" of a comment above.
If the "disrespecting authorities" means "when told not to do it, I continued shitting in the street in public, being drunk/high, hanging around threatening people for money, and generally acting like an asshole because normies are chumps, rules are for the sheeple, and I feel no obligation to the straight square citizens because fuck them", then yeah I'm with the "okay actions have consequences and you're getting in trouble there".
Obviously they let the defendants speak for themselves at the trial.
This isn't always a good thing. I remember one case I was involved in where a guy tried to choke his Uber driver. The judge asked him why he did it and he shouted "HE MISSED MY EXIT!"
That having been said, yes, I agree that some percent of commitments are frivolous and unfair.
First off, I don't buy the "80% of homeless people are only on the streets for a year" nonsense. It's difficult to systematically study that population and the only people who care about this enough to study it are bleeding heart liberal douchebags. I do not trust them to keep their ideology out of their sociology so I believe that 80% figure is purely designed to make people have more sympathy for homelessness ("oh they're not bad people they just had some bad luck"). My guess is that they gerrymander the denominator of that equation to include people no normal person would think of as homeless. The kind of homeless that people actually care about (pitching tents, starting fires, breaking into warehouses, begging for change on the same corner every day, etc) are definitely not on the streets for < 1 year on average.
Now the solution. Just like crime, I'm sure that the worst 5% of offenders account for 90% of the problems. This was the idea behind 3 Strikes, which is an excellent policy. The sob stories you read about the poor college kid getting his third strike for pot are completely cherrypicked nonrepresentative examples. Establish something similar for homelessness: 5 arrests for vagrancy/disturbing the peace/etc in 24 months (or whatever is the optimal threshold) and you're labelled a chronic vagrant and any non-serious crime you commit from now on shunts you to an administrative system where you're either a) involuntarily committed if you're mentally ill or b) placed in a Joe Arpaio-style low-security internment camp: just fence off a few thousand acres of scrubland somewhere. Put it in some third-world shithole like Bolivia, even. Put them there for, I dunno, a year. It doesn't really matter. The point is you have someplace to put them that both gets them out of MY way and incentivizes them to not get arrested again. Parolees go through a halfway house for 2 months in an attempt to get back on their feet. I realize that almost everyone will be stuck in an endless cycle and just keep getting arrested again. I don't care. Most of these people are worthless human trash and will never be productive again no matter what resources are thrown at them. Just herd them like the semi-feral animals that they are and try to keep them from doing damage in the most cost-effective way that doesn't become explicitly inhumane. It will be unpleasant for them. It SHOULD BE.
> First off, I don't buy the "80% of homeless people are only on the streets for a year" nonsense
There's a bizarre tendency among some people who fancy themselves as "helping" to massively exaggerate the size of a problem by expanding the definition of the problem to include as many people as possible. So now,
"Homeless" includes anyone who is stays in a hotel or with a friend while looking for a new apartment.
"Mentally ill" includes everyone who ever feels depressed or anxious (the source of Scott's "22% of people have mental illness" statistic)
"Autistic" includes everyone who is a bit socially awkward.
Cramming more and more people into these categories may or may not help you get funding, but it sure as heck doesn't help the people with major problems to be lumped into a category with people who have minor problems.
>Now the solution. Just like crime, I'm sure that the worst 5% of offenders account for 90% of the problems. This was the idea behind 3 Strikes, which is an excellent policy. The sob stories you read about the poor college kid getting his third strike for pot are completely cherrypicked nonrepresentative examples. Establish something similar for homelessness: 5 arrests for vagrancy/disturbing the peace/etc in 24 months (or whatever is the optimal threshold) and you're labelled a chronic vagrant and any non-serious crime you commit from now on shunts you to an administrative system
Yup. That draws a nice clear line that deals with the power-law-distribution nature of the problem and selectively limits the harm caused by the worst 5%.
"you can slightly alleviate some of these problems with long-acting injectable antipsychotics, which can be given at the doctor’s office, but the patient still needs to go to the doctor once every few months.)"
Appointments every few months seems a much lower bar than every week or so. What happens when countries lean heavily into long acting antipsych?
Since the problem seems to always boil down to homeless crazies not being able to take their meds consistently, if a person requires antipsychotics to be barely functional, that person should be in some sort of supportive or institutional environment.
People keep saying "Housing First", what does it actually mean? What kind of housing, and where? Who pays for it? What are the conditions to live in it? If you give homeless people free houses, how do you prevent people from becoming homeless to get free houses?
I feel like a lot of people just mean "build more middle class apartment towers in San Francisco" because my rent is too damn high. Which may or may not be a good idea, but it just crams more middle-class people into San Francisco, it doesn't solve problems for people at the bottom.
This post underestimates how rational most crazy homeless can be when exposed to the right incentives.
For example, notice how crazy homeless people who attack others just have a knack for attacking old Asian ladies? How many news stories have you seen where a crazy homeless person attacks a muscular military man and gets his ass beat for it?
Draconian penalties will reduce the number of noncompliant dramatically.
"Do you keep a completely sane person locked in the mental institution forever? Or do you let them out, at which point they will inevitably stop taking the drugs and become psychotic again?"
Well, the problem is that our medications have improved. In the past, the meds wouldn't improve them so yes, they would have stayed in the mental institution forever.
The presumption in your whole article is that the mentally ill should have choices and freedom that dramatically restrict the choices and freedom of others, and I'm not sure that's fair.
So for example if people stop taking their meds they minute they leave an institution but wail about being stuck in an institution while on their meds, then we can decide to slap an electronic anklet on them and make sure we can track them. If they don't show up for meds, then they go back to the institution.
San Francisco has more homeless people than beds because lots of people find California attractive for homeless life, due to their mild winters. Why should California have to pay a fortune for housing psychos simply because they don't like Tennessee and New York is too cold?
And so on. So yeah, arbitrarily cruel and draconian it is. They can sit in a psych ward while feeling sane if the alternative is sitting and shitting on the sidewalk.
There are certain problems that are simply unavoidably complex and expensive because they require customized individual attention and most of the solutions are not automate-able. If we were serious about addressing this issue (and I don't think we are on the large scale) we'd have to accept that a quality solution is going to seem quite inefficient. It would have to start with coming up with a system to create thoughtful individual plans and then have a housing, transport and executive function support structure to support those plans. knowing full well that a sizable portion of the population will still fail and fall thru. Doing the short term hospital tango combined with sweeping incarceration, pushing people into the margins of cities and towns, letting them fend for themselves and just going numb to it is a much simpler and cheaper, if less humane and more messy solution overall. It's the one we've chosen. Part of that solution includes shutting the fuck up when you're about to say "we should do something about this".
Can we replace the pledge of allegiance with some generalized version of your introductory paragraph?
"Any...legislation must be made of specific policies. In some sense, it’s impossible to be “for” or “against” the broad concept of X. Everyone would be against a bill that devastated [some valued aspect of the world related to X] for no benefit. And everyone would support a magical bill that [achieved utopia with regard to X]. In between, there are just a million different tradeoffs; some are good, others bad. So (the technocrat concludes), it’s incoherent to support X. You can only support (or oppose) particular plans."
Great article! My nonprofit is working on a mental health solution that aim that we hope increases agency for folks to make actionable changes that'd improve their well-being. Our differentiation is that we focus on using meaning & purpose to motivate people.
We're still early but some of our testing has shown promising results. We definitely haven't worked with a homeless person yet, but if were to try our intervention at a small scale during steps 3-4, I'd be curious if we were able to have an impact even on a subset of people.
If you know anyone that'd be good to connect with, let me know!
A lot of people here seem upset by the "vibes diagnosis" part of the article. But I don't see how else it could work. The legal system often requires the reasonable judgement of agents, whether they are judges or juries or in this case psychiatrists. The more specific the law is the more constrained the actions of agents are. A very specific and exhaustive policy could be implemented. Then when a clearly dangerous patient gets released and hurts someone else the psychiatrist will just shrug and say, sure the guy was clearly a danger but the 10-step Ultra Legal Psychosis Evaluation (tm) said he was fine! What can I do, the law is the law.
Besides, mental evaluations are very subjective anyway. It's not like a psychiatrist can give out a test strip and if it turns blue you're free to go, but it turns pink and you're institutionalized. I suppose evaluations could require a triumvirate of psychiatrists to agree, to reduce the chance of bad subjective evaluations. But that would require triple the staff, which is probably not realistic.
Hi Scott. This is an absolutely excellent article you've written here. I'm not going to make this about me, but I will say that I have some qualifications for knowing a bit about this topic (not as many qualifications as you, obviously) and I believe you have absolutely nailed it. You have said all the things that need to be said, you said them clearly, and I don't think you left anything out. However, I have an observation, and perhaps a question, about the meta-level here. That is, it's clear by the end of the article that your target audience for this essay is conservatives — for example, that's the impression I get from a sentence like 'Don’t just write yet another article saying “the damn liberals are soft on the mentally ill”'. Also, your statement that "...all of these 'We Should Do Something About The Mentally Ill' articles..." treat Housing First as their "foil" suggests that the "all" you are referring to here is actually limited to the conservative-o-sphere, because it's certainly not true that all *liberal* pundits on the topic of mental illness and homelessness are opposed to Housing First. In fact, I'm kind of curious about why you dismiss any discussion of Housing First so quickly on (apparently) no basis other than its reputation in the conservative world, without addressing the relatively large evidence base. I assume you didn't want to get sidetracked from the key point you wanted to focus on, which is fine, but it's interesting that you presented your reasons for ignoring it as coming from the conventions and biases of conservative-pundit-world rather than your own didactic priorities.
So, I guess the question I have here is this: to put it bluntly, does this essay appear to be targeted at conservatives because you are aware they are the ones who need to hear it most (at least on this topic specifically)? Or does the essay appear to be targeted at conservatives because you're simply most interested in talking to conservatives in general?
Of course, in the final analysis, the general principle of your essay, the principle that "if you want to think of yourself as a serious pundit, or at least a commentator who isn't a moron, you should be somewhat specific about policies you're proposing and not just whine and rant a lot" is very good advice for anyone, anywhere on the political spectrum. You clearly (clear to me, at least) implied this generality in your intro about anti-pollution sentiments. I do want to give you a lot of credit for being balanced at that level.
Thinking about New York, where you can actually get a bed in a homeless shelter if you want one, I am not very sympathetic to these logistical concerns about institutionalization. A very small portion of New York's ~100k homeless are the ones people have a problem with--terrorizing subway cars, shouting at passers by while clearly not in their right minds. This very small portion of the homeless, who refuse to go to shelters available to them--let's say 10,000 people, but it's actually much less--could and should be institutionalized.
I totally reject the jump between "actually when you let sane-seeming homeless people out of the asylum, they revert to using drugs and being psychotic" and "ok I guess we must build a massive social safety net to solve the problem from the bottom up." There are obvious ways to prevent this--progressively longer institutionalization for repeat offenders, for example. As it is, no one is doing this at all! Crazy people defecating on the subway just keep on doing that! So to me, it comes off as a small logistical nit that is then used to smuggle in a complex web of social services, instead of institutionalizing the vanishingly small portion of New York's population that causes problems for everyone as well as themselves.
Separately, I'm more sympathetic to the intractability of SF's homelessness problem, because as you describe, you can't even get a bed in a shelter in the first place (though this is a really obvious starting point for change).
I worked as a public defender for a few years after law school. In my state we did not represent people at 96 hour commitment hearings. But I can assure you that in the analogous situations where commitment for months was a possible outcome, we would have met with the defendant for at least an hour about just the hearing itself, and likely another hour or two about whatever inciting incident had made them a client before that point. It was not uncommon to have hours worth of conversations with clients who had fixed delusionary beliefs, sphexishly returning to non sequiturs, and/or severe problems with logic and memory.
In the event that a client was absolutely incoherent and unable to communicate about his case or our representation of him, we would review medical report summaries, make notes for questions, and reach out to family members or other contacts, among other strategies. Even on a rushed basis and in circumstances where the ward was entirely non-interactive, I would not have considered anything less than 1-2 hours of review to be adequate representation of somebody in an adversarial hearing the result of which might be commitment for weeks or months or longer.
In my time serving as a GAL, which can similarly impact a person's liberty interests, the absolute BARE minimum would've been something like an elderly patient in skilled nursing following a devastating stroke who could not communicate ideas at all, and who the public administrator or family needed guardianship to have him placed there and the service paid for. In those cases, no matter what I was told, I always still insisted on personally traveling to the facility to verify with my own eyes the person's condition and attempt to speak with them, and review the doctor's interrogatories, and find the nurse who works in his wing and ask her questions about him, and even under ideal circumstances this would take at least an hour not counting travel time.
I seriously doubt that ANY attorney is handling serious commitment hearings in the fashion that Markie Post handled bail hearings on TV's "Night Court", and if you ever find one that is you should report them.
"They lose their prescription and don’t know how to get another one. Or they call their insurance, insurance whines “these drugs cost $500 and you lost your last prescription too, we’re not paying”, and they don’t know what to do."
If someone doesn't pay their child support because of bad luck or poor executive function, they get several chances but eventually end up in jail. If one doesn't pay a fine, he goes to jail. If one violates probation? Jail. Disobeys a court order? Jail. "Didn't take the drugs that stop one from being a danger to everyone around them" isn't an exception. If someone consistently "loses" their prescription, lock them up.
"Another homeless person steals their pill bottle thinking it might be opioids; later they will grind them up, snort them, and have the worst day of their lives."
Turns out bums are backstabbing, thieving scum who will steal anything they can, on the off chance they can sell it or use it to get high. This is a shock and surprise to absolutely no one, but we're not allowed to point out that the patient likely did the same thing to someone else quite recently.
"The patient messed up their appointment with the welfare bureaucracy that was supposed to give them a free subway pass, so they didn’t get one, so now they can’t make it to their doctor’s appointment."
He didn't mess it up. He missed it because he was high. But it doesn't matter anyway, because he always jumps the turnstile even when he has a pass.
"The patient went to their appointment with the welfare bureaucracy that was supposed to give them a free subway pass, but in the waiting room they spotted a drug dealer who had a grudge against them, so they left because they worried they’d get beaten up."
Turns out bums are dangerous, violent scum who regularly knife each other, often about the things they did to get high. This is a shock and surprise to absolutely no one, but we're not allowed to point out that the patient likely did the same thing to someone else quite recently.
"The patient was in the hospital with sepsis during their psychiatrist appointment, and nobody told them how to get an alternative psychiatry appointment.
The patient wrote their appointment time on a piece of paper, which they left in their tent, which got flooded in a rainstorm and all their stuff was washed away."
And because the best way to get a pass on any kind of accountability is to demonstrate learned helplessness, he got high instead.
"Am I just being gullible? Are these people just making fake excuses?"
Yes. The truth is that they got high, sobered up a bit, realized they missed an appointment to stay out of jail, called, found out about the fine, used their standard lie to get out of it, and then got high again.
"In San Francisco, the average wait time for a homeless shelter bed is 826 days. So people mostly don’t have the option to go to a homeless shelter. If you criminalize unsheltered homelessness, you’re criminalizing homelessness full stop; if someone can’t afford an apartment or hotel, they go to jail."
They could leave SF, but that's where they can find drugs and get high. They could get a job, but then they couldn't be high.
"Most (?) homeless people are only homeless for a few weeks, and 80% of homeless people are homeless for less than a year. If someone was going to be homeless for a week, and instead you imprison them for a year, you’re not doing them or society any favors."
Basically all of those are not actually on the street, so they wouldn't be criminal.
"How long should prison sentences for homelessness be? Theft is a year, so if homelessness is more than that, it becomes rational for people to steal in order to make rent. And realistically it will take police years to arrest all of the tens of thousands of homeless people, so if a sentence is less than a year, then most homeless people will be on the street (and not in prison) most of the time, and you won’t get much homelessness reduction."
What is deterrence and how does it work?
"What’s your plan for when homeless people finish their prison sentence? Release them back onto the street, then immediately arrest them again (since there’s no way they can suddenly generate a house while in prison)? Connect them to social services in some magical way such that the social service will give them a house within 24 hours of them getting out of prison? If such magical social services exist, wouldn’t it be cheaper and more humane to invoke them before putting someone in prison?"
You make the crime something like establishing an encampment within city limits, and once they have to encamp somewhere without a lot of traffic for begging or pickpocketing, they will leave.
Hell, you live in San Francisco, where homelessness is almost celebrated and bums are a Special Class exempt from a lot of law.
"Don’t mumble something about “I just want these poor people to be able to get the treatment they deserve yet don’t know how to ask for” before going back to railing against the damn liberals."
Ok. These people are scum who choose this life because it lets them get high and dump most of the costs of their conduct onto innocent people. There may be a handful of organically insane people among that number, but that's what the asylums were for. Yes, historically asylums were terrible, but that's in large measure because they were full of people who would stab their neighbor because the squirrel in the window promised to take them to the magical kingdom of shudooweewa if they made someone bleed. It's really hard for people to maintain a sense of compassion when dealing with a population more dangerous and unpredictable than a pack of wolves. But the modern ethic is that letting them rip each other apart is totally ok as long as innocent people have to bear a lot of the burden, because passivity is innocence.
remove red tape, limit zoning restrictions, green light alternative housing for dome homes, shipping containers, whatever that can be fabricated en masse (they can 3D print structures now), remove fees and red tape for those wanting to build their own home. Used to be you could go into the woods and build a cabin.
Maybe also relax mortgage requirements - if you prove you can pay your rent on time for 3 years you should just qualify. Sure the bank wants a down payment to make the risk worth their while but it costs more to deal with homeless people (let the government subsidize a minimum 5% down payment b/c its cheaper in the long run).
I hate this one but maybe we need a "social service" for getting housed and that being the only function it performs. They'll cover fees, help you submit the paperwork, tell you from top to bottom what you need to do step by step until you can acquire a home via the means above.
The real problem is bureaucracy and regulation - lack of money just makes it more difficult.
I like this idea as a carrot, but I think it should also be coupled with something like the sticks some of the others here are proposing (eliminating tent cities, better enforcement against public nuisances, etc.)
“…go straight to the part where you explain how you plan to do better.”
OK.
1. Build out more homeless shelters so that nobody is forced to live on the street. This includes reputable shelters, but could also be extended to some abandoned warehouses or parking lots or fields with cots, teepees and Quonset huts and porto-potties, with food and water and 24 hour guard service.
2. Allow affordable housing to be built, primarily by specifically allowing converted garages, multi family rooms, and most importantly, mobile homes.
3. Require anyone sleeping on the street or erecting a tent to go to the above defined shelter. If they refuse, arrest them in a non-draconian way.
4. Arrest anyone disturbing the peace with derelict rants or defecating in public or engaged in petty theft. If the police aren’t willing/able to do this, get a new police chief and/or DA.
5. Build mental facilities and create a process to sort who goes to these rather than jail. I will leave the details to those experts actually willing to try and solve it. If nobody is capable of designing this system, then, I will settle for just sending the repeat offenders to jail.
In California, the budget for all this is probably a fraction of the billions already set aside to address the homeless problem. If not, spend more, but do it in an effective way which doesn’t pander to the “housing first” special interest lobby.
You need some sort of triage based system. Both for mentally ill homeless people and for regular criminals. Try to evaluate what type of intervention a person needs, and give them that, starting with the people who need the cheapest interventions. Some people just need a place to stay for a few weeks. Some people need relatively simple psych treatments.
- Housing first for the ones without severe addicition or mental illness
- Group homes(assisted living facilities for those discharged from psych wards until they get their life together
- Long term psych hospitals for those too dangerous and unresponsive to medication
- Pressure but don't force addicts into treatment. Possibly send them to prison eventually if they can't get their shit together. Addiction often has underlying causes so try to treat those.
It's not a cheap system but not so expensive that it couldn't be paid for with budget cuts to other programs and maybe a little bit of debt and taxation. NYC has some of these features already but they are underfunded.
I have worked with guardianship and mental health in downtown Toronto for over a decade.
As long as it is an option to live on the street for free, lots of people will choose that option (or default to that option to avoid more difficult choices). Wherever they are permitted, encampment communities grow faster than Austin.
It does not take too long living on the street using drugs and drinking every day for someone to convert themselves into the category of intractably addicted and mentally ill.
I think Scott has started from the "intractably mentally ill" point and done a great job of discussing the tradeoffs and issues with coerced care options. This is where I worked and I agree.
But isn't the real issue that we have SO MANY MORE homeless and mental health issues and drug addictions than in prior decades?
I think the proper way to evaluate the benefit of making sleeping outside illegal is in how much it slows the current machine converting at risk people into lifelong mental health and addiction patients.
I support zero tolerance for encampments despite the obvious fact that many current mentally ill and vulnerable people will suffer under such a policy. I believe a much larger number of people will be forced to find a path other than setting up a tent and self-medicating.
Well, looking at much of the rhetoric and the comments here, the problem people seem to have is not that the homeless people are dying on the street, but that the homeless are dying on *their* street. That's a much simpler problem to solve, no?
Homelessness is not new, and SF has long been a magnet for the homeless. Being an old guy, I think it might be helpful to look at how SF dealt with the problem in, say, the 1950's. Do you know any old-timers, Scott? My impression is that one thing they did differently is that they did not treat "the homeless" as a single population.
There were at least four separate populations: (1) "bums" - hoboes, drifters, etc. The cops wouldn't let them panhandle, annoy people, camp or spend nights in public parks, etc. Basically they had to "move along" and find the local skid row, where there was very cheap lodging, soup kitchens, shelters, etc. (2) drunks and addicts who passed out in public, or close to it - they put them in drunk tanks in jails until they sobered up. (3) obviously crazy people - took them to the local psychiatric hospital, where they were observed for a few days. If they didn't regain functionality, they were sent to long-term asylums. (4) people who were functional, and didn't want the hobo lifestyle, but were just really down on their luck. The were referred to charitable relief agencies, usually religious. Maybe they were given bus fare back home.
Of course all the people in charge back then were cruel and heartless, which helped.
It sounds as though a technological solution to part of the problem would be antipsychotic drugs that don't have to be taken every two weeks, perhaps some sort of continuous release pill or device.
I'm very late to this party, but I want to plug this in here anyway: this essay makes the case for the problem of crazy homeless people being more or less intractable, which I...don't want to say is wrong or incorrect or anything, because Scott is speaking from a position of knowledge/experience that I don't have and if there were simple ways to ameliorate these problems, I would imagine some earnest young School of Social Work grad would have figured it out a long time ago.
That said, I can't help but notice that the problem seems to be getting significantly worse over time. There seem to be more homeless people per capita, and they seem to be crazier and more anti-social than ever. That being the case, I can't help but feel that there is *something* wrong with current policy wrt: crazy homeless people. Public policy with regard to homelessness and mental health has not been static, either. It has changed substantially over time. I know, I know...correlation and causation and all that, but if you just consider the logic of "we have been plagued by problem X for some time, we changed our approach and problem X got worse rather than better (and significantly worse, at that),' it's hard for me to believe that the status quo is the best we can do.
As the essay says, though, I am not motivated to learn the intricacies of tetrathorpazine and its various chemical properties necessary to formulate meaningful policy proposals. Easier to just hang in the suburbs and chime in with the occasional "you guys are f#$%ing the dog!" admonition.
For the problem of psychotic homeless people, what about long-acting antipsychotics? Obviously it's not a complete solution, but those who are homeless and psychotic seem like they are among the least likely to improve their situation without medical intervention.
I'm sure there are reasons antipsychotic LAIs aren't the routine treatment (or maybe they are?k for people who are psychotic and "dangerous" enough to be involuntarily committed, but I don't know what they are. Perhaps as a psychiatrist, Scott, you have more insight into that area.
For the chronically homeless with other medical problems that make it more difficult to become housed (other mental illnesses, drug addiction, severe cognitive disability), it seems like cost is a significant barrier to improving the situation - there just aren't enough inpatient beds, as you point out. I'm sure there are countless cost-benefit analyses; but some of them (which probably get disproportionate left-leaning media coverage) find cost *savings* from permanent supportive housing for homeless people with chronic mental illness. Like this one: https://morrisoninstitute.asu.edu/sites/default/files/housing_is_health_care_report_2021.pdf
Is this just a bad study with flawed methodology? If not, then that would seem to point to a primarily political problem: it means that although the public would save money by providing more PSH, for some reason it doesn't happen. Maybe this is because it's very hard to reduce police force sizes on purpose; or because people don't want to give homeless people what feels like a handout; or maybe some other reason. But this seems worth exploring.
Where does intent among bad actors creating the systems fall into this discussion? Not sure how true that is but that's a pretty popular opinion for people to have. I can't imagine fixing homelessness with the tools/incentives we have societally right now.
A few questions about drug-addled chronic homelessness in the US.
1. Why do the worst affected congregate around downtown neighborhoods ? If the welfare resources get moved to an abandoned part of town, would they also move there ?
2. Where is the line for cruel and draconian ? Liberals move the goal posts on it often enough, that you can't blame people for failing to qualify their solutions. Mandatory confinement for those who've commited crimes or at-least mandatory displacement do not sound cruel or draconian to me.
3. Why is the call for 'more housing' taken to be a call for 'more housing with first world amenities' ? Why can't we put people in large hostel bunkers. A homeless person is entitled to a roof & bed. Separating out cohorts by drug-consumption, at-risk-ness and criminal record can't be that hard. You don't need 'more housing'. You need a large barn with a bunch of bunkbeds and a public restroom.
Building codes, usually. In the 60s a lot of city building codes were put into place requiring X number of feet for a bedroom, with X number of windows, etc. Many, perhaps most, were put into place to make flophouses illegal. In a flophouse you basically got a bed in a closet, but they were dirt cheap to stay at. Building codes made them illegal to build or operate, put in place by the well meaning reformers on one end (who argued that we needed basic minimum standards for the sake of tenants) and home owners/real estate developers on the other end (who wanted the poor people flophouses attracted driven out of town).
So in most cities in America today if you wanted to build a big shelter with just a roof and a bed, you would probably fall afoul of building codes and never be allowed to build or operate it.
This article, it seems to me, fails to engage with the question of why people become homeless. Like cancer, there are many causes for homelessness, and we should not expect to find a single intervention that works well across the board (except, perhaps also like cancer, aggressive and draconian interventions).
One taxonomy I have seen divides the homeless into three groups with distinct needs:
* The “have nots” are simply poor. They need more housing construction to lower the price of housing, and in the meantime other social interventions like food stamps, cash aid, job training, safe sleeping spaces, etc.
* The “can nots” have serious mental health or substance abuse problems. They need some kind of institutional supervision, whether it’s full institutionalization, group homes or something akin to parole.
* The “will nots” have opted out of capitalist society and are just bumming around. They are the modern hobos. As long as they aren’t bothering anybody they don’t really need any intervention; to the extent they are committing crimes, they just need criminal justice.
Note that there are interactions between these groups. In particular there is a pathway from contributing citizen, to have-not, to will-not, because among other things being homeless is very bad for your mental health.
That seems a reasonable way of dividing them up. In my descriptions, I normally elide the "will nots" (which I've sometimes seen described as "lifestyle homeless"), because there are so few of them, and by themselves they don't tend to cause as much of a problem.
I suspect that talking about "homeless" or "unsheltered" is unhelpful, and makes it harder to come up with a solution. IMO, there's basically the people who need shelters and food banks and job assistance, and then the people who need intensive medical assistance, and then the people who need prison. (And again, at the end, the "will nots" are left over.) "Homeless" is just as much of a symptom as "fever" or "cough", and while a certain amount can be done by treating the symptom, it's easier to make progress if we know the cause.
Would echo that the real pain / frustration for folks who live in cities which have significant numbers of unhoused (mentally ill or otherwise) is the associated criminal activity.
1) Theft of packages, items in cars, and from local businesses. This "death by 1000 cuts" impacts quality of life hugely: both directly (my stuff stolen) but also fewer local amenities because they can't remain profitable with the loss from theft.
2) Unsanitary / dangerous environments in places which are visited frequently as part of your day to day life (and for tourists/ visitors to the city) - particularly areas rife with drug use / trade. Having to watch out for used needles / human waste on the way to my kids daycare is a big drag on quality of life (and makes me want to leave). On the "bad experience for tourists/ visitors" - aside from the economic hit our many businesses take from fewer tourists coming because our city feels unsafe, it's also pretty exhausting having family / friends continually tell you how awful your city is because they visited civic center.
I think simply put a huge benefit comes out of simply enforcing existing laws effectively. I don't see this as rocket science, cities across the world do this every day. Police need to find and arrest people who break the law (drug dealing, theft, selling stolen property, public intoxication/incapacitation due to alcohol or drug use). To achieve this, we need to make it easier for police to find these law breakers - I'd advocate for a significant expansion in CCT cameras around the city etc. and DAs need to prosecute these crimes with vigour.
This will by its nature push the worst elements into ideally the criminal justice system or (less desirable, but still preferable to today) less monitored parts of the city (read semi industrial type neighborhoods).
The severe mental illness issue I think is overblown - yes random dude screaming at you is bad. But continuous law breaking by 100s more people is far worse. If the mentally ill dude breaks the law, then he goes to jail (and gets his anti-psychotics there).
Why can't we innovate the antipsychotic options. If the crux of the problem is the point at which the individual stops taking their medication, can't we do better there? Immunisations and contraceptives are now available in long-term, slow release options. Some ranging up to the 4-5 year mark. Is this out of the question for antipsychotics? Then intervention could look like: institution - short release medication, working with medical/social workers, becoming better-minded, signing over to long term medication, release into public housing...
I assume when people are saying we should crack down on homelessness in liberal city x, they generally mean pick a less liberal city y that has less homelessness and start imitating their policies. It seems unlikely these existing cities are the version of maximally draconian described above. I think this is a little to easy on the speaker as more concentrated cities are more liberal and also have more homelessness so the causality might not always be the direction the speaker hopes, but it seems like a reasonable position empirically.
This is quite easy: enforce laws regardless of the perpetrator's presumed state of mind. It's not the penal system's job to read minds and hearts. It's their job to enforce laws. Anything else is a dystopia. The so-called insanity defense is insulting to both victims of crime and mentally ill people.
As to the fact that an apartment in the Bay Area costs a fortune, that's easy as well: not everyone has to live there. My schizophrenic family member has been living happily for decades in the woods where he is a danger to no one and can live on a shoestring budget without having to work. Personally, I'd love to live in central London, but I can't afford to live there. That's life.
The only thing that will "solve" mental health is actual medicine, that is long-lasting, cheap to manufacture and distribute, and doesn't have horrific side effects. Let science work on that.
The legal, medical, and housing systems are all their own messes, the last thing we need is to further confuse the problem by trying to combine them.
>It's not the penal system's job to read minds and hearts.
It's absolutely the penal system's job to read minds and hearts. They even have a fancy latin phrase for it.
If you run over a person with your car because you wanted to kill them, you get a much much harsher punishment than if you run over a person with your car because you accidentally drove through a red light. Intent is a key factor in most offences.
I have a limited reading scope on substack. But this piece does remind me of a recent Freddie DeBoer piece about the woke left being unable to verbalize any potential solution for the mentally ill beyond myriad variations of throwing more money at it. Point being that unless involuntary treatment and institutionalization is on the table, it is a useless discussion (ie if a mentally ill person can reject that largesse, then additional money adds nothing).
But this is a useful extension of that question. So let’s say we can institutionalize these people against their will….then what? Cuz we can’t actually “cure” these psychiatric issues, but only treat them. And the treatment only works as well and to as much extent as the patient takes them. So an inpatient who takes his meds and gets better, then is discharged and stops taking his meds, will simply get worse and end up institutionalized yet again. It’s lather /rinse/ repeat. I have no idea how you break that cycle. A Hitchens-ian wicked problem.
I have a limited reading scope on substack. But this piece does remind me of a recent Freddie DeBoer piece about the woke left being unable to verbalize any potential solution for the mentally ill beyond myriad variations of throwing more money at it. Point being that unless involuntary treatment and institutionalization is on the table, it is a useless discussion (ie if a mentally ill person can reject that largesse, then additional money adds nothing).
But this is a useful extension of that question. So let’s say we can institutionalize these people against their will….then what? Cuz we can’t actually “cure” these psychiatric issues, but only treat them. And the treatment only works as well and to as much extent as the patient takes them. So an inpatient who takes his meds and gets better, then is discharged and stops taking his meds, will simply get worse and end up institutionalized yet again. It’s lather /rinse/ repeat. I have no idea how you break that cycle. A Hitchens-ian wicked problem.
> . And the treatment only works as well and to as much extent as the patient takes them. So an inpatient who takes his meds and gets better, then is discharged and stops taking his meds, will simply get worse and end up institutionalized yet again. It’s lather /rinse/ repeat. I have no idea how you break that cycle
This seems like the same logic as "there's no point in cleaning things, they'll just get dirty again".
Maybe things do get dirty again. Maybe you do get stuck in an endless cycle of cleaning things and watching them get dirty again. But if you're cleaning them then they spend some of the time clean, and have a lower limit on how dirty they get. And if you never clean them then they just get worse and worse.
I agree. I’m simply saying that’s not an actual solution….or simply a temporizing one. Maybe that IS the best it can be, absent an actual “cure”. I’d be fine with that.
Then we have to bite the bullet and look at institutionalisation. If you can maintain your stability once released, because now you do have accommodation and support, good luck to you.
If you're not at that stage yet, but you can cope if in assisted living, then that's the next step.
If you continue to skip your meds, run out on the assisted living, and end back up on the streets because you can't do without lean*, then we are looking at "now you live in the asylum". It's important that we don't just dump people in asylums and leave the places to degenerate due to lack of funding, but if you can't live in any kind of fashion on the outside if left to your own devices, then for your own sake and the sake of the rest of the people around you, you get a nice comfortable cage with enrichment for what remains of your life.
I agree. But it does leave open the possibility of long term/indefinite institutionalization….with all the necessary infrastructure and funding required to sustain it.
It would, but it would need oversight. That's where things slipped in the past and ended up with the bad reputation that tarred all institutions.
What we can't have are 'for-profit' treatment centres/asylums, because the incentive there is "maximise gain for the shareholders". They may start off well, but end up cutting corners to squeeze out the last drops of profit from the government contract.
That's why I'd incorporate charitable bodies with the new long-term institutions, to help handle some of the burden. Not put it all on government agencies and not put it all on private charity.
As it stands, we effectively are using the corrections system to deal with the problem of the intractable homeless who are that way due to mental illness/drug addiction/other problems. The penal system is not intended or suited for that, and the public health system seems to be hampered by teh problems Scott describes: get them stabilised, get them out, if they go off their meds rinse and repeat.
We are pumping a lot of money into the problem, but it doesn't seem to be doing much about the basic problems of "this person is incapable of taking care of themselves, but is not suitable for jail and is just in and out of mental hospitals, so long-term, what do we do?"
Mixing ideas from the comments together, I like the carrot proposed by Meta Ronin, and the stick proposed by Wanda Tinasky. Start by improving housing prospects, and for the chronic bums that still can't get it together, impose more draconian measures.
Something I would like to add in the stick category is what I call "vagrancy sentencing". Basically if you get picked up for pitching a tent in a public park, or arrested for some other offense and it turns out you have no place to go right away when released, instead of getting a fixed sentence, you get a vagrancy sentence. This means you stay in jail until either somebody comes to get you, or you get outsourced to a mental hospital or some monitored treatment program. For some vagrants this would simply mean making a phone call: "Mom, Dad, I screwed up..." For others it may mean getting in touch with social services who can assist with subsidized housing, drug rehab, etc. For those who get arrested again (two or three strikes), then the consequences get more unpleasant.
Also, building on Meta Ronin' mention of building cabins in the woods, I could see this being proposed to certain individuals who aren't helpless or psychotic but just can't handle the industrial age life. What I'm thinking of is a wilderness survival program for those who volunteer and pass certain screening requirements (one of which is passing one or more wilderness survival courses). Those who qualify get dropped in some set-apart section of wilderness where they are basically on their own. In order for this program to work they must have NO public-funded outside help. Maybe private charities willing to foot the bill could deliver supplies and letters (though everything delivered should be bio-degradable). Apart from that the only contact with the outside world would be someone helicoptering in once a year to deliver messages and see if anyone's had enough and wants to return to modern civilization. But no publicly funded food, medicine, clothing, policing...nothing. Everyone who signs on understands that their life is in their own hands, and if they sustain serious injury or illness, or go Lord of the Flies on each other, then so be it.
> But if you’ve been demanding an end to pollution for years, and nothing has happened, then it might be time to hit the books, learn about hexamethyldecawhatever, and make sure that what you’re demanding is possible, coherent, and doesn’t have so many tradeoffs that experts inevitably recoil as soon as they have to think about the specifics.
Nah; that’s nerdy and low status. Much better to refuse to reason with the nerds and intimidate them into trying to please you anyway, as they owe you, since you can beat them up and steal their lunch money.
> So when people say “we should do something about mentally ill homeless people”, I naturally tend towards thinking this is meaningless unless you specify what you want to do - something most of these people never get to.
Not meaningless: it means, “I can’t be bothered to specify what I want, or even to make my demands consistent. Let someone else humiliate themself trying to do the thankless and impossible job of pleasing me”. Be careful what you wish for, though: the bolder and more confident version is, “Just rid me of those people who inconvenience me. You can send them to concentration camps and incinerate them alive for all I care. And don’t lecture me on learning from history or somesuch—I’m too cool and high status to listen”.
> most of these decisions are based on vibes that only loosely connect to the written law.
All the better to show whose vibes matter and whose don’t. Status, status, status all the way down.
> I admit that if you’re willing to be arbitrarily cruel and draconian (life sentence for someone and their entire family the moment the bank forecloses on their home!) you can make this one “work”. But anything less than that and it becomes just another confusing bad option.
So it’s probably not a case of “anything less than that”, but “Let someone else bear the costs and risks of admitting such willingness, even to themself”.
> Don’t just write _yet another article_ saying “the damn liberals are soft on the mentally ill”.
> If your plan is
If your plan is to gain status and money by being conspicuously unhelpful, writing yet another such article is exactly the way to go.
The way this is framed confuses me a little. I think homelessness and mental illness are two separate problems, with significantly different causes and probably distinct policy solutions. Why combine them? Which of these is the greater social problem? Which, if either, is getting worse more quickly? Do we really have a worsening problem that needs a new solution?
Rates of homelessness probably reflect economic scale factors. I've been reading articles lately that we do not build enough affordable housing. This doesn't just affect the mentally ill, obviously, the articles I have been reading were mostly focused on the effects on young and new couples and families. We probably need a better housing policy. Maybe this is one market that the Federal government should regulate more closely.
If the problem is centered on mental illness, I am not aware offhand of any reasons why this should be getting worse. Saying that we should do something about mental illness is a little like saying we should do something about diseases--well, yeah, sure; and we are, have been for hundreds of years. What else do you want?
I will say that a little prevention can replace a lot of expensive cure. Give homeless mentally ill (or maybe just poor people) a counseling resource (I mean a case worker, not a therapist) that they can access easily and develop a relationship with, and I expect that the rates of homeless mentally ill people acting out in ways that other residents find worrisome will go significantly down.
Or is the problem that mentally ill homeless people are becoming somehow more visible and intrusive to middle class voters? That sounds like a local policy problem to me. Has San Fransisco been cutting back on homeless shelters? Health care clinics? Maybe what's changed are city budgets, not large scale social forces that require a nation-wide policy solution.
My locality (not SF) is spending approximately $100,000 per homeless person per year, from city and county and regional and state and federal and nonprofit funds, and yet the problem is worse than a decade before. It's not, strictly speaking, "lack of funding" that's the root of the problem.
They are mutually interacting problems. A person with severe mental illness or substance abuse problems is more likely to become homeless; and a person who loses their housing is more likely to turn to substances to cope, or to develop mental health problems.
tl;dr. Question: would it be possible to maybe, just maybe, look at other countries' solutions to the problem. In an overwhelming % of countries, there just aren't those armies of psychotic homeless roaming the streets.
In the UK, the vast majority of out homeless people seem to be much, much better behaved than e.g. in San Francisco. (I have actually been to SF a number of times, so this is based on direct observation)
Our UK homeless people seem to contain a fair number of addicts (e.g . a couple of days ago, I am in the pharmacist to pick up a prescription and get chatting to local homeless guy who is in the queue to pick up his methodone prescription), but are, in the vast majority, not noticeably psychotic.
something seems to be different about the US.
(Of course, here we have a National Health Service) and the exact same infrastructure that was supplying recovering addict homeless guy with methadone would also be able to supply antipsychotics, if needed.
> But okay, suppose you build those institutions. How long are you keeping people there? Remember, someone’s going to come in, start taking antipsychotics, and (if the drugs work) appear significantly saner within 2-4 weeks. Best-case scenario, they’re completely sane. Now what? Do you keep a completely sane person locked in the mental institution forever? Or do you let them out, at which point they will inevitably stop taking the drugs and become psychotic again?
A person who, once released from an institution where they're locked up in, will "inevitably [...] become psychotic" is NOT mentally sane. Claiming otherwise is ridiculous. So I read this as "Should we really make a decision based on ground truth, even if the mere appearance points the other direction?" which I'm not really sure why anyone would ask as a (seemingly) rhetorical question.
Scott writes, very sensibility, "On the other hand, ordinary people should be able to say “I want to stop choking on yellow smoke every time I go outside” without having to learn the difference between hexamethyldeca-whatever and tetraethylpenta-whatever."
And then the rest of the post is him asking people to learn the difference between hexamethyldeca-whatever and tetraethylpenta-whatever (i.e., here is a massive list of potential problems that I as an expert have identified--reader, you must solve them). I think a lot of the logic around these problems is not so great and makes them seem more intractable than they are ("if the penalty for homelessness is greater than the penalty for stealing then people will steal to make rent" is a statement so devoid of common sense it seems almost like a parody of a rationalist). But even if these were good points... I don't care. I want the expert to partner with me on how to solve the "yellow gas I'm choking on" problem, not explain how complicated it is and how silly a straw man who "blames the liberals" is while I sit there and asphyxiate.
Some people are stealing to make rent. A lot of people are stealing because they are professional criminals and sending them straight to prison prison (not hospital prison) is exactly where they should be going.
"She's not rich and is under pressure, which is why she came prepared with equipment to shoplift":
Yeah, I'm thinking the lady is part of a criminal gang/professional shoplifter.
"A shoplifter found with a “de-tagger” in her pocket after she stole from four stores in a row admitted the thefts were premeditated, a court has heard.
Mother-of-one Ilona Tintari (28), who stole clothes and groceries worth a total of €289, was “not a rich person” and was under pressure, her defence said."
"Wahh wahhh wahhh I'm the mother of five kids and the grandmother of three" - yeah but you are also a professional shoplifter and thief who uses your kids to enable you to steal and are training them up to be thieves in their turn. No sympathy for you here, lady.
"My poor client has drug and alcohol addiction problems" - okay, she can get clean in jail, since being out in public has no effect on her stopping:
"The prosecuting barrister said Ms Casey is well known to gardai as a “serial shoplifter”.
“I am aware of drugs and alcohol issues. She has a serious drug addiction. She is well known to security guards. Efforts have been made to bar her from shops. When she was granted bail an order was made on her to stay away from Limerick city centre. She has 143 previous convictions,” said Mr O’Sullivan.
These include thefts, possession and sale or supply of drugs, public order, threatening / insulting / abusive behaviour and assault causing harm.
Mr O’Sullivan asked Garda O’Shea if the series of thefts were particularly brazen?
“Yes. No effort was made to conceal her appearance,” said Garda O’Shea, who added Ms Casey was easily identifiable on CCTV.
Erin O’Hagan, barrister for Ms Casey, said her client has pleaded guilty, it is her first time in the circuit court and is a lady who has struggled with addiction for many years.
The barrister said the accused has four children and her eldest is expecting a child."
"Okay, you get one last chance - after your last 76 chances" - maybe this woman needs the kind of structure that is found, oh I don't know, in jail? (Okay, I might give her a chance at hospital prison not prison prison, but if she reoffends after getting out of hospital prison, it's prison prison for her):
"Yesterday at the sentencing hearing, defence solicitor Shane Collins Daly said the 32-year-old understood that her offending could not continue.
Judge Dorgan said, in placing the accused on a probation bond, that there were three things in particular that the woman needed in her life: to get away from negative peers, have structure in her day, and get counselling.
Julianne O’Farrell of Marble Hall Park, Douglas, Cork, pleaded guilty to carrying out thefts at Diesel on Oliver Plunkett St, Dunnes on Merchants Quay, at Boots at Douglas (all in October/November this year), and on May 18, 2021, at Phelan’s pharmacy.
Sergeant Gearóid Davis said the accused had a total of 232 previous convictions, including 73 for theft, before the four latest offences."
"These poor kids are just trying to pay the rent!" Yeah, I'm sure:
"A TOTAL OF 14 people are due before the Courts of Criminal Justice and Swords District Court today for 23 separate charges relating to recent robberies.
The group of 13 males and one female were arrested as part of Operation Táirge, a criminal investigation by gardaí into crime targeting commercial premises in the north Dublin area.
Gardaí said offenders sometimes can be violent, with some using weapons such as knives and sharp implements, inducing fear and panic among victims.
In one case, petrol was poured onto a counter within a retail premise to invoke fear.
The operation has led to the arrest of 15 people connected to 20 incidents and Gardaí said the intelligence-led operation aims to identify people involved in retail crime.
Organised retail crime is where a number of people act together, targeting outlets to steal significant quantities of goods to sell back into the supply chain through the black market.
It can also involve refund fraud with the purpose of making a financial or material benefit.
The stolen goods are then sold to a “fence” who either sells them at a particular location or in some cases may sell them online in an activity known as e-fencing."
People in genuine need may steal food, baby supplies, or clothes. People who do this kind of robbing are not 'in need' but are professional criminals.
This kind of case is a grey area; the accused has previous convictions for theft, but stealing groceries does fall more on the side of the "in need" scale:
I have no idea if this is a troll or not, but the kind of "I'm applying to university here, also I'm here illegally, stole goods from stores over two days" (and may or may not be the same person as "also I had a knife on me") is not, I submit, the kind of person we really need to import:
"Customer: Hie, I was caught shoplifting yesterday by the police and the store manager of brown thomas for the crimes I did two days ago that add up to 1100. I also had a few things from boots and pennies that they forced me to say I stole the things i was carrying too. I returned all the shoplifted stuff. I did confess to everything. I have an upcoming court case. Will I be arrested? How long will my sentence be ? This is the first time to ever be arrested. I am also in ireland illegally. Does that make my case worse ?
Lawyer's Assistant: What was the value of the items?
Customer: 1200
Lawyer's Assistant: Have you talked to an Irish lawyer about the shoplifting charges?
Customer: No
Lawyer's Assistant: Is there anything else the Lawyer should know before I connect you? Rest assured that they'll be able to help you.
Customer: It's form 3 stores within a space of two days. The store says they have cctv footage but they didn't show me"
"Hi, so i got caught shoplifting in Ireland, this is my first time getting arrested for stealing 2 shirts, the amount of them was 1100 euros, the clothes were not ruined still in good condition for sale, and they also caught me with a small cutter/knife, I have to go to the court tomorrow, am I in big trouble?
JA: What happened with any prior shoplifting charges?
Customer: This is my first attempt
JA: Have you talked to a lawyer about the shoplifting charges?
Customer: no, I’m gonna have the lawyer that they gonna give me tomorrow
JA: Is there anything else the Lawyer should know before I connect you? Rest assured that they'll be able to help you.
Customer: no"
*If* this is genuine, seems like they'll (most likely) skip the country back to the UK, or if they do go to court, they'll get a fine. I'd be perfectly happy for them to experience an all-expenses paid stay in one of our salubrious prisons, to round off their trip to my country.
I don't really know what the system is like here in the UK, but I find it impossible to believe it's as bad as this.
If the question is "what specifically should we do about mental illness?" and laypeople don't have the detail to give a coherent answer and experts are too ground down by the psychotic bureaucracy, why don't you just look at other countries, pick an approach that works better than yours - that is, having a society that seems designed to drive people mad and then forces to live, unmedicated and mumbling to themselves, in tents beside the road - and then do that?
I expect the Danes have got some kind of pragmatic, effective, humane compromise going on. They usually do.
> Another homeless person steals their pill bottle thinking it might be opioids; later they will grind them up, snort them, and have the worst day of their lives.
I wonder, what exactly is going to happen if you do it?
Has anybody tried a bounty system yet? Utterly shooting from the hip, here, so I assume there are massive problems. But:
Identify some reasonable financial reward for any person or institution that can successfully intervene in a homeless person's welfare according to some kind of metric; let's say, stable employment and housing over two years, with no arrests. For a rough starting point on the size of the bounty, you can use some back-of-the-envelope estimate of the anticipated cost to the [government body] that a homeless person is likely to represent over their lifetime when otherwise left to their fate- that way, this program would approach revenue-neutral. Every time a person without a permanent address interacts with the system (either by being arrested, going to a city homeless shelter, or whatever), the intake process includes updates the bounty for that person with whatever new information they reasonably can. I would vaguely expect the bounty to land anywhere between $300-800,000 USD, but that's a really rough guess.
At any time, a homeless person and a [government]-certified bounty-seeker (either an individual or an institution) can enter in to a mutual legal contract, one in which the bounty-seeker assumes some degree of liability and caretaking responsibility for the homeless person going forward. As in the foster care system, bounty seekers would have wide discretion in how they met their care responsibilities, but regular visits by program representatives would probably be essential. In exchange, if the homeless person ever meets the [government]-designated target metrics, bounty-seekers receive the bounty in full.
When entering the relationship with a bounty-seeker, the homeless person would be signing away a degree of autonomy for the duration of the program (to a maximum of, say, five years), probably intermediate between an adult and child. For example, the homeless person would be obliged to remain in regular contact with the bounty seeker, and the latter would be able to call the police and initiate a search if the homeless person remained out of contact for more than a few days. However, the homeless person would also remain in regular contact with [government] authorities at various levels, and could initiate an early "divorce" by some costly but attainable method.
There are obvious concerns- any compromise in autonomy is a recipe for abuse, though I'm not sure a "foster care lite" system is actually worse than living on the streets full stop. And the bounty-seeker and homeless person share the incentive to cover up criminal behavior and other lapses, which isn't great; you'd need to choose your 'payout' metrics pretty carefully to minimize how much people could game the system. But it would carve out some room for individual relationships between (employee) caregivers and homeless people, with a lot of the bureaucratic complexity shunted to relations between state or city agencies and bounty-seeking institutions. And you'd get some of the benefits of decentralization, such as specialists working with different types of homeless people. Nor would you need to replace any existing government apparatus; you could just start this program and scale down the rest of it if and when it succeeded, and could easily begin with a small trial program.
The bounty-seekers bear liability for signatories, and have assumed caretaking obligations. If a homeless person in this program is going hungry, doesn't have a stable place to sleep, is involved with criminal behaviors, etc., then the bounty-seekers are on the hook.
Put the bounty seeker on the hook for too much and no one will want them.
Another problem, if the bounty seekers are being unreasonable, the homeless psycotic person isn't in a good position to put in complaints. This could be everything from complaints about the quantity/quality of food recieved to complaints of sexual abuse.
Maybe making the homeless person themselves choose between a list of big companies? And let reputation effects do it's work. Homeless people will talk to each other. If one company is stingy, soon this will be widely known.
As I said here where I live in the UK the vast majority of the local homeless folk are not causing a problem.
So, one guy was behaving kind of badly, and got the dubious distinction of posters being [put up with his mug shot and the local police number ... like, "if this guys causes you any more grief, phone the following local police number with this reference" ... never saw him again. This got to be on the order of les than 1 in 100 homeless people. The guy claimed to have Aspergers Syndrome when I spoke to him. Let me reserve some skepticism on the alleged DX, given I know other folks with autism DX of various levels of severity, from the usual high-functioning posters around these parts to the much ore severely affected. But maybe; he was showing obvious signs of psychosis.
I am driving hime, late at night, past the local homeless shelter .. dude is lying in the midle of ther road, very drunk.
Ok, stop the car, check that this is not an accident scene. Nope, he hasn't been hit by a car, at least, not yet. He's not having a seizure,, as far as I can tell, just very very drunk. Come on dude, this is a really bad place to take a nap, let me at least help you out of the road. I phone through to the homeless shelterthis guy had (presumably) been trying to reach. They are spectacularly unenthused about the prospect of having to deal with this guy. Oh well, it's a mild UK night, and he'll probably be fine outside just as long as he doesn't fall asleep in the traffic.
More generally, there seem to be about two kinds of homeless peopke@
a) Just poor, and got evicted because they couldn't afford the rent. This group os really easy for the government to help .. subsidized housing, and they'll be fine
b) alcoholism/dug addiction/mental illness. In these case,, the problem isn;t really a lack of housing.
I guess my question is, if this problem is (apparently, visually, i have no idea what the epidemiology looks like) so much worse in a handful of American cities than basically any other developed nation on Earth...is there something these other places are doing that could be copied here? Is universal healthcare the only factor seperating the Bay Area from Geneva?
Maybe this has been commented on before, but before Reagan signed the Lanterman-Petris-Short Act in 1967 there just weren’t screaming schizophrenics on the sidewalks in California; and much more recently, according to New Yorkers, they just weren’t any in New York City under Mayors Giuliani and Bloomberg, at least not anywhere near as many as now, and before Giuliani was Mayor.
Perhaps this has been answered, but to this San Franciscan non-expert the solution seems to me to be: do what was done before Reagan and what was done until 2013 in New York City
One thing that's changed since 1967 is the cost of housing, especially in California and NYC. Multiples more expensive relative to lower income percentiles? From what I've read, it seems like many times people fall off the housing ladder, become homeless, and the stress of this experience leads to mental health or substance abuse issues.
That perhaps explains California, but not New York as housing was already extremely expensive under Giuliani and Bloomberg, and according to New Yorkers they just didn’t have the sheer numbers of street crazies under those Mayors as they did before, and do afterwards
New York has real winters. Real winters cause substantial attrition to the unsheltered homeless. or at least the ones who can't or won't scrounge up bus fare to California.
I think it’s important to reopen asylums, not because it was a bad idea to close them but because drug-induced psychosis is on the rise. If the resources that worked to deal with organic mental illness can’t keep up with drug-induced mental illness even outside of California, it’s time to go back to confinement.
It would have been nice to get a handle on the root causes before it came to this, but we haven’t and I don’t see anyone jumping on it now, either.
I know I'm late to comment, but unlike most of Scott's articles I actually take issue with what I understand to be the central claim here, which is that it is necessary to offer specifics about what you would do about the seriously mentally ill and chronically homeless population if you are going to make general criticisms. My concern is that both the size of the population in question and the social service systems in place to respond to that problem vary quite widely. Thus, an article that meets Scott's request for specifics will invariably be local instead of national in scope which will naturally limit its audience. For instance, I live in Minnesota. I know the systems we have here, and there are some differences between what Scott describes and our systems here, namely that there is a greater use of shelters due to cold weather, a lower population due to the same, a serious risk of exposure injuries for those who do live outside, but also (from what I can tell) a more robust system of group homes, community behavioral hospitals, and even state-built housing to help people live in the community when they discharge from hospitals. My criticism of my state's system is that people tend to rise to the level at which they fail, meaning if they can leave hospital they go to a locked group home with a high staffing ratio, then if they do well they go to an unlocked group home that still does meds, then to a group home that doesn't do much, then finally to minimally supported housing, at the same time as they gradually are de-tethered from the state's commitment process such that they often get to a level of autonomy they can't really handle, stop meds or start meth or both, become homeless, and begin the cycle again. My belief is that people who demonstrate that they can't achieve a certain level of autonomy after several years should be kept at the level at which they succeed, meaning people who show repeatedly that they don't do well with unlocked settings or outside of the hospital should not be expected to graduate to a less restrictive setting, and more people will be involuntarily committed indefinitely.
Ok, so that's my criticism of the system, but how well does it apply outside of Minnesota? Probably not that well. Can I make that criticism interesting to a national audience? Probably not. Does that mean I don't get to participate in a national debate about these issues? According to Scott, probably? On the other hand it seems better to make a general point like "involuntary commitment has a lot of benefits, actually" or " a more paternalistic approach to the seriously mentally ill and chronically homeless population would be beneficial". You can engage people that way without going through the " ok, here's how I would apply these principles in my local and particular situation" tap-dance, a dance which few people outside of your locality would find engaging..
Some random ideas I plucked out of the air right now (I work on improving mental health crisis care full time and am currently implementing a contract with a California county to run their mobile crisis response program, and live in SF with an office in SOMA, so I probably have more context about the situation than most, but these are only poorly-thought-out answers:
- idea 1: in many counties, the most visibly psychotic/disturbing people who get thrown into hospitals and jail repeatedly are known to the county and sometimes enrolled in intensive programs for ‘high-system-utilisers’ as they are euphemistically called. The programs are called ‘Full-Service Partnerships’, and they already exist and are somewhat funded, in most counties. Basically, a team of people takes responsibility for making sure the person stays out of the system and ‘recovers’, basically meaning they aren’t causing problems. The means by which they do this are deliberately flexible, but it basically boils down to ‘be really persistent and annoying at following up with them and finding them and essentially be their prosthetic executive function system’. Proposal: pay those teams handsomely for periods with no incident (no complaints called in on the person, no arrests, hospitalisations) with a few active penalties for when certain bad outcomes happen. Basically, make it lucrative for someone with excellent executive function to figure out how to ‘get this person to behave’. There are probably only around 800 such individuals in SF (if the number of people enrolled in Alameda county’s high-utiliser program is a good rule of thumb to go by, they have about that number but a higher population) so even if you paid each team $1 million a year (ridiculously more than those teams currently get paid) that would be $800 million plus some admin costs for the whole of SF. Politically difficult because of the norm that people who work in social services should not be profit-motivated (even thought there are cases where they obviously are).
- Idea 2: bribe individual drug dealers to leave and avoid downtown San Francisco. Like a paid restraining order against a location. If the dealers leave many people with addictions (who are the ones who end up with meth psychosis) will not stay. Politically spicy. Could theoretically be done by wealthy private individuals.
- Idea 3: install cameras on every single street in downtown SF, train some AIs to recognise dangerous and disorderly behaviour, pay a team of corporate-optimiser-types to bring down rates of disorderly behaviour, again rewarded handsomely for periods and stretches of no disorder. They can do anything legal to resolve it, and are probably given some budget to do so. This could possibly be funded by private individuals but I have no idea what the cost would be.
I could probably come up with more. These are rough. I’ll think about it.
IMO the framing problem here is that there is no discussion of the absolute benefits of urban density. When people live in cities, they are not living in sprawling exurbs, they are not building mcmansions, and most importantly they are mixing every day with people unlike them. The current approaches to homelessness (and many of commenters' arguments), place individual rights above this clear community benefit. And all rights, outside the few enumerated in the constitutional amendments, are subject to public policy trade offs. Choose density.
"I admit that if you’re willing to be arbitrarily cruel and draconian (life sentence for someone and their entire family the moment the bank forecloses on their home!)"
How original; members of the public describe specific behaviors that make public space or their residential neighborhoods like open air prisons where they can be harassed at any time - public defectation and urination, businesses being robbed, mugging, assault, streets becoming disgusting, frightening sewers - and what does someone like you say? "OH, YOU JUST HATE POOR PEOPLE!" Why should any of us see you or anyone that's like you as anything but hypocritical and degenerate, clearly justifying a population designated problematic because of behaviors that can be traced to actual crimes in every city where the taxpayer is told they can either embrace laxity, or be "cruel and draconian"?
"Damn liberals", political representatives, got psychiatric hospitals closed and continue to close them at the state level. They've sued at the state level to ensure there are absolutely no restraints put on dangerous, antsocial people, including mandated treatment in exchange for avoiding prison time,, something you call "cruel" (big secret who you sympathize with more, those that have had horrible experiences with the population you're describing, or, um, your clients, I guess) and basically, they agree with you that the public has no say in arguably one of the most important problems in public safety. Those count as your first lies, lies of omission.
"Damn liberals" - people like you, and certainly, left lobbyists that want to claim to be the best caretakers for this population in ideologically-captured orgs that are far worse than worthless in providing solutions and "care" (doing nothing but lobbying against meaningful intervention) - have ensured there are no solutions and won't be, for the foreseeable future, even though Kendra's Law and Laura's Law are proof this was once enough of a priority to electeds (after women were murdered, of course - only then does your kind grudgingly admit, there might be a widdle problem).
They (you) ensure we do not have more beds. That states can't get the feds to pay for long-term involuntary psych care, or continuity in care after incarceration (which is often necessary, and should be used if someone commits a violent crime - "cruel and draconian!).
YOU are the problem, Scott. You are. People like you, your side, left-wing activists that justify that most heinous crimes, and fittingly, only talk about "mental illness" being an excuse for horrible, violent behavors when there is a body to collect or a woman is, say, shoved into the path of a subway car and paralyzed.
I have rights as a taxpayer and a citizen; they are universally disregarded by my representatives, other voters, academics, and the entirety of the press that gets the microphone, and phonily wrings their hands. There are men that terrorize entire neighborhoods in cities like New York for years and years on end, sexually assault women, threaten people, are undercharged on the tiny chance the police finally arrest them, and the press cackles with glee at the helplessness of citizens. It always makes for a great, gory, emotionally compelling news story because of its very hopelessness, and the understanding citizens don't deserve any kind of relief! It makes for an even better story when the neighborhood drug-addicted groper graduates to killing a woman.
They all phonily wring their hands about the "dilemma" of the rights of your clients (obviously) to terrorize the public, versus the rest us.
This is guilt-tripping people to accept their own misery, and worse. It is actual cruelty to those of us that can participate in public life without harassing or physically assaulting others, or making shared space dangerous and disgusting to even pass through.
You're a depraved person and your essay telling people they should do nothing, have no options, and are wicked for focusing on their own rights is self-seeking.
I pitied you when some verminous little reporter at the NYT went after you for being dissident. I don't anymore. You're the same creatures.
"Why should any of us see you or anyone that's like you as anything but hypocritical and degenerate, clearly justifying a population designated problematic because of behaviors that can be traced to actual crimes in every city where the taxpayer is told they can either embrace laxity, or be "cruel and draconian"? "
Do you have an actual specific solution to propose that you want to argue isn't lax or draconian?
And we are talking here about the large number of people who are homeless and causing a nuisance. (Say including public defecation.)
You start talking about the much smaller number of outright murders. Presumably in an attempt to conflate the two issues and make all homeless people sound like murderers.
In short, your imaginary evil version of Scott bears hardly any resemblance to the real one.
So psychotic are only one category of chronically homeless, yes? Another big category are drug addicts. So even if we could “get the mentally ill off the streets”, there are still a bunch of people who are just addicted to hard drugs.
I think one reason we less-informed just want a “make it go away button” is that it seemed a lot better before Covid. Then Covid happened, a lot of people talking about defunding the police, then something something a lot more florid homelessness. I’ve seen the stats that blue cities aren’t necessarily worse than red ones, but it isn’t the biggest stretch for people in nyc/sf/portland/seattle to see all this and think:
“There’s Something that works to make this go away because it was better before so we were probably doing that thing then stopped.”
And also…
“This started getting bad right after the summer of Floyd, so maybe it’s those woke policies that are to blame.”
As far as actual solutions, from reading your descriptions two things jump out:
-a lot of people are being released early because sedation can mimic not being psychotic
-a lot of people are lost to follow up because of friction in the healthcare system
The former seems relatively easier to solve if you’re being draconian - minimum stays.
The latter? I guess I’d look around the world to see if anybody is doing it better. An army of case workers would be nice but probably unrealistic.
And I’d be really curious to know what changed around Covid. Why didn’t it seem this bad before?
Universal Basic Income would resolve nearly all of the world's homeless problem.
Warning for any snowflakes who may get triggered by sharing one of my own videos, this is my video. Secondary warning, it comes from my religious biblical perspective as a rabbi.
> Universal Basic Income would resolve nearly all of the world's homeless problem.
Only if drugs, gambling and bad decisions somehow disappear from the world, and would be magically replaced with thousands upon thousands of new houses. Otherwise an influx of additional paying customers for the same housing stock would just raise the prices, and people would still be capable of drinking, sniffing, gambling or plain losing their UBI check and then remain as homeless as before.
> can you make homelessness a crime? As of last month, yes you can!
But that's not what the link says. It says local municipalities can make camping in specific public places a crime, not being homeless. I'm sure there are many places where not a lot of people would object to somebody camping there. True, those places may not be very attractive - e.g. far from places where you can procure drugs, steal things, beg for things or just enjoy walking in the sunshine naked and pooping on the sidewalk, but don't such places actually exist?
> and they can’t think of a good one
Are they trying? Because so far in CA I am seeing the plan is "let's just let people camp anywhere, turn any neighborhood into a dump, and let's on top of that stop enforce laws about petty theft and harassment, and also let's make easy for the same people to maintain their drug habits and see how that works out". Does it work out well? I don't think so. But I don't think their ideology allows them to admit it.
The opening paragraphs, "something should be done about the bad air but I don't know what," make me think of Winston Smith in the novel 1984. He can see all around him that the Party's policies are damaging, but he knows that they have lots of people who could debate and tell him how wrong he was, and he couldn't argue with them.
This also reminds me of a discussion I had back in college, where a girl in our project group was very much against child labor. She wanted everyone to know it. Child labor all over the world should be banned and eradicated. But I said that this wouldn't mean the children go to school and live happy lives. They work because the family needs the money to survive. So child labor isn't the problem, it's just a symptom of the problem, which is poverty. That's what to focus on. Surprisingly, I made her grudgingly agree. Most people would be upset: All that they'd hear was that I APPROVED of child labor and wanted it to remain.
Which, in turn, reminds me of another conversation, with an old woman. She was sad because animals have to die when humans eat meat. I pointed out that meat is an excellent source of nourishment for us, predators as we are, and studies show no replacement protein can fully replace animal protein. It also gives us great pleasure to eat it, and it is a constantly renewable pleasure. Since we aren't robots, we need pleasure to keep going.
And keep going we should, because humans are the vanguards of Life, the only ones who can help Life advance and overcome all possible obstacles. So that Life can live forever. Are the animals and humans who live right now more important than the ones who live tomorrow? Or any tomorrow after that? There could be lots of suffering for all lifeforms, and eventually death, in a distant future. If not before, so when the sun slowly and painfully extinguishes all life. We need to prepare. Human advancement is the only way to prepare. All the other lifeforms just keep eating and sleeping and dying, repating that with no progress. We should therefore eat meat to strengthen us and give us an easy and renewable pleasure, so that our work can continue.
But of course, all she heard was "this guy is anti-animal!" It's the last time I argued with grandma.
But Portugal has already fixed drug addiction, didn't they?
Since housing is a human right, apartments can be freely built, rented or sold with a minimum area of 97 sqft (which is often enough for bed, bathroom and kitchen!) (this is the minimum size across most of Europe).
Any people using drugs are arrested and immediately brought before a panel for doctors, who will "judge" you on the spot without appeal. If you are found to be addicted, you will be forcibly institutionalized as long as the panel deems it necessary (in public or non-profit rehabs with adequate funding).
If you are not addicted, you can be fined 1000 Euros, which is more than a month of minimum wage (and enforced by a prison sentence if you don't pay). They can also decide that you need to stop seeing certain people and check in with doctors and the police on a regular base (basically putting you on parole, again enforced under threat of fine or prison).
By decriminalizing drug use, they were able to replace lengthy legal processes and prison-first with immediate administrative sentences and prison-as-a-threat. Portugal is extremely harsh on drugs, but in a smart way.
Since 2020, Portugal went from the second highest heroin use in Europe to one of the lowest despite of ongoing poverty.
What about going out to the countryside and building a boarding school but for adults?
They never have to see any paperwork. They eat food in the cafeteria where someone makes sure they have their pills. They do some cooking and cleaning work, and get some lessons perhaps. They do a bunch of sports and games and activities. (Think scouts) They absolutely have a scheduled art time and a large supply of crayons.
They are allowed out, if they fill out a 20 page form stating they have somewhere to go. (So the only ones who get out are the ones with the executive capacity to fill out paperwork that is needed to live in society at large. )
This institution would need to be more accommodating of sex and booze than a regular boarding school.
The solution is simple: literally just treat mentally ill people like children until they prove that they are capable of surviving on their own.
Can't find them because they're homeless? Just build housing complexes for them.
The housing complexes are too dangerous because they're full of mentally ill people? Have security cameras installed everywhere and security guards at a central point in the complex where they can easily and quickly respond. Also, automatic curfew (so if you want to get in or out after a certain time, you need to check in with the security complex).
They don't fill out their medication prescriptions? That's OK, administration at the central office knows their medications and will handle the paperwork. The pills will even be delivered directly to their apartment.
Basically the idea is to have a system that could best be described as "Prison Lite." It doesn't have the brutality of prison (because these people aren't criminals - if they commit crimes due to their mental illness, they absolutely should be sent to jail) but it's not as fun or free as regular society (because you want them to work to get off the system rather than becoming a burden). Getting out is easy: they simply have to take over all the duties that the central office was managing for them and consistently show that they can care for themselves (and take their medications regularly) without relying on the central office to do it.
The reason America doesn't want to do this isn't because it would be HARD: it's because we're so focused on rugged individualism that we can't admit to ourselves that not everybody is cut out for it.
I've heard that in Europe there has been a lot of success with criminalizing public intoxication and camping, providing free drug rehab, and making participation in that drug rehab mandatory or else you go to jail.
Well, those places are doing different things, for a start. So you still need to pick one.
For example, Singapore will execute you for possessing drugs (legally, for trafficking, but their standards for proving that are... very easy for a prosecutor to meet, let's say). So they have a very low rate of drug abuse, which no doubt makes the problem of homelessness easier to deal with. And you can't really implement that sort of a system with a vague wave of the hand and "do whatever they're doing over there". You need a critical mass of people to say "actually, yes, we do want to hang druggies."
An important point for both criminals and homeless crazy people/drug addicts is that leaving them on the streets imposes a lot of costs on the world, but an individual hospital or state agency or city agency's budget doesn't have to pay those costs, whereas those budgets have to cover the costs of taking them off the streets and putting them in jail or in an institution.
Yes. I don't have as much experience as you or in the same area, but this all matches what I do have, and I agree with your number 7.
wrangling a building full of psychotic adults is very different from wrangling a building full of sane adults.
You say cameras in locker rooms. Okay, you put those up, on day 1 you see one person shitting in a corner while a second person pins a third person to the wall and demands money and a fourth person shoots up drugs in another corner. When you try to talk to any of them about it they ramble about the CIA and the aliens and the simulation, and honestly their paranoia in this case isn't completely wrong, you *did* put up cameras to watch them, after all. Maybe you *are* the alien feds. The next several days are much the same. The security and janitorial resources required to keep up with this are orders of magnitude higher than a youth hostel.
If they're on camera committing crimes, arrest them for it.
https://www.overcomingbias.com/p/universal-basic-dormshtml
> The Soviets understood that if people don't have shoes, the solution is not that the government redistributes money. It is that the government builds a shoe factory and makes shoes.
We have a market economy in which people use money to buy things, so giving people money does suffice for most things.
> SF has a huge budget. Why cannot they build?
The Bay Area is where anti-growth coalitions have been most dominant https://whorulesamerica.ucsc.edu/local/san_francisco.html They hate developers and made it nearly impossible for them to build things, and those restrictions also make it practically impossible for the government to build things.
Japan is full of Japanese people, and I don't think they have a high homeless rate in the US either.
Muho Nölke used to live in a homeless encampment in a japanese public park before he got appointed as abbott of Antaiji. He met his wife in that park IIRC. His description of his homeless life in Japan sounded nice.
My plan is “be arbitrarily cruel and draconian,” as defined by “the damn liberals.”
I still think it's worth explaining how. There are lots of possible draconian policies, ranging from pretty justifiable to totally idiotic.
Plus, new government policies are virtually always messy and inefficient. When you avoid giving specifics, you get to dance around that fact, which hardly seems fair. The implementation problems become more obvious when you get into the details.
Cruel and draconian policies will be executed no more competently than kind and gentle ones; we shouldn't let people pretend otherwise.
Depends. One cruel and draconian option is to announce an end to police resources for investigating the killing of homeless people. Vigilantes would change the incentives for homelessness. With some surveillance this would double as a way of identifying all the vigilantes while they're only killing those we've already given up on, and we could always go back on our word and prosecute them for murder.
I'm not saying this is a good idea, mind you. Just pointing out that the idea-space is vast.
See, this is a perfect example. Once you say that stuff out loud, it's immediately obvious that it would be a giant horrible clusterfuck.
And what we have now isn't? It at least has the merit of being a different clusterfuck. But it allows the well-to-do to escape seeing the consequences of their behaviour, so morally worse perhaps.
Compared to state-sanctioned random street murders, current policy is awesome.
>And what we have now isn't?
Compared to that? No, of course not.. It's not even close.
Isn't the answer to "who killed this homeless person?" usually "this other homeless person"? I don't think vigilantism is involved much, if at all, and stopping police investigations wouldn't make much of a difference to the numbers of homeless people getting killed.
https://jacobin.com/2022/05/homeless-homicides-data-surge-victims-suspects
"Figures from the Los Angeles Police Department show that people experiencing homelessness are roughly twice as likely to be victims as suspects. According to the city’s open data portal, which goes back to 2010, unhoused people have been victims in about two-thirds of homicides in which someone was identified as homeless (417) versus suspects in about a third (215).
Tellingly, an LAPD public records request for data since 2017 shows, if you remove homicides where both the victim and suspect are homeless — likely leaving more of the oft-sensationalized “stranger danger” cases — the proportion of houseless victims to suspects tilts further: 171 to 51, more than three to one.
The public-records request data confirms a rapid rise in annual totals of homicides involving a “homeless/transient” victim and/or suspect: from thirty-eight in 2017 to forty-four in 2018, fifty-two in 2019, seventy-one in 2020, and 106 last year — likely an all-time high. Going back further, to 2010, the portal’s data shows a similar recent spike: for 2010–19, the total homicides including a homeless victim and/or suspect was 364. Already this decade, it’s 268.
Two agencies shared numbers with me that seem to confirm a recent surge: In Denver, a police spokesman notes, fifteen of the ninety-six homicide victims in 2021 were homeless. In San Diego in 2020, Lt. Andra Brown notes, unhoused people were victims of four and committed three homicides; last year, they were victims in eight but committed just one."
Killers who are not themselves homeless persons seem to be criminals already, going by this case:
https://abc7.com/los-angeles-homeless-serial-killer-shooting-update-today-homicide-search/14133694/
"The suspect in the three fatal shootings of homeless people in Los Angeles was identified as a man who was already in custody after being arrested earlier this week in connection with the murder of a San Dimas resident who was shot during a follow-home robbery, authorities announced Saturday."
This is not but reminds me of wet streets and rain.
Yes of course right now vigilantes don't do anything, because they'd be prosecuted. If you talk to people affected by homelessness, however, you stay to think that one out of every hundred or thousand might be willing, were there no enforcement, to solve the problem.
>Isn't the answer to "who killed this homeless person?" usually "this other homeless person"?
"[T]wice as likely to be victims as suspects" suggests that it isn't, no?
Anyway, that aside, a few recent murders of homeless people in Southern California that got media coverage turned out to have been done by thrill-killers who presumably thought that it would be easier to get away with.
Of course, that could just be these cases getting more media coverage because they are at first mysterious and senseless, as distinct from "homeless person A and homeless person B got into an argument at their encampment, whereupon B stabbed A at their mutual encampment in front of a bunch of witnesses who knew them both," as the latter case would be resolved quickly without a lot of sleuthing.
Just pointing out that just because a homeless person is twice as likely to be a victim as a suspect doesn't mean that the killers aren't usually other homeless people. Even if we know all the killers, there's likely to be less than the number of victims, because a lot of people who kill are relatively likely to commit more murders. But in reality there's going to be a lot of cases where no suspect can be identified.
There seems to be a little bit of fiddling with the figures - yes, if you take out all the cases where the homeless person A was murdered by the homeless person B, then you are left with the homeless people murdered by the non-homeless. That may or may not be higher proportionately, but there doesn't seem too much wiggle room if, in San Diego in 2019, there was one homeless murderer and eight homeless murder victims but in 2020 there were three homeless murderers and four homeless murder victims. *Something* caused that jump up in homeless murderers: homeless victims from 1:8 to 6:8
How much of these numbers boil down to when a homeless person is killed the PD has no clue who did it, and never learns?
Skimming that article I see the numbers for how many people died (easy to measure) and how many suspects were homeless.
What I DO NOT see is how many suspects (let alone convicteds) actually were non-homeless.
Big surprise that, as per usual with Jacobin, you can't even tell if they are deliberately hiding this data or simply so stupid they don't even realize that it's THE most important number...
That sounds like a pretty messy solution. I agree that it would be inexpensive. I'm not sure why you think this is a rebuttal to the parent commenter.
Probably because it is, but thanks for playing.
Implementation =/= no longer implementing. Implementing a return to a long-ago previous policy such as 'if we catch you being shifty in our town the police will beat you with clubs' is different per sec than informing all the armed Americans who are sick to death of problems like this that the police will no longer be implementing the fairly recent effective ban on mob justice.
Messy, inefficient implementation of policies that protect the law-abiding citizenry and any unintended victims will eventually have recourse may be superior to the status quo for many people. The impact classes are totally different: parents, for example, probably care a lot more about their children not being harassed or dodging needles on the street than they care about the drug-addled ward of the state dumping the needles to begin with. If kind and gentle policies do nothing for normal people, they will eventually give up on them and vote for the cruel and draconian that does.
Also this is clearly a commentary on "damn liberals" calling anything that actually has an impact "cruel and draconian," like maybe not having open air drug markets where people commit slow suicide in public parks.
People committing slow suicide in public parks is more of a nuisance or a depressing eyesore than an actual danger to the "law-abiding citizenry," isn't it?
No. Junkies leaving used syringes in the parks that my nephews might want to play in is, in fact, an actual danger to them. I do not want my nephews getting Hep-C (or anything else) because they stepped on something that a junkie couldn't be bothered to clean up. Yes, I have helped pick up other people's used sharps in public parks.
I realize that I'm stereotyping by presuming these are typically left behind by junkies and not diabetics, but I think I can live with that.
In fairness, the risk of any given diabetic having hepatitis or other needle-transmissible illness still seems high enough to be worth taking seriously.
I'd be curious as to how many Californian homeless persons are originally from California? Surely there can't be *that* many naturally-occurring crazy people per capita, and if there are, that's a sign of something much more worrisome.
Minimum-security jail sentences might be the most humane short-term option for people who can't look after themselves, and if most people cease being homeless within a year then clearly incurable mental illness is not what's keeping them on the streets.
afaik yes, most homeless do not relocate.
IME the... "obvious"? "problematic"? homeless:
1- ALWAYS have a drug problem, at best severe alcoholism, most frequently polyaddicts including at least one of cocaine, opiods, or amphetamie-class stims.
2- Are substantially below average at mental function in at least some way even while sober
3- as a result of the above, literally cannot handle taking care of themselves. Whether you consider them responsible for their own behavior or not, there are people who just cannot handle life.
SF has a major problem because housing costs raise the threshold of how hard it is to take care of yourself. Once you end up broke and homeless once, you fall into the visibly obvious problematic homeless attractor. That happens more often when it is more expensive to support yourself.
Remember that still, MOST homeless people are in a temporary situation that they get out of, with or without state help, with or without friends or family. Not without no help, just that ~80% of people who experience homelessness in their lives manage to get out of it.
I'm in favor of providing as much help as we can to the people experiencing homelessness and prosecuting opiod distribution with extreme public brutality
I agree with that. “Arbitrarily cruel and draconian as defined by the damn liberals“ is merely a bounding box, not a specification.
I think that you have to go pretty far along the fascism axis before you make a difference. If you are advocating for rounding (some) homeless people up and killing them (which would both be in your bounding box and also objective-limit effective, but at a price a damn liberal like me would not be willing to pay), then instead of vaguely gesturing at it, please state it outright.
If you had something short of that in mind, please clarify why you think it would change the behavior of homeless people where current disincentives fail.
My cruel and draconian policy is "yes we will criminalise persistent homelessness and the more mentally ill you are, the longer your sentence".
Since nobody wants to build asylums any more because of stupid Hollywood shit like "One Flew Over The Cuckoo's Nest", my new prisons will be called "prisons" but they will in fact be asylums to treat the mentally ill homeless, hopefully get them stabilised, and enable them to have a roof over their head, food, clothing, bathing facilities, and some kind of routine before they get turfed back out on the streets. If there isn't a plan in place to support the person once released, that's an extension of the "sentence" so they won't be turfed back out to live on the streets while we flail around to get them some kind of halfway house or accommodation.
Needless to say, there will be strict inspections to make sure the 'prisons' are not hellholes and that the government money is being spent effectively. I will go all-in on being a horrible cruel draconian by permitting charitable bodies -including, gasp! religious and double gasp! even Christians - to be involved, particularly in the post-release "help people get jobs, accommodation, ongoing support and treatment, half-way houses, assisted living, whatever they need" phase.
Staff will be properly trained and properly paid, but nobody is going to get rich off this. There will be no 'private nursing homes where one nurse is looking after a hundred patients while the owner buys their second luxury home' arrangements. However many we need to provide a decent ratio of care will be hired. Anyone who thinks they can have a side hustle smuggling in drugs, booze, porn, or exploiting the inmates will go for a long trip on a slow boat to China.
(That may or may not be a metaphor).
Maybe some of the inmates are in such a state that they can never live independently, even with support. Well, they'll be our lifers.
Yes, I am willing to get the "You Fascist Monster!" medal of honour from the damn liberals and bleeding-heart progressives for my bold policy initiative.
No way the owner of these 'private nursing homes' only has two luxury homes. They have at least four, plus the 'corporate hunting lodge'.
Two in their name, the rest in the names of spouses, family members, or offshore tax haven foundations 😁
This creates a really tantalizing incentive for some of the more ambitious Christian organizations: to declare lack of faith as mental illness. After all, only a crazy person would reject Christ and thus embrace the Devil, right ? It is our duty to bring these poor benighted souls to the Lord !
That's not an issue of incentives so much as a two part demonstration of coordination.
Centuries ago when society was full Christian, this scenario was just the norm.
Now when society is mostly not practically Christian, this scenario is almost impossible.
I wouldn't mind this if the inmates had 24/7, guaranteed, uncensored Internet access. (Except in the specific cases of people where doctors *seriously, specifically* think *unfiltered* Internet might make their condition worse.) I think with the modern world being what it is, the lack of Internet access is one of the most prima facie inhumane and torturous aspects of forced instutionalization *or* regular prison. It cuts you off from, potentially, some of the most meaningful human contacts in your life. The fact that it's limited even for lifers/long-term mental patients is I think an archaism as much as anything — people treat it as if it's like "not giving them a free TV set", as opposed to what it really is, potentially cutting them off from their loved ones forever.
I don't think the internet needs more crazy people on it.
Loved ones can write letters to stay on contact. If they're too lazy to do that, they were probably going to dump their mentally ill loved one eventually anyway.
Medals aside, how are you going to pay for this? And where is the political will to actually do it, and do it right (no hellholes), and *fund doing it right* going to come from?
We're already throwing tons of money, depending on what country you are from, at it. Why not take some of the $848 million San Francisco is allocating to homelessness support services and build, staff, and run one prison/asylum with it?
https://hsh.sfgov.org/about/budget/
"The proposed budget allocates $846.8 million to HSH in FY 2024-25 and $677 million in FY 2025-26.
With ongoing Our City, Our Home funding, HSH’s budget has more than tripled since the first year of the Department’s operation.
92% of the proposed two-year budget would be appropriated to homelessness response system services, including 60% ($916.6 million) to housing. Housing costs go towards subsidies and services that keep households who have exited homelessness stably and successfully housed as well as new units."
The running costs are going to be the largest chunk of change we need, but if they can afford to throw hundreds of millions each fiscal year at the problem, they can afford to stump up fifty million to keep one prison going for the year each year (I have no idea if it would cost fifty million, but I'm thinking about having decent facilities and plenty of qualified staff).
'More than tripled'. Take a gander at that and think about it for a bit. Started in 2016/17 with a modest budget of $224 million, now proposing to spend $847 million in 2024/25. I'd be ashamed to look my diabolic stony-hearted fascist monster compeers in the face if I couldn't make a go of one lousy little asylum in its own grounds with fifty million in my hot little hands to do it up right.
I support this plan. It happens to be a lot like the plan I was going to lay out, but decided to read some of the comments before doing so. So maybe I'm just biased towards ideas that seem similar to the ones I'm already thinking about.
"Too far along the fascism axis" seems to include anything that gets clean streets and no open air drug markets when Xi Jinping isn't visiting. Is it a timing thing: it's okay for a week or two, but not for months or years?
It's unclear to me if you think gassing the hobos is the only thing that will make a long-term difference (and is of course wildly unacceptable), or if you're jumping to a grossly uncharitable example just for the fun of it. Forced relocation to comfortable but not downtown housing is probably too far along the fascist axis too.
Where, even vaguely, is the acceptable liberal line that doesn't let a small minority of anti-social people inflict themselves on the innocent citizenry with virtually no recourse? Is there one?
I believe that there are a large number of liberals who are not progressives or communists. People who can think. People who can make tradeoffs. People who can hear an idea without emotional hysterics when a word they don't like is used.
I have to say "I believe" (instead of "I know") because I have not heard from anyone who meets this description in a long time. Social media makes it worse. I bet there were always emotionally unstable people within the left, but those people had no way to publish anything I might read until the internet made it easy.
I miss the reasonable left. I wish I could hear from them. I know many of them are now small-R republicans.
The APEC cleanup wasn’t some remarkable accomplishment—they just shuffled people around to Oakland and neighborhoods further away from downtown.
Several comments throughout the thread seem to think any form of relocation is unacceptable so I still think it fits my frustration with that above comment. I figured the cleanup was some sleight of hand.
Well for starters I'd say we don't need to criminalise being homeless, we just need to criminalise committing crimes.
The problem isn't the crazy people who walk around muttering or the homeless who sleep in their car for a couple of weeks, the problem is the crazy or homeless people who actually commit crimes which harm others. Right now the criminal justice system seems to default to giving them some soft sentence, hoping that this is somehow going to cure them, which it doesn't.
Drastically increasing prison sentences for "minor" offences would have two good effects. The criminals who are making semi-rational decisions will be much less likely to commit crimes. And those who are irrational can be safely confined and forced to take their meds.
If this sounds inhumane then I'm perfectly willing to work on making more humane prisons into the bargain.
How about starting by scaling up production of those GPS tracking anklets already being used for some types of parole? Seems like simply being able to find previously-arrested individuals again, on short notice, would open up a lot of useful options, and "wear this unusually sturdy wristwatch in case we need to contact you again" doesn't seem like the sort of thing that's too heinously excessive to apply for a first offense.
Yup. To my mind
>There are an infinite number of ways that semi-psychotic homeless people can miss appointments. The half-life of these people’s contact with the medical system is a month or two. So they’ll miss their appointment and get off the drugs. The police aren’t going to start a nationwide manhunt for a psychotic homeless person who’s indistinguishable from all the other psychotic homeless people.
sounds like: This is a lossy system. My knee-jerk reaction is that it needs redundancy. In addition to the locator beacons, what I would add is:
- The half-life for losing contact with the medical system is a month? Schedule appointments once a week _even at the cost of making the appointments lower quality_ . Do perfunctory, perhaps automated appointments.
- Since these people are homeless, have at least their prescriptions held at the pharmacy, _not_ in their tent. Use some flavor of ID - fingerprint, retinal scan, whatever to match patient to prescription at the pharmacy, rather than having them have to keep ID in their tent.
This is all in the interests of keeping as many of them as sane _as possible_. Now, there are large chunks that this won't solve:
Medications with side effects bad enough that people stop taking them, even when they have them.
Expensive housing. That is a huge problem way beyond just the mentally ill homeless, and a whole separate discussion, and a lot of approaches have been tried and have failed.
We have a winner. GPS tracking anklets are very old technology at this point. The technology is dirt cheap. It's really insane that we don't use them more.
Ought to be possible to do for https://en.wikipedia.org/wiki/Service_of_process#Personal_service_by_court_services_process_server what ATMs did for bank tellers.
"The problem isn't the crazy people who walk around muttering or the homeless who sleep in their car for a couple of weeks, "
No, the problem is crazy people who walk around muttering and shouting and screaming and shitting on the street and threatening people, and the homeless people who sleep in their cars permanently and use facilities that weren't designed for long term living.
There, fixed it for you.
You didn't fix anything, you just re-conflated the things that Melvin was trying to point out that people are irrationally conflating.
Wrong, I changed *isn't* to *is*.
This is a really obvious and sensible solution that Scott seems to have almost deliberately ignored in service of making this problem seem intractable. This is actually a really easy problem to solve and cities like New York have previously solved it before losing the technology in a City of Ember like fashion. Step 1) build enough shelters so that people with nowhere to go don't have to sleep on the streets, 2) enforce the law (you can't do crimes or sleep on the street and if you do you'll go to jail), 3) congratulations you have solved the problem most people care about which is not being accosted by crazy violent people who live in the street. We did it folks, and in only a few hundred words.
Step 1 runs against the very obvious problem of "nobody wants a homeless shelter near them", besides politicians implementing Big Brained Ideas (both of the leftist and rightidt variety) making the shelters unworkable even IF they are built
Only if we fix the prisons first.
There's a thread down below that talks about privatization of the problem. Perhaps we combine that with "be arbitrarily cruel and draconian". Call it a "last chance" program. If the company can successfully reintegrate you into society, they get paid and the problem is solved. If not, you get drafted in our forever wars and go directly to the front line. Set a fixed timeline for reintegration and define success as the ability to retain a place of residence.
To be frank I'm sick of both the homeless problem and the forever wars, but if we're stuck with both, when life gives you lemons... Damn this is dark.
Random people who don't want to be there, never mind the whole mentally ill bit, are just a dangerous liability on the front line rather than helpful in any way.
Not to mention the expense and difficulty of transporting them there and upkeep in the meantime.
I think you're right in modern warfare as conducted by the US, but I do think historically a lot of this was done
Convicts have been used a lot over the centuries in various roles; untreatably psychotic mental patients less so; any army with the state capacity to conscript mental patients has relied on either ordered formations or complex weapons to some extent.
Isn't this in fact what Russia is doing today in Ukraine?
I considered the liability aspect after posting and my mind came up with: paratroopers. Effectively human weapons turned loose behind enemy lines. Best case you damage your enemy, worst case they defect and become another country's problem.
Indulging the idea further: this seems to potentially be the current play with "asylum seekers" in the US at least according to some sources.
I don't see cost as a real counter argument as it is likely less than a lifetime on government services.
And I have to reiterate how abysmally dark these ideas are and that I'd rather both problems (war and homelessness) be solved more compassionately.
The more I think about it, the more we're really just on track to gladiators.
However expensive it is to take care of a homeless person now is nowhere near as expensive as training a single paratrooper.
The US military already have things that you can drop at the enemy from the air to inflict not-very-targeted damage. They call these things "unguided bombs" and they come at just a few thousand dollars apiece, and don't require food or much space when stored.
Ehh, kind of. Certainly, a conscript-based military has to be designed in a different way than a volunteer one, and you do definitely need at least some volunteers (to be commissars/blocking troops, at the very least) but Russia has demonstrated that it can be made to work even in modern times.
I'm not sure they're demonstrating it can be made to work - the invasion seems to be a shambles compared to expected performance, and they're still picking fit young men who they just don't value for some reason rather than incorrigable homeless people off the street - generally the young men have families back home, something to lose, and the general ability to do things.
You said "Random people who don't want to be there, never mind the whole mentally ill bit, are just a dangerous liability on the front line rather than helpful in any way."
Conscripts are "random people who don't want to be there". Apparently they're helpful in the proper framework. They would definitely be a liability if put into a designed-for-volunteers system, and they are definitely always less useful than the same amount of volunteers, but apparently that's not enough to make them infeasible.
Now, yes, chuck insanity into the mix and it gets a bit trickier (although I imagine a well-designed boot camp might be able to mitigate a lot of the insanity prior to deployment), but you explicitly claimed that that wasn't necessary to conscripts' uselessness.
Yup, and even Russia briefly looked at the idea of conscripting their own homeless and said - "nope!". There was some politician voicing the idea early in the war, and reports of isolated cases of this happening, but it didn't really go anywhere.
Well the draconian fascist in me would say that we wouldn't send them to fight the serious wars, just little wars that we start for the purposes of giving the hobos something to do. You can't invade Russia with an army of American hobos, but maybe you can invade Papua New Guinea?
Government interventions are often useless, but "let's solve the problem by privatising it" is even more useless. What happens is that the entities interested in such schemes see $$$$ instead of public service, are more interesting in wringing out the maximum return for the shareholders, and often do worse than the government agencies in the first place.
'Get recruits by emptying the prisons' and 'jail or the army' is a time-honoured practice for militaries, but 'use the homeless' isn't a good substitute. You need people who are minimally competent and trainable to be soldiers, and even criminals need to be more the "robbery" and "juvenile petty shit" than "multiple murders and assaults" types.
https://taskandpurpose.com/military-life/join-the-military-or-go-to-jail/
It depends on your approach. Prigozhin was having great success with the prison-to-military pipeline (perhaps a little too much success, in fact, which is why he's dead now). The magic recipe appears to be to have a core of loyal (and well-paid) veterans who will babysit the convicts (by shooting any dissenters and wannabe deserters), and to send the convicts into the meat-grinder as quickly as possible. Putin tried to take over Prigozhin's business (after the latter's unfortunate spontaneous mid-air explosion), but (possibly due to the overall corruption level of the Russian army) is not having nearly as much success. His convicts keep deserting, or worse, surviving the meat-grinders and returning to their home towns, to resume committing whatever crimes got them thrown in jail to begin with.
There's a far better option along the same vein: instead of pointlessly butchering them, give them homes in the conquered territories. In fact, you can open that up as an option to everyone, and solve more problems.
I'd have no problem sending them to the front with the promise that if the effort is successful, they would share in the conquest. I think I disagree with giving territory to someone who didn't fight for it.
All of that said, my preference would be for neither homelessness nor war to exist. We're too damn rich of a country to not have asylums big enough to adequately treat the psychotic patients we turn out on the street.
I see where you're coming from, but in my view, they WOULD be fighting (albeit a prolonged lower-intensity conflict), to HOLD valuable territory in hostile conditions. For this to work, I expect you'd need far more manpower than your soldiers can reasonably provide. Perhaps you could give your soldiers rent from the properties for a few decades before transferring ownership to the residents?
I expect the homeless would make poor soldiers, but perfectly adequate settlers.
Ah, I see where you're coming from! Sort of a great frontier approach. I'm on board.
Lebensraum! Though that wasn't intended for the mentally disabled.
I can see the bastard shaking his head in disbelief. "Only ze Americans could think to combine lebensraum mit mental illness, ach, mein gott."
The Euphrates will be our Mississippi.
What conquered territories? What wars of which country are y'all guys talking about? I thought it was a post about the US homeless.
That was tried in Vietnam. Google "Mcnamara's morons." It didn't go well.
What I could see working in conservative states (only) is low-cost, tented prison camps, like the WWII Japanese American "relocation centers", i.e. internment camps. These were situated many miles inland, often in remote and desolate locales.
No one has the right to be sustained on other people's dime, i.e. by forcing other people to pay taxes under threat of imprisonment themselves. If you can't survive a low-cost relocation center/internment camp, you can't survive in the modern world. Oh dear, never mind, how sad. Let's move on from emotions, and protect productive society.
Such camps would be extremely unpleasant. So be it. That should be an excellent deterrent. If internees demonstrate the ability to contribute to society - or at least not to be an active detriment - they should have a way to earn their release. If they don't, they should be offered a painless way out: e.g. equip every cell with a ligature point and a length of rope, and confer upon people the discretion what to do with their lives.
Nasty? Yes. Realistic. Also yes. Better than how LA or San Francisco are currently dealing with this? Definitely yes.
"Enslave the homeless" might effectively be the same thing, but that would make it private rather than government-run (always an improvement!).
'Enslave' is probably overwrought, given that these people wouldn't be actually earning their keep; it's also not in line with my actual intent. If we're striving for a pithy one-word encapsulation of my preferred policy, it would be: 'Exile', i.e. get these people away from productive decent citizens who deserve to be allowed to live their lives unmolested.
Parachute them into the Alaskan wilderness…
Forced labor for the homeless was the traditional solution. But there really aren't a lot of jobs any longer that are economically meaningful if you're both completely without qualifications and actively hostile to the task.
You don't really need it to be economically meaningful, you just need it to keep them busy and (ideally) to help offset the cost.
Many low security prisons are prison farms -- I doubt they're particularly efficient as farms go, but it keeps the prisoners busy and sometimes teaches them useful skills that they can use to go get a job once they're released. If I had to be in prison I'd choose doing farm work over sitting around all day.
As a political compromise, how about making them not quite so unpleasant and calling them "rehabilitation centers" rather than "internment camps"?
Earn their release? Why not put these camps deep in the Alaskan wilderness, fifty miles from the nearest road? Don’t stop anyone from leaving, but make it very clear that nobody is going to be looking for them. Maybe give them tracking bracelets or ankle monitors or something; if they shed those they shed them. If you can get through fifty miles of roadless wilderness and back to civilization you are probably reasonably fit and thoughtful; if you can’t and gambled and lost…well, not our problem. Good day to be an Alaskan buzzard.
Besides, you could argue that you aren’t technically stopping them from leaving. Meet your requirements, or take your chances in the Alaskan bush. If you can find a way to get a buddy with a snowmobile to meet you at the fence…well, it’s public land, nobody is going to stop snowmobile guy from riding through it or you from meeting him.
I'm plagiarising this idea if I'm ever appointed King-of-the-World! ;)
Because it can be countered by just a small number of dissenters who want homeless people to be free and are willing to make daily snowmobile runs.
Reminds me of https://detoxcampcomic.com though admittedly that's a slightly different "undesirable" demographic and involves a lot of supernatural elements.
"No one has the right to be sustained on other people's dime… If you can't survive a low-cost relocation center/internment camp, you can't survive in the modern world. Oh dear, never mind, how sad. Let's move on from emotions, and protect productive society."
I was trying to think how to respond to this, and realized that Scott had already done so, a decade ago:
"But society came and paved over the place where all the roots and berry plants grew and killed the buffalo and dynamited the caves and declared the tribal bonding rituals Problematic. This increased productivity by about a zillion times, so most people ended up better off. The only ones who didn’t were the ones who for some reason couldn’t participate in it.... Society got where it is by systematically destroying everything that could have supported him and replacing it with things that required skills he didn’t have. Of course it owes him when he suddenly can’t support himself. Think of it as the ultimate use of eminent domain; a power beyond your control has seized everything in the world, it had some good economic reasons for doing so, but it at least owes you compensation!"
From the post "Burdens", here: https://slatestarcodex.com/2014/08/16/burdens/
For the rest, this sounds like the traditional early 19th century solution of workhouses with involuntary confinement, although I don't know that any of them went so far as to include suicide apparatus in each room; that's an innovation. But the general idea is familiar. I would suggest that before thinking about setting up internment camps for people unable to afford housing and/or unwell enough to manage, you ought to look carefully at why those institutions were dismantled in the first place.
Thanks for the link - I'll read it after work/at the weekend. I think the short answer though is that I disagree with this:
"...most people ended up better off. The only ones who didn’t were the ones who for some reason couldn’t participate in it.... Society got where it is by systematically destroying everything that could have supported him and replacing it with things that required skills he didn’t have. Of course it owes him when he suddenly can’t support himself."
I think that a more accurate, but less emotionally cathartic answer is that historically people who couldn't support themselves died. Modern liberals delude themselves that everyone has equal potential. In fact, I think that a small but significant % of people are simply totally unable to add any value to the modern world. Such reasoning is leading European nations, which are largely to blame for welfare states, to effective bankruptcy. Take France, for example:
- government spending 15% points above the OECD average
- welfare spending is 18% of GDP, nearly double the OECD average
- public debt is 112% of GDP, among the highest in OECD
- retirement age remains among the youngest in Europe
- civil service employs 5.7m people
- 5.5% deficit and rising
- no balanced budget for 50 years
That's the model which Democrats are attempting to impose in the US: ever-growing spending to throw money down a black hole. By contrast, I believe in Friedrich Hayek, Ludwig von Mises, Milton Friedman and Thomas Sowell:
• If you tax something, you get less of it.
• If you subsidise something, you get more of it.
• Western countries: (a) tax productivity; and (b) subsidise parasites.
• Welfare throws evolution into reverse.
"I think that a more accurate, but less emotionally cathartic answer is that historically people who couldn't support themselves died."
The passive voice evades no end of responsibility, or tries to. If someone who used to be able to support themselves, dies because you paved over all the wild fields and killed all the buffalo, then it isn't a matter of "they died", you killed them. If the claim is that they could have supported themselves by working in the factories you built on the paved-over fields, then you killed them because they couldn't or wouldn't work in your factories.
Which, yes, is the sort of thing our ancestors did to a lot of people. It isn't namby-pamby "modern liberalism" to say that was probably wrong and we shouldn't do things like that.
Ah, yes - I see what you mean.
What I was disputing however was the underlying contention that "someone who used to be able to support themselves, dies because [one] paved over all the wild fields and killed all the buffalo".
My proposition is that, historically, vast swathes of 'useless' people died without being mourned, and that it is an entirely modern conceit that we can throw evolution into reverse and conjure up a society in which we ensure the survival and thriving of the truly worthless (meant objectively, not pejoratively: i.e. people who really do have no value).
I genuinely believe (having worked for 5 years in the UK criminal justice system) that welfare and liberals/left wingers have thrown evolution into reverse.
I'm surprised that most places (?) don't sweep up the homeless, put them on buses, drive them 200 miles away and dump them there to be homeless somewhere else. It could either be made legal or semi-legal, or done completely illegally in the confidence of getting away with it.
This obviously isn't anything like an actual solution, but it's *got* to be tempting to "solve" your local problems.
"Wet houses" for drug users is probably a decent option - essentially a simple shelter where you can get your drugs injected by professionals until you die or you decide to try to fix your life. It's vastly cheaper for society than the homeless financing their drug habits through crime, anyway.
This way, there'd be no need for force - a roof over your head and your drugs is what they *want*.
IIRC this is already done; it’s called Greyhound therapy.
I'm unsurprised at hearing this. It makes too much sense from a local perspective.
If most homeless people stop being homeless within a year or so, how does incurable mental illness explain the homelessness crisis?
Completely different populations. Chronically homeless are not the majority of the homeless population, but they are the modal group that people think of when they hear the word "homeless," and they're the ones disruptive enough to normies to constitute a "crisis."
Wouldn't there be rather more room in homeless shelters and housing projects if the ~80-90% that are not mentally ill were induced to leave California and/or get off the streets?
....No? I'm saying the majority of that 80-90% don't interact very much with the shelters and aren't visibly on the streets. They're couch-surfing, sleeping in cars, etc. Those people moving might free up resources in food banks and the like, but shelters are still primarily going to house the same population of chronically homeless they do now.
It's an odd definition of "homeless" to include everyone currently bunking with a neighbour, and if that's true I'd be curious about the source of the statistic.
Th part that's missing is that you do not distinguish between
- things that are difficult/impossible because of the law/convention AND
- things that are actually immoral. (yes vague term, opinions differ...)
You simply elide the one with the other. Let's not do that.
If we do not do that, then the space that opens up is forced confinement that is not "prison". It doesn't occur in a prison, and it doesn't require as much infrastructure (ie is cheaper than) a prison because we don't need things like armed guards and searchlights; a facility placed in the middle of nowhere that's essentially like a homeless shelter today basically does the job. The main additional constraints are limitations on dealers being able to visit whenever they like, and making it not exactly trivial to simply walk out the place, or be driven out.
Now, given the above design is this "immoral" (as opposed to "illegal/unconstitutional"? Well that depends on your mental model of a schizophrenic.
(a) Is the person happier living in filth and squalor than in a regimented environment? The homeless advocates claim no. I don't trust a damn thing they say, but if we go along with this claim, then we are in fact providing the schizophrenic with the housing and structure that it is claimed they desire, so what's the problem? The fact that they no longer have access to street drugs?
The rest of us accept that while we have some flexibility in our lives, we may well have to live in a place that is far from our first choice for whatever reason - school, job, military commitments whatever.
I don't see why this basic fact of life for everyone else becomes an unacceptable burden for the homeless. You can live housed by the state -- out somewhere in Northern California far from the vices of the city and the rest of the population. Or you can live illegally on the street in LA, subject to being arrested for breaking the law in multiple ways. These are much the same choices the rest of us face.
An on-going problem is lack of honesty by advocates. What is the claim that the state owes these people? Housing? Or "housing wherever I want, of whatever form I want, subject to no oversight, with the ability to hurt my neighbors as much as I wish, and with ample access to street drugs"? Because the arguments always claim the first, but then veer off into the second as soon as details are required.
(b) the schizophrenic is not the only person in the equation, there is also the rest of society. The traditional thinking has always been that to take advantage of living in society you are expected to follow social rules; and if you are unwilling to do so then society doesn't owe you anything.
Once again the issue is not "illegal/unconstitutional", it is is this an immoral viewpoint?
The liberal stance has always been "your rights end where mine begin", and this seems to fall into that category, in much the same way that we're willing to ban political entities explicitly committed to ending liberal democracy.
So yes, by all means bring up the issues of law because they delimit what is possible. But don't confuse the issue by claiming that the *legal* bounds of the possible admit for no "reasonable" options beyond those bounds. The law can and has been changed. The constitution is not a suicide pact.
Sometimes hard choices must be made and someone will be hurt no matter what, but cruelty as a goal in and of itself is never a good look. Unless your goal is to sound like a Hollywood movie villain, in which case, great job!
As Nick Lowe's girlfriend observed way back in 1979: you gotta be cruel to be kind, in the right measure.
Other reason a homeless person might miss their prescribed social-worker or psychiatry appointment: they have an unrelated physical illness that makes it difficult for them to travel halfway across the city day of, and they aren't allowed to simply communicate with the social worker by email.
I'm curious what the process is like in rural areas that lack a hospital with a psychiatric ward. I live in a remote area where inpatient psychiatric care is not readily available.
Does a rural police officer still have to find a way to transport someone to a suitably large hospital wherever one can be found?
I don't know about the 'States, but in Australia: yes, you'll be strapped down in an ambulance (with IIRC a policeman in the back with you) and driven to the nearest city large enough to have a hospital with a psych ward. I haven't had personal experience with this in places where said large city is more than a day's drive (though I imagine that doesn't happen in the 'States), but my guess would be that you get taken by plane.
This is roughly the case in Canada as well; though the person will first be assessed by a doctor in their local area who can order a 72 hour hold; and at that point the person will be transported to one of the few hundred hospitals designated to involuntarily hold psych patients for up to two weeks (with extensions after that). In very remote communities this can indeed involve plane transport since we have areas not accessible by road; but its rare and in practical terms people with that level of psychosis requiring revolving involuntary admissions aren't staying in those remote communities.
Relative to how Scott described the process above, our definition of "harm to themselves or others" is a lot more literal and less vibes based. We're never admitting a person for whom that isn't VERY clearly true (and not just for involuntary admissions- due to bed you can't really be admitted as a voluntary patient unless you're meeting the criteria that could make you involuntary). However the vibes play out in the opposite direction- if its a huge logistical challenge, a physician in a very remote area is going to try a lot of other options to make things work in their community before signing a Mental Health Act form.
I can see this logistical challenge scenario playing out here in the United States as well. Ambulances, ambulance drivers, emergency physicians, they are all in short supply and I am guessing there would be a tendency to try to avoid the substantial investment of time to transport someone to another region and complete all of these processes.
I think that only really is a thing in really remote Alaskan communities and in that case…if Timmy develops schizophrenia, maybe aided by dank Alaskan weed, he gets hauled to Fairbanks or something by police Cessna.
Often it's to bus them to the nearest major city, which is why American downtowns have so many crazy homeless people.
Huh, that makes more sense than my guess that in rural areas, they tend to starve to death.
This also applies to non-crazy homeless people. Rural areas and smaller towns/cities will often have a little capacity for addressing homelessness, such as basement cots in a few churches, but the general answer is to drive/bus them to somewhere with more capacity.
Many small cities are happy not to develop that capacity. They would rather send the problem elsewhere than address it locally. Even if they were willing and able to address it locally, there are strong second- and third-order effects of being within driving distance of a major city and having a reputation for generosity towards the homeless.
In rural areas, such people generally not homeless because housing is much cheaper, houses are much larger, and they or a relative/friend usually have a place they can stay in despite their conditions.
See: https://twitter.com/aaronAcarr/status/1504619986580557829
I think you are incorrect, at least if you are speaking from the United States context. In my career I don't deal directly with homelessness, but I sometimes work with people who do. I've consistently heard that homelessness is a significant rural issue, and when it's come up directly in my career, there certainly seems to be an extensive problem in rural Kentucky.
Is this an issue that you track on an ongoing basis? I'm surprised to hear the claim that homelessness is not a rural issue, but perhaps in some regions of the world it is not.
This is some national coverage from a few years back: "Unsheltered And Uncounted: Rural America's Hidden Homeless" https://www.npr.org/sections/health-shots/2019/07/04/736240349/in-rural-areas-homeless-people-are-harder-to-find-and-to-help
"When it comes to homelessness and housing issues, one-third of rural Americans (33%) say homelessness is a problem in their local community, while more than one in ten have experienced several types of housing problems in their current residence..." https://www.rwjf.org/en/about-rwjf/newsroom/2019/05/four-in-ten-rural-americans-report-problems-paying-for-medical-bills-housing-or-food.html
I've only glanced at the articles, but a rural definition of a homeless problem is unlikely to match an urban one. When "in town" refers to a village of a thousand people, even *one* homeless person is a visible problem.
"Difficulty getting to medical services"? Most rural counties don't have bus service, so you're walking if your car doesn't work.
Neither of the links you provided disputes the data Mark linked to. The data from Mark *is* from an organization that regularly tracks this type of data. The claim is not that homelessness is not a rural issue, only that it is not as bad as it is in urban areas.
On Kentucky specifically, from the 2023 HUD Point in Time homelessness report:
"Over the longer period, from 2007 to 2023, the number of people experiencing homelessness declined in 25 states and the District of Columbia. [...] The largest percentage decreases were in Louisiana (42%), West Virginia (41%), Kentucky
(41%), and New Jersey (41%)." Page 18
So homelessness may be a problem in Kentucky, but that problem isn't especially bad relative to the rest of the country (rates of homelessness in KY are below the median for the country), and improving (though the report notes a 20% increase from 2022-2023, which was typical throughout the country).
https://www.huduser.gov/portal/sites/default/files/pdf/2023-AHAR-Part-1.pdf
I am currently in charge of a project to implement mental health crisis response teams in an area pretty much like this (regional city, large rural parts of the county). The police officer transports the person the the nearest emergency department, and, depending on the rules in the area, has to stay with them until they are admitted there, or the person is assigned someone to watch them while in the ED. Then they stay in the emergency department until someone finds a bed for them in an inpatient psych hospital, which could be many hours away or across the state. The hospital then has to arrange transport for them. In the area I’m launching this program, there are no inpatient psych wards for under 18s in the entire county, so the hospital staff have to call around to all the other hospitals in the region until they find them a bed. Kids stay in this emergency department for an average of about five days, waiting. The average length of stay for people in the ED for mental health reasons in this region is 12x that for people with only medical reasons, because of the difficulty of finding beds, and because they aren’t legally allowed to be evaluated until they are sober.
Sometimes it’s really as bad as it could be.
"And anyway, now we’re back to Housing First, the solution that all of these “We Should Do Something About The Mentally Ill” articles treat as their foil."
That seems to happen a lot!
I think it's probably because the Housing First people are right, and it's pretty much impossible to fix somebody's other problems while they're homeless. We keep trying to find ways around that fact, but reality refuses to cooperate.
I mean, "build more housing" will be helpful for people who are homeless for simple financial reasons, but I gather that's a fairly different set of people from the destructive people on the street that people are complaining about, and that those people are often homeless because, in addition to the financial problems, anywhere they try to live, they get kicked out for wrecking the place. So what do you do about that?
Admittedly I guess one answer would be "build *so* much more housing that even such people can afford to buy their own house from which they can't be evicted", but I don't think that's really possible in a city -- the way you build more housing is by building *up*, not by building lots more individual houses that a person could buy. (I guess condos exist, but I have to assume those have *some* sort of provision for dealing with people who wreck the common areas and/or structure of the building itself, right?)
(...hell, even when you own a house outright, you don't have arbitrary legal right to wreck it, right? Building codes exist for a reason...)
Social housing for the mentally ill exists, there just isn't enough of it. We could have more, if we had more housing overall.
My solution, which mixes housing first with being cruel and draconian, is "build cheap kinda-crappy housing in cheap areas instead of downtown San Francisco". This does require overcoming some nimbyism and also some objections of the form "but it's cruel to force people to move 50-100 miles away to single-room tenement apartments", but it does actually solve the main problems.
And it requires interventions at a much higher level of government than is typical for this problem. The state of CA or a hypothetical Greater Bay Area Co-Prosperity Sphere could do this; no city government can.
Certainly if I were redesigning the US I'd take a lot of powers away from local governments and give them to the states. Local governments should do zoning and garbage collection and parks, they shouldn't be running their own goddamn school systems or police forces.
I'd probably break up some of the bigger states as well to get everything at a more reasonable scale.
AIUI, local government powers derive from those of the State, so the State can take them back at its own discretion.
I'm thinking about a Greater Bay Area Co-Prosperity Sphere, and wondering who would be the equivalent of the Japanese in that case. Would it be tech moguls who think they know best and are going to force their solutions onto everyone else? What about homeless NGOs that force every non-SF city to take Sf's homeless, making it seem like they've solved the problem by making everywhere else worse? Or would it actually be an effective institution run by competent leadership (maybe an AI)? Clearly, we should create the GBACPS and find out.
This creates ghetto towns - which create a new set of issues - and if these locations are not integrated with accessible community services, what's the plan for treating the underlying issues?
The main issues with ghetto towns are just that they're full of dysfunctional people, but those people are going to exist either way. (In this case I don't think it would create whole towns - the actual number of crazy homeless people who harass passerby is surprisingly low, they're just very prolific).
Re community services - seems easier to build those outside of a busy and expensive downtown area anyway. I don't expect they'd be especially well done, but then they're not especially well done now either. I at least don't expect they'd be worse.
who pays for the community services in the ghetto? If the local council isn't receiving rates etc from residents, then you're saying that some other community needs to carry that cost. I appreciate SF downtown needs a solution, but sweeping people up and moving them somewhere else isn't solving the problem, it's just tidying it up for the people living in downtown SF. Supporters of this policy aren't looking for a solution to homelessness/mental health, they're looking for a service to create insulation against a problem being located on their doorsteps. If the problem were dispersed across all communities, the cost is evenly spread across the services required to address it, and the chances of keeping it on the agenda might be higher.
"Out of sight, out of mind."
Why is it important for them to be "in mind"? If the mind only furnishes vexation with them, or solutions that are de facto draconian, isn't it better that the taxpayer should stop thinking about them at all, so that homelessness may take an ever-increasing share of the public budget without any pushback?
The goal isn't first and foremost to treat the issues, it's containing and preventing them from being an nuisance to the rest of society. Although, it does allow community services to be concentrated at that location. Seems like the best of bad solutions to me.
Also, it seems to be often the case that the issues aren't treatable. Perhaps things have changed, but I knew a guy who was periodically inssane because he stopped taking his medications...intentionally. Because the side effects were intolerable. He was a professional quality pianist...but couldn't develop a career. (Truthfully, while he was professional quality, he wasn't better than the median for that profession.)
OTOH, most of the time he was an engaging conversationalist, honorable, truthful, and a good enough friend that I tried to babysit him though one of his episodes...but couldn't. He developed paranoid hallucinations.
Note, however, that when he was on his meds he didn't remember the times when he was off them, but only noticed the side effects of the meds.
That's fine. I admire you for expressing this framing. The cost of sweeping up the nuisance doesn't address the pipeline that creates that nuisance, so do you assume that moving the current homeless population to the new location, will mean that next month, you'll expect to clean up the newly arrived homeless people and send them to the ghetto? Do you genuinely expect that the politician that proposes a budget to send community services to ghetto will win votes / donations from tax payers of the cleaned-up communities, to fund the community services that will support the needs of the residents of the ghetto?
If you keep them there involuntarily, that’s just an asylum. If they are there voluntarily, you’re going to have the same issues with treatment compliance.
One largely-missed option is to permit people to build cheap housing. Society has, in its infinite majesty, decided that neither the rich nor the poor are allowed to buy cheap housing, and it's kind of a problem.
I go to a convention in San Francisco every year. A bunch of my friends do crazy stuff like pack four people in hotel rooms. I don't; I look for the terrible hotels where the room is *at most* twice as large as the bed and there's shared bathrooms on every floor. These used to be legal to build for straight-up residence, and they no longer are, but they're much cheaper and frankly only slightly less convenient.
We allow college kids to live in these situations - why don't we allow adults to live in these situations?
There's lots of cheap housing, it's just not in San Francisco. I don't know why the "we should build cheap housing" conversation always seems to start and end in the few places where that's geographically impossible.
Why is it always "We should build more shitty apartments in San Francisco" instead of "We should build more trailer parks in Arkansas"?
Housing is expensive throughout the Bay Area, not just San Francisco.
> Why is it always "We should build more shitty apartments in San Francisco" instead of "We should build more trailer parks in Arkansas"?
Because people want to live in the Bay Area, where jobs and their existing families/friends are located. They don't want to live in Alabama. If you build more trailer parks in Arkansas, they will sit empty.
But the people in California don't want more people, so it's really just too bad if more people want to live there.
It should be the other way around. Let's say I own land in California and want to build an apartment building on my land, and people want to rent those apartments. That should be my business, and it's really too bad if my neighbors burst out crying at the sight of an apartment building.
You can't stop people from moving in because of our constitutional right to travel. Which is pretty much non-negotiable, nobody wants to have to show their passport and proof of income to cross state lines. So immigration to major metro areas (in and out of California) will continue. You have two choices: either build shitty apartments for people to live in, or they'll turn your sidewalk into a shitty apartment. Which do you prefer?
There's plenty of perfectly sensible middle class people with good jobs who have left the Bay Area because it's too expensive. If you're choosing to sleep in someone else's doorstep in San Francisco rather than a warm trailer park in Arkansas then... well, that's a choice you shouldn't be allowed to make.
You can't afford that warm trailer in Arkansas if you don't have a job because there are no jobs in Arkansas.
There's housing that is cheap because land and construction prices are cheap. There's virtually no housing that's cheap because it's designed to be minimal. That's what I'm arguing here - "let people have cheap housing, not all housing needs to be high-quality".
If you're in Nowhere, Arkansas this isn't as useful of a thing to be able to do because even a one-bedroom house is pretty cheap. If you're in the SF Bay Area, it is.
(But this should be allowed in Arkansas as well.)
I'll quote a comment of mine from below:
> And climate aside, I think a lot of it is the combination of wealth and leftiness in SF. The combination of those two things implies: a) good odds of handouts, b) funded social services, and leftiness implies c) permissive legal environments, but also wealth implies d) high property values. Thus, homeless accumulate in places with high property values, but not through the obvious causal connection.
Actually, a lot of San Francisco's problems date back to a Supreme Court decision that city governments could not limit their public assistance programs to residents of the city. This might have been specifically designed to destroy cities that had generous public assistance programs.
How do you define the residency of a homeless person?
How do you define the residency of a homeless person?
How do you define the residency of a homeless person?
Why is it geographically impossible?
Making housing cheaper will make a lot o fthings better, but it won't do much for your untreated life-wrecking mental illness.
Housing the homeless would remove a lot of the barriers these people have for treating their mental illness since police / social workers now can know exactly where these people are. Which should in theory make it easier to get them to take medication or go in for appointments...
Actually, as our host pointed out, treating someone's mental illnesses gets a lot easier when they're housed.
That might or might not be true, but what does it have to do with my question?
Because San Francisco is on a relatively small peninsula, and other than the park space, it's *already* covered in buildings. And still, more people want to move there, so the value of the land is very high. And construction costs are high.
Now, I have proposed building a series of half-mile cubed arcologies the entire length of Golden Gate Park, but most of the residents of San Francisco whom I know have objected to this idea.
San Francisco has fairly low density compared to eg even suburbs here in Singapore.
Though I can believe that it is _socially_ impossible to build more. Just not geographically.
Manhattan is roughly 4 times more dense than SF. We could absolutely build more on the peninsula.
Arkansas already has cheap housing, so marginal gains are lower.
Part of the issue is that even in the places with 'cheap housing' it is still very expensive, which makes the solution of 'give everyone a house' cost a ton. Housing could be significantly cheaper everywhere, even if places like San Fran are the focus because of their exorbitant prices.
I agree, but with a caveat: shared property tends to create problems. Housing projects are a great example of this. Rowhouses work much better, and I've seen tiny single-room houses specifically for this purpose. But that probably runs up against "cheap", again.
The sort of stereotypical example is Wild West boarding houses, where the tenants are just long-term renting and don't own the property. I am personally totally fine with that but I believe it's currently not legal without behaving a lot more like a hotel.
Boarders need to be people who aren't horribly disruptive, though possibly having the option of being a boarder means that fewer people do a serious downhill slide.
To me it seems like some combination of allowing some type of cheaper via less/shared space and some relaxed building requirements but still humane and structurally sound housing, and at least enough asylum beds to house all the worst offenders, makes the most sense.
If people run their boarding houses privately, they can decide who to rent to.
I wasn't talking about problems caused by sane law-abiding people...
Singapore does just fine with people owning individual flats in a larger building.
Singapore executes drug traffickers, regularly imprisons drug users for several years, and also uses judicial caning on drug users, robbers, vandals, and voyeurs.
This is only a very very small selection of cultural differences that make something work in Singapore that would absolutely disgust your average San Franciscan or otherwise urban American. Start caning drug users and maybe a few years later you could have social housing. Don't put the cart before the horse.
I wasn't talking about problems caused by sane law-abiding people...
This. Re-legalizing poorhouses solves a lot of these issues.
(Ofc, this is generally not what housing first people mean)
You're 100% right. The problem is that most people think we definitely need more housing, but in their heads they imagine more spacious, well-furnished apartments. That's not feasible, or even terribly helpful. The illegality of small, spartan apartments is the issue. We need to permit the construction of cheap, crappy housing, because that's the logical step up from homelessness. We've removed the bottom rung of the ladder.
bingo
Building any housing would help.
If you build on the top end, people across the wealth spectrum will all move up by one rung, freeing an existing crappy unit on the bottom rung.
That process is called 'filtering' if you want to do more reading.
I don't think that's quite right. Agreed that building any housing will lower the price of housing overall.
But consider as an extreme example: a city where regulation prevents an apartment being listed smaller than 1000 square feet. This is going to place a floor on apartment prices even if a ton of new housing is built. Someone who can only afford to pay $200/month is still going to be out of luck. They will be priced out by people moving from other cities, or by non-residential uses for those apartments, because renting such a place for $200/month is always going to be a loss for the landlord.
The more popular phrase from the quote you're alluding to is "majestic equality."
Fair point, though also you apparently haven't visited a college dorm recently.
The super fancy California college I went to had much bigger rooms, about 4 times the size of a bed for singles or twice that if you have a roommate.
There's a crucial dynamic that this overlooks - many people get dramatically worse _after_ they hit the street. When you go from having a fixed home to being homeless, suddenly you lose most of whatever support network you might have had (because they can't find you), your physical health takes a toll, and you're more exposed to bad influences.
There's a crucial difference between:
1. Building housing to keep prices low will help keep people off the streets, and
2. Putting the currently homeless in housing will help them get off the streets.
Both things can be true but with significant differences in details.
If you build more housing for everyone, that significantly brings down the cost of government subsidized housing, usually through 1) reducing competition for government housing units from non-needy people (lowering the amount of gov housing you will actually need to achieve your objective), and 2) by reducing many of the regulations needed to make private housing easier to build, you also reduce the regulations needed to build government housing.
I liked something I've heard Chinese developers did - they offered housing swaps when they were buying land.
If you were a current homeowner, living in an old run down home, they would house you while they were building an apartment tower and then give you several of the new units.
Honestly, this wouldn't work on homeowners in the US (where the old homes are in better states of repair and the residents are vehemently opposed to apartments even if they're nice new amenities). But it might work on landlords as a kind of three-for-one deal in a package where the developer builds 30.
There is an age gap in this. The people in charge lived through the era where we did build enough housing for all the poor people. They were called housing projects with several high rise buildings filled with virtually free housing. They were hell on Earth because it put all the poor people together. And poor people are disorderly.
They were all torn down.
It's chicken and egg, though: the people who respond best to getting housed are likely to not have been homeless long, or are otherwise stable.
The worst, and the most visible, problem is the "crazy junkies in tents on the streets" homeless and just putting them into housing and then saying "job accomplished" is not enough. They won't take their meds, they may be incapable of independent living, they may trash the place or simply live in squalor or end up with predatory types taking advantage of them.
There does need to be ongoing support and engagement, and that is where people fall between the cracks, as listed by Scott above: miss appointments, can't get new appointments, can't handle the bureaucracy, don't take their medication, are just one more in the caseload of overworked social workers, etc. Putting them in housing is the first step, but it isn't enough on its own, and sometimes it may be better not to put them into housing until they're stable enough to handle independent living.
It's housing first, not housing only. And I don't think there's any way around it. I don't think there's anyone who's better left homeless until they're more stable, because I don't think you can expect anyone to get more stable while they're homeless.
My brother used to work in the Youth Services Bureau, here in Ottawa, so I've heard a decent bit about this. Housing people who aren't capable of living independently is a hard but well-understood problem. It's mostly a matter of money, and if housing wasn't so mind-bogglingly expensive it would be cheaper.
>if housing wasn't so mind-bogglingly expensive
Room, meet elephant!
I very much agree it's not housing only, but the trouble is, such programmes cost money, and to trim down costs things like support services will be pared down. So instead of having the community nurse calling every week to make sure the client is managing, that will be once a month, maybe, if you're lucky.
So what seems like an easy quick fix will be to stick people in cheap, possibly government-built, housing and then leave them to sink or swim, and a lot are going to sink.
Housing First is also an infinite money pit, especially if there's no willingness to remove people that refuse treatment and will continuously destroy the housing and terrorize their neighbors.
> pretty much impossible to fix somebody's other problems while they're homeless.
I get this argument, but is it any easier to make someone not homeless when they have other problems? Will they wander away from or destroy their home before their illness is under control? Will they be unable to get a job and resort to begging on the street in order to eat, taking up too much time to do anything else? Will they voluntarily take their meds (or remember to do so) just because they have a roof and a bed? Or do you still need some (probably draconian and invasive) infrastructure at the same time?
Idea: have, after steps 1-5, have private companies in charge of getting the people help. For each person who lapses, goes back on the streets, and gets arrested, the private companies pay a fine. For each person who becomes a successful and functional member of society, the private companies get a large financial reward. This would unlock the ingenuity of the free market to figure out what to do in particular cases, which would probably involve the companies carefully making sure that people figure out the mess with insurance. So basically I'd just have a step 8--funnel them to private companies who are financially incentivized to care for their well-being.
Where do they get the money to pay the fine?
Presumably from the large financial rewards for the success cases
Fake homelessness to get "fixed" in order to earn the reward in 3... 2... 1...
The private companies are the ones that pay the fines, to be clear, not the homeless.
But you need to avoid Goodhart's law: Such a company would have huge incentives to "filter" the easy-to-reintegrate homeless from the problematic ones. One obvious way is for the company to have "reasonable employee protection practices" which somehow always end up classifying the worst homeless as threatening or a danger to the staff and thus excluding them. More extreme, such a company would be incentivized to make people homeless to easily re-integrate them. A scammer could e.g. take children of employees who are leaving for university and first make them "homeless" for a few days and cash in on the rewards. More grey area schemes are certainly also possible.
Idea: they'd have to take the homeless who meet criteria 1-5 at random! Also, if they filter easy-to-reintegrate homeless, that might not be so bad compared to the status quo where it seems even those guys are being failed.
So they have to take on homeless people who has previously assaulted their staff? That seems incompatible with employee protection laws. What if the staff gets a restraining order against a homeless person?
If they are allowed to filter, there will be a race-to-the-bottom where the most successful company will be the one that filters the best (since removing your 5% worst homeless is much more profitable than making the homeless you have 5% more likely to re-integrate. Remember that most homeless people re-integrate quickly if left alone).
Maybe require them to be taken at random unless people assault their staff or commit other crimes to their staff, in which case it's their choice whether to keep them. Alternatively, set up betting markets for individual homeless about how likely they are to have various positive outcomes, and then reward people only for beating the betting markets.
If you can filter homeless people by making them commit crimes against your staff, then the most profitable company will be the one who is hyper-vigilant against anything that could be a crime, and also provokes or fabricates crimes.
(I'm not trying to shit on any market solution: obviously "make the government run everything" has an incentive problem, so does everything. My pessimistic side thinks the only good solution is "have high asabiyya" and people will do what's right damn the incentive.) But I think your proposals thus far have too obvious incentive problems that would be too easy to exploit, because filtering will be so profitable for this specific problem.)
Betting markets are great of course, I'd support that.
Glad we agree on betting markets. Yeah, I think there might be some way around this--maybe have heavy oversight so that people don't goad mentally ill people into attacking staff for profit or allow heavy suits for that sort of thing.
why would filtering would not be hard to prevent if the company has no control whatsoever over who they get?
Like the government makes a contract with the company that says "we will assign 10% of cases to you." then the company gets 10% of the cases as determined by a random number generator picked by the government. How does the company filter then?
> Maybe require them to be taken at random unless people assault their staff or commit other crimes to their staff, in which case it's their choice whether to keep them
OK, so now you've just created an incentive for me to get my most problematic clients to assault my staff. This doesn't sound great.
Yeah, speaking as someone who knows two people who used to be "staff", I'd prefer some other solution that wouldn't have put them in danger.
you could make it that once someone was a selected client, you still get the fine if they arent integrated regardless of whether or not they keep being your client
Police and prison guards have to do that too, don't they?
Whatever legal mechanism allows Private prisons to impression people who previously assaulted their staff should allow these companies from taking on people who assaulted their staff.
This can be problem with studies of ways to reduce homelessness. When you dig into them, you can find out that they recruited solely from among populations who had already been filtered for ability to follow rules and live cooperatively in groups (such as being residents of a shelter that requires things like "no smoking" and "no drug use" and so forth).
The UK tried the privatisation solution with its probation service (the people who help ex-prisoners get their lives back on track). It went horrifically for basically the reasons you outline: writing contracts for these services is nigh impossible.
But I wouldn't be surprised if the contractors made out like bandits for a while.
>Such a company would have huge incentives to "filter" the easy-to-reintegrate homeless from the problematic ones.
This would be an actually good thing. If the "homeless problem" is, in fact, several different problems of different difficulties and which require different solutions, being able to separate them would help a lot.
As long as you have multiple companies in competition you could do something similar to an auction to assign cases. The easiest ones that everyone is eager to take on naturally pay the least, then the reward increases until someone decides it's worth their time.
Good idea really. You should write this up more fully, and push it to people of influence in red-state large cities. (Because I don't think blue states will go for this level of private involvement)
Besides providing an "insurance advocate" as you describe, the company might pay some minor costs for the homeless person (like insurance copays or transit passes), pay for a bit of financial counseling, and so on.
It's not obvious to me what Goodhartian complications could arise, but it strikes me that a trial program could be run, and adjusted or cancelled if Goodhart interferes too much.
And when the private company pays out the reward to shareholders in the form of a dividend, rather than reserves it against future fines and declares Chapter 7?
I can't think of any reason any for profit organization would sign up to do that.
You're getting close to https://www.overcomingbias.com/p/who-vouches-for-youhtml
Social workers have pretty similar incentives in practice - they already want people to become successful and functional members of society, using ingenuity where possible. I like Ethan’s suggestion onto make companies bid on involuntarily-committed people to assist, as a way to combat Goodharting, but I still think the free market’s ingenuity would go towards gaming the rewards rather than improving outcomes. These companies would still try to improve outcomes where possible, but they wouldn’t have the force of the free market behind those efforts - it will always be easier to game the rewards than to solve the problems listed under “threaten people into attending appointments”. These companies will still use ingenuity to help their people, but in the same “where possible” way that social workers would.
what is the normal path that leads to "these kinds" of homeless people? i've been radicalized by the Land Value Tax + UBI Georgist movement. i want to believe that many people who end psychotic could have helped themselves earlier in life, if we didn't have a housing crisis and weren't wage slaves to the landlords.
Realistically schizophrenia is mostly genetic and hard to change.
Best case scenario, you have a loving family who notices when you start to become schizophrenic, you get put in an early detection / "first break" program and put on antipsychotics early on, they work for you, and then you can live a pretty normal life, with your family taking care of you during the intervals when the illness breaks through.
Medium case scenario, you don't have this or the drugs don't work perfectly, you're pretty confused a lot of the time, you get into some government program, you get a free house, you stay there, social services check on you every so often, and you basically do fine with a breakthrough episode once every few years and a lot of negative symptoms.
It sounds like you think maybe the homelessness causes the psychosis rather than vice versa. I think that's not really how things work, although I can imagine that if a previously stable psychotic person suddenly becomes homeless, that might be stressful enough to cause a breakthrough episode.
So if money and available social workers were unlimited, is that medium case scenario what you'd support for the long term homeless with persistent mental health problems and no familial support network?
If so, would this create incentives for comparatively functional people to get classified this way (along the lines of disability fraud)?
If resources were effectively unlimited, I'd provide graded living quarters. A basic one that emphasized "durable, cheap, and easily replaceable". Grading up into nicer quarters that perhaps required a bit of maintenance. First you are moved into the cheap housing, and if you trash it, you stay there. Otherwise after awhile you can move to a nicer place. And at the top someone who acted as a custodian to try to resolve any quarrels. Cameras in the hallways, so any fights you could tell what was happening. Bad behavior, and you get relocated to another dorm where you start over. (But will good mail forwarding!) Even at the cheapest end it's a safe place to sleep, and an address that people can contact you by mail at.
When you get a job and can find a place of your own you can move out, but don't force someone to move out if they don't have some place to go. (Not even if they could afford to have another place.)
Note: This would not be family housing. It would be for individual adults. Children would need separate housing and care.
I looked into it recently, and the schizophrenia research money in the UK is a joke. Like, total annual research budget is around £10m.
Is it the same in the US?
Is it the nature of the aetiology of schizophrenia that a huge increase in funding would likely make no difference? Or is it that it's not a 'sexy' thing to put money into, so it's neglected?
Sometimes the best solution to a resource constraint is to alleviate the bigger fixable problems and then reallocate resources to the smaller problems that can't be fixed.
We have an over-capacity system. Poverty causes crime, homelessness, drug abuse, traumagenic mental illness, and many other problems. Genetically predisposed psychosis is a fraction of the total utilization of these systems I would surely think? We should be able to free up a lot of resources to better manage the unfixable problems, like genetically predisposed mental illness, by dealing with poverty.
Don't get me wrong, your search for silver bullets is noble. It would be great to have a better solution for schizophrenics. But there are viable solutions in the big picture even if there are no silver bullets.
I can only speak from my experience in Canada, and it depends on which services you group together as "these systems", but psychosis is present in a large majority of people regularly utilizing most homelessness services. Some of that psychosis is genetically predisposed like schizophrenia, a lot is drug induced.
Honestly, most of the homeless people with only poverty related issues are not that hard to help. Most don't even need the help of current programs because they have existing social supports like families, and the ones who don't have that still get helped relatively easily once and then either leave homelessness or require minimal interaction with the system. The biggest challenge is just that its hard to get them help quickly when the system is so overcapacity because of all the psychosis, and the difference between getting help in 3 days vs 3 months is REALLY important when someone is first entering homelessness. But over the long term you're left with the people who are the most complicated to help- ie they have severe mental illness or substance abuse issues or some other extremely challenging behavioural issues.
Functionally we've already done all of the reallocating of resources to that latter population, to the point where we probably need to be looking at adding back protected resources for the easiest to help people to get them help more quickly.
That's very fair, but doesn't Canada have a much smaller and better managed homeless population? Some cursory googling suggests 1/3, but numbers are all over the place, admittedly. I've seen estimates between 8 and 171 homeless Americans per 100,000 while the Canada numbers I could find were 53 so I would need to go deeper and sadly I have to work now.
I guess more to the point we would probably just directly measure how many homeless are schizophrenics if we want to know how much that's the issue. But it seems like non-drug-abuse psychosis is <50% of the population (again cursory searching suggesting ranges between 3% and 65%.. ugh.. sadly I have to work)
I did specify my location just incase there were differences, but I would expect the specific subset of the chronically homeless utilizing services to be pretty similar (and for this to not be well captured in easily Googleable stats). Canada does have some advantages (better laws making it easier to treat people with mental illness), and some disadvantages (much less affordable housing). In both countries its also worth noting that the problem is not equally distributed- Southern Ontario and Southern California are much more similar to each other in terms of homelessness than either is to rural Saskatchewan or rural South Dakota respectively.
Anecdotally, some engineers I know who moved to San Francisco but come back to Toronto and Waterloo frequently have said they think things are moderately worse in SF, and some other people I know who travel between Vancouver and Seattle say things look basically identical.
> Poverty causes crime
It doesn't seem to track the business cycle.
It seems to track as a long term solution. Poverty and lack of education growing up are major risk factors for criminality and drug abuse.
They "predict" it, but that's not the same as causing it. Judith Harris' "The Nurture Assumption" covers lots of things people assumed caused certain outcomes but turn out to merely be correlated.
I suspect they are causes, because of the existence of a correlation combined with obvious reasons they are a cause. Living in a resource constrained environment will logically lead to you being the kind of person who does things they need to do to get by. If your choices are to bully your classmate or go hungry, you are more likely to bully your classmate. In the long term, the more poor you are, the more pressure there is for limited resources, and the more pressure you get put under to be strong, hard, and survive a more vicious pecking order. That's eventually a recipe for mental illness and criminality. Similarly, not being educated will leave you with far fewer apparent economic options that increase the relative value of criminality and fewer critical thinking tools that will help you decide not to be a criminal.
I'm not saying that poverty and lack of education are the only problems, and I don't think ending these would alleviate the need for law enforcement, but these issues are fixable problems that morally should be fixed and (thinking like an engineer) they would reduce the amount of pressure placed on this downstream bottleneck that depends on common public resources if they were fixed for a good decade or so and we consequently had fewer traumatized kids becoming criminals and crazy homeless people.
Is schizophrenia the only thing that causes people to be disruptive and homeless?
I've read about people deteriorating due to homelessness, which does seems plausible-- lack of sleep is bad for people.
I'm not sure "mostly genetic" is accurate. Certainly there are genetic "will break" causes, and others that are "will break under stress" (perhaps of some particular kind).
I'd be more likely to guess it was 1/3 genetic, 1/3 physical environment, and 1/3 social. Note that impoverished areas tend to suffer more pollution of various kinds as well as suffering more social stress.
Can't the causal arrow go both ways? Surely some homeless people are psychotic because of years or decades of alcohol binging and withdrawal?
Is there any evidence that alcoholic brain damage works that way? The brain damage typically downstream of alcoholism doesn't seem to resemble actual psychosis all that much, except for the presence of hallucinations in some people with advanced Wernicke–Korsakoff syndrome. Admittedly this is based on some quick googling plus my limited but nonzero experience around people who chronically abused alcohol for decades.
For whatever it's worth, in popular culture the babbling street drunk seems mostly to be viewed as pathetic but not particularly dangerous.
Also drugs, Scott. How much less psychosis would there be in the Tenderloin if meth didn’t exist?
There are plenty of people who would not end up psychotic if they never got addicted to meth or various other substances.
I met somebody who told me she'd fried her brain with too much cocaine and now needed antipsychotics indefinitely. Somebody else told me that'd happened to his son. Philip K Dick wrote that a A Scanner, Darkly was based on people he'd met who fried their brains with drugs. If drugs can cause psychosis, then maybe: homelessness => feel like crap => drugs => psychosis
Huh, I don't see a lot of extreme cocaine addicts, but this doesn't seem to correspond to anything textbook to me. If you fry your brain with cocaine I would expect you to end up depressed or something, but I'm surprised to hear someone ended up psychotic.
People end up with psychosis like symptoms from amphetamine abuse, like Phillip K Dick. Cocaine should do the same. It isn't an effect of long term use, just an acute effect from high use short term. There is a reason most anti-psychotics are dopamine antagonists as you surely know.
lots of rich people do a lot of coke (lot of people - in the service industry for example - do ampthetamine), and they don't end up that bad.
given that base rate it seems reasonable to believe Scott that most crazy people on the street lost both the genetic and socioeconomic lottery at the same time.
None of those people are doing meth or cocaine enough to cause psychosis like symptoms. It's very hard to do, even if you want to do it, but it happens regularly enough that it's notable in the psychiatric literature and a reason psychiatrists think antidopaminergic drugs actually treat the symptoms, rather than mask them.
I don't doubt it that it happens (after all you can get permanent - or maybe just very long lasting, but no one does the follow-up at 5+ years - pyramidal side-effects from psych meds that tinker with dopamine), I just think that it's naive to think that somehow "those people" don't do enough coke yet some random other people do.
Of course usually if rich people have problems they usually don't end up in case reports involving involuntary this or that.
The woman I knew well; her diagnosis was "psychosis which responds to anti depressants". In the mental hospital she believed the nurses were conspiring against her specifically, which is classic schizo stuff, but by trial and error the doctors figured out that antidepressants made her passable. I guess there's not a clean break between schizo and depression.
Street cocaine is typically adulterated with meth and/or fentanyl.
Like a lot of the manic energy associated with cocaine comes from that adulteration, pure cocaine is (I'm told) more of a euphoric feeling
To your original comment Asahel, an old friend of mine who had a psychotic break traced it to being given weed laced with something (probably amphetamines). Looking back he certainly had some prodromal signs but I could see an event like that (and subsequent hospitalization) pushing him over the edge
Are you sure it wasn’t methamphetamine?
"i want to believe that many people who end psychotic could have helped themselves earlier in life, if we didn't have a housing crisis and weren't wage slaves to the landlords."
Well, speaking from my time in social housing, we had (when I was there) at least one client who was schizophrenic. When she was on her meds, she was fine and could hold down a job. When she went off her meds (as she tended to do), she lost her job, ended up at the customer service desk talking a mile a minute about how the neighbours were breaking into her house to smear shit on her kitchen walls and what were we going to do about it (what the department did was routinely send out a pair - with clients like these you NEVER send out one person on their own because of risk of the client coming back with false accusations of assault or robbery or worse, things which have happened - of workmen to change the locks and give her new keys, even though no, the neighbours were not, in fact, breaking into her house to smear shit on the walls). She also liked to accuse the government of spying on her via the council (us) putting cameras up through her toilet.
In short, being a wage slave to a landlord was *not* the problem here.
You're asking one of the most important questions: How do we prevent this, rather than (just) try to fix it once it happens?
> “the damn liberals are soft on the mentally ill”.
I agree with your point in the post. I’ll add though that a policy that is adjacent to this is be “cruel and draconian” to the subset of homeless who commit anti-social crimes. If we removed the subset of criminals from west coast homelessness the problem would be still visible but far far less concerning to those of us who live among it.
This is where I land too, but I'm suspicious that there must be some reason we don't do it, the sort of thing I'd learn about if a police officer ever wrote a post like this one.
My guess is that homeless people who stab someone are pretty quickly taken care of (except maybe in SF during the worst administrations), and people are complaining more about homeless people who camp somewhere and litter and yell at people randomly. My guess it that it's hard (or just hasn't been done) to frame a law such that you can put a homeless person in jail for littering so much they destroy an entire park, but don't put a random guy who throws away a cigarette butt in jail (though honestly I am completely unsympathetic to this guy and think maybe a little jail would be good for him).
I would welcome learning more from people in law enforcement.
Never ignore the possibility that the damn liberals actually are crazy. Some of the other policies they have favored from time to time certainly do not seem to take the option off the table.
I am quite certain that some liberals are crazy. But that is not specific to one political point of view. I'm also certain that the news media give excess attention to the more extreme views. And that some people will adopt extreme views just to get the attention.
All fair. But in some places, the crazy wing of one or the other party has gained supreme political control, and one should not forget the fact when evaluating their policy decisions. It's possible that what seems crazy (left or right) is, in fact, crazy. I would suggest that Seattle and SFO might be on the list of such places.
Here in Seattle, people are complaining the loudest about homeless people who steal things. We've got areas of the city where people essentially can't get packages delivered to their porches because they'll get stolen, and all too often can't leave bikes locked up outside because they might get stolen too.
People walking by homeless camps have seen bike "chop shops" there, but the police won't do anything. In the police's defense, on the rare occasions they do arrest homeless people for theft, the county attorney will just drop the charges.
Meanwhile, the second-loudest thing people are complaining about is that several blocks of downtown near the tourist area, and around one of the main bus transfer points, has been taken over for years by an open-air drug market. I've seen many stories of people (mostly women) who've stopped taking the bus because they've been harassed and threatened at that stop.
When I say something needs to be done, this is what I'm usually thinking of.
I assume the "stealing packages" thing is a combination of it being hard to catch them in the act, and normal police inaction/incompetence. We had a (non-homeless) person hit and run a friend recently, got their license plate on camera, and the Oakland police didn't care at all. I don't know why this happens, I assume police underfunding.
Yeah, I'd totally believe police underfunding and undermanning; Seattle Police Department hasn't been able to hire anywhere near enough to make up for everyone who quit since the Floyd protests. But here, I think just a big a problem is how the county attorney keeps dropping charges, which discourages arrests in the first place.
None of this is related to homelessness as such, except that it provides a nice-sounding social justice rationale for the attorney to drop charges. But it's like shako said - we're not really upset at people being homeless; we're really upset at the antisocial things some very-visible homeless people do.
Someone (Peter Moskos? Matt Ashby?) has written about this- its an interaction between the big increase in administrative burden for arrests, and the decreased chances of any sort of prosecution. A police officer who spends 6+ hours doing paperwork just to see the person released without charges before they're even finished isn't going to keep making arrests for petty crimes like theft, vandalism, sexual harassment, etc.
Looking around online, that seems to be a perennial complaint about the Oakland police. Someone explained that hit and run is only a misdemeanor and unless bodily injury is involved, it's not worth the bother.
I lived near Oakland a long time ago, in the golden 2000s, and I remember a public meeting organized by the Oakland police where they explained that they will not investigate petty theft, and in fact any crime less severe than serious assault (especially sexual assault) and murder -- as a matter of policy.
Oakland PD is the D league of police in the Bay Area. It doesn't have adequate funding and the population is the most hostile. So most A tier cops avoid it, while OPD gets rookies and the leftovers. Then there's the fact that they have half the police they should that similar size+crime cities do. Guess how many police are patrolling at one time among 430k people in the crime that Oakland gets? 200? 100? It's 30! 30 officers to respond to whatever mayhem is going on. One officer busy filing paperwork and driving 2 hours to Dublin jail for every 40,000 people...
If they have to drive from California to Dublin to get to a jail, no wonder they don't bother chasing up crime!
(A very poor joke, I admit).
Arrest Report 10-X-999-4-C:
"In the merry month of June, when first from home I started..."
> Meanwhile, the second-loudest thing people are complaining about is that several blocks of downtown near the tourist area, and around one of the main bus transfer points, has been taken over for years by an open-air drug market.
And you can also get a Big Mac, if you dare! :-)
I find the porch pirate thing weird. America is generally seen as having more crime than Europe. But in Hungary, while I don't consider myself very worried about crime, I find it very much obvious that if you leave something unattended outside in a city, it's going to get stolen, and not necessarily or primarily by the homeless. It would never occur to me to order something and not be at home; if I can't be at home, I order to a pick-up point. And yet Americans have packages left on the porch and expect them to stay there, and it counts as an especially bad area if they tend to get stolen?
Indeed, I've also noticed that American single family houses are often depicted with an unfenced front yard (I guess that's what enables delivery on the porch in the first place?), while in Hungary, everyone's garden is fenced in both the city and the country.
There's also that thing about always leaving the front door open, which apparently still happens in some blessed realms.
I leave my front unlocked all the time, but I don't live in America
Small town America can be a very high trust environment. I know people who regularly leave doors unlocked, whether or not they are home. Others will leave their cars running while making a quick shopping trip at a convenience store.
The computer monitor I am using right now was delivered to my front door. I was not at home. Amazon called to ask how I wanted to handle that, since it was a brightly labeled computer monitor box. "Just leave it in an apartment hallway?" Yeah, that's fine. And it was fine. I have never gone two days without seeing delivery packages on doorsteps in my hallway. There is no outer lock or even an outer door, just an open hallway. We have never had a single theft.
Rural America is great. We still have farm stands with open money boxes. If I saw anyone trying to rip them off, I'd be plenty pissed, "Dude you want Northies to go away!" The long term benefit far outweighs the one time gain.
Rural America is great. We still have farm stands with open money boxes. If I saw anyone trying to rip them off, I'd be plenty pissed, "Dude you want Northies to go away!" The long term benefit far outweighs the one time gain.
I used to work in very rural West Virginia and I never locked my doors. I know people who would have to really search just to find their house keys and who just left their car keys in their car at all times.
I now live in a sub-division in central Virginia, but it's not a gated community. We have a fenced yard but it's for keeping kids/pets in, not keeping anyone out. There's no lock. We have packages left on our porch (or, if the delivery person doesn't feel like opening the fence and walking up the stairs, outside the gate). No concerns. My wife doesn't like it when I leave the doors unlocked, but I often just forget. Same with my car.
Prior to now, we lived in another medium sized (few 10s of thousands) central Virginia town, but on a main street close to a soup kitchen. We had a lot of poor and/or homeless foot traffic. We were better about locking our doors, but still had packages left on the front porch and never had a problem.
My brother lives in a medium sized town in south-eastern Pennsylvania. Same situation, and they leave their doors unlocked even more often than I do.
My point is that there are still a lot of places where theft and similar crimes are mostly an afterthought. That's not to say they don't happen -- they definitely do, but they're rare enough that people just aren't that concerned.
Many parts of the country used to be "higher-trust".
High trust generally requires enforcement if the trust is broken. This can be difficult in areas of dense population with rapid departure available.
Things are similar where I live. It's just assumed that, if you leave something on the street, someone will pick it up and carry it off.
Humans from Poland were similarly weirded out by single family residences not surrounded by a high wall.
It's maybe part-culture, part-density. I live in a top-5 US metro, within the main city but in a single family neighborhood. I get stuff delivered to my porch and don't worry about it. My neighbors often leave their front door open. Porch pirates around here aren't homeless people, I think it's a combination of crimes of opportunity and "regular" criminals.
My neighborhood used to be like that, but I would not recommend it any more, especially to women, given a particular incident a few years ago.
Keep in mind the fact that in America if you trespass in someone's yard, especially with the intention of burglary, the homeowner can shoot you dead, normally without serious legal consequences. Not saying it's necessarily a good thing, but it makes fences less necessary...
I am not a lawyer, but that doesn't sound true. If it's true at all, I imagine it's true in just a few places.
That is absolutely not true. Not even Texas allows deadly force against simple trespassers, though I’m sure there are a few cases of rural prosecutors not charging it.
I had my bike stolen, tracked it down via GPS to a bike chop-shop. I called the cops for an escort so I could go get it. Ended up giving up because it was fully chopped to bits. Talked to the cops for a while and they said the city won't let them prosecute the chop shops because then people get mad about them harassing homeless people. Obviously the cops could be lying, but...
I knew a young lady who got punched in the face and given a concussion in the 42nd Street subway station by the Times Square Free Hugs Guy when she told him she didn't want a free hug.
I went and looked him up and found a 2000 word New York Times article about him from three years before that starts off making him sound harmlessly eccentric and eventually makes clear he's a violent loon who has beaten up lots of young ladies in Times Square and Washington Square Park. And I found five or ten other articles about his being a scary nut, plus videos of him being a scary nut, plus there is a Free Hugs character in the "Angry Birds" movie.
Apparently, the number of really scary crazymen on the streets of New York City is under 4 digits. Heck, NYC maintains a list of its 50 scariest street people. If you took just those 50 off to a peaceful lunatic asylum in the countryside, daily life in New York would be less stressful for young ladies.
My suggestion is that states should double their capacity for locking violent nuts up in restful rural surroundings. When they get that done, they can think about doubling the capacity again. Even that wouldn't clear off all the nonviolent homeless drug addicts, but it would improve the quality of urban life for everybody else, including for the nonviolent homeless.
I think the classic description of this issue is "Million Dollar Murray" by Malcolm Gladwell. A tiny, tiny fraction of the homeless population racks up enormous charges at hospitals and prisons because of a never ending cycle of get drunk, aspirate your own vomit, catch pneumonia, go to the hospital ICU, get released, get drunk, aspirate your own vomit and on and on. That was the genesis for Housing First, the idea that you're spending hundreds of thousands on these guys anyway so you might as well give them an apartment and a full time nurse.
How do they get drunk in prisons? Seems bizarre that if someone has such a history, we can't break the cycle by keeping them away from alcohol.
Homelessness almost never results in charges that keep people locked up for more than a few weeks or months. Then on release they rapidly revert to their old behaviors.
First you take a trash bag and some oranges......
"you're spending hundreds of thousands on these guys anyway so you might as well give them an apartment and a full time nurse."
Very important to note that the full time nurse is what makes such a programme work, but of course in our world, what tends to happen is that a bunch of cheap housing is made available, the people are dumped into it, and the promised supports never materialise. So the crazy and hapless just degenerate while 'housed' and their problems are not really tackled.
Building a ton of cheap (shabby) housing or apartment blocks, and dumping an entire population of the really hard cases into that, and then leaving them there with no support, is how you get places like the Ballymun Towers which were for ordinary working-class people moved out from inner-city tenements but which deteriorated into bad areas.
https://www.thejournal.ie/ballymun-flats-2-1972131-Mar2015/
"Work first started on the first Ballymun project in 1965 and it was initially planned to include about 3,000 homes – the vast majority of which would be flats in Ireland’s first high-rise, out-of-centre public housing scheme.
A town centre with shops and other amenities was supposed to be built in time for the earliest waves of tenants, but the construction was delayed for years and residents were left without some basic services.
The development was also plagued with failures including lift faults, heating problems and claims Dublin City Council wasn’t keeping up with the general maintenance backlog."
https://en.wikipedia.org/wiki/Ballymun_Flats
"The Ballymun Flats were built in the 1960s to accommodate the rising population, particularly to accommodate former residents of inner-city areas which were being cleared in the process of 1960s urban slum clearances. Whilst suffering from a lack of sufficient public amenities, several schools served the area (Holy Spirit N.S. and Ballymun Comprehensive), as well as an Eastern Health Board medical centre and a purpose-built shopping centre. The area suffered from many social problems such as drugs and rampant crime. The causes of these social problems, and the subsequent discrimination faced by many people with Ballymun addresses when seeking employment outside the suburb, have been disputed, but Ballymun generally paralleled the experience of many working-class people in the 1960 and 1970s when placed in high-rise locations."
For such projects to work, you need a mix of population which includes stable people, families, etc. and that's tricky, plus the massive investment in support structures. That's expensive, which means it's the part that gets omitted, and then you end up with stories like the Mayfair Hotel as linked above.
Yes, it's the combination of housing plus counseling that is critical. Why couldn't such a model be the modern eras version of the old asylums?
This. Not to get too old-school Progressive, but the key is to take them out of their previous environment and society, remove all their links, and pressure them to integrate into mainstream society by example and osmosis. Destroy the old culture and assimilate them into the new. This can't be done if they're still surrounded by the same type of people as before. It'd be like taking a bunch of alcoholics, handing them the AA handbook, and telling them to meet every week in a pub.
>a never ending cycle of get drunk, aspirate your own vomit, catch pneumonia, go to the hospital ICU, get released, get drunk, aspirate your own vomit and on and on.
<morbid semi-snark>
Doesn't each trip through the ICU carry a significant chance of breaking the cycle - with a trip to the morgue?
</morbid semi-snark>
Yeah. I mean, read "Million Dollar Murray" if you get the chance., Like him or not Gladwell is a talented writer and he's able to pull off the trick of personifying the homeless crisis through an individual in that article quite nicely.
Much appreciated! Is there a non-paywalled version of the article? I saw a summary (power law distribution, dominated by a small fraction of the cases).
"Free hugs" guys (I think they're usually guys) are a global phenomenon, you need not worry that the Angry Birds character is based specifically off the New York one.
The first Free Hugs guy was in Sydney.
And then there's the $2 Deluxe Hugs guy https://www.youtube.com/watch?v=wJfYAJJYMqg
I think it would be trivially easy to make ‘being homeless’ not criminal by itself (as you discuss above) but a (massively) aggravating factor in any other crime.
In the UK at least this used to be what happened in effect: lots of people had a justice problem with it. And whether it would solve the problem in practice is doubtful (enforcement, court efficiency, lawfare, prison space). But legally you could produce the system to do it.
"This is your first offense, minor crime, so we'd normally let you off with a warning. But, we can't figure out where you live, so you also get a tracking anklet. If it starts blinking and beeping, head to the nearest police or fire station or public library soon as you can... else we'll have to send somebody, and then you get a night in jail. After about a year, battery will run out and the strap will come loose, at which point you can turn it in anywhere that accepts deposit bottles to get a thousand bucks, cash, as our apology for inconveniencing someone who turned out to be an honest citizen."
It's not just "yell[ing] at people randomly". It's carrying on loud and angry conversations with themselves or thin air, sometimes involving talk about killing people in various ways. It makes the person seem dangerous and unpredictable, and sometimes a passerby catches the person's eye, and then person follows the passerby for a bit, yelling at them specifically (and I think this does happen more with smaller women). Who's to say that they don't have a knife?
This, IMO, is part of why people develop the "completely ignore the existence of homeless people" reflex, and avoid places where that's not physically possible. It's a safety measure. It's dangerous to draw any attention to yourself.
yeah, it bothers me a lot when people moralize about how bad it is that we don't talk to or make eye contact with homeless people on the street. If I did that I'm pretty sure I'd be dead. The people who moralize about this seem to think it's because the homeless don't take up any space in my attention, but it's exactly the opposite - they take up a *lot* of space and I'm terrified.
ETA: being homeless is not actually the crux, and I wish I knew a better term for the kind of person I'm saying I'm afraid of - people who are on the street acting violently psychotic and/or so dirty that there's significant disease risk if they touch you at all.
Most of those people are homeless, but not all of them. And certainly some homeless people don't have those traits and I'm perfectly happy to interact with them.
I actually do make eye contact and at least nod or respond, for the ones that don't seem high or crazy. But I'm not as worried about self-preservation as most people.
I tend to divide the homeless into 2 categories. The first is simply homeless, and may or may not have jobs, but given a bit of help to get back on their feet, they can rejoin society. This makes up something like 60% of the homeless population, and are the people that pilot programs work on, and whom "housing first" would help. And they're not the ones who cause visible problems for non-homeless people. (I say "visible" just as a bleeding-heart reminder that homelessness itself is a problem.)
Then there are the other 40% who have some combination of severe mental illness, drug addiction, or "chronic anti-social behavior" (anything from robbery to shoplifting to shitting on the sidewalk to inability to follow simple rules). These don't tend to last long in shelters (which often have rules like curfews, no smoking, no drug use, and so forth). When given housing, they rapidly destroy it. (I know two people who've worked a job cleaning up afterwards.) This is the group that causes most of the visible problems.
Scott seems to be just glossing over this point. He mentions that most homeless are just homeless for a few weeks. But this is irrelevant, because the homeless that we need policies to handle so they don't cause problems for everyone else are *not* in this category.
I'm not sure I'd go so far as "glossing"; bimodal distributions are hard to get a grasp on.
When I lived in Seattle I tried to maintain a policy of always acknowledging the homeless and responding to them when they started talking to me. Some of them were sweet, like the guy who said a prayer for me after I gave him a cigarette. Some were rude, but my worst experiences (getting jumped, having someone scream racial slurs and death threats at a friend) started without any input on my part.
Yeah, I've never had any problems myself, either. With a bit of exposure, I think it's fairly easy to classify a lot of them as "safe". But I understand if some people don't want that exposure, or if some people overgeneralize and start treating dangerous ones as safe.
I've done some volunteering involving walking on routes in a group to hand out food to the homeless and engage them in casual chatter. It only happens on routes which are pre-determined to be safe, and the volunteers (walking as a group) develop a tacit sense to predict whether someone will be dangerous to approach.
It's quite an eye-opening experience, and it helps to de-anonymize the homeless and better understand their predicament. There's an underlying social network for the homeless, mapped over the city, that you don't otherwise notice. You can directly see the difference between people who are heart-wrenchingly kind and grateful, and those whose life choices are innately antisocial.
That sounds like a very good thing to do!
>So realistically what will happen is they’ll be back on the street, a year later they’ll get arrested for some other reason, the police will notice they violated the treatment order, and the judge will try to add an extra year to their sentence for the treatment order violation. Then if their lawyer is really good, he’ll spend his 0.01 minutes on the case arguing that his patient has one of the excuses above, which will always be true. Then the judge will either give them a year in prison or not.
This doesn't seem like a great description. Crime is pareto distributed. The most problematic individuals have hundreds of arrests, dozens of convictions, and no doubt thousands or tens of thousands of victims. That they keep offendings is consistent with the modal punishment for even non-victimless crimes being 0, and the mean being pretty close to 0, as well.
This relates to the sequence listed above. It seems to imagine police evaluating someone in a vacuum. In a reality, the problematic characters are usually already "known to law enforcement" who've interacted with them hundreds or thousands of times, and the people in question already have "known mental health issues."
Many people see that the US has a high incarceration rate, notice that it has victimless crimes on the books, and put two and two together, assuming that the US is excessively draconian in its assignment of crimes and their punishments.
In reality, the US has a lot more crime than other countries, so if anything, the US has an underincarceration problem.
E.g. the US has an incarceration rate 3 times as high as Singapore's, but a homicide rate 55 times as high as Singapore's.
An incarceration rate 4 times that of the UK, but a homicde rate 6 times that of the UK.
An incarceration rate 5 times that of Italy, Belgium, and South Korea, but a homicide rate of 12 times, 6 times, and 12 times those countries.
An incarceration rate 10 times that of Norway, but a homicide rate 12 times that of Norway.
An incarceration rate 14 times as high as Japan's, but a homicide rate 27 times as high. [I'm sure someone's put together a proper article with plots of these].
See Cremieux here: https://x.com/cremieuxrecueil/status/1705283540420546814 who notes the pareto distribution of crime, the US incarceration rate, and the relationship between incarceration rates and crime rates.
It seems to be a choice, especially in Progressive cities with high homelessness to allow a small percentage of the population to run rampant, victimizing the public, including crimes like assault, not just littering.
To reiterate, it's not about identifying marginal cases, but about choosing to lock up serial offenders, whether in a prison or an institution.
"don't put a random guy who throws away a cigarette butt in jail (though honestly I am completely unsympathetic to this guy and think maybe a little jail would be good for him)."
Welcome to the Side of Social Conservatism and Darkness, Scott 😁
>My guess it that it's hard (or just hasn't been done) to frame a law such that you can put a homeless person in jail for littering so much they destroy an entire park, but don't put a random guy who throws away a cigarette butt in jail (though honestly I am completely unsympathetic to this guy and think maybe a little jail would be good for him).
It's not hard, it just wasn't legal until the Supreme Court overturned Martin recently. For instance, you have a law against camping in public parks. Then anyone with a tent in a public park gets fined, kicked out of the park, and their tents and stuff confiscated. After a while people don't camp in the park anymore. They find more out of the way places to sleep, which is good for the public because they're more out of the way.
This is why on the West Coast you get public areas taken over by tents and shanties and you don't see that in Central Park: New York isn't under the 9th Circuit's jurisdiction, San Fran and LA and Seattle are. And under Martin, if you didn't have enough shelter beds available to shelter *every homeless person in the city* then you couldn't arrest *any homeless person* for camping in the park, or on the sidewalk. Now that that's gone we'll see some changes.
Huh. Am I reading this correctly that you think the person who throws a cigarette butt on the ground should go to jail? That seems like a pretty wild over-response to me.
Depends on what we define as "crimes"?
But crimes are already crimes and you get sent to jail for them. You don't need an additional policy for crimes by homeless people, that's just criminal justice.
All of these articles about 'the homeless problem' cite a handful of cases where something is stolen or someone is assaulted or w/e. But those could be solved with normal law enforcement.
The 99% of the 'problem' that they're actually trying to 'solve' is just people who it is unpleasant to look at or listen to or smell as you walk around the city.
I think the point everyone has been making is that no, you don't
NY's system is far from perfect but CA could really take a page or two. NY didn't deinstitutionalize as much as other places. Post-COVID there has been a huge shortage in funding and staff, and people have gotten crazier (possibly post-viral brain damage), but the bones of the system are not bad.
There are state hospitals for the criminally insane where all the treatment resistant crazies are warehoused. Regular dangerously crazy people mostly go to private hospitals where they stay a few days to a few weeks, and are provided with a state attorney and access to a judge to petition for release and drug refusal. There are also programs to provide long acting injectables and follow up with patients.
Developmentally disabled people get state funded, privately run group homes, which are generally pretty good. Extending that program to people too crazy for outpatient care but too sane for hospitalization could work maybe.
"What’s your plan for when homeless people finish their prison sentence? Release them back onto the street, then immediately arrest them again (since there’s no way they can suddenly generate a house while in prison)?"
I'm not defending the *rest* of the plan, but isn't that what halfway houses are for? "You live here until you find permanent housing or your probation is up, whichever comes first."
I don't know exactly how this works. Given that there aren't enough homeless shelter beds, I would be surprised if there were enough halfway house beds. I'd also be nervous about any system that privileged prisoners over non-prisoners (ie nonprisoners have to wait years for a homeless shelter bed, but prisoners get a halfway house bed immediately). If you're going to do something like that, just skip the prison and give the homeless the halfway house beds.
Don't get me wrong, I'm in the "just make more housing" camp. I was just pointing out that there's already a system that could ("could") deal with this specific bullet point.
Homeless shelters are already notorious for being dangerous. Many homeless prefer sleeping in the street in a place of their choosing rather than go there. Thus the aggressive homeless crowd out more peaceable ones who would be easier to re-integrate.
A fun fact is that currently the federal government defines homelessness in a technical way that excludes people recently released from prison, so they don’t qualify for programs that help house homeless people (because the current definition uses ‘did you have somewhere to stay for the most recent X weeks as their main criteria, and the person -did- have a place to stay--prison!). I’m currently sitting on a California govt committee that is trying the get this changed.
I noticed many suggestions start with some form of building more housing, shelters, tents, etc. Sounds expensive.
A potentially "arbitrary cruel and draconian" suggestion for how to get this done (apologies if this has already been suggested; I have not combed through all 1000+ comments):
1) Prisoners build more housing, shelters, tents, etc.
2) <arbitrary cruel and draconian part> Tie sentencing directly to work produced. Eg. building something equates with a fraction of one's sentence served. This would require more supervision and skills training.
3) If you want to take this further, you can even tie basic needs like food and shelter to work produced. Then if prisoners aren't capable/willing/too stubborn/etc. they remove themselves by starving.
Pro: shelter built at a fraction of current costs.
Con: kinda sounds gulag-y
Yes, but then you have to build a ton more halfway houses, and as Scott said if you're going to spend that money anyway you can put them in social housing *before* sending them to jail.
Can we look at what other places do? What is eg Salt Lake City’s solution? (Possibly, export the homeless to SF). What about Zurich? Singapore? Edinburgh?
The US in general and SF in particular seems to have this problem unusually bad, so one could reasonably look elsewhere for ideas.
I was going to make the same point. In environmentalism, the answer to "why do we have this problem and, say, the Germans don't" can plausibly be "because they outsourced their production of tetrahydrosomething to us". But with mentally ill people, that's not likely. The base rate of schizophrenia etc should be similar (if not, that would be the first question to dig into), but in the various places in Germany I've lived in and seen, encountering a raving homeless is maybe a once-a-year thing, not a daily occurrence. I don't know what the procedures are like here, but I'm willing to guess they don't qualify as draconian...
In Germany, homeless people have a right to a shelter. (But not a right to a shelter where they can bring their dog or their different-gendered partner, which are common reasons not to use a shelter.) More importantly, homeless people can receive welfare cash (Tagegeld or even Hartz IV) but the city they're in can attach conditions to that, like you get the cash only if you're in a shelter. And where you go to pick up the cash is also a place where various social work programs can find you.
And I don't think psychotic people get released from hospitals that quickly. IIRC an involuntary stay at a locked ward is weeks not days.
I can confirm this seems to work to some significant degree. There are some homeless people I meet in the street (in large cities only) but they seem more like drug addicts than like psychotic people.
I also meet a few psychotic people (so few I can recognize them and could probably learn their names if I cared) but they don't look homeless; they don't stink and they'll frequently have new sets of clothes. So yeah, whatever Germany is doing differently seems to be working, and I very much doubt the differences that I know about (above) are all there is to it.
It could also be that violent people are always arrested right away. Where I live there is a place where there are pretty much always 15 homeless people, but they just sit there or walk around and drink beer. Maybe they are all non psychotic or at the violent people have just all been arrested.
I always just feel bad for them, I think even young women mostly aren't scared to walk around that place.
Yes, my feeling is that in Canada 80-90% of homeless are on the street because of drug/alcohol addiction and maybe 10-20% because of a legitimate mental illness (not caused by prior substance abuse). The 60% of homeless people who have neither drug problems nor mental illness - which someone mentioned as being their estimate for the US homeless population - I am sure does not exist in Canada due to a) a welfare system which pays a sufficient amount that even if you don't work you can still afford an appartment and b) climate.
In particular, different experiences regarding the association between homelessness, crime and mental illness are interesting. In Budapest we have homeless, but the only problem is they stink; they seem far too lethargic to pose any threat. We have some threatening-seeming people, but they generally aren't the homeless. Perhaps our homeless just drink booze, while yours take meth?
The base rate of schizophrenia is not in fact equal across different populations.
Where is it highest and lowest?
Look at https://ourworldindata.org/grapher/schizophrenia-prevalence. The band "0.2% to 0.3% incidence" covers a remarkably wide range of countries.
Between Scott's past writing on culture-bound illnesses (including schizophrenia as a permanent condition), joking-not-joking about the San Francisco egregore, and Albion's Seed type founder effects, I don't think it's actually that unlikely that the US produces more mentally ill and concentrates them into few areas, with runaway feedback loops related to these.
San Francisco has its share of psychotic homeless people, but I haven’t noticed more here than in other major US cities. What SF does have that some of those other cities don’t is a highly visible concentration of fentanyl-addicted, mostly non-psychotic, homeless people on the streets in the middle of downtown.
I talk a little more about this at https://www.astralcodexten.com/p/book-review-san-fransicko, but I think most places' solutions are a combination of:
1. Cheaper housing so that more people can afford homes
2. Cheaper housing so that the government has an easier time giving free homes to people who can't afford their own
3. Homeless shelters
4. Frequent bad weather, forcing the homeless to use the homeless shelters at least sometime, which gets their foot in the door
5. Laws requiring the homeless to use the homeless shelters, which I am much less against when the homeless shelters exist.
In solutions 1 and 2 what matters is not the absolute level of prices but the level relatively to available resources. The average income and the tax take in SF are extremely high compared to any other city. It probably does not solve the first cause as what matters there is not the average income but a bottom 5% income at that can be low in SF relatively to house prices. However if solutions 2 and 3 are not implemented it is because SF government is disfunctional, not because of high prices.
I think also, better enforcement of drug laws. Many of the problematic homeless aren't mentally ill, they're drug addicts, and the US has pretty much given up on enforcing its drug laws.
I think people underestimate how much worse the drug problem is in the US than in other countries. Germany has about 2,000 drug overdose deaths a year, while the US with ~3x the population has over 100,000(!).
The "give Oxycontin to everyone who claims to have chronic pain" policy was confined to North America, AIUI.
Clearly this means that the first step of a realistic solution is deporting all crazies to Alaska, with each state paying a fee per head for the privilege. As an additional bonus it's much harder to get fentanyl there I'd guess.
Minimum fee could be based on making sure the https://en.wikipedia.org/wiki/Alaska_Permanent_Fund stays proportional, and then the lower 48 could be given an option to pay more - however much more they like, according to whatever criteria they like, with some sort of assurance it won't result in discrimination-related lawsuits - to secure higher priority for particularly obnoxious individuals when the overall not-technically-a-gulag system starts running into capacity limits. Would probably still end up at least a little bit less terrible than existing for-profit prisons.
Alaska, being under the 9th Circuit's jurisdiction, is also currently having a major homeless encampment problem. Hopefully with the Supreme Court decision they can start implementing option 5, but in the meantime a good portion of the folks you deport to Alaska will freeze to death with opioids in their pockets and a bottle in their hand.
https://www.nytimes.com/2023/11/13/us/anchorage-homeless-deaths.html
Notably, last year the Mayor of Anchorage floated a proposal to buy homeless one way tickets to Seattle. I'm still not sure why they didn't actually do it.
If there are not enough homeless shelters, jobs, ... for all then apply requirements to get them.
If you have only room for 10% of the homeless, make the rules strict enough so that only 10% can possibly comply with them. Increase cruelty for the remaining 90%.
Use those 10% as a good example why this policy works because they will have more success stories than the 90%. Ensure funding for another 10% this way.
Repeat until the problem is so small that a solution for the rest can be payed for.
I searched a bit for Switzerland. If you want to know every bloody detail, here is a 50-page English summary of how homelessness is handled in Switzerland.
https://www.bwo.admin.ch/dam/bwo/en/dokumente/02_Wie_wir_wohnen/22B_Wohnen_und_Armut/bericht-obdachlosigkeit-februar-22.pdf.download.pdf/Obdachlosigkeit_FHNW_Bericht_EN.pdf
First of all, my own impression is that it is handled pretty well in Switzerland. The report says that the number of roofless people (living on the street) is about 2,200, which sounds low to me compared to the Swiss population of 9 million. After some severe failures in the 80s/90s(?), Switzerland has adopted a very supportive policy towards drug addicts, and this works very well.* From my own experience, you don't see drug abusers or roofless people on the street, though you sometimes (like, every few weeks) someone in public transport who seems mentally ill or perhaps even roofless.
I have skimmed through the report (no guarantee that I got everything right), and my main takeaway is:
1) There is a good social safety net, especially with financial aids. The regulations are pretty sane. One excerpt:
"The extent to which a person is in need is assessed according to the regulations and principles applicable at the place of support (Art. 2 paras 1 and 2 SocRA). The place of support, i.e. which canton is responsible for paying social assistance, cannot always be clearly determined. In its information sheet 'Local responsibility in social assistance', SKOS provides tools for determining the place of residence of a person in need. If persons with Swiss citizenship are in need of immediate assistance outside their canton of residence, the canton of residence must provide it (Art. 13 para. 1 SocRA). In the event of disputes regarding liability for assistance, the canton in which the person in need resides must provide assistance, at least temporarily, until the legal obligation has been clarified. The canton of residence is also responsible for foreign nationals who are not resident in Switzerland (Art. 21 SocRA). They too are entitled to at least emergency aid. The provisions of SocRA therefore establish the principle that a person in need receives assistance in emergencies, even if they are outside their canton of residence, their canton of residence is unknown or they have no place of residence."
2) The good safety net makes the numbers so small that they can be handled somewhat individually, and officials usually do feel responsible for it. Again an excerpt:
"As far as the assessment of possible measures is concerned, most cantons feel able to judge the advantages and disadvantages of the different offers. It is generally recognised that a certain degree of individuality is essential – even with emergency concepts. There is a need for privacy, which is why emergency shelters that are shared with several people are often only considered suitable to a limited extent."
3) Most rooflessness concentrates in the six largest cities, and those have developed concepts, and invest effort into the problem.
4) As mentioned, there is a pretty good support system for drug addicts.
The report contains a wealth of information and is actually well-written. It also contains some interesting figures, for example a breakdown of what officials perceive as the main reasons of homelessness on page 33/34. If anyone wants to read the whole report, I would quite interested in another summary.
* The drug support system in Switzerland will be put on a severe stress test right now because a crack wave is running through Europe. Crack addicts are much harder to reach with supportive measures than the usual cocaine/heroin/alcohol addicts. It is yet open which European systems can handle this.
When I was at the ACX Zurich meetup, I noticed the city was very pristine and asked some Swiss people how they dealt with poverty. They said "everyone here is rich". Seems like a good solution if you can make it work.
Zurich is a bit of an edge case, since the people who can afford to live in the city are generally rich, and those who can't afford it often live across the border in Germany. That's also the case in Geneva and Lugano with France and Italy respectively.
Yes, that's pretty much on point, too.
It certainly helps the social service budget if a substantial fraction of your workers are "guest workers" who have to stay employed or go back to their origin countries.
Switzerland is indeed a paradise (one could argue it has been built thanks to tax evasion and "blood" money which filters into its banks from around the world), but indeed a very safe and clean place to go for a walk. Cost of living is expensive enough to dissuade most homeless people from trying to make a go of it as well, I reckon.
Zurich was quite different from that in the 90ies and it had some interesting policies to deal with the issues. Not always successful in all cases (see eg. the movie "Platzspitzbaby") but apparently overall successful if you see the way it looks now.
Just a list of policies that they used in combination to battle the open drug scene of homeless people at the "Platzspitz park" (also known as "Needle Park" back then):
- be very cruel and draconian to dealers and all others that did not comply with requirements
- take all addicts/psychopaths/homeless to their hometown/village for them to deal with the issue. This didn't solve anything on its own but it ensured that it was no more seen as a "Zurich problem" but rather a "Swiss problem". In addition, the people were taken out of their problematic surroundings.
- offer methadone, other programs and social housing for those willing to comply with certain rules. They got the conservative state to allow and finance these only once it was seen as a Swiss problem.
- offer help on a privately funded basis to some more people with less strict requirements.
I don't know what the actual *policies* are in Edinburgh, but I can say that while it's reasonably common to see beggars or rough sleepers on the streets or in the parks (I guess I see one or two a day, on average?), it's *very* unusual to see people shouting or being randomly threatening.
Stereotyping, but I'd imagine the anticipated reaction in Scotland would be an effective deterrent that SF lacks.
Came.to here to.say this. Details matter, but the bigger picture .matters too. Easier access to welfare helps , easier access to medicine he!ps.
Salt Lake City tried Housing First but results were mixed; the Salt Lake Tribune described it as "a shrug." They did find that substance abuse was a more difficult issue than other mental illness in many cases. TL;DR: Costs skyrocket, motivation to keep it going does not, when the vouchers run out the people are no better off.
One note I'd highlight from the below links is that Finland had a very successful Housing First program... with a 3:1 subject to staff ratio regarding various counselors, nurses, etc. To make housing first work it's a long-term ICU.
I wrote a couple reddit comments on it in the past: https://www.reddit.com/r/TheMotte/comments/kcsx2u/culture_war_roundup_for_the_week_of_december_14/gg1aks9/ https://www.reddit.com/r/TheMotte/comments/l9xgxr/culture_war_roundup_for_the_week_of_february_01/glzw9s8/
I believe universal health care greatly reduces bureaucracy, which makes the system more navigable and accessible. People are less likely to fall off at points about insurance, paperwork, prescriptions, and in-network locations.
That could be, but universal healthcare is not universal (at least, not if you mean something like the British NHS). Switzerland and Singapore (to use two examples from my OP) both have insurance based systems. They might be less complicated that their American counterparts (could hardly be more so) but I presume there would still be insurance and paperwork to deal with. And even in NHS type systems there will be prescriptions to deal with.
I'm not sure how it works in Israel, but there are markedly fewer homeless people on the street, and they also seem much less threatening. My instinct is to say that stronger families are a factor. Which leads me to think you can't solve this with "light touch" social services. They have to really be involved all the time.
I feel like this article presupposes a lack of experts. Like from an idealized hierarchical standpoint, people should be able to make reasonable requests like deal with homeless people or pollution, and the system should have experts that are equipped to translate said reasonable requests into systematic policy. And we do have experts technically, bunches of think tanks and colleges and advocates have decades of research on how to deal with this stuff supposedly. So the question should be what exactly goes wrong in the expert to policy pipeline. It is logically strange to expect regular people to invent public policy that is better than the people who's job it is to do so in order to be able to advocate for it. And yet it seems like that this is how it should work these days.
I think the problem is something like - all (?) the experts support the current policy, and all the normal people who aren't experts say we should "do something about the mentally ill". The experts can't think of anything to do, so they don't, and then the normal people complain louder. See also the discussion in https://www.astralcodexten.com/p/book-review-the-revolt-of-the-public
Is it that the experts can't think of anything to do, or that they aren't willing to recommend what they can think of?
Those would both look the same to people who aren't closely paying attention, and the existence of some places without the problem (in the recent past! And even some places today!) is evidence for the latter.
This seems most likely to me. I suspect there are social pressures preventing experts from suggesting anything on the draconian end of the spectrum
There are social pressures preventing experts from suggesting anything at all, because it's a culture-war issue. Proposing specifics in public is an invitation to be attacked by one or both sides, based on criticism of (in preference order):
1) perceived ideological impurity in the actual specifics,
2) anything else the so-called "expert" has ever said or done,
3) anything anyone they're vaguely associated with ever said or did,
4) whatever someone with better demographic credentials is willing to lie about
Not to mention that few humans actually want a solution. Rather, they want to score points at the expense of the other team.
Lots of humans want a solution, the problem is that too few debaters do.
Yes, and all actual solutions involve messy trade-offs and it's easy to point to the ugly parts in any specific proposal but hard to come up with a better one.
Experts are invested in the system as is.
Yes, this is it.
So do you personally believe that the policy we have right now is actually the best possible policy and the only reason regular people should consider these questions is to recognize how intractable the problem is? Cause maybe that is the case.
Well, the ordinary people may also get fed up enough to coalesce around a revolutionary movement of some sort. Which may even solve this particular problem, at the cost of creating a hundred of new exciting ones! So it goes.
Solutions some experts might advocate for, like "build more long term living solutions for the chronically serially mentally ill so that more people can access longer term involuntary commitment", are both at odds with current political trends in the ivory tower and with the public.
California just passed a ballot proposition to fund $6 billion worth of exactly that type of thing so I think it’s difficult to argue that it’s counter to current sentiment.
I think it’s a specific example of “the elite consensus is good for the elite but not good for ordinary people” dynamic that’s playing out in lots of different ways in different places and contributing to the rise of the anti-elite
The experts are paid to implement the current solution, so if they decide to advocate for a different solution they are advocating to put themselves out of a job. (It’s rare for someone to be paid well to be agnostic about the solution to e.g. homelessness)
I think in this case it's just 'the experts know that you can't fix this without spending a lot of money and changing some zoning laws' and the people who want the problem solved are also against those things.
"If your plan is to “lock them up long-term”, keep in mind that (for now) there are almost no institutions equipped to do this. Each state usually has one center with a 3-digit number of beds for the most recalcitrant patients."
I think most people are thinking off something like the California Department of State Hospitals, specifically DSH-Atascadero, DSH-Metro, DSH-Napa, and DSH-Patton. Admittedly these are forensic hospitals but I think that matches their intuition of how some of the mentally ill homeless should be treated: if they've committed a crime and they've got an obvious mental illness, they should be sent away to a secure institution by a judge until they're better. And a lot of the disturbing homeless are committing crimes.
Admittedly, most people don't know enough about the California government to know about DSH but I think that's the kind of thing they're internally thinking of. And I'm not sure we could quickly scale up 2-4 new hospitals but it's not impossible.
California used to have a huge and quite lovely public mental asylum in bucolic Camarillo. Lots of celebrities like Charlie Parker spent time there. It got shut down when lunatic asylums went out of fashion, and is now repurposed as the very nice campus of Cal State Channel Islands.
Interesting, I hadn't heard about Camarillo. This bit from the wiki article (1) jumped out at me:
"Another contributing factor was in 1996, when Governor Pete Wilson empowered a special task force to research reasons for and against the closure of the Camarillo State Hospital and Developmental Center.[2] The task force cited that the facility, which housed as many as 7,266 patients in 1954, had only 871 clients in 1996. The hospitals per capita costs had risen to nearly $114,000, second highest in the state mental health system. These factors prompted the initial closing of one-quarter of the facility's 64 units and later, on June 30, 1996, the hospital officially and permanently closed."
Which makes this sound like primarily an economic issue, which makes sense. When they closed Camarillo, the issue wasn't beds, that wouldn't explain a nearly 90% decrease in patients served, but the $100k price tag per patient (in '96 dollars, now I think it's closer to $200k). That matches what I'm seeing in the budget (2), although I might be misunderstanding it, $75 million on "capital outlays" and $3.4 billion on "State Operations" sure sounds like the costs are overwhelmingly on personnel and managing patients safely, not building more beds.
...it is insanely depressing that $200k/person/year is insanely expensive to keep someone off the streets and yet is still probably cheaper than what SF has tried.
I still think this comes back to moral intuitions. A lot of liberals really, really dislike mental institutions and...yeah, they're not bad in the way liberals think they are but they're also way worse, if that makes sense?
(1) https://en.wikipedia.org/wiki/Camarillo_State_Mental_Hospital
(2) https://www.dsh.ca.gov/About_Us/docs/2024-25_Governors_Budget_Highlights.pdf
> it is insanely depressing that $200k/person/year is insanely expensive to keep someone off the streets
My reflexive snark is that it may cost more than that to *live* in SF as an ordinary person. Dunno if that's a fact or not, though, but it's not off by an order of magnitude, surely.
Here's Charlie Parker's "Relaxin' at Camarillo," recorded after a multi-month stay at the Camarillo Mental Hospital after an unfortunate incident.
https://www.youtube.com/watch?v=mU6zEYX8w84
Charlie didn't appreciate his record company's choice of title for this track.
I have seen it repeatedly said (but not fleshed out with much detail) that the capacity (beds) of state mental hospitals used to be much higher, and it was relatively common for people to be committed to them for long periods. So perhaps "there are almost no institutions equipped to do this" is a statement about our times. ...
https://en.wikipedia.org/wiki/List_of_defunct_Massachusetts_State_Mental_Facilities lists 14 closed mental hospitals. https://apps.bostonglobe.com/spotlight/the-desperate-and-the-dead/series/community-care/ (2016) says "Massachusetts has reduced state-funded inpatient psychiatric beds by more than 97 percent." with a graph showing "Inpatient bed capacity for psychiatric patients" peaking at 23,560 in 1953 declining to 671 in 2015.
So just going back to "how we did it when I was a boy" -- which people then seemed to perceive to be better -- would require nearly two orders of magnitude higher psych beds -- and associated staffing. In that situation, it might be possible to lock someone up, start them on meds, hold them for the several weeks for the meds to improve their mental state and adjust the prescription as necessary, and only then release them. Even better if during that time a social worker can be connecting them to an adequate array of housing/work/support services/family/etc. so they don't immediately fall apart when then walk out the door.
... The web tells me that the UK has about 24,000 inpatient psych beds with a population that is about 10 times that of Massachusetts. So that's maybe 4 times as many beds per-capita.
Here's my brief history of the rise and fall of lunatic asylums:
https://www.takimag.com/article/gaslighting-ourselves/
This is much less of a problem in many other Western democracies (Canada excluded, it's bad to be homeless there). Maybe... see what works there?
Heck, look at the states where it works better, like... Texas?
I should caution you that I've heard that a lot of places in the USA solve their homeless problem by buying the homeless bus tickets to San Francisco, which works great for them but won't work for San Francisco. Checking other countries avoids this issue.
I thought they were being bussed to Seattle?
https://mynorthwest.com/1415605/seattle-homeless-bus-ticket-conspiracy/
I mean, to Oklahoma
https://www.readfrontier.org/stories/we-fact-checked-social-media-claims-and-urban-myths-about-homelessness-in-oklahoma/
I mean, to Asheville
https://www.citizen-times.com/story/news/local/2023/02/02/fact-check-is-ashevilles-growing-homeless-population-being-bused-in/69849267007/
I mean, to Spokane
https://www.inlander.com/news/why-other-communities-help-buy-bus-tickets-to-send-homeless-people-to-spokane-and-vice-versa-17699493
Or was it to Las Vegas?
https://www.deseret.com/2001/10/31/19614236/busing-homeless-just-myth/
And San Francisco just sending them all over, too.
https://sfstandard.com/2024/04/04/san-francisco-lost-homeless-people-buses/
Just endless cycles of mythical homeless people being bussed all over the country.
It is possible that what I have heard is wrong. That is why I put those words in my post.
I find it interesting, however, that of the five non-paywalled citations you gave (Citizen Times is paywalled for me), zero actually address the specific claim. I would appreciate a direct rebuttal rather than pattern-matching me to a bingo card.
How about direct support, beyond what you've heard? That seems like the more natural move here.
I don't live in the 'States (I'm an Aussie) and have little experience with directly researching things there; this would seem pretty difficult. I am also not amazingly motivated, for related reasons - I care about US problems when they risk becoming my problems (cultural stuff that affects the rest of the Anglophone 'Net, for instance, or anything that risks the USA no longer functioning as the lynchpin of the Western alliance system), but otherwise it's frankly not really my place.
Bottom line is: no, I'm not going to investigate this thoroughly enough to have direct knowledge. I pointed out what I'd heard because it's relevant and noted a way to sidestep the issue. If what I've heard is inaccurate, okay, fine. If people don't believe me without me doing such investigation, okay, fine, I don't really care.
I made the second half of the second comment not because I was invested in the proposition, but because the reply itself hit some red flags independent of content - specifically, the full sarcasm is TTBOMK not appreciated here, and per Bounded Distrust/Media Very Rarely Lies (and my skills as a shopper avoiding imitation products) I am immediately suspicious of anyone who goes to great lengths to imply X without actually saying X ("because putting 'butter' on the package of a fat spread will help sell it, any such spread that doesn't prominently say 'butter' can be assumed to be legally barred from doing that by virtue of not actually being butter").
(To be fair, the red flag is not as big for a random commenter (who can tell straight-up lies and largely get away with it) as for somebody big enough to plausibly get sued.)
Just house the homeless in buses that keep driving back and forth!
It's to any large city that actually provides social services. I know it happens at a regional level, but if "Texas to SF" is a thing I'd guess that it's solely because of the culture war.
Fortunately, once they've spent one night in a non-shelter, or sometimes have been in the city for more than 6 months, surveys will count them as "local".
I need an upvote button or something to avoid saying, "This," but having worked and volunteered with social services in medium and small cities: exactly this. The small city's homeless plans beyond a couple of nights are "can we buy you a bus ticket back to wherever your family lives?" and "have the police drop them off at the homeless shelter in the nearest medium city" (which is also where they can catch the bus back to wherever their family lives). In the medium city, we did have out-of-state people with no home, job, or money arrive (bus station again) because they heard the system was better/less overcrowded than where they were coming from.
California is about 40 million people, or a little over 10% of the country in terms of population. Yet their homeless population is grossly disproportionate.
I wonder how much of that is just weather. LA or SF seem like much better places to sleep rough than Chicago or Boston.
Or Dallas, for that matter. The summer heat is unbearable if you have nowhere to shelter from it, and winters are "generally" mild, but there are enough days with sub-freezing temperatures and howling wind (in that part of the country the two usually go together) to make sleeping in the rough as deadly as it is in Boston.
Mythical homeless people, or a nationwide game of hot-potato with disruptive expensive unwanted people?
More likely, people on the margins tend to drift to places where the living seems to be better (or at least, less worse) based on whatever their priorities are. So those places will have more people who've slipped over the edge.
(Though in point of fact, there have been times when the welfare bureaucracy in New Hampshire would give the unemployed free bus tickets to the neighboring Massachusetts. But that was a time when Mass. had very low unemployment and was desperate for more workers, so it's possible that the Mass. Office of Labor and Workforce Development was actively encouraging it. Oddly, it turned out to be easier to relocate whites to Boston than blacks; apparently it was on average easier for a white immigrant to find a friend/relative to crash with than a black immigrant.)
Here is a news story from my home rural state where multiple police officers state that they regularly put homeless people there on a bus out of state. Including buying tickets & managing logistics for them. Unless you think the entire article is fake, including the specific names & pictures of the officers quoted, this does seem to be a pretty real thing
https://www.bangordailynews.com/2019/11/12/news/bangor-is-buying-bus-tickets-to-warmer-states-for-people-with-no-roof-over-their-heads/
Have you been to Texas? Nobody in Texas thinks Texas has anything that "works better" w.r.t. the homeless. Maybe better than San-Francisco, but that is setting the bar so low you have to dig a ditch for it.
Tbh most of the places with smaller visible homeless population just have long and cold winters.
Are you talking about EU? We have universal healthcare and better social security, so there are fewer homeless people in general. For one you are not at a risk of losing your home at the first sight of a major illness. Plus people who are mentally ill are hospitalized and then usually taken care of through some social security systems (depending on the country – some EU states are better at it than this). In mamy countries there is usually some sort of subsidized housing and people get social workers who assist them in daily living. Basically you need to raise taxes (or tax the rich more) and put lots of money into having a coherent, working social security systems, like European countries did.
Sadly, that's Communism, which is Obviously Unacceptable, so back to the drawing board.
Raising taxes tends to be unpopular unless that social safety net is already in place. Start by aiming to keep the overall tax burden the same, but shift more of it onto stuff that's naturally easy for the government to measure, because without the government's direct and ongoing involvement it wouldn't exist at all: land-use rights (distinct from structures built thereon), professional licensing, intellectual property, that sort of thing.
Reduced overhead costs for dealing with tax fraud means more revenue for actual useful government services, less hassle for taxpayers, and considerably less deadweight loss across the whole economy due to tax avoidance.
Resultant goodwill can then be leveraged to raise tax rates, if doing so is still necessary, and most of the burden of such an increase would then fall on rich people or megacorps who were extravagantly wasting something which other people could be making more socially-beneficial use of: slums or vacant lots in valuable locations, patent trolls, etc.
The EU is funded with VATs. They can efficiently raise lots of revenue because there is a broad base, rather than trying to concentrate on the rich.
What if we abolish the DEA and just let anyone buy anti-psychotics over the counter?
I was also thinking about this, but:
- You'd be abolishing the FDA, not the DEA, for this
- You'd want to give them out for free, because they're cheap enough that the government could easily afford this, but homeless people have no money and even a very cheap price would be an obstacle for them.
- Realistically there would be various horrible side effects, but maybe still a net benefit given how bad psychosis is.
The really exciting option would be giving GLP-1RAs (eg semaglutide) free and over the counter for opioid addiction. But this is much harder, both because these drugs are way more expensive, and because there would be a profitable arbitrage operation in smuggling them to normal people who want to lose weight.
I'm skeptical of the impact of semaglutide on addiction to opioids given it didn't even successfully beat my addiction to gelato.
OK, why not give semaglutide free over the counter to everyone? I've heard that obesity is a huge public health issue costing our healthcare system tons of money, so that might even save money in the end?
(Yeah, yeah, various horrible side effects, but maybe net good?)
At a certain point once production has ramped up enough that might be economic. But currently supply is constrained.
Interesting idea, really. Of course, the pharma companies expect to make (cue Dr. Evil!) BILLIONS OF DOLLARS each year from these drugs, but on a national level, the federal government could just pay them off and it would be a rounding error in the federal budget.
is this a situation where the medication is too good? if there were no antipsychotics to give these people, the ability to demonstrate improvement would be hampered and easier to justify commitment. also the need to keep them off the street would be greater. what does medicating them actually accomplish? (not trying to be unsympathetic to their condition, legitimately curious how much better their experience is medicated vs non-medicated)
I think you've touched on the combined medical/political dynamic. Before we had antipsychotics, people who developed severe mental illnesses were hopeless and it was admitted that the only thing to do was lock them up and care for them as best we could. Hence state mental hospitals. With antipsychotics, a substantial fraction of those people -- with careful support and supervision -- could live freely. So between humanitarian and financial incentives, the state mental hospitals were closed down, but the well-supported slots in community mental health facilities were never funded. Though some of that error is because people still tended to think the bulk of the expense was in the big buildings rather than in the corps of well-trained workers that made it all work.
From what I see in the press, it might be useful for the government to just hand out buprenorphine for free to cut back opioid addiction. But I expect that things aren't as simple as they are made out to be in the press I read.
How about just giving them a 1 or 2 years' supply from their first prescription?
I think you’re missing the goal of a short arrest (few days). Part of the problem is the homeless are in areas where society doesn’t want them to be. They’re near city downtowns where tourists spend time or near commercial districts or in otherwise nice parks. If you can arrest them for a few days and keep arresting them until they move somewhere else … the goal is to eventually force them to move to the more acceptable areas vs. least acceptable areas. This is obviously not ideal but in the mean time the city gets more tourism, more office rentals, etc. Europeans ruthlessly arrest homeless people who hang out in the touristy areas. SF doesn’t, yet.
Very true. These policies can amount to, "We're going to make your life significantly less pleasant if you don't stay where we want you to stay and live how we want you to live while you're homeless." Which sounds harsh, but doesn't have to be in practice, and certainly makes the cities nicer for most people.
My impression is that less touristy areas are more residential areas and the residents don't like having homeless people around any more than the tourists do (and I'm more sympathetic to them since they have to live there 24-7).
Agreed. People don’t want them in the residential areas or suburbs either and for good reason. But my guess is cities can identify certain areas where they would prefer the tents to set up. Something like industrial areas or run down parks. The key is that city officials should be able to use arrests as a strategy to move the tents/homeless concentrations without having to face a million lawsuits.
Cities used to have "skid rows" where living was really cheap ... and where the police didn't care what the people did because people who had any money at all didn't live there. But those have been either "urban renewed" or gentrified out of existence in most cities.
There are tons of areas in cities that are neither touristy nor residential. In cities that pursue these practices -- at least those with which I have any familiarity -- such places are usually where the homeless are directed.
It makes more sense to send them tp industrial areas for 2 reasons :
1. Industrial areas don't have nimbys. Easy to put up a few barns, bunk-beds and bathrooms
2. Industrial areas can have menial jobs to go around.
Downtown usually the most-dense part of any city by an order of magnitude. So even after adjusting for land-use, more residents are affected by homeless-ness if it exists in downtown than if it did on the outskirts.
If it was that economical to build housing in industrial bits, you'd think someone would already be doing that to sell more apartments. I wonder what's stopping them?
Zoning.
Right: the logical improvement of that strategy is to just keep them in those places with physical barriers. These are the "Sanctuary districts" from DS9, which frankly I think are a much better idea than how they were portrayed in the show.
Look up Marc Dones. He was hired at $250,000 per year to oversee a $140-million budget for the King County (Wash.) Regional Homeless Authority. He had no relevant experience and no related education, and was not even familiar with the area (being from Ohio).
He was, however, the exact kind of person "damn liberals" like. So, while I don't have a specific "plan to do better," I could see--along with many others who are on the Left--he was going to fail. We could do better by doing nothing, but one thing would be to avoid hiring clearly unqualified people. Is that enough a plan to start from?
Forget Marc Dones - look up who was Chairman of the San Francisco Housing Authority in 1976.
Say what you will about Jim Jones, but being able to get a bunch of people to pack for the Guyanese jungle and commit mass suicide shows some real leadership and organizational chops. "Leaders" like Dones struggle to maintain the office copiers or inspire subordinates to get their TPS reports in on-time.
I am suspicious that California is doing the best it can possibly do, given that no other place in the developed world (and certainly no other state!) has even close to the same degree of this problem, despite many others having good weather or expensive housing or mental illness or drugs. CA has around 60% of all unsheltered homeless in the country, despite having only 12% of the population. It’s difficult to believe nothing can be done when every place I’ve ever been to seems to have it better under control.
>despite many others having good weather or expensive housing or mental illness or drugs.
This is false. As of 2024, Hawaii is the only other state that approaches California in good year-round weather and housing expense. And Hawaii is obviously far more difficult to reach for your average homeless American.
Add to that, Honolulu is usually in the top ten major American cities for unhoused population per capita anyway.
Though I wonder how much of this is just a second order effect of good weather correlating with high housing prices.
Honolulu resident here. There's a homeless encampment less than a mile from my home. Last year a homeless woman from that encampment broke into my house, and I interrupted the burglary. She had a history of doing that but I was the first to press charges. The gal was Micronesian, a demographic which often includes people who come on a visitor's visa but don't return. A quick internet search of her name revealed that her two little kids had been put in foster care a few months before the burglary. She required an interpreter during the court proceedings. She wasn't deported and did a short stint in jail before sentencing where she was released for time served.
Is it unreasonable to limit the accrual of unemployable immigrants as a measure to address the homelessness of an urban area?
Micronesia actually has a treaty of free association with the US that grants all Micronesians the right to live and work in the US without a visa, so she would have been there legally. It's diplomatic compensation for being occupied and nuked by the US military.
Honolulu is the cheapest US destination from Micronesia, and I can only assume living in a tent in a park in a safe and prosperous US city is preferable to living in an informal residence on a low lying island that's threatened by sea level rise. I'm not sure what the solution is - Oahu desperately needs more housing and better transit and I think this problem is downstream of that. It's difficult to build things there, though, because of the Jones Act restrictions on shipping and the standard NIMBY factors of zoning and environmental review, with the added wrinkle of every new project being vulnerable to protest as a settler colonialist violation of indigenous Hawaiian rights. Which is kind of the original sin the whole state has to deal with.
"And anyway, now we’re back to Housing First"
The way you wrote it, that's not Housing First, that's Housing Second, after spending a few weeks in an institute, taking medication, talking to a social worker, and visibly appearing better. Such an approach seems a lot more likely to work than throwing a bunch of obviously unstable people together in free housing.
This probably sounds draconian and cruel, too, but in fairness, all these discussions seem to assume that this person is in San Francisco and can *never ever leave for some other, more affordable place.* I get it -- it's tough leaving home, and maybe they'd be leaving friends. But they wouldn't be the only people leaving SF over rent prices, and they'd pretty clearly be among the most rational.
So I dislike articles like this when they say things like "the average wait time for a homeless shelter bed is 826 days" or "cheap apartments in SF are $1000 / month."
I have a friend who was homeless for around a year in another major American city, and he said it was always 100% feasible to get a shelter bed if he wanted one. Indeed, there were several options.
On a different note, I also think that if one were going to go a "cruel and draconian" route, homeless shelters might be able to change policies to better support that and prevent some of the issues you highlight. If it takes 826 days to get a shelter bed, then zero of the typical people you mention who are briefly homeless are getting shelter beds. If all of the people who were homeless for longer were either leaving or in jail, then more of those people probably would get beds. Am I saying this is the policy I favor? No, I agree it's a hard problem and I'm not sure what the right answer is. But things like this need to be kept in mind, too.
"I have a friend who was homeless for around a year in another major American city, and he said it was always 100% feasible to get a shelter bed if he wanted one. Indeed, there were several options."
I've heard the same thing in a number of articles about the recent "Grant's Pass" Supreme Court case. In a lot of cities, there are shelter beds available... for people who want one and are willing to put up with the shelter's rules.
Until the recent Supreme Court ruling, that meant that sometimes a court would say the beds weren't available. Sometimes, the rules were so strict that made sense - but sometimes not, and nobody was confident the court would say any particular set of rules was fair enough the beds could be counted as available.
It's more efficient for homeless people to move to places more affordable than SF.
There's that island near Fisherman's Wharf that used to house a lot of people but is currently mothballed; perhaps that could be put to use.
For the most part I agree, people definitely have a bias towards staying where they are even if it isn't actually in their best interest. But I imagine it is challenging as a homeless person to get a ride to a different city?
Yep, why on earth do we even want a single homeless shelter in SF? They should all be built out in Nowhere, California and everyone should be bussed in there from around the state. If you're poor you shouldn't get the right to free housing in the second most expensive city in America.
At one point, there were something like 600,000 Americans in long-term psychiatric institutions, and that was in a less populous America. Start by locking up 600K and then lock up more. Ah, but where do you put them? The 50 states are dotted with the creepy and picturesque ruins of all the old mental asylums--you can't put them there!
It's true that the current government (states, local and federal) are totally incapable of building and running a vast network of psychiatric hospitals, but don't we want government to do things like build nuclear power plants and also lots of housing? If I'm making an argument for cheaper housing and you say "government can't/won't ever allow more building," am I supposed to say that you have won the argument?
Unless we want to embrace full anarcho-capitalism, we have to believe that it is possible to have a government that can do things that it did in the 1950s like (a) apprehend and detain the severely mentally ill, (b) back and create lots of nuclear power plants, and (c) build abundant housing and infrastructure.
The 600K number was a combination of:
1. People with dementia eg Alzheimers
2. People with Down's Syndrome and other developmental diseases
3. People with neurosyphilis
4. People with extreme untreated schizophrenia that you basically don't see since the invention of antipsychotics.
As lifespans increased, we spun off a new type of institution (nursing homes) for dementia. As Down's syndrome tests got better, we started aborting more of those children, and also were able to find more compassionate ways to care for the ones there were. With the invention of penicillin, we cured neurosyphilis. And with the invention of antipsychotics, schizophrenia became a pretty different disease with a pretty different prognosis.
We never had 600K schizophrenics locked up in a world where antipsychotics existed. I agree it would be possible to do this, it would just be a kind of novel plan and start seeming weird once all those people got antipsychotics and were mostly better.
This is essentially the state of Californias plan. Build a bunch of new asylums, pass laws that define a way to lock homeless up in them.
Where can I read more about this plan?
If it turns out that we don't need to lock up that many people, that's great news! But, as an NYC resident, I'm tired of the usual song and dance where an insane person pushes somebody on to the subway tracks, and it inevitably turns out that they have been cycling in and out of custody over 20 times.
All these individuals need to be locked up and if the number is only 250,000 or 400,000, that's fine with me. But they need not to be on the streets.
When the severely mentally ill are allowed to roam free, we all are living in the asylum, and there is no one to protect us from them. And of course, people in poor and more crowded neighborhoods have to deal with the brunt of the disorder.
My impression is that the number of potential subway track-shovers is surprisingly small even in NYC. Taking, say, the 100 scariest loons in NYC off to restful rural lunatic asylums would make a major dent in the number of random violent attacks in New York, making life less nerve-wracking for everybody else.
In fact the number of chronic homeless is relatively small. IIRC a study done in NYC found something on the order of tens or hundreds of thousands of homeless over the course of a decade--but the vast majority were homeless for the period of a day or two, rapidly discovered that life on the streets was no fun, and transitioned themselves onto a friend's couch or mom's basement.
The one who couldn't, in the words of the study's author, had "tenuous" social connections. In other words mom had kicked them out for pawning her tv for crack or they were so mentally ill that their friends and family were simply incapable of caring for them. But they were a tiny minority, small enough to house given relatively modest government expenditures.
I wish I had the source but when I lived in Seattle, I read that about 5% of the homeless use about 80% of the support services. I assume those numbers pertain to dollars and not doctors visits or shelter beds.
I can really see that in my minds eye: a tiny subset of homeless pushing people on tracks in NY; a tiny subset setting fire to their newly built tiny house in SEA.
To my tech-addled brain, this means there's a cheap way to produce massive impact without huge changes to law or spending billions on increasing social services: become very good at spotting these worst offenders and get them off the streets into forced care.
Regular folks win. _Other_ homeless people win even more because there's a lot more dollars available for their support. And the worst offenders are safe and getting the care they need.
It's difficult though because even if essentially all of the 100 scary-homeless-random-crimes are done by people who've been cycling through the system for decades, only a very small fraction of the people cycling eventually commit a scary-homeless-random-crime.
>it inevitably turns out that they have been cycling in and out of custody over 20 times.
Whatever happened to "three strikes" laws?
Maybe the person cycling in and out of custody 20 times is not committing felonies the 20 times, but there should be _some_ way to notice that someone is a hazard to people around them after multiple convictions.
If they are going to get better and stay better, then great, but the whole point of your article is that they won't. If a person is pretty sane while medicated but doesn't stay medicated unless under supervision, putting them under supervision seems like a decent plan.
(in and of itself, at least. I'm not sure about the economics or politics of it, or whether it's morally justified, or whether these places would turn into hotbeds of abuse or something.)
I'd love to see a breakdown of what fraction of the people who used to be in asylums
- can be successfully medicated, and stay on the medication without further effort
- can be successfully medicated, but have a high probability of "falling through the cracks", e.g. administrative snafus that the patient can't navigate past
- can be successfully medicated, but have bad enough side effects that they actively resist being medicated, even if they have the drugs in hand
- can not be successfully medicated with our existing pharmaceuticals
( somewhat orthogonal to these would be what fraction are hazardous to people around them )
My uncle is in more or less this situation, a nursing home for the mentally ill after he stopped taking his schizophrenia medication. You could view it as either a very comfortable and relaxed prison, or as a nursing home where the inmates are not allowed to leave (numpad lock on the door with a code given to staff and visitors but not residents). Seeming weird is definitely not an issue in his case, because everyone who knows him knows this is the only way at this point for him to have some semblance of a normal life.
This is in New York State, and I'm not sure whether the arrangement could be expanded to cover chronically homeless people, but I guess it's a proof of concept. My best guess is that this costs $160,000 per year funded by Medicaid. I'm also not sure how well equipped they are to deal with violence - I assume they are able to handle occasional instances where a resident arm-wrestles a nurse away from doing something, and anything more severe would get handled by the legal system (which is actually functional, unlike in California).
It sounds like having more homelessness shelters + longer periods of mandatory commitment solves this problem almost completely.
I agree "more shelters" is a great first step, although see Claim 4 at https://www.astralcodexten.com/p/book-review-san-fransicko.
I'm not sure what longer periods of commitment would solve.
I definitely think more shelters are the bigger deal. I was just thinking that longer periods of commitment (if you have enough shelters that it's viable) means you have longer for social workers etc to be in contact with unhoused people and it's easier to track them etc (so people come to them instead of expecting mentally ill psychotic people to be the ones doing their own self-discipline/paperwork/time management/executive function etc).
Yeah, I’m surprised that Scott doesn’t see the value of longer periods of commitment, which seems like the obvious answer to me. I’m not schizophrenic, but I’ve been on brain pills, and they really do make you feel weird, especially in the early stages, and those growing pains tend to last longer than psychiatrists say they do, in my experience. I don’t think it’s a surprise that a lot of homeless people stop taking their meds when their lives are already so chaotic—it’s a tremendous change (and even more so if you have to deal with extreme side effects). Having an asylum/halfway house kind of situation (with less intense care requirements than a hospital but still meaningful supervision) where they can live for six months to a year as they acclimate to their meds and even out would, I suspect, solve a lot of the problems outlined in this post. It would give them a roof over their heads and a stable address where case workers can find them (and where they could receive mail and paychecks/gov support!) as they get used to being on meds, and they could go through the process of e.g. learning how to independently get their meds refilled while in a stable and more directed environment.
You said in this article that commitments are not long enough for the drugs to actually start working, and that people whose drugs have not started working may go off them because they think the drugs are an Illuminati plot or whatever. Longer commitments for psychosis would patch that (though so would massively-extended-release antipsychotics).
+1. Yeah that's partially what I meant, thanks for spelling it out.
This seemed sufficiently obvious to me that rather than post it myself I did a keyword search in the comments for "period", and got here with minimal scrolling. I do think it's a good suggestion.
Specifically, let's extend the involuntary commitment duration to "however long it usually takes for the desired effect of the drugs to actually kick in, plus a week or so so that they can get used to the full effect". Per the article this is 2-4 weeks for antipsychotics, so go with 4-5 weeks there. May be different for other drugs.
Should probably also expand psych hospital capacity to cover the increased load, but I'm less certain about the exact numbers there. Especially since the goal is to eventually bring the number back down by actually fixing the problem (i.e., making them permanently healthy).
Why do they shelters need to be in SF or even within 100 miles of SF? They should be out in the desert on dirt-cheap land that no one else wants.
It's definitely draconian, but I'd be comfortable with sentencing chronically homeless + jobless people to a year in out in the country camp. I just don't see many of these people getting better and I think getting them out of the way and giving them a simple life may be an answer. Especially on low cost land in robust basic construction.
Included would be free hot meals, shelter, air conditioning, television, in a refugee camp outside of population areas, eg, like many miles away.
Is "the country camp" a euphemism for prison, or a different thing? If a different thing, does the thing currently exist?
Likely something like this: https://www.cdcr.ca.gov/facility-locator/conservation-camps/
Maybe they should have come up with a name for it which doesn't sound so similar to "concentration camp".
I don't think it exists. In my mind, it would be somewhere between a summer camp and minimum security prison, located a minimum of 50-100 miles from any metro area. Any significant crime there could escalate to normal jail or prison.
The point would be to redirect funds from unrealizable rehabilitations, volunteer organizations, charities, and emergency services into a minimal cost simple existence.
I am unsure if this is possible or feasible.
For all of these solutions, it doesn't matter if it exists or not, because with the billions we are already spending on homeless solutions we can make it exist!
I think my plan is "it should be a crime to make things awful for everyone in a busy public area".
For example if someone is on a crowded subway and they start shouting death threats, they should get arrested.
After they are arrested, I am okay with whatever process we implement that makes sure that they don't go back on the subway and resume shouting death threats. If that means we find a miracle medical process that makes them functioning citizens, great. If that means they go to a mental institution, fine. If that means they go to prison, that is acceptable.
Wherever they go, they should stay there until we are confident that letting them free won't lead to them getting back on the subway and shouting death threats. If they are in a mental institution on antipsychotics and are perfectly lucid, but we predict that releasing them leads to an 80% chance of shouting death threats on the subway, then they stay in the mental institution for life. If there aren't any mental institutions with space, then they stay in prison for life.
I am a little bit sad about this but I would rather have nice public spaces than have free crazy people.
I agree with this. My guess is that it's very hard to get police to be around for any given case of threatening and screaming, so most of the time the perpetrators never get arrested. I think this is why the debate has become "arrest homeless people on the grounds that they're probably the kind of people who do this" vs. "change nothing". It seems to me that more/better policing should solve this, but I'm not a police officer and I expect they would be offended by me saying they should trivially be able to do their jobs better.
From your description above:
> A police officer sees a mentally ill homeless person and assesses them as disruptive. Technically the officer should assess whether the person is “a danger to themselves or others”, but in practice it’s all vibes. They bring this person to the ER of a hospital with a psychiatric ward.
it sounds like currently threatening-and-screaming people are considered "disruptive", so they get taken to an ER and then released a few days later?
I wonder if there exists a law-enforcement process that arrests people for threatening and screaming (and isn't just catch-and-release). I suspect that, in San Francisco at least, no such process exists.
New York does seem to have a plan to "involuntarily hospitalize" people, though it's not clear how long the involuntary hospitalization lasts. https://www.theguardian.com/us-news/2022/nov/30/nyc-eric-adams-involuntarily-hospitalize-mentally-ill-people Civil rights groups complained, which makes me think this sort of thing is not widespread.
If San Francisco does have a process like that and it's simply not able to catch people, then I guess I would advocate for putting cameras in public spaces, so that the police can find evidence of threatening-and-screaming when it is reported. There apparently already are cameras on subway cars but I'm not clear if there are cameras in eg the Tenderloin.
>and it's simply not able to catch people, then I guess I would advocate for putting cameras in public spaces, so that the police can find evidence of threatening-and-screaming when it is reported.
Seconded! Cameras are now cheap (and, frankly, are pretty pervasive anyway). As a citizen: If we are more-or-less under surveillance anyway, we should get _some_ gain, like fewer threatening-and-screaming people at large, from it.
I know the commenters are edgy so I wasn't paying it much mind, but I'm shocked that you agree. Consider it as a Rawlsian lottery: you can have quiet public spaces where no one randomly yells at you, but if you develop psychosis, you'll be deprived of liberty and of the right to refuse treatment that has severe side effects, possibly for life. Would you accept that deal?
I think you're misreading me? I'll explain what I mean by "Ralwsian", sorry if you're already familiar but that seems to be the most likely miscommunication.
Currently, Scott is not psychotic, and you probably aren't either. But there's some risk you'll develop psychosis at some point (around 3% for a single psychotic break, around 0.3% for schizophrenia). This partially puts you behind a "Rawlsian veil of ignorance": you don't know whether you'll end up psychotic or not. (Partially but not fully, because you can use family history to estimate the risk. Scott generally likes contractarianism + Rawls as a way to ground moral judgments.)
You can have opinions now about how you'd prefer to be treated if in the future you become psychotic 1) in general, 2) unpleasantly loud, or 3) dangerously violent. You could in theory declare psychotic!you to be a different person, or to have no rights, but you'll still experience what this person experiences.
At the personal level, this looks like advance medical directives, powers of attorney, savings, insurance. (Not really relevant to this topic, but a good thing to plan for anyway.)
Now scale it up, and imagine a whole society made up of copies of you, all deciding together: each person deciding how they'd like to be treated if they later go [at all/loudly/violently] psychotic is equivalent to all the non-psychotic people deciding on the treatment of all the [subtype of] psychotic people. (Since nobody knows where they'll end up, there's no difference between selfishly deciding what's best for oneself, and deciding what's best for the average person — this is what Rawls is about.)
In this situation, you have a choice between (possibly among other options):
A) Don't bother psychotic people; if they scream, well, being annoying is not a crime; don't give them antipsychotics unless they say they want them or unless they're physically attacking someone.
B) If someone is psychotic and bothers people (e.g. by yelling in public), put them somewhere they can't leave, and force them to take antipsychotics even if they say the side effects are unbearable.
If you pick (A), then you have a certainty of being yelled at in public. If you pick (B), then you have a certainty of having nice quiet public spaces, but a 3% chance of being locked up and forced to take unpleasant drugs, and a 0.3% chance that this will last a lifetime.
I very very strongly prefer (A) over (B), and I expect most people do too! So in this Rawlsian scenario, whether I'm selfish or altruistic, I pick (A).
Now, in real life, people aren't in fact making decisions all together like this. If you put a lot of effort into fighting for the rights psychotic people, and then become psychotic, then your own past efforts will only improve your situation a little bit; and this only has a 3% chance of happening. So if you're purely selfish, then it's not worth it to you. But if you value the welfare of other people, then you can jump from the Rawlsian hypothetical to real life, and treat psychotic people the way you'll want to be treated if you become psychotic.
Yes, I'm serious. A society where you get yelled at kind of sucks, but much less than a society where you get locked up for yelling in public. That's… hardly an outlandish position that people would only hold in jest…
Is this a difference in values, or in expected outcomes? If you don't "remove" people for yelling or committing mild vandalism, there's yelling and mild vandalism, but nothing I'd think of as society ceasing to function (e.g. it's still possible to live, run businesses, and go to school in San Francisco). Do you expect worse consequences? Or do you agree those are the consequences, but think they're worth imprisoning people for yelling in public?
If we do have a difference in values, then yeah there's no point in arguing, we're going to have to fight it out. Realistically, I expect to lose in the short term and win in the long term, with future generations shaking their head at the barbaric mistreatment of persons of neurospiciness or whatever that'll be called in 2424.
The veil of ignorance is some kind of strange disease that seems to hack into certain people's brains and delete the capacity for common sense. "Yes, if may seem like a good idea to jail murderers... but have you considered a thought experiment where you yourself were born a psychotic murderer? 🤓".
Are the drugs more unpleasant than schizophrenic episodes are? Because if they're preferable, even with their side effects, to having schizophrenic episodes, which a lot of schizophrenics in their lucid moments seem to believe they are, then it doesn't seem like an undue burden, from behind the veil of ignorance, to expect schizophrenic people to take them and thus make themselves compatible with society.
There's enormous disagreement. Among bloggers who are frenemies of this blog, Freddie deBoer is full-throatedly in favour of them and ensures as hard as he can that he'll be forced to take them if he wants to go off them during an episode, and @loving-n0t-heyting Tumblr considers them one of the worst fates that can befall a human being and ensures as hard as she can that she'll never be made to go on them again.
I understand that they are not pleasant to be on, and consequently, lots of people stop taking them once the symptoms go away, causing the symptoms to start coming back.
3% is probably high. In addition as Alexander points out it looks like schizophrenia has a large genetic component. From what I can tell it often manifests in adolescence or early adulthood so if you have passed those milestones you are more than likely safe in terms of personal risk.
The other thing is it's not just a question of yelling at people. It's living in filthy, dangerous conditions that will almost certainly result in a drastically shortened life span. Who is served by letting somebody die slowly on the street when they are clearly incapable of taking care of themselves?
These two options are a false dichotomy, there are more. I'd of course choose C): Please, please lock me down if I ever become dangerous to people, I might hurt some kids! I might kill the neighboring little boy's mother! I would rather die myself.
If I just yell a bit outdoors: this is an uncertain area. I'd rather be free I think, but then again I'd probably not enjoy life in the street filth and danger. I'd take the asylum if these are the only two alternatives. Or another case: I knew a psychotic old lady (not homeless, not in danger) who had her apartement smelling of feces so badly that the whole house of 6 flats was unusable for other people. This is a measurable cost for society; she was eventually taken to a nursing home against her will. I plan to prevent this happening to me by investing in a good pile of diapers when I reach her situation. Yet dementia can prevent me from using them; I probably agree that I should be moved to a nursing home too at such a point. It will be very painful and can totally happen to me.
The Rawlsian conclusion should require you to consider "what if I was one of the kids being hurt by the homeless" as well as "what if I was the homeless forced to be locked away".
The problem with the violently psychotic isn't simply "they will yell at you in public", it's "they will threaten you and may indeed assault you".
What are the chances/odds of "get assaulted" versus "get yelled at"? You calculate out the 3% chance of being locked up. I think if I ever got to the point of being an actual danger to others, I would want to be locked up. "Yes well she did murder that guy, but the risk is acceptable because do you want the 3% chance of being locked up if you get crazy enough to go around murdering people?" may be very damn liberal, but I think if it's a choice "get murdered or get locked up", a lot of people would go for "okay lock me up".
There may well be people who would choose "get murdered, I would hate to be locked up for life" and good for them, but for those of us who would rather not be murdered, we get a say, too!
>I very very strongly prefer (A) over (B), and I expect most people do too!
I think analytic philosophy with its methods and cultural practices (thought experiments like the Rawlsian veil of ignorance, making underspecified claims like "x is intuitive") specifically trains people to succumb to these types of cognitive pitfalls. When you look at empirical cross-cultural psychological research like e.g. "The WEIRDest People In The World," what you find isn't that there is some sort of universal convergence to a specific set of values or a way of thinking. What you find is that culturally parochial practices like liberalism or worshipping the sovereignty of the individual are very culturally unique and that the majority of the world does not think in the way the "West" or "Americans" or "people who have received training in analytic philosophy" do.
For example, after the Arab Spring there wasn't a widespread proliferation of liberalism and democracy in the affected Arab countries. But the people there did act rationally and accomplished what they wanted to do - they reinstated theocratic government, constitutional monarchies, military dictatorships, etc, because they thought that was the best way to govern, not because they hadn't considered the Rawlsian veil of ignorance enough. If you ask the stereotypical bad-because-they're-in-the-Western-outgroup Muslim "If you were behind a veil of ignorance, would you really support honor killings?" their answer wouldn't be "Holy shit I never thought about it like that," it would probably be more along the lines of "Yeah, if I was born a whore and acted on it and dishonored my family and went against Islamic teachings, of course I would deserve to be bludgeoned to death." In other words, the stereotypical "bad" Muslim isn't making a mistake or acting ignorantly - they think differently than you do, don't share the same values you do, and are probably perfectly consistent in their support for honor killings and the encroachment of Islam on governmental duties, or any other cultural practice you might deem irrational or unendorsable from behind the veil of ignorance. This hypothetical Muslim example is mostly unnecessary though - in these comment responses you have a multitude of people disagreeing with you that there is anything obvious about what you take to be a mundane and straightforward application of the veil of ignorance to the possibility of someone becoming a psychotic homeless person.
Basically, training in analytic philosophy doesn't grant you this a priori insight into what every rational person, in every place, all across time, would think when exposed to your views, and existing cross-cultural research and historical events where there have been uprisings and revolts don't support the idea that people are coming to some sort of one way of life or one way of thinking that analytic philosophers can outline in their armchair endeavors. If you want to find out whether people do in fact all agree with one of your presuppositions, you have to go out there and ask, not use your failure of imagination or failure of cognitive empathy as evidence that nobody nowhere could ever disagree with you. (Charitably, you don't say "nobody nowhere," you just say "most people" but leave that heavily underspecified. Most people across all of human history? Just most people alive today? Most people in the future? I think making accurate empirical predictions about any of these reference classes is extremely difficult - but oh, here come analytic philosophers ready to chip in that a variety of empirical claims about how people think, speak, or act are just "intuitive" simpliciter.)
idk there's the same lottery for things like "being a murderer". A rule like "If you're in a state where you can't safely interact with others you don't get to interact with them, regardless of whether that state is 'your fault'" seems pretty reasonable to me honestly.
(ETA: and yes, if *I* become violently psychotic or otherwise a danger to the people around me, *please* lock me up somewhere where I don't hurt anyone. This doesn't even feel like biting a bullet, it feels like the obvious prosocial opinion to have.)
I'm curious whether you live in a place with a severe problem with psychotic street people - I think if I didn't/hadn't, all this would seem unnecessarily cruel to me, but as someone who has violent things shouted at them daily, has to ride a BART that reeks of urine and step over human feces during their work commute, and a few times a month gets followed down the street by one of these people, I just want to be able to safely go for a walk in my city.
(also, my coworkers regularly have complaints that a violently psychotic person outside the office building made it difficult for them to get in or out, like, threateningly standing in their way and moving to block them. it is unreasonable for this to be normal in a big city in a developed country in 2024.)
I wonder how much of the urine and feces in public places could be mitigated by simply setting up accessible, vandal-resistant bathrooms, with city government (or a specialized subcontractor) paying for maintenance. If the only toilets in reasonable walking distance are associated with specific businesses, who'd chase you off for scaring their customers... well, you gotta go somewhere.
> vandal-resistant bathrooms
Another option is to set up accessible normal bathrooms and throw people in prison for vandalizing them.
If we can do vandal-resistant bathrooms, that's great -- but I suspect the usual way to vandalize a bathroom is to smear feces all over everything, and I don't know of a way to make a bathroom that's resistant to that.
First possibility which springs to mind is making every interior surface a seamless mass of sloped and contoured stainless steel, with an automated self-clean cycle involving sensors and spray nozzles in the ceiling. Work out a sensor array that reliably recognizes crud on the walls but can't be usefully tapped into for voyeurism, set a debris-removal algorithm to incrementally escalate from "garden hose" up through various combinations of heat, pressure, increasingly harsh chemicals, etc., and if somebody manages to apply a turd which literal sandblasting can't pry loose, call for help from a human technician.
A given municipality might instead determine that their money would be better spent on something less elaborate, like off-the-shelf "port-a-john" chemical toilets, and go for 'replace' rather than 'repair' when faced with sufficiently extreme vandalism, but then again I've already seen bizarrely over-engineered benches and "bike racks" intended to manage the issue, so "Frank Gehry's Brick Shithouse" could maybe be the right fit for some planning committee's needs.
SF finds it nigh-impossible to build public bathrooms. https://www.nbcbayarea.com/news/local/san-francisco/san-francisco-noe-valley-expensive-toilet/3511302/
The reason why we can't have nice things is that public bathrooms are then used for drug dealing, drug taking, prostitution, and makeshift camps by homeless people and petty criminals.
Sounds like we need to decriminalize residential construction.
SF already does this; the bathrooms are staffed by people 24/7 whose job is to monitor and clean them.
Real people aren't minimum-maximizers like Rawls thinks they should be. Their revealed preferences from their behavior show they care about normal upsides to probabilistic actions rather than solely being fixated on avoiding the worst possible outcome.
I think Rawlsian analysis is mostly useful to stop people from stumbling into admiring setups like, say, Sparta, where a few at the top are glamorized, while the vast majority are enslaved, and often randomly murdered, but the losing side is less readily visible.
I don't see any way in which Rawlsianism is superior to typical utilitarianism.
Easier math. Some people have a really hard time weighing different moral values against each other, or doing integrals across population demographics, but can intuitively realize they wouldn't want to have their own personal face eaten by a leopard, and then, with some help from Rawls, realize that a vote for the Leopards Eating Peoples Faces party is not actually a vote for a better world.
When it's a technocrat with a supercomputer, working all the angles out to ten decimal places, sure, utilitarianism is probably the way to go. Drunkard at 4 am? Let's try the approach that won't run out of swap space while he's reaching for car keys, and still usually ends up pointed at least vaguely in the right direction.
The utility monster is a standard example. Of course, a near identical criticism can be made of Rawls ( ie a situation where you ask the many to make huge sacrifices in exchange for a slim benefit to the few).
Yes, and I would be skeptical of anyone that wouldn't take that deal.
First: Rawls' concept of the veil of ignorance is deeply flawed and I reject the line of argument.
Second: If I weren't rejecting the argument, yes, I would take that deal. Psychotic homeless people suffer terribly and die quickly. I hope that if I ever develop such bad psychosis that I end up on the street, I will be involuntarily confined.
> Rawls' concept of the veil of ignorance is deeply flawed and I reject the line of argument.
Could you elaborate on why?
> If I weren't rejecting the argument, yes, I would take that deal.
Same here. In my current non-psychotic state of mind, it seems like part of my ethical duty to my fellow humans.
> Could you elaborate on why?
I don't know their specific reasons, but one would be that you can only decide based on your current values. There's no mind of perfect emptiness to consider in the before-time, even when you're consider a case before you're doing that relative to your current values.
(I do think Rawls-like arguments still work decently, but I don't think they're quite as strong as some people take them to be, but it is a decent *baseline* for the start of an argument about how to treat a group which you aren't a part of)
I sort of thought that the point was to bypass values by appealing to self-interest? You don't need to have an empty mind to go from "should I hurt them" to "should they hurt me".
My impression of the police perspective is they feel like there is no point investing time and energy into a case that is not going to go anywhere. Say someone calls up and says "Hey there was a crazy homeless guy yelling death threats". It is totally within their capabilities to take witness statements, get a hold of CCTV footage, identify the offender, patrol known homeless areas looking for him, etc. These people are not criminal masterminds hiding their tracks, you absolutely can find them, charge them, get a bench warrant when they inevitably don't show up for court, go find them again and arrest them etc, etc.
But at the end of all that the public defender is going to say "Look, my client obviously has severe mental health issues, he didn't have criminal intent, your honor should send him off to psychiatric care". And the judge will agree so he gets released to someone like yourself who gives him some pills, and then he gets better, and then he gets released, and then he stops taking his pills, and then he's yelling at people on the subway again and the cop asks himself "Well what was the point of all that?"
I live in Melbourne, Australia, I think this is basically how things work here and everything is fine. We have roughly the same proportion of psychotic people as the US. It's an expectation that if you are not institutionalised, your psychosis is under at least enough control to keep you from harassing other people trying to go about their day.
My vague understanding of the US in general and California in particular is that George Soros is actively recruiting district attorneys who do not enforce the law and that this is encouraged by the "Abolish the Police" nut jobs. It's more a "crime is out of control" than "psychosis is out of control" issue.
Exactly correct.
I doubt that George Soros is personally behind it, but there is a strong tendency for people with liberal sympathies to vote for such district attorneys. Less well-known is that the conservative side of politics in the US has a strong libertarian streak and *also* dislikes the idea of locking people up simply because they're scary. So the dream is popular that we only need to lock people up if they've committed crimes that they're legally responsible for.
I don't think this is how it works in Australia - possibly there's some state-to-state variation but the current practice to me appears to be "get the NDIS to house and treat mentally ill homeless people at great expense".
The NDIS is a giant clusterfuck but this is not specific to the psychotic population (which is a small proportion of the population served); its problem is that it is staffed exclusively by bureaucrats who take a million years and a billion dollars to approve a client changing their T-shirt. (Source: I'm a medical provider who has to write letters to the NDIS.)
Some chronically psychotic people are provided for by the NDIS (at great expense, but AFAICT no greater than chronically severely autistic people, or stroke victims, or people with spinal cord injuries, etc). These tend not to be the violent ones who are a threat to society; they end up in jail, or in forensic psych institutions like Thomas Embling. A psychiatrist who worked in Thomas Embling once told me it's actually much harder to get out of an institution like that vs jail, because the burden of deciding the patient is no longer a threat to society rests exclusively on the treating psychiatrist, and this is scary for the treating psychiatrist (how sure are you really that this person won't stab someone? 90% is nowhere near enough when it's your career and reputation on the line)
So sometimes the patients actually prefer to get sent to prison, for above reasons, and because the drugs there are better.
From a legal theory standpoint it's simple enough:
(shouted threats) x (witnesses who felt threatened) => number of counts of simple assault.
If he's got a knife or something, upgrade that to assault with a deadly weapon. Hard part is collecting enough evidence to convince the judicial system it's not a complete waste of time. Maybe hire more judges, clear case backlogs, bring back the right to a speedy trial?
I would add: this is not a plan about mental illness. This is a plan about crime and law enforcement.
If some of the people who are doing the screaming-and-threatening are psychotic, that's very interesting and someone should be tracking the statistic, but I don't see it as relevant to whether they should suffer consequences for their actions.
People have twice now attempted to round my plan off to something much larger -- "why do you want to imprison all homeless people?" "why do you want to imprison all psychotic people?" I don't. I want to imprison all screaming-and-threatening people, and that's a small fraction of homeless people, and (I believe) it's also a small fraction of psychotic people.
This is both extremely reasonable and how it works in many places around the world, including where I live
I expect the beneficiaries of tougher mental asylum laws will be Deep State and corporate bureaucrats who will have their enemies committed.
I have heard many stories of this happening in the Soviet Union, but none about it happening in the US during our era of longer-term commitment. Does anyone know of anything like this?
https://en.wikipedia.org/wiki/Gustl_Mollath
That's a case in Germany, not the US.
It was a big news story because it happened in unified democratic Germany. In socialist East Germany, there were huge numbers of politically inconvenient people committed to mental asylums. They weren't even shy about it - socialism was so Obviously Good that refusal to participate in it was openly declared evidence of insanity.
https://en.wikipedia.org/wiki/Adrian_Schoolcraft
Why don't they already just have their enemies sent to prison instead? We don't have many insane asylums, but we've got a ton of prisons.
Because it's much harder to get a court to convict someone for a specific crime that they haven't done than it is to get a doctor to sign a piece of paper.
Historically, the rumors were that the enemy that would get you committed was a family member to whom you had become inconvenient for one reason or another.
This seems like a weird and unfair strawman:
> Okay, then can you just make it a crime to be mentally ill, and throw everyone in prison? According to NIMH, 22.7% of Americans have a mental illness, so that’s a lot of prisoners. “You know what I mean, psychotic homeless people in tents!” Okay, fine, can you make homelessness a crime?
> (followed by five paragraphs about how your ideological opponents want to imprison people for being homeless)
I don't want to make homelessness a crime. Lots of homeless people are perfectly harmless. I want to make *shouting threats in public spaces* a crime.
Keep in mind that the "strawman" version of criminalizing homelessness per se was just endorsed by the Supreme Court, so it can't be very much of a strawman.
My guess is that many homeless people are the type of people who *would* scream at someone, but it's rare for them to be caught by a police officer in the act of doing this, so most of the time it doesn't get punished. People would like to make things easier by punishing being in the class of people who would do this (homeless), but this seems like a weird rights violation.
The Grant Pass decision didn't rule that laws that criminalize sleeping outdoors were fine - they narrowly ruled that they don't violate the 8th amendment (which, they say, refers to the method of punishment only).
The majority decision states that they can still be challenged on other grounds. For example, they leave open the possibility that fining people for sleeping outside constitutes a disproportionate fee.
As I recall from my read of the opinion, the criminalization would also apply to non-homeless people who camp outside just like homeless. And would not apply to homeless people who stay in a shelter (so, "sheltered homeless"). Thus, it isn't criminalizing a status. The dissent points out that there are more homeless in that town than there are shelter beds, but I don't seem to recall the decision addressing the question of whether it was permissible to criminalize sleeping in parks when there were literally no shelter beds available.
Part of the problem with the 9th circuit precedent that had been overturned, was that it was interpreted to mean that shelter beds were not counted as "available" if the homeless person wanted to smoke and the shelter was non-smoking (as almost all are), or if the homeless person said that the shelter had a "religious atmosphere". The latter was conflated with being forced to attend religious services, but they are not actually the same thing.
A given city can't control how many homeless people enter, so it seems unreasonable to demand that they have enough homeless shelter beds for the current homeless population before they can prevent people sleeping in the park.
I agree. I think the dissent was hinting that they don't agree, but I don't particularly respect the dissent; it was more concerned with sweeping generalities than dealing with the details of law and practice. There was a distinct flavor of wanting a particular outcome in this particular case, and not caring about how they got there.
If we have police move unsheltered to shelters until they're full, and then ignore unsheltered, that doesn't incentivize the unsheltered to do much of anything, but it does incentivize the construction of new shelter beds. That seems OK? At some time in the night, the signal goes out to patrollers that the shelters are full and they have to ignore the unsheltered who aren't otherwise causing problems. If someone complains, there's a simple and correct answer that incentives a solution.
It seems like this ends up as a demand to provide shelter beds for all the homeless people who may ever show up in my town, or I'm not allowed to have public parks and libraries be usable because I have to let homeless people camp out in them.
I think it's fine for a town to simply say "nobody is allowed to camp in this city park and we will arrest you if you do," so that the city park can be used for its intended purpose instead of as an impromptu open-air homeless shelter. I don't think this implies an obligation to shelter as many homeless people as show up and demand shelter.
I think the alternative to allowing the city to do this is not having public parks where kids can be let play on their own or moms can push their strolers.
Yeah, it runs into a small-scale version of one of the glaring contradictions in reflexive left-wing politics.
Open borders? Or UBI and socialized health care? We could have either, but we can't have both.
After checking a bit, let me point out the obvious. What works elsewhere is PATERNALISM.
Once you are in the "clutches of psychiatry", they don't let you go. Upon release you are placed into some sort of housing, your appointments are monitored and a social worker will find you and drive you there. You will be given multiple chances to get a job and/or rehab. Your meds will be delivered to you if you cannot pick them up. They remind you to take them. There will be a social safety net so you are never in a situation where you end up on the street unless you really really try to.
In retrospect, it makes sense: people who are not able to take care of themselves for a time because of a fixable mental infirmity are taken care of by the state, until they can. That's what we do with children already.
I still think you're eliding over all the difficult parts.
"They don't let you go" - okay, so the person is in a locked facility? Placed in "some kind of housing"? Does the housing have locks on the door, or can they leave? What if they do leave? "Multiple chances to get a job", oh, great, with whom? How are you enforcing that they take mentally ill people. What happens when the mentally ill people are less good workers than other people they could hire, or have some kind of crisis on the job, as even the best-treated person might once in a while?
"Paternalism" is a vibe, not a solution, and I think you're overestimating your ability to convert this vibe into a solution that could work once fleshed out.
It seems to work in places like Sweden. There are no locks, but people rarely just disappear into the ether (I assume cold winters make it harder, too). But also, if you go through your list of reasons why people get off the prescription meds, there would be much fewer of those in such a setup. The system helps you (and often gently forces you) to avoid trivial and non-trivial inconveniences. You have an id, your prescriptions/appointments/address etc. are in the system tied to that id (as is almost everything else in a sane id setup). There are government-sponsored useful work projects that help people get on their feet, so there is little competition with "better workers". The system actually cares about you. Taking a mental health day does not mean you get fired.
Not that it's all happy utopia, bureaucracy often backfires in fantastically creative ways.
But I guess at this point we are talking about reforming the whole society into more of a social democracy, a non-starter in the US. Still, the point is that some people need some degree of parent-like supervision at least for a time, and it's up to the state to provide it if they do not have any other support system. Hence paternalism.
Sweden's not just a 'social democracy'. It's a tiny country that was incredibly homogenous for most of its history. It's not that they have a system that 'actually cares about you' , it's that their entire system is closely related in terms of genetic distance. Witness how, the moment migrant populations have started increasing, the 'system that actually cares about you' starts electing far right parties in substantially greater numbers than ever before.
> "Multiple chances to get a job", oh, great, with whom?
I believe you're looking for this:
https://en.m.wikipedia.org/wiki/Sheltered_workshop
Germany has a lot of these. A typical example of such work would be disassembling broken appliances for recycling, or simple crafts like basket weaving. The work isn't valuable, so these places pay less than minimum wage. In Germany and many countries there are special exceptions to minimum wage laws for such workshops. They have trained staff and good connections to the local health care providers landscape, especially Assisted Housing facilities. I believe these would surely be able to employ psychotic people, at least as long as they take their meds.
And that Wikipedia article says: "In 2021, California banned organizations from paying disabled people less than minimum wage, giving the agencies who employ disabled workers until 2025 to either pay their workers the statewide minimum of $15.50 per hour or shut down."
Seems to me like that's a promising point to address, where a specific policy change could help? If these workshops also give work and inclusion and a little money to psychotic people, as long as they do take their meds?
Seems like a not-crazy solution to me to subsidize those workshops, for state $s to go to make up the difference between how much they're paying and minimum wage, to the extent they're genuinely helpful in preventing very bad societal outcomes. Maybe this proposal is too naive for reasons I don't fully understand?
I'm generally against workfare but maybe this is exception?
Rather than workfare, it might be useful to think of it sort of like a dark mirror of firefighters, or sysadmins, or other crisis-response sorts of roles.
"In a particular type of emergency, there is a very specific thing which society as a whole needs you - yes, you personally - to be ready to do. Until that situation arises, here's some tedious, tangentially related stuff you can keep busy with, but if you screw up the details of that, no one will really care unless it becomes a problem for the one big thing. We'll pay you whether it explodes or not, but be all the more glad to do so if you cleverly succeed at preventative maintenance."
For a firefighter, the emergency is 'people trapped in a burning building.' For a sysadmin, unscheduled server downtime. For somebody with severe mental health problems, relevant potential crisis is a public containment breach of their personal demons. Skills involved there are far less rare and prestigious, and moral hazard is a potential factor, so naturally the pay won't be quite as good... but the whole point of a minimum wage is that even the worst deserve some consistent degree of dignity and advancement prospects, rather than being dragged down as far as the market will bear.
I think California is in a particularly difficult situation, for reasons I outlined in another reply, but I can answer some of your questions for my paternalistic society, Norway, where there are significantly fewer mentally ill homeless people (and not just because they’re doing such a good job).
I don’t want to suggest that Norway has everything figured out. They haven’t. There’s a shortage of resources, and many suboptimal outcomes. But the system does suggest some answers to your questions.
“the person is in a locked facility? Placed in ‘some kind of housing’?”
Yes and yes. Depending on diagnosis. Often both, in turn. You graduate from locked facility to housing. I assume this is common even in California, though, but that it’s a matter of resources?
“can they leave? What if they do leave?”
Yes. As soon as possible (often not soon enough) you get your own apartment, and you’re free to come and go as you wish. Though you don’t get housing unless you’re reasonably safe to allow out into society as an outpatient, and likely to stay. If you leave, with no place to go, and it’s a problem, you’ll probably be identified and helped soon enough, as there’s no big haystack of homeless people for a needle to hide in. Bad things happen, but it’s unusual enough that it seems to spark debate every time.
“Get a job … With whom?” There are protected businesses that exist for this purpose. Bicycle repair shops, fulfillment, simple food prep, light manual labor, etc. Often (not always) businesses that wouldn’t otherwise make sense in a high-cost country like Norway if they were purely profit-driven (e.g. gift-wrapping services) and typically offering jobs that don’t require a lot of customer interaction. Wages and/or other aspects of the business are subsidized, prices are competitive, and customers understand that they may sacrifice some efficiency and sophistication for price and social benefit. These businesses take crises and low productivity in stride (and are rigged to handle it), and no enforcement is necessary.
Because of the scale and nature of the issue in California, the way the culture and economy and politics work, the role of drugs and the criminal justice system, etc, etc, I don’t think California could or should copy that system if they wanted to. And even if they did, it would take a long time, a lot of money, and they’d find it wasn’t perfect.
However, I’m not fond of “it can’t be done” rhetoric, which is very common among experts who know how it’s always been done. (For the same reason, I wanted to ask your clinic director if it wouldn’t be possible to overbook, taking no-shows into account when scheduling, and use good communication and positive incentives, rather than blaming and punishing the patients for the bad finances?)
The older I get, the more often I think “there are no solutions, just tradeoffs”. However, there are usually tradeoffs to be made – especially if you’re willing and able to fiddle with many variables at once, to break out of some local optimum.
I think Sergei was trying to point to a set of better-functioning systems elsewhere, rather than outlining a complete system in itself.
"Some kind of housing" in my local context would mean Community Care Units (see https://www.betterhealth.vic.gov.au/health/serviceprofiles/clinical-residential-rehabilitation-services-community-care-units-service) or Supported Residential Accommodation (see https://www.housing.vic.gov.au/supported-accommodation#what-is-specialist-disability-accommodation), thought it might also mean long-term hospitalisation in a Secure Extended Care Unit (see https://www.health.vic.gov.au/mental-health-services/secure-extended-care-units) or getting locked up in I-Can't-Believe-It's-Not-Prison (https://www.forensicare.vic.gov.au/).
I think the general pathway for psychotic homeless people is to get sent to an inpatient ward (which is reasonably secure) a few times, then end up in a CCU (which is probably vaguely secure in that you have to ask the nurses to let you out) and enter SRA (which is not at all secure but someone will notice if you disappear) if they seem stable. If they leave, someone will put a small amount of effort into finding them, and then they'll stay in secure accommodation longer next time. My brother worked night shifts in a SRA house as a disability carer while he was in university and the most traumatic thing that happened was a morbidly obese resident rolling onto and bursting a colostomy bag, so I don't think they're terrible places. I am not sure whether they're cost effective.
California must have inpatient care and forensic mental health. Perhaps it's missing long-stay residential services and supported accommodation in the middle, or missing the ability to send people to those services, or missing government funding for enough beds? Or more probably I'm misunderstanding the system and patients just aren't getting sent to those services for legal or procedural reasons.
Well, I think Sergei is more correct than you think: "paternalism" includes not just "XXX provides you with the resources you need" but also "you must obey XXX in using those resources". It's the opposite of libertarianism.
Basically https://www.overcomingbias.com/p/who-vouches-for-youhtml
Saying Psychiatrists regularly commit people on “vibes” doesn’t say much for the profession of psychiatry and degrades the credibility of the writer who is implicitly using his status as a psychiatrist to bolster his case.
“Hey listen to me I’m a psychiatrist…an expert…, but my expertise is basically vibes and you shouldn’t trust psychiatrists’ judgment…except for this article of course”
I didn't say psychiatrists' expertise or judgment was vibes. I said that the commitment process was based on vibes (ie judgment-related factors) rather than a simple clear legal algorithm.
Although I think the track record of psychiatrists in predicting objective outcomes (suicide, homicide, etc) is in fact pretty bad. My impression is that psychiatrists shouldn't claim to be able to predict these things beyond common sense, and mostly don't. The expertise they claim is in knowing how to treat mental illness.
So then one solution to your query is for psychiatrists (or others) to develop better predictive criteria
My question is whether that is hard because
1. It’s inherently a difficult prediction
2. The field of psychiatry doesn’t have the interest or the training to develop quantitative predictive models…they like treating patients… not predicting murder
3. Both
While I accept #1 to a point…I’ve encountered people who have committed violent crimes and there were indicators …so I have trouble believing it’s a crap shoot also
It's 1 - or at least, I sometimes see smart people try to make statistically sophisticated predictors and publish papers which, if you read between the lines, show they've failed pretty badly.
Don't get me wrong - you can easily predict that poor mentally ill people with a past criminal history will commit more crimes. You just can't pick out which ones or when more than common sense would allow.
From the your comments, it seems like more shelters solves so much of the problem that it becomes a qualitatively different problem. Why not put that front and center in the main article?
What will the rules be on the shelter? Will it allow smoking? Drug use? Having visitors at night? Can people come and go at all hours? Can you store possessions there?
No smoking - no drugs - 10 pm curfew - you get one locker - if you stay on the street instead of going here you go to jail. If you're good you can get a 4x7 foot dorm (shared bathroom tho)
Done. Easy. At least as a Step 1 - we can iterate as we go.
The problem is not that this wouldn't work, but is unimplementable. (Moreover, *any* solution is unimplementable because for some reason a plurality(?) of the population wants this "anarcho-tyranny-via-homeless-schizos" status quo so we're at a loss)
Keep building more shelters, each with slightly different (but clearly posted) rulesets, until demand is saturated. Collect data on success rates, complaints, etc.
If a shelter isn't nice enough, then people will choose to live on the street instead.
And it's too nice, then people who are currently just barely paying the rent on their crappy apartment will decide it makes a lot more sense to become homeless so they can live in the shelter instead... so they can spend their rent money on drugs instead.
When a crime is commited, make them wear a GPS tracker which they are not allowed to remove. Now, the social workers can follow them around for continuous administration of meds.
This is only a semi-serious proposal.
But it's at least less draconian than: "lock them all up" ....
That sounds like the start of a thriving market in electronic components from GPS trackers...
"Stealing a GPS tracker monitored by someone with law enforcement on speed dial" is somewhat saner than "stealing live power lines", but only somewhat.
And yet where I live power line theft is a frequent issue. GPS trackers also don't seem to deter car thieves, so obviously there are ways to jam the signal and then disable the units.
Are the people stealing power lines stealing them while they're live, though? Stealing power lines with the power off is significantly less insane.
What I'm getting at is that if any disruption to the GPS signal results in an immediate scream to law enforcement, you'd better have a hell of a getaway car ready in order to pull that off and not get immediately arrested (jamming won't help if the "oh shit" detector is upstream of the tracker, because the jamming will itself result in the scream). RL isn't quite up to the level of that Star Trek episode where a guy breaks his tracking anklet and two seconds later Starfleet beams in with phasers at the ready, but you're still talking minutes if this is prioritised.
They are indeed, with sometimes fatal results.
Well, I mean, yeah, I did call it insane (I read a bunch of Darwin Awards about this, although I think the curator said she wasn't accepting new ones as fried copper thieves were getting boring).
But TTBOMK those dumb enough to try it don't usually get far enough to get paid, so a "thriving market" still doesn't happen (well, in this case the stolen-scrap-metal market does, but only because there are non-power-line sources of stolen scrap metal - old copper phone lines, copper pipes, and so on, and that's just copper).
This is maybe true in a world where GPS trackers are monitored constantly, removal is prioritized, and consequences are severe, but that's not the world we live in, unfortunately.
People remove GPS trackers all the time. Or sometimes they just leave them on while they go murder people, and that's not noticed until the following Monday because the courts don't observe the monitors on nights or weekends. Obviously this could change, but that's the current state of affairs.
Yeah, my impression is that in our ancient humanocentric era, trackers are mostly useful for people who have successfully bargained with the legal system for more freedom, and thus they have a personal incentive not to mess with the tracker in case it gets found out and the freedom is revoked.
Of course, in the upcoming AI-centric era, our overlords won't have these mere flesh-and-blood limitations.
That's what I thought about too. And to sweeten the deal, give them a bag of food after they take their pill.
There is a “NIMBY” angle to this. My European city has a problem with homelessness. I once helped in the day shelter, only to speak and provide soup to homeless from Spain and Romania. They had specifically come to the Netherlands for the better homeless facilities. Makes you kind of hesitant about providing more facilities..
I remember interviewing homeless people, social workers and others when I lived in San Francisco a long time ago, and I heard a lot of reasons why people came to California – including a version of this one about homeless facilities.
A lot of people – especially outsiders, starving artists, LGBT+ not accepted in their own town, people who frequently use and romanticize drugs, anachronistic hippies/beatniks/hobos/hipsters etc. – have a very romantic vision of California. Many of those are probably high-risk for severe mental illness, too, without going into reasons. The Netherlands, particularly Amsterdam, has a similar image in Europe, I think.
In California’s case, however, I heard a rumor that towns and counties across the States (unofficially) dealt with homeless and other “undesirable” people by buying them a one-way ticket to SF or LA, with the promise of a better climate, better social services (at least then), and general California Dreaming. I didn’t confirm it, and am agnostic about it, but I’ve been to some small towns that I could believe that of.
If you’re a place that has a reputation as a good place to be homeless, and if other places nudge (or push) their homeless in your direction, I don’t know that it’s possible to build and staff shelters fast enough, but that’s where I’d invest my first two cents. (But also, physical paper prescriptions, strict appointment hours w/ no-show fines, the insurance system, etc. seems old-fashioned, counterproductive, and designed to fail.)
After reading you, I am surprised by the apparent size and intractability of this problem in the US. I'm European, and extremely critical with almost everything we do (or rather, *don't* do), but we don't seem to have this issue here (perhaps it is the greater social safety net? Definitely not us being good at making housing available). Perhaps there's something to be studied here?
Despite all of Europe's problems with housing, it's still much better at housing than the US is (speaking in broad generalities of course). I can get a nice apartment in Paris for cheaper than a bad apartment in a second tier city in the US. Part of this is that average salaries in Europe are lower, but *entry-level salaries* in Europe are often the same or higher, and that's what's relevant for people at risk of homelessness.
There's probably a good reason for this, but:
Why are antipsychotic drugs even controlled? It feels like a lot of this could be improved if instead of jumping through doctor hoops to get ahold of them, you could just roll on down to the drugstore and fork over five bucks for a ten-pack.
Are they addictive? Are they societally dangerous in the way that unnecessary use of antibiotics theoretically is?
No. Most medications with side effects are controlled because that's how the government works. Antipsychotics have lots of side effects, including a few particularly nasty ones like giving you permanent tics that will never go away if you take too high a dose for too long.
I honestly feel like "deregulate the purchase of non-addictive medication" might be more productive than trying to deregulate marijuana.
They have a sedative effect, don't they? Do they have the potential to be used for date rape (as benzos notoriously do), or to keep sex slaves under control? Either would pose at least some issues with fully opening the floodgates.
The issue is the *chronically* homeless camping out in maximally public areas, like around subway stops. Option 1 is to fund a few asylums in big cities, and put the chronically homeless in there for long periods. Option 2 is to give police officers cattle-prods and task them with zapping any highly public homeless, so at least they'll learn to hide in a back-alley or in a hole or something.
I'm only half-joking, by the way. Liberals will say it's utterly inhumane to do things like this but most peoples' willingness to vote for liberal politicians goes down a bit every time they see the homeless. By letting a very small number of people dominate the image of big cities causes severely disproportionate backlash over the long term.
Semi-draconian:
1. Build the mental institutions. Make them reasonably nice, nicer than prison at least, but cheap enough to actually get built.
2. Send mentally ill people *who are convicted of crimes* there instead of sending them to prison. Doctors can recommend people go there voluntarily perhaps, but involuntary commitment is for people who would be involuntarily incarcerated anyway.
3. Incrementally increase sentence lengths for repeat offenders. Rather than have the same person alternate in and out every 3 months because they keep failing to take their meds and commit petty crimes, you identify that this person cannot function in normal society and you let them stay there nearly indefinitely. Maybe the nth sentence is n times longer than it would be for an ordinary jail sentence, or maybe some more mathematically smooth function that took into account severity for preceding crimes too, but something like that.
Some people might describe this as "cruel and draconian", but whether it is or not depends on how nice the facilities end up being. It would probably cost more than just housing said homeless people, but the point is that only mentally ill criminals who can't function even with free housing would end up here. Or maybe if it's too nice then you incentivize homeless people to commit crimes in order to get here (or circumvent that by just letting them voluntarily commit themselves). There are some kinks to work out. But we're already paying to house a lot of these people in jail, so I'm not sure there's that much difference economically.
The signing of this law (https://en.m.wikipedia.org/wiki/Lanterman–Petris–Short_Act) by Reagan and a suite of other laws in the 60s gutted the states ability to confine people long term in the manner that you suggest. Addressing this would be a good place to start for the solutions that you propose.
I think this would handle plenty of currently-hard cases:
https://www.overcomingbias.com/p/who-vouches-for-youhtml
I think there's a lapse where we put people in jail for homelessness even though they would only be homeless for a week, since the people "who could only be homeless for a week" and "disruptive homeless who commit crimes" is a venn diagram with very little overlap. So you can be cruel and draconian to the latter, and that's fine with me.
Another thing is that the local solution works for most people. You just need to make sure you are somewhat less not-cruel than some non-trivial subset of other places. Even within the subset of nearby places with lots of bleeding-hearts, some (e.g. Palo Alto or Redmond!) are not as not-cruel as others (e.g. San Francisco or Seattle!). You cannot really call the former cruel, but the problem concentrates much more in the latter.
You don't have to worry about "not being nice doesn't work cause if everyone does it...". Sure, it doesn't work in abstract, but in the real world there'd always be plenty of idiots who would then get what they deserve.
I don't understand your last sentence, or what you mean by "the local solution works for most people", but it sounds like you're describing a race-to-the-bottom of cruelty? If every place has to be more cruel than its neighbors, then if SF becomes more cruel than Palo Alto, Palo Alto will become more cruel to keep up, and so on
I think the point is that you don't need to race to the bottom because SF is all the way up at the top, so you can stay one step from the top and still have all the psychotic homeless go to SF.
Of course, this doesn't work for SF, but SF hasn't participated in the race to the bottom for 50 years and it shows no sign of starting now.
Ah, SF is the slow guy in the "I don't need to run faster than the bear" lesson.
What Richard said... I put it in a less charitable and more general form - for any problem where the solution for one actor is "don't be dumb" but it won't work if everyone follows it, the solution /would/ work in practice, because there's no shortage of dumb people in the world ;)
The point is that there will be some place that will not have the resources to expel the homeless, and the homeless will all be driven there, where they can safely be forgotten by society.
A lot of the solution to the social work side of- and to similar welfare policy problems- is:
1. Building more houses, as others have noted.
2. Putting serious money into a simple, streamlined bureaucracy that gives support and money to people. No more "wonder not-for-profits" with shiny brochures. No more debt relief for Pell grant recipients who work for five years in underserved communities on days that start with a T. No more complicated programs designed by well intentioned over-woke shiny eyed do-gooders. Uncomplicated, generous distribution of welfare.
Support includes, in this context most notably and in addition to financial support:
Antipsychotics
Housing
Government subsidized starter jobs
A lot of the reason America doesn't do this is because Americans have convinced themselves that government fails so much that they've let their own state capacity atrophy, and developed the frankly insane belief that NGO's and private companies can handle areas like this with less graft and corruption. The incentive compatibility problems alone boggle the mind.
Thanks for articulating this. I could never really put my finger on it, but my impression of so many things related to “spending for social good” in the US come in the form of fractured individual providers and solutions, be it health care, student loans, homeless services or what have you.
I still don’t really know how to explain it, but your description with the shiny brochures somehow captures my sense well.
The NGOs have done a very, very good job marketing themselves to the people and to the government.
I think of the NGOs as the progressive left's answer to the more standard privatization thing, where the cronies of the governor get a sweet deal on some state asset that's being privatized.
> So when people say “we should do something about mentally ill homeless people”, I naturally tend towards thinking this is meaningless unless you specify what you want to do - something most of these people never get to.
I disagree. It's a coordination mechanism for gathering support for a type of policy proposal. Actually working out the details of the policy proposal should probably be left to people with a better understanding of dynamics of the current problem (such as perhaps you). But the general statement should be interpreted as "I think that it is bad that we let homeless people slowly die on our streets, and there appear to be a sizable group of homeless people who would not significantly benefit from simply giving them housing (because they would refuse it or destroy it or simply die slowly in it), and we should collectively come up with a better solution for that group".
I understand that you're probably reacting to articles proposing simplistic solutions or suggesting that the root problem is merely that the Outgroup Tribe has political power. Those aren't particularly helpful. But there are still people who deny that there's any problem, or who deny that there's any problem that can't be solved by building more housing, and those people present an obstacle to experimentation that might let us develop a better way. Coordinating against them is a first step.
Great response
I think the number of people in SF/Berkeley/Oakland who deny that there's any problem is quite small. You can't do anything in those places without being directly accosted by the problem.
I don't think it's mostly those people, specifically, I think most of the impetus comes from people who don't see it themselves. But even among the group you mention, I suspect a number of them have either acclimated to the problem, or have succumbed to social pressure to pretend that the problem isn't as bad as they think.
It is a coordination mechanism in the sense that politics where people yell out random issues is a coordination mechanism. A poor one compared to trying to increase the average understanding of the challenges and potential solutions. For every article about a complex topic, that actually proposes any decent plan at all, there's what feels like a thousand that have only heat (your ''coordination mechanism''). And that's not even getting to that an *actually* adequate article would essentially be a series of planning proposals of different ways to resolve homelessness.
Of course, we don't expect people to read that much, but we barely even expect them to read a basic article about a topic before saying they have a strong opinion.
I get the idea you're talking about, but as far as it is a coordination mechanism it is a poor one with lots of side effects to the overall sanity level of society. They refer to the problem but it is already known as a problem — potentially it needs to be emphasized! But honestly that is rarely the issue. Both political parties think there's issues with homelessness, they just don't have the competency to propose a whole-hearted solution or the ability to agree on methodology.
There's definitely areas where this sort of weak coordination scheme was beneficial, like getting worried about pollution. However it quickly drives oxygen out of the room, making so reasonable discussions about planning are choked out.
I'm not saying heat is a coordination mechanism! That's not at all what I'm talking about, and for most of his post, and most of the arguments he makes, that's not what Scott is talking about either.
This is specifically about people saying "I notice this problem but I don't have any ideas for a solution". I maintain that there is nothing wrong with that.
If you think there's something wrong with people saying "I notice this problem and the reason we don't have a solution is the other party are all Nazis", then we agree. And finally I would further maintain that the problem with that is obvious and has nothing to do with not proposing a solution.
I wasn't being polite in my own post, apologies.
I do think that a lot of people's way of talking about topics saying "I notice X issue" is just a minor form of heat. Yes, it isn't anywhere as bad as "I notice X issue and the other people are evil because Y", but it still has the problems of driving out talking about solutions. Especially in carefully considering solutions that have notable trade-offs, I think that when you have a large amount of people *saying* "X is bad" rather than just a general acknowledgement that "X is bad", you have problems.
> This is specifically about people saying "I notice this problem but I don't have any ideas for a solution". I maintain that there is nothing wrong with that.
I also think this is mildly uncommon, or even when this is what is literally said there's the implicit bounds on what they think are acceptable. Having people be.. I don't feel like I have a good word for this.. worked up? The problem is not caring, caring is good, but rather posting about it a lot. Keeping it in mind as part of the background Problems. That sort of thing makes it harder for anyone to make a significant proposal, as it makes the proposal more likely to have heaps of positive and negative attention. Negative attention tends to win out, carving at the rough edges but not necessarily in good ways, but positive attention also makes it harder to maintain self-awareness. If people understood the problems better, then the negative attention would be focused on parts that actually need fixing.
So I think a decent summarization of my complaint is that a lot of people talking about an issue makes it harder for those who actually pay attention to the issue to get anywhere. The attention from so many people makes proposals weaker and harder to produce solutions that are not obvious from the typical commenter's perspective, because that under-educated/under-specialized attention onto the issue weakens it.
I agree it is a coordination scheme and just going "everyone silence" would have its own undesirably large side-effects, but I'm very skeptical of its quality as a way to coordinate and of the side-effects it has on society.
Has anyone read How Big Things Get Done by Bent Flyvbjerg, or The Fifth Risk by Michael Lewis? HBTGD outlines a process for making complex problems simpler (plan slow, act fast). It identifies political risk as a source of compromise against interests. TFR took a look at the disruption that came from the 2016 POTUS transition. These books identify successful projects as well as the blunders (consistent with the problems in your post). The pattern in your example compounds 2 significant problems and touch-points across psychology, pharmacy, policing, crime/law and admin in transport, health and housing. It might be reasonable to expect project management risk in coming up with a solution that caters to each of these elements of the risk profile. I wonder if there are elements of ideas in this thread (eg: using the social impact bond model that @BENTHAMSBULLDOG is describing) with the iterative process that Flyvbjerg outlines. That might be casework patterns that are aimed at supporting homeless people who struggle with mental illness into stable accommodation. If the casework is paused because of people not getting the approval for a free subway pass, then the data collection point that could prompt the caseworker to meet the person with the travel pass before the appointment might remove one of the disruptions from the cycle you have outlined. Small interventions may produce data that allow the social impact to be framed in a way that supports the commercial risk taking that could incentivise risk taking as part of a solution. Flyvbjerg's book has many of examples showing how big complicated projects or problems are broken into smaller components, and then solutions are planned and refined in testing and iteration. Lewis' book shows how these grand efforts fall off the rails without management and with the pressure of political risk. Maybe those who are saying that there is a problem, are willing contributors to an aspect of a solution. Calling for a perfectly designed policy solution, without the iteration might exclude the meaningful engagement that could be provided if it were possible to coordinate the interaction with those people who may have an element of insight. Maybe a small part of a solution could be a rent arrears database which health care providers could access. The access could form part of a risk assessment which might give the health care worker an indication of whether a person may be facing homelessness and could offer intervention resources (I accept that these may not be readily available). This wouldn't help those who are already homeless, but it might a data insight to help address an at-risk-of-homelessness segment of this group.
To the extent the issue is keeping apointments, can we just get rid of appointments?
Like in places with free soup kitchens people go to to eat, can the social workers just hang out in the soup kitchens and meet with them there?
Also can the social workers be given copies of the perescriptions so they can refefel then for the paitents.
Or, if that doesnt work can there be a database of persriptions associated with images and names, so that pharmasits can look up the person's name in the database, see that the image matches how the person looks and give them the medication, even if they lose the perscription?
yeah I'm a little confused by this concept of "losing the prescription" - in my experience, when I get prescriptions they are digitally sent to the pharmacy, and I go to the CVS or Walgreens or whatever that it was sent to and give them my name and date of birth and they pull it up. If it's a controlled substance I do have to show ID but I assume the people Scott is describing do too.
I'm not homeless or in poverty, but I don't see why this would be a matter of privilege - why can't the doctors who work with homeless people also call the prescription directly into the pharmacy?
I thought Scott just meant they lost the actual bottle of pills after filling said prescription, hence the insurance company complaining about the cost.
My plan is:
- Keep steps one and two
- Step 3 becomes "Psychiatrist assesses whether patient is capable of living an independent functional life, and prepares report for the court".
- Step 4 becomes "Court holds a hearing to determine if a patient is indeed incapable of independent functional living, relying heavily on the psychiatrist's report".
- Step 5 becomes "If the court finds that the patient is incapable of independent functional living, it designates a family member (if one exists) as the patient's guardian, and they are now responsible for keeping him/her fed, housed, medicated, etc. This does not need to be voluntary. Guardians get wide latitude in terms of how they go about it, but extreme abuse/neglect is criminalised.
- The patient's carer gets paid a reasonably generous state-funded stipend to support them in taking care of the patient.
- Patients who do not have any family (or whose family are themselves incapable) get put in state-owned housing with state-paid social workers filling the role of guardians. But this is a last resort, and even a distant cousin counts as "family" if that's all that can be found.
- Patients who later recover to a point of being able to live independently and functionally can apply to the court to have their guardianship removed.
- Also make it so developers do not have to apply for permission before building (they still have to comply with building codes and regulations and can be inspected/audited to ensure they are), so houses are cheaper.
Why require designating a family member? Being a caretaker of a violent schizophrenic is a lot of incredibly draining work. I don't see why having the bad luck of being related to such a person should result in you having to care for them, especially if it's a distant cousin.
Because family should look out for family. And because other solutions are not working well. My country (Australia) has gone down the route of having a massive new disability insurance scheme that is ballooning in cost and is spending huge amounts - sometimes over a million per year for one person to house violent schizophrenics independently and have social workers come help them with their needs (in groups of at least two for safety reasons). And it's just not sustainable.
What's your solution?
So I am not allowed to be estranged from family? What is the definition of "family"? What if the only family lives on the other side of the country or in a different country?
What kind of question is "what is the definition of family?" I already specified that it would extend to include distant cousins. I don't believe that's an insufficient level of detail for you to decide if you do or don't like the idea.
Courts would be able to take account of all circumstances when designating a guardian, so if there is some particular reason why it's just not workable for you to take care of your relative then you can explain that to the judge and he can give responsibility to another family member or, ultimately, to the state if no one suitable can be found.
That said I would not envision living on the other side of the country as a sufficiently good reason to refuse guardianship. We're talking about homeless people, by definition they have no fixed address.
What's your solution?
I dunno, I think I'd like to know in advance how many of my relatives I may potentially be on the hook for and where they are or may be located.
I get it, you like your own idea. The details need thinking through.
I would indeed prefer to have qualified professionals who opted in to their field taking care of these people en masse than to foist them on their family members who may or may not do the job very well at all.
Having family do it doesn't magically make it take fewer resources, and in fact it probably takes more because there's no economy of scale benefits. The resources are just being spent by families directly rather than taxpayer dollars.
On the contrary, having the government do it absolutely does require more resources. Most things the government does end up being very costly, and disability support is no exception. Sometimes that's worth it if it's something that only the government can effectively do, but if you can find a different solution you should.
It's nice to think that economies of scale would reduce costs but it's not true in practice. My wife does the finances for a mental health disability support provider and the money spent is staggering. And at the same time the providers are constantly on the edge of bankruptcy, and the clients are not experiencing an enviable standard of living (though obviously better than homelessness). You'd save money and probably get better client outcomes by paying a family member $100k/year to look after their own relative.
The cost of the NDIS is getting completely out of control. It will soon cost more than the age pension. And we still have homeless people! Not as many as America, but given the cost of our approach the fact that it is only a partial solution is pretty grim.
I think it does need to be voluntary, though. I am not going to be happy if my psychotic cousin from out of state, who I met five times in my life at reunions, is suddenly *my* problem
I like a lot of aspects of your proposal, though. I suppose what it looks like in practice is drastically increasing the "carer's allowance" that people are entitled to through Centrelink, in recognition of the fact that close family members are often better in lots of ways at caring for their disabled relative than the state
This already exists in many counties in California, including SF (and many other states). It’s called conservatorship.
The snag is if a homeless person is acting crazy, then once they are hauled in and kept in a police cell or a psych ward for a while they may recover, like a drunk sobering up under similar confinement. So to a psychiatrist tasked with assessing them, it must sometimes feel like having to open a fridge door to see if the light is on!
Psychotic people don't recover just by being forced to stay in a quiet environment. It doesn't work that way. Their brain is malfunctioning.
There are many places on Earth that have substantially lower density of homeless psychotic people than downtown San Francisco. Actually, any city I have been to, across dozens of countries, has a lower one. There must be a reason for this and I genuinely do not know what that is Theoretically, I can think of the following explanations. 1) The rest of the world has a lower underlying rate of mental illness, by an order of magnitude. If that is the case, then this is the root cause and that is what you should be at least discussing if not addressing. 2) The rest of the world has displaced their mentally ill to San Francisco. This might work for Berkeley or even Austin, but I do not see this as a plausible mechanism for e.g. London, UK and for most other places. 3) They are solving this problem in some ways.
That means that a San Francisco lay person can reasonably write "damn liberals are soft on mentally ill and are not doing whatever literally every other city on Earth does with a small fraction of resources available in SF".
It also means that a San Francisco expert on mentally ill people has an alternative option to admitting that nothing can be done other than tinkering around the edges of their current clearly defunct system - just look what some other places are doing and try to think which of these solutions would work best in SF?
It's certainly *mathematically* possible San Francisco is not doing anything wrong: if in the UK, homeless people are handled locally and in the US they're all sent to San Francisco, San Francisco will have an incidence of homelessness 300x the UK national average and 300x less resources per capita to deal with the problem.
If somehow nobody is shipping homeless to Austin or Zurich or London or Madrid then maybe San Francisco did something wrong to be the place where everyone sends their homeless?
It certainly could be that San Francisco is doing something uniquely wrong. Other explanations could be:
- SF has the best weather in the United States to be homeless
- in other nations exporting homeless people is politically toxic
- in other nations national programs obviate the need to export the homeless
- other cities are extremely cruel to homeless people and so the homeless go to SF
- SF is really nice to homeless people and so the homeless go to SF
Only one of these is plausibly SF's fault. Nobody denies that SF is probably doing something wrong. But your original post is framed this way: "SF has way more homeless people, therefore, it *is* fucking up in some way all the other cities in the world do not." If the argument gets watered down to "SF could be doing something wrong" then, well, sure. But at that point it's much better to figure out what the wrong thing instead of relying on the argument.
1) not true, many places have the same weather, but not this problem
4) this is self contradictory, if something exists everywhere except for one city, it isn't extreme by definition
2) and 3) may be true, but I do not know how large organised homeless export to SF is relatively to the stock of SF homeless and homeless export in other directions. Do you have any data on that?
I don't - I'm not an expert - but neither are you, and you're the one saying that "SF has way more homeless people than other cities => mathematically, SF therefore must be doing something wrong." That's the entire argument you've made. I'm not going to try and do a process of elimination on every other possible alternative explanation to rescue your argument for you.
I do not use the word "mathematically" lightly and I did not use it here. In any case, I appreciate there may be a set of unique and implausible circumstances that make SF such a unique magnet for homeless and/or crazy people and that can not be influenced by that administration.
Most of those points, while theoretically plausible, are factually untrue and just go to show that SF *is* actively doing something wrong, on top of whatever the state of California is doing wrong. (Comparing it to other states with very different weather is probably unfair.)
Maybe it's partly the ratio of the population of the country to the population of the city? London is the biggest city in Britain (by far), but SF isn't even in the USA's top 10 (by some counts, anyway).
I think some of it is also a product of time. The "housing first" people have one thing right, in that one of the pipelines into being one of the "visible problem homeless" is spending too much time as one of the "invisible good homeless". Perhaps we've let our safety net decay for so long that we've had a greater proportion of people move from the good category to the bad one, while other countries may have had better ways of dealing with the good category, thus reducing their future numbers of the bad category.
And climate aside, I think a lot of it is the combination of wealth and leftiness in SF. The combination of those two things implies: a) good odds of handouts, b) funded social services, and leftiness implies c) permissive legal environments, but also wealth implies d) high property values. Thus, homeless accumulate in places with high property values, but not through the obvious causal connection.
Unusually for Scott's posts, he doesn't link to any of the pieces he's responding to, so it's a little hard to say how fair he's being. The most recent piece I've seen is Freddie Deboer's (https://freddiedeboer.substack.com/p/well-i-dont-know-about-this-involuntary), which doesn't seem so much like a "we should do something" argument as a "ideological opposition to involuntary institutionalization is foolish" article. And it does seem like he has a point: solving the problems with involuntary institutionalization, problems Scott thoroughly details, is going to be hard enough *without* a widespread belief among young progressives that these problems shouldn't even be solved because the project is wrong to begin with. I'm curious to know if Scott has a position on the moral merits there, or if he thinks it's pretty much irrelevant as long as the practical problems are so daunting.
I think one can also infer from DeBoer's piece that political/philosophical orthodoxy might be a barrier to reform.
I think they should at least be given an implant with antipsychotic drugs before being discharged. That should keep them from being psychotic for the next year.
> If your plan is something else that will solve everything with no tradeoffs, then you owe it to your readers to explain what that is.
How about this modest little proposal: free government-provided fentanyl, as much as you want, whenever you want, no strings attached. Fentanyl is super-cheap to make, or so I hear, so I'm sure it'd cost less than what we're currently spending on the homeless problem. There'd be a certain "adjustment period" at first, but I think we'd rapidly reach a new equilibrium with much less bother all around. Plus, it might put a lot of drug dealers out of business, so it's really killing two birds with one stone, as it were!
In addition to the obvious ethical concerns, most of the people who have become addicted to opioids in the US during the "opioid crisis" are neither homeless nor psychotic. This would hit those people at least as hard.
(I used the words "modest" and "proposal" in close proximity?)
They give out free opiates to addicts in parts of Canada, though not fentanyl specifically.
That's probably nicer. My understanding is that fentanyl is cheap, but gives a much less pleasant high.
The point of this article seems to be to emphasize the intractability of the homelessness situation, which it does a great job of, but I still wonder if it would be prudent to not emphasize mental illness so much. Could it be that drug use, not mental illness, is the key factor? Would stricter drug laws help alleviate these issues? Repeat for housing access, etc, etc. To believe that mental illness is the key factor in homelessness, wouldn’t you have to accept that cities with unusually high rates of homelessness also have higher rates of mental illness to others. I would guess that this is probably not true.
What about Fairweather Lodges? (https://en.wikipedia.org/wiki/Fairweather_Lodge). Psychologist who invented and tried out the idea wrote a book about it and how surprisingly successful it was. Tried to interest hospital administrators in the idea -- sent them a description of his program and its results, offered to do pretty much anything, including come to their area and spend as long as needed, at no charge, to help the hospital set up a trial program. Nobody was interested. I, like anyone else, find it hard to believe that a household of homeless people with no staff in residence could work, but I don't think Fairweather was lying.
I can't imagine this being solved without a truly enormous investment, like, Manhattan Project plus some, into mental health support at every level of acuity:
- for the most severe cases or people who are incorrigibly violent, permanent institutionalization
- for people who simply do not take their meds, assisted living complete with nurses making sure people take their medication (under the threat of permanent institutionalization)
- for people who actually take their meds until life happens, Free Houses (TM), or, at the very least, free meal tickets redeemable at centers where they can also be followed up and provided their medication so they don't just disappear from the system.
The price tag on this would be enormous, like, actual whole percentage points of GDP at the national level or whatever polity is trying to implement it. I don't think any polity would be willing to pay for it.
Do other countries require Manhattan Project levels of investment to deal with it? Even within the US, poorer red states have fewer homeless people (to a significant extent because housing is cheaper because it's easier to build).
Society already houses the mentally ill, in prisons and jails. Involuntary commitment takes place in the form of prison sentences.. Maybe it would make sense to try to return to the old standard pre-1950's and try to operate dedicated asylums again.
It relates to a problem I see in the criminal justice quite often. What should you do with someone who punches a stranger every couple of years?
I see quite a few people like this, they clearly aren't mentally healthy and they aren't dangerous criminals. It would be Draconian to give them life imprisonment the 4th time they punch someone but I am also not sure you can let someone be free if you think there is an 80% chance they will punch a shop assistant in the three years after their punishment.
This is how we could deal with such a person:
https://www.overcomingbias.com/p/who-vouches-for-youhtml
One comment with the link would have been sufficient. This gets inconvenient.
There are a very large number of comments on this post. With a smaller number, I am more likely to assume any given reader has read any given comment.
How many random people do you get to beat up before we stop letting you do it? As I get older and less able to respond effectively to an assault by a crazy guy or just a thug who likes hurting people, I find that I prefer a smaller number of people we let you hurt before we decide that the best place for you in our society is inside a cage with the door locked.
Isn’t the usual story that there was a large “deinstitutionization” effort during the Reagan administration that led to a large increase in homelessness? If that’s right then it seems strange to say that there’s no feasible way of keeping large numbers of people institutionalized longer. Where were they all in the 1980s? Granted that was a few years ago so maybe the capacity has eroded, but it seems like if we managed to do it then then it’s surprising to hear it would be so radically unworkable now.
Deinstitutionalization was a multidecade process that started around the time of Kennedy.
It happened around the time chlorpromazine was discovered - the first antipsychotic. Prior to that, schizophrenia or "insanity" meant you lived in an institution for the rest of your life, plus or minus a few wild therapies like giving you insulin until you passed out, deliberately infecting you with malaria, or a frontal lobotomy. (And electroshock, but this is actually somewhat effective and still used today in some recalcitrant cases)
Definitely. Effective medications are a big part of the reason that deinstitutionalization wasn't worse. And it makes me wonder if intensive therapy in a residential setting, a 21st century asylum, is perhaps viable from a resource consumption perspective.
I don't think it was Reagan; he may have finished it, but I'd thought it started as a left-wing movement after some horror stories about asylums got publicized.
This is largely true. People point to Reagan largely because he passed the strictest laws at the national level to force de-institutionalization, but the process started much earlier in individual states (and other countries also deinstitutionalized!) The movement was sort of like modern criminal justice reform in that it was largely grounded in left wing ideology, but the immediate cost savings appealed to conservatives who pushed it through.
However I would point out that early deinstitutionalization was actually pretty successful because there were a lot of people in institutions that really should have been managed in the community. Each round of deinstitutionalization this became less true. By the time Reagan made it so that almost nobody could be institutionalized, all the low-hanging fruit had been picked and the only people released were people who really should not have been.
Good point! The population is not uniform, and if you keep removing the lowest-hanging fruit, eventually you need extension ladders.
> Most (?) homeless people are only homeless for a few weeks, and 80% of homeless people are homeless for less than a year.
I worried about this statistic, too, because it's difficult to know exactly what they mean by "most" when counting people who are only homeless for a few weeks. Do they mean anyone who was homeless at any time during a year, or a decade?
The link says this:
https://endhomelessness.org/homelessness-in-america/who-experiences-homelessness/chronically-homeless/
> On a single night in January 2023: There were 143,105 homeless individuals with chronic patterns of homelessness. That is nearly 22 percent of the total population of homeless individuals.
So, what's "total" and what's "chronic"? But they had a link to their source:
https://www.huduser.gov/portal/sites/default/files/pdf/2023-AHAR-Part-1.pdf
> On a single night in 2023, roughly 653,100 people – or about 20 of every 10,000 people in the United States – were experiencing homelessness. Six in ten people were experiencing sheltered homelessness—that is, in an emergency shelter (ES), transitional housing (TH), or safe haven (SH) program—while the remaining four in ten were experiencing unsheltered homelessness in places not meant for human habitation.
> About one-third (31%) of all individuals experiencing homelessness reported having experienced chronic patterns of homelessness, or 143,105 people. This is the highest number of individuals experiencing chronic patterns of homelessness counted in the PIT count since these data were frst reported in 2007. Two-thirds of individuals experiencing chronic patterns of homelessness, or almost 93,000 people, were counted in unsheltered locations. This is also the highest number recorded.
So I don't know where that "80%" or "nearly 22%" came from. 143105/653100 is 21.9%, but why didn't they just say so? I suppose the second article did the math and rounded, and then Scott rounded again, but why is the original article's math different? There's a definition:
> Individual Experiencing Chronic Homelessness refers to an individual with a disability who has been continuously experiencing homelessness for one year or more, or has experienced at least four episodes of homelessness in the last three years where the combined length of time experiencing homelessness on those occasions is at least 12 months.
But that "with a disability" has to be a mistake, right? Either they're defining the wrong term, or used the wrong definition. (Or the entire thing is compromised.) And it still doesn't actually define "chronic"; I wonder if they just asked people "would you say you are experiencing chronic patterns of homelessness" and recorded the answer.
Here's some tidbits:
> Nearly half of individuals who experienced chronic patterns of homelessness in the United States were in California (47% or 67,510 people). California accounts for nearly six in ten of all unsheltered individuals experiencing chronic patterns of homelessness in the United States (57% or 53,169 people).
> Los Angeles had, by far, the largest number of individuals experiencing chronic patterns of homelessness in the country (30,442 people or 21% of the national total). New York City had the second largest number of individuals experiencing chronic patterns of homelessness, 4,548 people (or 3% of the total). In Los Angeles, more than 8 in 10 individuals experiencing chronic patterns of homelessness were found in unsheltered locations, while in New York City, less than one-ffth (18%) are unsheltered.
In Britain, we used to send people away “for a stay in the countryside”, a euphemism for being detained in a mental asylum effectively. Once there getting people to take their anti-psychotics is no problem, and while you describe the detention as draconian and cruel, expecting seriously ill schizophrenics to be able to navigate a modern society seems more cruel to me, and simultaneously imposes their behaviour on the rest of us. There’s a nice summary of the history of the asylums here: https://beyondthepoint.co.uk/a-history-of-mental-asylums/
Overall, this post strikes me like most written by policy experts in that it says, “oh solving X is impossible I assure you”, then disregards the obvious solution because it’s beyond the pale to their sensibilities. In other words - not impossible, I just don’t want to
I've heard a really good term for that. "Admiring the problem".
+1
> Overall, this post strikes me like most written by policy experts in that it says, “oh solving X is impossible I assure you”, then disregards the obvious solution because it’s beyond the pale to their sensibilities. In other words - not impossible, I just don’t want to
Ah, yes, like when you ask someone to take care of a problem like, oh, a sink full of dishes, and they say that, "well, the sponge is due for a cleaning and I should look up the latest discussion of how to do that on reddit, and we don't have the good dish soap only the old stuff which doesn't do quite as good a job, and I might need to toss stuff in the trash and we only have one extra trash bag so I should go to the store first, and I think my right arm muscles are weirdly overdeveloped so I'm going to do all the scrubbing with my left hand, which takes 3 times as long and it's before my bedtime, that is if I'm going to get in an hour of meditation tonight..."
They disreagrd the obvious solutions because they have a vested interest in status quo. People don't give up power, prestige, influence, money, excitement etc if they are not forced to.
Theft is a year of prison? Is that applied? My main source of information about the US is people living in San Francisco so I may be heavily biased here but at least in SF it does not seem like everyone gets arrested.
> “You know what I mean, psychotic homeless people in tents!” Okay, fine, can you make homelessness a crime?
I think the “you know what I mean” would be psychotic people who are a danger to themselves and others, not homeless people. And I would be interested in what commitment would look like for these people could look like - not sure it would be good, but not just prison, new institutions focused on treatment with pathways to release once on anti-psychotics for some period of time?
Anyways, disappointed by this straw man in an otherwise informative post.
As many have said, the real issue people are concerned about isn't those without places to live being present in public spaces per se, it's a small minority engaging in anti-social behavior (whether induced by drug addiction, mental illness or general misanthropy) that make the lives of everyone else around them, and the immediate surrounding environment, significantly worse. There's an overlap between these two groups, but that's incidental. Indeed, punishing homelessness as a proxy for anti-social behavior is unnecessarily cruel when we can just focus on the anti-social behavior.
Most of the people who threaten and harass others, create public nuisance, or physically ruin public spaces, are absolutely identifiable, especially over time. They're repeat offenders. It's ridiculous that we should be constrained from dealing with known perpetrators just because it's impractical to "catch them in the act".
All your points about the impotence of the current system to deal with this are well taken. But I'm not sure why it's so impractical to formally advocate what many urban municipalities do informally - roust anti-social perps away from highly trafficked, desirable areas where they infringe on everyone else's quality of life, to less populated areas where their presence would incur a much smaller social cost. I don't think anyone really believes there's an absolute entitlement to inhabit a specific public space regardless of one's behavior. I'd love to hear the counterargument.
You could say that the differential policing of the Tenderloin neighborhood in San Francisco represents a version of this. Skid Row in LA, etc. The complaint you hear in these cities boils down to how ineffective these "containment" policies are.
Everyone knows there are some parts of a city where anti-social behavior is simply not tolerated, and others places where it's allowed to proliferate with impunity. Thats why smug, fatalistic dismissals of the rising concern around this reek of bullshit and deflection. It's always been a political choice, not an inevitable feature of urban living.
The reason it’s couched in ‘helping’ them is because turbolibs won’t accept any change at all unless it is.
That’s why the language is deceptive.
Even though it is probably, as you yourself admit, potentially actually useful.
"I asked the clinic director why we had such a punitive policy, and she said that without the policy, patients would miss so many appointments that the clinic couldn’t make money or pay staff."
Could this be fixed by not being so rigid with appointments and overbooking things? Like, let's say 75% of clients miss their appointments. If you book 4 people at the same time, then on average 1 is going to show up. Of course sometimes more than 1 shows up but then maybe you could tell them to wait or tell them to return another time.
Obviously this is far from magically respectful of their time, but at least as an alternative to punitive policies it seems like it might be worth having.
Tracking bracelets, send people to them to give them their drugs.
This seems like rather a good idea.
Housing: build basic shelter huts outside the city, with little to no infrastructure.
Think no electric grid, no running water, yes village well
This should be very very cheap, and will protect them from wind rain and sun.
Cold and heat are a bit of an issue, but coats should be fine for winter and summer is generally surviveable
You can be draconian too, and have any homeless people disturbing the peace (begging, screaming etc) whipped (or something more palatable to modern voters - like broken bones or killing them - I suppose) for second offenses, and of course heavy disciplinary action to the person responsible for them
Reminds me of the proposal for universal basic dorms:
https://www.overcomingbias.com/p/universal-basic-dormshtml
Psychotic homeless people would probably be kicked out of the urban ones.
I would support individual rooms and even personal shacks
I was a community mental health worker in the UK in the noughties. My employers were supposed to be the carrot, but we ended up being the stick. We would visit people on the NHS mental health books, and “support” them to remain living in their rented accommodation, some of which we owned, and promote independence including employment. Sounds good, right? So why the scare quotes? Well, most of the clients had been referred to us while being detained in hospital, consequently the clients’ issues were skewed towards psychosis. Was that the plan? I never got to the bottom of this. But some features/bugs of the programme made us a bad fit for this client group, regardless. (1) The role required no qualifications - our company emphasised “lived experience” of mental health issues, which in real life meant personal experience of mental health problems up to and including bipolar (but not schizophrenia), or experience as a carer.
(2) Promoting independence & employment - this was not an extra, it was integral to our funding, we had to bid for the tender every few years and provide evidence that we were improving employment outcomes for our clients. This leads me to believe the programme may have been designed for unemployed depressives, but other features don't fit with this e.g…
(3) Our role as landlords - landlords have a “duty of care” to their tenants in common law: providing fire extinguishers and the like. Rightly or wrongly, the company interpreted this very broadly, meaning we had to inspect client properties to ensure they weren't using the flat in a dangerous way e.g leaving the gas on. But we went further still - one client was a hoarder, there were boxes everywhere, and my boss believed this was a fire hazard, so we threatened to evict him and he relapsed. This problem was exacerbated by…
(4) Gender issues - most of our clients were male, but I was the only male member of staff. The hoarder (male) was the tip of the iceberg, but most of our clients’ flats were were in a poor state, albeit not unusual for a single man, sadly, but the bar for “unacceptably messy flat” was set by females, so we had to badger our clients to tidy up, and if they didn't comply…
(5) Relationship with mental health services - we were dependent on the NHS and social services for referrals, therefore we had to show willing by snitching on our clients. Fair enough if the paranoia was flaring up, but as I say “duty of care” was interpreted so widely that we were under pressure from management to report clients who weren't doing the washing up, because this was evidence they were relapsing. Cue more visits from CPNs, Social Workers, etc. To be fair to my managers (why?) even if we had maintained client confidentiality ruthlessly, we had so many written records that only the seal of the confessional would have protected us if a client had ended up in trouble with the law.
I hope by now you can see why I used scare quotes - this “support” was often the exact opposite and made clients no better, or sometimes worse. There were good days - busking with a client on World Mental Health Day was the highlight. But the funding stream was Supporting People and it most definitely didn't do what it said on the tin.
Two takeaways - firstly, this project to the outside world probably looked liberal and wishy washy if you want to lock everyone up, but the popular image of psychosis is what it is, and any “liberal” project is going to be influenced by this as well in real life. Secondly, while I was there David Cameron became PM and The Age of Austerity swept us away - I was sad, but I reflected that a poorly funded state would at least have fewer resources to badger the mentally ill.
But like the Murphy's, I'm not bitter.
Probably a naive question. Why this is not a problem (or at least not to the same extent) in Europe ? I guess there are less cases but if schizophrenia is mostly genetic, shouldn't the cases per capita be similar?
Rates of schizophrenia are not actually equal among population groups. It also seems to be higher among immigrants for some reason.
Could drugs like fentanyl be a significant exacerbating factor for mental health problems? Europe seems to have less of this (evidence: according to the Economist Europe only has 10% of the US's drug deaths https://www.economist.com/europe/2023/11/16/fentanyl-kills-thousands-every-year-in-america-will-europe-be-next - sadly paywalled after the first couple of paragraphs, but I couldn't find anything else that got to the point so succinctly, though there are lots of articles worrying that some clown will think of importing fentanyl to Europe).
It should be noted that large scale psychiatric institutions that could hold a significant population existed throughout the 20th century but were abandoned mostly because the damn liberals turned against them. One Flew Over the Cuckoo's Nest and all that.
The only solution is to bring them back in some form maybe like psychiatric halfway houses.
I don’t know who counts as a liberal for you, but in the UK deinstitutionalisation is associated mostly with Thatcher.
https://en.m.wikipedia.org/wiki/Care_in_the_Community
I thought it was Regan who dropped funding for them. Maybe I'm misremembering
A little from column A, a little from column B. The anti-psychiatry movement, as represented over on this side of the pond by the likes of R.D. Laing, wanted to do away with such institutions and indeed the very notion of "mental illness" which they perceived as a stigma attached by society to those who dared to be different. To be fair, there were also genuine cases of neglect and even abuse in such institutions.
So close down the asylums, let the patients go home, and instead provide 'care in the community'.
This coincided happily with Thatcherite/Reaganomics where such large institutions were often located in spacious grounds and/or prime locations, and the covetous eyes of the "privatise everything and sell off the family silver" types in government fell upon them as being money troves that could be sold off for development.
As for "care in the community"? That never worked out as hoped for by the optimists, and indeed the term became a jokey reference to "that guy is nuts". True, at that time we hadn't achieved the pitch of raving drug-addled people defecating in the streets and living in camps, we just had the "nutter on the bus" to be the stereotype.
https://en.wikipedia.org/wiki/Care_in_the_Community
https://www.urbandictionary.com/define.php?term=care%20in%20the%20community
Would "Just go back to how it was handled in the 1950s, because despite the well known disadvantages is was still better than the current system" be sufficient details?
I would suggest looking at other places and other time periods, and seeing what worked (and didn't worked) for them.
Also perhaps do some randomised trials for any intervention, so we can learn whether they actually did anything?
There's a great article, against (most of?) the "be draconian" options, "Homelessness and the issue of freedom" by Jeremy Waldron[1]. It's not specifically about the mentally ill, but all homeless. Essentially, he argues that while opposition to draconian treatment of homeless is usually made on left-wing grounds, such as compassion, it is also unconsionable purely on right-wing grounds, that is, on the basis of the value of freedom . It's not just a polemic, but a thorough and clear treatment - he's a philosopher.
His basic argument (and this may be a poor summary) is that freedom is situated - to be free to do something entails there being somewhere that you are free to do it. And that things most of us take for granted - freedom to sleep, urinate etc - are still important freedoms., and depriving people of them is unconsionable:
"Moreover, though we say there is nothing particularly dignified about sleeping or urinating, there is certainly something deeply and inherently undignified about being prevented from doing so. Every torturer knows this: to break the human spirit, focus the mind of the victim through petty restrictions pitilessly imposed on the banal necessities of human life. We should be ashamed that we have allowed our laws of public and private property to reduce a million or more citizens to something approaching this level of degradation."
'Even the most desperately needy are not always paralyzed by want. There are certain things they are physically capable of doing for themselves. Sometimes they find shelter by occupying an empty house or sleeping in a sheltered spot. They gather food from various places, they light a fire to cook it, and they sit down in a park to eat. They may urinate behind bushes and wash their clothes in a fountain. Their physical condition is certainly not comfortable, but they are capable of acting in ways that make things a little more bearable for themselves. Now one question we face as a society – a broad question of justice and social policy – is whether we are willing to tolerate an economic system in which large numbers of people are homeless. Since the answer is evidently, "Yes," the question that remains is whether we are willing to allow those who are in this predicament to act as free agents, looking after their own needs, in public places – the only space available to them. It is a deeply frightening fact about the modem United States that those who have homes and jobs are willing to answer "Yes" to the first question and "No" to the second '
If anyone objects to these quotes, please do read the rest of the article, which deals with possible objections much more clearly than I am likely to be able to.
[1] https://constcourt.ge/files/2/Journal2019.1/Jeremy-Waldron-2019.1eng.pdf
Declaring something "unconscionable" doesn't get you very far if you don't have any other plan for dealing with the problem. He can be frightened or disturbed all he wants, but other people aren't going to tolerate mentally ill homeless people taking over public property.
I mean, yeah, in the US we pretty-much do tolerate that. People leave for the suburbs or do business with private companies to provide "public" spaces that don't let homeless people sleep in them as a result, but (for example) our local downtown library typically has a dozen homeless guys sleeping in chairs.
So in the olden days there were many fewer mentally I’ll street homeless and also it was easier to keep people involuntarily committed. But also antipsychotics weren’t as good.
It sounds like you’re saying we couldn’t just go back to how it was in the old days because the meds got better, so now people just get all better and it feels unfair to keep them in institutions (but then they go off their meds)?
The homelessness problem seems to have been exacerbated in the past 10 years or so
Something must have caused that
Isn't there some policy we can point to that is actually ineffective that we can reverse?
Also among the homeless what percentage suffer from psychosis?
I assume a significant amount would otherwise be healthy if not for drugs, is the rise in homelessness partially due to not arrested open drug users?
“If you want tens of thousands of people in institutions like these, then you’ll need some kind of vast nationwide building program”
It’s this. At least assuming you’re mostly replying to deBoer in this article. It wouldn’t need tens of thousands of institutions. Thousands maybe.
If you've ever visited Europe you'll probably notice that there are far fewer homeless people on the street, and almost no psychotic homeless people. So clearly for all the problems outlined, there are solutions that work. I'm guessing its some combination of: more spending on community mental institutions, more spending on social workers, free medicals services, less restrictions on forcing people into treatment. But I have no idea. Anybody have any insights?
Hopefully some European readers chime in on what they actually do. Matthew Yglesias sarcastically calls it "carceral urbanism". https://x.com/mattyglesias/status/1686399658493358080
What about payment for taking antipsychotics like in this study: https://www.nationalelfservice.net/treatment/antipsychotics/depot-antipsychotics-if-you-pay-me-you-can-keep-injecting-me/
It is baffling to me that this isn’t better covered, but Sam Quinones (author of the excellent Dreamland, on opioids) spent a long time in homeless encampments around the country talking to homeless people. In his opinion the number one reason homelessness skyrocketed is because one of the precursors of meth became poisonous. Basically the US worked with Mexico to ban the import of some important chemical precursor, so the drug makers had to find an alternative, and the alternative leaves a residue in meth which causes psychotic symptoms. So many people who were addicted to meth but could keep a job and home went overnight to being unable to do so. He said he heard this story over and over. He’s a very credible source, but weirdly I’ve never heard anyone else talk about it.
https://www.theatlantic.com/magazine/archive/2021/11/the-new-meth/620174/
This would also explain why this is more unique to the US
Is it? I live in Australia and meth users here become psychotic too
I'm going to express my scepticism at the reliability of drug addicts. Just like everyone in prison is innocent, I'm sure that "the problem wasn't that I was addicted to meth, the problem was they changed the formulation".
'Hearing this story over and over' is just as much leaning in the direction of "the junkies used this as an excuse" as it leans in the direction of "meth suddenly became poisonous".
To be clear this is something that isn't just coming from the meth users themselves, but other homeless people surrounding them, people providing social services, and health care providers treating them. The shift is REALLY hard to miss if you're even casually exposed to people who use meth.
That being said the specific mechanism of a residue in the meth from the new production process is just a theory, and its likely that at least some of the massive change in presentation we're seeing is just from people doing so much more meth now that its so much cheaper. But the fact that there's been a massive change in the presentation of meth users seems really, really clear.
Mexico banned imports of ephedrine in 2009. That's where it started.
The homeless/psycho/zombie epidemic right now cannot be addressed apart from cutting off the supply of cheap Mexican P2P meth. Which requires closing the border, among other things. You'll never get the left onboard as long as they're all in on open borders. Can't stop migrants: can't stop meth either.
Quinones goes on to explain that in much more detail in *The Least of Us*-- it is WELL worth the read.
Would upvote this if I could, if only for being something other than the usual talking points.
Its weird that no one has managed to identify what that precursor is exactly, despite this supposedly being a huge problem.
Tweakers believing there's some kind of contaminant or that there's a different formulation that's harming them is a tale as old as meth. The fact is, chronic meth use is what leads to psychosis. Quinones is being highly credulous.
If you stuck unremovable RFID trackers on the people you could find them.
I think the idea that we can simply Do Something About The Crazy Homeless People comes from the fact that the problem feels bigger than it used to be. We have moved away from the Pareto frontier, so intuitively it seems like we should be able to move back
We probably can't actually do this for the same reason we couldn't simply choose to revert whatever pushed us from a 1960s crime rate to a 1980s crime rate, we're not sure what the cause is, but it *seems* like we should be able to.
The crime rate didn't get stuck at its 1980s level, it entered a long-term decline starting in 1994, getting back to the 1960s level. Then 2014 & 2020 boosted it up again, but now it's back to declining.
We're much richer now than in 1950. Why can't we afford the same number of bughouses as they had?
In Soviet Union we used to round up all homeless people and send them off to university to study nuclear physics, so they could become janitors in America after blue jean salesmen took over the country.
In America you would have to prevent not homeless people from abusing the system to get free tuition, so you should randomly distribute people in 3 groups: 1/3 get drafted into the military, 1/3 get regular medication and treatment, and 1/3 go to (liberal-majority) university.
"If your plan is to “lock them up long-term”, keep in mind that (for now) there are almost no institutions equipped to do this. Each state usually has one center with a 3-digit number of beds for the most recalcitrant patients."
Before chlorpromazine became a thing, pretty much every county had a long term mental hospital.
Anyway, the whole thing sounds like a sort of argument for socialism or maybe Social Darwinism.
Just how do socialist countries deal with mentally ill homeless people?
Several comments in the thread addressed this.
>can you make homelessness a crime? As of last month, yes you can
This is misleading. First, it implies that the city can arrest people at any time simply because they are homeless, regardless of the time of day or what the person is doing at the time. That is not the case. You cannot, in fact, make homelessness a crime, because it is an Eighth Amendment violation to criminalize status (the original case was re a law that made it illegal to be addicted to drugs). All of the Justices (except Thomas) agree with that. The issue was whether a law making it illegal to sleep in public de facto criminalizes the status of being homeless, if the city does not provide enough beds for its entire homeless population.
Second, it was only in the Ninth Circuit that such laws were unenforceable. The Supreme Court decision did not alter the status quo. (Edit: did not alter the status quo outside the Ninth Circuit, that is)
PS: I am not opening either way on the merits of the law, nor on its constitionality. I am merely clarifying what happened.
It altered the status quo for the Ninth Circuit, but not the rest of the country.
Yes, I meant to say that but somehow forgot to. Thx, will edit
"These take about 2-4 weeks to make people less psychotic. But one of their side effects is sedation, that side effect kicks in right away, and heavily-sedated people seem less psychotic. So realistically the person will stop seeming psychotic right away."
I don't think you're right about this Scott. This review - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1413955/ - talks specifically about the fact that studies have found statistically significant improvements in core psychotic symptoms in the short-term independent of changes in excitement, hostility, and agitation.
I don't think Scott is denying that. He's saying that the side effect of sedation is likely to occur regardless of the other things, and that alone will make people "seem less psychotic".
I don't think Scott would've used the word "but" in that paragraph if he wasn't trying to make the argument that it's not actually the antipsychotic effects you're seeing.
He's saying we will see sedation, and thus the person will appear less psychotic from that alone. Even if the person has also experienced something that will add up to "statistically significant improvements" with a large sample size, that can still be less than the effects of 2-4 weeks of treatment, but the side effect can make a small real improvement appear larger.
Interesting. It sounds to me like there's a lot of potential for improvement on #5 and #6 on that list.
Since I can barely figure out how to use the medical system, and usually just avoid it because of the hassle, I find it unconscionable that we expect psychotic homeless people to be able to use it.
I often see blue cities make the headlines for giving out "free crack pipes" etc: https://www.cbsnews.com/sanfrancisco/news/free-crack-pipe-program-in-san-francisco-hopes-to-build-on-initial-effort/
What if the government instead set up a central distribution center for free anti-psychotic meds? No paperwork, just give them your name, they'll pull you up in the system, and err on the side of giving out the drugs. Maybe the FDA would complain? Seems worth fighting them on, though
My initial thought was "this is a good idea" because anti-psychotics are so miserable that who would want to abuse them? But from a quick google, maybe there is some risk (e.g. https://bpspubs.onlinelibrary.wiley.com/doi/full/10.1111/bcp.15420), but some abuse doesn't necessarily mean abuse-at-scale. Plus, the cost/benefit might work out regardless.
Robin Hanson's proposal, which wasn't even intended to deal with the homeless specifically, seems like it would work:
https://www.overcomingbias.com/p/who-vouches-for-youhtml
How?
There will no longer be any judgement-proof people who get in trouble over-and-over. Everyone will have an insurer authorized to do whatever is necessary to stop their charges from getting convicted of any crimes. Is the insurer objectionable in the authority it exercises over you? Switch to another one. No one is willing to insure you with the freedom you want? Sounds like you're the problem and just need to accept such restrictions.
It's a cool idea, but my brain immediately envisions a sci-fi dystopia built on the system. :-)
Instead of scifi, look to David Friedman's "Legal Systems Very Different From Ours" https://slatestarcodex.com/2017/11/13/book-review-legal-systems-very-different-from-ours/ It used to be common for people to belong to groups that were supposed to keep them accountable, and pay wergild if someone they were accountable for broke the rules.
Yes, something like that existed. But now we have many more people, and much more cleverness applied to gaming systems, and it's easy to spread knowledge of how to game systems, and it's probably possible to build a for-profit enterprise based on gaming the system...
"The system" isn't paying out money to be gained by gaming the system. Insurers will pay it out, and they'll derive their revenue from insuring people. I could foresee a failure case where we have inefficiently high restrictions on all of us because our legal system makes too many things illegal (and the insurers effectively restrict us), which wasn't as much of a problem when laws were inconsistently enforced, but that's not a "gaming the system" failure.
“If such magical social services exist [providing housing the day you release someone from prison], wouldn’t it be cheaper and more humane to invoke them before putting someone in prison?“
This bit isn’t quite fair. The system would have the entire duration of the person’s jail term to arrange services/housing for the day they are released. Nothing magical required.
In fact, this could be reframed as “temporary food and shelter (jail) provided during the social service bureaucracy waiting period”. This would make it so the government would save money if they improved the social services bureaucracy because jail probably costs more per day.
Also, nice article, thanks for writing it!
How much is the “mistaking sedation for recovery” problem a systematic problem versus an illustrative example here? If it’s actually a major part of this process, that’s the kind of thing policy could usefully target.
Eg a policy of not discharging patients before treatment effectiveness has had time to work given our knowledge of drug effect times. In other words if you get committed with psychosis, you’re defaulted to being in there for 4 weeks.
This is a policy problem, but consider the tradeoffs being faced. If you move from holding someone for 4 days to 4 weeks you need 7x more beds, with 7x more staff, to treat the same number of people. Even if you assume you're not facing a resource constraint of that many staff existing to be hired, and that there is available land to build all those new psych wards, you still have the fiscal cost involved.
I am mostly familiar with the Canadian system, and for psychosis we do tend to keep people admitted for longer than 4 days (I really hope that's an exaggeration on Scott's part!). But we're generally discharging not because we think someone is fully stabilized, but because they're more stabilized than the 20 people waiting for their bed to open up. Psych beds are a REALLY scarce resource and we're trying to ration them as best we can. We already can't find enough people with the skills and willingness to work in these settings just to maintain our existing number of beds, let alone add new ones (which has led to hiring a lot of staff who really should not be working in this setting, or in healthcare at all). You can train people, but its hard to scale that up by much more than say an additional 10% per year, even if you somehow had the political capital to throw nearly unlimited money at it.
"Its hard and expensive" isn't a great excuse not to do it- indeed I really support expanding this capacity! But a lot of things that seem like simple policy changes have hard and expensive real world aspects that come with them.
>"If you move from holding someone for 4 days to 4 weeks you need 7x more beds, with 7x more staff, to treat the same number of people."
Possibly less, and maybe even lower over time.
It seems plausible that a non-trivial portion of the treated population would have multiple 4-day holds in a single 4-week period (possibly in different institutions, but at a system level that should be a wash), so the number of distinct patient-days wouldn't go up as much.
And to the extent that it can actually get more people out of the cycle, the total need should decline. Illustrative example with made-up numbers: if the average patient gets a 4-day hold every month, but would only get a 4-week hold annually (N.B., still a pessimistic assumption!), that's a 40% reduction in utilization.
Yeah, you're correct that second order effects matter here, that people treated longer will have less re-hospitalizations afterward. Now mind you I think your pessimistic assumption of only a 4 week hold annually is actually WILDLY optimistic, but you will see improvement.
In terms of short term readmissions that could be prevented by a longer hold though are probably less than you'd expect.
Many of the problems you describe with getting consistent access to help remind me of the book “The Persistence of Poverty: Why the Economics of the Well-Off Can't Help the Poor” by Charles Karelis, who is a philosopher.
The book (as I recall from reading 15 yrs ago) describes a framing of how the barriers to escaping poverty stack up. It’s like having five bee stings: if you get a salve that makes 1-4 of them not hurt, you still have one that hurts and remain in great pain. Poverty is like this: you have several barriers to earning enough to support yourself, and solving some of them is often not enough to allow someone to hold a steady job.
The barriers to consistently accessing and receiving mental health care sounds very related, perhaps even a special subset of the same issue.
Like the typical reader here, I'm not at all in poverty. But it intuitively strikes me as similar to other aspects of my life. The notion of self-improvement just doesn't resonate with me like it does to other readers of rationalist sites, as I expect any marginal change in my behavior to result in negligible changes in outcomes. But that sounds like rationalization for my own laziness & apathy.
If I may be so bold: harshness with yourself is not a good motivator in the long-term. Look into mindful self-compassion. It helps you face your problems realistically (like if you messed something up) while leaving you in a constructive frame of mind to move forward.
Harshness with myself is not an issue. I really am apathetic.
“My own laziness and apathy” is a harsh framing, in my view. This is not about whether or not the framing is factually accurate.
I am not an expert and I don’t really know your situation. I’m just observing how you have described it. If you would like to know more, look up Kristin Neff’s books about this.
Uh, I would be for that bill, that baby-formula threatening bill. What am I missing?
I can't imagine the thought process that would involve making the lives of babies so tenuous as to rely on a single supply-chain ingredient, to say nothing of the pollution that would later make them choke.
You should learn to imagine things better: https://en.wikipedia.org/wiki/2022_United_States_infant_formula_shortage
So - I should imagine that a bunch of babies died during the infant formula shortage, that I didn't hear about? Or I should imagine that the outsourcing of childcare - the only reason to go through the much more arduous process of formula-feeding over breast-feeding unless you are one of the mothers that are unable to nurse - did not make babies more rather than less vulnerable?
I like play-pretend as much as anyone, so just tell me the correct backscratcher imagining.
ETA: I was a formula-fed baby. Because breastfeeding is what animals and savages do. That was some cool imagining!
I don’t see any other realistic option than to rebuild mental health facilities, loony bins, bit houses, whatever you want to call them. Then mandate things like cameras, audit, and even pretend patients to prevent abuse.
Have some policy that the more times you go through the system the longer your involuntary commitment. So in your scenarios if you fail out x number of times you just stay forever unless some other person vouches to provide you with care.
There are a lot of drug addicts who need someone to stand between them and the giant cliff they’re walking toward.
We can’t just let people die in the streets. I don’t know why this isn’t seen as compassionate to the people with these problems.
I find these discussions very frustrating because homelessness is an entirely self-imposed problem with technical solutions. Everything boils down to stupid regulation.
Here are a few things that (combined) would solve the homelessness problem:
1. Remove all restrictions on housing units in SF. As Scott said, 80% of homeless people are homeless for a few weeks. Why? Because they miss rent! Austin has had _declines_ in rents over the past year. Unleash building in SF and you break the pipeline to homelessness.
2. Develop or get the FDA to allow slow-release drugs. If the issue is these people need to be on anti-psychotics for 4 weeks, then give them a form factor that keeps them on anti-psychotics for 4 weeks without intervention.
3. Move the ~$1.4 billion (yes, you read that right) that is currently being incinerated by the city of San Francisco to non-profits and use that to build 5x the number of involuntary confinement beds for the people who truly cannot be helped. And confine them.
1 won't happen because NIMBYs prefer to keep their views over letting people be homeless. 2 won't happen because regulatory capture. 3 won't happen because of rampant corruption. But these are all solvable without "being arbitrarily cruel and draconian"!
1. Provide ~infinite shelter in a big military style tents with rows of beds an hour outside the city, where land is cheap, people are more spread out. Run a bus line to the nearest public transit or into the city. Make the zoning such that vendors would be able to operate nearby if they wish. Consider making it a special economic zone so that minimum wage laws don't apply and vendors could profitably employ people who stay there. It should have some security and enforce standard laws so that it's safe to sleep there, but not particularly comfortable or private.
2. Enforce laws in the shelter and in public against drugs and being a public nuisance. People that violate that go into the criminal justice system and go to jail.
Or you know, you could go full Wirehead City
https://www.piratewires.com/p/wireheading-city-george-hotz
This all makes a lot of sense. Like a lot of public policy debates, it seems like we're circling the drain going over the same half-baked solutions over and over.
So let's brainstorm. What might be some more effective solutions?
- Make SROs effectively legal again (or some other form of ultra-cheap housing that gets a pass on zoning and whatnot)
- Give homeless mentally ill people GPS trackers and have social and medical workers visit them wherever they are (to some degree, this could even work without the trackers)
- Develop long-term implants for psychiatric medications (or even injectables that last a little longer)
- Develop neuro-stimulation treatments for psychiatric conditions
- Come up with some other longer-lasting treatment
- Expand the housing supply so that less people experience homelessness, which seems like it would be a big risk factor for worse mental health
What if we did some or all of those?
The only viable solution I see is rebuilding long-term psychiatric hospitals. Many of the patients we’re talking about here are people who really can’t manage their own lives well enough to live independently in a stable way for any length of time. One big argument in favor of bringing back asylums is that they’ve actually been successfully tried before. Yes, it’s a lot of construction, but I think in the long-term it is far easier than creating some giant social service organization to hunt people down and keep them medicated.
Do other countries do better? What do they do?
I've seen a video about Japan having a non-government solution-- there are cheaply rentable gaming cubicles, so homeless people have somewhere to sleep. I don't know where they get the money for the cubicles, maybe from their families.
The Japanese population is different (even within the US, Japanese-Americans have low rates of crime & homelessness).
So, it seems like there was a time where visibly crazy homeless people weren't taking over all public spaces--where public parks and libraries were very rarely overrun with people with no fixed address sleeping in them, for example. Is there a reason we can't go back to the policies that we had then? What man has done, man can aspire to.
>But most of the time, it’s because some trivial hiccup comes up in getting the prescription refilled, or in getting to the doctor’s appointment.
>Am I just being gullible? Are these people just making fake excuses? I don’t think so.
You don't need to be homeless, lack insurance, be psychotic, or lack determination to get care, to have these problems. Last year I had nasal surgery at a major hospital in a major city. I had family waiting to take me home and ready to pick up my prescriptions for me. The hospital's pharmacy had already closed before they were ready to discharge me (couldn't they have filled it while I was in recovery? Nope!), so they automatically called it in to my regular pharmacy... which was closing in 15 minutes. Tried to call the hospital to have them send a new prescription to a 24 hr pharmacy, and couldn't get a hold of anyone. So no meds for me.
Next morning I woke up, sent someone to the pharmacy, and found out it was closed for Veteran's Day until the afternoon. We tried again to call the hospital, and got nowhere. Operators refused to transfer me, transferred me to the wrong people, or told me to call back Monday. One did text an emergency room doctor, who didn't respond for hours, then refused to act because they didn't think it was important.
When the pharmacy opened, they told me the doctor who wrote it wasn't licensed to write prescriptions in the state, which was false and a database error, but they *also* had been calling the hospital and couldn't get a hold of anyone. Ultimately I was able to email my surgeon directly, and he apparently was checking it on a Saturday when he wasn't working. He got a new prescription written, but it was still over 24 hrs before I got my first dose of post-surgery antibiotics.
It worked out in the end and I had an extremely smooth recovery, but I can easily see how someone else would give up and then end up in the emergency room with a major infection.
Thank you for writing this! Yup, it is _very_ easy to fall through the cracks, even just in the process of getting a routine prescription filled. I've had my own (_far_ less worrisome and time critical) problems in getting a routine prescription refilled (three channels of communications failed thus far...).
"How long are you keeping people there? Remember, someone’s going to come in, start taking antipsychotics, and (if the drugs work) appear significantly saner within 2-4 weeks. Best-case scenario, they’re completely sane. Now what? Do you keep a completely sane person locked in the mental institution forever?"
I found this a rather arresting way to describe anti-psychotic drugs: they make people "completely sane"? A psychiatrist would make this judgment about, say, someone who had been menacing people in the street two weeks prior?
I guess I thought it was more of a science.
The words “best case scenario” are doing a lot of work there. Certainly, not everyone will be “completely sane”, but some subset of psychotic patients being within the range of a normal, non-psychotic individual while on antipsychotics seems plausible to me
Take the person in the area who not long ago went into his next door neighbor's house and beat his neighbor's son with a bat to the head repeatedly. The child lived but will not now have a normal life according to his father.
This is a stand-in for any other incident you like. The guy who killed his parents and then went on a killing spree of strangers, including a mom pushing a baby carriage. He had many interactions with law enforcement over the danger he represented.
Anyway, these examples are as numerous as the oft-repeated "mentally ill not dangerous" claim, so let's take it as a given those are two opposed facts and it's obvious, which one is the compulsory lie.
To me, the bar for "completely sane" would be if the person, being so very completely sane for a time, would recognize that he needed to be locked away from other people going forward, regardless of his state of mind at that moment. Anything short of that would not be "completely sane" to me.
Again, I said best-case scenario, but I think this is plausible. For example, Freddie deBoer has been very open about his own mental health problems - not quite killing sprees, but pretty extreme hallucinations and some harmful actions he really regrets. My impression is he's now completely normal (well, for a commie blogger) on antipsychotics. He seems extremely regretful of his past actions, but isn't locking himself away because he's fine when he's medicated.
(the people who actually commit horrible crimes are locked away in any case, because insanity defense just shunts you to a mental hospital, it doesn't leave you free)
Freddie is bipolar and not schizophrenia, but I think it's possible (though uncommon) to get this level of success in schizophrenia too.
Sure - but Freddie deBoer did not beat anyone over the head or knife a passerby.
I rarely agree with him but I do think he presents his honest POV. And I really believe that he would say that if he had really seriously injured someone - he ought not to be at liberty to do it again should he fall back into psychosis. Or, alternately, if he had serially assaulted people again and again on the streets or subways of his town, even if no one needed hospitalization.
I grant that he may find this possibility easier to contemplate because he has a good deal of inner mental resources, that are not available to the average crazy person, perhaps, for whom the freedom to locomote may be the principal joy in life.
But I don't think he furnishes a counter-example to his own convictions on this point, at least until the drugs get really, really good and the "refuse to take them" problem goes away.
I don't expect any of this to change, under the current cultural regime, and the only hope lies with understanding the brain someday.
I think that the difference between a psychotic person who is just weird/annoying and one who kills someone is sometimes just moral luck, and not a fundamental difference in the kind of psychosis they have or how treatable it is.
Well, obviously I defer to you as an MD, on the shared propensity for harm.
But the idea of "moral luck" argues for more incarceration rather than less.
And if beds are always going to be scarce even if we were to return to the idea of incarceration, then the severity of the offense seems like as good a place as any to triage.
You are missing the forrest fir the trees. That is OK, It is hard for the fish to see the water.
The problem is a general housing problem. Not a free housing problem, just not enough housing for a sane, capable person working a minimum wage.
The issue is it has becomes so bad, it would take years to build all the missing housing created from the 2008 crisis and bad housing policies even if everyone agreed to go with the right policies right now.
Maybe ship people to China, I Heard they have ghost towns.
I think you are right that this is a genuine problem, and it makes everything else worse, but I don't think this is any of the main problems for people who are currently living on the streets with uncontrolled life-wrecking mental illnesses or addictions. The guy who's currently couch-surfing with a friend or sleeping in his car because he couldn't make rent would be helped by cheaper housing, but the guy who wanders around in public screaming back at the little voices needs an entirely different class of help. Cheaper housing won't do much for him. At the margins, it might make it easier for him to stay on his meds and stay engaged with the social service bureaucracy once he's stabilized, but if he keeps going back off his meds and relapsing, having housing be 50% cheaper isn't going to help.
The best prospect for people at the very bottom is probably allowing something like rooming houses. But those places will (and must) kick out people who are disruptive and dangerous, as a lot of people are in the middle of some kind of psychotic episode.
Well, if you smoked for 40 years and now have cancer, stopping smoking won't cure you.
However, the remedy for society would be to reduce smoking as much as possible. Treating the symptoms is fine, but you also have to treat the source of the problem as well.
Expensive housing causes a bunch of other social problems, but it doesn't cause schizophrenia or bipolar disorder or drug addiction or alcoholism.
We should make housing more affordable because that would have a lot of good effects, but we still will need to deal with people with uncontrolled mental illness who can't or won't maintain themselves on their medications and so become a danger to themselves or others.
Homelessness creates trauma, weakens social support networks and those destabilize people and create homelessness as you know it.
> but it doesn't cause schizophrenia or bipolar disorder or drug addiction or alcoholism.
I agree with Nir that simply being homeless can lead to a bunch of other problems. There may not be a direct causal link, but there's a strong correlation. And I think there's a category of psychological damage that most normal people aren't even aware exists, a gaping black pit below us that most of us go our whole lives without noticing, because we're walking on a thin floor built of social connections.
It seems like the basic model here is like this: People with mental health issues are on a spectrum, where some are going to have a mental health crisis no matter what environment they're in, some won't have such a crisis in almost any environment, and some can be pushed into a crisis by various levels of bad environment.
It seems clear there's some level of this going on--just keeping on your medications and getting to your doctors' appointments is a hell of a lot easier if you have a fixed address and a car and a phone and such.
What's not clear to me is how big this effect is. Are there lots of people who were rendered unable to care for themselves due to a mental illness triggered by being homeless (say, being kicked out of their apartment or home), poor, or the victim of a crime? ISTM that a lot of people have PTSD related issues from some trauma, but I don't think many end up unable to hold down a job, or have a psychotic episode, or whatever. But this is a place where I just don't know much and don't trust my intuitions at all.
Speaking as a relatively high-functioning person with PTSD, I think the big problem there is reliability. Sometimes the best solution when triggered is to simply leave the situation, and that's not always possible at jobs. (I wind up volunteering a bunch instead, at places where I'm useful but not necessary.)
And there's also the problem that the medications which work best to relieve PTSD symptoms seem to be alcohol, THC, and opiates. :-/
Also, I don't have any good statistics myself, but in a free clinic I've seen numbers that indicated that victims of childhood sexual abuse are highly overrepresented in the homeless population. I think I recall a conversation where someone with more experience (therapist or psychiatrist) said that CSA, and common circumstances around it like keeping secrets and not being believed, tend to result in PTSD and a reflexive lack of trust in all authority figures. Which is something I can easily see leading to life on the streets, especially in combination with self-medication via street drugs.
How about:
1. single-payer healthcare system
2. free public transport system, patrolled by competent cops so it continues to function and doesn't become an ersatz homeless shelter, who are themselves overseen by a well functioning internal affairs department
3. voluntary state or national register for "clinically essential drugs administered to at-risk individuals", which uses fingerprints or iris scanning for identification, has a database which legally cannot be subpoenaed for anything short of child sex crimes or homicide, and which you are placed onto after getting a single prescription for antipsychotics while committed unless you opt out; anyone on the register can get certain meds from a pharmacist without a second prescription unless they've been inactive for five years or more
I live in Australia. We have 1., we effectively have 2. for mentally ill homeless people (I think public transport staff are told to let anyone who's visibly mentally ill but not too distressed through the gates), and I have no idea if 3. already exists or not.
>has a database which legally cannot be subpoenaed for anything short of child sex crimes or homicide
Reminder that some jurisdictions and Australia in particular have highly-absurd legal definitions of "child sex offence" which make this exception at least somewhat swallow the rule. Drawing a cartoon depicting two entirely-fictional children having sex is a "child sex offence" here in Oz (although rarely enforced - I publically confessed to this a couple of years back when attempting suicide, and while the police showed up they didn't do anything other than take me to the psych ward).
I don't really care about the minutiae of whether Lisa Simpson porn is a child sex crime or not. The reason to make special rules for child sex crimes and murders is to avoid the predictable bad press, not because it matters. Such a fingerprint database won't be instrumental in catching many people, because those high-profile crimes are rare and large swathes of people already have their fingerprints taken by the ABF or the police anyway.
Iris scanning would be even better than fingerprints because it's almost useless for forensic purposes.
Re - it being hard for social workers to track these people down, how hard would it be legally to allow police officers to share information with social workers.
Like, to the extent that these people are doing disruptive things, people are probably complaining to the police. Maybe not every disruptive thing they do is arrest-worthy and maybe not every report of an arrest-worthy thing comes with enough evidence to actually make the arrest, ... but would it be illegal for the police to say
"Oh the crazy guy yelling about tiny spiders in the rain is hanging out on Madison Avenue these days? I can't arrest him for doing that but I know that tiny spiders in the rain guy's social worker is Mark, I'll let him know that's where to find him
?
"you can slightly alleviate some of these problems with long-acting injectable antipsychotics, which can be given at the doctor’s office, but the patient still needs to go to the doctor once every few months."
This was an intriguing side bar which maybe deserves more attention. If we're talking about something that only has to happen every few months, that's not much easier for self-compliance but easier for state violence to enforce. Let's conjure up briefly that every time a police officer encounters someone on the street and obviously homeless they scan them with some means of identifying them like they scan license plates on every car they see. (Yes, I'm going to exercise my prerogative to handwave the ID technology here. Maybe the person has been chipped.) Is this person due or overdue for every three months anti-psychotic inject they've been assigned? If yes then they get hauled in for their next injection and dumped back out on the street by nightfall.
It won't "solve homelessness" but maybe it solves people wandering around with untreated psychosis? How medically practical are these long-lasting injections? Will they really result in people given them behaving better?
Long acting injectable anti-psychotics are really effective and a huge breakthrough, though not a complete panacea. You need a patient to actually respond to them and tolerate them (not all do), and then there's some degree of experimenting to figure out how long you can go between doses without losing effectiveness, and there's variation for different drugs. "Every few months" is something I've basically never seen, but all the points above still stand for a once a month injection which is more realistic (at least with the commonly used injectables in Canada). They're also more expensive than pills which is not the biggest deal, but my understanding is the insurance bureaucracy the US deals with is a pretty big barrier. Missing a dose by a few days is generally fine, but if someone misses for an extended period of time you also have to re-titrate them up to a treatment dose again. There are some additional risks and challenges that come from them being an injectable but they're relatively minor. It can also be challenging to inject them into the muscle properly on a very fat individual, and they have a side effect of weight gain, but I'd say that becomes an issue in less than 5% of cases. But again, overall they are great, and they increase adherence and decrease rehospitalization.
The thing is you can't just handwave away how you get the person in the room for the injection every month. Even in jurisdictions like Canada where you don't have the legal barriers to bringing someone in to get their injection, you need to have available police resources and be able to find and ID the person, which is hit or miss. Using recreational drugs also lowers the effectiveness of the LAIAs (though potentially less than oral meds?), and of course there's lots of drug induced psychosis in non-schizophrenic homeless people, homeless people with brain injuries, etc. And then you still have a homeless person at the end that requires a bunch of supports, just a less psychotic one that's potentially easier to house. But they're a very useful tool, and I'd guess there's a lot of room to expand their use in the US, even if the impact the public notices is likely to be marginal.
The city I am most familiar with spent all its ARPA Covid money on the homeless ($188 million). I am not sure how that played into the ordinary city spending on it but I do know they are trying to figure out how to keep that additional money flowing, in perpetuity, from the locals (taxes and charity) versus federal taxpayers.
Of course it has always had a city budget center dedicated to the homeless, doled out to various non-profits to spend.
Around ten years ago, I'd say, that budget started to really grow. From ten, fifteen million maybe, to 30 million, then up, and mostly up again with a little fluctuation.
This year it has two components: $80 million for "homelessness response efforts" and another $87 million for a neologism - "deeply affordable" housing with what is called "a continuum of care".
This is real money. For its efforts, the city seems to purchase more homeless people, basically.
I don't mean that in an entirely snarky way. I mean, yes, it is obviously true - there is a runaway number of homeless camps and street people, far above what there used to be.
But I think that a lot of the city's voters like this situation.
An open-air insane asylum is not unpleasing to them. It plays into their worldview. It is sort of like a zoo of their favorite people, those they consider most worthy.
All that of course has nothing to do with whether it is humane.
Then too, the people like me who don't care for this status quo, don't necessarily care that much about the "humane" aspect either. For me it is twofold: I don't care for the civic affects, the aesthetics of it, the trash and general mess; and I don't like that the money that might be/used to be spent on other things such as parks or other civic improvements of a vintage kind (or not spent at all lol) is entering this widening maw of homelessness.
Like, I don't really understand why society would expend *so much* on something from which it can expect no benefit. *Something* of course - always has and always will be - spent.
I don't mind if people want to say I'm inhumane, or a monster. But I want it on the record that the opposite view to mine, is no more "humane".
Spend the money to set up free housing that is obviously better than living on the street, but you have to sign away some rights to enter it. I.E., let a social worker make some medical decisions for you, consent to searches to find drugs, the police can return you after curfew until you get a discharge that requires showing a prima-facie plausible plan about where you'll live and how you'll support yourself, etc. Ideally these housing complexes would also have psychiatrists either on staff or who can visit. Then, if you're temporarily homeless, you just get the temporary help you need. If you need longer term care to manage mental illness, it's much easier for you to get it. If you turn down this option and decide to be dangerously psychotic in public, it's socially much easier to give you a draconian involuntary commitment.
>Another homeless person steals their pill bottle thinking it might be opioids; later they will grind them up, snort them, and have the worst day of their lives.
What happens if I snort these medications?
I think this might have been a guess on Scott's part. Quetiapine (Seroquel, or might have a different brand name in the US) is absolutely diverted to be used as a recreational drug for a high, including by snorting it. This is probably most common in prisons and locked mental health units, but it wouldn't shock me if people did it on the street too. I have no idea about other second generation anti-psychotics, but I really doubt it would be "the worst day of their lives", even if it might not give a very good high. Not an antipsychotic, but Bupropion (Wellbutrin) is also commonly diverted and snorted for a high.
The exception here is likely to be Clozapine, where I'd imagine crushing and snorting would have a pretty high risk of wild swings in blood pressure and heart rate that could be pretty dangerous.
I have two small thoughts here, apologies if they are naive or stupid.
1) I don’t necessarily think it is just to lock someone up just because they are a danger to others theoretically. I do however think it is just to lock someone up if they have repeatedly proven they are a danger to others. In my neighborhood in NYC, there are several well known offenders who walk around and randomly accost or attack (for the most part) women. I am not a police state guy - I don’t want to live in Singapore. But if you’ve punched 5 people at random, you should go to jail. I don’t really care if you are talking to yourself, are homeless, smell bad - that’s life. I don’t want to criminalize being weird. I just want to criminalize punching people on the street. I just want those laws enforced. I don’t think this reform requires some major restructuring of our healthcare or criminal justice systems. I do recognize that some well intentioned bail reform policies have probably contributed to this issue.
2) On the general subject of crazy seeming distressed homeless people..why does this not exist in Europe? Obviously I am exaggerating, and don’t know anything about mental health in Europe. But I do know that, walking around anywhere in NYC, including the most wealthy or touristy areas, I am likely to encounter a naked homeless man in clear distress. And when I go to London or Paris, this happens less. Despite not having conducted a rigorous experiment to prove this, I am confident that this problem is much more specific to NY than it is London, Paris, etc. So what are they doing? If it is cruel and unjust, we don’t have to copy them. But I am curious.
It feels like this *has* to be a list of excuses given that
1) This didn't use to be an issue
2) It isn't an issue in most places
Are we to assume that no city in Japan has mental health issues as bad as SF, or that they're just doing something differently?
Well said! _Both_ history _and_ peers are existence proofs for a solution.
Taxes to build many more managed care facilities and force people to live there, better then jail
Re: Grants Pass ruling allowing states to criminalize homelessness, it obviously sounds dystopian and Kafka-esque if you're away from home, lose your smartphone and wallet and are rendered as having "no choice" but to sleep in public and go to jail.
Though in practice most jurisdictions start with a citation and then escalate to prison on repeat offense.
But lets say it's something more persistent. A wildfire wiped out the nearest set of towns and you have a lot of refugees (as happened with the Holiday Farm Fire in Oregon a few years ago). Every hotel and motel and campground is maximally packed. It's not even legal to allow people to camp on private property in all nearby counties (due to a history of hippies probably going too far). Do we really want the police to sweep these people up into jail for camping out in parks?
One of the interesting parts of the Grants Pass, Oregon case is that homeless shelters did have capacity, but they do not allow drug use in the shelters, which made them unappealing to homeless drug enjoyers who preferred to camp out in public parks and sidewalks.
A reasonably humane compromise is probably that the police cannot start the citation-to-arrest pipeline for sleeping in public unless they can look up on their smartphone that a homeless shelter exists with capacity within a something mile radius. At least that creates a direct public incentive to produce shelters if we want to clear homeless off of our streets.
Walt Bismarck had an interesting solution that’s in the cruel and Draconian camp, but if done properly could arguably be less cruel than the status quo.
“To address this we should build an enormous facility in Western Nebraska to house the homeless and cheaply shelter the ones who can’t take care of themselves (or who have severe mental health issues) while rehabilitating the ones addicted to drugs. Make this a federal mandate and sweep the homeless off the streets, but take care of them in a really nice way so the bougie gals have an excuse not to feel bad about it.”
https://newaltright.substack.com/p/how-to-castrate-the-left
I've seen "housing first" objections mostly around substance abuse, not endogenous mental illness - as in, that we're enabling people to be homeless addicts. While perhaps some harm prevention groups have lost the plot (e.g. is it really important to provide pipes and foil? does this actually offset a significant danger like needle use?), this still kinda falls into the same category. If you want people off the streets, you need to remove barriers to people being off the streets. Zero tolerance policies are a big barrier.
Here in Denver, hotels were turned into permanent housing for homeless. From my perspective as a citizen, this was a HUGE success. Within a matter of weeks last Nov/Dev, we went from homeless tents and trash piles everywhere none at all. Now I rarely see tents (and then only on the outskirts of town), and the same small bit of visible homelessness that has been here as long as I can remember.
Unconditional permanent housing + aggressive sweeping is an ethical solution, I think, as long as they remain paired. But I'm assuming such a program isn't feasible in SF, given the scale of the problem and housing.
As to other interventions: better anti-psychotics! Easier said than done, but I hope sufficient dollars are being funneled in that direction. Perhaps there should be an org like Givewell but focused on identifying and mitigating sources of societal decay. While the cost/benefit of anti-psychotics can't touch anti-malarial interventions in terms of lives saved, perhaps there is an argument to be made in terms of system level effects.
My understanding is that hotels get ruined when forced to take in homeless people. https://www.latimes.com/california/story/2023-08-16/mayfair-hotel-was-beset-by-problems-when-it-was-homeless-housing
It *really* matters a lot whether the subset of homeless people you are housing in a hotel is "poor person who lost his job and couldn't make rent" vs "untreated crazy person."
These hotels were purchased by the city and made available to the homeless population, i.e. are no longer operating as hotels. But yeah, I'm sure upkeep (along with community management) is quite a challenge.
I haven't read any comments, so my apologies for repeating other people's points.
First of all, can we all acknowledge the contradiction at the heart of:
"Do you keep a completely sane person locked in the mental institution forever? Or do you let them out, at which point they will inevitably stop taking the drugs and become psychotic again?"
If I need someone who is not myself to keep reminding/ordering/forcing me to take meds without which I would be psychotic, then I am NOT, in fact, completely sane.
To answer the question: "A person who acts sane as long as they take their meds but has to keep being reminded to take said meds" sounds like a great candidate for some kind of halfway house: not as restrictive as an inpatient mental institution, but there's a nurse/social worker on premises and someone goes around all the apartments daily and tells all the residents, "please remember to take your meds today" with the understanding that if you start acting more than a certain level of erratic/psychotic, that means we can't trust you to take your meds on your own and it's back to the inpatient mental facility for you.
As for the bigger picture: I am a Polish-born naturalized American citizen. I love my adopted country, but mentally ill homeless people are one issue where I think my birth country did a much better job, and they did this by being much more on the side of public order rather than a homeless person's right to scream incoherently and pee on a random street corner. "The needs of the many outweigh the needs of the few."
Of course I understand that a ton of $$$$$ would have to be spent on building and staffing a lot of inpatient mental institutions, and I'm happy to pay higher taxes to make it happen. But I think our thermostat should adjust from "is this person an immediate danger to self/others" towards "is this person competent to live on their own", and if the answer to the latter is no, then they go into either an inpatient mental facility or, if possible, some kind of halfway house where they have some freedom but also someone to look in on them regularly and make sure they're coping.
> "is this person competent to live on their own"
Yeah. This is tough to square with America's broad protection of the individual right to live as one chooses, but I do think we could come up with a better solution, if enough people were able to discuss this calmly and rationally and humanely.
Agree with this take
"If I need someone who is not myself to keep reminding/ordering/forcing me to take meds without which I would be psychotic, then I am NOT, in fact, completely sane."
This isn't even limited to psychotic people! I can't tell you how much work I put into making sure my depression patients, who will become horribly depressed if they don't take their depression medication, who know this, who have had it happen to them many times before - continue taking their depression medication. Some people are just really bad at meds in a way that's hard to explain.
There are places in the world where mass homelessness just isn't a problem. One of the most common comments you'll see from people who visit Japan or Singapore, for instance, is how clean the cities are and how they see almost no homeless people. Clearly this problem isn't impossible to solve. Why don't we see what those kinds of places do and mimic that as much as possible?
I do think other places have more sensible approaches, but also Japan just doesn't have the problems we have. Fore example, they have a MUCH lower crime rate. Are their police far more effective? When confronted with a criminal who simply refuses to confess, they get stumped. The police don't have to do the things US police do, because they don't have to deal with the same criminality.
They get like a 95% confession rate, so I think they're not so stumped as all that. They just are able to apply a lot more pressure to get a confession.
I once had a judo instructor, with a jujitsu background, who showed us a technique used by Japanese police to "convince" people to put their hands in a position where they could both be handcuffed. Simple, excruciatingly painful, and apparently leaves no physical evidence behind.
Whenever I think of Japan's high confession rate, that comes to mind.
They do get to hold people for longer. But they are also dealing with a very different population of suspects than US police.
I can imagine arguments at least as persuasive as this one that it's impossible to e.g. land a rocket, and yet I could ignore them all because I've seen a rocket land.
Similarly, there are lots of cities where homelessness is a very minor problem. How should I reconcile an argument like this, about how some problem is intractable, with data showing that the problem is worsening in some places, and virtually solved in others? Or are my premises wrong, and there are no jurisdictions without a big mentally ill homeless population that aren't doing the maximally draconian thing?
There's a line that goes "these people who claim to be so out of touch with reality that they can't control themselves or be responsible for their actions somehow have the clarity to direct their assault and harassment disproportionately towards people who can't defend themselves". Now, I don't know how much this is true from personal experience. Perhaps some others can comment.
But maybe this is true even *if* they genuinely are psychotic. If it is then the whole hypothetical about making mental illness a crime is a strawman. Assaulting people is already a crime. The only thing you need to disincentivize such behavior is the right to self-defense and existing law enforcement.
In my experience working with individuals with psychosis, it is absolutely the case that someone can both be psychotic to the point of not being able to control their actions while also being able to target people less able to defend themselves. However both of those exist on a spectrum rather than a binary, some psychotic individuals will be completely indiscriminate, and I've actually even seen psychotic patients in hospital manage to focus their aggression on the people most able to defend themselves to try to minimize someone getting hurt by their violence, but not able to control the violence. Psychosis is really not logical or straightforward- for one fun example, lots of patients are able to correctly point out the logical flaws in delusions expressed by another patient, but not apply that to their own delusions.
In general you aren't going to get much change by trying to "disincentivizing" assaultive behaviour from psychotic individuals though; the only options are to treat the person or restrain the person.
> somehow have the clarity to direct their assault and harassment disproportionately towards people who can't defend themselves
That's just animal instinct. Flee before strength; pursue after weakness.
> Assaulting people is already a crime.
A) For the chronic cases, the assault seems pre-determined, so the hope is that we can intervene before any actual assault happens. That seems better all around.
B) By the first paragraph, the people assaulted are going to be the ones least capable of defending themselves.
C) While I am somewhat curious about the dynamics of a modern society where a high percentage of all people carried concealed guns in public, and I do think it's possible that such a society might reach an equilibrium with less public danger than modern America, I very much doubt that moving in that direction would improve things in the short term.
Scott, what a great post. I think one thing I'd like to expand on is the criminal component.
A lot of "draconian" solutions necessarily require the criminal law (because you get minimal returns out of suing homeless or very poor people). In the United States, this means you're activating a *ludicrously* inefficient system to deal with low-level problems. It might be satisfying to a person of a deontological bent that no theft go unpunished, but it's hardly optimal. A lot of "soft on crime" policies in my jurisdiction come from a place of simply not wanting to bother with the time and expense of punishing an instance of shoplifting.
See, prosecutors make "good deals" that include no jail time as a way to get people to admit their guilt and move the case along. If you don't make "good deals" and decide to be draconian, people will fight back: they'll insist on trials for stealing a bag of chips...and nobody actually wants that, because trials have a ton of process. When I get a shoplifting case, I demand security footage (if available). Just getting that to me from the store is often more costly for the store than the stolen bag of chips. If I went to *trial* on a shoplifting case, I'd probably win unless two witnesses appeared for a whole afternoon: the employee who caught the lifter and the cop who showed up when/if they were called. Losing an employee for an afternoon is already a decent amount of time and expense for a victim, to say nothing of the police/jury/judge/clerk resources that get spent. If the plan is to put someone in jail for 60-120 days for stealing a bag of chips, you've turned a case people would normally shrug and admit to into something that is as worth fighting about as a white collar credit card theft. If the plan is to put someone away for 5-10 years for their next instance of loitering because they haven't learned their lesson the previous 128 times, we've turned a low-level misdemeanor into the trial of the century.
Finally and probably most important to your point: the supreme court did recently rule that you can technically criminalize homelessness, but actually prosecuting the "crime" of homelessness might be onerous in the future, since there would be numerous active defenses, everything from "there were no shelters available" to the truly preposterous "oh gosh, this was a big misunderstanding, I was walking back to my house and then a dude came out of nowhere and beat me and threw me in a ditch and that's why i'm in this ditch at 3AM". Trouble is that even if your defense is truly preposterous, you get a trial...
> Just getting that to me from the store is often more costly for the store than the stolen bag of chips.
Right, but that's just one instance and one victim. Repeat enough, escalate, spread to others, and the damage to society exceeds the cost of prosecution, but it's still not in any single victim's personal interest to prosecute.
It's kind of like showing up for jury duty. Or voting. What do I, personally, get out of it? What's in it for me?
I think that's exactly correct, but I think the "balancing" tends to be a political question that varies a lot from jurisdiction to jurisdiction, and that's the point I'm trying to make. Prosecutors are the ones who make decisions about how much this is really worth everyone's time, and often with inputs from victims, if they exist.
I think strictly enforcing the penalties of anti-homelessness laws might be even more difficult than strictly enforcing the penalties of anti-shoplifting laws, simply because the defendants have even less to lose by fighting it out, and might even be more sympathetic to jurors and judges.
In short, my point was that irrespective even of the cost of jail and prison, it's really expensive and onerous to prosecute people, and if you increase the stakes of prosecution, it gets even more expensive and onerous.
"it's really expensive and onerous to prosecute people"
That's a very valid concern, but there has to be some middle ground between "it's not worth the hassle to engage the creaky machinery of the judicial system to prosecute some loser for stealing a packet of biscuits" and "you can commit crime with impunity, just remember to keep your total of swag below the magic figure of $950!"
I see there are actually penalties for shoplifting in California, but if nobody can be bothered to prosecute them, or would rather make "good deals", then what use is "don't steal or you may go to jail for six months!" deterrence?
https://www.egattorneys.com/shoplifting-penal-code-459-5
"Shoplifting in California is normally a misdemeanor offense that carries a maximum potential penalty of:
* up to six months in the county jail, and
* a fine of up to $1,000."
It's not the one guy who sometimes steals a packet of biscuits that is the problem, it's the guy who is robbing stores 178 times, or the organised gangs of professional thieves, all encouraged because "too much hassle to go after a petty crime like this".
"If the plan is to put someone away for 5-10 years for their next instance of loitering because they haven't learned their lesson the previous 128 times, we've turned a low-level misdemeanor into the trial of the century."
Prosecuting people for stealing a packet of biscuits is silly, I agree. However, if this is your 129th time stealing biscuits and you've been given chance after chance and no jail time and you still persist in stealing biscuits, hell yeah go to trial and go to jail.
There comes a point where soft treatment doesn't work any more. If you are not going to turn things around after the first 129 times the judge let you off, you are not very likely to suddenly have an epiphany the 130th time. Giving some people chance after chance is just encouraging crime. If the "good deal" is "you admit you stole this, we don't prosecute you" and the person goes off to continue stealing biscuits with no consequences, how good a deal is that for society at large? "Gosh, why on earth did this last grocery store in the neighbourhood close down, it can't have anything to do with the constant dripping of petty theft going unpunished, no it must be the fault of greedy fat-cat capitalist owners!"
I think what i'm saying is that this is a phenomenon we see across a number of American jurisdictions, from California (which Scott is mostly discussing) to Minnesota (where I practice). The criminal justice system isn't set up to handle the number of trials that you'd create by like, going ham on loiterers and rogues. We'd need a lot more jurors, judges, prosecutors, and defense attorneys. The hypothetical homelessness prosecutions Scott discusses are likely to be more difficult, I'd say.
This was a really interesting comment and helps me think about this problem in a different way, thanks. Is there a good reason we can't treat homelessness like we treat traffic violations? The first N (5? 10?) offenses could be treated as infractions that special administrative courts could adjudicate efficiently. Fines only, no jail time, defendants are pro se by default. After N citation convictions the person is labelled 'chronic vagrant' and there's a criminal trial for serious jail time. Put em in low-secuity Joe Arpaio style internment camps for a couple years (or whatever).
Seems like this solves the "criminal courts are inefficient" part of the problem. Are there obvious problems with this (other than political ones)?
Obviously, any solution here starts with "make it easy and cheap to build more housing." If not for the mentally ill homeless, it should at least result in fewer homeless overall and a much more clear and manageable problem in the chronically mentally ill and homeless.
For the rest, I think the solution is equally "clear." Obviously the acute care system has nowhere to put the seriously mentally ill, nor do the prisons. There are long-term care facilities designed for weeks-to-years stays, but they're rare and underfunded. The solution here seems to make them less rare and less underfunded, though this of course costs money.
That said, I feel like this article is more defeatist than it needs to be. Certainly I can sympathize with a professional who's seen the broken status quo every which way for years, but surely "hey maybe we need to bring institutions back but with a more modern and compassionate approach focused on rehabilitation" isn't too much of a stretch.
You are asking the wrong question and thus getting absurd answers.
Instead of “How can we help these psychotic homeless people” the right question is “How can we prevent psychotic homeless people from harassing members of the public?”
The answer is, of course, camps.
This is good. Nice to get some detail on the systems involved. Too me it looks like some sort of nationalized medicine and efforts to build a ton of housing would help. Tremendously frustrating that the US doesn't seem to have the will/capacity to make big interventions to solve problems.
Wouldn't basically all homeless people qualify for medicaid in their states? I assume it's horrible to try to get through the bureacracy and get any treatment if you're homeless and not very functional and in some kind of mental health crisis, but ISTM that the mechanism for providing/paying for care is already in existence.
Nationalized medicine avoids a lot of the hoop jumping of the US healthcare system and the homeless are bad at jumping through hoops.
Yes! This is huge.
The point is, there's already a scheme for paying for their medical treatment. Why do we expect some future nationalized healthcare to be less bureaucratic and more accessible to people with no fixed address and major mental health problems than this federal/state program to provide healthcare to the poor?
There's a fair bit of bureaucracy that could be eliminated by the assumptions that every single person gets a certain minimum standard of care, and that patient billing is unnecessary for that minimum standard. A lot of the paperwork is because only certain types of people and treatment are reimbursable, and there can be finicky minute-by-minute tracking requirements. It wouldn't all go away with a universal system - fraud would still be a problem - but the current gatekeeping requirements are mind-boggling.
IIRC when I applied for Medicaid the process involves proof of address within the state and ability to receive mail at that address. Not sure how a homeless person would handle this.
There has been a lot of discussion about housing and its economics in reference to this post. It is a knotty and expensive problem.
Can't we at least guarantee everyone a P.O. box, maybe with a fingerprint enabled lock? Surely we have the funds to pay for _that_.
Medicaid varies from state to state. Mine has removed a lot of hurdles, but others, including I think CA, still have lots of bureaucracy even on the patient side. And that's not even talking about what providers need to do in order to handle Medicaid patients: I've heard of areas (geographic and medical) where the paperwork takes longer than the treatment itself.
Much of Scott's very useful discussion appears to be responding to (or at least addressing) some of the proposals in Freddie De Boer's NY Msg article from a few weeks ago.
https://nymag.com/intelligencer/article/the-case-for-forcing-the-mentally-ill-into-treatment.html
Is the problem of unhoused mentally ill people a new thing? Has the proportion of psychotic people increased over time? I suspect some would say yes, due to effects of the modern diet, increased pollution, shrinking church attendance, or some other cause, but I am skeptical.
Isn't it possible that the problem of crazy people on the street has been pretty much constant (or possibly decreasing) with time? We may be more concerned with homeless psychotics now because we have fewer other things to worry about.
It's possible that our anxiety over unhoused psychotics is a symptom of our relentless utopianism, the idea that every societal ill can and must be solved. The problem may well be one that we have always lived with, and we will just have to learn to tolerate, or at least avoid.
If so, this would tend to point up that for some, utopia and dystopia are outwardly indistinguishable.
I'll point out (without knowing the answer to either) that this is conflating two different questions:
1) Is the number of crazy people going up?
2) Is the *proportion* of crazy people going up?
Exposure to crazy people scales really well. It only takes one crazy person to make a given street corner a street corner with a crazy person on it. If population goes up that one crazy person just services more non-crazy people. So if we have more crazy people in an absolute sense, that might both make it seem like there are more crazy people and not need to be explained by any social problems other than general population growth.
The rise of P2P meth formulations (MUCH cheaper than old meth, and much more likely to cause long lasting psychosis) has definitely caused an increase in the number of unhoused people with psychosis. There are other factors that have made the problem more visible as opposed to bigger (ie someone in an abandoned building being violently psychotic has little impact on others, someone being violently psychotic on a crowded bus has a big impact on others). But the impact is definitely much, much larger than it was 5 years ago
I had not heard of P2P meth. I just dd a quick search and it sounds terrifying. Thank you for bringing this to my attention.
The other piece alongside new meth is fentanyl (also widespread and cheap) causing more frequent ODs, but widespread Narcan meaning that those ODs are often reversed. Each OD presents a risk of brain damage from hypoxia, and some individuals living on the street are very frequently ODing and being given Narcan. Over time you've got a lot of people with brain damage that results in bizarre, often aggressive, behaviour
Is there any value in catching people early in the development of their psychosis, and getting them treatment while helping them avoid homelessness? Seems like that would be the best way to go here if the rewards and difficulty of treating them later on are so low and high respectively - not sure how to do the former, but the latter can be done with enough cheap housing (AKA SROs) and maybe some public housing with social services.
San Francisco used to have 18,000 SROs. I wonder what happened to them...
Early intervention programs for psychosis are indeed extremely effective, but there's not a lot of low hanging fruit to pick there since most places have already implemented them; and first episode psychosis is a very small proportion of total psychosis (let alone the psychosis you see in the street). All the benefits of prevention that come from them have already basically been taken advantage of.
Thread from Cremieux that touches on this: https://nitter.poast.org/cremieuxrecueil/status/1756391232459210910#m.
Notable points:
21% of homeless people suffered from psychosis and 11% suffered from full-blown schizophrenia. That's 4-7 times and almost 10 times the general population rate.
Schizophrenia comes with extremely elevated risks of hurting others.
Despite how bad psychosis and schizophrenia are, there are great medications for them and depot options are becoming more and more available.
We just have to have the will to get people the care they need.
The latter point is discussed a bit here: https://nitter.poast.org/cremieuxrecueil/status/1697698509221167288#m along with the importance of early identificion of psychosis.
He further discusses the efficacy of treatment for psychosis, as well the importance and benefits of early detection here: https://nitter.poast.org/cremieuxrecueil/status/1664491391139864576#m (related: https://nitter.poast.org/cremieuxrecueil/status/1664460478238662663#m).
What are the interaction effects of illegal drug use (specifically amphetamines and opioids, but to a lesser extent things like crack, PCP, marijuana) on the degree of clinical psychosis and “recidivism” into homelessness?
Others may know this literature better than I do, but what is wrong with a simple first step of rigidly enforcing drug possession laws that are already on the books in homeless encampments?
It surely wouldn’t entirely solve the problem of homelessness but it would take the subsection of the homeless population off the street who don’t have the capacity to avoid bad decisions about taking steps towards recovery - whether that’s recovery from mental illness, drug addiction, or a combination of the two.
>Most (?) homeless people are only homeless for a few weeks, and 80% of homeless people are homeless for less than a year. If someone was going to be homeless for a week, and instead you imprison them for a year, you’re not doing them or society any favors.
I don't think this is a good argument, at least from the perspective of "draconian, unprincipled government that is trying to just the solve the problem with minimal side effects".
For example: you can simply make it illegal to be homeless for more than a year. While our current institutions are not well set up to handle the problem, this essay raises a bunch of objections on the basis that defining the problem is intractably hard. I don't think that's true. I think it's pretty easy to define the problem. The vast majority of people are never involuntarily institutionalized, much less repeatedly. The vast majority of people are not homeless for any significant length of time. Those two filters alone would do a *pretty good* job of pinning down the population we're talking about.
If you operated the current system, but people who keep getting re-committed for being homeless and insane over twelve months or longer go to a long-term institution (prison, or something similar to prison but not intended to be punitive), this would largely fix the problem (from the perspective of normies trying not to get screamed at in public) over the course of approximately 1 year. This would represent about a 30% increase in the total prison population in the US.
This is *pretty bad* from a civil rights perspective, which I assume is why the essay is trying to steer away from it, but it's not literally true that it wouldn't work or is somehow definitionally incoherent. The problem is fairly easy to fix, just not in a way that respects the humanity and civil rights of insane vagrants and retains any hope for their rehabilitation. I think it's worth being straightforward about that.
> it's not literally true that it wouldn't work or is somehow definitionally incoherent.
100% this. Just like 3 Strikes for crime, there is definitely a power law distribution for homelessness where some small population of re-offenders is responsible for 90% of the actual problem. It's trivial to identify those people: X vagrancy arrests over Y months and you're a "chronic vagrant" and we just put you in a separate category. Throw em in some low-security internment camp away from population centers. Commit the mentally ill. Simple. It'll cost some money but it's definitely worth it to reclaim our city centers.
The whole advantage of banning homelessness (as opposed to waiting for the homeless to commit specific crimes) is that it's enforceable. A cop can see a person sleeping on the street, realize he's homeless, and arrest him.
"Ban homelessness for more than a year" is much harder. A cop sees a person sleeping on the street and . . . what? Asks "how long have you been homeless?" "One day", the person responds. "Can I see your state documents showing the date you became homeless?" the cop asks. "I can't even consistently poop in a bathroom and you expect me to have state documents?" says the homeless person. Then the cop tries to bring them to trial, the public defender asks for proof that the person has been homeless more than a year, and the cop doesn't have it.
So take fingerprints or other biometrics whenever someone is involuntarily committed, and (while they are being treated) ask them to provide some sort of proof they have a home.
If, at their sanest, they can't, you record that information in their file and make a note. If you involuntary commit someone with the same biometrics twice and there's a previous note at least one year ago (but maybe less than five), you say "okay this person has both been repeatedly involuntarily committed and is persistently unhoused and we have documentation of both, we don't need to put this person back into the revolving door cycle".
Again, I get why you find this sort of thing unwholesome (it is), but I feel like because of that you really aren't applying yourself to figuring it out. It's just not that hard to come up with a metric by which people can be shunted off the cycle of repeated involuntary commitments that you originally described.
Seems overly skeptical. This isn't the unknown frontier of policy- most rich places outside N. America don't have this problem, and pre-1960s America didn't have this problem. Even pre-2000 America didn't have that bad of a problem.
Claiming we need to be "be cruel and draconian” is clearly hyperbole- unless you think the Rest of World is cruel and draconian or that pre-2000/1960s America was such.
Scott over-indexes on mental illness and under-indexes on "response to incentives". Homeless encampments are largely open-air drug markets, where the homeless can ply their wares, get benefits, etc... Would they rather be living at the 4 Seasons? Sure, but if the choice is living somewhere squalid but sheltered with no drugs outside of SF and living in a drug market in SF, they choose the latter. Simply not allowing them that choice will force them to make other arrangements- just as they did pre-2000.
Most mentally ill still respond to incentives and all druggies do. If we shutdown the encampments, they will move on to other, less anti-social living arrangements. They might even move to a more affordable place than SF/NYC!
I'd be happy to vote/pay taxes for more asylums, but Scott is playing dumb here. My wife worked at John George in Alameda- they know *exactly* who the "frequent flyers" are- the people who need to be locked up (who'd it'd be much cheaper to incarcerate than to waste police/emt/medical resources on them on a daily/weekly basis). There's no real issue identifying those who need involuntary help. Are there marginal cases? Sure, but we could resolve 90-95% of the problem without any real dispute among medical experts.
It's not like someone has a bad day, terrorizes a BART car, then gets taken to the psych ER and they say "let's commit him for 10 years". No- they see the same person for weeks/months/years at a time and are completely unable to do anything to help them or society. A simple rule like "the 3rd time. you are taken to a psych ER you get involuntarily committed for 1 year", with escalating commitments on further episodes would resolve much of this issue.
I feel like we could refer more back to this site's review of San Fransicko:
https://www.astralcodexten.com/p/book-review-san-fransicko
.. and how the problem of homelessness in _general_ relates to the problems of the severe. A reasonable explanation, to me, would be that what specifically ills SF & the other West Coast cities is:
1. High housing costs lead to high homelessness, many of whom have some level of dysfunction but only a small percentage of which are truly disturbing.
2. Those small percentage of the highly disturbed (and disturbing) are highly visible and take up lots of space in the public consciousness.
3. But for authorities, it's difficult to separate the smaller portion of high needs people from the larger population of not-great-but-not-as-bad people who mostly just want to live in tents and keep to themselves, given that the latter still demand some attention.
4. Thus, it becomes a question of state capacity. Cheaper housing would not fix the worst cases, but it would help reduce the local homelessness population so that what resources exist can focus on the hard cases more.
you make a convincing argument for locking them up and never letting them out. if the only solution to their miserable slow-motion suicide is to forcibly corral them so they will keep taking their anti-psychotics, then i guess that's the only solution
What if we built some sort of homeless ghetto in the middle of nowhere and shipped all the most problematic homeless people there? Maybe we just need to bring asylums back.
Your treatment of the "throw them in prison" position seems like a strawman. You don't have to throw them in prison immediately. Police often give warnings well in advance of taking action. A basic policy could be something like:
-First encounter: Warning, explain the new system.
-Next encounter that is more than two months after the first warning: Signature bond.
-If they don't show up in court for their signature bond, a warrant for their arrest, which realistically will only matter if they have another police interaction before they turn up at court to resolve it.
And police have plenty of discretion, they can always give additional warnings. I'm confident that this type of strategy will avoid locking up the type of temporarily homeless person who's about to get back on their feet. I'm also convinced that the criminal justice system is the only way to keep these people in one place long enough for their medication regimen to get established.
That said, the only truly humane and effective solution is to rebuild the asylum system and bring back long-term involuntary confinement. You've explained at length in this article how you can't expect homeless people to stay on their meds or come back for appointments, so long term involuntary confinement seems like the obvious solution. What's your objection? That SF can't build buildings? SF needs to solve that problem in any case...
BTW, what's up with this idea that people should be released within a few weeks, when we know it's very likely that their symptoms are just being masked by sedation? The normal medical standard is that you don't discharge them until you're convinced that they're stable, not just that it's plausible that they're stable. In the rare cases that a patient does become "completely sane" earlier than expected, I think it's completely reasonable to keep them a bit longer to make sure. And if you do release them and see them again a month later, surely you need to take that into account next time?
Am I a housing first advocate? I feel like this was much less of a problem 70 years ago. The big difference is that flophouses have been zoned out of existence. Reviving them would not solve everything, but it might make a big impact.
Not homelessness specific (I'm fortunate to live in a place where crazy homeless people aren't a visible concern), but just generally it feels like no political movement is willing to engage with intractability at all. Everyone just assumes all problems are solvable, easily, but someone is standing in the way. Nobody is willing to settle for the best bad solution or acknowledge tradeoffs. I can no longer engage with political discussion on either side because I find this so frustrating. Some (Most!) policy problems are genuinely hard to solve.
It sounds like a disproportionate hurdle for people in this cycle is consistent use of antipsychotics. Doctors want to give them to people and people want to take them, but minor difficulties spiral with a lack of ability of doctors and patients to easily coordinate. Has anyone tried subdermal tracking, so that an official is able to physically locate the person where ever they may be and physically had them a their medication? Are there subdermal, slow-release anti-psychotics available so that the patient wouldn't even have to think about remembering to take these meds?
How do all of the other developed countries in the world do it? The general tone of this piece is, here are a bunch of practical & logistical barriers that make mass institutionalization of psychotic homeless really difficult. But my understanding is that Giant Tent Cities Of Psychotic Homeless is a uniquely American problem. As a good faith question- what are Britain and France and Germany and Spain and Japan and South Korea and Australia doing differently from us? Do they just have way more hospital capacity for long-term institutionalization? How do they make psychotic patients take their anti-psychotic drugs?
Most people in tent cities are not the hardest cases. It's true that most homeless people will usually have some level of dysfunction, but not usually to the point that they're a serious threat to public order other than just taking up space and making a mess.
For obvious reasons, social perception tends to focus on the worst cases, but it distorts the debate to confuse the hardest cases from a bigger population of people who fluctuate into homelessness on the margins.
To be clear, both things are problems, and very much related, but mass homelessness and hard-to-control-psychos aren't the same thing.
Anecdotal:
The country I live in has a halfway functional health system, state subsidised housing and a welfare system that should prevent "anybody" from ending up on the streets. This makes the causality very obvious, the only possible first order cause for homelessness ist an unwillingness or inability to interact with the bureaucracy that would provide housing (actual housing, not shelter) - something I can empathise with, I hate interacting with bureaucracy but I certainly would hate being homeless more. "unwillingness or inability" of course comes in the common flavours of mental illness and drug abuse as discussed here.
Which is to say it is extremely hard to "just spiral into homelessness" as you apparently can in the US (?). Once people are homeless however, it seems our instituations are just as helpless / incapable dealing with it. There does not seem to be a good solution other than "prevention".
I don't know how to translate this into American and I am almost certain that you will get the wrong mental image but here is an attempt: I live in one of the largest cities of the country (order of magnitude 1 million people). On Sunday morning I take my daughter near the local train station (local, not the city center) in the hopes of buying breakfast. There is a Starbucks-like affair there that has put some chairs outside. These belong to the place. One is occupied by a clearly "problematic" man with a bottle of hard alcohol (Vodka or equivalent) in front of him. No hiding in a brown bag here. I decide to sit inside rather than sitting outside. Man leaves, we have breakfast, we leave. Police is now there, looking around, man is out of sight, even if he were in sight, what would they be accusing him of, Police leaves. We take a bus somewhere. Hours later, on our way home we come by the Station again. This time from the bus we can see that the police is there again, the very same man is lying on the ground, apparently helpless, police officer is putting on gloves, apparently to feel his pulse. An ambulance is arriving in the background. I think "wow that man certainly wasted my taxes by making the police come twice within a couple of hours".
This is a noteworthy episode in the sense that it does not happen every day. What does happen every day is that somebody will tell you a sob story on the subway asking for the equivalent of a dollar or (this at least is the current meta of that story) something to eat. This is prohibited but I have never seen it enforced.
Tent cities arise wherever you let them arise. I've seen tent cities start to spring up in Australia, but eventually the police get rid of them. There's certainly people who get welfare payments sufficient to pay rent but will instead choose to live in tent cities if you let them so they can spend their rent money on drugs; it's important not to let them have this option.
Dealing with these sorts of people who have complex problems is difficult and the only way to do it is with an appropriate combination of carrot and stick. Sometimes you gotta hold your nose and give free shit to someone who doesn't deserve it, sometimes you gotta hold your nose and be mean to someone who doesn't deserve that either.
If I may offer an overly pat explanation, it's that the US is polarised between people who refuse to ever use the carrot and people who refuse to ever use the stick, which means that neither gets used.
This essay would be compelling if the homeless problem wasn't unique to the West Coast. Nearly every other jurisdiction on the planet has solved this one way or another, so it's not like politicians need to actually break new ground in policy development. It's perfectly fair to make a generic complaint about the issue and expect politicians to decide who to copy.
NYC has a significant homeless problem. I've seen a lot of homeless in smaller Midwestern cities, too.
I think, similar to how some elders require assisted living, some psychotic people require assisted living. It's not pretty or nice, but our world is not pretty or nice. The alternative isn't working.
Let's build a mess of new lower-than-lowest-security class of prison. Homelessness is put on a new tier of crime that doesn't show up on your criminal record at all, and the sentence is six months in this new lowest-tier prison. The new class of prison focuses on rehabilitation, treatment, education, and work programs.
(What's the difference between a prison and a housing project, once we've decided we're not going to -allow- people to be homeless?)
It makes a whole lot of difference to the residents whether their doors lock from the inside or the outside.
If we as a society have decided we are not okay with them walking outside and living on the streets, the question isn't really about which direction the doors lock from.
> What's the difference between a prison and a housing project
There's also the ability to get a job and accumulate capital, and the ability to move out to somewhere nicer if you have income.
A big one, which can cut the other way, is how safe you are from the other residents.
Getting a reliable income stream sounds like "time off for good behavior" to me.
I mean, in a housing project you can leave during the day and work somewhere, but in a prison that's not so feasible?
Sounds like a work program to me.
If you don't care about freedom, they're probably quite similar?
But seriously, I think freedom is an underrated ingredient. People can perform well in restrictive environments and then completely fall apart when faced with the choices of the real world. I don't think we'd be doing people favors by restricting them more than necessary.
That this is true in the general case doesn't mean it is remotely true in the specific cases involved. Indeed, given where their use of freedom has gotten them, it seems rather generally false for the cases under consideration - where their use of freedom is generally applied to, for example, not take their medications.
That's where the support structure is needed - don't just dump them back out when the sentence is finished. People who can't handle the transition/have no-one like family to help them out? Halfway houses, assisted living, something like that.
People who will be otherwise okay but just need someone to check in on them from time to time, who they can contact f they have a problem? Let's do that, too; that's what the probation service and social workers are supposed to be for after all.
People who just cannot cope without a routine and, if left to themselves, will fall right back into chaos but do okay in the regimented environment? Yeah, then we're looking at lifers, but that doesn't mean that they can't have relatively comfortable lives in the prison; give them little jobs to do, give them privileges, let them be in low-security places where there might be a garden or grounds to tend. Hell, let's try something like day release where they can go into nearby town or visit family, but carefully monitored to make sure they are not going to fall back into addiction, and they return to the prison afterwards:
https://www.citizensinformation.ie/en/justice/prison-system/being-released-from-prison/#1e38a8
"In most cases, you can be released on compassionate grounds if there is a family emergency, such as a death or serious illness. You may also be released to visit family at Christmas, or to attend special family occasions such as christenings or communions.
If you demonstrate good behaviour and engage in structured activities in prison, you may be granted day-to-day release to participate in work or training outside of prison during the day. You return to custody in the evening.
You may also be granted day-release near the end of your sentence to build family relationships before your release."
Naturally, if this is abused, then you lose all your privileges and go right back to "locked up permanently".
You and me should get together for our new combined "Yes I'm An Evil Monster And I'm Proud Of It" prison-building schemes 😁
If the only damn way to get anything done is to put people into prison, well okay then let's the hell have prisons. But different levels of prisons. Not so much for the criminally insane but for the 'so addicted and/or crazy they can't function' types. Something along the lines of the Central Mental Hospital (and today I learned the term "forensic patients"):
https://en.wikipedia.org/wiki/Central_Mental_Hospital
And if they're not crazy, just in bad circumstances, they go to your low-level prison for rehabilitation. If people/governments won't or can't pay out for hospitals, then let's use the 'law and order' approach and appeal to get institutions that can treat and support such people built, even if we have to call them prisons.
Oh good somebody -did- understand what I was getting at. Thank you.
I was also thinking about multiple tiers of "homeless prison" catering to different needs (probably not every homeless person needs to be kept on their medication all the time) but erased that paragraph because it got overly specific.
But among many other advantages, calling your housing-and-rehabilitation program a prison also lets you route around a lot of housing regulations.
Also clears up emergency responders from dealing with low-stakes crimes and faked medical emergencies by people who are just looking for a bed and a meal.
I think we have a third person elsewhere in this long thread willing to get aboard the Prison-Industrial-Asylum-Complex Pipeline train 😀
Hmm... This calls to mind Dante's circle of virtuous pagans (in contrast to the _rest_ of the prison system, and in contrast to the _rest_ of hell...).
You should start by asking why they have the right to put people away even if they haven’t done anything wrong. And if the people who put people away should be the go-to-authorities for deciding what to do.
I have seen with my own eyes people being committed to insane asylums even though they haven't done anything wrong and aren't insane (unless making jokes and breaking social norms is insane). Instead of asking what we should do about them, maybe the first step should be to stop doing that to them?
I do not accept that vibes is a good substitute for rule of law. A lot of the problems are actually caused by misdiagnosis by the so called experts (who are not neutral by any stretch of the imagination), but somehow they have a veto on what we can and should do. People like you talk to THEM instead of the patients. And they talk to external actors instead of talking directly to the patients. Perhaps you say, that's the law,, but if a law is unjust, we shouldn’t follow it. Isn’t that one of the most important lesson of the 20th century?
The experts have a clear and consistent record of opposing everything that works that doesn't give them full control. Maybe you should think of them as being in the control buisness, not the health buisness. They think they can assess whether people are insane or not even without talking to them, just observing them!
The court always defer to the psychiatrists, but why don’t they let the defendants speak for themselves in a court of law? Did you speak to the patients in your case? Or god forbid, did you ask the experts what the patients opinion is, what their state of mind is and so on?
Now go to your favorite forum and ask some experts how to interpret this. Inject your morphine and make sure you get a sanitized version of what I just wrote, so that it is easier to refute it. Strawmen don’t fight back.
"unless making jokes and breaking social norms is insane"
What social norms did they break? "Don't walk on the grass" or "Don't defecate in public, expose yourself in front of a preschool, and rip out copper cabling to sell to junkyards"?
There's a spectrum there, no doubt, but I more and more tend towards "those arguing for drug decriminalisation and 'it was just a joke' about public order offences are the problem".
The social norms they broke were in the category of disrespecting authorities. They have also been falsely accused of breaking other norms similar to the ones you mentioned, but without a shred of evidence.
Arguing for drug decriminalisation is sure to raise the suspicion of paternalistic authorities, since their modus is looking for anything that deviates from the norms. You are supposed to worship the drug laws and if you don’t, you must have something to hide. Probably drugs. That’s their modus. It is based on moralizing, and is a yuuuuuuuge part of the problem.
Moralization has all kinds of externalities, with devastating consequences for those on the receiving end of it. That is one of the reasons (far from the only one) why drugs need to be decriminalised. Fighting moralization is and should be an important priority. It is like an all permeating disease in some countries. If 'vibes' are allowed to determine how we commit people in the age of hi-tech surveilance we have lost democracy. I don't think people realize just how much they are giving away if they allow experts free rein to determine if someone should be committed based on their assessment of the patients 'mind', by using 'vibes. I mean holy shit!
I must also add that astral codex is wrong on some of his premises. This one for instance:
”And everyone would support a magical bill that cleaned the skies with no extra hardship on industry.”
People who benefit in terms of power, privilige, money etc would fight tooth and nails against solutions even if they come ”with no extra hardship on industry”. Assuming that the system is free from corruption is more than a little naive. It is easy to be fooled by the idea that no one would seriously want people to go to prison or insane asylums if they are not criminal or insane, but evidence proves this is just wrong.
My problem with the drug decriminalisation/legislation argument is that there is "nobody except nice people like me who can responsibly use fun party substances and continue to be productive citizens will take advantage of this" reasoning mixed in with "and this will magically do away with criminals gangs" plus a helping of "and so if people do fuck up their lives by being junkies, well tough for them, let Darwin sort them out because they'll overdose, kill themselves off, and the problem is self-solving".
If your anti-authority anti-social pals just fucked up their own lives, the rest of us could cope with that - even if it involved "We are the cosmic horrors" of a comment above.
If the "disrespecting authorities" means "when told not to do it, I continued shitting in the street in public, being drunk/high, hanging around threatening people for money, and generally acting like an asshole because normies are chumps, rules are for the sheeple, and I feel no obligation to the straight square citizens because fuck them", then yeah I'm with the "okay actions have consequences and you're getting in trouble there".
Obviously they let the defendants speak for themselves at the trial.
This isn't always a good thing. I remember one case I was involved in where a guy tried to choke his Uber driver. The judge asked him why he did it and he shouted "HE MISSED MY EXIT!"
That having been said, yes, I agree that some percent of commitments are frivolous and unfair.
First off, I don't buy the "80% of homeless people are only on the streets for a year" nonsense. It's difficult to systematically study that population and the only people who care about this enough to study it are bleeding heart liberal douchebags. I do not trust them to keep their ideology out of their sociology so I believe that 80% figure is purely designed to make people have more sympathy for homelessness ("oh they're not bad people they just had some bad luck"). My guess is that they gerrymander the denominator of that equation to include people no normal person would think of as homeless. The kind of homeless that people actually care about (pitching tents, starting fires, breaking into warehouses, begging for change on the same corner every day, etc) are definitely not on the streets for < 1 year on average.
Now the solution. Just like crime, I'm sure that the worst 5% of offenders account for 90% of the problems. This was the idea behind 3 Strikes, which is an excellent policy. The sob stories you read about the poor college kid getting his third strike for pot are completely cherrypicked nonrepresentative examples. Establish something similar for homelessness: 5 arrests for vagrancy/disturbing the peace/etc in 24 months (or whatever is the optimal threshold) and you're labelled a chronic vagrant and any non-serious crime you commit from now on shunts you to an administrative system where you're either a) involuntarily committed if you're mentally ill or b) placed in a Joe Arpaio-style low-security internment camp: just fence off a few thousand acres of scrubland somewhere. Put it in some third-world shithole like Bolivia, even. Put them there for, I dunno, a year. It doesn't really matter. The point is you have someplace to put them that both gets them out of MY way and incentivizes them to not get arrested again. Parolees go through a halfway house for 2 months in an attempt to get back on their feet. I realize that almost everyone will be stuck in an endless cycle and just keep getting arrested again. I don't care. Most of these people are worthless human trash and will never be productive again no matter what resources are thrown at them. Just herd them like the semi-feral animals that they are and try to keep them from doing damage in the most cost-effective way that doesn't become explicitly inhumane. It will be unpleasant for them. It SHOULD BE.
+1
> First off, I don't buy the "80% of homeless people are only on the streets for a year" nonsense
There's a bizarre tendency among some people who fancy themselves as "helping" to massively exaggerate the size of a problem by expanding the definition of the problem to include as many people as possible. So now,
"Homeless" includes anyone who is stays in a hotel or with a friend while looking for a new apartment.
"Mentally ill" includes everyone who ever feels depressed or anxious (the source of Scott's "22% of people have mental illness" statistic)
"Autistic" includes everyone who is a bit socially awkward.
Cramming more and more people into these categories may or may not help you get funding, but it sure as heck doesn't help the people with major problems to be lumped into a category with people who have minor problems.
>Now the solution. Just like crime, I'm sure that the worst 5% of offenders account for 90% of the problems. This was the idea behind 3 Strikes, which is an excellent policy. The sob stories you read about the poor college kid getting his third strike for pot are completely cherrypicked nonrepresentative examples. Establish something similar for homelessness: 5 arrests for vagrancy/disturbing the peace/etc in 24 months (or whatever is the optimal threshold) and you're labelled a chronic vagrant and any non-serious crime you commit from now on shunts you to an administrative system
Yup. That draws a nice clear line that deals with the power-law-distribution nature of the problem and selectively limits the harm caused by the worst 5%.
"you can slightly alleviate some of these problems with long-acting injectable antipsychotics, which can be given at the doctor’s office, but the patient still needs to go to the doctor once every few months.)"
Appointments every few months seems a much lower bar than every week or so. What happens when countries lean heavily into long acting antipsych?
Since the problem seems to always boil down to homeless crazies not being able to take their meds consistently, if a person requires antipsychotics to be barely functional, that person should be in some sort of supportive or institutional environment.
This is an excellent argument in favor of "Housing First"...
People keep saying "Housing First", what does it actually mean? What kind of housing, and where? Who pays for it? What are the conditions to live in it? If you give homeless people free houses, how do you prevent people from becoming homeless to get free houses?
I feel like a lot of people just mean "build more middle class apartment towers in San Francisco" because my rent is too damn high. Which may or may not be a good idea, but it just crams more middle-class people into San Francisco, it doesn't solve problems for people at the bottom.
I’m firmly in the draconian camp.
You know you can simply put people in jail right? The jails can be cost effective. Outsource it to Arizona.
This post underestimates how rational most crazy homeless can be when exposed to the right incentives.
For example, notice how crazy homeless people who attack others just have a knack for attacking old Asian ladies? How many news stories have you seen where a crazy homeless person attacks a muscular military man and gets his ass beat for it?
Draconian penalties will reduce the number of noncompliant dramatically.
Does "draconian" necessarily imply "cruel"?
Because I think I *lean* toward draconian -- but I don't think of myself as cruel.
"Do you keep a completely sane person locked in the mental institution forever? Or do you let them out, at which point they will inevitably stop taking the drugs and become psychotic again?"
Well, the problem is that our medications have improved. In the past, the meds wouldn't improve them so yes, they would have stayed in the mental institution forever.
The presumption in your whole article is that the mentally ill should have choices and freedom that dramatically restrict the choices and freedom of others, and I'm not sure that's fair.
So for example if people stop taking their meds they minute they leave an institution but wail about being stuck in an institution while on their meds, then we can decide to slap an electronic anklet on them and make sure we can track them. If they don't show up for meds, then they go back to the institution.
San Francisco has more homeless people than beds because lots of people find California attractive for homeless life, due to their mild winters. Why should California have to pay a fortune for housing psychos simply because they don't like Tennessee and New York is too cold?
And so on. So yeah, arbitrarily cruel and draconian it is. They can sit in a psych ward while feeling sane if the alternative is sitting and shitting on the sidewalk.
There are certain problems that are simply unavoidably complex and expensive because they require customized individual attention and most of the solutions are not automate-able. If we were serious about addressing this issue (and I don't think we are on the large scale) we'd have to accept that a quality solution is going to seem quite inefficient. It would have to start with coming up with a system to create thoughtful individual plans and then have a housing, transport and executive function support structure to support those plans. knowing full well that a sizable portion of the population will still fail and fall thru. Doing the short term hospital tango combined with sweeping incarceration, pushing people into the margins of cities and towns, letting them fend for themselves and just going numb to it is a much simpler and cheaper, if less humane and more messy solution overall. It's the one we've chosen. Part of that solution includes shutting the fuck up when you're about to say "we should do something about this".
Can we replace the pledge of allegiance with some generalized version of your introductory paragraph?
"Any...legislation must be made of specific policies. In some sense, it’s impossible to be “for” or “against” the broad concept of X. Everyone would be against a bill that devastated [some valued aspect of the world related to X] for no benefit. And everyone would support a magical bill that [achieved utopia with regard to X]. In between, there are just a million different tradeoffs; some are good, others bad. So (the technocrat concludes), it’s incoherent to support X. You can only support (or oppose) particular plans."
Great article! My nonprofit is working on a mental health solution that aim that we hope increases agency for folks to make actionable changes that'd improve their well-being. Our differentiation is that we focus on using meaning & purpose to motivate people.
We're still early but some of our testing has shown promising results. We definitely haven't worked with a homeless person yet, but if were to try our intervention at a small scale during steps 3-4, I'd be curious if we were able to have an impact even on a subset of people.
If you know anyone that'd be good to connect with, let me know!
A lot of people here seem upset by the "vibes diagnosis" part of the article. But I don't see how else it could work. The legal system often requires the reasonable judgement of agents, whether they are judges or juries or in this case psychiatrists. The more specific the law is the more constrained the actions of agents are. A very specific and exhaustive policy could be implemented. Then when a clearly dangerous patient gets released and hurts someone else the psychiatrist will just shrug and say, sure the guy was clearly a danger but the 10-step Ultra Legal Psychosis Evaluation (tm) said he was fine! What can I do, the law is the law.
Besides, mental evaluations are very subjective anyway. It's not like a psychiatrist can give out a test strip and if it turns blue you're free to go, but it turns pink and you're institutionalized. I suppose evaluations could require a triumvirate of psychiatrists to agree, to reduce the chance of bad subjective evaluations. But that would require triple the staff, which is probably not realistic.
Hi Scott. This is an absolutely excellent article you've written here. I'm not going to make this about me, but I will say that I have some qualifications for knowing a bit about this topic (not as many qualifications as you, obviously) and I believe you have absolutely nailed it. You have said all the things that need to be said, you said them clearly, and I don't think you left anything out. However, I have an observation, and perhaps a question, about the meta-level here. That is, it's clear by the end of the article that your target audience for this essay is conservatives — for example, that's the impression I get from a sentence like 'Don’t just write yet another article saying “the damn liberals are soft on the mentally ill”'. Also, your statement that "...all of these 'We Should Do Something About The Mentally Ill' articles..." treat Housing First as their "foil" suggests that the "all" you are referring to here is actually limited to the conservative-o-sphere, because it's certainly not true that all *liberal* pundits on the topic of mental illness and homelessness are opposed to Housing First. In fact, I'm kind of curious about why you dismiss any discussion of Housing First so quickly on (apparently) no basis other than its reputation in the conservative world, without addressing the relatively large evidence base. I assume you didn't want to get sidetracked from the key point you wanted to focus on, which is fine, but it's interesting that you presented your reasons for ignoring it as coming from the conventions and biases of conservative-pundit-world rather than your own didactic priorities.
So, I guess the question I have here is this: to put it bluntly, does this essay appear to be targeted at conservatives because you are aware they are the ones who need to hear it most (at least on this topic specifically)? Or does the essay appear to be targeted at conservatives because you're simply most interested in talking to conservatives in general?
Of course, in the final analysis, the general principle of your essay, the principle that "if you want to think of yourself as a serious pundit, or at least a commentator who isn't a moron, you should be somewhat specific about policies you're proposing and not just whine and rant a lot" is very good advice for anyone, anywhere on the political spectrum. You clearly (clear to me, at least) implied this generality in your intro about anti-pollution sentiments. I do want to give you a lot of credit for being balanced at that level.
It's targeted at Freddie DeBoer because I was annoyed by one specific article he wrote.
Thinking about New York, where you can actually get a bed in a homeless shelter if you want one, I am not very sympathetic to these logistical concerns about institutionalization. A very small portion of New York's ~100k homeless are the ones people have a problem with--terrorizing subway cars, shouting at passers by while clearly not in their right minds. This very small portion of the homeless, who refuse to go to shelters available to them--let's say 10,000 people, but it's actually much less--could and should be institutionalized.
I totally reject the jump between "actually when you let sane-seeming homeless people out of the asylum, they revert to using drugs and being psychotic" and "ok I guess we must build a massive social safety net to solve the problem from the bottom up." There are obvious ways to prevent this--progressively longer institutionalization for repeat offenders, for example. As it is, no one is doing this at all! Crazy people defecating on the subway just keep on doing that! So to me, it comes off as a small logistical nit that is then used to smuggle in a complex web of social services, instead of institutionalizing the vanishingly small portion of New York's population that causes problems for everyone as well as themselves.
Separately, I'm more sympathetic to the intractability of SF's homelessness problem, because as you describe, you can't even get a bed in a shelter in the first place (though this is a really obvious starting point for change).
I worked as a public defender for a few years after law school. In my state we did not represent people at 96 hour commitment hearings. But I can assure you that in the analogous situations where commitment for months was a possible outcome, we would have met with the defendant for at least an hour about just the hearing itself, and likely another hour or two about whatever inciting incident had made them a client before that point. It was not uncommon to have hours worth of conversations with clients who had fixed delusionary beliefs, sphexishly returning to non sequiturs, and/or severe problems with logic and memory.
In the event that a client was absolutely incoherent and unable to communicate about his case or our representation of him, we would review medical report summaries, make notes for questions, and reach out to family members or other contacts, among other strategies. Even on a rushed basis and in circumstances where the ward was entirely non-interactive, I would not have considered anything less than 1-2 hours of review to be adequate representation of somebody in an adversarial hearing the result of which might be commitment for weeks or months or longer.
In my time serving as a GAL, which can similarly impact a person's liberty interests, the absolute BARE minimum would've been something like an elderly patient in skilled nursing following a devastating stroke who could not communicate ideas at all, and who the public administrator or family needed guardianship to have him placed there and the service paid for. In those cases, no matter what I was told, I always still insisted on personally traveling to the facility to verify with my own eyes the person's condition and attempt to speak with them, and review the doctor's interrogatories, and find the nurse who works in his wing and ask her questions about him, and even under ideal circumstances this would take at least an hour not counting travel time.
I seriously doubt that ANY attorney is handling serious commitment hearings in the fashion that Markie Post handled bail hearings on TV's "Night Court", and if you ever find one that is you should report them.
"They lose their prescription and don’t know how to get another one. Or they call their insurance, insurance whines “these drugs cost $500 and you lost your last prescription too, we’re not paying”, and they don’t know what to do."
If someone doesn't pay their child support because of bad luck or poor executive function, they get several chances but eventually end up in jail. If one doesn't pay a fine, he goes to jail. If one violates probation? Jail. Disobeys a court order? Jail. "Didn't take the drugs that stop one from being a danger to everyone around them" isn't an exception. If someone consistently "loses" their prescription, lock them up.
"Another homeless person steals their pill bottle thinking it might be opioids; later they will grind them up, snort them, and have the worst day of their lives."
Turns out bums are backstabbing, thieving scum who will steal anything they can, on the off chance they can sell it or use it to get high. This is a shock and surprise to absolutely no one, but we're not allowed to point out that the patient likely did the same thing to someone else quite recently.
"The patient messed up their appointment with the welfare bureaucracy that was supposed to give them a free subway pass, so they didn’t get one, so now they can’t make it to their doctor’s appointment."
He didn't mess it up. He missed it because he was high. But it doesn't matter anyway, because he always jumps the turnstile even when he has a pass.
"The patient went to their appointment with the welfare bureaucracy that was supposed to give them a free subway pass, but in the waiting room they spotted a drug dealer who had a grudge against them, so they left because they worried they’d get beaten up."
Turns out bums are dangerous, violent scum who regularly knife each other, often about the things they did to get high. This is a shock and surprise to absolutely no one, but we're not allowed to point out that the patient likely did the same thing to someone else quite recently.
"The patient was in the hospital with sepsis during their psychiatrist appointment, and nobody told them how to get an alternative psychiatry appointment.
The patient wrote their appointment time on a piece of paper, which they left in their tent, which got flooded in a rainstorm and all their stuff was washed away."
And because the best way to get a pass on any kind of accountability is to demonstrate learned helplessness, he got high instead.
"Am I just being gullible? Are these people just making fake excuses?"
Yes. The truth is that they got high, sobered up a bit, realized they missed an appointment to stay out of jail, called, found out about the fine, used their standard lie to get out of it, and then got high again.
"In San Francisco, the average wait time for a homeless shelter bed is 826 days. So people mostly don’t have the option to go to a homeless shelter. If you criminalize unsheltered homelessness, you’re criminalizing homelessness full stop; if someone can’t afford an apartment or hotel, they go to jail."
They could leave SF, but that's where they can find drugs and get high. They could get a job, but then they couldn't be high.
"Most (?) homeless people are only homeless for a few weeks, and 80% of homeless people are homeless for less than a year. If someone was going to be homeless for a week, and instead you imprison them for a year, you’re not doing them or society any favors."
Basically all of those are not actually on the street, so they wouldn't be criminal.
"How long should prison sentences for homelessness be? Theft is a year, so if homelessness is more than that, it becomes rational for people to steal in order to make rent. And realistically it will take police years to arrest all of the tens of thousands of homeless people, so if a sentence is less than a year, then most homeless people will be on the street (and not in prison) most of the time, and you won’t get much homelessness reduction."
What is deterrence and how does it work?
"What’s your plan for when homeless people finish their prison sentence? Release them back onto the street, then immediately arrest them again (since there’s no way they can suddenly generate a house while in prison)? Connect them to social services in some magical way such that the social service will give them a house within 24 hours of them getting out of prison? If such magical social services exist, wouldn’t it be cheaper and more humane to invoke them before putting someone in prison?"
You make the crime something like establishing an encampment within city limits, and once they have to encamp somewhere without a lot of traffic for begging or pickpocketing, they will leave.
Hell, you live in San Francisco, where homelessness is almost celebrated and bums are a Special Class exempt from a lot of law.
"Don’t mumble something about “I just want these poor people to be able to get the treatment they deserve yet don’t know how to ask for” before going back to railing against the damn liberals."
Ok. These people are scum who choose this life because it lets them get high and dump most of the costs of their conduct onto innocent people. There may be a handful of organically insane people among that number, but that's what the asylums were for. Yes, historically asylums were terrible, but that's in large measure because they were full of people who would stab their neighbor because the squirrel in the window promised to take them to the magical kingdom of shudooweewa if they made someone bleed. It's really hard for people to maintain a sense of compassion when dealing with a population more dangerous and unpredictable than a pack of wolves. But the modern ethic is that letting them rip each other apart is totally ok as long as innocent people have to bear a lot of the burden, because passivity is innocence.
I think you're wrong about the other cases - if someone doesn't pay child support, the state garnishes it from their wages.
Many of these people aren't drug addicts, and many of them are too insane to be deterred by deterrence.
One option is garnishment, another is revoking licenses. But incarceration is absolutely an option.
If someone is so insane that they cannot be deterred, they are too dangerous to remain among the public at all.
remove red tape, limit zoning restrictions, green light alternative housing for dome homes, shipping containers, whatever that can be fabricated en masse (they can 3D print structures now), remove fees and red tape for those wanting to build their own home. Used to be you could go into the woods and build a cabin.
Maybe also relax mortgage requirements - if you prove you can pay your rent on time for 3 years you should just qualify. Sure the bank wants a down payment to make the risk worth their while but it costs more to deal with homeless people (let the government subsidize a minimum 5% down payment b/c its cheaper in the long run).
I hate this one but maybe we need a "social service" for getting housed and that being the only function it performs. They'll cover fees, help you submit the paperwork, tell you from top to bottom what you need to do step by step until you can acquire a home via the means above.
The real problem is bureaucracy and regulation - lack of money just makes it more difficult.
I like this idea as a carrot, but I think it should also be coupled with something like the sticks some of the others here are proposing (eliminating tent cities, better enforcement against public nuisances, etc.)
I don't disagree at all
“…go straight to the part where you explain how you plan to do better.”
OK.
1. Build out more homeless shelters so that nobody is forced to live on the street. This includes reputable shelters, but could also be extended to some abandoned warehouses or parking lots or fields with cots, teepees and Quonset huts and porto-potties, with food and water and 24 hour guard service.
2. Allow affordable housing to be built, primarily by specifically allowing converted garages, multi family rooms, and most importantly, mobile homes.
3. Require anyone sleeping on the street or erecting a tent to go to the above defined shelter. If they refuse, arrest them in a non-draconian way.
4. Arrest anyone disturbing the peace with derelict rants or defecating in public or engaged in petty theft. If the police aren’t willing/able to do this, get a new police chief and/or DA.
5. Build mental facilities and create a process to sort who goes to these rather than jail. I will leave the details to those experts actually willing to try and solve it. If nobody is capable of designing this system, then, I will settle for just sending the repeat offenders to jail.
In California, the budget for all this is probably a fraction of the billions already set aside to address the homeless problem. If not, spend more, but do it in an effective way which doesn’t pander to the “housing first” special interest lobby.
You need some sort of triage based system. Both for mentally ill homeless people and for regular criminals. Try to evaluate what type of intervention a person needs, and give them that, starting with the people who need the cheapest interventions. Some people just need a place to stay for a few weeks. Some people need relatively simple psych treatments.
- Housing first for the ones without severe addicition or mental illness
- Group homes(assisted living facilities for those discharged from psych wards until they get their life together
- Long term psych hospitals for those too dangerous and unresponsive to medication
- Pressure but don't force addicts into treatment. Possibly send them to prison eventually if they can't get their shit together. Addiction often has underlying causes so try to treat those.
It's not a cheap system but not so expensive that it couldn't be paid for with budget cuts to other programs and maybe a little bit of debt and taxation. NYC has some of these features already but they are underfunded.
I have worked with guardianship and mental health in downtown Toronto for over a decade.
As long as it is an option to live on the street for free, lots of people will choose that option (or default to that option to avoid more difficult choices). Wherever they are permitted, encampment communities grow faster than Austin.
It does not take too long living on the street using drugs and drinking every day for someone to convert themselves into the category of intractably addicted and mentally ill.
I think Scott has started from the "intractably mentally ill" point and done a great job of discussing the tradeoffs and issues with coerced care options. This is where I worked and I agree.
But isn't the real issue that we have SO MANY MORE homeless and mental health issues and drug addictions than in prior decades?
I think the proper way to evaluate the benefit of making sleeping outside illegal is in how much it slows the current machine converting at risk people into lifelong mental health and addiction patients.
I support zero tolerance for encampments despite the obvious fact that many current mentally ill and vulnerable people will suffer under such a policy. I believe a much larger number of people will be forced to find a path other than setting up a tent and self-medicating.
Well, looking at much of the rhetoric and the comments here, the problem people seem to have is not that the homeless people are dying on the street, but that the homeless are dying on *their* street. That's a much simpler problem to solve, no?
Even more that the homeless are *shitting* on my street.
Homelessness is not new, and SF has long been a magnet for the homeless. Being an old guy, I think it might be helpful to look at how SF dealt with the problem in, say, the 1950's. Do you know any old-timers, Scott? My impression is that one thing they did differently is that they did not treat "the homeless" as a single population.
There were at least four separate populations: (1) "bums" - hoboes, drifters, etc. The cops wouldn't let them panhandle, annoy people, camp or spend nights in public parks, etc. Basically they had to "move along" and find the local skid row, where there was very cheap lodging, soup kitchens, shelters, etc. (2) drunks and addicts who passed out in public, or close to it - they put them in drunk tanks in jails until they sobered up. (3) obviously crazy people - took them to the local psychiatric hospital, where they were observed for a few days. If they didn't regain functionality, they were sent to long-term asylums. (4) people who were functional, and didn't want the hobo lifestyle, but were just really down on their luck. The were referred to charitable relief agencies, usually religious. Maybe they were given bus fare back home.
Of course all the people in charge back then were cruel and heartless, which helped.
I agree completely about seeing the problem in terms of baskets as opposed to a single population.
One new dynamic might be that cheap psychosis inducing drugs might be rapidly funnelling people from baskets 1, 2 and 4 into basket 3.
Everyone should have read Sam Quinones work by now about how cheap meth and the encampments are symbiotic. One relevant article to this discussion is: https://www.theatlantic.com/magazine/archive/2021/11/the-new-meth/620174/
It sounds as though a technological solution to part of the problem would be antipsychotic drugs that don't have to be taken every two weeks, perhaps some sort of continuous release pill or device.
Invega Trinza is once every three months, but it's new and expensive.
Would it be hard to deliver some standard drug in a continuous release packaging, perhaps something inserted under the skin?
I'm very late to this party, but I want to plug this in here anyway: this essay makes the case for the problem of crazy homeless people being more or less intractable, which I...don't want to say is wrong or incorrect or anything, because Scott is speaking from a position of knowledge/experience that I don't have and if there were simple ways to ameliorate these problems, I would imagine some earnest young School of Social Work grad would have figured it out a long time ago.
That said, I can't help but notice that the problem seems to be getting significantly worse over time. There seem to be more homeless people per capita, and they seem to be crazier and more anti-social than ever. That being the case, I can't help but feel that there is *something* wrong with current policy wrt: crazy homeless people. Public policy with regard to homelessness and mental health has not been static, either. It has changed substantially over time. I know, I know...correlation and causation and all that, but if you just consider the logic of "we have been plagued by problem X for some time, we changed our approach and problem X got worse rather than better (and significantly worse, at that),' it's hard for me to believe that the status quo is the best we can do.
As the essay says, though, I am not motivated to learn the intricacies of tetrathorpazine and its various chemical properties necessary to formulate meaningful policy proposals. Easier to just hang in the suburbs and chime in with the occasional "you guys are f#$%ing the dog!" admonition.
For the problem of psychotic homeless people, what about long-acting antipsychotics? Obviously it's not a complete solution, but those who are homeless and psychotic seem like they are among the least likely to improve their situation without medical intervention.
I'm sure there are reasons antipsychotic LAIs aren't the routine treatment (or maybe they are?k for people who are psychotic and "dangerous" enough to be involuntarily committed, but I don't know what they are. Perhaps as a psychiatrist, Scott, you have more insight into that area.
For the chronically homeless with other medical problems that make it more difficult to become housed (other mental illnesses, drug addiction, severe cognitive disability), it seems like cost is a significant barrier to improving the situation - there just aren't enough inpatient beds, as you point out. I'm sure there are countless cost-benefit analyses; but some of them (which probably get disproportionate left-leaning media coverage) find cost *savings* from permanent supportive housing for homeless people with chronic mental illness. Like this one: https://morrisoninstitute.asu.edu/sites/default/files/housing_is_health_care_report_2021.pdf
Is this just a bad study with flawed methodology? If not, then that would seem to point to a primarily political problem: it means that although the public would save money by providing more PSH, for some reason it doesn't happen. Maybe this is because it's very hard to reduce police force sizes on purpose; or because people don't want to give homeless people what feels like a handout; or maybe some other reason. But this seems worth exploring.
Where does intent among bad actors creating the systems fall into this discussion? Not sure how true that is but that's a pretty popular opinion for people to have. I can't imagine fixing homelessness with the tools/incentives we have societally right now.
A few questions about drug-addled chronic homelessness in the US.
1. Why do the worst affected congregate around downtown neighborhoods ? If the welfare resources get moved to an abandoned part of town, would they also move there ?
2. Where is the line for cruel and draconian ? Liberals move the goal posts on it often enough, that you can't blame people for failing to qualify their solutions. Mandatory confinement for those who've commited crimes or at-least mandatory displacement do not sound cruel or draconian to me.
3. Why is the call for 'more housing' taken to be a call for 'more housing with first world amenities' ? Why can't we put people in large hostel bunkers. A homeless person is entitled to a roof & bed. Separating out cohorts by drug-consumption, at-risk-ness and criminal record can't be that hard. You don't need 'more housing'. You need a large barn with a bunch of bunkbeds and a public restroom.
>Why can't we put people in large hostel bunkers
Building codes, usually. In the 60s a lot of city building codes were put into place requiring X number of feet for a bedroom, with X number of windows, etc. Many, perhaps most, were put into place to make flophouses illegal. In a flophouse you basically got a bed in a closet, but they were dirt cheap to stay at. Building codes made them illegal to build or operate, put in place by the well meaning reformers on one end (who argued that we needed basic minimum standards for the sake of tenants) and home owners/real estate developers on the other end (who wanted the poor people flophouses attracted driven out of town).
So in most cities in America today if you wanted to build a big shelter with just a roof and a bed, you would probably fall afoul of building codes and never be allowed to build or operate it.
This article, it seems to me, fails to engage with the question of why people become homeless. Like cancer, there are many causes for homelessness, and we should not expect to find a single intervention that works well across the board (except, perhaps also like cancer, aggressive and draconian interventions).
One taxonomy I have seen divides the homeless into three groups with distinct needs:
* The “have nots” are simply poor. They need more housing construction to lower the price of housing, and in the meantime other social interventions like food stamps, cash aid, job training, safe sleeping spaces, etc.
* The “can nots” have serious mental health or substance abuse problems. They need some kind of institutional supervision, whether it’s full institutionalization, group homes or something akin to parole.
* The “will nots” have opted out of capitalist society and are just bumming around. They are the modern hobos. As long as they aren’t bothering anybody they don’t really need any intervention; to the extent they are committing crimes, they just need criminal justice.
Note that there are interactions between these groups. In particular there is a pathway from contributing citizen, to have-not, to will-not, because among other things being homeless is very bad for your mental health.
That seems a reasonable way of dividing them up. In my descriptions, I normally elide the "will nots" (which I've sometimes seen described as "lifestyle homeless"), because there are so few of them, and by themselves they don't tend to cause as much of a problem.
I suspect that talking about "homeless" or "unsheltered" is unhelpful, and makes it harder to come up with a solution. IMO, there's basically the people who need shelters and food banks and job assistance, and then the people who need intensive medical assistance, and then the people who need prison. (And again, at the end, the "will nots" are left over.) "Homeless" is just as much of a symptom as "fever" or "cough", and while a certain amount can be done by treating the symptom, it's easier to make progress if we know the cause.
Would echo that the real pain / frustration for folks who live in cities which have significant numbers of unhoused (mentally ill or otherwise) is the associated criminal activity.
1) Theft of packages, items in cars, and from local businesses. This "death by 1000 cuts" impacts quality of life hugely: both directly (my stuff stolen) but also fewer local amenities because they can't remain profitable with the loss from theft.
2) Unsanitary / dangerous environments in places which are visited frequently as part of your day to day life (and for tourists/ visitors to the city) - particularly areas rife with drug use / trade. Having to watch out for used needles / human waste on the way to my kids daycare is a big drag on quality of life (and makes me want to leave). On the "bad experience for tourists/ visitors" - aside from the economic hit our many businesses take from fewer tourists coming because our city feels unsafe, it's also pretty exhausting having family / friends continually tell you how awful your city is because they visited civic center.
I think simply put a huge benefit comes out of simply enforcing existing laws effectively. I don't see this as rocket science, cities across the world do this every day. Police need to find and arrest people who break the law (drug dealing, theft, selling stolen property, public intoxication/incapacitation due to alcohol or drug use). To achieve this, we need to make it easier for police to find these law breakers - I'd advocate for a significant expansion in CCT cameras around the city etc. and DAs need to prosecute these crimes with vigour.
This will by its nature push the worst elements into ideally the criminal justice system or (less desirable, but still preferable to today) less monitored parts of the city (read semi industrial type neighborhoods).
The severe mental illness issue I think is overblown - yes random dude screaming at you is bad. But continuous law breaking by 100s more people is far worse. If the mentally ill dude breaks the law, then he goes to jail (and gets his anti-psychotics there).
Why can't we innovate the antipsychotic options. If the crux of the problem is the point at which the individual stops taking their medication, can't we do better there? Immunisations and contraceptives are now available in long-term, slow release options. Some ranging up to the 4-5 year mark. Is this out of the question for antipsychotics? Then intervention could look like: institution - short release medication, working with medical/social workers, becoming better-minded, signing over to long term medication, release into public housing...
I assume when people are saying we should crack down on homelessness in liberal city x, they generally mean pick a less liberal city y that has less homelessness and start imitating their policies. It seems unlikely these existing cities are the version of maximally draconian described above. I think this is a little to easy on the speaker as more concentrated cities are more liberal and also have more homelessness so the causality might not always be the direction the speaker hopes, but it seems like a reasonable position empirically.
> And the social workers can’t show up at their door, because these patients are homeless and hard to track down.
I'm sure there are many reasons not to do this, but... don't ankle monitors solve this and therefore a big chunk of the practical problem?
This is quite easy: enforce laws regardless of the perpetrator's presumed state of mind. It's not the penal system's job to read minds and hearts. It's their job to enforce laws. Anything else is a dystopia. The so-called insanity defense is insulting to both victims of crime and mentally ill people.
As to the fact that an apartment in the Bay Area costs a fortune, that's easy as well: not everyone has to live there. My schizophrenic family member has been living happily for decades in the woods where he is a danger to no one and can live on a shoestring budget without having to work. Personally, I'd love to live in central London, but I can't afford to live there. That's life.
The only thing that will "solve" mental health is actual medicine, that is long-lasting, cheap to manufacture and distribute, and doesn't have horrific side effects. Let science work on that.
The legal, medical, and housing systems are all their own messes, the last thing we need is to further confuse the problem by trying to combine them.
>It's not the penal system's job to read minds and hearts.
It's absolutely the penal system's job to read minds and hearts. They even have a fancy latin phrase for it.
If you run over a person with your car because you wanted to kill them, you get a much much harsher punishment than if you run over a person with your car because you accidentally drove through a red light. Intent is a key factor in most offences.
I have a limited reading scope on substack. But this piece does remind me of a recent Freddie DeBoer piece about the woke left being unable to verbalize any potential solution for the mentally ill beyond myriad variations of throwing more money at it. Point being that unless involuntary treatment and institutionalization is on the table, it is a useless discussion (ie if a mentally ill person can reject that largesse, then additional money adds nothing).
But this is a useful extension of that question. So let’s say we can institutionalize these people against their will….then what? Cuz we can’t actually “cure” these psychiatric issues, but only treat them. And the treatment only works as well and to as much extent as the patient takes them. So an inpatient who takes his meds and gets better, then is discharged and stops taking his meds, will simply get worse and end up institutionalized yet again. It’s lather /rinse/ repeat. I have no idea how you break that cycle. A Hitchens-ian wicked problem.
I have a limited reading scope on substack. But this piece does remind me of a recent Freddie DeBoer piece about the woke left being unable to verbalize any potential solution for the mentally ill beyond myriad variations of throwing more money at it. Point being that unless involuntary treatment and institutionalization is on the table, it is a useless discussion (ie if a mentally ill person can reject that largesse, then additional money adds nothing).
But this is a useful extension of that question. So let’s say we can institutionalize these people against their will….then what? Cuz we can’t actually “cure” these psychiatric issues, but only treat them. And the treatment only works as well and to as much extent as the patient takes them. So an inpatient who takes his meds and gets better, then is discharged and stops taking his meds, will simply get worse and end up institutionalized yet again. It’s lather /rinse/ repeat. I have no idea how you break that cycle. A Hitchens-ian wicked problem.
> . And the treatment only works as well and to as much extent as the patient takes them. So an inpatient who takes his meds and gets better, then is discharged and stops taking his meds, will simply get worse and end up institutionalized yet again. It’s lather /rinse/ repeat. I have no idea how you break that cycle
This seems like the same logic as "there's no point in cleaning things, they'll just get dirty again".
Maybe things do get dirty again. Maybe you do get stuck in an endless cycle of cleaning things and watching them get dirty again. But if you're cleaning them then they spend some of the time clean, and have a lower limit on how dirty they get. And if you never clean them then they just get worse and worse.
I agree. I’m simply saying that’s not an actual solution….or simply a temporizing one. Maybe that IS the best it can be, absent an actual “cure”. I’d be fine with that.
Then we have to bite the bullet and look at institutionalisation. If you can maintain your stability once released, because now you do have accommodation and support, good luck to you.
If you're not at that stage yet, but you can cope if in assisted living, then that's the next step.
If you continue to skip your meds, run out on the assisted living, and end back up on the streets because you can't do without lean*, then we are looking at "now you live in the asylum". It's important that we don't just dump people in asylums and leave the places to degenerate due to lack of funding, but if you can't live in any kind of fashion on the outside if left to your own devices, then for your own sake and the sake of the rest of the people around you, you get a nice comfortable cage with enrichment for what remains of your life.
* https://www.urbandictionary.com/define.php?term=Lean A wonderful new thing I learned about, and wish I hadn't
I agree. But it does leave open the possibility of long term/indefinite institutionalization….with all the necessary infrastructure and funding required to sustain it.
It’d become a parallel of the corrections system.
It would, but it would need oversight. That's where things slipped in the past and ended up with the bad reputation that tarred all institutions.
What we can't have are 'for-profit' treatment centres/asylums, because the incentive there is "maximise gain for the shareholders". They may start off well, but end up cutting corners to squeeze out the last drops of profit from the government contract.
That's why I'd incorporate charitable bodies with the new long-term institutions, to help handle some of the burden. Not put it all on government agencies and not put it all on private charity.
As it stands, we effectively are using the corrections system to deal with the problem of the intractable homeless who are that way due to mental illness/drug addiction/other problems. The penal system is not intended or suited for that, and the public health system seems to be hampered by teh problems Scott describes: get them stabilised, get them out, if they go off their meds rinse and repeat.
We are pumping a lot of money into the problem, but it doesn't seem to be doing much about the basic problems of "this person is incapable of taking care of themselves, but is not suitable for jail and is just in and out of mental hospitals, so long-term, what do we do?"
Mixing ideas from the comments together, I like the carrot proposed by Meta Ronin, and the stick proposed by Wanda Tinasky. Start by improving housing prospects, and for the chronic bums that still can't get it together, impose more draconian measures.
Something I would like to add in the stick category is what I call "vagrancy sentencing". Basically if you get picked up for pitching a tent in a public park, or arrested for some other offense and it turns out you have no place to go right away when released, instead of getting a fixed sentence, you get a vagrancy sentence. This means you stay in jail until either somebody comes to get you, or you get outsourced to a mental hospital or some monitored treatment program. For some vagrants this would simply mean making a phone call: "Mom, Dad, I screwed up..." For others it may mean getting in touch with social services who can assist with subsidized housing, drug rehab, etc. For those who get arrested again (two or three strikes), then the consequences get more unpleasant.
Also, building on Meta Ronin' mention of building cabins in the woods, I could see this being proposed to certain individuals who aren't helpless or psychotic but just can't handle the industrial age life. What I'm thinking of is a wilderness survival program for those who volunteer and pass certain screening requirements (one of which is passing one or more wilderness survival courses). Those who qualify get dropped in some set-apart section of wilderness where they are basically on their own. In order for this program to work they must have NO public-funded outside help. Maybe private charities willing to foot the bill could deliver supplies and letters (though everything delivered should be bio-degradable). Apart from that the only contact with the outside world would be someone helicoptering in once a year to deliver messages and see if anyone's had enough and wants to return to modern civilization. But no publicly funded food, medicine, clothing, policing...nothing. Everyone who signs on understands that their life is in their own hands, and if they sustain serious injury or illness, or go Lord of the Flies on each other, then so be it.
> But if you’ve been demanding an end to pollution for years, and nothing has happened, then it might be time to hit the books, learn about hexamethyldecawhatever, and make sure that what you’re demanding is possible, coherent, and doesn’t have so many tradeoffs that experts inevitably recoil as soon as they have to think about the specifics.
Nah; that’s nerdy and low status. Much better to refuse to reason with the nerds and intimidate them into trying to please you anyway, as they owe you, since you can beat them up and steal their lunch money.
> So when people say “we should do something about mentally ill homeless people”, I naturally tend towards thinking this is meaningless unless you specify what you want to do - something most of these people never get to.
Not meaningless: it means, “I can’t be bothered to specify what I want, or even to make my demands consistent. Let someone else humiliate themself trying to do the thankless and impossible job of pleasing me”. Be careful what you wish for, though: the bolder and more confident version is, “Just rid me of those people who inconvenience me. You can send them to concentration camps and incinerate them alive for all I care. And don’t lecture me on learning from history or somesuch—I’m too cool and high status to listen”.
> most of these decisions are based on vibes that only loosely connect to the written law.
All the better to show whose vibes matter and whose don’t. Status, status, status all the way down.
> I admit that if you’re willing to be arbitrarily cruel and draconian (life sentence for someone and their entire family the moment the bank forecloses on their home!) you can make this one “work”. But anything less than that and it becomes just another confusing bad option.
So it’s probably not a case of “anything less than that”, but “Let someone else bear the costs and risks of admitting such willingness, even to themself”.
> Don’t just write _yet another article_ saying “the damn liberals are soft on the mentally ill”.
> If your plan is
If your plan is to gain status and money by being conspicuously unhelpful, writing yet another such article is exactly the way to go.
The way this is framed confuses me a little. I think homelessness and mental illness are two separate problems, with significantly different causes and probably distinct policy solutions. Why combine them? Which of these is the greater social problem? Which, if either, is getting worse more quickly? Do we really have a worsening problem that needs a new solution?
Rates of homelessness probably reflect economic scale factors. I've been reading articles lately that we do not build enough affordable housing. This doesn't just affect the mentally ill, obviously, the articles I have been reading were mostly focused on the effects on young and new couples and families. We probably need a better housing policy. Maybe this is one market that the Federal government should regulate more closely.
If the problem is centered on mental illness, I am not aware offhand of any reasons why this should be getting worse. Saying that we should do something about mental illness is a little like saying we should do something about diseases--well, yeah, sure; and we are, have been for hundreds of years. What else do you want?
I will say that a little prevention can replace a lot of expensive cure. Give homeless mentally ill (or maybe just poor people) a counseling resource (I mean a case worker, not a therapist) that they can access easily and develop a relationship with, and I expect that the rates of homeless mentally ill people acting out in ways that other residents find worrisome will go significantly down.
Or is the problem that mentally ill homeless people are becoming somehow more visible and intrusive to middle class voters? That sounds like a local policy problem to me. Has San Fransisco been cutting back on homeless shelters? Health care clinics? Maybe what's changed are city budgets, not large scale social forces that require a nation-wide policy solution.
My locality (not SF) is spending approximately $100,000 per homeless person per year, from city and county and regional and state and federal and nonprofit funds, and yet the problem is worse than a decade before. It's not, strictly speaking, "lack of funding" that's the root of the problem.
They are mutually interacting problems. A person with severe mental illness or substance abuse problems is more likely to become homeless; and a person who loses their housing is more likely to turn to substances to cope, or to develop mental health problems.
tl;dr. Question: would it be possible to maybe, just maybe, look at other countries' solutions to the problem. In an overwhelming % of countries, there just aren't those armies of psychotic homeless roaming the streets.
Dammit, when I hear people talk about the "draconian camp", I get flashbacks to Dragonlance...
In the UK, the vast majority of out homeless people seem to be much, much better behaved than e.g. in San Francisco. (I have actually been to SF a number of times, so this is based on direct observation)
Our UK homeless people seem to contain a fair number of addicts (e.g . a couple of days ago, I am in the pharmacist to pick up a prescription and get chatting to local homeless guy who is in the queue to pick up his methodone prescription), but are, in the vast majority, not noticeably psychotic.
something seems to be different about the US.
(Of course, here we have a National Health Service) and the exact same infrastructure that was supplying recovering addict homeless guy with methadone would also be able to supply antipsychotics, if needed.
This paragraph puzzles me:
> But okay, suppose you build those institutions. How long are you keeping people there? Remember, someone’s going to come in, start taking antipsychotics, and (if the drugs work) appear significantly saner within 2-4 weeks. Best-case scenario, they’re completely sane. Now what? Do you keep a completely sane person locked in the mental institution forever? Or do you let them out, at which point they will inevitably stop taking the drugs and become psychotic again?
A person who, once released from an institution where they're locked up in, will "inevitably [...] become psychotic" is NOT mentally sane. Claiming otherwise is ridiculous. So I read this as "Should we really make a decision based on ground truth, even if the mere appearance points the other direction?" which I'm not really sure why anyone would ask as a (seemingly) rhetorical question.
Scott writes, very sensibility, "On the other hand, ordinary people should be able to say “I want to stop choking on yellow smoke every time I go outside” without having to learn the difference between hexamethyldeca-whatever and tetraethylpenta-whatever."
And then the rest of the post is him asking people to learn the difference between hexamethyldeca-whatever and tetraethylpenta-whatever (i.e., here is a massive list of potential problems that I as an expert have identified--reader, you must solve them). I think a lot of the logic around these problems is not so great and makes them seem more intractable than they are ("if the penalty for homelessness is greater than the penalty for stealing then people will steal to make rent" is a statement so devoid of common sense it seems almost like a parody of a rationalist). But even if these were good points... I don't care. I want the expert to partner with me on how to solve the "yellow gas I'm choking on" problem, not explain how complicated it is and how silly a straw man who "blames the liberals" is while I sit there and asphyxiate.
Some people are stealing to make rent. A lot of people are stealing because they are professional criminals and sending them straight to prison prison (not hospital prison) is exactly where they should be going.
"She's not rich and is under pressure, which is why she came prepared with equipment to shoplift":
https://watchers.ie/2024/05/22/another-foreign-national-caught-robbing-in-shopping-centre-miss-tintari-came-prepared/
Yeah, I'm thinking the lady is part of a criminal gang/professional shoplifter.
"A shoplifter found with a “de-tagger” in her pocket after she stole from four stores in a row admitted the thefts were premeditated, a court has heard.
Mother-of-one Ilona Tintari (28), who stole clothes and groceries worth a total of €289, was “not a rich person” and was under pressure, her defence said."
"Wahh wahhh wahhh I'm the mother of five kids and the grandmother of three" - yeah but you are also a professional shoplifter and thief who uses your kids to enable you to steal and are training them up to be thieves in their turn. No sympathy for you here, lady.
"My poor client has drug and alcohol addiction problems" - okay, she can get clean in jail, since being out in public has no effect on her stopping:
https://www.limerickleader.ie/news/crime-and-courts/1549408/brazen-serial-shoplifter-has-total-of-143-previous-convictions-limerick-court-hears.html
"The prosecuting barrister said Ms Casey is well known to gardai as a “serial shoplifter”.
“I am aware of drugs and alcohol issues. She has a serious drug addiction. She is well known to security guards. Efforts have been made to bar her from shops. When she was granted bail an order was made on her to stay away from Limerick city centre. She has 143 previous convictions,” said Mr O’Sullivan.
These include thefts, possession and sale or supply of drugs, public order, threatening / insulting / abusive behaviour and assault causing harm.
Mr O’Sullivan asked Garda O’Shea if the series of thefts were particularly brazen?
“Yes. No effort was made to conceal her appearance,” said Garda O’Shea, who added Ms Casey was easily identifiable on CCTV.
Erin O’Hagan, barrister for Ms Casey, said her client has pleaded guilty, it is her first time in the circuit court and is a lady who has struggled with addiction for many years.
The barrister said the accused has four children and her eldest is expecting a child."
"Okay, you get one last chance - after your last 76 chances" - maybe this woman needs the kind of structure that is found, oh I don't know, in jail? (Okay, I might give her a chance at hospital prison not prison prison, but if she reoffends after getting out of hospital prison, it's prison prison for her):
https://www.echolive.ie/corknews/arid-41288500.html
"Yesterday at the sentencing hearing, defence solicitor Shane Collins Daly said the 32-year-old understood that her offending could not continue.
Judge Dorgan said, in placing the accused on a probation bond, that there were three things in particular that the woman needed in her life: to get away from negative peers, have structure in her day, and get counselling.
Julianne O’Farrell of Marble Hall Park, Douglas, Cork, pleaded guilty to carrying out thefts at Diesel on Oliver Plunkett St, Dunnes on Merchants Quay, at Boots at Douglas (all in October/November this year), and on May 18, 2021, at Phelan’s pharmacy.
Sergeant Gearóid Davis said the accused had a total of 232 previous convictions, including 73 for theft, before the four latest offences."
"These poor kids are just trying to pay the rent!" Yeah, I'm sure:
https://www.thejournal.ie/fourteen-people-due-before-dublin-courts-for-shoplifting-6250150-Dec2023/
"A TOTAL OF 14 people are due before the Courts of Criminal Justice and Swords District Court today for 23 separate charges relating to recent robberies.
The group of 13 males and one female were arrested as part of Operation Táirge, a criminal investigation by gardaí into crime targeting commercial premises in the north Dublin area.
Gardaí said offenders sometimes can be violent, with some using weapons such as knives and sharp implements, inducing fear and panic among victims.
In one case, petrol was poured onto a counter within a retail premise to invoke fear.
The operation has led to the arrest of 15 people connected to 20 incidents and Gardaí said the intelligence-led operation aims to identify people involved in retail crime.
Organised retail crime is where a number of people act together, targeting outlets to steal significant quantities of goods to sell back into the supply chain through the black market.
It can also involve refund fraud with the purpose of making a financial or material benefit.
The stolen goods are then sold to a “fence” who either sells them at a particular location or in some cases may sell them online in an activity known as e-fencing."
People in genuine need may steal food, baby supplies, or clothes. People who do this kind of robbing are not 'in need' but are professional criminals.
This kind of case is a grey area; the accused has previous convictions for theft, but stealing groceries does fall more on the side of the "in need" scale:
https://www.breakingnews.ie/ireland/high-court-quashes-eight-month-prison-sentence-imposed-on-young-mother-1487978.html
I have no idea if this is a troll or not, but the kind of "I'm applying to university here, also I'm here illegally, stole goods from stores over two days" (and may or may not be the same person as "also I had a knife on me") is not, I submit, the kind of person we really need to import:
https://www.justanswer.com/ireland-law/lekg7-hie-caught-shoplifting-yesterday-police.html
"Customer: Hie, I was caught shoplifting yesterday by the police and the store manager of brown thomas for the crimes I did two days ago that add up to 1100. I also had a few things from boots and pennies that they forced me to say I stole the things i was carrying too. I returned all the shoplifted stuff. I did confess to everything. I have an upcoming court case. Will I be arrested? How long will my sentence be ? This is the first time to ever be arrested. I am also in ireland illegally. Does that make my case worse ?
Lawyer's Assistant: What was the value of the items?
Customer: 1200
Lawyer's Assistant: Have you talked to an Irish lawyer about the shoplifting charges?
Customer: No
Lawyer's Assistant: Is there anything else the Lawyer should know before I connect you? Rest assured that they'll be able to help you.
Customer: It's form 3 stores within a space of two days. The store says they have cctv footage but they didn't show me"
https://www.justanswer.co.uk/ireland-law/m309e-caught-shoplifting-ireland-first-time.html
"Hi, so i got caught shoplifting in Ireland, this is my first time getting arrested for stealing 2 shirts, the amount of them was 1100 euros, the clothes were not ruined still in good condition for sale, and they also caught me with a small cutter/knife, I have to go to the court tomorrow, am I in big trouble?
JA: What happened with any prior shoplifting charges?
Customer: This is my first attempt
JA: Have you talked to a lawyer about the shoplifting charges?
Customer: no, I’m gonna have the lawyer that they gonna give me tomorrow
JA: Is there anything else the Lawyer should know before I connect you? Rest assured that they'll be able to help you.
Customer: no"
*If* this is genuine, seems like they'll (most likely) skip the country back to the UK, or if they do go to court, they'll get a fine. I'd be perfectly happy for them to experience an all-expenses paid stay in one of our salubrious prisons, to round off their trip to my country.
I don't really know what the system is like here in the UK, but I find it impossible to believe it's as bad as this.
If the question is "what specifically should we do about mental illness?" and laypeople don't have the detail to give a coherent answer and experts are too ground down by the psychotic bureaucracy, why don't you just look at other countries, pick an approach that works better than yours - that is, having a society that seems designed to drive people mad and then forces to live, unmedicated and mumbling to themselves, in tents beside the road - and then do that?
I expect the Danes have got some kind of pragmatic, effective, humane compromise going on. They usually do.
> Another homeless person steals their pill bottle thinking it might be opioids; later they will grind them up, snort them, and have the worst day of their lives.
I wonder, what exactly is going to happen if you do it?
Has anybody tried a bounty system yet? Utterly shooting from the hip, here, so I assume there are massive problems. But:
Identify some reasonable financial reward for any person or institution that can successfully intervene in a homeless person's welfare according to some kind of metric; let's say, stable employment and housing over two years, with no arrests. For a rough starting point on the size of the bounty, you can use some back-of-the-envelope estimate of the anticipated cost to the [government body] that a homeless person is likely to represent over their lifetime when otherwise left to their fate- that way, this program would approach revenue-neutral. Every time a person without a permanent address interacts with the system (either by being arrested, going to a city homeless shelter, or whatever), the intake process includes updates the bounty for that person with whatever new information they reasonably can. I would vaguely expect the bounty to land anywhere between $300-800,000 USD, but that's a really rough guess.
At any time, a homeless person and a [government]-certified bounty-seeker (either an individual or an institution) can enter in to a mutual legal contract, one in which the bounty-seeker assumes some degree of liability and caretaking responsibility for the homeless person going forward. As in the foster care system, bounty seekers would have wide discretion in how they met their care responsibilities, but regular visits by program representatives would probably be essential. In exchange, if the homeless person ever meets the [government]-designated target metrics, bounty-seekers receive the bounty in full.
When entering the relationship with a bounty-seeker, the homeless person would be signing away a degree of autonomy for the duration of the program (to a maximum of, say, five years), probably intermediate between an adult and child. For example, the homeless person would be obliged to remain in regular contact with the bounty seeker, and the latter would be able to call the police and initiate a search if the homeless person remained out of contact for more than a few days. However, the homeless person would also remain in regular contact with [government] authorities at various levels, and could initiate an early "divorce" by some costly but attainable method.
There are obvious concerns- any compromise in autonomy is a recipe for abuse, though I'm not sure a "foster care lite" system is actually worse than living on the streets full stop. And the bounty-seeker and homeless person share the incentive to cover up criminal behavior and other lapses, which isn't great; you'd need to choose your 'payout' metrics pretty carefully to minimize how much people could game the system. But it would carve out some room for individual relationships between (employee) caregivers and homeless people, with a lot of the bureaucratic complexity shunted to relations between state or city agencies and bounty-seeking institutions. And you'd get some of the benefits of decentralization, such as specialists working with different types of homeless people. Nor would you need to replace any existing government apparatus; you could just start this program and scale down the rest of it if and when it succeeded, and could easily begin with a small trial program.
This has been discussed elsewhere here in the comments, there are several thoughtful responses there.
Problem.
1) Sign up every homeless person available into this scheme.
2) Give them all a $0.10 sticker saying "don't be homeless".
3) Statistically some of them will sort themselves out.
4) Profit.
This can be solved by auctioning off the bounty rights.
The bounty-seekers bear liability for signatories, and have assumed caretaking obligations. If a homeless person in this program is going hungry, doesn't have a stable place to sleep, is involved with criminal behaviors, etc., then the bounty-seekers are on the hook.
Put the bounty seeker on the hook for too much and no one will want them.
Another problem, if the bounty seekers are being unreasonable, the homeless psycotic person isn't in a good position to put in complaints. This could be everything from complaints about the quantity/quality of food recieved to complaints of sexual abuse.
Maybe making the homeless person themselves choose between a list of big companies? And let reputation effects do it's work. Homeless people will talk to each other. If one company is stingy, soon this will be widely known.
As I said here where I live in the UK the vast majority of the local homeless folk are not causing a problem.
So, one guy was behaving kind of badly, and got the dubious distinction of posters being [put up with his mug shot and the local police number ... like, "if this guys causes you any more grief, phone the following local police number with this reference" ... never saw him again. This got to be on the order of les than 1 in 100 homeless people. The guy claimed to have Aspergers Syndrome when I spoke to him. Let me reserve some skepticism on the alleged DX, given I know other folks with autism DX of various levels of severity, from the usual high-functioning posters around these parts to the much ore severely affected. But maybe; he was showing obvious signs of psychosis.
I am driving hime, late at night, past the local homeless shelter .. dude is lying in the midle of ther road, very drunk.
Ok, stop the car, check that this is not an accident scene. Nope, he hasn't been hit by a car, at least, not yet. He's not having a seizure,, as far as I can tell, just very very drunk. Come on dude, this is a really bad place to take a nap, let me at least help you out of the road. I phone through to the homeless shelterthis guy had (presumably) been trying to reach. They are spectacularly unenthused about the prospect of having to deal with this guy. Oh well, it's a mild UK night, and he'll probably be fine outside just as long as he doesn't fall asleep in the traffic.
In the UK, at least, the problem seems to be alcoholism/other forms of addiction, and very rarely psychosis.
More generally, there seem to be about two kinds of homeless peopke@
a) Just poor, and got evicted because they couldn't afford the rent. This group os really easy for the government to help .. subsidized housing, and they'll be fine
b) alcoholism/dug addiction/mental illness. In these case,, the problem isn;t really a lack of housing.
These are not unrelated though, because the stress of losing housing can lead to addiction and mental illness.
Yes, I'd agree with that. Helping the type (a) people with subsidized housing before they become addicts might be really effective intervention..
I guess my question is, if this problem is (apparently, visually, i have no idea what the epidemiology looks like) so much worse in a handful of American cities than basically any other developed nation on Earth...is there something these other places are doing that could be copied here? Is universal healthcare the only factor seperating the Bay Area from Geneva?
Maybe this has been commented on before, but before Reagan signed the Lanterman-Petris-Short Act in 1967 there just weren’t screaming schizophrenics on the sidewalks in California; and much more recently, according to New Yorkers, they just weren’t any in New York City under Mayors Giuliani and Bloomberg, at least not anywhere near as many as now, and before Giuliani was Mayor.
Perhaps this has been answered, but to this San Franciscan non-expert the solution seems to me to be: do what was done before Reagan and what was done until 2013 in New York City
One thing that's changed since 1967 is the cost of housing, especially in California and NYC. Multiples more expensive relative to lower income percentiles? From what I've read, it seems like many times people fall off the housing ladder, become homeless, and the stress of this experience leads to mental health or substance abuse issues.
That perhaps explains California, but not New York as housing was already extremely expensive under Giuliani and Bloomberg, and according to New Yorkers they just didn’t have the sheer numbers of street crazies under those Mayors as they did before, and do afterwards
New York has real winters. Real winters cause substantial attrition to the unsheltered homeless. or at least the ones who can't or won't scrounge up bus fare to California.
That is one long subtweet my dude. Link and quote or don't engage; it just makes you look afraid of me.
No it doesn't. I wish you hadn't said that.
I think it’s important to reopen asylums, not because it was a bad idea to close them but because drug-induced psychosis is on the rise. If the resources that worked to deal with organic mental illness can’t keep up with drug-induced mental illness even outside of California, it’s time to go back to confinement.
It would have been nice to get a handle on the root causes before it came to this, but we haven’t and I don’t see anyone jumping on it now, either.
If you legalise drugs then people will use less drugs.
Or at least that's been the drug policy mantra in the US for the last several decades and there's no time to check whether it works now.
Well, given that EEE-legalizing drugs has been such a smashing success, REE-legalizing them can't get that much worse.
Things were pretty bad leading up to illegalizing drugs. Those who have forgotten history often choose to repeat it.
I know I'm late to comment, but unlike most of Scott's articles I actually take issue with what I understand to be the central claim here, which is that it is necessary to offer specifics about what you would do about the seriously mentally ill and chronically homeless population if you are going to make general criticisms. My concern is that both the size of the population in question and the social service systems in place to respond to that problem vary quite widely. Thus, an article that meets Scott's request for specifics will invariably be local instead of national in scope which will naturally limit its audience. For instance, I live in Minnesota. I know the systems we have here, and there are some differences between what Scott describes and our systems here, namely that there is a greater use of shelters due to cold weather, a lower population due to the same, a serious risk of exposure injuries for those who do live outside, but also (from what I can tell) a more robust system of group homes, community behavioral hospitals, and even state-built housing to help people live in the community when they discharge from hospitals. My criticism of my state's system is that people tend to rise to the level at which they fail, meaning if they can leave hospital they go to a locked group home with a high staffing ratio, then if they do well they go to an unlocked group home that still does meds, then to a group home that doesn't do much, then finally to minimally supported housing, at the same time as they gradually are de-tethered from the state's commitment process such that they often get to a level of autonomy they can't really handle, stop meds or start meth or both, become homeless, and begin the cycle again. My belief is that people who demonstrate that they can't achieve a certain level of autonomy after several years should be kept at the level at which they succeed, meaning people who show repeatedly that they don't do well with unlocked settings or outside of the hospital should not be expected to graduate to a less restrictive setting, and more people will be involuntarily committed indefinitely.
Ok, so that's my criticism of the system, but how well does it apply outside of Minnesota? Probably not that well. Can I make that criticism interesting to a national audience? Probably not. Does that mean I don't get to participate in a national debate about these issues? According to Scott, probably? On the other hand it seems better to make a general point like "involuntary commitment has a lot of benefits, actually" or " a more paternalistic approach to the seriously mentally ill and chronically homeless population would be beneficial". You can engage people that way without going through the " ok, here's how I would apply these principles in my local and particular situation" tap-dance, a dance which few people outside of your locality would find engaging..
Some random ideas I plucked out of the air right now (I work on improving mental health crisis care full time and am currently implementing a contract with a California county to run their mobile crisis response program, and live in SF with an office in SOMA, so I probably have more context about the situation than most, but these are only poorly-thought-out answers:
- idea 1: in many counties, the most visibly psychotic/disturbing people who get thrown into hospitals and jail repeatedly are known to the county and sometimes enrolled in intensive programs for ‘high-system-utilisers’ as they are euphemistically called. The programs are called ‘Full-Service Partnerships’, and they already exist and are somewhat funded, in most counties. Basically, a team of people takes responsibility for making sure the person stays out of the system and ‘recovers’, basically meaning they aren’t causing problems. The means by which they do this are deliberately flexible, but it basically boils down to ‘be really persistent and annoying at following up with them and finding them and essentially be their prosthetic executive function system’. Proposal: pay those teams handsomely for periods with no incident (no complaints called in on the person, no arrests, hospitalisations) with a few active penalties for when certain bad outcomes happen. Basically, make it lucrative for someone with excellent executive function to figure out how to ‘get this person to behave’. There are probably only around 800 such individuals in SF (if the number of people enrolled in Alameda county’s high-utiliser program is a good rule of thumb to go by, they have about that number but a higher population) so even if you paid each team $1 million a year (ridiculously more than those teams currently get paid) that would be $800 million plus some admin costs for the whole of SF. Politically difficult because of the norm that people who work in social services should not be profit-motivated (even thought there are cases where they obviously are).
- Idea 2: bribe individual drug dealers to leave and avoid downtown San Francisco. Like a paid restraining order against a location. If the dealers leave many people with addictions (who are the ones who end up with meth psychosis) will not stay. Politically spicy. Could theoretically be done by wealthy private individuals.
- Idea 3: install cameras on every single street in downtown SF, train some AIs to recognise dangerous and disorderly behaviour, pay a team of corporate-optimiser-types to bring down rates of disorderly behaviour, again rewarded handsomely for periods and stretches of no disorder. They can do anything legal to resolve it, and are probably given some budget to do so. This could possibly be funded by private individuals but I have no idea what the cost would be.
I could probably come up with more. These are rough. I’ll think about it.
>- Idea 2: bribe individual drug dealers to leave and avoid downtown San Francisco.
:-) Reminds me of some do-not-plant farm subsidy programs!
IMO the framing problem here is that there is no discussion of the absolute benefits of urban density. When people live in cities, they are not living in sprawling exurbs, they are not building mcmansions, and most importantly they are mixing every day with people unlike them. The current approaches to homelessness (and many of commenters' arguments), place individual rights above this clear community benefit. And all rights, outside the few enumerated in the constitutional amendments, are subject to public policy trade offs. Choose density.
"I admit that if you’re willing to be arbitrarily cruel and draconian (life sentence for someone and their entire family the moment the bank forecloses on their home!)"
How original; members of the public describe specific behaviors that make public space or their residential neighborhoods like open air prisons where they can be harassed at any time - public defectation and urination, businesses being robbed, mugging, assault, streets becoming disgusting, frightening sewers - and what does someone like you say? "OH, YOU JUST HATE POOR PEOPLE!" Why should any of us see you or anyone that's like you as anything but hypocritical and degenerate, clearly justifying a population designated problematic because of behaviors that can be traced to actual crimes in every city where the taxpayer is told they can either embrace laxity, or be "cruel and draconian"?
"Damn liberals", political representatives, got psychiatric hospitals closed and continue to close them at the state level. They've sued at the state level to ensure there are absolutely no restraints put on dangerous, antsocial people, including mandated treatment in exchange for avoiding prison time,, something you call "cruel" (big secret who you sympathize with more, those that have had horrible experiences with the population you're describing, or, um, your clients, I guess) and basically, they agree with you that the public has no say in arguably one of the most important problems in public safety. Those count as your first lies, lies of omission.
"Damn liberals" - people like you, and certainly, left lobbyists that want to claim to be the best caretakers for this population in ideologically-captured orgs that are far worse than worthless in providing solutions and "care" (doing nothing but lobbying against meaningful intervention) - have ensured there are no solutions and won't be, for the foreseeable future, even though Kendra's Law and Laura's Law are proof this was once enough of a priority to electeds (after women were murdered, of course - only then does your kind grudgingly admit, there might be a widdle problem).
They (you) ensure we do not have more beds. That states can't get the feds to pay for long-term involuntary psych care, or continuity in care after incarceration (which is often necessary, and should be used if someone commits a violent crime - "cruel and draconian!).
YOU are the problem, Scott. You are. People like you, your side, left-wing activists that justify that most heinous crimes, and fittingly, only talk about "mental illness" being an excuse for horrible, violent behavors when there is a body to collect or a woman is, say, shoved into the path of a subway car and paralyzed.
I have rights as a taxpayer and a citizen; they are universally disregarded by my representatives, other voters, academics, and the entirety of the press that gets the microphone, and phonily wrings their hands. There are men that terrorize entire neighborhoods in cities like New York for years and years on end, sexually assault women, threaten people, are undercharged on the tiny chance the police finally arrest them, and the press cackles with glee at the helplessness of citizens. It always makes for a great, gory, emotionally compelling news story because of its very hopelessness, and the understanding citizens don't deserve any kind of relief! It makes for an even better story when the neighborhood drug-addicted groper graduates to killing a woman.
They all phonily wring their hands about the "dilemma" of the rights of your clients (obviously) to terrorize the public, versus the rest us.
This is guilt-tripping people to accept their own misery, and worse. It is actual cruelty to those of us that can participate in public life without harassing or physically assaulting others, or making shared space dangerous and disgusting to even pass through.
You're a depraved person and your essay telling people they should do nothing, have no options, and are wicked for focusing on their own rights is self-seeking.
I pitied you when some verminous little reporter at the NYT went after you for being dissident. I don't anymore. You're the same creatures.
Reading comprehension fail.
He didn't accuse anyone of hating the poor.
"Why should any of us see you or anyone that's like you as anything but hypocritical and degenerate, clearly justifying a population designated problematic because of behaviors that can be traced to actual crimes in every city where the taxpayer is told they can either embrace laxity, or be "cruel and draconian"? "
Do you have an actual specific solution to propose that you want to argue isn't lax or draconian?
And we are talking here about the large number of people who are homeless and causing a nuisance. (Say including public defecation.)
You start talking about the much smaller number of outright murders. Presumably in an attempt to conflate the two issues and make all homeless people sound like murderers.
In short, your imaginary evil version of Scott bears hardly any resemblance to the real one.
I’m thinking through this…
So psychotic are only one category of chronically homeless, yes? Another big category are drug addicts. So even if we could “get the mentally ill off the streets”, there are still a bunch of people who are just addicted to hard drugs.
I think one reason we less-informed just want a “make it go away button” is that it seemed a lot better before Covid. Then Covid happened, a lot of people talking about defunding the police, then something something a lot more florid homelessness. I’ve seen the stats that blue cities aren’t necessarily worse than red ones, but it isn’t the biggest stretch for people in nyc/sf/portland/seattle to see all this and think:
“There’s Something that works to make this go away because it was better before so we were probably doing that thing then stopped.”
And also…
“This started getting bad right after the summer of Floyd, so maybe it’s those woke policies that are to blame.”
As far as actual solutions, from reading your descriptions two things jump out:
-a lot of people are being released early because sedation can mimic not being psychotic
-a lot of people are lost to follow up because of friction in the healthcare system
The former seems relatively easier to solve if you’re being draconian - minimum stays.
The latter? I guess I’d look around the world to see if anybody is doing it better. An army of case workers would be nice but probably unrealistic.
And I’d be really curious to know what changed around Covid. Why didn’t it seem this bad before?
Universal Basic Income would resolve nearly all of the world's homeless problem.
Warning for any snowflakes who may get triggered by sharing one of my own videos, this is my video. Secondary warning, it comes from my religious biblical perspective as a rabbi.
https://youtu.be/RbdMLip-_Hk
Our society is so cruel that most people fail to even realize how cruel it is.
> Universal Basic Income would resolve nearly all of the world's homeless problem.
Only if drugs, gambling and bad decisions somehow disappear from the world, and would be magically replaced with thousands upon thousands of new houses. Otherwise an influx of additional paying customers for the same housing stock would just raise the prices, and people would still be capable of drinking, sniffing, gambling or plain losing their UBI check and then remain as homeless as before.
> can you make homelessness a crime? As of last month, yes you can!
But that's not what the link says. It says local municipalities can make camping in specific public places a crime, not being homeless. I'm sure there are many places where not a lot of people would object to somebody camping there. True, those places may not be very attractive - e.g. far from places where you can procure drugs, steal things, beg for things or just enjoy walking in the sunshine naked and pooping on the sidewalk, but don't such places actually exist?
> and they can’t think of a good one
Are they trying? Because so far in CA I am seeing the plan is "let's just let people camp anywhere, turn any neighborhood into a dump, and let's on top of that stop enforce laws about petty theft and harassment, and also let's make easy for the same people to maintain their drug habits and see how that works out". Does it work out well? I don't think so. But I don't think their ideology allows them to admit it.
The opening paragraphs, "something should be done about the bad air but I don't know what," make me think of Winston Smith in the novel 1984. He can see all around him that the Party's policies are damaging, but he knows that they have lots of people who could debate and tell him how wrong he was, and he couldn't argue with them.
This also reminds me of a discussion I had back in college, where a girl in our project group was very much against child labor. She wanted everyone to know it. Child labor all over the world should be banned and eradicated. But I said that this wouldn't mean the children go to school and live happy lives. They work because the family needs the money to survive. So child labor isn't the problem, it's just a symptom of the problem, which is poverty. That's what to focus on. Surprisingly, I made her grudgingly agree. Most people would be upset: All that they'd hear was that I APPROVED of child labor and wanted it to remain.
Which, in turn, reminds me of another conversation, with an old woman. She was sad because animals have to die when humans eat meat. I pointed out that meat is an excellent source of nourishment for us, predators as we are, and studies show no replacement protein can fully replace animal protein. It also gives us great pleasure to eat it, and it is a constantly renewable pleasure. Since we aren't robots, we need pleasure to keep going.
And keep going we should, because humans are the vanguards of Life, the only ones who can help Life advance and overcome all possible obstacles. So that Life can live forever. Are the animals and humans who live right now more important than the ones who live tomorrow? Or any tomorrow after that? There could be lots of suffering for all lifeforms, and eventually death, in a distant future. If not before, so when the sun slowly and painfully extinguishes all life. We need to prepare. Human advancement is the only way to prepare. All the other lifeforms just keep eating and sleeping and dying, repating that with no progress. We should therefore eat meat to strengthen us and give us an easy and renewable pleasure, so that our work can continue.
But of course, all she heard was "this guy is anti-animal!" It's the last time I argued with grandma.
But Portugal has already fixed drug addiction, didn't they?
Since housing is a human right, apartments can be freely built, rented or sold with a minimum area of 97 sqft (which is often enough for bed, bathroom and kitchen!) (this is the minimum size across most of Europe).
Any people using drugs are arrested and immediately brought before a panel for doctors, who will "judge" you on the spot without appeal. If you are found to be addicted, you will be forcibly institutionalized as long as the panel deems it necessary (in public or non-profit rehabs with adequate funding).
If you are not addicted, you can be fined 1000 Euros, which is more than a month of minimum wage (and enforced by a prison sentence if you don't pay). They can also decide that you need to stop seeing certain people and check in with doctors and the police on a regular base (basically putting you on parole, again enforced under threat of fine or prison).
By decriminalizing drug use, they were able to replace lengthy legal processes and prison-first with immediate administrative sentences and prison-as-a-threat. Portugal is extremely harsh on drugs, but in a smart way.
Since 2020, Portugal went from the second highest heroin use in Europe to one of the lowest despite of ongoing poverty.
What about going out to the countryside and building a boarding school but for adults?
They never have to see any paperwork. They eat food in the cafeteria where someone makes sure they have their pills. They do some cooking and cleaning work, and get some lessons perhaps. They do a bunch of sports and games and activities. (Think scouts) They absolutely have a scheduled art time and a large supply of crayons.
They are allowed out, if they fill out a 20 page form stating they have somewhere to go. (So the only ones who get out are the ones with the executive capacity to fill out paperwork that is needed to live in society at large. )
This institution would need to be more accommodating of sex and booze than a regular boarding school.
The solution is simple: literally just treat mentally ill people like children until they prove that they are capable of surviving on their own.
Can't find them because they're homeless? Just build housing complexes for them.
The housing complexes are too dangerous because they're full of mentally ill people? Have security cameras installed everywhere and security guards at a central point in the complex where they can easily and quickly respond. Also, automatic curfew (so if you want to get in or out after a certain time, you need to check in with the security complex).
They don't fill out their medication prescriptions? That's OK, administration at the central office knows their medications and will handle the paperwork. The pills will even be delivered directly to their apartment.
Basically the idea is to have a system that could best be described as "Prison Lite." It doesn't have the brutality of prison (because these people aren't criminals - if they commit crimes due to their mental illness, they absolutely should be sent to jail) but it's not as fun or free as regular society (because you want them to work to get off the system rather than becoming a burden). Getting out is easy: they simply have to take over all the duties that the central office was managing for them and consistently show that they can care for themselves (and take their medications regularly) without relying on the central office to do it.
The reason America doesn't want to do this isn't because it would be HARD: it's because we're so focused on rugged individualism that we can't admit to ourselves that not everybody is cut out for it.