Where are the homeless supposed to go?

[u/Garey_Coleman]

Cities have been cracking down on homeless people so they can’t have encampments or stay on sidewalks. At the same time usually the shelters are full. So those who are unable to get into a shelter, where are they supposed to go?

[u/bikinibeard]

How many overdoses and died? Because the overdose death rate is highest in our housing first projects here, which is why I’ll never support it. I’ve heard the same thing, “some people do really well, some don’t.” Let’s add: some die. That’s not acceptable.

I’m all for Housing Second after a long term (90 day) medical detox, med adjustment and a psychiatrist signs off on it. Staff— doctors and nurses, medical professionals— must take control because this is a healthcare emergency.

[u/ConfusionsFirstSong → u/bikinibeard]

Do you have stats to back up your claim? Because the literature overwhelmingly supports housing first. https://nlihc.org/sites/default/files/Housing-First-Evidence.pdf

You seem to ignore the fact that people die due to being on the streets. Due to ongoing substance use there, due to victimization, due to exposure to the elements, due to diseases they might not get if they had basic housing and hygiene available. They tried “treatment first” housing policy for decades. It didn’t work, and cost a lot more. Housing first does not mean housing only. It means give someone somewhere to live and it becomes a lot easier to get them off substances. Idk if you actually have met unsheltered unhoused people who use substances, but they typically are further pushed to use substances by both necessity ie stimulants to stay awake at night so as not to be victimized, or due to despair at their situation. Giving people something to work to keep, ie housing, gives them a reason to try.

Also nowhere keeps people for 90 days except maybe private rehab/residential settings. Expecting the government to pay for those—talk about expensive. Not to mention people who use substances have civil rights, and being compelled to complete multi months long treatment in order to just get housing access is an abusive tactic.

[u/bikinibeard → u/ConfusionsFirstSong]

I was homeless. HAVE YOU EVER BEEN?

I volunteer weekly at St. Vincent de Paul in Oakland— WHAT DO YOU DO?

I cook once a month and help feed an encampment of about 40 people- WHAT DO YOU DO?

Nearly every single homeless person I come in contact with has the same extenuating circumstances that keep them homeless: addiction, mental illness, violent/sexual criminal record.

Half the people we personally put into private rooms overdosed. Half of those die.

I have watched data collectors (that are always working with or in conjunction with the NGOs that receive the most homeless dollars) ask their questions and I’ve seen their surveys.

Example: “Were you ever evicted? Note: eviction can be when a family member or romantic partner makes you leave. Eviction can be when you have rented a hotel room and you are told to leave. Eviction can be a shelter that no longer serves you.”

See how that works? That’s literally ever single homeless person.

[u/ConfusionsFirstSong → u/bikinibeard]

I respect your experience, your trauma and your work. However, you’re overlooking the bigger picture.

Im a housing worker with people in the depths of psychosis and people using meth and fentanyl every single day. Most are already in intensive outpatient treatment. We try to encourage that. Housing first does NOT and should never come at the expense of access to substance and mental health treatment.

I’ve also lost people to drugs, to victimization, to chronic illness that went untreated because they were on the streets. None of them would have fared any better if they were still unhoused due to lack of sobriety as a barrier. In fact some of the most tragic deaths wouldn’t have happened at all if they just had a home to go to. They cannot get sober much less mentally healthy while sleeping behind dumpsters, under bridges or in tents.

Housing First has been proven over and over, in Canada’s At Home/Chez Soi study, the VA, HUD, SAMHSA. They all show better housing stability and NO INCREASE IN SUBSTANCE USE.

Realistically there is no funding nor enough facilities for 90+ days of inpatient treatment for every homeless person, nor would forcing it be ethical. Mandating institutionalization would be coercive and a breach of civil rights under current law. Housing first with intensive community treatment is the best of all scenarios available.