‘Housing-first’ is barely step one to fixing homeless disaster in San Francisco

Tracey Mixon never thought she would be homeless.

She lived in an apartment in Hayes Valley for 30 years before moving out with her 8-year-old daughter in 2018. The new management took over, a paperwork made them out of the subsidized rent and they couldn’t make the market payments.

Life became a revolving door for short-term housing solutions: couch surfing, a detour to the First Friendship Baptist Church on Steiner Street, the Raphael House on Sutter Street and back to couch surfing.

“We managed to survive, but I wouldn’t wish my worst enemy would,” Mixon said.

It took almost a year, but Mixon, 50, was placed in a unit in the Eddy and Taylor Family Housing Building on Tenderloin, a permanent supportive housing facility where many residents are eligible for subsidized rent and have easy access to volunteer services, such as e.g. psychological support, vocational training and advice. She said it changed her life because it gave her and her daughter “a fresh start” and the chance to stabilize work, education and wellbeing.

This is the promise of the Housing-First philosophy, which San Francisco was one of the first major cities to adopt: give someone a permanent place to live, provide convenient access to robust care and resources, and a cascade of positive outcomes will follow.

“Homelessness is literally the lack of a home,” said Margot Kushel, who leads the Benioff Homelessness and Housing Initiative at the University of California San Francisco. “The solution is called living.”

Mixon eventually ended up in an apartment, but the scale of human suffering observed across the city suggests that San Francisco has yet to crack the code to turn this rosy philosophy into effective policy.

“Solving the homelessness crisis requires resources and a commitment to accommodate everyone – and then the ability to tailor services to meet needs,” said Kushel.

Numerous cities have run pilot projects showing the effectiveness of housing-first policies on a small scale. The easiest way to see this is how stable people become when they enter the unit, meaning they can afford reduced rent payments, stay in apartments, and provide services as needed.

Denver placed 365 chronically homeless people in homes where they had access to extensive services. Of these, 86% stayed home after one year and 77% after three years, according to the Urban Institute. Her health also improved. After two years in supportive accommodation, participants saw a 40% decrease in emergency room visits and a 65% decrease in city-run detox facilities.

Santa Clara County ran a similar pilot for people who frequently used acute medical, psychiatric, and other emergency services before choosing where to stay. Between 2015 and 2019, those in permanent care accommodation stayed there for 93% of the study time and they had fewer visits to the emergency room. In contrast, those who were not housed in supportive housing units were less likely to find stable housing.

The San Francisco hotel accommodations program also demonstrated the potential benefits of moving people off the street to apartment-like units. The city moved quickly to accommodate over 3,700 people affected by homelessness in rooms in 25 different hotels during the pandemic, with support from federal funding to reimburse those costs. Service providers say they have seen increased engagement with residents and improvements in quality of life, mental health and substance use.

Upscaling

According to Emily Cohen, assistant director of the Department of Homelessness and Supportive Living (HSH). However, at the last census in 2019, 8,000 people were still living on the streets or in shelters, and many people believe the number has increased during the pandemic.

In addition, as of June 30, there were 984 open-ended positions from a portfolio of over 8,000 units. Of the vacant positions, 633 were ready to move in after a recommendation.

Cohen acknowledged that failure to scale up a Housing First program to meet local needs “is one of the reasons people don’t necessarily feel the success of Housing First”.

Part of the problems that are escalating is the lack of funding, an obstacle created by the $ 1.1 billion the city allocated to homelessness over the next two years, and nationwide efforts in support of the supportive Housing called Project Homekey should be toned down significantly.

While Kushel said the Santa Clara pilot program was successful because of its laser-sharp focus on low-income housing investments, Cohen said San Francisco has struggled in the past to choose a strategy to stick to.

Mayor London Breed’s homeless recovery plan could be a start to the kind of massive investment likely to take to turn San Francisco living into a focused, viable solution.

The city plans to place 4,500 people in permanent supportive housing units and to increase its inventory of such units by at least 1,500 by June. If successful, this would be the largest expansion in 20 years.

However, according to the latest data from DataSF, The City has purchased 714 permanent supportive housing units and only placed 823 people in existing ones, more than a year since Breed announced their proposal.

Cohen acknowledged that The City needs to move faster: “San Francisco is not realizing its potential in terms of the speed with which people should be moved into apartments. This process is currently taking too long from the assessment to the transfer and the transfer to the placement. “

Shelters

Some believe that part of the answer lies in right to shelter laws, like the one in New York City, which mandate that shelter be provided to anyone at risk of homelessness. The result is a sprawling urban shelter system that slept more than 18,000 adults a day for the past fiscal year, according to the New York City Homeless Department.

Lawmakers tried – and failed – to do something similar in San Francisco. Most recently, supervisor Rafael Mandelman proposed a law in April that would have obliged the city to draw up a plan to protect all homeless people in tent sites, tiny homes or other options within two years. It was initially submitted to the committee.

While there will always be a need for short-term shelters, Kushel said that “a focus on shelter rather than housing is the worst of all options” because it “costs society a lot and does not solve homelessness”.

Still, San Francisco increased its bed capacity from 3,493 between January 2019 and January 2021 to 5,080, according to homelessness and supportive housing data. At the beginning of the year, 4,000 people were living in shelters or shelters.

“When people are in shelters, they are very homeless,” said Kushel. “They may be more out of the public eye, so it ‘solves’ the problem for the people who are housed, but that’s not at risk in this crisis.”

prevention

While housing initially helps put people in a more stable situation, the harsh reality remains that it is often too late by the time someone gets to a place they can call their own.

The Santa Clara study showed “extremely high death rates” even among those successfully housed. Of the 423 participants – some received a housing agency, some did not – the median age was 51 years, but 70 people died.

Another 2015 study published in BMC Public Health showed that chronically homeless death rates remained relatively unchanged even when people lived in supportive housing.

“Homelessness is absolutely devastating to health,” said Kushel. “By the time we shelter people, they are close to death, and then they die. Blaming Housing First is a little rich, but nonsensical. “

For every person homeless in San Francisco, there are more who are on the verge of falling into it. All it took Mixon was a series of financially troubled months to lose their three-decade home. Providing affordable housing to people on the brink of homelessness could gradually reduce the tragic effects of street life.

“That’s exactly why we have housing first, and that’s why we need housing first,” Cohen said. “These are the people who are most likely to die on the streets if we don’t intervene. Do we have to intervene earlier now? I would argue, yes. “

Breed’s plan to increase the city’s permanent housing support could stop the proverbial bleeding, but there is no solution to chronic homelessness that doesn’t include prevention.

The $ 1.1 billion also includes unprecedented investment in these prevention efforts guided by a general rule of thumb. Cohen says: For each additional housing resource, four prevention and two housing resources should also be added.

“We can’t get out of here,” she said. “We also have to prevent people from becoming homeless and create a safe place for them to become homeless.”

cgraf@sfexaminer.com