After having spent just about 20 years in the non profit sector serving the intersecting populations of homelessness, poverty, mental health and substance use I can say your attempt here is admirable.
Here’s my two cents… why is homelessness on the increase no matter how much money is thrown at it? Firstly, the political environment and contemporary policy focused on humans rights has changed the way homelessness is viewed and addressed systemically. Second, accessible housing stock across the spectrum has not grown in relation the population needing housing. Housing first models only work in markets where there is a wealth low cost housing and amiable landlords. But, the housing first experiment is at its end: the market doesn’t bare the necessary stock, the market is inaccessible and landlords are done with offering there assets to non profits in search of housing for clients who destroy their space.
Shipping people off to non urban areas to be warehoused will never happen. It’s too anti human rights and our political system is committed to propping up the ‘rights’ of the marginalized over just about everything else. However, I agree, too am not keen to have under managed housing sites serving this population anywhere near my home, and why should we? It’s not nimbyism, it’s common sense… and nimbyism is just another jargon term advocates use to offload responsibility to communities, I don’t buy it anymore
The drugs are worse, fentanyl has destroyed swaths of lives over the past decade. Meth has generally replaced cocaine crack. The intensity of addiction grows.
And the myth that all this investment helps people become productive members of society is just untrue. For the majority of people housing, mental health and substance use supports, if lucky, achieve a level of stabilization, which is great, but not much more, so people are then stuck on the dole for life.
Therapeutic recovery communities are an answer for some, but not all.
The ideology of Harm reduction has changed our approach from increasing health outcomes to accepting an individual’s right to live at risk, while magically funding them to do so.
Involuntary care will only work for a select few and is costly.
More housing across the spectrum, away from neighborhoods , with policy that crack down on social disorder and camps, Opportunities for therapeutic recovery centers.
Regarding mental health, change our system, create upstream solutions for more youth and families.
The current medical approach is supposed to be compassionate and respectful of the individual’s rights to make their own choices about their health care problems. Unfortunately, people with addictions and mental health problems struggle to make informed, rational, long range decisions about their treatment options, because their brains have been hijacked by their conditions. So, we are expecting irrational people who can’t think straight to make rational decisions. Leaving them to wallow in misery because they can’t think straight isn’t really compassionate, but the advocates and activists want you to think it is. The Alberta approach has drifted back toward giving the mentally ill and addicted a “nudge” in the right direction.
The logic that stabilizing the housing would take one problem off the plate so they could focus on the other problems really doesn’t work all that well. I’ve researched fairly extensively, and the only large scale example where it might have worked was Denmark, but even there the details are hard to parse out, and they are still chasing their tail, trying to have enough housing to meet the demand.
The other part of the “homeless” problem is that there seems to be a subset of anarchists in the mix. These seem like people who don’t have huge issues with mental illness or drugs, but they figure they have a right to set up camp somewhere, not pay rent, avoid taxes, and generally flout social and societal conventions. They are often interviewed in the media, and have all the right words to say about the poor down and outs they live among, but they can tell stories of their own fairly stable life on the streets over a span of months to years. Some even have jobs, but have landed in situations where the income is less than the outgo (poor decisions, family support obligations, gambling, general inability to get along with others at work and at home, criminality, possible antisocial or psychopathic tendencies) They aren’t the same as the others. They’ve chosen to live on the streets. They resist efforts to move them off the streets. I’m not sure they would accept Housing First options, because there are rules. They should be subject to the same laws as the rest of us.
As a police officer in the ‘70s, ‘80s and ‘90s I was regularly called upon to assist people who were clearly in need of mental health care. The laws, and the protocols, at that time enabled us to convey such people to facilities where doctors could examine them and, when necessary (ie if the subjects would not voluntarily accept treatment) ‘section’ them and hold them for their own good and that of the community.
Twenty-odd years ago those secure facilities started to close down. Moreover, doctors became increasingly reluctant to commit patients into care against their will. What we are seeing now is, in part, a result of that evolution.
Homelessness - living on the street - is not the problem. It’s a symptom of a much larger and more difficult (or impossible) problem.
Society needs to realize that we cannot rehabilitate and reintegrate today’s unhoused, at scale. Most of the homeless are never going to be “cured”, so our solutions need to be focused this way.
Alan Graham and the city of Austin, Texas have developed a good approach for addressing the homelessness epidemic, documented in a story by the NYT here:
Great article David. I believe involuntary long term care facilities need to be opened up, specifically for treatment resistant addicts. Access to treatment ought to be expanded obviously. But the conversation around this issue never seems to focus on the fact that 30-40 percent of opioid addicts will NEVER shake their addiction in a lasting way. We need a different strategy for this population and letting them rot in the streets while they commit crimes to feed the habit is not an acceptable solution
It appears to me that for some time, exacerbated by the pandemic, we have been dealing with the predictable results of the efforts by advocates, supported by provincial governments, to close mental health facilities in the 1980s
We certainly do need to address mental illness. But while we're doing that, there are thousands living on the street and neighbourhoods at risk from associated violence and crime that also need addressing. One simply can't wait for the other to go away.
Is there actually an epidemic of mental illness? Or is it just that the shutdown of mental institutions (like Riverview and Essendale in Vancouver) that began in the late 1970s with the introduction of psychotropic drugs, which were supposed to guarantee mentally ill patients a "normal" life (if they were actually prescribed and actually took the drugs), has demonstrated that in fact institutions like this are needed and it's time to get past the social stigma. Of course not all street dwellers are mentally ill and in need of treatment, but a good portion of them are, and they need help. The experiment has failed. Larger scale drug treatment institutions are also clearly needed. The current model (in BC at least) is unworkable and ineffective. Addicts are revived sometimes several times a day by naxolone and put right back where they came from, ready for the next trip. Setting up cute little tiny house communities and other gathering places in urban and suburban areas without the necessary treatment facilities is a fools errand. Mentally ill and drug addicted street dwellers invariably attract the third spoke to the homeless wheel: the criminal element. Perhaps if the first two spokes were dealt with more effectively and efficiently by larger scale treatment the third one would subside, maybe.
My mother worked at Essendale and was very upset with the decision to close it. She knew what was coming. PM Thatcher ordered "community care" with a similar effect in Britain a bit later. I like David's idea with perhaps a bit more work and then a pilot. I have watched the "evolution" of the Downtown Eastside in Vancouver since the 60s. There is community there but also a ton of hurt. We have to keep trying.
So did my mum as a nurse in the 50s and early 60s. I did a bit of research on why places like that were closed down. It is coincidental with the invention of psychotropic drugs that were supposed to replace what was termed "incarceration" in mental institutions. Those drugs work but only if you're prescribed them and take them. I worked on a trial of someone suing the BC health system for life-changing injuries suffered at the hands of someone undergoing a psychotic episode who was refused treatment at various downtown Vancouver hospitals and told to go back to his shelter. He went nuts with a machete. His mother testified that he should have been institutionalized decades ago. he was a danger to society. but instead he lived in the DTES.
After having spent just about 20 years in the non profit sector serving the intersecting populations of homelessness, poverty, mental health and substance use I can say your attempt here is admirable.
Here’s my two cents… why is homelessness on the increase no matter how much money is thrown at it? Firstly, the political environment and contemporary policy focused on humans rights has changed the way homelessness is viewed and addressed systemically. Second, accessible housing stock across the spectrum has not grown in relation the population needing housing. Housing first models only work in markets where there is a wealth low cost housing and amiable landlords. But, the housing first experiment is at its end: the market doesn’t bare the necessary stock, the market is inaccessible and landlords are done with offering there assets to non profits in search of housing for clients who destroy their space.
Shipping people off to non urban areas to be warehoused will never happen. It’s too anti human rights and our political system is committed to propping up the ‘rights’ of the marginalized over just about everything else. However, I agree, too am not keen to have under managed housing sites serving this population anywhere near my home, and why should we? It’s not nimbyism, it’s common sense… and nimbyism is just another jargon term advocates use to offload responsibility to communities, I don’t buy it anymore
The drugs are worse, fentanyl has destroyed swaths of lives over the past decade. Meth has generally replaced cocaine crack. The intensity of addiction grows.
And the myth that all this investment helps people become productive members of society is just untrue. For the majority of people housing, mental health and substance use supports, if lucky, achieve a level of stabilization, which is great, but not much more, so people are then stuck on the dole for life.
Therapeutic recovery communities are an answer for some, but not all.
The ideology of Harm reduction has changed our approach from increasing health outcomes to accepting an individual’s right to live at risk, while magically funding them to do so.
Involuntary care will only work for a select few and is costly.
More housing across the spectrum, away from neighborhoods , with policy that crack down on social disorder and camps, Opportunities for therapeutic recovery centers.
Regarding mental health, change our system, create upstream solutions for more youth and families.
The current medical approach is supposed to be compassionate and respectful of the individual’s rights to make their own choices about their health care problems. Unfortunately, people with addictions and mental health problems struggle to make informed, rational, long range decisions about their treatment options, because their brains have been hijacked by their conditions. So, we are expecting irrational people who can’t think straight to make rational decisions. Leaving them to wallow in misery because they can’t think straight isn’t really compassionate, but the advocates and activists want you to think it is. The Alberta approach has drifted back toward giving the mentally ill and addicted a “nudge” in the right direction.
The logic that stabilizing the housing would take one problem off the plate so they could focus on the other problems really doesn’t work all that well. I’ve researched fairly extensively, and the only large scale example where it might have worked was Denmark, but even there the details are hard to parse out, and they are still chasing their tail, trying to have enough housing to meet the demand.
The other part of the “homeless” problem is that there seems to be a subset of anarchists in the mix. These seem like people who don’t have huge issues with mental illness or drugs, but they figure they have a right to set up camp somewhere, not pay rent, avoid taxes, and generally flout social and societal conventions. They are often interviewed in the media, and have all the right words to say about the poor down and outs they live among, but they can tell stories of their own fairly stable life on the streets over a span of months to years. Some even have jobs, but have landed in situations where the income is less than the outgo (poor decisions, family support obligations, gambling, general inability to get along with others at work and at home, criminality, possible antisocial or psychopathic tendencies) They aren’t the same as the others. They’ve chosen to live on the streets. They resist efforts to move them off the streets. I’m not sure they would accept Housing First options, because there are rules. They should be subject to the same laws as the rest of us.
As a police officer in the ‘70s, ‘80s and ‘90s I was regularly called upon to assist people who were clearly in need of mental health care. The laws, and the protocols, at that time enabled us to convey such people to facilities where doctors could examine them and, when necessary (ie if the subjects would not voluntarily accept treatment) ‘section’ them and hold them for their own good and that of the community.
Twenty-odd years ago those secure facilities started to close down. Moreover, doctors became increasingly reluctant to commit patients into care against their will. What we are seeing now is, in part, a result of that evolution.
These shelter housing sites would be more acceptable if laws were upheld around them.
Any illegal activity, drugs, assaults, disturbances etc. should not be allowed, and laws should be strictly enforced.
Police should be close by to nip any illegal sctivity in the bud.
Hopefully the legal system would help out by putting in prison for a long time everyone who is involved in illegal acivities.
Homelessness - living on the street - is not the problem. It’s a symptom of a much larger and more difficult (or impossible) problem.
Society needs to realize that we cannot rehabilitate and reintegrate today’s unhoused, at scale. Most of the homeless are never going to be “cured”, so our solutions need to be focused this way.
Alan Graham and the city of Austin, Texas have developed a good approach for addressing the homelessness epidemic, documented in a story by the NYT here:
https://www.nytimes.com/2024/01/08/headway/homelessness-tiny-home-austin.html
This approach involves moving homeless people out of the city and into an environment where they can live out the rest of their lives.
It’s long-term hospice. That’s how we need to think about this problem, if we’re going to be honest.
Great article David. I believe involuntary long term care facilities need to be opened up, specifically for treatment resistant addicts. Access to treatment ought to be expanded obviously. But the conversation around this issue never seems to focus on the fact that 30-40 percent of opioid addicts will NEVER shake their addiction in a lasting way. We need a different strategy for this population and letting them rot in the streets while they commit crimes to feed the habit is not an acceptable solution
It appears to me that for some time, exacerbated by the pandemic, we have been dealing with the predictable results of the efforts by advocates, supported by provincial governments, to close mental health facilities in the 1980s
Solutions are easy. It’s finding the will that’s hard.
https://hoisttheblackflag.substack.com/p/no-more-excuses?r=26wsm2
We must address the epidemic of mental illness first .
We certainly do need to address mental illness. But while we're doing that, there are thousands living on the street and neighbourhoods at risk from associated violence and crime that also need addressing. One simply can't wait for the other to go away.
Is there actually an epidemic of mental illness? Or is it just that the shutdown of mental institutions (like Riverview and Essendale in Vancouver) that began in the late 1970s with the introduction of psychotropic drugs, which were supposed to guarantee mentally ill patients a "normal" life (if they were actually prescribed and actually took the drugs), has demonstrated that in fact institutions like this are needed and it's time to get past the social stigma. Of course not all street dwellers are mentally ill and in need of treatment, but a good portion of them are, and they need help. The experiment has failed. Larger scale drug treatment institutions are also clearly needed. The current model (in BC at least) is unworkable and ineffective. Addicts are revived sometimes several times a day by naxolone and put right back where they came from, ready for the next trip. Setting up cute little tiny house communities and other gathering places in urban and suburban areas without the necessary treatment facilities is a fools errand. Mentally ill and drug addicted street dwellers invariably attract the third spoke to the homeless wheel: the criminal element. Perhaps if the first two spokes were dealt with more effectively and efficiently by larger scale treatment the third one would subside, maybe.
My mother worked at Essendale and was very upset with the decision to close it. She knew what was coming. PM Thatcher ordered "community care" with a similar effect in Britain a bit later. I like David's idea with perhaps a bit more work and then a pilot. I have watched the "evolution" of the Downtown Eastside in Vancouver since the 60s. There is community there but also a ton of hurt. We have to keep trying.
So did my mum as a nurse in the 50s and early 60s. I did a bit of research on why places like that were closed down. It is coincidental with the invention of psychotropic drugs that were supposed to replace what was termed "incarceration" in mental institutions. Those drugs work but only if you're prescribed them and take them. I worked on a trial of someone suing the BC health system for life-changing injuries suffered at the hands of someone undergoing a psychotic episode who was refused treatment at various downtown Vancouver hospitals and told to go back to his shelter. He went nuts with a machete. His mother testified that he should have been institutionalized decades ago. he was a danger to society. but instead he lived in the DTES.
Yes and yes