WEEKEND READ: A New Approach to the Homeless Crisis in Los Angeles — Maybe Nationally

L.A.’S APPROACH TO HOMELESSNESS IS UPSIDE DOWN AND BROKEN. HERE’S A NEW APPROACH THAT MIGHT WORK AND UNITE ANGELENOS

In keeping with the simplistic and often downright simple-minded dichotomies that have infected every corner of U.S. politics these days, when it comes to homelessness most politicians in L.A. have joined one of two distinctly opposed, and yes, distinctly simple-minded, sides.

One side (let’s call them the Hatfields) believes the only possible solution is so-called permanent supportive housing. That is, every one of the tens of thousands of homeless people living on the streets, and the tens or perhaps hundreds of thousands living in marginal housing (as we previously covered extensively, no one knows for sure how many homeless live in L.A. and official estimates are so unreliable as to be less than useless) is deserving of their own individual apartment, free of charge, for life, as well as a full slate of services they need to stay clean, sane, sober, employed, and out of jail.

On the other side are the McCoys, who say no, no, no, the only thing that can finally address the spiraling situation is an immediate declaration of a state of emergency. The McCoys argue that extraordinary (and possibly extrajudicial) measures can free up the necessary resources and cut the endless bureaucratic red tape that stand between the City and solutions. Before we can get homeless people into apartments we need to get them off the streets.

Both the Hatfields and the McCoys believe that their solution is the solution, and if the other side would just get out of the way we’d at long last join hands, sing Kumbaya, and usher the literally unwashed masses into sparkling new facilities that will in one fell swoop solve the crisis once and for all.

And if you believe either of them there’s a bullet train in Fresno I’d like to sell you.

Both solutions have been tried, repeatedly over years and at great cost to the public fisc not to mention the public’s morale. And both have worked, kind of, for a while, here or there, and otherwise failed spectacularly. In 2016 and 2017 City and County voters approved a pair of ballot initiatives that collectively have pumped some $4 billion into – oh, let’s call them “solutions” and “programs.”

How’s it working? In 2017 there were 33,000 homeless people in the City and 55,000 in the County. By 2022 the populations had increased to 42,000 and 69,000 respectively. This, despite two and a half years of near-universal eviction protections for L.A. tenants, not to mention all those billions in spending.

But the Hatfields and McCoys have dug in. Rather than coming together and figuring out a better way forward they take potshots at each other. If you think talking to a Trump supporter can be challenging, try talking a YIMBY out of permanent supportive housing. You may as well try to stop an Abrams tank with a handful of rocks.

The problems with both approaches are well enough known by now that they don’t need to be repeated. Suffice it to say, in the real world permanent supportive housing has proven to be almost never permanent, rarely supportive, involving units that sometimes barely qualify as housing at all. And a state of emergency comes with myriad known and unknown legal and law enforcement ramifications.

For this installment of the all aspect report’s WEEKEND READS series, we present a novel approach to the homeless crisis in L.A. Starting with a demographic snapshot, it breaks down the homeless population into four broad “tiers,” each with roughly similar characteristics. It also identifies specific confounders across tiers, such as experience with incarceration, history of domestic abuse, etc. The goal is to start viewing the homeless population as a collection of individuals with shared life experiences. It’s meant as a thought piece, and likely will be expanded and revised with time and experience.

SNAPSHOT OF L.A.’S HOMELESS POPULATIONS

Demographics	Behavioral characteristics	Lived experiences
36.1% are Latino (compared to 48.5% of the overall population) 33.7% are Black (compared to 8% of the overall population) 25.5% are White (compared to 26.3% of the overall population) 67.1% are male 32.5% are female 0.3% are trans/non-binary 22% are youth (<26 years old) 9.9% are seniors (>55 years old) 19% are physically disabled 8% are veterans	41% overall report substance use or mental health issues 27% report substance use alone† 25.1% report long-term mental health issues alone† 84% of homeless adults are unemployed 70% of homeless people have been in jail/prison 85% of the adult prison population have substance use disorders (“SUD”)	62% are chronically homeless (>1 year) 50% of homeless women report domestic or sexual violence 33% of all homeless report domestic or sexual violence 48% graduated from high school 32% have a bachelor degree or higher

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WE MUST START BY RECOGNIZING THAT LOS ANGELES DOESN’T HAVE A SINGLE HOMELESS CRISIS, WE HAVE MULTIPLE HOMELESS CRISES

It isn’t just clever semantics to distinguish a single homeless crisis from a collection of spiraling homeless crises; it’s a fundamental shift in how we perceive and therefore respond to tragic situations unfolding across Los Angeles.

For two decades it has been conventional wisdom that homelessness is a housing issue, that is, a single cause behind a single crisis, presumably with a single solution. Yet the above demographic snapshots paint a far more complex, nuanced picture. Some people will benefit immediately and for the rest of their lives simply by finding a stable, permanent place to live. However, hard experience leaves no doubt that that is a small percentage of the overall population.

Many more, if not the overwhelming majority, need other interventions. They cannot wait months or years for so-called permanent supportive housing (“PSH”) to come online[‡]. They need triage. They need mental health and substance abuse services today, not whenever the City and County get around to finishing another multimillion dollar “affordable” housing development and they’re lucky enough for their number to come up on the random list of applicants.

There are myriad reasons and situations that lead to someone languishing on the street. When it comes to solutions one size does not fit all. A 45-year-old Black woman who ends up on the street out of an abusive marriage has fundamentally different needs than a 20-year-old white guy who just got off a bus from somewhere else with nothing but a few bucks and a bag of meth to his name.

We must design specific interventions that reach specific sub-populations. We can start by looking at different cohorts of homeless Angelenos, and look for common denominators from which we can build effective, compassionate, mindful interventions that will actually work.

Another important point: These solutions will depend in part on raising an entire new army of volunteers. Our response to the homeless humanitarian crisis must be an all-hands-on-deck, Manhattan Project, wartime footing, choose your analogy effort.

Government has shown it cannot do it alone. The nonprofit sector has shown they cannot do it alone. The only way this crisis gets solved is with smart, compassionate, results-based strategies that engage different cohorts of homeless people differently and also activate thousands of volunteers in every single corner of the City.

WE NEED TO IDENTIFY COHORTS OF HOMELESS PEOPLE WITH SIMILAR EXPERIENCES AND NEEDS AND TAILOR SOLUTIONS

What follows is a suggestion for a new approach to homelessness, one that starts with people’s actual needs and experiences. It identifies four broad tiers of homelessness based on the severity. “Tier One” starts with people who are either very recently homeless or on the brink of full-time homelessness. Effective interventions hopefully can catch them before they begin a true death spiral. At the other end of the spectrum, “Tier Four” consists of individuals who have been homeless so long and/or experienced such trauma that they have completely lost their way back. Many if not all the individuals in this tier will require extensive, potentially lifelong services and help.

Of course even within these tiers there will be still more granular distinctions. For example, 70% of homeless people have been incarcerated. Again, someone who just got out of county jail for their first minor offense has far different challenges than a hardcore ex-con who spent 20 years in a supermax prison. Individuals who have experienced extended solitary confinement present still other issues.

One of the central, ongoing challenges is the degree to which individual homeless people are willing to accept help in the first place. Statistically and anecdotally we know that a huge portion of so-called hardcore homeless – identified here as Tier Three and Tier Four – are resistant to any kind of shelter.

Tier One: On the margins

Cohorts:

• Individuals who became homeless recently (<30 days without meaningful shelter)
• Individuals cycling in and out of homelessness
• Individuals who are marginally housed (couch surfing, residing with friends or relatives, staying in temporary lodging)
• Individuals who are homeless by choice

General characteristics:

• Able to tend to basic daily needs
• No significant psychological, emotional, or addiction issues
• Receptive to meaningful, thoughtfully targeted interventions
• Maintain some degree of connection with family and friends
• Tend to be either younger or older than the average homeless population

Immediate needs:

• Safe, comfortable, stable shelter
• Meaningful connections to services and resources geared toward an immediate return to self-sufficiency
• Meaningful opportunities for stable employment
• Social activities and opportunities to engage with the community
• Assistance mending relationships with family and friends

Ongoing needs:

• Most will have none
• Some will need periodic check-ins or ongoing light/talk therapy

Interventions:

• Connections to resources for permanent housing, including standard market rate rentals
• Connections to job and career counseling appropriate for each individual’s experiences
• Connections to educational opportunities, including traditional schools and colleges as well as trades
• Low-level emotional support such as talk therapy, group therapy, group activities, sponsors

Goals:

• Immediate compassionate shelter and triage options according to need
• Prevent people falling into homelessness in the first place
• Prevent those who recently lost housing from spiraling into long-term or permanent homelessness
• Complete return to complete self-sufficiency
• Assist willing out-of-city and out-of-state homeless people with returning home
• In turn, teach recovering homeless people and people who were prevented from becoming homeless in the first place to “pay it forward” and help others in similar situations

Tier Two: Slipping away fast

Cohorts:

• Individuals who have been homeless for less than six months
• Individuals with substandard but still permanent shelter (vehicles, improvised shelters, squatting in abandoned or condemned structures)
• Individuals with mild challenges with drugs and alcohol, such as young people who have not yet succumbed to hard core addiction and can still be “caught”
• Individuals with mild but long-term psychological or emotional issues (including those who have more severe conditions like schizophrenia but are able to maintain their treatment regimens)
• Individuals whose experiences have caused them to “choose” homelessness

General characteristics:

• Able to tend to basic daily needs without assistance
• Psychological, emotional, and/or addiction issues that do not significantly disrupt  an individual’s abilities to interact with others, maintain relationships, and remain employed
• Mild resistance to targeted interventions, resistance often based on prior bad experiences with service providers and/or the City
• Most still maintain some degree of connection with family and friends, though in many cases those connections are fraying rapidly

Immediate needs:

• Safe, comfortable, stable shelter
• Meaningful connections to services and resources
• Meaningful opportunities for stable employment
• Social activities and opportunities for community
• Assistance mending relationships with family and friends

Ongoing needs:

• Continuing treatment of psychological, emotional, and/or addiction issues
• Ongoing “check-in’s” to ensure individuals remain committed to their course of action and that appropriate resources continue to provide support
• Most Tier Two homeless individuals will not need long-term care, support, or monitoring.

Interventions:

• Connections to resources for permanent housing, including standard market rate rentals
• Connections to job and career counseling appropriate for each individual’s experiences
• Connections to educational opportunities, including traditional schools and colleges as well as trades
• Low-level emotional support such as talk therapy, group therapy, group activities, sponsors
• Minimal ongoing supportive services for those who need or want it, particularly ongoing counseling or therapy

Goals:

• Immediate compassionate shelter and triage options according to need
• Focus on mental health and drug addiction to prevent problems from spiraling out of control
• Likewise, use temporary shelter to prevent short-term bad luck from metastasizing into long-term or hardcore homelessness
• Like Tier One, the long-term goal for Tier Two homeless individuals is a return to complete self-sufficiency
• Assist willing out-of-city and out-of-state homeless people with returning home
• In turn, teach recovering homeless people to “pay it forward” and help others in similar situations

Tier Three: Rock bottom

Cohorts:

• Individuals who have been homeless more than six months and less than 24 months
• Individuals living long-term in illegal encampments that don’t have the characteristics of those in Tier Four
• Individuals with moderate to severe psychological, emotional, and/or addiction issues but who have not yet reached the point of no return

General characteristics:

• Inability to perform some of the basic daily life tasks
• Severe psychological, emotional, and/or addiction issues including extreme delusions, paranoia, extreme mood swings, tendency toward physical violence, tendency toward physical or psychological self-harm
• Severe resistance to outreach and services
• Severe trust issues
• Often prefer street life to any form of shelter or housing
• Virtually no contact with family or friends

Immediate needs:

• Safe, comfortable, stable emergency shelter
• Emergency triage for physical and emotional harms
• High degree of one-on-one intervention
• Possible use of conservatorships in extreme situations

Ongoing needs:

• More intensive psychological/psychiatric services
• Ongoing counseling and therapy services
•  Supportive housing on a long-term basis
• Job placement assistance
• Potential long-term care in a licensed facility

Interventions:

• Scaled humanitarian interventions modeled after successful operations in disaster zones (such as Hurricanes Katrina and Rita, the 2004 Southeast Asia tsunami, the Fukushima disaster, and the like)
• Permanent humanitarian relief facilities including relief camps, Red Cross style Humanitarian Relief Facilities (“HRF”), mobile relief assets (especially medical)
• Safe sleeping sites
• Permanent facilities that provide temporary and short-term shelter options such as tiny homes, shared housing, and pod sharing at identified City and private properties
• Law enforcement involvement as necessary to prevent criminals preying on long-term homeless

Goals:

• Immediate compassionate shelter and triage options according to need
• Help people recover from intensive psychological problems, including potential long-term or even lifelong treatments
• Prevent fatalities, especially via drug overdose
• Assist willing out-of-city and out-of-state homeless people with returning home

Tier Four: Lost the will

Cohorts:

• People who have been homeless for two years or more
• Individuals whose psychological, emotional, and/or addiction issues have resulted in a complete break from society, even reality
• Individuals with severe, acute psychological, emotional, or physical wounds that require immediate lifesaving interventions
• “Hardcore” homeless: Individuals living for extended periods or permanently in the worst encampments characterized by crime (both random and organized), sexual violence, sexual exploitation, drug manufacturing and sales, constant physical peril, infections, vermin
• Individuals who are past the point of no return and who will require lifelong interventions, treatments, and services including permanent supportive housing

General characteristics:

• Total Inability to perform any of the basic daily life tasks
• Living in the most extreme conditions including languishing in their own filth, life-threatening levels of infectious diseases and vermin
• One or more active illnesses including necrotizing fasciitis, shigellosis, typhus, trench fever, tuberculosis, hepatitis, HIV, etc.
• Permanent, debilitating psychological, emotional, and/or addiction issues including complete breaks from reality, extreme paranoia, hallucinations, extreme mood swings, extreme tendency toward physical violence, extreme tendency toward physical or psychological self-harm
• Extreme resistance to outreach and services
• Extreme trust issues
• Prefer street life to any form of shelter or housing
• Complete break in contact with family or friends

Immediate needs:

• Safe, comfortable, stable emergency shelter
• Emergency triage for physical and psychological pain

Ongoing needs:

• Permanent supportive housing
• Long term, in most cases lifelong  treatments and services

Interventions:

• High degree of one-on-one intervention
• Use of compassionate conservatorships in extreme situations
• Use of compassionate involuntary civil confinement in extreme situations
• Neighborhood training sessions to help housed residents do their part when and where safe
• Collaboration with law enforcement to combat criminal activities at illegal encampments, particularly organized crime groups that intentionally prey on homeless people

Goals:

• Immediate compassionate shelter and triage options according to need
• Prevent fatalities, especially via drug overdose
• Assist willing out-of-city and out-of-state homeless people with returning home

WE CAN START BY IDENTIFYING BASIC NEEDS AND INTERVENTIONS THAT ALL HOMELESS PEOPLE NEED, AND USE THEM AS FOUNDATIONS FOR LONG-TERM INTERVENTIONS[§]

While the different tiers have different specific needs we can identify some common needs and interventions. These fundamentals ought to be included in all levels of humanitarian intervention and service.

Food – As a major City, Los Angeles throws as much as 40% of its food ends up in the landfill. We cand design effective interventions that capture some of this unnecessary waste and re-route it to those in need. To help meet the special needs of children, we also must ensure that we can reliably provide infant formula and baby food, as well sack lunches to take to school.

Clean water – Recent events around the country, including right here in Los Angeles, have reminded us that clean, potable water is not something to be taken for granted. As extreme heat and other weather events become more common due to climate change and other factors we must be mindful of how quickly we can find ourselves in a crisis.

Safe Spaces – Some homeless people literally just need a break, a chance to catch their breath in a safe, welcoming, compassionate place. These spaces can provide temporary (a few hours) relief from street life. They can be as simple as a red cross-style tent or an unused or underutilized property. Some also should be connected to full-scale Humanitarian Relief Facilities, as described below.

Shelter – Likewise, we must shift from an obsessive focus on PSH to more nimble, realistic, and cost-effective temporary and short-term solutions that, if executed correctly, prevent the need for PSH in the first place.

Personal Hygiene – To date the City’s efforts to provide clean porta-potties and hand washing stations, much less hot showers and personal hygiene supplies to homeless people have been abysmal. No one in Los Angeles should ever know the want of a toothbrush. We can do better, and we will.

Clothing – It’s amazing what a clean set of clothes and can do for a person’s outlook. Clean clothing must be available for those who may have little more than the clothes on their back.

Clinics – An even greater failing has been the City’s and County’s collective in ability to provide stable, reliable, available health care services to homeless people in L.A. We must look to successful programs elsewhere and learn from them. Fore example, Union Rescue Mission in downtown L.A. partners with local universities who donate their time and expertise to provide the Mission’s clients with  services like essential dental care, professional mental health services, and even full-time legal aid counseling.

SERVICES CAN BE DELIVERED THROUGH DEDICATED HUMANITARIAN RELIEF CENTERS

Relief Center – These centers could be modeled after those Red Cross HRFs. They should professionally staffed and open every day to provide a safe place for people with nowhere else to go. Relief centers can provide separate spaces for men and women with enclosed courtyards, green spaces, and gathering areas.

Family Relief Centers – Some relief centers need to be special places where mothers and children can get off the streets and engage in one-on-one interaction or simply find a quiet space where a tired toddler can nap or a mother can rock a baby to sleep. These relief centers should also provide books, games, toys, puzzles, and learning opportunities. They can be partnered with nonprofits like School on Wheels.

Services Centers – Scheduling a job interview, applying for aid, saving money, or enrolling a child in school are virtually impossible without an address or telephone number. Trained staff and community volunteers can assist with a variety of issues and critical needs. include recovery from substance abuse, vocational guidance, parenting skills, nutrition education, and financial management.

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[*] Numbers are drawn from the 2020 point-in-time (PIT) count and NIH data.

[†] Note this is double the percent reported in the 2019 PIT count, as a result of “new methodology.” According to most experts it is still a massive underestimate.

[‡] Another truth we have learned through experience is that PSH is not always permanent, rarely supportive, and in many cases barely qualifies as housing by any reasonable standard.

[§] This list largely was cribbed from the Union Rescue Mission’s website (https://urm.org/services/emergency/)