California doesn’t have a homeless crisis

We need to stop saying homeless “crisis” — California has myriad different homeless crises

We must think and act in terms of “tiers” of homelessness — Start with Los Angeles, the nation’s homeless epicenter

***Different cohorts have vastly different needs and challenges, yet policies are inflexible, one-size-fits-all — only serves to sustain the failed, fatal status quo***

It doesn’t take a Ph.D. in psychology or sociology to realize that the homeless people depicted in the collage above have vastly different needs on their individual roads to recovery and/or self-sufficiency. All were taken within the borders of the City of Los Angeles. The woman living in the camp pictured in the top left has fundamentally different needs than the woman to her right, discussing how she is on the brink of homelessness.

Yet the City of Los Angeles treats them the same, plugging them both into the arduous, glacial-paced, bureaucratic-intensive process euphemistically known as “permanent supportive housing” (PSH).

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

For two decades it’s been conventional wisdom that homelessness is a housing issue. A single cause behind a single crisis, presumably with a single solution. While policymakers and other officials acknowledge mental health, addiction, trauma, domestic violence, cyclical poverty, and other contributing factors, with apologies to the late Senator John McCain, the solutions always come down to, “build, baby, build.” Yet the above snapshots paint a far more nuanced picture. Some people will benefit immediately and for the rest of their lives if they are provided a stable, permanent, publicly funded place to live. However, hard experience leaves no doubt that that is a relatively small percentage of the overall population, perhaps a small minority.

Many, if not the vast majority, need immediate interventions that may have little or nothing to do with permanent housing. For that matter, many cannot wait months or years for PSH to come online — assuming it ever does[1] (I have documented elsewhere the hundreds, likely thousands of city- and county-owned units designated as homeless housing that stand vacant for months. In some cases years). These folks need triage, they need rental assistance, they need a safe place to park their vehicle or RV. They need a helping hand, a kind word. They need to be connected with resources they themselves can then pursue independently. Others need emegency mental health and substance abuse services today, wherever they happen to be, not whenever the City and County get around to finishing another multi-million dollar “affordable” housing development and they’re lucky enough for their number to come up on the list of applicants.

Again, there are myriad reasons and situations that lead to someone languishing on the street, and the people who find themselves in those situations come from wildly differing backgrounds. They’re down-on-their-luck professionals sleeping in tents next to career criminals, domestic abuse victims sharing a sidewalk with hardcore drug addicts. A 45-year-old Black woman who ends up on the street as the result 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. One size does not fit all. In fact, the particular size the city has designed fits virtually no one.

It is clear from these baseline demographic details that 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 among different ones from which we can build effective, compassionate, mindful interventions that will actually work.

Let’s look at just one statistic from the table above. 70% of homeless people have been incarcerated at some point in their lives. That’s a staggering number. One thing you learn very quickly interacting with people who have served time, particularly hardcore cases in state and federal prisons, is that they are often extremely difficult to house. People who have been incarcerated often refuse any sort of communal or even multi-family living arrangement. I’ve been told on many occasions point blank, “I won’t live anywhere but in a house or on the street.” Be definition, starting with PSH with this coo

Another important point: These solutions will depend in part on raising an entire new army of volunteers. Let’s be crystal: 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.

The basis of this new approach must start by recognizing, broadly, the various cohorts of homeless people. That is, we must address different homeless crises rather than a homeless crisis. We need to think and act in terms of“tiers” of homelessness, starting with those who still have a roof over their heads but are at risk of homelessness in the immediate or near future. We also need to focus on provisions and services that can be brought online far more rapidly than “all PSH all the time.”

A few common threads can be the foundation for more broad-based interventions and solutions[2]

Before getting into the different cohorts/tiers it’s essential to explore some common threads among them. These fundamentals ought to be included in all levels of humanitarian intervention and services, and mark a good place to start. In fact, if in the coming months we establish reliable provision of basics like hot food, clean water, basic hygiene, safe spaces (outdoors to start), and connections with actual services we will be miles ahead of where we are today. That’s because we will be helping the folks who are in the first two tiers, preventing them from slipping away, while at the same time providing dependable basic services for the more “hardcore” cases while they await PSH in months or years. PSH proponents argue you can’t help someone who doesn’t have a roof over their heads. If that’s true, then we definitely can’t help folks who don’t have a warm meal in the stomachs.

No one can argue with the following, and policy ought to be refreshed to start here:

Food – As much as 40% of the food in L.A.’s grocery stores and restaurants ends up in landfill. This is nothing less than a moral crime at a time when hundreds of thousands of families experience some degree of food insecurity every year. We can design effective interventions that capture some of this extreme waste and re-route it to those in need. To help meet the particular 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. We have learned from the pandemic, we must now actualize those lessons.

Safe Spaces – Some homeless and at-risk 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.

Clean water – Insane as it is to say in the United States in 2023, 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.

Humanitarian Relief Facilities

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.

Tiers of homelessness

TIER 1: ON THE BRINK

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
• Actively working to avoid homelessness but often are frustrated and even thwarted by the very emergency/urgency services that are supposed to help

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:

• None — the goal with this cohort is to get them back on their feet and back to self-sufficiency as quickly and permanently as possible

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

TIER 2: 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
• Many are actively working to get out of homelessness but are frustrated and even thwarted by the very emergency/urgency services that are supposed to help

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
• 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

TIER 3: 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:

• Counseling and therapy services
•  

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

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

TIER 4: 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 emotional harms

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

Conclusion: A new way forward

Despite decades of effort, countless billions in spending, and the involvement of armies, Los Angeles — like California as a whole — is farther than ever from solving the homeless crisis. As the saying goes, a form of insanity is to keep doing the same thing over and over while expecting different results.

Only one question remains: Who will lead?

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[1] 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.

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