Why California Keeps Making Homelessness Worse

12.9.2019

California made homelessness worse by making perfect housing the enemy of good housing, by liberalizing drug laws, and by opposing mandatory treatment for mental illness and drug addiction.

What happened in California isn’t the first time that we progressives let our idealism get the better of us. To understand how the current disaster unfolded, we have to go back in time, back to the post-World War II era when progressive reformers convinced themselves and others that they could destroy the country’s system for dealing with the mentally ill and replace it with a radically different and wholly unproven alternative.

the psychiatrist E. Fuller Torrey, M.D., in his devastating and critically-acclaimed 2014 history,

Reformers felt they could do better. In 1945 they proposed community-based clinics not just to treat but also to prevent mental illness. They called for a federal takeover. Congressional advocates frequently invoked the US government’s Manhattan Project as inspiration. If America could build a nuclear bomb in a few years, why couldn’t we prevent and cure mental illness?

The reformers were so confident in their convictions that they smashed the state mental institutions before creating an alternative. The reformers hyped new psychiatric drugs, which reduced the symptoms of schizophrenia, as a bridge to the new system. There was little resistance to the radical changes by existing mental institutions, whose leadership had been demoralized and discredited. And yet there was no evidence that community-based treatment would work. Between 1948 and 1962, the test that clinic reformers pointed to as the model had not prevented a single case of mental illness or treated a single individual with schizophrenia.

, a novel about a sane but socially maladjusted man who was drugged, electro-shocked, and lobotomized by a mental institution, became a best-seller. In 1967, the film “King of Hearts” depicted psychiatric inmates after World War II as living happily once freed from their asylum. In 1975, the year “One Flew Over the Cuckoo’s Nest” became a hit film, Michel Foucault argued in

Over the next two decades, state mental hospitals would empty out. But the vast majority of released patients ended up homeless on the street. Congress had “encouraged the closing of state mental hospitals without any realistic plan regarding what would happen to the discharged patients,” notes Dr. Torrey, “especially those who refused to take medication they needed to remain well.”

In the end, no more than 5% of the federally-funded clinics “made any significant contributions to the care of patients being released from state mental hospitals,” finds Torrey. Financial abuses were rife, with clinics building tennis courts, swimming pools, and rooms for fads like “inhalation therapy” that did nothing for people with schizophrenia.

The problem, Torrey and other advocates for the mentally ill say, wasn’t de-institutionalization but rather the failure to provide new forms of treatment. “The majority of lives were little different than they had had while hospitalized,” he concludes, “and a significant number were considerably worse off.” Many didn’t even realize they were mentally ill, similar to some Alzheimer’s patients. For decades, radical reformers sought de-institutionalization in even the most extreme situations. In 1985, a public defender got a mentally ill client released from jail even though he had been found eating his feces.

in California, including Governor Jerry Brown, assumed “small-is-beautiful” policies would be better for the environment. Out of hubris, the reformers sought to smash the old institution before creating a new one. Intriguingly, that’s exactly what reformers would do again in California, 50 years later.

Homelessness experts and advocates disagree. “I’ve rarely seen a normal able-bodied able-minded non-drug-using homeless person who’s just down on their luck,” L.A. street doctor Susan Partovi told me. “Of the thousands of people I’ve worked with over 16 years, it’s like one or two people a year. And they’re the easiest to deal with.” Rev. Bales agrees. “One hundred percent of the people on the streets are mentally impacted, on drugs, or both,” he said.

Bales says things worsened ten years ago when L.A. and other California cities rejected drug recovery (treatment) as a condition of housing. “When the ‘Housing First’ with a harm reduction model people came in they said ‘Recovery doesn’t work,’” said Bales. “But it was after that when homelessness exploded exponentially.”

“Imagine having a sick child and hoping he attacks someone once a month so somebody can do something!” said Snook. “That is so out of sync with the rest of the country, and with what mental health care looks like, that it is laughable.”

“When you look at the amount of money being spent, and then you hear the argument that we need more money? You have to ask, ‘How much more?’” said Snook. “Right now it’s just good money after bad. There’s no oversight and no accountability.”

“[Housing First] is a dogmatic philosophy,” said Bales. “I’ve lost friends. One of my closest friends is attacking me for pushing for housing that costs $11,000 instead of $527,000 per person. He can’t get that we can't provide a $527,000 to $700,000 apartment for each person on the street. I’ve been in planning meetings where people said, ‘Everybody deserves a granite countertop,’ but that isn’t going to work for 44,000 people.”

Despite the emergency, and in some ways because of it, homeless reformers are hopeful today that California will seek a more moderate path toward treating mental illness and drug addiction and providing shelter. “The problem is so bad and so significant that there’s an opportunity now,” said Snook.

One sign of trouble was the resistance by some in California to receiving help from the federal government. “[Trump's] budget has proposed slashing public housing … and eliminating community development block grant dollars,” LA’s mayor

But others were more conciliatory “I am wary of any such offer from an administration that consistently demonizes vulnerable people,” the governor’s top homelessness advisor, Sacramento Mayor Darrell Steinberg, told me “And yet, if the federal government wants to offer resources to help bring people indoors and to offer federal facilities to shelter and house people, we should readily listen. We cannot afford to politicize an issue which needs real thought and real commitment.”

It’s hard to see any of what needs to happen as particularly partisan. “The key is focusing services on the seriously ill,” argues Snook. “You provide extended care. You open up beds for when they are stable. You provide care to people to stay out of the system.” What about the homeless who are not mentally ill? Focus on the hardest population first, he urged. “Once you get that population addressed, you can move on to the others. This is what New York City did. Once you get that population serviced, you’re not in crisis mode anymore, and you free up money for everyone else.”

Read more: Forbes

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