In March 2021, a joint funeral for seven residents was held at the Mission Hotel in San Francisco. The hotel is one of the properties leased by the city to house unsheltered residents, and deaths occur so frequently in these facilities that communal memorial services have become commonplace. Although causes of death vary, 40% of the deaths commemorated at these services are due to drug overdose.
These former hotel residents were homeless, so the city assisted them by providing them with permanent shelter. Given a strict definition of “homeless,” this seems to solve the problem. People who didn’t have a home before now own a home.
But for people suffering from trauma, mental illness, and substance abuse, homelessness is a symptom of a deeper problem. This is especially true in the age of fentanyl. We can warehouse all the people currently living on the streets and hang a “Mission Accomplished” banner over the door of their new home. Still, we eventually realize that we were too quick to uncork the champagne.
Since the passage of the Homeless Emergency Assistance and Rapid Transition to Housing (HEARTH) Act in 2009, the federal government’s approach to solving homelessness has been driven by a “housing first” philosophy.
After 15 years, the Department of Housing and Urban Development’s recent Homeless Assessment Report, released in December, showed a 12% increase in homelessness nationwide from 2022 to 2023, and we believe that this approach should be recognized as inappropriate.
Housing First is based on the theory that most of the problems that homeless people suffer from, such as alcohol and drug addiction, are a result of, not the cause of, their homelessness. Supporters believe that stable permanent residency would ameliorate these ancillary problems.
Housing First policies focus on the rapid rehousing of homeless people, with the majority of federal funding going toward so-called “permanent supportive housing” (PSH). In theory, these facilities, such as San Francisco’s Mission Hotel, include support services, but in practice they are often ignored. Under federal law, PSH facilities cannot require residents to abstain from alcohol.
In practical terms, Housing First largely amounts to an “out of sight, out of mind” solution to homelessness. People die indoors, not on sidewalks.
The fentanyl crisis has exposed the callousness of this policy. For example, researchers at the University of Pennsylvania found that 56% of fatal overdoses in New York City’s homeless population occur in PSH facilities and shelters. Housing-centered policy approaches are clearly failing due to their own measures.
Recognizing the connection between addiction and homelessness makes it easier to understand why the unsheltered population continues to grow.
Homeless encampments in many major cities are often surrounded by open-air drug markets that attract drug addicts. It is not uncommon for residents of these so-called “tent cities” to reject housing offers. San Francisco Mayor London Breed said 60% of the residents the team provided housing “refused to accept assistance or move indoors.” Some people decided to stay on the street even though they already had housing.
In the early 20th century, Nels Anderson, a former homeless sociologist who became the nation’s leading expert on homelessness, described the phenomenon. Unlike alcohol or cocaine users who can live drug-free for long periods of time, “heroin or morphine users are unable to separate themselves from their sources for very long,” he writes.
Fentanyl keeps an opioid addict hooked even more strongly than heroin, so most users will ignore seeking treatment without some form of compassionate intervention. One former drug addict said: Addiction is the loss of the freedom to be abstinent.
Affordable housing is an essential part of solving homelessness, but it is never enough. In West Virginia, where homelessness is rare but addiction is rampant, it should serve as a somber reminder that drug abuse and overdose deaths won’t just disappear behind the welcome mat.
Christopher Culton is a research fellow in housing and homelessness at the Independent Institute in Oakland, California. He wrote this on his InsideSources.com.