Malcolm Gladwell: Tipping point on homelessness

In the latest New Yorker, Malcolm Gladwell ("Tipping Point," "Blink") does a nice job of explaining the Gavin Newsom/Angela Alioto policy on homelessness, though the article doesn't mention Newsom, Alioto, or SF. 

The substance of Gladwell's piece ("Million-Dollar Murray") is old news to those of us who were paying attention in June, 2004, when Alioto, Chair of San Francisco's Ten Year Planning Council on homelessness, presented the mayor with a copy of the council's Ten Year Plan at a press conference at City Hall.

The main impetus behind the city's shift away from Continuum of Care to the Supportive Housing approach was the realization that it was a minority of the homeless that were costing the city so much money, much like a minority of cops are responsible for using excessive force in the police department. Deal with that hardcore minority, and you are on the way to a real solution to the homeless problem.

Gladwell explains where the country---and San Francisco---went wrong in trying to come to grips with homelessness:

In the nineteen-eighties, when homelessness first surfaced as a national issue, the assumption was that the problem fit a normal distribution: that the vast majority of the homeless were in the same state of semi-permanent distress. It was an assumption that bred despair: if there were so many homeless, with so many problems, what could be done to help them?

This perspective explains why Mayor Brown, in a state of the city speech during the height of the city's homeless crisis, could throw up his hands and say, "There's not much one little city can do about homelessness. It's a national problem."

But, in Gladwell's account, a graduate student in Boston spent time in a homeless shelter as part of a research project and discovered that almost all of the people he was in the shelter with had cycled out and were going on with their lives. He put together a data base to track who was coming in and out of the system and discovered that homelessness doesn't have the distribution he expected. 

Instead, it had what statisticians call a "power law" distribution, with most of the activity at the extreme, like a few cops are responsible for the excessive force incidents in city police departments. 

He found that the reality was that 10% of the chronically homeless were the ones commonly seen on the streets and, more importantly, costing cities the most, as they cycled in and out of emergency rooms and city jails. New York was spending $62 million on 2500 hardcore homeless every year. Boston tracked 119 chronically homeless and found that, over a five-year period, they accounted for 18,834 emergency room visits at $1000 a visit.

San Francisco isn't mentioned in Gladwell's article, but Philip Mangano is. Mangano comes out of Boston and is head of the US Interagency Council on Homelessness, which oversees the programs of 20 federal agencies. Mangano played an important role in convincing Mayor Newsom, Angela Alioto, and the Homeless Council to target the city's hardcore homeless. 

The result was the San Francisco Plan to Abolish Chronic Homelessness, which was presented to the mayor, with Mangano present, and the public during that June, 2004, press conference. 

Gladwell provides a succinct narrative of Mangano's mission:

In the past two years, he has crisscrossed the United States, educating local mayors and city councils about the real shape of the homelessness curve. Simply running soup kitchens and shelters, he argues, allows the chronically homeless to remain chronically homeless. You build a shelter and a soup kitchen if you think that homelessness is a problem with a broad and unmanageable middle. But if it's a problem at the fringe it can be solved. So far, Mangano has convinced more than two hundred cities to radically reevaluate their policy for dealing with the homeless.

The San Francisco Plan estimated that there are 15,000 homeless in SF, and 3000 of them qualified as "chronically homeless." This 3000 were consuming 63% of the city's $200 million homeless budget, which is comprised of city, state, and Federal funding. The Ten Year Council logically concluded that the city needed to start by concentrating on those 3000 people. 

The first step is to provide these folks with "supportive housing," that is, a room where social services---psychiatric care, drug counseling, food stamps, etc.---can be delivered after the person is off the streets. 

The big flaw in the Continuum of Care approach is that housing was divorced from social services under the assumption that the homeless had to be "stabilized" before housing was made available.

This meant that in effect more than 1000 "homeless service programs"---including General Assistance---in San Francisco were actually enabling homeless people to continue to live on the streets.

What shocked me about that 2004 press conference that unveiled SF's new policy on homelessness was that not a single city progressive political leader was present. 

In fact, it's still not clear that progressive city leaders have either read the Alioto report/plan or understand its significance.