Homelessness: You've Got Questions, We've Got Answers

For KQED’s week of homelessness coverage, we asked you to submit your questions on homelessness. We received over 1,300 submissions. This week, Bay Curious answers some of the most frequently asked.

What are the most common causes of homelessness?

Homelessness mostly arises from poverty and a lack of affordable housing. In the Bay Area, the cost of housing is outpacing what people making minimum wage can afford. When they lose their jobs, or their housing, they are at risk for becoming homeless.

In San Francisco during the 2017 Homeless Count, 22 percent of the respondents reported job loss as the primary cause for their homelessness. Eviction accounted for 12 percent of responses.

Other people were forced out of their homes due to interpersonal tensions: arguments with family (13 percent), and breakups and divorce (10 percent). These things alone do not cause homelessness. It’s a systemic issue involving poverty, inadequate safety nets, lack of opportunity and an increasingly expensive housing market.

The second most self-reported cause of homelessness was alcohol or substance abuse (15 percent).

Outside of San Francisco, causes homeless people cite shift slightly. Read the full report for your county for more details.

• Santa Clara County 2015 (2017 report expected later this month)
• Alameda County 2017
• San Mateo County 2017
• Marin County 2015
• San Francisco 2017

It’s important to note that two-thirds of the respondents cited one or more health conditions. These include physical illness, physical disabilities, chronic substance abuse and severe mental health conditions.

“We know that having mental health problems increases your risk of homelessness and that homelessness worsens mental health problems,” says Dr. Margot Kushel, a professor at UCSF who specializes in homeless issues.

“The most common mental health problem among people who are homeless is severe depression, followed by bipolar disease, followed by schizophrenia. People have this view that everyone has a thought disorder and that’s just not true,” says Kushel.

Kushel also wants to point out that some of the people you see on the street acting erratically are actually housed and in treatment programs.

“People who are housed may still be out on the street engaging in behaviors that might look like they are homeless,” says Kushel. “In fact, many of the people who don’t have housing in this city are invisible to the general public. You’d never guess that they don’t have a home,”

What do I do if I think someone needs help?

Like most cities, San Francisco has a  a 311 number to call if outreach or other resources are needed.

In fact, there are multiple outreach groups that aid homeless people, such as the San Francisco Homeless Outreach Team (415-734-4233) or the San Francisco Mobile Crisis Treatment Team (415-970-4000)

For more information, KQED published a story on this three years ago or you can check out the San Francisco Coalition on Homelessness’ 10 Things To Do When You See Homeless People.

Are other cities sending their homeless to San Francisco with one-way bus tickets?

Yes, people are being sent here, but it doesn’t work the way you think it might. Most cities have programs that put homeless people on buses. These buses bring homeless people to friends and family where they can find support and a stable living situation. Some people arrive here using such programs.

San Francisco also has one of these programs, it’s called Homeward Bound. It provides a ticket, travel aid and an escort to the bus for people who have confirmed housing and support in another city. Since 2005, over 10,000 people have gotten bus tickets through the Homeward Bound program.

Yet, while reuniting people with friends and families can be a good thing, homeless advocates worry that the bus ticket programs are abused and don’t help people but simply export people and their problems elsewhere. Some participants in the program are not even going home but simply to other areas that might have an open bed. Critics claim that these programs don’t do enough to ensure that people’s needs will be met at their destination.

But cities have an economic incentive to keep the program running. San Francisco’s Homeward Bound program spends an average of $185 per ticket, whereas housing and caring for people without shelter can cost thousands of dollars.

That said, there have been examples of bus tickets being used illegally. A few years ago, a Las Vegas hospital was found to be systematically putting mentally ill patients on Greyhound buses out of town. It was estimated that about 500 patients had destinations in California. Last year, San Francisco won a $400,000 settlement from the state of Nevada to cover the medical costs of some 24 patients who arrived in the city with one-way tickets.

Do any of the homeless choose life on the street? 

“When people who are homeless are offered a safe and decent place to call home, we find they always say yes,” says Jennifer Friedenbach, the director of San Francisco’s Coalition on Homelessness.

“People often mistake turning down one night in a shelter as choosing to be homeless. They don’t understand that you have to lose all your belongings, separate from your pet, separate from your partner and wait in line for hours on end, only to get five hours of sleep and get kicked out in the next day without your property and survival gear,” says Friedenbach.

Other reasons people cite for opting out of shelters include violence, racism, homophobia and transphobia. There are others who decide to sleep on the streets because they want to avoid the bureaucracy and restrictions that come with living in supportive housing. “After going through the merry-go-round of social services … people might not be interested in a sheltered treatment-type program for long periods of time. They want to be more independent and off on their own,” says  Eduardo Vega, a past director of the Mental Health Association of San Francisco .

In regard to long-term housing, the director of Hospitality House, told the San Francisco Chronicle that there’s more to a person’s refusal of housing. “A lot of times people have been traumatized and re-traumatized and they don’t think [their lives will change]. They might need a little bit more work in order to be able to make that leap.”

What happens to all the money that San Francisco spends on the homeless?

San Francisco allocated over $241 million on homelessness for the 2015-2016 fiscal year. 

The proposed budget for the 2017-2018 fiscal year includes $245.5 million to address  homelessness and supportive housing. The plan allocates over $11 million for outreach and prevention and over $203 million towards shelter and housing.

Why are there so many homeless people in San Francisco, and why are they so visible?

“It’s because of the high housing costs. San Francisco has a huge homeless population because it’s one of the most expensive cities,” says Kushel, the UCSF professor who specializes in homeless issues. “There is a myth that homeless people are drawn to San Francisco because it’s such a great place to be homeless. But research doesn’t hold that up.”

“The draw of a milder climate only has a marginal effect,” says Eduardo Vega, the previous director of the Mental Health Association of San Francisco.

According to the 2015 San Francisco Homeless Count, of the 7,539 people counted, 71 percent lived in the city before they lost housing. Only 10 percent came from outside the state and the remaining 19 percent came from elsewhere in California.

“We do know that across the country, when people become homeless, they tend to migrate to a city. That’s because it’s hard to experience homelessness in a suburban area. You might have to walk 4, 10, or 20 miles to the nearest service agency. So, people tend to move to cities, but there’s nothing about San Francisco in particular,” says Kushel.

According to Vega, the ratio of housed to unhoused people in San Francisco is unremarkable for a city of its size.

“Because we have a small dense metropolitan area and a lot of people are crowded into the same 4 square miles downtown, there is a perception that the problem is somehow much worse in San Francisco,” says Vega.

In the 2015 report by U.S. Housing and Urban Development, San Francisco’s homeless population, in sheer numbers, is smaller than New York, Los Angeles, Seattle, San Diego, Las Vegas, D.C. and Chicago. 

“The problem is that homelessness is a big problem across the country. But here people are seeing lots of homelessness and getting sensitized to it, which is good,” says Vega.

Why are there so many young homeless people in San Francisco than other places?

“More and more, we are seeing Bay Area youth becoming homeless,” says Mary Howe, director of the Homeless Youth Alliance. The organization provides a safe space for homeless youth in the Haight neighborhood and focuses on providing harm reduction services. The Haight is one neighborhood where young people living on the street are highly visible.  

Many young people become homeless after aging out of the foster care system. Some were homeless with their families but left because they don’t want to be a burden. Some leave abusive, traumatic or neglectful homes. Others are kicked out after coming out as LGBTQ. In San Francisco, 48 percent of the young respondents in the 2015 homeless count identified as LGBTQ. 

Similar to the adults, many of the homeless youth lived here before becoming homeless. According to the Homeless Youth Count, 56 percent of the homeless youth population was living in San Francisco prior to becoming homeless. Another 25 percent came from another county in California and 19 percent came from out of state. Many of the newcomers head to the Haight.

“I do think the Haight in particular is an international destination for young people. It will always draw people in, as it did in the ’60s. People still view it as something better than what they are leaving,” says Howe. “I also want to point out that many of the people paying rent in San Francisco are actually not from here either.”

Are there any plans for adopting a “Housing First” program similar to that in Salt Lake City?

According to Kevin Fagen, Salt Lake City has “all but ended chronic homelessness.” The city accomplished this through an aggressive “Housing First” program, which quickly puts people into permanent housing. There are no requirements for eligibility, such as sobriety, treatment or service participation. Over 2,000 people who were formerly chronically homeless are housed in what is described as “showpieces of modern architecture.”

So why can’t San Francisco do this? Well, the city actually does have a Housing First program.  According to the San Francisco Chronicle, it includes about 5,000 units of supportive housing in the Tenderloin neighborhood. But why hasn’t the program seen the same success as Salt Lake City?

According to Chronicle reporter Kevin Fagan, Salt Lake City has more data on its homeless population, enabling the program to target the most at-risk people on the street. These are the people who use emergency services most. By identifying these folks, government and nonprofit agencies can quickly house and begin supportive services catered to the individual’s needs.

San Francisco has no single information network that tracks homeless people and the services they use. This hinders the city’s ability to help people who need it most.

Fagan says that another reason San Francisco’s program isn’t as successful is because it’s harder to cultivate a culture of self-improvement in the Tenderloin.  Residents with substance abuse issues have a difficult time breaking old habits. Counselors in the Tenderloin are spread too thin and can have up to 100 clients each. By comparison, the Salt Lake City program has one counselor for every 15 residents.

“We provide a fair number of [Housing First units], but we need a lot more,” says Vega, the director of the Mental Health Association of San Francisco.  

Today, San Francisco still has 1,745 chronically homeless individuals and 18 chronically homeless families.  To provide more supportive housing similar to the Salt Lake City model, the main obstacle will be the cost. Building housing in the country’s most expensive real estate market costs heaps more than in Utah.

Furthermore, the high prices both cause homelessness and create barriers to finding a home outside of government support. In Salt Lake City, the program has a 15 percent turnover each year as people are able to transition out and support themselves. In San Francisco, less than 5 percent of the residents leave the program each year. They stay longer because they cannot afford to leave.

This story was originally published on June 21st 2016. It was updated on June 23rd 2017.