Photo by Nina Strehl on Unsplash

Our goals: Stepping stones on our path to peace.

 
  • If you walk through the Tenderloin neighborhood of San Francisco, Skid Row and Venice Beach of Los Angeles, and the Blade in Seattle, you’ll witness people of all ages and races injecting and smoking meth, cocaine, heroin, and fentanyl on the sidewalk. You’ll see large homeless encampments, prostitution, and violence. In Venice Beach, tent fires are common as is assault and theft. Neighborhoods like these are what Europeans call “open air drug scenes.”

    Ending these drug scenes would reduce crime, drug use, and homeless encampments. Fortunately, there are many examples of cities successfully abolishing open air drug scenes. In Amsterdam, police and social workers broke up the open air drug scene in the then-dilapidated neighborhood of Zeedijk by offering social services and enforcing the law. Social workers extended methadone, treatment, and shelter, while police ticketed drug users who were using in groups. When these users did not pay their tickets, they were arrested and given a choice between a drug treatment plan or incarceration. Today, Zeedijk is a beautiful and thriving mixed-income neighborhood. Lisbon, Frankfurt, Vienna, and Zurich also used police and social services to end open air drug scenes.

    New York used smarter policing to end the infamous open air drug scene in Times Square in the 1990s, which helped reduce drug-related killings by 90 percent. Increased police presence has been shown to deter crime in a way that longer prison sentences have not. In High Point, North Carolina, police targeted three neighborhoods with open crack cocaine dealing. They sat down with the dealers and showed the extensive evidence they had gathered of the their crimes. The police officers offered job training, tattoo removal, and social services to help the dealers restart their lives as an alternative to jail. These interventions broke up the open drug market in ways previous arrests over decades had not. Philadelphia and Seattle have also had some success in breaking up open air drug scenes.

  • California needs a new, statewide agency to tackle the problems of homelessness, drug addiction, and untreated severe mental illness. Call it Cal-Psych. Cal-Psych would serve these populations and get them off the streets through new policies and assertive social workers with “whatever it takes” mandates. 

    One-third of the homeless have severe mental illness and the severely mentally ill are ten times more likely to be in prison than in state mental hospitals. This is a humanitarian crisis. Cal-Psych would be responsible for procuring the psychiatric beds needed for the severely mentally ill to get treatment. Cal-Psych would also be responsible for implementing an expanded use of assisted outpatient treatment and conservatorship, which mandate medical treatment. Many severely mentally ill individuals require mandatory treatment to be healthy. Cal-Psych caseworkers would have enough funding to provide the support that their clients need. They would know if their clients had stopped taking medication, were back on the street, or had committed a crime. Cal-Psych would have mobile units capable of performing on-the-spot psychiatric evaluations and enrollment in treatment programs. 

    Because a large number of the homeless are addicted to drugs, Cal-Psych social workers would coordinate with law enforcement to break up open air drug scenes like those in the Tenderloin and Skid Row. Cal-Psych would secure and manage expanded, on-demand drug treatment. Every time someone has overdosed and survived, Cal-Psych workers would be able to connect that person to treatment. And residential drug treatment would be longer so that people in recovery are not released back into the world right when their cravings are peaking. Addicts who have committed nuisance crimes or crimes to feed their addictions would be offered drug treatment as an alternative to jail, and Cal-Psych would provide case workers who can support people in treatment. 

    There are models of effective and humane responses to the mentally ill and street addicts in the U.S. Arizona and Texas have police officers trained to handle mental health calls. They track down people who have violated court orders for treatment. They check in on people. They often have social workers with them. Crucially, their status allows them to handle people who might be in a violent, psychotic state, which social workers are usually not equipped to handle.

    Cal-Psych would also manage housing for the homeless. It would be responsible for ensuring every Californian has a right to shelter by buying and building the shelters and housing necessary to get the homeless inside. As part of treatment programs for the severely mentally ill and the drug-addicted, Cal-Psych case workers would be able to offer housing on a contingency basis to their clients, meaning that clients would only receive housing if they met preconditions like taking medication or sobriety. This approach has been shown to be effective at housing individuals and improving their health outcomes. Purchasing residential homes and converting Project Roomkey hotels into contingent housing would be a first step. The governor could issue state-of-emergency declarations to acquire shelters and housing for Cal-Psych.

    Cal-Psych would be statewide because many of the homeless are mobile and move across counties. When this happens, they shouldn’t lose their case workers or access to programs. Localities have also widely failed to address the homelessness crisis and the state has more buying power and capacity to implement the needed changes. Californians themselves are so fed up that they now believe that state officials are responsible for solving homelessness as opposed to localities by a 62 to 38 percent margin. However, we would not abandon the current system overnight. We should not repeat the mistakes of the community health advocates of the 50s and 60s who closed mental hospitals without having suitable replacements. Cal-Psych would begin in just a few counties and would expand once it is successful. 

    The money for Cal-Psych could come from three sources: California’s failed Mental Health Services Act, which spends little of its money on severe mental illness, Medicaid, and, over time, city and county funding currently sent to unaccountable nonprofit service providers.

    Cal-Psych’s care for the homeless that truly meets their needs represents a moral, human, and technological frontier for California. If enacted, it would be arguably the most comprehensive and effective homelessness program in the country. Californians would no longer feel the shame that accompanies seeing someone in a psychotic state on the street, living in tents along the highway, or shooting up fentanyl on the sidewalk because the people who previously struggled under those conditions now have the care, incentives, and resources they need.

  • Californians see so many homeless individuals sleeping on the sidewalks or in encampments because the state has chosen to not build homeless shelters and instead build permanent supportive housing. This policy choice has made homelessness worse. San Francisco has expanded its permanent supportive housing from over 6,000 units in 2005 to nearly 11,000 in 2019, but saw its unsheltered homeless count rise 95 percent. Today, San Francisco has the greatest quantity of permanent supportive housing units per capita of any major city in the United States. It has twice as much as New York and three times as much as Chicago and Los Angeles, yet it still has the worst homelessness problem in the country.

    Refusing to build shelters in favor of permanent supportive housing forces homeless Californians to sleep outside where they are more likely to suffer from violence, addiction, and overdose deaths. Large homeless encampments foster open air drug scenes and general disorder in our cities that hurt the homeless the most. In Venice Beach Los Angeles, fights and fires break out regularly, endangering the lives of the homeless there. And, contrary to what homeless advocates say, the homeless do want shelter. There are frequently long lines outside of shelters in San Francisco.

    Housing First is the philosophy guiding San Francisco and California’s homelessness policies. Housing First holds that the only solution to homelessness is to give each homeless person a permanent place to live without preconditions. Housing First advocates believe that shelters divert spending that could be better used on housing.

    The evidence does not suggest that Housing First is the best way to end homelessness. In a 14 year study, a team of Harvard researchers found that just 12 percent of the homeless placed in Housing First stayed housed after ten years. In a study widely touted by Housing First advocates, 86 percent of recipients of housing stayed housed for nearly the entire length of the two and a half year study.

    But there was a twist. The Housing First intervention did not lower the rate of deaths compared to homeless people who did not have access to housing without preconditions. A study of 249 homeless people in San Francisco found that Housing First did not decrease the number of hospitalizations the homeless experienced. The National Academies of Sciences, Engineering, and Medicine published a review of the scientific literature of Housing First and found that there was little evidence that permanent supportive housing improves health outcomes, other than limited data suggesting it does so for people with HIV/AIDS.

    The problem with Housing First stems from the fact that it doesn’t require that people address their mental illness and substance abuse, which are often the underlying causes of homelessness. Several studies have found that people in Housing First-type housing showed no improvement in drug use from when they were first housed. A literature review in 2009 suggested that Housing First’s harm reduction approach may actually worsen addiction. A study in Ottawa found that, while the Housing First group kept people in housing longer, the comparison group saw greater reductions in alcohol consumption, problematic drug use, and greater improvements to mental health, after two years.

    The inability of Housing First to improve health and housing outcomes suggests that housing should be offered on a contingency basis, meaning that homeless individuals can only access housing if they meet requirements around drug use and/or medication.

    Researchers have found ways to use housing to reduce addiction. Between 1990 and 2006, researchers in Birmingham, Alabama conducted clinical trials of abstinence-contingent housing with 644 homeless people with crack-cocaine addictions. Two-thirds of participants remained abstinent after six months, a very high rate of abstinence, compared to other treatment programs. Other studies found that around 40 percent of homeless people in abstinence-contingent housing maintained their abstinence, housing, and jobs. In a randomized controlled trial, homeless people were given furnished apartments and allowed to keep them unless they failed a drug test, at which point they were sent to stay in a shelter. Sixty-five percent of participants completed the program.

    Instead of attempting to guarantee Californians a right to housing, which will likely never be realized, Californians should instead be guaranteed a right to shelter. New York City, a city with over 77,000 homeless people, has sheltered 95 percent of its homeless population. It does not suffer from the same problems of open air drug scenes and homeless encampments. California should also require the homeless to sleep in a shelter bed if they have nowhere else inside to sleep. Cities should not permit the breakdown of public order and adverse health effects of unsheltered homelessness.

Our action items.

 
  • We need to sound the alarm, and educate parents and kids that they could die from fentanyl poisoning and drug overdose.

    The U.S. and California failed to prepare our children for a world of abundant and easily-accessible hard drugs. As a result, tens of thousands of our loved ones are succumbing to addiction, poisonings, and overdoses, every year.

    We are developing a drug education platform based on what is proven to work. We are searching for partners with experience in this field. We are seeking to understand past successes such as the “Truth” campaign led by young people targeting tobacco companies for trying to convince children that smoking was cool.

  • What Californians call “homeless encampments” are what Europeans call “open drug scenes,” and they must be broken up for the health of the homeless and to restore public safety and peace. Breaking up open drug scenes requires a combination of social services, law enforcement, and redevelopment.

    The process does not require mass incarceration. In North Carolina, police broke up an open drug scene with community outreach workers. They offered drug dealers assistance with education and job placement as an alternative to arrest and incarceration.

  • California cities have reduced enforcement of laws against public drug use, defecation, theft and other supposedly “victimless” crimes. To some extent this is because laws like Proposition 47, passed in 2014, decriminalized shoplifting of items valued under $950 and possession of three grams of even hard drugs. But the hesitancy of city leaders to prosecute suspects has also contributed to weak enforcement of laws. And that means the supposedly “victimless crimes” do, in fact, have victims.

    These trends are rooted in fears of returning to the tragedy of mass incarceration, but laws must be enforced if we are to have livable and walkable cities, and to get people the care they need. Law enforcement should not go after people who are using drugs peacefully in their own homes. Laws can be enforced without the massive monetary and human cost of mass incarceration and curtailed civil liberties.

  • Fentanyl has radically altered drug use. It is many times more potent than other opioids. Sometimes drug dealers deliberately or accidentally poison their victims with counterfeit drugs. The buyer believes they’re getting one drug, but in reality what they purchased is laced with fentanyl.

    In order to prosecute drug dealers for murder in the case of a fatal poisoning by real or counterfeit drugs, prosecutors need to prove implied malice — that dealers knew their actions could kill. “Alexandra’s Admonishment,” Senate Bill 350 in the 2020-2021 legislative year, would have given District Attorneys the discretion to give dealers a formal warning informing them that their actions could prove fatal. If the dealer is caught selling drugs that kill someone, then they can be charged with voluntary manslaughter or murder. This is a necessary deterrent to save our communities from the scourge of fentanyl poisonings.

  • Social media companies are exercising extraordinary powers over our minds and over our children. Some, like Snapchat, are where young people are buying drugs, including ones that kill them. Others, like Instagram, appear to be contributing to anxiety and depression among adolescents.

    We need to hold social media companies accountable and turn them toward solving rather than worsening the problem. Parents and families need greater insight into how social media companies are manipulating the emotions of their children. And social media companies must be turned into tools for improving well-being, resiliency, and mental health.

  • California lacks the institutions and laws it needs to care for its vulnerable citizens. Drug treatment and psychiatric care are not perfect, and the people suffering severe addiction and/or mental illness are among the most difficult to treat. Mandatory treatment as an alternative to incarceration has worked around the world.

    As much should be done as possible to encourage people to get help voluntarily, but for people who repeatedly break the law, judges should be able to offer treatment instead of prison. The governor must take action through the legislature or by ballot initiative to restore mandatory drug treatment and psychiatric care, through Cal-Psych, as an alternative to the pre-Prop 47 strategy of incarceration.

  • California counties cannot solve the problems of open drug scenes piecemeal because of the transient nature of the homeless population. At least thirty percent of street addicts in San Francisco were homeless before they arrived in the city. The same number is true for Venice Beach’s open air drug scene. California’s governor must create a state-wide agency, Cal-Psych, to remove addicts and the mentally ill from the street through voluntary drug treatment and psychiatric care, as well as by working with the courts to oversee involuntary care through conservatorship and assisted outpatient treatment. The CEO of Cal-Psych would report directly to the governor and be the best-in-class. And Cal-Psych would have the purchasing power to expand psychiatric beds, navigation shelters, and residential homes across the state.

  • Unsheltered homelessness is harder on the homeless than being sheltered. California must have sufficient shelter beds for all. It should also require the homeless to use them to avoid creating dangerous homeless encampments and open air drug scenes.

    Some homeless people resist shelter because the shelters do not allow the use of hard drugs. Others resent that shelter placements are currently only available for ninety days at a time, and or feel that facilities and security are inadequate.

    But other homeless people do want shelter. In 2019, there were 1,200 people on the waitlist for shelter on any given day in San Francisco. Housing First activists have successfully advocated the diversion of funding from basic shelters to apartment housing units for the homeless, which take more time and resources to build. The result is a shortage of any accommodation for the homeless.

    Once California has secured a shelter bed for all who need it, then it should return to building longer-term housing. Housing should be contingent, which improves health outcomes. It should be a reward for abstinence or other steps people take on their personalized Cal-Psych plans.

  • A strong police presence is good for communities — it is proven to prevent homicide and crime. Efforts to defund the police are demoralizing to police officers and, when combined with civil unrest and anti-institutionalist rhetoric, contribute to rising homicide, inequality, and disorder.

    At the same time, we need to do more to reduce police violence and discrimination against communities of color. Officers must be held accountable and take responsibility for their actions, and lethal force must be a last resort. We need law enforcement to coordinate with empowered social workers and humanely direct the mentally ill to the care they need.

    Police reform that ensures safety, equity, and lawfulness will require funding, accountability, and dedication to better our existing institutions. As California pursues a third way between mass incarceration and lawlessness, it must both create Cal-Psych and develop the capacity of our police to deal with addiction and mental illness effectively.

  • Neighborhoods like the Tenderloin that are struggling with crime, open drug scenes, and decay are not locked into their sorrowful state. Equity-focused redevelopment can reduce crime, end open drug scenes, and revitalize neighborhoods. Housing vouchers and rent-controlled housing can prevent displacement of current residents. Redevelopment creates large quantities of new housing which ensures that developers can build a large amount of affordable housing.

    Such redevelopment turned Amsterdam’s Zeedijk neighborhood from an open drug scene into a thriving community for residents of many income levels. A similar transformation took place in the Alphabet City neighborhood in New York. Neighborhoods that attract crime and drug use are not an inevitable part of cities