Rates of homelessness increase every year. But it is a solvable problem.

Homelessness Is A Solvable Problem

by Lloyd I Sederer, MD – Chair, Get Help Board of Advisors

You would have good reasons to contest what the title of this article pronounces.

Rates of homelessness, especially chronic homelessness (defined federally as lasting more than one year), increase every year. Especially among people who have serious mental and substance use disorders. 

Nationally, over half a million people ‘sleep rough’ on urban streets and in encampments. “Skid Row”, in downtown LA, has the highest, persistent and most alarming collection of chronically homeless people in this country. Are those data proof that homelessness is not a solvable problem? Only if you don’t know about the near to hundreds of US cities, counties and states that have had measurable, often impressive, reductions in those living (trying to survive is more accurate) on our streets.

Complex, enduring problems require carefully and persistently executed solutions –  dedicated to measuring and achieving needed changes. No one solution fits all – and can vary from place to place. We are best formulating solutions with local governments, community-based service agencies, advocacy groups, apartment building owners, faith and recovery-based organizations, Business Improvement Districts (BIDs), and others who must serve a role (or need to) in mitigating the suffering and blight that has spread in their neighborhoods. This approach has been called “teams of teams”.

My New York Times letter describes this problem today in NYC, and what I did to significantly reduce it during my five years as mental health commissioner for the city. That approach blended teams with performance-based contracting. One non-profit organization has enabled communities throughout this country to house over 230,000 people in the last 10 years; it also has enabled many cities to end chronic homelessness among Veterans. Their remarkable success has been achieved with about no new money. What works is when money is well spent, not wasted through fragmentation among those charged with responsibilities for making critical intervention, and lack of data and continuous quality improvement to keep on getting better. (Disclosure, my wife founded and is the CEO of that organization).

Get Help is working with LA government agencies and service providers by delivering an information platform that will allow them to know, in real-time, who needs assistance, where to immediately access it, and to follow each individual (with privacy protections in place) over time to understand and achieve better longer-term outcomes.

A recent Vice article depicted the limitations of shelters as a solution to chronic homelessness. It details why people on the street avoid them. As true as these reasons often are, they are not ubiquitous. There are shelters that are safe, clean, have on-site or local treatment programs and case managers and who do not “street” their residents every morning (as some do). We need to know and use those types of shelters – as well as Y’s and other safe accommodations; “first step, supported housing”; rental assistance vouchers; and mental health and substance use (and primary care) services in order that those on the streets can bring greater clarity and commitment to their housing and recovery efforts. And we must assiduously avoid criminal justice (jails and prisons) “solutions”: As Pastrisse Cullors, who founded BlackLivesMatter, and whose brother suffers from schizophrenia, has said, “no one gets well in a cell.”

The methods that make homelessness a solvable problem include: knowing each person by name, social security number, photo (which almost all consent to) or other reliable identification; relentless attention to real-time data; weekly performance meetings that show what is working where, by who, and what is not; a “command and control” approach where the Mayor, County Executive or Governor commits to the plan and has all her/his agencies abide; and performance-based contracting (organizations hew to what they are being paid to do – which in this case is to house people, not give them peanut-butter sandwiches, business cards and empty promises).

All that takes leadership, vision, and staying the course. There are no easy solutions to chronic homelessness, but there are solutions. Get Help stands ready to assist government (and other payers and providers) that are poised to make a difference. Our mission is to help reduce the human suffering that abounds on our city streets, needlessly, and at great social, community and economic cost. We are just getting started. But the light is there, providing illumination and direction.