For the vast majority of San Francisco’s unhoused residents, even those who seek shelter, housing or treatment for mental health or substance use, it’s only a matter of time before they end up back on the street.
Based on interviews with 584 currently unhoused San Francisco residents and 25 focus groups, a new report depicts a “revolving door” between the streets and services that focus too much on immediate, short-term assistance and not enough on long-term stabilization.
Released Thursday by a team of advocacy groups, nonprofits and academics known as the Our City Our Home coalition, the report emphasizes the need to provide a wide variety of supportive housing options, move away from the exclusive focus on congregate shelters and navigation centers and make mental health and substance use treatment options more accessible.
The coalition lays out a transformative vision for the future of San Francisco’s homelessness services using funds from Proposition C, a measure passed by voters in November 2018 to raise an estimated $300 million annually through a gross receipts tax on companies making above $50 million.
Proposition C is currently tied up in legal battles with its detractors, who say it needed to pass with two-thirds support from voters instead of the 61% it received. The City Attorney’s Office maintains a simple majority was sufficient for passage.
Most recently, the Court of Appeals sided with San Francisco, but additional challenges are expected. In an effort to unlock the funds, city officials have also placed a business tax reform measure on the November ballot, Proposition F, that would allow the city to generate equivalent revenues if a judge ultimately rejects the validity of Prop. C.
Of the interviewees, 43% lost their housing because they couldn’t afford rent, due as much to job loss as to wages being insufficient to pay the bills in a city where median rent for a one-bedroom sat well over $3,000 pre-pandemic.
Such grave housing insecurity doesn’t happen overnight. Nearly 51% of survey respondents said they were without a lease before they became unhoused, which points to “the precarity of many of those just before becoming homeless,” said Chris Herring, a fellow at Harvard University’s Inequity in America Initiative, who worked on the study.
Perhaps most jarring, experts said, is the failure of The City’s permanent supportive housing programs. One of six individuals surveyed reported previously having lived in these units at some point before experiencing homelessness, which the report authors said demonstrated the need to increase not only the supply of supportive housing but also the quality.
“This is the form of housing we have the most control over. At the very least, we should ensure we are doing everything possible to keep people in their housing — from adequate support services to rental assistance,” the report said.
Contrary to the popular narrative that many individuals residing on San Francisco’s streets don’t want help, nearly 80% of people interviewed have either used or tried to use a shelter in the past five years.
They reported long waitlists, few beds, and complicated curfews as well as prior bad experiences as primary barriers. Other said discrimination, fear of theft and rigid rules that made it hard to work certain jobs or exacerbated mental health conditions kept them away.
Around 58% said they’d prefer sanctioned encampments with basic amenities such as showers and a toilet — similar to the safe sleeping sites in the Haight and at Civic Center — to existing shelters.
Jennifer Friedenbach, executive director of the Coalition on Homelessness, attributed this preference to the lack of dignity and privacy associated with group settings. A sense of autonomy is key to someone’s chances at self-actualization and stabilization, she added.
Additionally, respondents painted a picture of shelters and navigation centers that fail to set them up for success upon departure. They suggested case management and transparent pathways to supportive housing would be instrumental to a more positive shelter experience.
The report recommends deep investment in making more high-quality housing available for the unhoused, maintaining sober shelters in addition to spaces for those who still using drugs or alcohol, lowering barriers to entry and expanding safe sleeping sites.
A bright spot in the report was the revelation that, when accessed, mental health and substance use treatments are effective.
Though 34% of survey participants reported current challenges with substance abuse, most often with methamphetamines, heroin, alcohol and cocaine, only half had received treatment. That’s despite an 80% success rate in helping people partially or totally meet their goals, among those who had successfully accessed treatment.
The same is true for mental health treatment. While half of survey respondents said they currently suffer from mental illness, only 40% had received clinical support.
In both cases, pathways to treatment can be complicated and, at times, exclusive. Limited availability, inordinate costs borne by the patient, treatment specialists that don’t reflect the experience of the unhoused and a zero-sum approach to sobriety can feel like insurmountable obstacles to some.
The study concluded there’s a need for flexible treatment philosophies as well as individualized support that can respond to the “wide range of variability” in the intervention needs of the unhoused. For example, while one person might benefit greatly from an abstinence approach, another might first need stability earned from other wraparound services for basic necessities such as food and clothing.
This is a “big missed opportunity,” according to study authors, who say the data shows a robust expansion of treatment options could greatly improve the quality of life for many individuals unhoused or teetering on the brink of homelessness. It can also keep them ending up back to the streets.
In addition, the study concluded that setting up a direct pipeline between treatment and various stages of supportive housing is essential to creating positive outcomes.
“Stability after treatment is hugely important,” said Cesar Espinoza, a peer researcher who says he grew up walking through the very revolving door this research reveals.
He emphasized the need to consider housing a part of health care and called on The City to pay more attention to the harm caused by the stigmatization of these conditions.
The report grounded its findings in direct feedback from currently unhoused and/or unsheltered individuals, using peer researchers to conduct many of the one-on-one interviews.
“It helped build a level of trust so that we were able to get information that’s useful and impactful. We were able to meet the people where they were at,” said TJ Johnston, a peer researcher with the Coalition on Homelessness.
These conversations revealed a distinct set of inequities.
Disproportionate burdens fall on San Francisco’s Black unhoused individuals, who reported being forced out of their homes at twice the rate of the general population by evictions or the threat thereof.
San Francisco’s trans unhoused individuals said they lacked representation in service providers, shelters and advocacy organizations. Trans women of color, specifically, also reported being deprived of housing at higher rates.
Experts concede this transformative overhaul will be costly, which is why the Proposition C funds are so crucial.
But they also note that it’s no comparison to the financial and ethical toll of continuing to allow people to spiral in cycles of crisis, stabilization and an eventual return to the streets.
Providing these kind of stable housing and health care options, they say, is the “only sustainable option, both economically and morally.”