Homeless people in San Francisco
According to Guus Bol, this situation is a problem induced by a failing mental health system
A homeless man on the beach in San Francisco
Just arrived in San Francisco and I already ripped my sneakers. Still a bit drowsy from my jetlag I wander out of the hostel to find a shoe store so that I can replace my beloved but tormented shoes. I’m walking down Mission Street when a homeless person asks me if I can spare a buck, I give him a dollar and walk on. A little further a guy in the same outfit asks me the same question, and as I am a guest in this city I should be friendly, I give him a dollar as well. Next, one peculiar guy requests nuclear weapons instead of money. This scene is repeated until I reach the shoe shop where I find some nice sneakers to replace the old ones, although I now have no money left to buy them.
I’m quite shocked by the number of poor people living on the street in San Francisco, so I ask the salesman in the shop how this is possible. How can there be so many homeless people in a wealthy country like the USA?
Although it’s hard to determine the exact numbers of unsheltered people, San Francisco counts about 2771 people who live without a roof over their heads: that is 1 in every 280 residents - an astonishing number when you compare it to other western cities. (1)
Every city uses their own method of counting homeless people, furthermore there is no conclusive definition of homelessness throughout the world. In order to compare the cities in table 1 I use the number of people living on the street on a single night stated by official counting programs instead of homelessness to reduce bias. This illustrates that San Francisco and Los Angeles have an elevated level of unsheltered people and parallel to that, most likely an elevated level of homeless people compared to other western cities.
Table 1: The ratio of people sleeping on the street versus total population (1,2,3,4,5)
| City | unsheltered people | ||
| San Francisco | 1:280 |
2007 |
|
| Los Angelos | 1:165 |
2007 |
|
| New York | 1:2169 |
2007 |
|
| London | 1:1946 |
2006 |
|
| Amsterdam | 1:7390 |
2004 |
The high level of homelessness can have a huge impact on a city, potentially increasing the crime rate and levels of drug and alcohol abuse. Also medical problems such as TB, HIV, pneumonia, Sexually Transmitted Diseases (STD) and other infectious diseases could increase, typically affecting those on the streets. Mayor Gavin Newsom knows very well that homeless people are a burden for the city and is making progress with housing programs to reduce this problem.(1,6) In my opinion, the Mayor is failing to address the root causes of the problem, one of them: the deinstitutionalization and subsequent failure of the mental health system.
The state of California reduced funding to mental health care several times beginning with deinstitutionalization in 1969. (7) Those patients, unable to take care for themselves without proper medical care, inevitably ended up in the streets. In Los Angeles, 31% of homeless people have some form of mental illness. (2) It is evident that the failure of the mental health system is only one contributing factor to this homeless problem and it is hard to determine in what extent it does. However 18 % of the homeless people in San Francisco attributed their homelessness to a mental disability (1) hence it is easy to assume that a failing mental health system plays an important role.
So now, instead of rebuilding the mental health system San Francisco is building shelters, which is like treating symptoms instead of the disease. This is endemic to politics; quick results are preferred over long-term investment in the future. Therefore this is not an acquisition against San Francisco it’s an example of inefficient quick result politics seen all over the world and, in my opinion, to often health systems have to pay the price. Countries, cities, governments and politicians should bear in mind that health systems are the cornerstone of society thus breaking down a health system means breaking down our society!
With a troubled mind, I’m now leaving the shoe store and heading back to my hostel. The shop assistant tells me that I shouldn’t worry about the rough sleepers; most of them are very friendly. A young man is sitting on the sidewalk outside the shop and even though I don’t give him a penny, he still wishes me a good weekend; a little odd considering it’s a Monday, but friendly. Then again, it is not the friendliness I worry about.
Guus Bol
4th year medical Student
Student at the University of Utrecht
The Netherlands
g.m.bol@students.uu.nl
(1) Kerry Abbot, Shelagh Little. San Francisco 2007 Homeless Count. San Francisco: Human Services Agency; 2007.
(2) Douglas Mirell, Estela Lopez, Howard Katz, Larry Adamson, Louisa Ollague, Owen Newcomer, et al. 2007 Greater Los Angeles Homeless Count. Los Angeles: Los Angeles Homeless Services Authority; 2007.
(3) Street Outreach: HOPE 2007 Results. New York City: NYC Department of Homeless Services; 2007.
(4) Street to Home Annual Report for London 2005/06. London: Broadway; 2006.
(5) E. Lindeman, S. Crok, J. Slot, L. Deben. Daklozen in Amsterdam. Daklozen en niet-daklozen aan het word. Amsterdam: HVO-Querido; 2004.
(6) C.W.Nevius. Newsom hints at new plans to address S.F.’s homeless problem. San Francisco Chronicle. 2007 December 6.
(7) Patricia Ryan. California Mental Health Financing 101. California DMH.
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