Opinion by Howard Husock•
It’s cliche to observe that socially conservative views emerge when liberals are “mugged by reality.” But when it happens to the governor of California and the local leadership of Portland and Seattle, it’s not trite — it’s important. That’s exactly what has happened in the form of a push by leaders from every Western state asking the same Supreme Court they so often vilify to overturn the 2019 ruling from the 9th U.S. Circuit Court of Appeals that local governments may not clear homeless encampments unless they can offer shelter for all those taken off the streets.
The argument to overturn emphasized the obvious: “The friction in many communities affected by homelessness is at a breaking point … and residents are suffering the increasingly negative effects of long-term urban camping.” Those, tragically, include tent cities, where open drug use, crime, human waste, and severe untreated mental illness are rampant. One can be sure that a breaking point has, indeed, been reached when even Gov. Gavin Newsom (D-CA) says the courts should not “block any number of reasonable efforts to protect homeless individuals and the broader public from the harms of uncontrolled encampments.”
What liberals do not acknowledge, however, is that they are reaping the whirlwind of policies they promoted for decades. And it is this fact that must be accepted if public order is to be restored.
Most notably, these policies include the deeply misguided idea to close hundreds of mental hospitals across the United States and “deinstitutionalize” patients on the grounds that mental illness was a “myth” without biological basis. Indeed, crucially, psychiatrist Thomas Szasz asserted exactly that in his 1960 paper “The Myth of Mental Illness.” Coupled with sensationalized reports of poor conditions in state hospitals, it was an argument that led, over time, to the loss of hundreds of thousands of hospital beds. The advent of Medicare, nothing if not a signature liberal policy, reinforced the trend by denying financial support for “institutions for mental disease.” States would have had to shoulder the financial burden themselves and, over time, chose not to do so. According to the Treatment Advocacy Center, long led by the dissident psychiatrist E. Fuller Torrey, “In the mid-1950s, there were 337.0 state hospital beds per 100,000 population. This ratio has fallen continuously to reach the woefully inadequate level of 11.7 beds per 100,000 people. … Health policy experts converge around a minimum requirement of 40 to 60 inpatient beds per 100,000 people to meet demand.”
The evident result was street homelessness. Torrey, a courageous voice in the wilderness, has long emphasized cause and effect: “Beginning in the early 1980s, studies consistently began to report that approximately one-third of the homeless population was affected by schizophrenia, schizoaffective disorder, bipolar disorder, or major depression. By the late 1990s, people with serious mental illness were reported to be 10 to 20 times more likely than the general population to become homeless.”
Liberals, however, continually cast this tragic trend as a problem of housing policy. The very term “homelessness” advances just that argument: that the condition must be addressed with “affordable housing.” Homelessness, per liberals, emerged because of Ronald Reagan turning his back on public housing. Indeed, the Martin v. Boise case, whose decision now protects the right to sleep outdoors, was argued by the Washington National Center on Homelessness and Poverty Policy. (Emphasis added.) Concerns about mental illness and its close companion, drug abuse, and a need to take their victims off the street, even involuntarily, amount to an effort “to blame and penalize and marginalize the victims rather than take the steps they haven’t found the political will to take,” according to the center’s Eric Tars.
Subsidized housing advocates have effectively been employing the specter of street homelessness to support their arguments for ever-increasing government support for renters generally. Yet this is a hard view to defend when California alone devotes $7.2 billion of its state budget to allegedly addressing homelessness by emphasizing the construction of affordable housing. Income, it’s argued, is the problem. Liberals want to make hardworking families the face of homelessness, entirely glossing over the view from the streets.
To be sure, not all the street homeless suffer from psychosis. The federal Substance Abuse and Mental Health Services Administration has reported that at least a third engage in substance abuse. But here, too, one cannot overlook liberal policy preferences. In promoting the legalization of “recreational marijuana,” liberals have effectively normalized drug use as part of daily life. There may have been a time when the dangers of marijuana were exaggerated, but that is no longer true. The Centers for Disease Control and Prevention estimated 3 in 10 marijuana users develop “marijuana use disorder,” including a need to use increasing amounts for the same effect, and that 10% become outright addicted. National Institutes of Health-sponsored research concluded that “a large proportion of individuals who use cannabis go on to use other illegal drugs.” Yet New York promotes legal cannabis as a vehicle for social justice by giving priority to one-time criminal drug dealers to obtain licenses.
Indeed, the state has made clear it hopes to realize a tax-revenue windfall from legalization. New York City has effectively surrendered to the idea that even drug use should be normalized. It has permitted the opening of two “harm reduction centers,” where addicts can use illegal drugs under medical supervision, and even advertised on subways how to “use safely.” Residents are being urged to carry Narcan, the overdose reversal drug, routinely in case they encounter a dying addict on the street. None of these liberal policies discourage the substance abuse rampant in homeless camps.
Undoing the damage of misplaced spending emphasis on subsidized housing, failure to treat mental illness, and tolerance for drug use will be a painfully slow process — if liberals can even be persuaded to try. The appeal to the Supreme Court to overturn the Boise decision is a start. That ruling clearly takes the side of those who believe housing is the cure for street homeless people, notwithstanding the fact that psychosis and illegal drug use may lead to a preference for street sleeping. The idea that having one’s own apartment will itself act to solve other problems — this is the approach known as Housing First — is questionable at best.
A recent New Yorker story on a Brooklyn “supportive housing” apartment complex, where street homeless people are taken in and meant to have social service help, painted a grim picture of drug use and violence, including some residents who continued street begging. Incredibly, the building included “affordable” units for tenants who had never lived on the streets. This represents, within its own walls, the misplaced idea that homelessness is fundamentally a housing problem.
The appeal to the Supreme Court that would permit municipalities to ban outdoor sleeping and, thus, homeless encampments must be viewed as a symbolic admission by liberals that things have gone terribly wrong. Even more promising, and already having practical impact, is an initiative in New York City. There, the administration of Democratic Mayor Eric Adams is availing itself of a state court decision, not previously well understood, to take the severely mentally ill off the streets, even involuntarily. The case of a disturbed Manhattan woman living on the street had long been taken to mean that involuntary commitment required a threat of harm to others. But the Adams administration looked more closely at the ruling’s language:
“[A] person may be involuntarily confined for care and treatment, where his or her mental illness manifests itself in neglect or refusal to care for themselves to such an extent that there is presented ‘serious harm’ to their own well-being.”
It has made use of that last phrase to begin to target the severely mentally ill street homeless and to place them, even involuntarily, in an expanding number of city and state treatment beds. The long-standing policy known as “treat and street” — that is, treating the short-term needs of street homeless people — has begun to be replaced by the 120-day stays needed to help patients become self-aware enough of their psychosis to be willing to take the medication they need to leave the street behind. The policy follows the tragic case, in January 2022, of Michelle Goh, a Manhattan woman shoved to her death on the subway tracks by a mentally ill homeless assailant.
State laws vary as to whether the lack of ability to take care of one’s own bodily needs can be grounds for involuntary commitment. But New York is receiving inquiries from other states and municipalities about the policy, indicating attitudes are changing.
In effect, the city and perhaps the states appealing the Boise ruling are in the early stages of reconstituting a mental health treatment system — one whose problems in the era of state hospitals have led to a nonsystem. Truly addressing the reasons for street homelessness, however, will require liberal cities and states to undertake major course corrections toward involuntary commitment, discouraging drug use, and understanding that housing costs are not the reasons for homeless encampments. At least there are signs of improvement.