Why Can’t San Francisco Solve Homelessness? It’s a Structural Problem.
It’s often said that you can judge the health of a society by how they treat their most vulnerable. If that’s the standard, San Francisco has been failing miserably—not just post-pandemic—but for the past half century.
Thousands of unhoused people with untreated mental health and substance use disorders live on the streets in San Francisco. The intersection between drugs and homelessness in San Francisco is well-documented, as unhoused people self-medicate to fix untreated mental health disorders. But deadly new synthetic drugs like fentanyl are causing overdose deaths to skyrocket, and the city is unprepared to deal with the opioid epidemic.
The city spends millions of dollars each year trying to fix homelessness in San Francisco—the Department of Homelessness and Supportive Housing is set to receive $646 million in 2024. But these funds haven’t helped. Homelessness in San Francisco increased 43 percent from 2005 to the last point-in-time homelessness count in 2022.
Elected officials have tried to solve the homelessness problem in San Francisco for decades, trying wildly different methods over the years. So why are there so many homeless people in San Francisco?
To find the inciting incident for the crisis we see today on San Francisco’s streets, we need to go back to the 1960s. Before the 1960s, people with mental health disorders in California were often treated in large mental health hospitals run by the state. These hospitals were poorly run overall, and often the sites of human rights abuses.
As the public became aware of these abuses, there was a campaign to close these hospitals. Advances in antipsychotic drugs like Thorazine gave advocates hope that people with mental health disorders could be treated back in their communities. State officials agreed, and began to shutter California’s mental hospitals in the 1960’s and 1970’s.
Unfortunately, funding and resources for community mental health care never arrived at the scale necessary to meet the need, and many people with mental health disorders ended up on the streets or in jail. Communities like San Francisco were left to try to devise solutions to care for the increasing number of unhoused people with mental health disorders on their own.
But San Francisco’s efforts have all been stymied by some major structural flaws with San Francisco’s government, and the history of homelessness in San Francisco is a revealing look at the flaws in the city’s government structure. Let’s break down the history and facts about homelessness in San Francisco.
Misaligned Incentives
San Francisco’s elected officials aren’t incentivized to work towards long-term solutions, they want quick political wins that increase name recognition. This might be best illustrated by the consecutive administrations of Mayors Dianne Feinstein and Art Agnos in the 1980s through early 1990s.
San Francisco’s homeless population began increasing in large numbers in the late 1970s. Large-scale homelessness was a relatively new phenomenon, and there wasn’t a lot of data surrounding homelessness yet, so Mayor Feinstein’s administration didn’t recognize the need to treat the underlying mental health or substance use issues that caused people to fall into homelessness. City officials viewed homelessness as a temporary problem, and tried to solve it with short-term solutions, like church shelters and soup kitchens—even housing the homeless in unused Muni buses parked in the Tenderloin. Despite this, Mayor Feinstein accomplished quite a bit during her time as Mayor, and was very popular with voters—California eventually elected her to the US Senate after completing two terms as San Francisco’s Mayor.
Art Agnos succeeded Feinstein as Mayor, and his administration recognized that San Francisco’s street crisis wasn’t going to be solved with quick fixes. During his term, city officials developed the Beyond Shelter strategy, focusing on wraparound services and treating the underlying causes of homelessness. This method took a long time to deliver results, voters grew frustrated with the lack of change they saw on the streets, and Mayor Agnos was voted out of office after one term in 1992.
San Francisco’s political culture doesn’t encourage the kind of long-term, collaborative solutions that actually work to solve big, citywide problems like homelessness. This broken culture is a major reason we started TogetherSF Action—we needed to change the conversation and incentivize politicians to work together to solve these difficult, long-term problems.
City Departments Don’t Coordinate
Throughout the 1990s and 2000s, city officials began to realize that homelessness in San Francisco wasn’t going away without serious intervention. The city began devoting more resources to combat the problem, allocating millions of dollars in each budget to solve homelessness in San Francisco. Despite these additional funds, city departments don’t coordinate with each other, meaning money and resources are wasted.
This well-reported article from the San Francisco Chronicle lays out the problem well. A person with substance use disorder may receive excellent care from one department or service, but when they try to take the next step of their treatment journey, there’s often no link to connect that person to the next department, and many people end up back on the street.
It's incredibly difficult for people with mental health or substance use disorders to navigate this treatment bureaucracy, which leads to poor patient outcomes. People who try to enter care are often turned away. If it seems crazy to spend millions of dollars trying to solve homelessness, without investing in the framework and connectivity to ensure people have a path to exit homelessness at the end of their journey, you’re right. But it’s a symptom of the structural flaws in San Francisco’s city government, particularly the fact that department leaders largely cannot be held directly accountable by the Mayor.
Governing By Extremes
San Francisco is governed by extremes, and city officials adhere to an all-or-nothing ideology. Currently, that means San Francisco attempts to solve homelessness with a housing-first approach. Housing-first is a model for solving homelessness that prioritizes providing permanent housing for unhoused people, but doesn’t necessarily address the surrounding issues that may have caused a person to fall into homelessness in the first place.
This focus on housing-first above other, more affordable types of shelter severely limits how San Francisco can respond to its homelessness crisis. It currently costs almost $1.2 million to build each unit of affordable housing in San Francisco. Even if San Francisco devoted its entire 2024 budget for homelessness ($646 million) to build affordable housing, the city would build less than 600 new units. This cost, combined with the lengthy approval process and lack of available space in San Francisco, means very little housing is actually built.
And while unhoused people need shelter to start to rebuild their lives, they often need additional wrap-around services to treat mental health and substance use disorders. The city’s response to the COVID-19 pandemic gives us a real-life example of how providing housing alone doesn’t solve San Francisco’s street crisis. In 2020, the city housed homeless people in 29 hotels around the city, with a plan to transition these individuals into permanent housing. But the program was beset by damage to hotels and poor placement rates, and did little to improve the number of people living on the street in San Francisco.
Our elected officials’ unwillingness to reevaluate their ideology when presented with data damages any attempt to solve the homelessness in San Francisco. The focus on housing-first to solve homelessness, even when San Francisco has proven for decades that it can’t build enough housing, means that the city is doomed to repeat the same mistakes for the foreseeable future.
There are some big barriers to solving the city’s street crisis. But just because elected officials have tried and failed to solve the interlocking problems of mental health disorders and homelessness in San Francisco for decades, doesn’t mean that we can't solve this crisis. San Francisco has two elections in 2024, and a major opportunity to elect results-oriented leaders and reform the government structure to make the city more manageable. TogetherSF Action will keep you updated on how your vote can make a difference with our upcoming voter guide. In the meantime, watch our free, 15-minute webinar to get a better understanding of the structural problems that make San Francisco so broken.