The first part of the crisis is the shear numbers and how they have grown to numerous, uncomfortable and embarrassing levels. The second crisis is no one seems to know what to do about it.

Every politician has a somewhat different and changing position about how to deal with the problem, and so do I. It’s hard to know where to start or find much agreement on how to resolve the situation.

A researcher at the American Legislative Exchange Council (ALEC) sums up the problem in a broader context.

By examining the problem of homelessness on a state level, we can better address the magnitude of the situation. California has the largest population of people experiencing homelessness with nearly 130,000, 90,000 of whom are unsheltered according to the Department of Housing and Urban Development. The city of San Francisco alone had a 30% increase in homelessness since 2015. New York has approximately 91,000 and Florida has over 31,000. California is in a state of crisis mainly to the lack of affordable housing and the significant housing shortage. The average house price in the Bay Area is $1.25 million. L.A. is the least affordable housing district in America.

Given these challenges, efforts to tackle homelessness through increased state involvement in the housing sector have not been able to yield the intended results. This strategy amounts to simply throwing money at the problem. Oregon has recently passed the first statewide mandatory rent-controlled bill for all citizens in March of this year as an emergency measure. Rent hikes are capped at 7 percent including inflation during any 12-month period. California is attempting to enact a legal “right to shelter” mandate modeled after that of New York in effect since 1981. Last year, New York spent $3.2 billion on services to house its homeless population and $1.5 billion on shelters. It has created a safe haven. The California “right to shelter” plan does not offer any specifics, yet California is spending tons of money with little signs of progress. California legislators have allocated $650 million, with $124 million for building more homeless shelters despite the majors’ request for $2 billion. The costs to build are much too high.

For another view, I turned to the N.Y. Times California Newsletter and spoke with Dr. Margot Kushel, a leading homelessness researcher.

Margot Kushel is having the moment she never wanted to have.

Dr. Kushel is an internist at the University of California, San Francisco. She started specializing in low-income populations shortly after graduating from the Yale School of Medicine, and has spent two decades researching the underlying causes and consequences of homelessness in relative anonymity.

Lately, however, she’s seen her profile rise, as the problem she has spent her career trying to solve has escalated.

Last year, Dr. Kushel was named director of an Institute For Homeless Research, which was endowed with $30 million from Marc Benioff, the billionaire founder of Salesforce. The initiative is focused on translating proven homeless solutions into widespread adoption and continuing to research what isn’t known.

Here’s the conversation, edited and condensed for length:

Tell me about your career and how you ended up specializing in homelessness.

When I started residency, I realized that approximately half of the inpatients we cared for were homeless. We would admit patients to the hospital, give them all this very high quality, expert medical care, and then, eventually, we would have to discharge patients back to their homelessness, meaning to outside. Patients would ask me to please not discharge them, but eventually we wouldn’t have a choice. Inevitably, a few days later, the patient would be back, often in worse shape than they had been in before. I remember thinking that there had to be a different way and decided to change my career plans.

Most people who become homeless “self-resolve,” meaning they find housing. We don’t know how long that takes, and whether we could shorten it substantially by intervening. We know that for most people, long-term subsidies are the answer, but there may be people who need shorter term help. We are going to try to figure out who needs what, while working to solve the main problem, which is the shortage of extremely low-income housing.

What would it take to end homelessness?

We’ve always known that most homelessness is a result, pure and simple, of poverty: the lack of a living wage, the lack of affordable housing and the insidious impact of racism. If we don’t fix the fundamentals, we are just patching a leaking ship. And that is what has happened.

It would take an investment in creating and sustaining extremely low-income housing and efforts to increase the minimum wage and to close the existing housing gap. Right now in California there are 22 units available and affordable for every 100 households with extremely low incomes.

What was the state of understanding our homelessness when you first got started versus what we know now?

When we first started, people believed that to provide housing, people needed to go through steps. First, a shelter. Then, if they “behaved well” (didn’t use drugs, took medicines, etc.), they could get to transitional housing. If they did everything “right” then they could be offered permanent housing. As a result, only a tiny proportion of people with behavioral disabilities became housed.

Housing First turned that upside down, recognizing that when people were homeless, they couldn’t attend to their mental health or substance use needs (or anything else). This has been enormously successful, housing about 85 percent of the most complex folks. There is overwhelming and incontrovertible evidence that this works—people are housed successfully, and then the other things follow.

What are some of the myths around homelessness?

You hear people saying things like, “You can’t just house people who have addiction problems.” You can, and you must. Another is that homelessness is caused by mental health and substance abuse problems. We know that most homelessness is driven by economic forces. The vast majority of people who become homeless could be easily housed if there were housing that they could afford on their income. Yes, having mental health and substance use problems are risk factors. But, most people with these disabilities are housed.

What don’t we know about homelessness?

There is a lot more work to be done in homelessness prevention. We know that for some people, a small infusion of resources (cash, services) can prevent homelessness. But, for every 100 or so people at high risk, only one will become homeless. So, we need to do a better job of figuring out who the potential homeless people are.

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