Mental Health Matters: Homelessness in America is a growing problem |

Mental Health Matters: Homelessness in America is a growing problem

Andrew Whyman
File photo |

My wife and I visit San Francisco frequently. For several years now, I have observed, with equal parts disgust and guilt, the growing “homelessness problem,” a problem shared with other mostly West Coast and Southern cities.

Daily, during my early morning walk on the world class Embarcadero fronting the water, I witness several people, mostly men, asleep under a filthy blanket or in an equally filthy sleeping bag, abandoned cardboard for a mattress, and plastic coverall to protect them from the elements.

Some pitch a tent on the sidewalk for a day or two. Some urinate or defecate in plain view. Some, preoccupied with demons only they can see, shake a fist and wail belligerently. Most sit on the pavement, unmoving, eyes seemingly vacant, and sit.

On my last outing, I saw the shrouded outline of a motionless person in what, I swear, was a third day of rigor mortis. Should I notice that there is something ugly, stinking, and wrong about this picture?

“Life on the street is hard, very hard. Beyond violence and thievery, there is no order, no routine, no structure, no assured sustenance — and no way to stay clean.”

I also see that New Orleans has an “Airbnb problem.” Historic residential neighborhoods play unwilling host to some 2,000-4,000 short term rental guests. On one side are people who plead that only by renting rooms do they have sufficient cash to rehabilitate their property after Hurricane Katrina or pay the mortgage after being laid off.

On the other are local preservationists, and residents of historic New Orleans neighborhoods, who see the unique charms and livability of their communities destroyed.

What strikes me is that so many solid middle class homeowners find it more difficult to remain in their homes.

And a snapshot: Oren Alexander, real estate agent to the rich, says his clients are no longer second-home buyers. Rather, they purchase “the four-pack” — a pied-à-terre in New York, a beach house in the Hampton’s, a ski villa in Aspen, and a winter condo in Miami.

These fortunate folk, says Richard Frank, writing about wealth in the 3/6/16 New York Times, “have property everywhere but live nowhere, moving with the sun, seasons, and an increasingly crowded calendar of V.I.P. events.”

Back to San Francisco; some 3,500 people sleep in the streets every night. The total homeless population is presently about 6,500 souls.

Years ago, when I worked in the public mental health system in San Francisco, I met some of these people. Many, due to mental illness and substance abuse problems, couldn’t hold a job, and eventually lost what shelter they had. Others, to include an occasional family, lost work, couldn’t afford the rent, and later, on the streets, became mentally ill.

It is often presumed that the homeless choose the streets. That presumption is wrong. Life on the street is hard, very hard. Beyond violence and thievery, there is no order, no routine, no structure, no assured sustenance — and no way to stay clean. This circumstance causes further emotional deterioration.

Says author and sociologist Don Stannard-Friel, “The trouble is that homelessness has developed so much over the years that it’s become accepted. People living in cardboard boxes under a freeway — until the 1980s we hadn’t had that since the Depression. We have to change our attitude. The problem is us.”

There are proven techniques to end homelessness — permanent supportive housing, on site mental health care, drug rehab, medical services and job counseling.

But, who pays? Income inequality in America is at the highest level in a century, and, not coincidentally, homelessness has increased. Congress refuses to provide federal support, and regional and local government cannot or will not.

Talk about penny-wise and pound foolish; leaving a homeless person on the street costs $60,000 per year in police, hospital, and other emergency services. Providing permanent housing costs $20,000. Do the math!

The solution is obvious; create the necessary housing. But we can’t get there. Too many competing interests. Too much blaming the poor for their poverty. Too much anger, fear, and indifference. Too little appreciation of how hard life is for those who live in the shadows.

Too much big money, pocketing 10-20-30 million a year and more, calling themselves job creators and spinning the twin myths of free markets and honest, wholesome competition. In short, too much at the top and too little at the bottom.

I don’t know if that will change. But I do know that owners of multimillion dollar condominiums will grow weary of stepping around bodies huddled in doorways, or encamped on sidewalks, demand change, and those bodies will be made to go somewhere else.

Incline Village resident Andrew Whyman, MD, is a clinical and forensic psychiatrist. He can be reached for comment at

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