by Randy Shaw on February 10, 2025 (BeyondChron.org)
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Three Actions Would Make Big Difference
San Francisco’s homeless population has changed. Today’s unhoused are less employable, more likely to suffer mental health issues, and more often addicted to illegal drugs than their predecessors of two decades ago.
Yet San Francisco has been on auto-pilot. Key city policies impacting supportive housing have not changed. Which raises the question: since housing the unhoused is more challenging than ever, why haven’t San Francisco homeless policies adapted to this new reality?
The city’s failure to make obvious, positive, and essential changes to its homeless policies has put enormous and unfair pressure on supportive housing sites. Three essential steps can quickly make a huge difference.
1. Mandate Case Management
It’s called “supportive housing” because of on-site case management support for tenants. But do people realize that tenants do not have to access this support?
Many people do not. They claim drug overdoses in supportive housing are a failure of its wraparound services. But no tenant is required to use these services. These overdoses reflect a system that doesn’t mandate services as a condition of tenants’ receiving subsidized housing.
Why aren’t services mandated? I was part of the discussion when that decision was made. It was part of the plans for the Tenderloin Housing Clinic’s (which I head) first leased supportive housing hotel in 1999. Some felt that people must want services for them to be effective. And that many unhoused would turn down housing if required to use case management.
1999 was a different unhoused population. Most simply required rents they could afford. Prospective tenants were far more employable. Mandating services seemed unnecessary. Many tenants soon got jobs and moved out; supportive housing was seen as a step to employment rather than the lifetime housing option it has primarily become.
Mayor Lurie should require mandated case management for all new supportive housing placements. It could make a huge difference.
Those refusing services after placement should be required to leave the housing within thirty days. For those who feel that it’s wrong to return people to shelters due to their refusing case management, San Francisco has a choice: prioritize its resources toward helping people trying to turn their lives around or continue subsidizing troubled people who refuse help.
I favor the former.
2. Designate Hotels for Tenants With Higher Needs
Supportive housing providers have long argued that people with extreme mental health and/or substance abuse problems should be placed in hotels with a higher level of clinical services. Yet this still doesn’t happen.
What happens when people with acute problems are placed in supportive housing that lacks the services they need? Overdoses, increased vandalism, and conflicts with other tenants.
The city should place those with extreme problems in hotels with a higher level of clinical services. And mandate those services. The city should stop placing people unable to function in an SRO without clinical care in hotels lacking these services.
Mayor Lurie talks a lot about helping those with extreme behavioral problems. The city’s longstanding approach—placing them in hotels lacking necessary services—must end.
3. Open Permanent Drug-Free Housing
I have written many stories on the need for San Francisco to offer permanent supportive drug-free housing (See, for example, “The Truth About Drug-Free Housing,” February 26, 2024) Yet the city still fails to provide a single hotel for those eager to escape drugs.
Supportive housing providers are not allowed to bar tenants on the grounds they use drugs. Drug addicts are not required to access any services.
Why are San Francisco taxpayers subsidizing rents for drug addicts who refuse help? Shouldn’t the city spend its scarce dollars helping people trying to turn their lives around?
Transitional drug-free housing leaves people with no drug-free housing option when their one to three year stay ends. Richard Beal, THC’s Director of Recovery Housing, has long called for a “bridge” connecting transitional programs to permanent drug-free housing.
San Francisco can create this bridge. It’s a question of changing policies from helping drug addicts avoid recovery to subsidizing rents for those seeking recovery. Those eager to get jobs and turn their lives around.
This seems like a clear choice to me.
Randy Shaw
Randy Shaw is the Editor of Beyond Chron and the Director of San Francisco’s Tenderloin Housing Clinic, which publishes Beyond Chron. Shaw’s new book is the revised and updated, The Tenderloin: Sex, Crime and Resistance in the Heart of San Francisco. His prior books include Generation Priced Out: Who Gets to Live in the New Urban America. The Activist’s Handbook: Winning Social Change in the 21st Century, and Beyond the Fields: Cesar Chavez, the UFW and the Struggle for Justice in the 21st Century.
