Homeless neighbors deserve compassion — and housing

Loss of income results in a frantic attempt to find housing, inevitably thwarted by ever-rising Bay Area rents. Then, a downward spiral from couch surfing to sleeping in a car to, all too often, the streets. Many turn to alcohol or opioids to stave off depression, or methamphetamine to stay awake and avoid being robbed at night. 

As a doctor in the safety net, I’ve become familiar with the daily challenge of helping patients manage their illnesses without having a roof over their head. Our efforts to help them in the hospital often feel inadequate, knowing that once they recover from their acute illness, they will return to an entirely unhealthy environment. I can write prescriptions for medications that cost hundreds or even thousands of dollars per month, but I can’t order what my patients need most — housing.

Going into the meeting, I expected to hear opposition to the facility. Homelessness feels like an intractable problem in the Bay Area, and the recent rise in anti-Asian crime has understandably become a major concern. Still, I was disturbed by the utter lack of compassion displayed by the vast majority of the audience. Many speakers depicted all homeless people as drug-addicted, mentally ill predators. One group of attendees even had small children waving signs reading “Protect Us.” Even those who avoided such explicit demonization expressed no sympathy for the plight of unhoused people, insisting that supportive housing would draw more homeless people to the area and would be a waste of money. 

These narratives about unhoused individuals are widespread, but are not accurate. The UCSF Benioff Homelessness and Housing Initiative recently interviewed 3,200 people currently experiencing homelessness throughout California. Its findings undercut many of the assumptions about homeless individuals on display at the community meeting. The unhoused are our neighbors — 75% of them were last housed in the same county where they are currently experiencing homelessness. Far from being violent predators, a large proportion of the unhoused are elderly and unhealthy. Nearly half of those surveyed were more than 50 years old, and the majority had at least one chronic illness. True, many homeless people struggle with substance use disorders — though still a minority. Those individuals deserve compassion and care as well.

Most importantly, numerous studies — including one conducted by UCSF researchers in Santa Clara County — have shown supportive housing keeps people housed and can reduce their use of emergency health care services. Other cities have used this “Housing First” approach to dramatically reduce homelessness without any evidence of increased crime near the facilities. I also care for patients who live in supportive housing facilities in San Francisco, and have seen firsthand how being housed and having access to targeted services helps them stay healthy and off the streets.

Housing First has been under attack recently from right-wing politicians and commentators, relying on the same tropes that were voiced at the Millbrae community meeting. Despite such claims, the facts are clear — a Housing First approach that incorporates permanent supportive housing facilities is the most effective and evidence-based way to address chronic homelessness.

I understand people experiencing homelessness don’t necessarily inspire sympathy, but neither do they deserve the vitriol displayed at the Millbrae community meeting. We should not abandon our neighbors who need help. Opponents of the proposed facility believe that it will bring more crime but, in truth, blocking supportive housing will only result in more people on the streets, more disorder and a greater burden on city services. We should not deny the most vulnerable among us the stability that only a home can bring.

Dr. Sumant Ranji is a professor of medicine at the University of California, San Francisco and a hospital medicine physician at San Francisco General Hospital.