The city has become a web of contradictions.\u00a0<\/strong>There\u00a0are<\/a>\u00a0thousands of new millionaires, and, by the latest\u00a0estimates<\/a>, 18,000 people in and out of homelessness. The headquarters of Uber, Twitter, and Square are blocks away from the open-air drug markets of the Tenderloin, Mid-Market, and SoMa. Wealthy families attending an art opening at the Civic Center have to cross through the tent encampments that line the sidewalks.<\/p>\n Residents, property owners, and small businesses\u2014who pay an enormous premium to live and work in San Francisco\u2014have begun to erupt in frustration.\u00a0<\/strong>Citizens\u00a0tell<\/a>\u00a0pollsters that homelessness is the city\u2019s most pressing issue and business owners\u00a0tell<\/a>\u00a0pollsters that “conditions on [the] streets have progressively deteriorated.\u201d<\/p>\n Mayor London Breed of San Francisco: Trying to address the city’s problems by expanding institutions the chronically homeless keep cycling through.<\/em><\/p>\n City Hall has begun coming to terms with the crisis.\u00a0<\/strong>Mayor London Breed recently hired a director of mental health reform, Dr. Anton Nigusse Bland, who compiled a statistical summary of the problem. People have long known that San Francisco has a homelessness problem, but Nigusse Bland discovered a population-within-a-population\u2014the so-called\u00a0\u201cperilous trifecta\u201d<\/strong><\/em><\/u>:<\/p>\n 4,000 men and women<\/a>\u00a0who are simultaneously homeless, psychotic, and addicted to alcohol, meth, or heroin.<\/strong><\/u><\/em><\/p><\/blockquote>\n About 70 % of them have been on the streets for more than five years; 40% have been on the streets for more than 13 years.<\/p>\n This is the city\u2019s fundamental predicament.<\/p>\n How do you help people in the grips of the perilous trifecta? What interventions could make progress? Where do social workers even start?<\/strong><\/em><\/p>\n It\u2019s almost impossible to understate the depths of this challenge.<\/p>\n Dr. Anton Nigusse Bland, city mental health director: Identified 4,000 suffering from the “perilous trifecta” of homelessness, mental illness, and addiction<\/em><\/p>\n San Francisco\u2019s current policy toward the perilous trifecta can be best described as compassionate neglect.<\/strong>\u00a0Every year, the chronically homeless cycle through the institutions of the socialized state, from hospitals, jails, and shelters, to sobering centers, case management appointments, and 72-hour psychiatric holds. Local government provides enough to meet an outward standard of compassion, but not enough to alter the trajectories of the homeless. The result is a disaster, which has drawn criticism across the political spectrum. Progressives are demanding more funding for existing programs, while moderates are bewildered by the eternal recurrence of tents, needles, and feces in their neighborhoods.<\/p>\n The current policy regime can be divided into three domains — the hospital, the jail, and the subsidized apartment.<\/strong><\/p>\n Together, these institutions represent the new orthodoxy of the modern urban approach: Homelessness is reduced to a set of social-scientific variables, to be manipulated through the intensive application of the medical and social sciences.<\/p>\n As part of its medical system<\/strong><\/u>, San Francisco currently\u00a0spends<\/a>\u00a0more than\u00a0$255 million\u00a0per year on mental health and substance abuse programs, many of which cater to the city\u2019s homeless. In a\u00a0recent audit<\/a>\u00a0of the behavioral health system, the city\u2019s budget and legislative analyst found that\u00a070% of all psychiatric emergency visits involved a homeless individual and that 66% of all visitors had co-occurring mental health and substance abuse disorders.<\/strong>\u00a0In total, the top 5% of \u201csuper-users,\u201d totaling 2,239 adults, the majority of whom fall into the perilous trifecta, accounted for 52% of total systemwide service use. Doctors at San Francisco General see the same set of patients so frequently that they have developed an entire\u00a0vocabulary<\/a>\u00a0to describe the population that circles in and out of their doors.<\/p>\n The jail system is next.<\/strong><\/u>\u00a0According to the San Francisco County Jail, the homeless\u00a0account for<\/a>\u00a040% of all inmates — despite being less than 1% of the city\u2019s overall population, and even after San Francisco decriminalized many quality-of-life crimes associated with homelessness.\u00a0Again, the perilous trifecta looms large. Inmates with co-occurring mental health and substance abuse disorders are\u00a0more likely<\/a>\u00a0to be homeless and more likely to be charged with a violent crime compared to the general jail population. The pithy observation about deinstitutionalization is largely true:\u00a0The people who might have once lived in the state mental hospital have simply been transferred to the county jail.<\/strong><\/em><\/p>\n Neither hospitals, jails, nor public housing have solved San Francisco’s homelessness epidemic.<\/em><\/p>\n Finally, the public-housing complex is the new great hope,<\/strong><\/u>\u00a0and fastest-growing public expenditure, for the homeless. Like many major\u00a0West\u00a0Coast cities, San Francisco has gone all in on \u201cHousing First,\u201d the theory that the municipal government must provide free housing for the homeless in perpetuity, with no expectations of sobriety, work, or participation in rehabilitation programs. For a city with a recurring homeless\u00a0population<\/a>\u00a0of 18,000, this is an enormous expense.\u00a0In 2019, San Francisco\u00a0spent<\/a>\u00a0$285 million on shelters and \u201cpermanent supportive housing,\u201d\u00a0plus<\/a>\u00a0$65 million on traditional public housing, vouchers, and SRO units.\u00a0At the same time, voters passed an additional $600 million bond to build \u201caffordable housing.\u201d But still, 67% of the Bay Area\u2019s homeless are\u00a0unsheltered<\/a>.<\/p>\n Even as they tout \u201cevidence-based interventions,\u201d \u201cdata-driven solutions,\u201d and \u201cbest practices,\u201d leaders in San Francisco have recognized the failure of the current system and proposed an ambitious reform agenda. However, in broad terms, this agenda only deepens its dependency on the social-scientific model and doubles-down on its worst assumptions. It can be summarized this way: deinstitutionalization, destigmatization, and decriminalization.<\/strong><\/p>\n In 2019, Mayor Breed and Supervisors Matt Haney and Hillary Ronen championed legislation for sweeping \u201cmental health reform.\u201d The plan would increase total spending on mental health and substance abuse to $500 million per year, and prioritize the homeless, create a central service center, and pressure private insurers to cover more costs. When it passed unanimously through the Board of Supervisors, Ronen\u00a0celebrated<\/a>\u00a0it as a progressive milestone: \u201cWe just created the first universal mental health and substance use system in the country.\u201d<\/p>\n San Francisco’s homeless problem can be traced back to the deinstitutionalization of the mentally ill after Ken Kesey’s 1962 novel and this subsequent film.<\/em><\/p>\n But this universality is only a theoretical formulation. The legislation does not include a funding source and, more important, simply expands the existing behavioral health system rather than reforming it.<\/strong>\u00a0For the perilous trifecta, the problem is often not access to services, but participation in services. According to the latest one-night\u00a0count<\/a>, only 17% of the homeless reported using mental health services and only 11% reported using substance abuse services.\u00a0For\u00a0the unsheltered population, these figures are almost certainly lower.<\/p>\n The problem is that members of the perilous trifecta are the least likely to seek services.<\/strong><\/u>\u00a0According to the Treatment Advocacy Center, approximately half the\u00a0patients<\/a>\u00a0with schizophrenia and bipolar disorder suffer from anosognosia, which is the inability to understand their own disorder, often leading to a refusal to enter treatment and take medication. Adding a serious addiction to methamphetamine, which can cause paranoia, psychosis, hallucinations, and violent behavior, only compounds the problem.<\/p>\n In the past, the solution to this paradox was compulsion. The state took custody of the \u201cgravely disabled\u201d and treated them in long-term residential institutions. However, with the exposure of civil rights abuses and the release of Ken Kesey\u2019s 1962 novel, \u201cOne Flew Over the Cuckoo\u2019s Nest,\u201d the United States gradually dismantled its mental health system,\u00a0reducing<\/a>\u00a0the number of mental health beds per capita by an astonishing 95% between 1955 and 2016.\u00a0Today, California has\u00a0fewer<\/a>\u00a0beds per capita than the national average, with San Francisco\u00a0having<\/a>\u00a0only\u00a0219\u00a0adult psychiatric beds available at a given time — drastically insufficient for the number of people in need.<\/p>\n Although Mayor Breed has tentatively moved towards a return to short-term \u201cconservatorships,\u201d a form of involuntary commitment for individuals who present a grave danger to themselves or others, the plan has neither the scope nor the force to significantly reduce the numbers of the perilous trifecta. Because of pressure from disability activists and the ACLU, which have\u00a0called<\/a>\u00a0conservatorships \u201cthe greatest deprivation of civil liberties aside from the death penalty,\u201d the plan is limited to individuals who have had eight or more involuntary psychiatric holds in the past year, which, in practice, would mean\u00a0less<\/a>\u00a0than 100 people citywide.<\/p>\n Mayor Breed did not return a request for comment.<\/p>\n San Francisco’s progressive District Attorney faces recall efforts in response to rising crime.<\/em><\/p>\n Many progressive socialists argue that there is too much force in the system, not too little.\u00a0<\/strong>San Francisco\u2019s district attorney, Chesa Boudin, took office in January 2020\u00a0pledging to<\/a>\u00a0substantially\u00a0reduce<\/a>\u00a0the county jail population, end cash bail, and\u00a0decriminalize<\/a>\u00a0quality-of-life crimes associated with homelessness, including public camping, drug consumption, prostitution, and public urination.\u00a0Boudin\u00a0contends<\/a>\u00a0that the criminal justice system in San Francisco is a domain of persistent inequalities \u2013 locking up a disproportionate number of poor and minority residents \u2013 and has become the dumping ground for the addicted and mentally ill.\u00a0<\/strong>Rather than continue this system, Boudin argues, the city\u00a0must<\/a>\u00a0\u201cimplement a comprehensive transformation of the criminal justice system to decriminalize and treat mental illness, housing instability, and substance use as public health issues rather than criminal justice issues.\u201d<\/p>\n Boudin\u2019s formulation does align with a single-day\u00a0snapshot<\/a>\u00a0of the San Francisco County Jail population from 2016,\u00a0which\u00a0found that 48% of inmates were African American, 70% self-reported substance abuse, and 10% were deemed to have a serious mental illness.\u00a0However,\u00a0the narrative that the city is somehow targeting non-violent drug offenders and \u201ccriminalizing homeless\u201d is specious.\u00a0<\/strong>The snapshot also shows that 68% of inmates were arrested for violence, weapons possession, and serious felonies. Contrary to progressive rhetoric, only 4% were arrested for drug crimes — a vanishingly small number of people for a city in the midst of a heroin and methamphetamine epidemic.<\/p>\n Authorities have\u00a0enabled<\/a>\u00a0massive open-air drug markets in neighborhoods like the Tenderloin.<\/em><\/p>\n The hard reality is that the perilous trifecta has fueled a boom in property crime and public disorder.<\/strong>\u00a0In 2019, at least 1,120 individuals in the trifecta spent time in the county jail. Although the homicide rate\u00a0remained static<\/a>\u00a0during Boudin\u2019s first year office,\u00a0burglaries have soared<\/a>\u00a0in a city that already\u00a0had<\/a>\u00a0one of the highest property crime rates in the nation, while authorities\u00a0enabled<\/a>\u00a0massive open-air drug markets in neighborhoods like the Tenderloin, which is a central hub for the homeless population.<\/p>\n The nexus between homelessness, addiction, and crime is clear:<\/strong><\/u>\u00a0According to city and\u00a0federal<\/a>\u00a0data, virtually\u00a0all<\/a>\u00a0of the unsheltered homeless are unemployed, while at the same time, those with serious addictions spend an average of $1,256 to $1,834 a month on methamphetamine and heroin. With no legitimate source of income, many addicts support their habit through a \u201chustle,\u201d which can include fraud, prostitution, car break-ins, burglaries of residences and business, and other forms of theft.<\/p>\n Boudin\u2019s plan to decriminalize such property offenses \u2013 the mirror opposite of the low-tolerance \u201cbroken windows\u201d approach adopted in the late 1980s as crime rates began historic declines \u2013 has contributed to the sense that he is not holding criminals accountable.<\/strong>\u00a0In 2019, the city\u00a0<\/a>had<\/a>\u00a0an incredible 25,667 \u201csmash-and-grabs,\u201d as thieves sought valuables and other property from cars to sell on the black market.\u00a0The following year, rather than attempt to prevent or even disincentivize this crime, Boudin has proposed a $1.5 million fund to pay for auto glass repair,\u00a0arguing<\/a>\u00a0that it \u201cwill help put money into San Francisco jobs and San Francisco businesses.\u201d\u00a0In literal terms, Boudin is subsidizing broken windows, under the notion that it can be transformed into a job-creation program.<\/p>\n Boudin did not return a request for comment.<\/p>\n Some San Franciscans are pushing back. Earlier this year, a group of residents and business owners launched a recall\u00a0effort<\/a>\u00a0targeting Boudin, arguing that his policies have enabled crime and not done enough to protect victims.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<\/strong><\/p>\n The final plank of San Francisco\u2019s policy platform is \u201cdestigmatization<\/strong><\/em>.\u201d Public health experts in the city have gradually\u00a0abandoned<\/a>\u00a0recovery and sobriety as the ideal outcome, preferring the limited goal of \u201charm reduction.\u201d\u00a0In a recent task force report on methamphetamine, the San Francisco Public Health Department noted that meth users \u201care likely to experience high levels of stigma and rejection in their personal and social lives,\u201d which are \u201coften reinforced by language and media portrayals depicting individuals who use alongside images of immorality, having chaotic lives, and perpetual use.\u201d<\/p>\n On the surface, this is a strange contention. If San Francisco\u2019s perilous trifecta is any guide,\u00a0methamphetamine use is heavily correlated with chaotic lives, perpetual drug abuse, crimes against others, and various transgressions against traditional morality.<\/strong>\u00a0The harm reductionists\u2019 argument, however, rests on the belief that addiction is an involuntary brain disease, akin to Alzheimer\u2019s or dementia. In this view, addiction is better seen as a disability, and any stigma associated with it is therefore an act of ignorance and cruelty. According to the Department of Public Health, the goal of harm reduction policy is to reduce this unjustified stigma and focus public policy on \u201cnon-abstinence-based residential treatment programs,\u201d \u201csupervised injection services,\u201d \u201ctrauma-informed sobering site[s],\u201d and \u201ctraining for staff on how to engage marginalized or vulnerable communities in ways that do not perpetuate trauma or stigma.\u201d<\/p>\n In practice, the task force recommendations would create an entire infrastructure to service addiction, rather than to reduce it.\u00a0<\/strong>Although proponents of harm reduction claim the mantle of compassion, it\u2019s a fatalistic theory. It assumes that most people cannot recover from serious addiction and, therefore, the social obligation is to provide the space and resources for addicts to pursue their own ends, which,\u00a0for<\/a>\u00a040% of the perilous trifecta population, means 13 or more years in and out of homelessness.\u00a0Activists have suggested\u00a0that<\/a>\u00a0addicts can \u201creduce harms\u201d by \u201c[using] indoors instead of on the street,\u201d \u201creducing how much [they are] using,\u201d \u201ctransitioning from injecting to smoking,\u201d and \u201ccontinuing to use one type of drug but quitting another drug.\u201d But in the face of the pathological overload of the perilous trifecta, these recommendations are negligently na\u00efve, relegating a large portion of the homeless to a lifetime of chaos, sickness, and despair.<\/p>\n In the long term, the real danger of destigmatization is that it would lead to the normalization of serious addiction and its consequences.<\/strong><\/u>\u00a0In San Francisco, progressives have attempted to normalize the worst aspects of street homelessness, minimizing the drug use, toxic waste, psychotic episodes, and related crimes; they have blurred the lines between sickness and health, madness and sanity. Moreover, without a trace of irony, they have weaponized destigmatization itself, stigmatizing anyone who opposes the breakdown of public order as \u201cfascists\u201d and \u201chomeless haters.\u201d<\/p>\n An entire social media community has arisen documenting the descent of San Francisco’s streets. Twitter\/homelessphilosopher\/@PoopScoopSF\/@sfstreets1\/ @PowelMason415\/@CleanUpWestSoma\/@EsmeAlaki\/@missmrm\/@markdfabela<\/em><\/p>\n The implicit wager of San Francisco\u2019s policy is that the social-scientific apparatus can rescue people faster than the perilous trifecta expands its ranks<\/strong>. But the evidence suggests the opposite: that San Francisco has become a magnet for the troubled homeless. Methamphetamine deaths\u00a0are<\/a>\u00a0up<\/a>\u00a0nearly 400% over the past five years; fentanyl overdoses\u00a0doubled<\/a>\u00a0between 2019 and 2020.\u00a0Meanwhile, the socialized state has reached a point of near exhaustion. First responders, police officers, and emergency room nurses are burning out. Psychiatrists at San Francisco General Hospital\u00a0despair<\/a>\u00a0about\u00a0the mass migration of out-of-state residents in search of the \u201cSan Francisco Special\u201d: \u201chousing, a psychiatrist, case manager, primary care provider, and transfer of Medicaid or general assistance.\u201d<\/p>\n The political class has insisted on greater control over the corporations, developers, and landlords, while deregulating life at the bottom.\u00a0<\/strong>The result has been a deepening inequality, and an even more anarchic world for the poor. There is an\u00a0entire<\/a>\u00a0social media community of mostly anonymous accounts who document the squalor of the encampments and psychotic episodes in the streets; they are the last resistance to the normalization of the perilous trifecta, and maintain their anonymity, it seems, out of fear of retribution. It\u2019s a dark reality, but perhaps a warning of what\u2019s to come.<\/p>\n In the end, San Francisco finds itself fighting a monster. \u201cHomelessness isn\u2019t just a problem; it\u2019s a symptom,\u201d\u00a0says<\/a>\u00a0its mayor.\u00a0\u201cThe symptom of unaffordable housing, of income inequality, of institutional racism, of addiction, untreated illness, and decades of disinvestment. These are the problems. And if we\u2019re going to fight homelessness, we\u2019ve got to fight them all.\u201d\u00a0But this is part of the reason homelessness has become so intractable — \u2014the political class has haunted its own world with abstractions; it has projected its own ideological premises onto the brutal reality of the streets.<\/strong><\/p>\n![\"\"](\"https:\/\/www.zerohedge.com\/s3\/files\/inline-images\/2021-04-30_9-50-15.jpg?itok=9fZ7LzGH\")
<\/picture><\/a><\/p>\n<\/picture><\/a><\/p>\n<\/picture><\/a><\/p>\n<\/picture><\/a><\/p>\n<\/picture><\/a><\/p>\n<\/picture><\/a><\/p>\n<\/picture><\/a><\/p>\n<\/picture><\/a><\/p>\n