Mon, May

Homeless Advocacy and Flat Earth Believers


iAUDIT! - Occasionally, I notice a news story about an oddball group called the Flat Earth Society.  As its name implies, society members believe Earth is flat, an idea not taken seriously since well before the birth of Christ. Greek mathematicians and astronomers calculated the planet’s circumference with uncanny accuracy in the third century BC. Spacecraft regularly take pictures of Earth’s spherical shape.  Nevertheless, flat earthers staunchly defend their views.  Initially, I dismissed flat earth believers as harmless eccentrics, like the stereotypical group of little old ladies who gather for weekly seances. Or maybe some people join because they want to be part of a massive satirical movement.  Unfortunately, I came to find there is a far more sinister side to the flat earth cult. 

Many flat earth theories are based on the belief that we have been the victims of centuries of deceptions, lies, and massive conspiracies by the “real” power behind government and science.  These lies include doctoring photos to make it appear the Earth curves away from an observer, phony scientific formulae used to measure the planet’s circumference, and most famously, the belief the moon landings were a massive government conspiracy, and footage from the moon was really shot on a Hollywood sound stage.  Of course, even a moderately powerful telescope can see physical proof of the landings by observing the detritus astronauts left behind on the moon’s surface. These conspiracy theories sow disrespect for science and feed distrust in government. 

One usually associates this kind of science denialism and willful ignorance with fringe groups and conspiracy freaks, on the intellectual level of people who think Neanderthals and dinosaurs coexisted on an Earth that is no more than a few thousand years old.  Yet there is a group of otherwise intelligent and educated people who share flat earthers’ disdain for facts: homeless advocates who stubbornly embrace Housing First as the one and only solution to homelessness. They continue to insist they have “proof” Housing First works, despite a long list of reputable reports that prove it’s a failed policy. Like their flat earth counterparts, they accuse anyone who disagrees with them as blind sheep who don’t want to accept the “truth”. 

Advocates point at statistics from the City and County claiming thousands of people have been sheltered or housed, when in fact both admit there are an unknown number of repeat clients who enter and leave the system at will. As the April 9 State Auditor’s report on homelessness performance measures says: “Specifically, the data show that only 13 percent of the exits from interim housing placements reported individuals moving into permanent housing. In contrast, the data show that 84 percent of exits from permanent housing placements reported individuals moving into other permanent housing. The data further show that 44 percent of the exits from interim housing reported individuals returning to homelessness, as opposed to 4 percent of exits from permanent housing placements”. 

To put those percentages into perspective, the report provides a chart on page 26 showing the path unsheltered homeless people follow once they enter the service system. Between July 2019 and March 2023, 247,866 clients exited interim housing facilities in the counties included in the audit. Of those, 44 percent, or 109,060 people fell back into homelessness. And there may be more who return to the streets because homeless agencies don’t know where they went. Reviewing Homeless  Housing Assistance Program (HHAP) funded programs, the audit reported, “…nearly one‑third of the exits from HHAP Round 1‑funded services left those services for unknown destinations. Because an unknown destination can indicate that the person did not know the destination, that the person refused to answer, that the data was not collected, or that the exit interview was not conducted, we cannot determine whether these people actually exited homelessness”. Only 13 percent, or about 32,220 people, transferred to permanent housing. But, as the chart shows, “permanent housing” is a relative term. 

Seventy-seven percent of those listed as permanently housed actually entered “rapid rehousing” facilities.  The National Alliance to End Homelessness says “Rapid re-housing provides short-term rental assistance and services. The goals are to help people obtain housing quickly, increase self- sufficiency, and stay housed. It is offered without preconditions (such as employment, income, absence of criminal record, or sobriety) and the resources and services provided are typically tailored to the needs of the person”. There are two key phrases in this statement. First, note the reference to “short-term” assistance and services. The assumption is that the client will eventually exit rapid rehousing for something more permanent.  Applying numbers to the percentages, of the 46,363 people entering permanent housing, 35,699 went into a rapid rehousing program rather than other facilities like permanent supportive housing. Therefore, how permanent that “permanent” housing may be is unknown. 

The second phrase is that housing is offered without preconditions—the No Barrier policy within Housing First. People are offered housing on the assumption they will accept services and those services will be more effective since the person has a stable living environment. This Housing/Services combination is the core of Housing First. The problem is there is almost no empirical support for that assumption. Several studies have debunked Housing First’s efficacy.  For example, a Stanford Economic Policy Institute report from May 2022 cites other studies that state “Housing First showed no effects in reducing drug use, alcohol consumption, psychiatric symptoms, or enhancing the quality of life (Rosenheck et al. 2003; Mares, Greenberg, and Rosenheck 2007; Stergiopoulos et al. 2010).”  An August 2022 National Institute of Health study stated “that there is no substantial published evidence as yet to demonstrate that PSH improves health outcomes.”  The NIH study is particularly interesting because it states there are positive health outcomes when Housing First is part of a whole-person service package that includes medical, mental health and recovery support as needed.  The study says people placed in permanent supportive housing and who receive appropriate support services are more likely to stay housed longer, and experience fewer health problems than those left on the street.  In Los Angeles, just the opposite is happening; because many advocacy groups oppose any form of temporary shelter, and because shelters have a well-earned reputation for poor management, people are being left on the street and unsheltered waiting for expensive and time consuming housing to be built. 

An April 2021 research paper from the journal Medical Care, published by the American Public Health Association, followed 73 chronically homeless people (the population Housing First targets), over a period of several years, and “found that housing retention was 82 percent after one year, but fell dramatically to 36 percent after five years, and to just 12 percent after 10 years. Long-term outcomes for this permanent supportive housing program for chronically unsheltered individuals showed low housing retention and poor survival.” Shockingly, the journal stated, “Nearly half of the cohort (45%) died while housed [my italics]. The co-occurrence of medical, psychiatric, and substance use disorder, or ‘tri-morbidity,’ was common.” 

These studies also debunk another favored myth of Housing First’s advocates. They insist the picture of the “service resistant” homeless person is an urban legend, based on peoples’ prejudices and misconceptions. However, as a report from the nonprofit service provider Hollywood 4WRD shows, The County Department of Public Health estimates 95 percent of people with substance abuse problems don’t want treatment.  About 50 percent of people with untreated mental illness don’t recognize they have a problem, a condition known as Anosognosia, or denial of a mental deficit. Therefore, a large proportion of the people Housing First is supposed to help don’t want that help. 

The dismal numbers in the State Auditor’s report, combined with the policy failure of Housing First, are reflected in the poor performance we can see in Los Angeles’ programs.  The City’s homelessness programs website, in the section on LAHSA cash requests, shows payments and statistics for the Highland Gardens Interim Housing Center. Note how few clients transitioned to permanent housing from July through December 2023; only three in six months. For just two of those six months, the City paid LAHSA $1,373,728 to operate the shelter. If you project that cost over the six months in the performance reports, it’s $4,121,184 to house three people,  or $1.37 million per person. 

For all its conspiratorial allure, the flat earth movement is still exiled to the fringes of society. Other than exasperating some scientists, flat earth’s outlandish theories have done little damage to society at large.  The equally vacuous theory of Housing First, on the other hand, has cost governments billions of dollars in wasted programs, and left tens of thousands of people on the streets, where they must fend for themselves, and where, in Los Angeles, six die every night.

(Tim Campbell is a resident of Westchester who spent a career in the public service and managed a municipal performance audit program.  He focuses on outcomes instead of process. Tim is a featured writer for CityWatchLA.com.)