SF Mayor's Homelessness Strategy Won't Work

Contributor
School of Nursing

At 12:30am on Christmas eve after ten and a half hours of public comment, the San Francisco Board of Supervisors voted affirmatively on mayor London Breed’s “state of emergency” declaration in the Tenderloin. This declaration vows to address the Tenderloin’s homelessness crisis by increasing police presence and the enforcement of anti-homeless laws.

This strategy won’t work and will likely exacerbate the problem.

According to the San Francisco Coalition on Homelessness, San Francisco began enacting anti-homeless legislation in the 1980s, with the city now having 23 laws that make behaviors associated with being homeless illegal. Many of these laws target bodily functions that unhoused people are forced to perform in public, such as sleeping, urinating, and defecating. Since San Francisco lacks both adequate shelter beds and public toilets, the end result is that homeless people are fined up to $150 per ticket for engaging in acts of daily living in public, with unpaid tickets often resulting in jail time, debt, and a criminal record that makes exiting homelessness even harder.

We already know that police responses to homelessness do not result in unhoused people getting access to services. A joint survey between UCSF’s Do No Harm Coalition and the San Francisco Coalition on Homelessness surveyed 351 homeless people, of whom 70% had been displaced from public by police in the past year. Of those 70%, 91% were displaced to other outdoor locations, and the remaining 9% to public indoor spaces. Only 24 displacements resulted in the unhoused person being offered services, usually a brochure or sandwich, and only 10 people ended up accessing a temporary shelter bed.

We also know that a police-based response to homelessness has public health consequences. When the City of Boston, MA adopted a police based homeless response strategy similar to San Francisco’s, epidemiologic modeling predicted a 15% increase in infectious endocarditis, 4% increase in skin and soft tissue infections, and 30% increase in fatal opioid overdoses. Constant move-along orders makes it extremely difficult for patients to have continuity of care.

As a public health nurse for example, I’ve lost count of the number of times I’ve been looking for a patient with a positive HIV, hepatitis C, or syphilis test and couldn’t follow up with them because their camp had been displaced. Police harassment, displacement, and confiscation of personal belongings cause chronic stress, leave people vulnerable to heat and cold related illnesses, and interfere with access to medical care and social services.

For all of these reasons, professional organizations are increasingly recognizing the health impacts of using police as a response to unhoused people and the American Medical Association, American Public Health Association, and the Center for Disease Control and Prevention all recommend against criminalizing homelessness.

Increasing police in the Tenderloin might make homelessness temporarily less visible, but it won’t do anything to address the underlying problems, like wealth inequities, wage stagnation, housing costs, and the lack of a social safety net. If London Breed genuinely wants to recognize homelessness in San Francisco as a “state of emergency”, she should be directing money towards evidence-based solutions.