Factually! with Adam Conover - Myths about Homeless People with Dr. Margot Kushel

Episode Date: May 8, 2024

Homelessness has reached a record high, with over 650,000 people experiencing it in the USA today. Despite this staggering number, many remain unaware of the true underlying causes of this crisis. Myths surrounding issues like drug use and immigration often serve as convenient scapegoats, deflecting attention from meaningful efforts to address the problem. This not only represents a moral failure towards those experiencing homelessness but also towards the communities affected by it. This week, Adam shares an illuminating conversation with Dr. Margot Kushel, Director of the Benioff Homelessness and Housing Initiative and a leading authority on the causes and solutions to the homelessness crisis. Dr. Kushel and the BHHI recently conducted the largest study of the homeless population in decades, and speaks with Adam about her findings, including surprising information about who comprises the homeless population, what it is actually like to be unhoused, and possible solutions to the crisis that may be closer to hand than we realize.SUPPORT THE SHOW ON PATREON: https://www.patreon.com/adamconoverSEE ADAM ON TOUR: https://www.adamconover.net/tourdates/SUBSCRIBE to and RATE Factually! on:» Apple Podcasts: https://podcasts.apple.com/us/podcast/factually-with-adam-conover/id1463460577» Spotify: https://open.spotify.com/show/0fK8WJw4ffMc2NWydBlDyJAbout Headgum: Headgum is an LA & NY-based podcast network creating premium podcasts with the funniest, most engaging voices in comedy to achieve one goal: Making our audience and ourselves laugh. Listen to our shows at https://www.headgum.com.» SUBSCRIBE to Headgum: https://www.youtube.com/c/HeadGum?sub_confirmation=1» FOLLOW us on Twitter: http://twitter.com/headgum» FOLLOW us on Instagram: https://instagram.com/headgum/» FOLLOW us on TikTok: https://www.tiktok.com/@headgum» Advertise on Factually! via Gumball.fmSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

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The Downloaded. A first listen is waiting for you when you start your free trial at audible.ca. Hello and welcome to Factually. I'm Adam know anything. Hello and welcome to Factually. I'm Adam Conover. Thank you so much for joining me on the show again. You know, homelessness is one of America's biggest crises. Homelessness numbers have been trending up since 2017 and reached a record high last year

with more than 650,000 people experiencing homelessness in America today. And this is true, especially where I live in California. But if you ask the average person or the average elected official why homelessness has skyrocketed, well, you're likely to hear the same old myths that people have been repeating for decades. That homeless people are being bused in from far away,

that all homeless people are mentally ill or on drugs, or that these are people who are just too lazy and don't want to work. Now, to be clear, all of these are false and have been disproven by the evidence. But these myths are told for a reason. They allow us to cast aside our own collective responsibility and our shame and blame the problem on someone else. And yes, I believe that we should be ashamed as a country of homelessness. I mean, here I am, in the wealthiest country on earth, in one of its wealthiest cities,

and yet I am surrounded by people, fellow citizens of the city in which I live, who have been left to die on the street. This kind of misery and deprivation is simply not something that is tolerated in a prosperous, well-run society. So its existence is evidence that America is failing as a country, not just economically, but failing to live up to basic fucking human values like dignity, health, and care. And you know, everyone has an opinion on homelessness, but very few people actually understand the actual causes. And if we want to solve this problem, we need to be clear-eyed about what the problem is

and where it is coming from. We cannot keep repeating the same old myths designed to make ourselves feel good. We need to know what the fuck we're talking about. Well, guess what? On the show today, we have an incredible guest who understands this problem more deeply than almost anyone else. But before we get into it, I just want

to remind you that if you want to support this show, you can do so on Patreon. Head to patreon.com slash Adam Conover. Five bucks a month gets you every episode of this show ad free and gets you into our awesome online community full of intelligent people who love to laugh and learn just as much as you do. And if you love standup comedy, head to adamconover.net. For my tickets and tour dates, I'm coming soon to a city near you. And now let me introduce this week's guest.

My guest today is Dr. Margot Cuchel. She's a professor of medicine, division chief at the UCSF Center for Vulnerable Populations, and she's the director of the Benioff Homelessness and Housing Initiative, which is a leading center for the study of homelessness. And last year, Margot and the center conducted the largest study of the homeless population in decades. Literally, she knows more about who is homeless

and what they are facing than almost anybody on the planet today, so there are a few people better equipped for this conversation. This was such a moving conversation that meant so much to me. I know you're gonna love that meant so much to me. I know you're gonna love it. So please welcome Dr. Margot Cuchel.

Margot, thank you so much for being on the show. Thanks for having me. So you have conducted one of the largest studies of homelessness in decades. Tell me a little bit about how you conducted that study and what you found from it. What were the headlines? Yeah, so we conducted it at the request of the California,

the secretary of the Health and Human Services Agency, Dr. Mark Galli, who called us up and asked us to do it. I'm gonna be honest with you, I was skeptical and said no a few times, but he sort of convinced us to do it. And then we were faced with how do we generate a sample that's representative of the largest state in the nation, you know, a state where an estimated now 180,000 people experience homelessness every night. And what we did was we decided to divide the state

into eight regions. These are regions that are kind of known and used in other policy planning. And then we threw information about every county and in the state into this massive computer model, and had it choose for us one county from each of the eight regions, I'll say right here now that LA County is its own region. So I can tell you we're in LA County. But we chose from the whole state and we spent a bunch of time in the communities, we were guided by advisory boards. So we had a group of people who themselves have been homeless,

sort of holding us to account, helping us understand the experience before we went out. We decided to do everything in English and Spanish and then we used interpreters if we ran into folks with different languages. In each county that we were in, we basically did an inventory of every place someone who was experiencing homelessness as an adult could be.

So encampments and shower lines and shelters and all the things. We took a random sample of those and then we went and took a random sample. We had interviewers with backpacks and Wi-Fi hotspots and iPads, and we randomly selected people and did an interview, lasted about 45 minutes. And then about one in eight folks we selected for what we call an in-depth interview. That's when we just turn on the microphone, just like you and I are talking now,

and really dug deep into the issues to understand that. So this is really deep field research. I mean, you're doing sort of not just a canvas how many people are present at a point in time, which I know is done in, for instance, LA County every year. You're finding out who these people are. You're getting their stories, how they became homeless,

what they are facing, where they are currently living, et cetera, and trying to get like a really broad picture. I'm, that's incredible work. Why is it not done more often? You said this is the largest study in decades. You would think that was such a critical problem. This would be happening, you know, everywhere in the country all the time.

Yeah, you might think, I mean, you know, we do do these point in time counts every, basically every other year, but they're not quite as scientific as this one was. And they're not really focused on the questions we were focused on, which is, who is homeless? How did they come to be homeless? What happens when they're homeless? And why are they still homeless?

Why aren't they leaving homelessness? It was really hard. I'm not going to lie. It costs a lot of money. It took a lot of time. It was very hard to do, but we think it's well worth it to do it. And I think we learned a lot of things that

maybe some people knew, but the general public didn't know. Some things that we really just didn't know the answer to. And we learned a lot from it. So it was a lot. It took a lot of time and effort to do it, but I'm really glad we did it. Well, I'm really glad that you did it too, because there are so many myths about homelessness

that I hear almost every day walking around Los Angeles. People are just shouting myths from the window. They're just like, all the homeless people are bused in from out of state. That's when you hear a lot, that people come to California to be homeless because the weather's so nice or other states bust them in. This is like an often repeated piece of common wisdom. So let's just start there.

What did your research find about where homeless people in this state actually come from? Yeah, it turns out people experiencing homelessness in California are Californians. Like who knew? Crazy that when people like lose their housing, the first thing they don't do is spend every cent that they had to come to the highest cost housing market in the country. Really crazy, right? I can tell you our team was out there in like 115 degree weather in 20 degree weather in pouring rain and blazing heat. I guess I would say maybe our weather is still was all that great either.

But but no, nine out of 10 people lost their stable housing in California. That means that they were living for quite a bit of time and, and really became homeless in California. 75% of people were actually in the same county that they lost their housing in. And, you know, like, how many is huge to the next nearest county, if you're in the middle of all the counties far away. But if you're in San Francisco County, there's no, you know, the other counties are right next door. Right. And people were really where they lost their housing. Actually, a much higher percentage of Californians were born in California

than Californians overall. Like I am. You can't tell from my accent and how fast I talk. I'm from New York, but, you know, I've lived here my whole adult lives. So am I, I am also from New York and yet I have lived in California for 10 years. So I am now, I've mixed feelings about it. I suppose I'm a mixed New Yorker Californian at this point. I would certainly, anybody who would question my bona fides

is that I've lived here for a decade, I pay my taxes, I think I get to say I'm a resident of the state, but you're saying that a higher proportion of Californians who are homeless were actually born here than in the population at large. Absolutely, absolutely. And then some people said like, how did you know people weren't lying?

And first of all, like, it's a little bit of an odd thing to lie about, but we were worried that people would ask us that question and we were sort of curious too And you know who I mentioned one in eight people got these in-depth interviews Yeah, and those in-depth interviews. They really just talked a lot about their life story and where they were when they lost their housing We were curious about this So we went back through that interviews because it was all the same people who were in the study

So we know what they answered to that first question You know where were you born and where did you lose your housing? And we listened to the recordings. And to be honest, our team was like frantically looking up names of random neighborhoods in small parts of California that we didn't recognize. Right? And like, if they were lying, they should have done their research on like random neighborhoods and random parts of California because we didn't know where they were and it turns out they were in California. So I have a lot of confidence in that. Well, and the idea that people would ask,

how do you know they're not lying? Well, what an odd level of suspicion to have about a person where you ask, where were they born, to assume that they might be lying about that when what would be even be the purpose of that sort of lie. It goes to show the level

of built in suspicion that a lot of people have about folks who are experiencing homelessness for, I know maybe we don't need to speculate about it, but that is, I think it goes to show the attitude that people have and hopefully your work is able to adjust that. I mean, if you were to paint a picture of someone who becomes homeless in California, right?

Nine out of 10 people were from here. Then why did they fall into homelessness? Was there a general picture that came into view that was most common? Yeah, I mean, you know, what we found was that people were desperately poor. And a lot of people were working jobs, lots of jobs, usually more than one job to try to make things go.

But we found, for instance, in the six months before people became homeless, the median monthly income for their whole household was $960 a month. And so what we found is, you know, there's that like aphorism or something that like things fell apart slowly and then all at once. Yeah, that really held true here. What we found particularly in this storytelling part of it was that people had had sort of hard lives were working really hard. And then things sort of slowly got worse. And so we heard of a lot of people who were like renting an apartment, let's say with their family,

and then someone got sick and they could no longer afford the family. So the family all rented a room and were smushed in together and were trying to make a go of it. And then something else bad happened. Their hours got cut or something. And then, you know, maybe they moved in

with their friends or family members until that fell apart. And so there was like not one thing, but in it, you know, in that there was one thing. So about 20% of people, 19% of people came directly from an institution, meaning do not stop go the next night. So they were discharged from prison onto the streets or a discharge from jail. The third commas most complex was drug treatment inpatient drug treatment centers discharged from there right to the streets. Yeah. So that was like one in five people. The rest of the people about half 49% of people came from what we called a non-leaseholder

housing arrangement. These were folks who had kind of lost their housing already, but were living with friends or family. Yeah. When we talked to folks, these were really stressful situations. Everyone was short of money. Tensions were running high. This is not like, oh, my brother came to stay with me in my four bedroom house in the suburbs

when I went to work as a lawyer. This was former people coming into a one bedroom house that now had 14 people in it. You know, tensions ran high there when things fell apart, they fell apart really quickly, like one day people had one day's warning. So generally what people said is most people left there because of an interpersonal conflict where they just felt like they couldn't impose anymore or, or they just needed their own space. Um, the other 32%.

I've heard that myself and for many years I did street engagement with a wonderful group called CELA here in Los Angeles. And when I would talk to folks, hey, you know, just say, how'd you end up here? And a lot of times they'd say, oh, I was staying here, but I couldn't stay there anymore. Couldn't stay there anymore.

I just couldn't. Exactly. Oh, it was an impossible social situation or financial situation that they knew they were imposing or the person that they were staying with was under such hard times that they couldn't stay with that person. A hundred percent.

And you know, it's interesting if you like rewind further, these folks had been like threatened with eviction before. So that's why they moved in, let's say with their brother. And then it just got to the point where it was just, they just felt like they couldn't do it. Money was tight, food was tight. We heard, we did this during COVID. And a lot of people were like, I was working. And so I was exposed to COVID. And I didn't want to bring it into grandma and killer. So I left, you know, those, those kinds of stories.

And then about a third of people, 32% left from a leaseholding situation where they actually were like on a lease or for a few percent of them on a mortgage for those folks the main reason was someone in the household lost income these were folks who's when we looked at those folks their median house those income fourteen hundred dollars they're paying seven hundred dollars a month in rent you know if your whole family is living on fourteen hundred dollars a month you can't really sustain paying half of it in rent because that other

700 is paying for food, for transportation, for healthcare, for everything. And so those folks got usually left, we found on a median of about a week. So basically, they basically had a, or maybe it was 10 days, they had an eviction notice placed and they were like, oh man, I'm getting out of here. They didn't call a lawyer, they didn't get help, they just left and fled. So those were the main reasons how people wound up in this situation.

You know, it reminds me of, I'm sorry, this image just came so vividly to mind when I was doing street engagement with CELA. So what we would do is just go out with food and water and meet people and then try to connect them with services. We also had a drop-in center. We would say, hey, do you wanna go to the drop-in center? We can have a van pick you up or you can get a hot meal.

Stuff like that. It's really basic, you know? I was doing it because I just wanted to get to know the people in my neighborhood. And I was out one day. We were at a sort of little public, not even a park, like a little, just, you know, a triangle in the middle of a couple of an intersection, you know, with like two benches or whatever.

And one of the guys I was with, who, wonderful man, sees a woman sitting on a bench and he's like, I need to go talk to that woman. Something's up with that woman. He goes up and talks to her. She's like in her early sixties, Spanish speaker but speaks some English. And he says, hey, are you doing okay? And she says, I just got evicted. And she was literally, she had gotten evicted

like the night before and was just sitting on a bench because she had nowhere else to go. She was just on a fucking bench in her. I was looking at her going, oh, these are the clothes she was evicted in. She like didn't have other clothes. I don't know where she was storing her stuff. Anyway, we were like, this is an emergency.

This was an elderly woman. And so, you know, Josh was able to get, you know, someone to show up that day. He had a number he could call. Very rare thing to have in Los Angeles, a number you can call to help someone in this situation. Was able to get her into some temporary housing. But it really struck me meeting her.

I was like, oh, this is happening in Los Angeles, in California, God knows how many times a day. And we just happened to be there to see it happen, like right in front of us. It was stunning to me. Harrowing, harrowing, really. I mean, we have these just earth shattering quotes of people talking about what that moment felt like. You know, they've worked their whole lives

and suddenly they're outside, they're terrified. And the aging part is really important. Like, you know, the median age in the study, 47, if you take out the really young adults who are sort of counted separately in the homelessness world or the folks with young kids are counted separately. Most of the folks are what's called single adults as are like over 25 and not with their kids, median age there or half of those folks, 48%

were 50 and over. And of those folks who are 50 and older, 41% had never been homeless before they turned 50. And that's like this woman you met, right? She's like, something went wrong. Maybe she got sick. Maybe her husband died and they were reliant on his pension or his work to pay the rent. And they're just out there like stunned and afraid. And yet the world treats them like they're like these at best alien invaders and at worst, you know, vermin. I mean, the language that our community uses to talk about people experiencing homelessness. And we felt that the people told us what it felt like to be seen as other and as dirty and as unworthy as criminal. You know, it's, it's really a big problem.

The picture you're painting also makes me think of how many steps of that process are invisible to us. Everybody knows what an encampment looks like on the street corner, but this woman who we saw and many other women like that, you would not have known from glancing, oh, she's resting. And it took my friend who was an experienced

outreach worker volunteer to know something was up, oh, something's not right with this picture. But so many of the other steps you describe where someone has a loss of income, so they move in with a relative or move in with a friend. And then even the steps past that, maybe next they're sleeping in the back seat of their car parked at their friend's house. You know, and so they're 100% yeah. Oh, that's just for a little while just for a little while.

But I would call that homelessness. I'm not sure if you would as a technical definition, but that is If you're sleeping if you're sleeping in your car, you're homeless if you're sleeping in your car You're in your friend's garage, which we saw and but what happened is you're sleeping your car in your friends garage, which we saw. But what happens is you're sleeping in your car in your friends garage. And then suddenly the neighbors call and say, hey, there's someone sleeping in my friend's garage, you know, my friend's driveway. And so they don't want to get their friend in trouble. Right. So they're like, Oh, don't worry, I really don't want to get you in trouble.

I'll, I'll go someplace else. And then what we found is like, eventually their car gets ticketed and towed and then they're in the tent, you know, it's like this downward spiral. Yes. That often the car is in the middle and then you're then you don't even have that. Yeah. But so many of those steps are not visible to people. And I think that's part of why people say, oh, these people must be coming from somewhere else.

Right. Because they don't see that in, like, I guarantee in my neighborhood right now, there are folks who are sleeping in their cars who I don't know about. Because I'm just seeing a car on the street or in someone's driveway, right? I'm not seeing the fact that there's homelessness

or at least great housing insecurity in my neighborhood. I'm not seeing the 12 people to a room. Right, you're not seeing the 12 people to a room because that's invisible to those of us who are lucky enough not to experience room. Right, you're not seeing the 12 people to a room because that's invisible to those of us who are lucky enough not to experience that. Yeah. So what, tell me about after people have been on the street for a while,

what does that life look like? What do people have to deal with? What information did your survey turn up? I mean, in a word, it is harrowing, absolutely harrowing. So we found that, you know, once people got outside or into a shelter, they stayed homeless a really long time, like about almost two years. The median time was most folks who experience homelessness in California do so unsheltered. So only 22% spent most of their time in any form of shelter.

So most were either outside or about one in five or in their car. People's health really fell apart. People had really poor access to any assistance. They just felt alone and abandoned. The level of violence people experienced was absolutely harrowing. Just shocking. That about 10% of people were sexually assaulted during this episode. Women and trans folks much more. Over a third were physically assaulted.

And one of the things that we found was that when they're assaulted, once they're homeless, they're assaulted by strangers. They're not like, you know, most, most people who experience violence, it's at the hands of someone who's known to them. Turns out not if you're homeless. And so people, you know, were sleep deprived, terrified, demoralized. Very few people were getting any help from anyone to actually get back into housing. And people would tell us about this Catch-22. They're like, you know, in order to get a job, you need to have some proof of who you are. You need to have an address. You need to have a phone so you can look for that job. And they wouldn't have those things. But they're like, since I can't get a job, I can't get out of the situation.

And they just felt trapped in this endless, terrifying loop. Yeah. I mean, you said so many things there I want to respond to. First, the fact that homeless folks are the victims of violence is so striking considering that a lot of people fear that homeless people cause violence, right? Because violence happens around homeless encampments. But the reason it happens is because they are so incredibly vulnerable. You know, I was on a city council, not city council, neighborhood council, very small

local meeting here in LA because there was a fire at an encampment that I live near. And there was a fire man, someone from the fire department on the call, and someone goes, oh, why do these fires happen? And he goes, oh, they just like letting their, they just like lighting their tents on fire. That's literally what this guy who works for the fire department said. And in this case, it was like someone else had come

and lit the tent on fire. And this, by the way, happened a year after, I forget who it was, it was like the son of an elected politician in LA was arrested and lit the tent on fire. And this, by the way, happened a year after, I forget who it was, it was like the son of an elected politician in LA was arrested because he was going around being an arsonist, lighting, you know, encampments on fire for fun. Like, if you are an arsonist,

if you're a crazy asshole arsonist who likes to see things burn, you might start with homeless encampments because they're the one place that you're never gonna get in trouble. Right. Right. Right. Where these are, these are the most vulnerable people. And so the, I mean, it's, I don't know. I feel like this is getting very dark, but it really, it depresses me so much.

It is dark, right? It is dark. I mean, I, you know, there was, wasn't it just about a year ago that five folks experiencing homelessness were like murdered like outside where they're being targeted and shot and killed in LA. And I have a, I had like written a blog post about it and it feels like it's unfortunately ever, ever present because like I wrote it when there was a spate of attacks in New York and DC and then it happened and, you know, name the city. It happened and people are sitting ducks and when you think about it, I don't know about you, but like when I get home, I lock my door

because that's sort of what we do. We don't leave all our doors and windows open. We lock our doors and it turns out if you're homeless, you have no door you can lock. Yeah. Yeah. Folks, I'm honored to say that the podcast is sponsored this week by The Washington Post.

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They don't want jobs. I, and I hate to tell too many personal anecdotes, but there was one time I was working at our drop-in center. We had, of course, free clothes. People would come and get free clothes. And a guy, one of our guests, a fellow experiencing homelessness comes and pulls a nice button up off the rack and goes, oh, this is great.

I can wear this to work. And I was like, oh, fuck, this dude's work. I talked to him. He's working full time. Yeah. And he's living in a tent, right? Yeah. And again, how common is that, that folks are literally, you know, working to some degree, but are still not able to afford a place to live?

Yeah, it's really common. I mean, we did this study during the pandemic and we had a slightly lower proportion, I think it was about 20% were working than I would have expected. I think part of that was pandemic related. Still 20%. Yeah, yeah, yeah. Oh, yeah, yeah, yeah.

Oh no, I mean, I did care of folks in my clinic because I'm a practicing physician who are janitors and Uber drivers. You know, I remember one of my patients telling me it was really hard, the only way his janitorial job would ensure him full-time hours was if he took the night shift. But then he said to me, but it's really hard

because he was like a large man, large black man who are often like targeted by the police, you know. And he's like, and so I'm trying to catch some sleep in my car when I get off my shift at, you know, seven in the morning. But if I like swift to a day shift and then I could sleep in my car at night, maybe I won't be so harassed. But then I won't have guaranteed hours.

It's like a total country. I take care of folks who drive Uber. And I had this harrowing interview during the study. I was, you know, would sometimes go out with the team and I was in one of the counties and was interviewing a guy by the side of his car and his car was gorgeous. I was thinking like, Oh, my car should be so clean. Like, you know, when someone takes a lot of pride in their car, it was like everything was clean except the entire back seat was like filled to the brim with all of his life's

belongings as was, it turns out, his trunk, as was the seat next to him. And he told me that I commented, you know, it's like your car is so like it's clear you take a lot of care of your car. And he said, Oh, yeah, you know, I was an Uber driver. And I love being an Uber driver. And I'm so proud of my car. But the problem is now, and I'm so proud of my car. But the problem is now, if I paid for a storage facility for my stuff, it would take all the money, you know, search for those are like $700 a month, all the money that I would make doing Uber. And if I don't pay for a storage facility, then I can't pick anyone up because my whole

car is filled with my stuff. And if I let go of my stuff, then this is all I have in this world. It was like this catch 22 that he couldn't get out of. Yeah. And what kind of stuff, I'm curious, do homeless folks have? Because a lot of times you see all big shopping cart, you imagine all so much hoarding or whatever,

but is that something you studied? Yeah, I mean, people have things like their medicines. So people had like, he had his like, Medi set next to him, you know, his medicines, people have their family photos. He had a folder with everything that proved who he was. Like if you think about it, like just, you know, your driver's license, your like, you know, social security card, anything that could prove to the world that he existed. He had his clothing, he had like downsizes clothing, but he still needed to wear clothing.

He had his toiletries. Even if you live in a cramped space, there is only so much stuff you can do without. I mean, you need to have close to change into you need to have you know people had like you know a photo album photos of his kids and things that he could really replace he had his charger for his phone and but the really horrible thing is like he was doing better than others and that he had this car we found out that over a third of people. found out that over a third of people had had all of their stuff thrown out in the last six months by some government agency. So like they would be out there in an encampment and then, you know, someone, you know, the public works or the police, depending on where they were, Sheriff's Office would quote unquote, clear the encamp equipment, which threw out all their stuff and and then and then force them to move and people told us like, oh, I used to have this case manager, they were helping me find housing. But like all my stuff got thrown out. I keep getting moved around.

I have no phone number. I don't think they can find me. And and then they had no stuff like over half of people told them one of the reasons they couldn't get back into housing is they didn't have any papers to prove who they were. And so they're like, how can I, someone said to me, so I was like, how am I supposed to get housed? I'm innocent, can't, Matt. I have no phone. I have no internet access. I don't have a job because how can I apply for a job?

I have no shower. I am like covered in dirt. I have no piece of paper to prove who I am or anything about me. Like I have no transportation. Like how am I supposed to either find housing or a job? Yeah, I know that, you know, in our organization, one of the things we would do would be help people,

help people get IDs. Yeah. And it would be a multi-step, month long process. I remember some of the volunteers I used to work with were so excited one day because they finally got this one guy a birth certificate. It was like literally these women are taking time out of their day to like figure out how to apply to the state of Colorado to get this guy's birth certificate so that then they can get him an ID so that then he can get

whatever else he needed the ID for and this was taking months. So imagine you do all of that and then you've got all of that, you know, in wherever you're keeping your stuff and it's all thrown away. Exactly. You're back to zero again. And you're like, it's like shoot some ladder or something, right? It's like back to the beginning. And it is a little bit, you know, like, you know, I prescribe people life-saving medicine and then it gets thrown away. And it is a little bit, you know, like, you know, I prescribe people life-saving medicine and then it gets thrown away. And then I'm sitting here like begging Medicaid to refill their medicine because like one part of the government threw their medicine out and the other

part of the government is paying to replace it. Like it doesn't actually make any sense. Oh my God. It's, it's so short-sighted. Well, you said, you know, people will be working with the case managers trying to get them into housing. Yeah. Another thing that you hear a lot,

people say there's enough beds, these people don't want housing, they've been offered housing and they've refused it. So what is the reality, at least in California, based on your study, when folks living on the street are seeking housing, how easy is it for them to get it? How often do they get it? How long do they get it, et cetera?

Yeah, it's impossible. So first of all, it's important for people to distinguish between emergency shelter and housing. So people get those confused all the times, and I actually hear like electeds confuse it all the time. So for the public who's never been to an emergency shelter, a lot of emergency shelters, sort of 400 people, one big room, shared toilets, you know, loud, noisy, you're kicked out every morning at six or seven and you have to wander the streets

at night and then come back and stand in line at night. So you can't get a shelter bed in this state. Like we had 42% of people on our study told us that they were trying to get shelter beds but couldn't, right? But the people who weren't trying told us like, look, they won't let me stay with my boyfriend there. And I'm not going to like this is the one person, this is my person, or they're, you know, or I get beat up when I go there. So I'm going to stay here in a corner and try to hide, right? So there are reasons people don't go, but they're not enough. But there is this myth out there that people don't want housing. And if that person exists, I haven't been able to find them. You know, like housing, a house that like, you know, you probably don't need permission in your house to leave or come.

You probably don't have like random strangers walking in, right? You get to do kind of what you want to do. No one is door knocking on your house to say, did you, I don't know, open a can of beer? They don't do that in my house. They don't come and ask me. And so once you offer that, everyone says yes. We did this other study a number of years ago in Santa Clara County.

So most, this is where Silicon Valley is, most expensive real estate market in the country, I think. And we basically help them find the about about 300 people who were the most sort of or maybe it was 400 people say 400 people who were like the most challenging folks on their streets in the county. These are folks who were like in and out of jail, the hospital, the psych emergency room, you know, really causing a lot of chaos. We basically found them and we were like, you know, we're not even going to ask them if they want housing because we're going to see them. Because the reason they're in this group is like they're getting arrested or getting pulled

into the ER all the time. So we just kind of put a note in their chart, like we flagged their police record and everything. And we're like, if they show up, when you're ready to discharge them, can you give us a call? So the deal was that they had to give us a call. And we had enough units of housing for about half of them. And so we showed up at about seven in the morning. And I'm actually not kidding. We literally showed up and we're like, Hi, we know you've been up all night, like in the ER, you probably don't feel that hot. And never met me before. But if you sign these 20 pieces of paper, we'll give you a coin flip, a 50-50 chance of getting into housing. We approached 426 people.

Two said, I'm really tired. I can't talk to you. Fair enough. One was eligible and said no. Every other person, 423 people were like 50, 50 chance. And all I have to do is like sign up and sign up to be in the study. Absolutely. We flip the coin that people who got into housing by the time we finished 91% of them

had been housed at the beginning 86% when we published our study had been housed. These are like the quote unquote toughest to house people like lots of psychiatric disease, lots of this and that. And then once they got housed, they stayed housed. We followed them for seven years and over 90% of the nights on average, they were housed for the next seven years. So these were the folks who are like the public is most freaked out about. You know, these are the folks who were in the psychiatric emergency department, you know, 10 times a year in jail, five times a year, you know, in the hospital four times a year, whatever, like really, really folks who were struggling mightily.

They all were like, sign me up. So this idea that people don't want housing, it's just not true. And what we found in the state study is people desperately want housing desperately. But there were just so many things. First of all, they couldn't afford it. They were like, you know, we when we asked them about the barriers to housing, it was a little bit of a hard question to ask them because they were like, looked at us like everyone sort of looked at us like, like, are you a little idiot? It's expensive, ma'am.

It's like rent is too damn high. They were literally like, what do you think? You know, like, you're not housed. This apartment I can find is $1,500 a month. I am housed. Yeah, why don't I have a Rolls Royce either, you know? Yeah, right, exactly. They were literally like, my poor staff would text me

and they're like, I feel kind of like an idiot to ask this question. They're like, I'm really dumb. But there are all these other reasons. People talked about, almost half of people talked about the discrimination they experienced in the rental housing markets. They're like, you try to go looking for housing if you look like me, they would say, lots of discrimination, lots of people not having the paperwork. They're like, have you ever tried to rent a house

where you have no clean clothes and no proof that you exist? Like, how are you supposed to rent a house? So lots and lots of barriers. And in terms of why people are on the street, in terms of those barriers, we almost should have tackled this earlier, because it's one of the biggest things that people say about folks who are homeless

is that they are either profoundly psychiatrically disturbed or that they are addicted to drugs. And that's why they ended up on the streets just because of drug addiction. How much did you find that was true? How much did that cause their problems? How much do those problems exist and how much were they caused by homelessness itself?

Yeah, well, to answer that, I mean, actually, is it okay if I start with like a little analogy that I feel like helps explain this? This is a... I would love an analogy. I live for them. You live for them. Awesome. So my good friend, Greg Colburn, wrote this with Clayton Alden, this amazing book called Homelessness is a Housing Problem. It was like joke, like you gotta love a book who's like entire thesis. It is a Housing Problem. It was a joke like you gotta love a book whose entire thesis, it's a great book, you should read it. But also the title sort of tells you the whole story. Right? Homelessness is a housing problem. And they use this analogy

that I've used a lot. They've used it's a great analogy, which is the analogy of musical chairs. So you imagine a kid's birthday party and 10 kids show up and there are 10 chairs and the adult plays the music and the kids show up and they're 10 chairs and the adults plays the music and the kids walk around adult pulls away chair turns off the music and the kids scramble for the remaining chairs. So you do a thought experiment and little Tommy night before sprains his ankle at a soccer game and Tommy shows up on crutches. He doesn't really know how to use any, you know, shows up at the birthday party and they're playing this game. You're a betting man. And they're like, who is still going to be standing when there are only

nine chairs? I think we would all put our money on Tommy, right? Who's like not going to be able to like dive bomb into the remaining chairs. Right. But what if you ask a different question? What if you ask the question like, why is there a kid standing? Well, there's a kid standing because you've got nine chairs and 10 kids and either some two kids are sitting in each other's lap or there's a kid who's standing, right? So, the same holds true for homelessness. In California right now, we have 24 units of housing for every 100 extremely low income households. Extremely low income households are basically any household that makes less

than 30% of the median income for the area they live in. So that's like a higher income in LA than it is in Fresno, but you get the idea. And available and affordable means that it exists, it's habitable, it's not occupied by someone who makes more money, and that they can afford it on less than 30% of their income because if you're that poor and you pay more than 30% income, you can't really pay for it. And so the idea is that we only have 24 units for every 100 households, we're a million units short. We basically are playing this giant cruel game of musical chairs, except we have 24 seats and 100 kids. So a lot of kids are sitting

on top of each other. And then we have a lot who are standing. It is not a surprise that who's left standing are often people with behavioral, we call in the medical field behavioral health disabilities, either mental health problems or substance use problems. Because those are disabilities that kind of interfere with your function, interfere with your social relationships. I'm a physician.

I don't think about those as moral failings. I mean, in the same way where I don't think having cancer or a heart attack or inflammatory bowel disease, those are not moral failings. They're just complex problems that are interactions of your genes and your luck and your environment. So anyway, yes, people who experience homelessness are much more likely to have substance use and mental health problems in their overall population. No, that is not why we have so much homelessness

in California. So, you know, yeah. What a good metaphor. Isn't it a good metaphor? It's really good because you would say, yeah, the kid with the sprained ankle is more likely to be standing because of the sprained ankle in part, but you don't say, that kid's got a sprained ankle,

that's why he's not sitting. Like he needs to fix his ankle before he can sit down. No, there aren't enough chairs. Get the kid a chair, he'll sit down. And if you had 10 chairs, Little Tommy would have found his way to a chair and the flip is also true. If little Tommy weren't on crutches and you only had nine chairs, there's still going to be someone standing.

Right. And so it's like a question of who loses out. And, and so, but yeah, it's absolutely true that people experiencing homelessness are more likely to have mental health and substance use problems. Some of it though, results from homelessness. Some of it is what set them up to be homeless for the chair reason, like we talked about. Some is a result. There's only so long you can experience sexual violence, physical assault, sleep deprivation,

and not get severely depressed or even worse. We found that a third of people, 35%, were using illicit drugs regularly. It's mostly methamphetamines. That is the drug of choice right now. And a third of the people who regularly, and these are folks who use three times a week or more. Of the people who use three times a week or more. I bet a third of them only started doing so after they became homeless. So I was going to ask that, you know, I mean, if you're. Look, I think if you were living on the street, uh, you might start doing some cheap drugs, you know, I mean, if someone hands you a pipe, you might be like, I'm having a bad day.

And this at least is something that's going to cheer me up a little bit. You know, like I can imagine how not to be glib about it, but I can imagine how that happens. But what's so funny is that what you said about, you know, drug abuse and mental health issues being diseases, not moral failings is true. And almost everybody in America, if you asked them which those things are, they would say, yes, that's a disease. And yet there's this moral dimension

that we always bring to it. I think all the time about this conversation I had with my neighbor, we were talking about homelessness in our neighborhood and he said, yeah, well, you know, a lot of these people, they're addicted to drugs and alcohol. And I was like, yeah, man, but so are we. Yeah, exactly. I'm smoking weed, but so are we. Yeah, exactly.

I'm smoking weed. I'm seeing you're recycling, dude. You're bringing out a lot of empty jack bottles every week. You know what I mean? But the difference is you and I are in our homes and these people are not. So what is the actual difference between us and why would you say these people need to get clean

before they have a home? You have a home and you're not fucking clean. You're popping pills. You're doing coke. Come on, man. I know. I mean, it's really like I mean, I for like a variety of reasons don't like I'm like the most boring human being in the world. I'm like the vegetarian, never smoke, never, never use pot. Don't haven't had a drink in like a million years.

You know, I'm like so boring. It's not even funny. And, and, and one thing about being nice, you look around and you realize like, Oh, wow. When you, when you don't drink, you realize how much people drink. And as a physician, you realize how much people, people drink a lot, right? I'll be at these events. Like I do a lot of public events where people are pretty hostile and like being really mad. I'm watching people. They're like, oh, come to the event. We'll have lovely wine. I was like, yeah, guess what, dude? You're drinking too. But I think also, one thing is we don't walk into people's homes and check if they're doing drugs and pull them out. That's just not a thing we do. The other thing is, yes, if it winds up being a problem for

you, which it is for many people, it does interfere with your social functioning. In fact, both mental health and substance use issues are actually sort of diagnosed, not by for instance, whether you use but diagnosed as an addiction if it interferes with your social function. So it's almost like racked up in it, you know, the difference is like really a little neurotic and having a mental health problem really hinges on whether it interferes with your social function. So of course, people who have a problem that interferes with their social function are more likely to be homeless. But there's so much we know so well that it doesn't interfere with the ability for people to be housed. And furthermore, as someone

who does tons of substance use treatment, it's so interesting for me now to hear this really horrifying backlash against harm reduction. And I and I'm like, do the opposite of harm reduction is harm increasing? Like, do you want to, do you actually want to increase people's harm? And, and I always wonder why people don't seem to notice that all of us who are actually doing substance use treatment, believe in it, right? We believe in it because I can't save the life of someone who's already dead. I can't, I can't help you kick your opioid problem if you're dead. It's too late, you're dead.

And yet what we heard time and time again, we heard some really interesting things about the substance use related to this. One thing we heard from people is people using it, what we would call instrumentally, which means that they're using it because they're homeless. Not to get myself in like a whole lot of problem with the law here, but if I were like that guy from Breaking Bad or something, if I were trying to design the perfect drug

to survive homelessness, you know, meth is sort of it, right? I believe that people use drugs to solve some problem in their lives. Like, you know, they use it to smooth, you know, they're like a little anxious. And so you drink a little bit and you feel less anxious. That's good, you know, whatever. This is certainly the reason I have always used any drug I have used is I got some benefit from it at the time. you know, they're like a little anxious. And so you drink a little bit and you feel less anxious. That's good. You know, whatever.

The reason I have always used any drug I have used is I got some benefit from it at the time. You get some benefit. I needed to sleep. So I fucking drank some Evan Williams, you know? Exactly right. That's why people use, right? And so if you're homeless,

we heard from so many people that the methamphetamines, you know, here they are, they're getting assaulted. Their suffix getting thrown away. They're like, hey, and they you know, here they are, they're getting assaulted. Their stuff is getting thrown away. They're like, Hey, and they're hungry. There's no food. They're hungry. What does Matthew math keeps you up. It keeps you alert and it keeps you from being hungry. It's not great. It does a lot of harm. We were really aware. It's not like people aren't aware. It's not like people are like, Oh, no way. I didn't know that this is bad for me. Everyone knows it's bad for them. But they're using it for

a reason. When we talk to people about quitting, we heard universally like, absolutely, but I can't do it. Don't don't take this from me. Now. Don't take it from me when I'm out here. I can't think about that right now. Get me into the housing and then I'll quit. So that's one thing. And the other thing was really, I think one of the things that was really eye popping to me was that over a quarter of people who either used alcohol heavily or used drugs regularly told us that at some point since they became homeless, they had actually attempted

to get into treatment and the door was closed. They couldn't get in. And one in five people told us that right now they were trying to get into treatment and the door was closed. They couldn't get in. And one in five people told us that right now they were trying to get into treatment and they're like, there is no treatment. I go, I show up when I'm supposed to show up and they tell me there are no beds or there's no treatment spots or there's nothing for me. And, and I think that that's really important to keep in mind. Um, you know, as a physician, I can tell you that, um, substance use treatment, it takes many times before it sticks. That's really important to keep in mind. As a physician, I can tell you that substance use treatment, it takes many times before it sticks.

That's just sort of how it goes. Just like we don't cure leukemia in a day, we don't cure substance use in a day. It takes some time and time again, and that's okay because people get there. But the people who are most likely to benefit are the people who have made that mental model switch in their head. They're like, I'm ready. I want to do this. And what we heard is that one in four people were like, had made that switch and there was no place for them get treatment. You put that with the public dialogue now. if we've got to force people into treatment. And I'm like, how about we use our, how about we increase our spots? How about we make it easier to use and come

back and talk to me once everyone who wants it can get it. But like we are, and I, you know, as a physician, I can't tell you how much like I'm like calling around begging first. It's hard to get treatment spots. And yet, and yet, like there's this myth out there that like we've got to force people because they don't realize that this is harming them. They are full well aware that is harming them. And a lot of them are ready for treatment. And we are the ones who are closing the door on their face. Yeah, because the the the beds simply aren't there. The rooms aren't there. There's so many times that you'll see some elected will have cleared an encampment.

You know, the cops come through, everyone's stuffed in the trash, and they say, oh, everyone was offered housing, everyone was offered treatment. Well, what was that offer? Hey, you can get on a wait list. Here's a form to fill out, here's a number to text. Okay, just stuff in the trash.

You know, like, it's not an offer. It's a, it's, it's a sign up for nothing. And if, and if they're not taking, if someone is out in the 110 degree heat and they're not taking the shelter, you're offering them, maybe you should give some thought into what, what are you offering them? And people are never offering housing. Like housing is just, you know, in San Francisco, they open up the wait list for Section 8. Section 8 is the voucher that pays, you know,

that you use on a free market. And it caps what you pay to 30% of your income. They open up the wait list for two weeks for the first time in a decade this fall. For the first time in a decade, the wait list. They had two weeks, you have to fill out these extensive paperwork. 65,000 people signed

up. They only have about 6,000 spots that will be distributed over the next few years. Wow. People are not offering people housing and they're turning it down. I mean, look at our study in Santa Clara. Those were the folks, we intentionally chose the folks who give the public the most headache, right? Who like, we were like, if these folks will take housing, everyone will.

These are the folks with the most significant, significant sort of behavioral health impairments and things. They all were like, sign me up, even though we showed up at arguably like the worst moment. We generally showed up after people who'd been up all night in the, you know, ER, or in the jail or something. And they were all like 50 chance and all I have to do is subject myself to being in the

study. Sign me up. Yeah. So I don't believe that people are offering people housing. It just isn't true. John Stewart is back in the host chair at The Daily Show, which means he's also back in our ears on The Daily Show Ears Edition Podcast. The Daily Show Podcast has everything you need to stay on top of today's news and pop culture. You get hilarious satirical takes on entertainment, politics, sports, and more from John and the

team of correspondents and contributors. The podcast also has content you can't get anywhere else, like extended interviews and a roundup of the weekly headlines. Listen to The Daily Show, year's edition, wherever you get your podcasts. And you know, we're spending so much time talking about folks with profound psychiatric illnesses

or substance abuse, who are the folks that the public is scared of. But there are also folks who have disabilities or situations that are not frightening, but that impair them just as much. There are people out there with kids, there are people out there with mobility issues. And an experience that really stuck with me was,

my introduction to this topic was we did an episode of my show, Adam Ruins Everything About Homelessness. We got involved with a wonderful organization that really stuck with me was, you know, my introduction to this topic was we did an episode of my show, Adam Ruins Everything About Homelessness. We got involved with a wonderful organization called Housing Works California. We interviewed with some folks from them, from there. Met a wonderful woman named Dorothy Edwards, who's since passed away, formerly homeless herself,

wonderful advocate. And so after we filmed the episode, during the next season of the show, they said, hey, do you wanna come down and just like, to one of our permanent supportive housing places and, you know, have a pizza party with the folks who are there and meet, we said, yes, of course, we'd love to do this.

We went down, it was a new building, a very rare thing to exist in Los Angeles. It was a new building that was dedicated to permanent supportive housing. They told us that these folks, the folks that were, that this is permanent housing with, you know, supportive services, and it was targeting folks who are most likely to die on the street.

And we went and met them and my feeling was, oh my God, every single one of these people's lives was saved by being in here. Because these were folks with profound impairments. Like, you know, someone who is mentally handicapped, right? Someone who you're like, my God, if this was my brother, I would be spending $100,000 a year to make sure he had the care that he needed,

because I have the resource. I have extended family members who need full-time care because of psychiatric conditions that they have. But this is someone who did not have that sort of family who was able to provide for them. I'm like, this guy's living on the streets? Sweet man can barely care for himself. You know what I mean?

Folks with, you know, folks in wheelchairs, folks on crutches, just, you know, people who, people who, for one reason or another, could not make their way in society. And what really crystallized for me in that moment is that we've built a society where you have to meet a certain bar to survive. You have to pay rent, you have to buy food, you need to spend all this stuff and you need to work to get the money to do those things. All right. So

let's just zoom way out. Most people can handle that. Say 99.9% of the people in society are able to hold down a job. They're able to get those fair needs met, but some group of people can't. Maybe they have a substance abuse issue. Maybe they have a psychiatric issue. Maybe they are in a wheelchair and they have no friends and family. Maybe whatever the fuck happened to them, there's some portion of people who cannot do that.

What kind of society do we wanna be? Do we, what do we want to have happen to those people? Do we want them to die on the street because they could not, you know, jump over the hurdles of life? Do we want to have to step over them on our way to work and like have our neighborhoods be less pleasant for us as well? Do we want to live around that kind of misery? Or do we just want to say, you know what, for that point one percent or whatever percentage it is, for that small percentage of our population,

let's just build a fucking building and put some nurses in it and let them be in the building. Cause you know what? That's going to be cheaper. They're not going to go to the emergency room. Our neighborhood would be better. The fact that we don't do that as a society is I think that one of the hugest indictments of America as a, not just as a system, as a culture that we allow this to happen. It's so. It's so embarrassing to me to see it on the street. I don't know how you feel about it because you do the work every day.

I think it's so embarrassing. And I think it's, and it feels like it's, you know that phrase, like the system is working exactly as designed. Like it's not as coincidence that like black folks fourfold overrepresented, right? Indigenous folks fourfold overrepresented. I? Indigenous folks fourfold upper represented. I mean, this is like the system working exactly as designed. Like, I live in subsidized housing.

I don't know, you might as well because my husband is an attorney and I am a physician, we own our house, we get this huge tax break, because we don't pay interest rate our mortgage like in what your own universe? does the government think it's important to give me a break on my housing and not a gentleman who's been a janitor and like worked his whole damn life like day in and day out, right? But he's been the fault, right? It's really crazy. And, and as I said, like, half of the folks are 15 older, we've done research that shows by the time folks are homeless and 15 older. They look much more like folks in their seventies and eighties so you see that there was like tubes coming out of them you know with like with my catheters in them on wheelchairs with their leg imputated.

And they're sleeping outside like what the hell are we doing? And yet everyone is like, oh my God, I'm so afraid of them. Like, you know, and they're terrible and they're from somewhere else. It really is a huge indictment. I had this really powerful moment a number of years ago. I often go to community meetings where they're trying to cite something just like the building you saw. And I knew Dorothy Edwards and she was incredible. And, and like, they were trying to build a building just like that for elders in Alameda County. And the, the, the, the neighbors were so furious that they put a bond measure like on the ballot to basically not allow them to do this. And so there was this meeting, community meeting.

And I show up to try to talk to people about like why they should do it. This is like near where I live, you know, the whole thing. And all these people in their matching t shirts screaming and yelling at me like I'm the Antichrist. I'm like, Oh my god, I'm not the Antichrist, but like screaming and yelling at me about, you know, how they didn't want this, how it was going to ruin it. And everyone uses the excuse of their kids is going to be unsafe for my kids. These were elders, by the way, they were offering this housing for like, oh my God, like they were offering this for elders. Not safe, not safe, not safe, yelling and screaming. And finally, there's this one woman in the corner, she hadn't said anything the whole meeting and we called on

her and she stands up and she says, you know, my name is so and so and I'm a middle school teacher in this community and I've taught a lot of your kids. I spend all day with your kids. I know your kids and your kids are looking around at all the suffering that they're seeing on the streets and they are asking where are the grownups? What are they doing? How are they allowing this? And so I too am worried about your kids. I'm worried about all of our kids and what they think about a world that is this cruel

and that allows people to sleep on the street. And it was like a, it was like a mic drop moment. It was incredible. She had so much courage, right? Because her neighbors were like screaming their heads off and she stood up and I thought, oh, for the moral courage, like what if more of us did that? What if more of us did that and admitted that let's talk about our kids' safety. It is not in our kids' interest to have people sleeping outside.

First of all, it's not safe for anybody, and people sleeping outside. But also, what does it say to our kids about who we are as a society that we are allowing this? What does it say to our kids that they notice that it's much more likely to be people of color, it's much more likely to be elders? It is a huge indictment of who we are.

And it is gonna take a lot of work to reverse that. And it is gonna take a lot of courage on people's part to be that person who is actually willing to look at the truth and not at the myths. He's willing to show up at that community meeting at seven o'clock on a Tuesday night and say, you know what, I'm in this neighborhood and I would like my neighbors to be housed. Maybe we'll all need to pay a little more taxes. Maybe we'll all need to give up some of our beliefs. But this problem doesn't have to be like this.

This is a choice and we can undo that choice. Yeah. Um, that story was so moving to me. It made me, uh, uh, missed up a little bit, honestly, um, because that is the question, right? Is why do we allow this? And, uh, personally, I don't even know that we have to give up that much. I understand that people don't want that, you know, you know, housing. I know that people don't want that permanent

supportive housing in their neighborhood because they think it's gonna hurt their property values. I say, what's worse for your property values? Right, exactly. Like people on the street? It isn't gonna hurt your property values. Right. Exactly. What's worse for your quality of life?

You know, what will actually make you less or more afraid if there's people sleeping on the street in your neighborhood or not? But, you know, we have this such a fucked conversation about this that is, again, not based in evidence, based in prejudice and myth and cruelty that I'm so grateful for your work for dispelling. So we've talked about some very heavy shit for the past hour, Margot.

Let's talk about what works. What did you find in your work about what actually cures homelessness? I mean, you said that there are people who you got a house and 90% of them were still housed some number of years later. So what works? So what works when people are homeless is housing. And it's like, everyone is like, oh, but what else works?

I'm like, well, there is nothing else that works, right? I mean, the problem is you don't have a house. What if we just got a Big Macs, would that help? I mean, what the fuck are people talking about? Like everyone, if I had another, The problem is you don't have a house. What if we just got a Big Macs? Would that help? I mean, what the fuck are people talking about? Like, if I had another, if I had a dollar for every time someone has an app that they want to cure homelessness,

and I'm like, I'm like, can you live in the app is the question? Can you apply me to it? I don't know. Oh my God. You know, what c cares homelessness is housing. And there are lots of communities that have done this, right? There are lots of communities that have done this.

So first of all, there is all of this sort of boogeyman kind of myth about housing first. And I sort of crack up when people describe it as this, you know, San Francisco Marxist idea because any guesses on the politician who brought it to bear and who had who sort when people describe it as this, you know, San Francisco Marxist idea, because, um, um, any guesses on the politician who brought it to bear and who had, who sort of created the federal really all credit to them for doing this? That great, you want to guess? I, okay, wait, wait, wait, because I know a little bit about this. So, so I want to guess and it would be better if I had no idea and you blew my mind, but was it somebody

in Utah? Cause I remember Utah was a state that tried a housing first very early. So Utah tried it early, although I always want to say, I love Utah, but I really also want to know they're a press person because they took San Francisco's model, applied it, and then everyone was like,

why doesn't San Francisco do what Utah did? And we're like, they took our model. But anyway, the politician who actually really is responsible for this is George W. Bush. That noted San Francisco Marxist lefty, George W. Bush, who, you know, who basically, there's a guy he I was just with him in Georgia yesterday, he really exists. His name is Sam Somberas. He's actually now in LA. He came up with this model through trial and error when he was, I think originally like in grad school in New York, where he spent a lot of time doing direct services to people experiencing homelessness and realized that what people really said they needed

what people really said they needed was housing. And what if we flip the script? And what if we, instead of like in the old way, you used to have to go to a shelter, and you'd follow all the rules, like no smoking, no drinking, no having your partner there, this, you know, you get up at six in the morning, you make your bed or whatever. And if you did everything right, including like made your bed every day, then maybe after a couple of months, you'd be offered like transitional housing. And again, if you did everything right, maybe you'd be offered. And what happened is like the 5% of people who made it through, I think it was about 20% got housed and everyone else was back to square one, chutes and ladders. So Sam switched the script and said, what if we offer

people the housing at the beginning as opposed to the end and Said, you know your tenant you have to follow the same rules of tenancy that anyone else does You can't like, you know assault your neighbor and you've got to pay your rent and all those things But you subsidize it so your tenant you it's not like a free-for-all. You have to do whatever other tenant does And then what if we offer you all these services and instead of instead of it being impossible to get into drug treatment, what if we're like, look, it's available for the taking. And let me talk to you every week and say, Hey, you thought about it some more. Do you want it? What he found was that people stayed

housed and lo and behold, they were much more likely to engage in like mental health treatment and substance use treatment if that's what they needed. So he created this program and it turned out as you said, it was cheaper because they like New Yorkers spent is spending an incredible amount of money on shelter incredible amount. And, and so like the George W. Bush administration, he has that like he had like that Harvard Business School kind of like, you know, let's look at the spreadsheet, let's look at what's more cost effective, what what has better outcomes. Oh, this does. Let's do this. And he was actually the one who really like brought it to federal awareness. A lot of cities, New York, Philly, San Francisco, were some of the early adopters did a bunch of research to show it really worked. And then under the next administration,

they really solidified it into law that that it became the law of the land in the mid-90s. This is how the federal government would support housing under this. For instance, a veterans administration, nobody in Congress, Republican, Democrat, wants there to be homeless veterans. And I do not think anybody who has served our country should spend a night on the street. I also happen to believe that nobody should spend a night on the street. But politically, it's an easier argument for veterans, right? So the VA has gotten a lot of money and with HUD and the VA together, Housing and Urban Development, to house homeless veterans,

they've 100% of that money has to be used under Housing First. They've driven down veteran homelessness by more than half. At a time when homelessness among everyone else has gone up, 100% adhering to Housing First, because that's what works. And so what works when people are homeless is to offer them housing. It needs to be subsidized. The market unfortunately isn't going to solve this problem. And then to say your tenant, you have to follow the rules of the tenancy. But we're not going to kick you out if you smoke a joint, just like no one's going to come and kick you out of your house.

If you smoke a joint, right, we're not going to kick you out for that. And we're going to offer services and make them really easily available. And one thing that people have to remember is that Housing First is not housing only. Like Sam Tsimzaris' model is that there are robust services, that those services are there for the taking. Because this doesn't really work if it isn't there. But what we have found is that if you do that,

and that's what we did in our study in Santa Clara, is that if you offer people housing, you offer them the safety and security of home. And, you know, we're not doing ourselves any favors to pretend that people don't have a lot of trauma and a lot of substance use and mental health problems. And so you offer services for that, but you don't make it contingent. You don't say you can't come indoors until you take up the drug treatment. You say, come on indoors, and then I'm going to keep offering you take up the drug treatment. You say, come on indoors. And then I'm going to keep offering you again and again and again.

And as soon as you say you're ready, it's here for you. Yeah. It works. And people thrive. And when people experiencing homelessness thrive, we all thrive. Right? All of our downtowns would be better if there weren't people sleeping on the streets. Like we would all feel safer on public transit

if there weren't people who had to sleep there, people would be healthier. People would have less substance use problems and less mental health problems and less physical health problems. People wouldn't be dying because they had no housing. And as a physician, I like to say that there is no medicine as powerful as housing. Like I spent a lot of years training to be a doctor and none of it really matters if people are outside, this is what matters. We need to get them into housing.

We know we can do this. You know, we are a country that can do hard things. Surely we can do this. And you know, what is the most infuriating thing about it? Well, first of all, that's wonderful. Thank you for that. The most infuriating thing about the fact that we are not doing this on the scale we need to. I understand housing first is the law of the land

in many parts of the federal government, but it's, and it works, but on a small scale, we have not scaled it up massively to, you know, we need hundreds of thousands of units of this sort of housing. We have much less than that. Instead, we send cops around and we throw people's stuff in the garbage

and we put people in jail and we put them in emergency shelters, da da da. What's so infuriating is that Housing First would work. It would solve the problem. And guess what? Everybody wants the problem solved. Everybody wants the homeless people to go away. Even the cruelest motherfucker on the planet is like,

I just don't wanna look at these people. And then you say, okay, well, I have a plan. It's shown by evidence. We have the largest study of homelessness in decades has been done. It shows it works. All we have to do is give the people homes and give them services.

And then the same motherfucker goes, no, I don't wanna give them a house no I don't want to I want to throw them in prison I want to I want to rough them up a little bit well which is gonna cost you by the way four times as much money by the way and not work and not work because this is the same person although go to jail for a minute and then they'll bounce out well why don't you stay in prison because it's not a fucking illegal to be unhoused. I mean, it's so infuriating how people's,

it's one of these areas where the prejudice of the public actually gets in the way of solving the problem the public wants solved. Right. And I think, you know, I think a couple of things. I think there are bad actors out there who are using this, you know, to sow dissent. It is no secret that homelessness is worse in blue areas because homelessness is worse.

Homelessness is much worse in California than in West Virginia, even though substance use and mental health problems are much worse in West Virginia. Why? Because housing is expensive. Why is housing expensive? It's not that homeless people are rushing in here. It's because you and I were rushing in here, right? We came here, we drove the housing prices like lots of people want to live here, right? So, but so I do think that there are

bad actors who are using this as a wedge issue to sow dissent. I think that there are a lot of people of good faith who are just unaware. And that's who I'm trying to speak to. Probably perhaps your listeners who just weren't aware that this is cheaper, it's safer, it's going to benefit us all. And it is not rocket science. And the people who tell you that it doesn't work, are lying. They're lying. This is misinformation to try to view dissent. And they're picking on poor, desperate, generally older people of color and using them to trick you.

And it's not helping you and it's not helping people. This is one of the few win-wins we have. It not only creates is better for people experiencing homelessness. It's better for us all. I'm going to stop us there. That is such a wonderful summation of this entire issue to cause all the way from the causes of homelessness to what life on the street is like, to how we can solve it, it's such a wonderful overview of it.

And I can't thank you enough for your research and for bringing a fact-based view of, you know, to a conversation that is so often based on prejudice and misinformation. So actually let's end here. If people wanna learn more about your work, where do they go? And if people want to be part of the solution,

what do you tell them to do? So to learn about our work, best ways to go to our website, homelessness.ucsf.edu, that's University of California San Francisco, homelessness.ucsf.edu. We make everything publicly available. We have charts and graphs and reports

and we've got webinars every month. Come join us and learn about this issue. If you want to be part of the solution, one, demand that your elected officials at every level of government, including Congress and the president, are doing what they need to do to solve this. We really can't solve this without Congress

and the federal government. They could make decisions tomorrow that could end this crisis. So we need you to stand up, to letters to, you know, to demand your elected officials follow the evidence and be that woman who showed up to that meeting on Tuesday at 9 p.m. when all of your neighbors are foolishly yelling and screaming. Be that person who says, you know what, I too am worried about our children. I too am worried about our society. And I would like to have my neighbors live inside

instead of on the sidewalk. Be that person. That will help a lot. Educate yourself, get involved and also believe that this is solvable. If we don't believe it's solvable, we're not gonna solve it. This is solvable, and we need to just act like it is and do what we need to do. Margo, thank you so much for coming on the show. I'm so grateful to you for being here and for all the work you do.

Thank you so much for having me. It was really fun. My God, thank you so much to Margo for coming on and having that incredible conversation. I know you loved it as much as I did. If you did, consider supporting the show on Patreon. Head to patreon.com slash Adam Conover. Five bucks a month gets you every episode ad free

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