Introduction

California is overdue for a turn toward pragmatism and moderation when it comes to the issues of mental illness, addiction and homelessness. Californians do not want to return to mass incarceration nor to mental institutions like the kind depicted in “One Flew Over the Cuckoo’s Nest.” At the same time, we want and deserve public order, which is breaking down across the state. 

The way every other developed nation solves homelessness is through assertive case management, mandatory psychiatric care and drug treatment, and sufficient facilities of different kinds for different populations, from psychiatric hospitals to homeless shelters to permanent supportive housing. But in California, we allow our most vulnerable mentally-ill and addicted people to live on the streets, endangering themselves and the surrounding community, out of the fear that treatment infringes on their civil rights.

There is a better way. To halt the degradation of human dignity and restore public order, California must provide, and require the homeless to use, basic shelter. And the limited housing for the homeless that exists should be available as a reward for positive behavioral outcomes, like overcoming addiction, taking one’s psychiatric medications, and performing successfully in job placement programs.  

1. Break-Up the Open Drug Scenes

What Californians call “homeless encampments” are what Europeans called “open drug scenes,” and they must be broken-up to restore public safety and peace. Breaking up open drug scenes always requires a combination of law enforcement, social services, and redevelopment. Breaking up open drug scenes does not require mass incarceration. In North Carolina, police broke up an open drug scene with community outreach workers. They offered drug dealers assistance with education and job placement as an alternative to arrest and incarceration.

2.Cal-Psych

California counties cannot solve the problem of open drug scenes piecemeal because of the transient nature of the homeless population. At least thirty percent of street addicts in San Francisco were homeless before they arrived in the county. The same number is true for Venice Beach’s open air drug scene. California’s governor must create a state-wide agency, Cal-Psych, to remove addicts and the mentally ill from the street through voluntary drug treatment and psychiatric care, as well as by working with the courts to oversee involuntary care through conservatorship and assisted outpatient treatment. The CEO of Cal-Psych would report directly to the governor and be the best-in-class. And Cal-Psych would have the purchasing power to expand psychiatric beds, navigation shelters, and residential homes across the state.

3. Enforce Laws

Many California cities have stopped enforcing laws against public drug use, defecation, and theft. To some extent this is because laws like Proposition 47, passed in 2014, decriminalized shoplifting of items valued under $950, and three grams of even hard drugs. But the hesitancy of city leaders to prosecute suspects has also contributed to weak enforcement of laws. These trends are rooted in fears of returning to the tragedy of mass incarceration, But laws must be enforced if we are to have livable and walkable cities, and to get people the care they need. Laws can be enforced without the massive monetary and human cost of mass incarceration and curtailed civil liberties.

4. Restore Mandatory Drug or Psychiatric Treatment As Alternative to Incarceration

Drug treatment and psychiatric care are not perfect, and the people suffering severe addiction and/or mental illness are among the most difficult-to-treat. But California currently lacks the institutions and laws it needs to mandate treatment as an alternative to incarceration. The governor must take action through the legislature or by ballot initiative to restore mandatory drug treatment and psychiatric care, through Cal-Psych, as an alternative to the pre-Prop 47 strategy of incarceration.

5. Universal Shelter, Contingency Housing

California must have sufficient shelter beds for all, and require people to sleep in them. A major reason for California’s growing homeless population and open air drug scenes is the diversion of funding from shelters to apartment housing units for the homeless. Housing should be a reward for abstinence and other steps people take on their personalized Cal-Psych plans.

6. Fund the Police

Efforts to defund the police are demoralizing to police officers and, when combined with civil unrest and anti-institutionalist rhetoric, contribute to rising homicide, inequality, and disorder. We need to ensure that the police prevent homicide and crime. We need law enforcement to coordinate with empowered social workers and humanely direct the mentally ill to the care they need. And we need to do more to reduce police violence and discrimination against communities of color. But there is nothing deterministically wrong with our institutions that can’t be fixed with reform. Police reform that ensures safety, equity, and lawfulness will require funding and dedication to better our existing institutions. As California pursues a third way between mass incarceration and lawlessness, it must both create Cal-Psych and develop the capacity of our police to deal with addiction and mental illness effectively.

7. Redevelopment

Neighborhoods like the Tenderloin that are struggling with crime, open drug scenes, and decay should be redeveloped. Through housing vouchers and rent-controlled housing, current residents would not lose a place to live in the neighborhood. Redevelopment creates large quantities of new housing which ensures that developers can build a large amount of affordable housing. Such redevelopment is what turned Amsterdam’s Zeedijk neighborhood from an open drug scene into a thriving community that is a wonderful place to live for residents of many income levels. A similar transformation took place in the Alphabet City neighborhood in New York. Neighborhoods that attract crime and drug use are not an inevitable part of cities.