I will only address the private sector/public engagement issue here. What I have discovered about the role we played in bringing the state, philanthropy and the non-profit sector together through the One California Program is that given the right framework, big ideas like this could have big impact. One-CA has altered the immigrant legal services landscape in California and that model is worth looking at.

Vagrancy is evidence of either mental illness, addiction or a refusal to work. If mental illness or addiction, the government must work with nonprofits to treat people; if the latter, incarceration. Public “camping” should be considered theft of public space that deprives others of the right to use that space.

I believe community members and leaders do not face the collective responsibility of every jurisdiction in providing services to prevent and respond to homelessness. It is an infrastructure requirement like water, sewers, public safety, roads and open space.

Government has to play a leading role, but also non-profits. Building affordable units for the homeless needs to be taken outside of normal economic parameters. If we insist market rate developers do this, it will require massive infusions from the taxpayers. There also needs to be creative use of redundant public spaces, like former military bases. It’s difficult to move this kind of housing into existing middle class family neighborhoods.

It strikes me that there are a couple of aspects of the homelessness problem that need more attention, one demographic and one economic.

The demographics of the homeless population are complex, and people become and remain homeless for a variety of reasons, which is why there is no single “silver bullet” to solving the problem. Some see homeless people as primarily those with drug and alcohol addiction problems or mental health issues, while others see people mainly down on their luck due to financial issues, oftentimes beyond their control, who just need a temporary helping hand. There is truth to both views, and both of these issues represent significant pieces to the puzzle, but the reality is more nuanced and varied, as noted in the response to the first question above.

Many acknowledge that securing a decent job is among the best ways for one to get himself or herself out of homelessness, but not enough attention is paid to the impediments that make this so much more difficult. Occupational licensing laws, for example, serve as a barrier to work by imposing government fees and oftentimes unnecessary education and training requirements, like hair braiders forced to attend expensive cosmetology schools to learn skills they will never use. In addition, a job paying $10 an hour might allow a homeless person to live in a boarding house or stay temporarily in a flophouse until he can work his way up the economic ladder, but minimum wage laws and zoning restrictions prevent such arrangements. Even payday loans, though they may not be cheap and are often demonized, nonetheless help many get through short-term financial emergencies. These may not be ideal arrangements, but they are still much better alternatives than resorting to loan sharks or sleeping in one’s vehicle or on the street.

As a public health and community health-minded leader in philanthropy, I doubt I have any new insights to share on the affordable housing crisis. But the civic conversation on homelessness is missing one key, critical element: our society and our region are manufacturing homeless persons faster than our ability to house them. LA City and LA County managed to newly house more homeless persons last year since these counts have been documented; but the number of people on the streets rose significantly anyway.

We will need to focus more intently on “going upstream” with our homelessness strategies: expanded community-based mental health supports & drug treatment, wrap-around services for foster care youth “aging out” of the system, and careful, coordinated “discharge planning” services for people released from jail — too many newly released persons from county jails are being released right into homelessness. We have got to pinch the homelessness pipeline upstream.

What is missing in a lot of the public conversation regarding homelessness is an accurate perception about who these people are and many of the root causes of homelessness. The most visible faces of homelessness tend to be those suffering from mental health problems and substance abuse, which negatively taints the way in which the general public feels we should be approaching the problem. There is also the persistent myth that the majority of those on the streets are from elsewhere and choose to be homeless in Los Angeles because of the temperate weather, or are shipped here from other states. While some are from our neighboring Southern California municipalities, a lot of these folks are simply our neighbors who have fallen into rough times.

Through the passage of measures that have dedicated funds to address the crisis, we have moved over 20,000 people into interim housing and approved thousands of additional supportive housing units. Without these resources, our homeless count for the County would’ve been closer to a 28 percent increase, in line with our neighboring counties. The solutions are working, just not fast enough or to scale enough. The government should stay the course on these proven approaches, while working in partnership with the private and non-profit sectors on housing growth across the board and economic opportunities to stem the tide of the newly homeless.

As a society we are paying for people to be homeless. We are paying for paramedics to attend to and transport them, we are paying for them to access our healthcare system through frequent high cost emergency room visits and hospital stays, and we are paying for their interactions with our law and justice system. We are also paying for the impacts they have on property values and the quality of life within our communities. What we are not doing is spending the money very wisely.

In 2006 Malcom Gladwell, author of the Tipping Point, wrote an article for the New Yorker about Million-Dollar Murray, an ex-marine who was an alcoholic and lived on the streets in Reno Nevada. Murray was a chronically homeless high utilizer of the emergency services, law and justice, and healthcare systems. Over a million dollars was paid for him to live on those streets.

Numerous cost benefit studies have concluded that it costs less to house this segment of the homeless population than to keep paying for them via these systems. There is one big impediment – the lack of societal and political will to allow those systems to pay for upstream interventions, in areas outside of their normal scope of responsibilities, which create the downstream savings.

There are some true innovations occurring, but only through workarounds. For example, funding housing for high emergency room and hospital utilizers is not an eligible reimbursable under Medical, so the Inland Empire Health Plan is using administrative money to house them and is showing clear savings. The private and non-profit sectors, along with local government, need to advocate for the use of existing funding to pay for results and support the federal and state governments changing laws and regulations to allow it.

It’s easy when addressing a crisis that is as complex as homelessness to gravitate towards safe and simplistic solutions, when in reality our response must be connected solutions that acknowledge the complexity of the issue. You might hear some say, “this is about mental health”. The truth is homelessness is the result of a lack of affordable housing and mental health treatment, more permissible drug use, less teeth in our criminal justice system, the deterioration of families, poor voter decisions on ballot initiatives, AND the list goes on.

What is missing from the conversation is complexity and leadership. It’s easy for people to identify the problem, but what we really need is leaders willing to move away from rhetoric and drive positive change. I applaud the work of Governor Newsom, our legislative leaders, and my colleagues – The Big City Mayors – who recognize the impact that homelessness has on the quality of life in California and who recently rolled up their sleeves to make sizable financial investments and programmatic changes to provide relief to local communities.

Also noticeably missing are changes to the way that our state and county approach mental health solutions, from the ability to force people in crisis into meaningful treatment when they are a danger to themselves and others, to how funding is distributed. Increasingly, the burden of servicing those in crisis is falling to municipalities, as the largest impact of non-treatment is local quality of life, but the funding for mental health, incarceration, and housing is allocated to other levels of government. This really ties cities’ hands, as residents call their mayors and councilmembers to seek relief from the impacts of homelessness.

Employment. California has begun to incorporate planning for livelihood-sustaining jobs into discussions of homelessness, but it is still an afterthought in a “housing first” model. A more explicit set of initiatives are needed to combine jobs (in social enterprise), economic mobility (via education/training (in the workplace or in other settings), and affordable/subsidized housing in a context where subsidize rent is gradually withdrawn rather than a cliff which disincentivizes work. Working people are able to contribute to their housing expense in an increasing share over time (and with flexibility as income fluctuates) if housing subsidy models can be more dynamic rather than fixed subsidies.

Much like the model of employing affordable housing residents in the upkeep of their properties, a similar social enterprise model could be expanded to involve homeless individuals in the construction of new housing (modular housing, ADUs, new residential development, etc.). The construction trade represents a career pathway that is adaptable and open to people with barriers (like criminal justice system involvement) that could be scaled up using the apprenticeship model to create a pipeline of individuals with lived experience providing the labor pool for housing construction. Wages paid represent individuals’ ability to pay for an increasing share of their housing costs, as well as avoided costs of incarceration, public assistance, etc.

Society must first admit that chronic homelessness is mostly due to drug/alcohol use. Many substance users are self-medicating due to past trauma, abuse or situation. A smaller portion of the homeless population is there because they do not take prescribed medications that help mitigate their congenital mental health disorders. They are unable to live a productive lifestyle because they self-medicate. These people need medication assistance/monitoring from county or state mental health departments. The smallest homeless populations are those who have suffered some form of economic loss and ultimately wound up on the street. This group is fairly easy to help. Most are willing to accept offered services. The other two groups rarely accept offered supportive services. Understanding the truth about how these people ended up on our streets is paramount to mitigating homelessness.

Government has a huge part to play regarding laws, enforcement, policies and funding. However, our government cannot adequately provide the time-consuming social based partnering with the chronic homeless population that’s sorely needed. There are not enough trained government professionals who can spend quality time with those who are drug addicted and self-medicate to escape past problems or abuse.

Until these affected homeless people develop a long-term trusting relationship with someone, there is little hope in getting the addicted person to accept help. From their point of view, they have been mistreated, let down or abandoned by many from their past. They need someone to help them through their recovery process. Someone they can partner with. They know they can’t do it alone. Our faith-based community, non-profits and other volunteers can be those partners. We need an army of trained volunteers to mentor our addicted fellow humans who can’t cope on their own. Government cannot provide this level of long-term support. Volunteers can.

There is no constitutional right to camp on a street. Police should remove people who do and take them to locations with toilet, shower, heating and cooling features, and soup kitchens. Liberal cities have been hesitant to take this action out of fear of not appearing compassionate. However, letting the homeless camp in front of a business or residence is unfair to all who have to pass that way, as well as customers of the businesses and those who live in the residences. Private sector and non-profits can help with drug counseling, providing information on how to obtain skills needed for jobs, sharing information about available jobs, and providing soup kitchens at the centers.

Our joint approach should view homelessness as an emergency, much like a natural disaster. This will involve both short term and long term solutions to provide housing and services to those experiencing homelessness right now. This will fundamentally alter how we approach building new housing of all types that can serve those currently experiencing homelessness and prevent additional people from experiencing homelessness in the future.

Missing is the conversation of wages and are the wages average workers earn enough to pay for housing. Are there housing assistance grants that can help individuals prevent eviction? Government at all levels need to regulate rental prices and provide clinical and health support for people who are in the streets because of mental illness or drug addiction. Organizations can help with case management and as outreach efforts to make sure that the resources that have been made available are able to be accessed.

In discussions on homelessness, the focus is largely on triaging the issue by providing shelter as soon as possible, which is critical and necessary.

On that front, nonprofits do a lot of good work in our communities and in general, prove to be more effective with their money and resources. Top charities, such as local Habitat for Humanity chapters and others, use approximately 90 cents of every dollar donated to the direct benefit of those they intend to serve. This often contrasts with government, which can offer lifetime retirement and health benefits, increasing their administrative costs.

Nonprofits remain key partners in leading the way in providing aid and support to those who find themselves homeless. However, while that is an essential component, it is only a temporary fix. We cannot solve this issue unless we also address its root causes.

Much of the problem is caused by government. If government is not limited in its scope, in line with our nation’s first principles, it becomes the problem.

In general, we know it is expensive to live in California, driven by many government policies. High gas prices and taxes increase the costs of goods and services. Mandates on employers limit entry-level work opportunities. All of these issues together compound the problem and can push individuals and families onto the streets or out of California.

Still, there is a role for government, and the recent state budget does allocate a record number of funds to provide local governments resources to help the existing homeless population. As always, though, with new money comes increased accountability. It has to be used effectively, efficiently, and with prudence if there is to be actual relief.

What is missing is what I’ve stressed above [in the prior question] – the idea that homelessness and housing affordability are increasingly connected. While mental health, substance abuse, and lack of support for veterans are important drivers, it’s the single parent, the student, the older folks next door, the hard-working immigrant family, the resident returning from incarceration, and so many others who can’t afford housing in our current economy and so increasingly find themselves un-housed.

What’s also missing is an honest discussion of the intersection of race and homelessness. Nearly 40 percent of L.A. County’s homeless population is African American, a pattern that has much to do with high rates of joblessness, over-incarceration and its after effects in labor and housing markets, and a legacy of housing discrimination that has resulted in a sharp racial wealth gap (which reduces the cushion that helps prevent a temporary income shortfall from becoming a full-fledge family crisis). When a pattern is this racialized, special efforts must be directed accordingly to reduce disparities even as we lift all boats (or better put, house all residents).

What is not yet missing – but I’m worried will soon be – is a sense that we can successfully address homelessness. The recent rise in the count has given the impression that none of our previous investments were working – but, as mentioned earlier, the forward momentum has been thwarted by a market throwing more and more people into housing instability. So let’s connect homelessness and housing affordability, engage everyone in the effort, and work together to build a better region.

In addition to a focus on reducing today’s on-the-street homeless, we also need to pay attention to the thousands of families living in overcrowded housing across Southern California. Families living in converted garages, garden sheds, or packed into a single bedroom present public health issues and other challenges for children. For families struggling to maintain safe, clean housing, family stressors are elevated. Unstable housing and frequent moves have been shown to increase mental health problems, developmental delays, anxiety, and depression. So, as we consider the overall housing crisis in our region, we should also be working upstream by ensuring families have adequate housing that equips children for future health and self-sufficiency, reducing the pipeline of those who ever become homeless.

Although government and the nonprofit sector play a critical role in addressing homeless and housing affordability, each of us as residents of Southern California need to be open to building quality supportive housing in our neighborhoods. Funding for affordable housing and supportive services is part of the equation, but overcoming community opposition for the development of new housing communities – including multifamily properties – is an essential ingredient to expanding our housing stock. As local community members, we need to stand up and publicly support the creation of new quality housing that will meet the needs of the homeless who currently call our local sidewalks their home.

What’s missing is a disaggregation of the “homelessness” problem into distinct categories with unique causes.

In the 1960s, California adopted the Lanterman-Petris-Short Act, which provided for the involuntary commitment and treatment of a person who is a danger to himself or herself or others or who is gravely disabled. The definition of “gravely disabled” included being unable to provide for the basic personal needs for food, clothing, or shelter. Disabling mental illness must be recognized and people must be helped, not cynically used as a justification for wasteful tax increases or proposed public works projects.

The problem of substance abuse cannot be helped by enabling addicts to conceal themselves in tents on the streets and other public spaces. Before any public, private or non-profit entity can help, that option has to be withdrawn.

To the extent that people are on the streets solely because they can’t afford to live anywhere, a combination of housing assistance and job opportunities is the rational solution, and because job opportunities come from businesses, it would be helpful for state policies to encourage hiring and to create the conditions that allow businesses to succeed in California.

One under-reported aspect is the number of homeless young people who are attending college in our region – at community colleges and Cal State campuses, even the UCs. It’s remarkable to imagine how they balance classroom assignments on top of the burdens that come with living without steady housing. Having to arrive on campus early to use a gym shower; hoping to make a connection with someone who may let them sleep in an office instead of a car.

Yet we need them to succeed in higher education if our region is to thrive. We need educated, trained or certified young people for the jobs that drive our economic growth and provide the services we all depend on. Like health care.

Fortunately, there are successful model programs that are helping young people maintain housing and stay in school. Some are designed especially for young people who have spent time in foster care. Think about it. Without access to year-round housing, if you’ve been emancipated from the foster care system, where would you turn when the dorms close for breaks? At UC Riverside’s Office of Foster Youth Support Services, help with housing is just part of the assistance that’s offered to help these young people thrive on campus.

Los Angeles-based Jovenes, through its College Success Initiative, offers a case-managed supportive housing program for homeless and foster youth enrolled at community colleges in East and South Los Angeles.

The California Wellness Foundation proudly supports the Office of Foster Youth Support Services, Jovenes and others. But private sector contributions from the philanthropic or corporate sectors aren’t enough. Our resources alone will never be able to meet the need.

The public sector needs to step up. We will all benefit from the contributions these young people will make to our region. I’ve met them. They are motivated. They want to create change and to contribute to the health and wellness of their communities. We all should be investing in their future – because ours depends on it.

The homelessness problem is more difficult to solve than the housing shortage and affordability problem. It is also more permanent and likely to keep growing for the foreseeable future. Our booming economy cannot stem this tide, nor can a potential glut of affordable housing. Mayor Garcetti’s major efforts of the last year could not so easily put “Humpty Dumpty together again.” What we are seeing is the broad unraveling of social support systems that we have relied upon for generations. Evidence of what is missing today can be gleaned by comparing the status of very low-income immigrants. Very few are homeless because they benefit from social support of kin and country folk. What is it that’s missing from our domestic homeless population and how can we rebuild that missing fabric? Or how can we help grow a wholly new social fabric that will provide support for our growing numbers of lost Americans? We had best figure this out with today’s homeless because this disintegration could well make deeper inroads into the middle class in the decade ahead.

The increase of the homeless populations in cities all across Southern California has become a crisis for taxpayers across the region. Access to public property, sidewalks, parks, trails, public centers is being denied due to legitimate safety and health concerns. This is tantamount to a taking of property from a property owner, in this case the taxpayers.

Over a decade ago the California State Legislature passed Senate Bill 2. It requires cities to identify in their housing element a zone or zones where emergency shelters are allowed as permitted use without a conditional use permit or other discretionary permit. Ever city in Southern California has an area where an emergency shelter can be built. The State of California needs to get serious about enforcing the law that they passed and holding cities feet to the fire. Cities need to stop pointing fingers at each other and build the required SB 2 shelter.

In addition to increasing efforts to provide mental health support, substance abuse treatment and other social services to those who need it, we need to focus on helping homeless individuals find jobs. Here in San Bernardino County, we are partnering with a nonprofit staffing agency to provide job coaching, placement, transportation assistance, and other support for persons experiencing homelessness and those on the verge of becoming homeless. This is a huge multi-dimensional problem in need of complex and innovative solutions.

Hundreds of thousands of L.A. County residents are on the brink of homelessness – one car repair, medical visit, or rent increase away from not being able to pay their rent. In fact, an estimated 600,000 people in L.A. County spend 90% of their income on housing. A recent study found, just a 5% rent increase in Los Angeles County would push an additional 2,000 residents into homelessness. The government has a responsibility to not only provide services to homeless individuals but also enact policies that prevent homelessness. We need government leaders to fund practices such as rent control, rental assistance for families in need, and universal legal counsel to prevent evictions. Beyond loss of shelter, housing instability has dire outcomes for health and wellbeing, education, as well as job access and retention. Studies show rent burden is linked to a higher number of doctor visits and a host of mental and physical ailments, including anxiety, depression, substance use and early death. In terms of educational outcomes, housing instability disrupts children’s learning, and makes them more likely to lag behind their peers and even repeat a grade. Children from low-income families, who experience the highest mobility rates, are at the greatest risk of suffering these harms. Strong renter protections are needed in order to avoid these negative consequences. Local and statewide elected officials have a duty to enact and enforce these policies, including strong tenant outreach and education programs. Yet far too often, elected-officials are swayed by the powerful landlord and real estate interests and don’t hear the voices of low-income tenants and people who have experienced homelessness. That’s why foundations – including community, corporate social responsibility, and family foundations – should fund tenant and community organizing. Overall the return on investment in community organizing is $90 to $1. We know it works.

Cities are required to identify sites for homeless shelters by law. Builders must have full “by-right” authority to build, with ministerial approvals only. Homelessness is not a crime. If sufficient housing is not produced, cities will not be permitted to enforce local “no-camping” ordinances and tent cities may develop in local parks and public open spaces.

The private sector can step up and help with major gifts to organizations like non-profit Orange County Housing Trust—matching Disneyland Resort’s $5 million gift for affordable and permanent supportive housing–supported by both OCBC and NeighborWorksOC. Affordable projects are very expensive to build and need many layers of both public and private dollars, as well as tax credits. There are projects for OC ready to go, waiting for help from us.

State and federal funding is important to financing packages but these funds are highly competitive and the need is far greater than the amounts offered; government must look carefully at all the “strings attached” to these funds–allow for local flexibility in use, and stop creating “little pots” of money for specific categories without flexibility. Mental health dollars are vast, but without allowance to build shelter, the monies may not be delivered for services–a place is needed to deliver services before services can be delivered. “Housing first” is still true. Cities and counties have a hard job educating a wary public, but they must keep trying, and then, when all else fails, do the right thing, follow the law: plan and approve these projects more efficiently.

Finally, cities and county, to their credit, have formed their own non-profit Orange County Housing Finance Trust to take public and private dollars, work together and fund those projects ready to go to end homelessness. We all must support them in their efforts and encourage them to deliver on the promise as soon as possible.