San Francisco Firefighters Become Unintended Safety Net for the Homeless
nytimes.com
nytimes.com
Also, I find myself doing what amounts to social work in my volunteer life now.
It's too bad we don't have decent, reliable public transportation so people can be housed relatively cheaply and still be able to get around quickly, easily and cheaply. This take the bus/bart for hours just won't work.
So we go on wasting resources, talent, and ability.
You'd think that would be the end of it, but one of the laid off firefighters is now running for council in a move most everyone reads as a "I'm going to give me and my friends our jobs back, so you should vote for me, otherwise the town will burn to the ground" move.
Perhaps the American tendency to blame unions is, in part, a direct result of the fact that Americans are less likely to have direct experience with unions. (As well as being a cause of that effect -- its a positive feedback loop.)
Interesting that you specifically mention San Francisco. SF-centric thinking on HN and in general is growing increasingly annoying, and this might be the reason your post is attracting downvotes. The world is bigger than your startup disneyland.
I was walking on (upper) Market St when a woman, sitting on a stoop, screamed out for help. I turned, saw her and then saw a flight of stairs behind her. She was wailing as if she'd just fallen down the stairs. I ran over to her, asked if she was ok (she was lucid so I figured she could tell me what had happened), but she just stared up at me screaming. I called 911 and told them what I thought had happened. The fire department, big rig and all, pulled up in about 2 minutes (station close by, but amazing response time, really) and the moment the first fireman hopped out of the truck you could just see the exasperation on his face. He made no urgent rush over to the woman. He just looked at me and asked if that was the woman and explained that they'd already been out to see her earlier that day, and many times in the past. I felt terrible, but of course had no way of knowing. Fireman just patted me on the back and said I did the right thing.
The moral (from an unnecessarily long story): it's almost impossible to know what's an emergency in these situations.
My thought (reading this on HN where I ignorantly think tech can solve everything) is to say that 911 calls in SF should include a picture of the person, but that's not sensible, of course, because seconds can sometimes literally be the difference between life and death.
Taking it a step further (in the tech can solve anything world), it might be interesting if emergency responders could send some sort of push notification to people inside a certain geofenced area and ask them to provide a live video feed of the situation as well.
One thing I wish this article would have touched on is what's featured in the caption to the photograph-- the ability for FD/PD to transport low-risk patients who are just drunk or high to sobering centers rather than to EDs. It's a fairly novel approach, and has made the quality of care provided to these people (and those others in the ED who actually need to be there) way better.
They're very helpful in giving context to data, and are commonly done by scientists etc. and called 'case studies'.
Street triage for people with complex mental health needs is important money saving work that improves lives.
Our social problems are ones that no single magic bullet can fix (except in the sense of destroying the problem by ending it all). If we want to be an advanced society we need to understand that every issue is a symptom. There is no one single cause, no one single solution. There are many contributing factors and each needs it's own solution that incentives the outcome we'd prefer to see.
Why is someone homeless on the street? Is it because housing is too expensive, there aren't enough jobs, they lack the skills for jobs that do exist, are they suffering from untreated illnesses (including mental), or is it some combination of those plus other issues that I didn't happen to list.
The above issues are also not in themselves entirely the causes of those issues. Our society is a complicated web of situations, and failure is both always an option and omnipresent among endeavors.
They have the equipment and muscle power to move people. What are a couple of EMTs going to do with a 600 lb guy on the third floor of an apartment building, or someone trapped in a smashed car?
Those seem like more edge cases (most people don't weigh 600 lbs and most car accidents are minor collisions with little to no fire danger). That doesn't justify the extra expense of using them in other situations like the ones mentioned in the article which could easily be handled by police and EMTs.
Right... and it's going to take that guy an extra five minutes to get to the hospital.
They can't depend on what people tell them on the 911 call. The average person is completely unreliable under stress.
It just not reasonable to use that many resources in 1 in a million scenarios like you are mentioning (where a 1-2 police officers and 2 EMTs couldn't handle the situation, the person calling couldn't provide enough information to determine whether fire fighters were needed and making it to the hospital 5 minutes sooner would have made a significant difference in the outcome of the victim)
Per the article, only 1.5% of the incidents the SFFD responded to involved fires and they had a budget of 330 million dollars. How much money could be saved by using police and EMTs in those situations? (and used in more effective programs that are actually going to help the homeless get off the street).
Source: I had a friend who was an EMT at the time of the switchover who had to leave the city to work in a nearby area because he didn't want to train for and fight fires.
Of course, Waterbury has a habit of fatal accidents involving fire trucks (including hitting each other!), so that made me feel like everyone loses in that one.
I remember one of the folks at Stamen design wanted to plot where SFFDs responders were going, and for what purpose. But he was stonewalled by SFFD and denied the info. SFFD does not want you to know that 90% of their calls are for homeless-related issues.
According to one higher-up in the SFFD EMS, this has to do with the software used to dispatch apparatus to calls. It was designed for a two-tier response (ALS v. BLS, as is used in many other cities) but since we don't do that sort of bifurcation of dispatch, it just sends the closest rig which is often fire. Beyond being noisy, can you imagine the damage done to the SF streets by having pumpers filled with water driving on them every day, and the damage done to the apparatus which are by no means cheap?
That might be tougher to do in a city though, and it might not be allowed under some state laws.
[1] http://www.sfgov2.org/ftp/uploadedfiles/mocj/CommInvlv_News/... [2] http://endsfstrugglewithchronichomelessness.blogspot.com/
There have been a number of times when I've been in difficult situations with severely drunken or otherwise vulnerable people, and every time I've called the local police station (rather than the emergency number) and they've sent someone over. But it's always the police I would call - never the fire brigade.
Although most people have no problem saying "police" not "ambulance" when they see someone in psychiatric distress.
(Admittedly that's sometimes the right thing to do. Police have section 136 powers to take people to a place of safety for assessment, and there's started to be street triage services working with the police).
The problem is that we don't really have a sort of emergency first responder triage department. The operators are it. There's isn't an EMT who can speed to the scene in a fuel efficient car on his own to bring you some bandaids or water and check your blood pressure (e.g., in the case of a homeless person prone with a needle in his arm), and then call for more help if needed, so, instead, a $300,000 hook and ladder truck full of 4 highly trained firefighters (also trained as EMT) is deployed to do the same thing.
Why is a fire truck helping a drunk instead of an ambulance?
https://upload.wikimedia.org/wikipedia/commons/f/f3/SFFD_amb...
Apparently sometimes they send the actual fire trucks, though. It would be interesting to know if these stats included the ambulance service.
The issue here is not homelessness, it's the waste of resources by sending the firefighters to tag along almost each and every ambulance call.
Looks like a classic case of perverse incentives. Somebody somewhere wanted to give them more work or more exposure and they ended up doing useless runs.
$230M / 6,700 homeless = >$34K per homeless person per year
Micro-apartments at ~200sq.ft., with really basic (read: mostly plastic/easy to wash, plus maybe a cot) furniture, could go for ~$800/month and still be a good deal for a developer. That's $9600/year. Throw in inexpensive food at another $800/month, and it would be $19,200/year, or a savings of $14,800 per year. Partner with a developer, guarantee the rents, and let the private sector fork over the capital for the building of WAY more than 500 units.
A lot of the cost is actually far more than $34k/person, by the way. There are charities that leverage this fact by finding chronic emergency-room users and getting them a home, food, and sometimes a companion animal. [1] When a homeless person checked into a hospital can cost $9000. An emergency room visit can cost $3700. [2] When someone has serious health issues, they can visit the emergency room multiple times a month; some end up costing the taxpayer $44,400 per year.
Apparently 90% of the homeless at any one time are just going through a bad spot in their lives. And giving someone a place to live can break the cycle of homelessness: You need to have an address to get a job, typically. You also need to be able to shower. Let them keep living in the cheap apartment if they want, but if their income passes a threshold then they need to start contributing to the room & board.
Or don't force them to pay; food and shelter really should be human rights anyway. Why not start in San Francisco? Everyone else would benefit by there being fewer people peeing on walls or sleeping on sidewalks, and by the (relatively) cheaper labor pool that would be available.
[1] http://www.npr.org/templates/story/story.php?storyId=1015075...
I imagine that maintenance of public infrastructure is a thing which won't go away any time soon.
If you define the above as a poverty line (and the re-education time slot is also usable for personal crafts/recreation/etc) then you've also very nicely defined a minimum wage which must be beaten. Providing the apartments at a monetary level in areas also defines a value level for housing in a given area, which is one way of eliminating price gouging (or at least giving added value when it is done).
Ideally they'd have social services and/or psychiatric care, and some of them, after sufficient care might then be able to work. But some are just going to be chronically unemployable.
> “You’re going to roll out of a station 20 times a day to go see the same chronic inebriate, the same mentally ill guy,”
You sure spend a lot of money for saving on socialized health care.
Are these units temporary housing for people on the street? What does the path away from homelessness look like in the bay area, with real estate costs and rent as high as they are?
Its hard to see how someone living on the street is going to be able to afford $1,000+ rent just for a studio apartment on whatever employment they can get coming off the street.
It starts the same way it starts everywhere: by getting sober, getting into a decent shelter, and becoming marketable as an employee. The cost of housing is neither the first barrier nor the primary one, and someone who is sober and marketable can always choose to seek work and housing elsewhere if that really becomes the primary obstacle.
Don't forget that although the cost of housing in SF is very high, so is the minimum wage. And the City has a lot of programs for people who are gainfully employed but struggling with the cost of market-rate housing. What they don't have is housing for someone who spends 20 hours of every 24 lying on the ground cracked out and shitting himself. No landlord can tolerate that kind of behavior, not even a publicly-funded one. It's a health hazard, a danger to other tenants, and does too much damage to the dwelling; never mind the fact that such a tenant will never be able to pay even token rent.
Which makes sense in a practical way, what we should be doing (inclusive we) is funding social programs to help people avoid spending 20 hours a day cracked out shitting themselves, You aren't going to stop everybody but the cost of doing it upfront is so much lower than doing it later.
That of course require that a government have a cohesive and inclusive strategy for dealing with the welfare of it's citizens and we don't seem to have that in the UK let alone the US.
There was another callout to that video of '14 police officers taking down a one legged black man': "Many onlookers saw not the police grappling with a mentally disturbed man as he kicked and bit, but yet another incident of police brutality."
I strongly believe in facts and information about the world, and the medium piece was one of the most one-sided unfair articles. Yes it was an opinion piece, but in the past we recognized that those who are in privileged positions of publishing have a special responsibility. Now a days when anyone can be a journalist, and hit-count are the name of the game, this has really pushed a lot of bad-faith and lazy journalism.
Also consider donating to a local organization, there are many good ones. I personally like Larkin Street Youth Services. They help homeless children and young adults (12-25) get back on their feet through housing, education, etc. At that age you really can put it all behind you with the right support.
China had similar approach for their Olympic Games :-(
Last college bowl season, I saw numerous college football players in downtown SF who had a game to play later that day.
If you make it all the way to the bay area, you're going to come into the city.
If they can't get them out of the city or into permanent housing, they're just going to wander around looking for a new place to collect change, soup, methodone, dope, and a corner to sleep in. That's going to anger residents and result in many conflicts.
http://marginalrevolution.com/marginalrevolution/2012/07/fir...
Ms. Friedenbach, you make yourself and your ideological camp appear naive and out of touch. No doubt, there are a handful of gainfully employed, productive and law-abiding citizens of SF who are homeless solely or primarily because they cannot afford an apartment. I am sure that the time they are forced to spend living in shelters, sitting on the BMR housing waiting lists, and looking for better opportunities in other cities with more affordable housing is painful, degrading, and infuriating. That sucks.
As for the other 6600+ of SF's 6700 homeless population, it's not going to make any difference whether housing is $10,000 a month or $100. These are people with no marketable skills (not even the ability to show up), no desire to work, major addictions (usually following multiple treatment interventions), severe mental illnesses, a preference for the street lifestyle, or some combination of those. Most live in SF not because they were born there or because they have jobs or family there but because there is no freezing weather and the City is accommodating, like spending a large fraction of the $330m SFFD budget sending trained firefighters to pick up the same few hundred people twice a day every single day of the year. All the free housing in the world isn't going to get them off the streets.
Bitching about the cost of housing in SF is fashionable. But I would really expect someone who works directly on the problems of homelessness and with homeless people to know better. The cost of housing is at most a very minor contribution to the problem. When you can show me that most of the people in the City who are homeless have jobs and are reasonably healthy, it'll be time to pin the blame on the housing market. Until then, get serious about addressing the real problems, or just accept that you're never going to and stop pretending.
Unaffordable housing may not be the reason someone is on the street, but its definitely a problem on the path away from that situation.
There are plenty of jobs in the rest of the state or the country, places where you can get an apartment for a couple hundred bucks a month. Given a choice between living on the streets in San Francisco or working minimum wage in Turlock, I know which I'd choose.
It seems like part of getting someone off the street is building a support system to help them stay on the path to recovery. If you establish that system in the bay area (maybe with local friends, family, social workers, etc) and then ship that person out of the city or state, what are the chances that they will return to homelessness when things get tough?
I would expect most people in that situation to make that call on their own. Personally, if my choices were to live in a homeless shelter in SF or in an apartment in Cleveland, I'd head east. But the point is that the City does have a lot of programs to help people who have a job and family in SF but can't afford market-rate housing. Someone in that situation has many options, of which leaving the City is only one. Someone lying in a pool of vomit on Tehama St. waiting for his fourth SFFD pickup of the day doesn't have any of those options.
Why not? There are a lot of people outside the city who would move there if they could afford it.
I can confirm that this also happens in Tempe (Phoenix), all the time.