Million-Dollar Murray: Homelessness may be easier to solve than to manage | Hacker News Reader

Million-Dollar Murray: Homelessness may be easier to solve than to manage

gladwell.com

91 pointsskushch45 comments

> An efficiency apartment in Denver averages $376 a month, or just over forty-five hundred a year, which means that you can house and care for a chronically homeless person for at most fifteen thousand dollars, or about a third of what he or she would cost on the street.

That assumes renters who don't try to destroy the place. However, some renters are considerably more destructive than others.

However, the big problem is that it assumes that homelessness is solely due to a lack of resources to obtain a home. If that were true, SF would have far fewer homeless and the shelters would be full.

Yet, many of SF's shelter beds are empty and folks who could be in the are on the street. Yes, they know about the beds - they prefer the street.

Are you really sure that they'd take an efficiency apartment? Are you sure that they wouldn't try to destroy it?

Someone pitching that as a solution should not only be aware of the possibilities but have reasons better than "an apartment is better than the street" because that's clearly not true for a large fraction of the relevant population.

Did you read the article in full? I know its a rude question to ask but it really seems like you didnt because youre falling prey to exactly the type of thinking it highlights as the problem. The solution doesnt "feel" right, and we humans are without peer in justifying our discomfort avoidance in cloaks of righteousness, truth, etc. That the correct solution just happens to coincide with the solution that avoids self-doubting discomfort is serendipity. Even this serendipity is so rarely noticed, let alone questioned, doesn't this seem odd?

Take for instance healthcare, its spiraling costs. A doctor ordering what some would call excessive tests for a patient is doing the right thing. It is better to be safe than sorry after all. The trial lawyers, insurance companies, government handouts and so on are the reason its skyrocketing.

What about the human fault of judging ones own immoral actions and impropriety on a relative scale of those around us? What about compounding that by generally giving everyone an "i am a good person" foundational belief. To examine it with no intention of challenging it will cause most people to feel a tangible unease because they're treading on some dangerous ground, a sense of fear that its best not to mess around in this place in case you break something accidentally. Each human with an intact "i am good" core applies goodness to all their actions by default, meaning if a person is not truly judging their motives or reasoning they are deemed to be "good" actions with pure motives because they are good and nothing specifically shows they're doing "bad" right that moment.

When the city with one of the fastest rising health costs in the US was examined it was found that the rising costs had a partner along for the trip, medical procedures and tests were rising as well. The doctors were doing nothing illegal, and obviously none of them thought they were doing anything wrong. So why the rise? It was just doctors increasingly exploring that grey area that doesn't challenge your central belief of your own goodness. Patient complains of headaches, and worries about something they read online about brain tumors, the doctor thinks its unlikely but its better safe than sorry, and imagine if he does have a brain tumor not only would i have missed it i might be sued too. Repeat this process over and over and goalposts move, more behavior is acceptable such as "ok so maybe she didnt need hip replacement surgery right now, but she definitely would have needed it soon, and im a far cry from Doctor EvilCompetitor, i cant believe he talked that poor shmuck into allowing brain surgery!".

Consider the complicated medical conditions that homeless contract on the streets with illness on top of illness requiring weeklong ICU visits, it becomes drastically reduced if a person is living in a home. A single avoided hospital visit of that kind alone can justify the free apartment for year or two or three.

Im trying to find that article again, will post link when i find it.

> Did you read the article in full?

My point is that the article doesn't contain all relevant data.

> A doctor ordering what some would call excessive tests for a patient is doing the right thing.

May be doing the right thing. Some people think that my life is worth $X. Who's to say that they're correct?

> Consider the complicated medical conditions that homeless contract on the streets with illness on top of illness requiring weeklong ICU visits, it becomes drastically reduced if a person is living in a home.

Assumes behavior not in evidence. Homeless in SF have "not street" options that they refuse. What makes you think that they'll take different options AND that their risks will chance correspondingly.

I note that lots of folks with homes manage to get "street illnesses" so it's not true that homes solve disease. There's a decent correlation for current "homed" populations, but that doesn't tell us what would happen if we "homed" other populations.

I think part of the point was that an apartment creates a sense of responsibility and pride in ownership a shelter bed does not.

I don't think anyone's saying this is the one true solution, but it makes sense, and perhaps should be given more of a shot than it has been to date.

Have you considered the possibility that many homeless people are specifically uninterested in the responsibility of an apartment? We're not talking about children or immature teenagers here. IMO the bigger risk with homeless people is treating them with condescension, thinking you know best what they should do. Maybe you don't.

Yes, I have, which is why I said it wasn't a magic bullet, but something that should be given more of a shot. If it helps 10% of homeless get off the street, that could be a huge victory in and of itself.

BTW, for someone so attuned to the sensitivity of the homeless to condescension, you seem to have no problem saturating your own speech with it.

> If it helps 10% of homeless get off the street, that could be a huge victory in and of itself.

Or, it could be a huge disaster. It depends on the costs.

> Yes, I have, which is why I said it wasn't a magic bullet, but something that should be given more of a shot.

Feel free. As the article points out, the experiment doesn't cost much, so you can do it and tell us how it went. It's <$400/month and it's tax deductible.

What? You're not willing to spend your money to prove your arguments? Then why should I spend mine? (And yes, I pay a lot more than $400/month in taxes.)

Wait, you're taking the example of SF, where you say many homeless people prefer the streets to a shelter, and extrapolating that to conclude that "a large fraction of the relevant population" would prefer the streets to an apartment?

It is a pitch and would only be an experiment, but what if it works on a small portion of the population of homeless. Then I think its worth it especially to those hardcore offenders.

Being homeless is offensive?

"Power-law solutions have little appeal to the right, because they involve special treatment for people who do not deserve special treatment; and they have little appeal to the left, because their emphasis on efficiency over fairness suggests the cold number-crunching of Chicago-school cost-benefit analysis."

This is exactly why programs like these won't take off. It's hard to present this kind of complex analysis of the behavior of a system to the tax payers for exactly this reason. The average person probably votes their conscience, not what makes the most sense from scientific studies, which are generally not widely published anyway. There's no simple moral argument to be made for giving homeless people free apartments that they don't deserve, and most voters won't think through a proof that has more than like two steps.

"the right, because they involve special treatment for people who do not deserve special treatment"

What amazing garbage. Well over half the homeless are such because they belong in a mental institution, the closing of which was a major successful crusade of the left through the '70s or so (many libertarians and some members of the right like Jerry Pournelle joined them in this and the more honest of them like Jerry admit the mistake). "The right" was entirely happy with "special treatment" for these people since that is the only humane way to accommodate them. (You have, I assume, spent a little time around a schizophrenic person? Their ability to think is PROFOUNDLY broken.)

Antipsychotics were and are amazing wonder drugs: my Mom did her nursing residency in the '50s and part of that was working in a psych ward. Later she took a job at that same hospital and was amazed to see one of the previously hopeless cases productively working there as a janitor or the like.

The problem is that antipsychotics are also seriously nasty drugs (even more so when the above crusade happened, before safe atypical antipsychotics were on the market (the first was so dangerous that you couldn't get the next month's prescription filled for your patient without sending in a blood sample)) and "compliance", getting people to take their meds, is for all too many an impossible challenge outside of an institutional setting. Note also that the "drugs and alcoholism" problems are all too often attempts to self-medicate.

Anyway, we ("the right") believe these people deserve "special treatment" (the causes are mostly genetic after all) but the left has outlawed the only one that works. Not much we can do now but to pick up their bodies off the street when it's all over as harscoat relates.

You gloss over the treatment of patients at the "mental institutions". It was truly horrendous and deinstitutionalization arose out of that. I don't think anyone would argue that we've arrived at a solution.

Also, "the right" today is much changed from the 70s.

I'd argue that institutionalization was simply reintroduced in many cities through 'quality of life' policing. For example, there's a reason why Manhattan in 2010 is pleasant and safe - it's because Giuliani's policies turned Rikers Island into the de facto mental institution for New York City.

Heather McDonald's 'The Jail Inferno' has some information on this, although it's not the primary focus of the article:

http://www.city-journal.org/2009/19_3_jails.html

I suspect that Rikers Island is not much better for the mentally-ill than the mental institutions of the 70s, although I haven't researched it and may be wrong. I strongly suspect that one way or another, the mentally ill will remain institutionalized in New York. The improvement in quality of life is so stark, not even the most liberal New Yorker will support relaxation of law enforcement.

"truly horrendous" was worse than dumping them out on the streets?

I'd say we've "arrived at a solution" since any attempt to limit the "personal autonomy" of the severely mentally ill gets absolutely nowhere, unless of course they end up in jail as they all to often do.

"much changed from the 70s"???

Could you be more specific? Note that I came of age in the '70s so I lived through that and subsequent periods in the evolution of "the right".

Here's one good essay to look at WRT to a thesis it touches upon WRT to three generations of activists on the right (e.g. Buckley/Rush/Drudge): http://www.americanthinker.com/2010/07/nobody_can_fire_andre...

http://en.wikipedia.org/wiki/Rosenhan_experiment for one.

I repeat with emphasis: was the proper solution to dump all the patients in institutions out on the street?

That "solution" does not automatically follow from the study you cited.

Power-law solutions have little appeal to the right, because they involve special treatment for people who do not deserve special treatment; and they have little appeal to the left, because their emphasis on efficiency over fairness suggests the cold number-crunching of Chicago-school cost-benefit analysis.

What a bizarre thing for Gladwell to write. He's inexplicably generalized from one particular power-law solution, giving free apartments to the chronically homeless, to state that all power-law solutions are politically unpalatable.

In the case of the tiny minority of excessively violent LAPD officers - a simple power-law solution would just be to assign them to useful administrative jobs. I can't really see how that particular power-law solution would aggravate the right or the left.

That solution would aggravate people who view the police as being part of their "tribe". Assigning some police officers to admin work lowers their status, and in effect the status of your entire tribe. This would aggravate authoritarians on both the right (e.g. Gonzales) and left (e.g. Biden).

This is also the objection to giving free stuff to the homeless - it elevates the status of another tribe (do-gooders/bleeding hearts, the people handing out the free stuff) at the expense of your tribe (hard working/god fearing).

You could almost certainly get conservatives behind such a plan and get liberals to oppose it, if you did it in a way that elevated the status of a right-leaning tribe (e.g., boot camp/military living for the homeless).

Malcolm Gladwell isn't alone in suggesting that the solutions to power-law type problems, which usually require focussing on small parts of the problem rather than making sweeping changes, are unpalatable to government. Jane Jacobs, in the Economy of Cities, suggests the same thing. However, she suggests it's due to the desire of government people to want to cause change rapidly: sweeping changes provide this promise in a way that spot changes might not.

Seattle actually put this into practice. The city funds and supports homeless housing for the most expensive homeless in the city. There is no requirement for sobriety. The project is called 1811 Eastlake (http://www.google.com/search?q=1811+eastlake) and it is not without controversy. Studies of the outcomes and cost analysis has been published in JAMA. Here is a summary: http://www.desc.org/documents/DESC_1811_JAMA_info.pdf.

My wife is an ER attending at Harborview, the hospital that sees most of these patients. Anecdotally, she has seen great outcomes out of the project, has toured it and is a big fan.

(Interestingly, Dr. Michael Copass, the patriarch of the Harborview ED and a pioneer in modern medical response calls these individuals "urban nomads")

"...It is very much ingrained in me that you do not manage a social wrong. You should be ending it."

Lots of good stuff in this article. I had a class on homelessness and an internship at a homeless shelter. A lot of what I have seen written about it is pretty stupid. But the ideas presented here have potential.

I remember a homeless called Lounis (after my studies, I joined Paris Firefighter Brigade), we collected him regularly because people would complain he was staying at their frontdoor. On our way to the hospital, he would sing with us in the truck, he would even do air guitar. The day some of my colleagues came back to the fire station after they collected his body on the street, we all felt like the police officers did for Murray.

The crux of the matter:

The cost of services comes to about ten thousand dollars per homeless client per year. An efficiency apartment in Denver averages $376 a month, or just over forty-five hundred a year, which means that you can house and care for a chronically homeless person for at most fifteen thousand dollars, or about a third of what he or she would cost on the street.

I believe similar observations have been made in subsidizing the price of fruit and vegetables (or even bikes and gym memberships) vs the medical costs of bad diets and lack of exercise, too.

It's not as simple as just throwing money at the problem and managing things differently.

I've been homeless before and it's not pretty, a lot of the people who I met on the street during that time would not have been able to just take an apartment and that would be their problem solved.

They are on the street for a reason and if the reason was purely financial then perhaps the apartment would help, but a lot of the time the reasons can be associated to mental health, poverty, drugs, alcoholism... and giving someone an apartment in those cases is unlikely to add anything to the solution.

What those people need is real support and care. And an apartment will just isolate them and risks exacerbating the problems for them.

> What those people need is real support and care. And an apartment will just isolate them and risks exacerbating the problems for them.

Not to say that I think that giving a homeless person a home will magically solve all his or her problems, but how does giving someone an apartment isolate him or her in a way that being on the street does not? (It's not a snide question; I've never been homeless, and maybe there's a stronger community than I see—but it seems unlikely that that community can provide the real mental and physical care that such an afflicted person would need, and that the people who can provide it find it easier to ignore a dirty person on the street than their next-door neighbours.)

On the street you're likely to congregate at points where people offer some basic assistance or there is security. This means things like food wagons, shelters, drop-in health centres and places where other homeless hang-out and you can pass a little time.

In those places a lot of voluntary help is given, workers chat to you, sometimes you'll even be given some new clothes, but nearly always you get to interact with others.

I cannot emphasise how hard being homeless and without a network is. You have no-one to talk to ever except for these people who by necessity you come into contact to. I also cannot emphasise just what happens if you have too much time alone and yet live in fear, hunger and with some problem (mental health, an addiction, etc).

Some of the people I knew from the streets wouldn't have survived in a house. They needed their contact as much as they needed their next drink, it was all they had and the only thing that prevented them from losing themselves totally.

The isolation from giving them an apartment is that no-one will visit, and if they do then not enough.

And the problems they'll have are worse and will go to basics such as hygiene. On the streets they never had to clear litter, pick up dirty clothes, and clean their environment... they would just move on if it was bad enough. In a flat most of the people I knew I believe would've just rotted and allowed the space around them to become full of junk and to also rot.

They'd need to be taught how to care for themselves. How to cook safely. How to budget and make money stretch (there is little thought of the future on the street, you spend what you have pretty quick in case you lose it. You wouldn't think of bills and taxes).

And to learn those things you'd need them to have sound mental health, alertness, awareness of their surroundings. You'd need to help them to shake off their addictions, and to respect themselves. You'd likely have to counsell them and provide support for mental health problems.

And if you achieved all of that. Then they would be devastatingly lonely. They won't have what you take for granted, there are no friends for them to call upon, family to visit, money to go sit and bar and chat. They'd be alone and desperately wanting to rid themselves of that loneliness.

In all likelihood they'd go back to the streets where they have contact, interaction and community. Where they didn't have to put in all this effort to care for themselves when apparently that amounts to loneliness and isolation.

It takes far more than a roof to stop someone being homeless. Homelessness is a state that encapsulates far more problems than just the lack of a house. To solve it, you need to address all of those problems and not just the lack of a roof.

We need a word different than "homeless", really. You say: "Homelessness is a state that encapsulates far more problems than just the lack of a house." But the word itself dates from a time when many people truly were simply homeless, and the concept itself of course predates English. Historically speaking (going back a ways, but covering a lot of centuries) one popular way to homelessness was simply to become a widow and lose your husband. (Which is why the Old Testament goes on at length about taking care of widows; it's not about having emotional compassion for one who lost their spouse, though that won't hurt, it's about supporting someone who now has no economic income.) Civilization has not always been as wealthy as it is now; someone says "homeless" and the very word itself invites them to think the old, simple case, not the modern complicated stuff you talk about.

Today we've pretty much solved the basic home problem in the civilized world. Perhaps not 100%, but nothing is ever solved 100%. What's left are the hard cases, which is what you are describing. Our cultural attitudes haven't updated for this fact, and so when people hear about the homelessness problem they naturally think the problem is simply... homelessness. Unfortunately it's a harder problem than that, and we make it even harder by misunderstanding it.

We need a word different than "homeless", really.

Today we've pretty much solved the basic home problem in the civilized world.

----------------

Some data on American housing and such, that may not be 100% accurate but should paint a general picture:

Around 60 years ago, the average new home was about 1200 sq ft and housed a family of 5 (2 parents, 3 kids). Today, it is over 2000 sq ft and houses a family of 3 (2 parents, 1 kid). This difference and other factors has helped create a widening gap between the haves and have-nots: Those who can afford a new home live like kings. Those who can't may be perpetually one paycheck away from homelessness. Most of the financing instruments we have are aimed at single family suburban homes designed to meet the needs of a 1950's-style nuclear family. Meanwhile, our demographics have changed and very few people fit that bill. The housing industry has been terribly slow to adapt to the changing needs of our changing demographics.

Also, historically, it was more common to live with extended family. This was more manageable back when more than half the American population lived and worked on a farm. You could always put someone to work on the farm to help cover the cost of feeding and housing them. But a more city-centric lifestyle means that if you have no job, you typically aren't viewed as a contributing member of the household and it is much harder for people to extend generosity in that regard unless they are truly wealthy. We also had more SRO housing and boarding houses -- just the sort of supportive environment that the Murray's of the world seem to need. This was part and parcel of the culture and was not considered some kind of "special service" for problem individuals who couldn't adapt. It was also cheaper than a stand-alone apartment. Apartments designed for a nuclear family or houses designed for a nuclear family make up the majority of housing stock in the US and it is financially out of reach for many single individuals. College students often get multiple roommates to make it work but it really isn't designed to work for them. The Murray's of the world lack the ability to force the current housing situation to serve them adequately and mostly don't have other options which did exist not that many decades ago.

I have a lot more thoughts and information on the subject but I don't care to beat it to death. The current housing situation really is a factor in why homelessness has been on the rise in recent years. Yes, it is one of many. But I don't think it can be lightly dismissed.

When I say the literal homelessness problem is mostly solved, I don't mean that everybody gets what they want. I mean that anybody with the basic ability to work, who is not insane, who is not for some reason simply unable to function in what we are pleased to call civilization for whatever reason, is able in a first-world country to put a roof over their head, even if that means accepting charity, or government handouts, or taking a roommate or three, or quite possibly moving away from where you are to go somewhere else and do some combination of the above. The current economic issues do make that challenging at this exact instant but on the scale of time I'm considering it's still just a blip. And the trend line remains clear; for instance, I'm pretty much ready to call this a Depression, yet it is of a different character than the previous ones, no soup lines, and there are many and good reasons for that, mostly revolving around the generally higher level of wealth the whole society has, even if you feel poor right now.

It is very tempting, whenever considering progress, to look ahead at how much work remains to be done, all the more tempting because it is a valid viewpoint, after all. But I think it is also helpful to honestly consider how far we have come, too, without constantly self-flagellating about the fact we haven't gotten to perfection yet. The problems you describe are not of the same order of magnitude of the problems that buro9 described.

But I think it is also helpful to honestly consider how far we have come, too, without constantly self-flagellating about the fact we haven't gotten to perfection yet. The problems you describe are not of the same order of magnitude of the problems that buro9 described.

I had a class on homelessness and did volunteer work in a homeless shelter and I have lived with the kind of stubborn personal problems that typically lead to homelessness. I am well aware of the personal factors involved. I don't think it is self-flagellation to realistically assess the impact the current housing situation has on the availability of suitable, affordable housing and how that relates to increased homelessness in recent years.

Great response. I think you're touching on a lot of the more fundamental problems in any approach to helping the homeless.

You mentioned contact and community a few times there - do you think that dealing with full homeless communities, or at least a subset of 5 to 10 people, would be more successful than trying to deal with individuals? Do you think that choosing a group of four homeless folks and moving them into either a single apartment or neighboring apartments would wind up having a greater chance of success? Or do you think that would perpetuate social norms that are nonconducive to more survivable lifestyles?

Take this as a component of any particular aid approach, by the way - there are no silver bullets and a lack of a roof is often a symptom of many other problems that can't be solved by craigslist's housing section.

Note that the pilot program described in the article included fairly intensive support by a team of social workers. I think Gladwell mentioned one caseworker for every 10 clients?

Here in the UK the welfare budget is nearly 6x the defense budget. Healthcare is around 3x. We're talking serious money here. Probably we spend as much on welfare and healthcare as the US spends on the military. And the results speak for themselves: chucking money at it is not the solution.

Often in London a homeless person will ask for money to stay in a shelter overnight, but the shelters are free, funded by the local councils, and always have spare beds.

http://en.wikipedia.org/wiki/United_Kingdom_budget

    190 social protection
    105 health
    ---
    295 total health & social
     38 defence
    ===
    519 total

population 62,041,708

http://en.wikipedia.org/wiki/United_States_federal_budget

    678 social security
    676 medicare & medicaid
    ---
   1354 total health & social
    782 defense
   ====
   3518 total

population 309,921,000

I had a look at similar numbers a few years back to back up a debate I was having and was surprised. The UK and US spend in the same order of magnitude per capita on public healthcare.

Sadly, though, this isn't good. The US's healthcare budget covers a minority of the population whereas the UK's covers almost everyone. The only reason the US's budget is inflated is due to the extreme inefficiencies and price gouging that are rampant in the US healthcare market.

I believe similar observations have been made in subsidizing the price of fruit and vegetables (or even bikes and gym memberships) vs the medical costs of bad diets and lack of exercise, too.

Not sure if you were trying to make this point but:

The reason many people don't eat enough fruit or go to the gym isn't because its too expensive.

Especially as meat is subsidized so heavily.

This guy and I'm sure a lot of others could be pretty well off if there was some type of rural co-op they could live and work on. It could save a lot of money and probably help these people a lot by getting them out of the city.

A lot of homeless people cannot, or will not, live in such a situation. There are so many well-meaning people trying to help the homeless that those who stay homeless generally have a compelling reason why they are. Either they're episodically violent which makes them unsafe to house with other homeless people, or they've simply adapted to the vagrant lifestyle and don't know any other. Makes the problem much tougher to solve.

The Delancey Street Foundation is an organization that has recuperated thousands of people who have hit rock bottom. And they do it without any government funding (they're self-supporting). One of the best examples of social entrepreneurship out there.

http://www.delanceystreetfoundation.org/

And if you're interested in the details of how the organization operates, I did some research and wrote about the organization on my blog:

http://nathanmarz.com/blog/mimi-silbert-the-greatest-hacker-...

What I would ask about these "power law" situations: Do we have any idea what moves someone from bad cop to really bad cop or homeless to homeless-and-totally-down-and-out?

While only a small number reach the "really bad" level, it seems plausible that there's a larger population who could move into that level if the competition or bad examples or whatever other restraining factors were removed?

Sure, only a tiny minority is flagrantly offending at a given point but if one doesn't understand how this minority arises, one doesn't really understand the situation.

I believe that homelessness is cheaper to solve than to manage.

However, it may be easier to manage (ignore) the problem than to solve.

Yep, that's generally how that kind of problem are solved..Close the eyes on it!

The article is a bit too well written, if theres such a thing. I got about halfway without pausing.

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