There needs to be proper leadership that understands how people live and work to build a city that can cater to everyone outside of the upper/middle class at major companies.
I think many in government knew this was going on, and becoming an increasing issue/epidemic in recent years, but until the public becomes outraged and is willing to support a big shift in policy and budget, what they can do is limited. It might be some of the people in government that we should feel most sorry for - they've been witnessing it for years and voicing concern, but few in the public will listen or do anything about it.
Perhaps I'm being too generous, but I see government and big institutions as behaving very much like computers, with much less intelligence and autonomy than the general public might think.
Government officials are constituents too and they should be able to figure this out even without any public feedback. This is their job. Ignorance and apathy have no place there and they would be fired in any other industry for this kind of incompetence. Unfortunately they're also in charge of any rules around accountability.
I still hold my point that the public may get "outraged" or whine about the problem, but they won't act or vote in alignment with that outrage until it actually impacts them. The homeless/opioid epidemic finally crossed that threshold and so they did. But that just proves my point that it's the public that must act/vote and see themselves as the responsible party, and not wait for the government to solve everything.
The reality is fine-grained democratic voting on every issue does not scale to today's world. People do not have the time, attention, education and understanding to vote properly on everything, and when you add in personal biases, lack of risk management, short-term outlooks, majority power, and special interests; things break down completely.
Many of these things which could improve civic life do not really need a voting process. It's not a system for the people (not anymore) but stays around because it removes accountability and provides regulatory capture for the few who profit. Of course, as you say, the very people who do not take action are the ones that need to take action for this to get better. I do not have an answer for that.
Tell it to Switzerland. The most recent referendum included such important issues as "should the government offer subsidies to farmers who leave the horns on their cows".
Having lived in Switzerland a while, direct democracy may not be perfect but it definitely works. It might not work in America but it works.
Switzerland is also around 8M people which is smaller than some cities in bigger countries so it barely qualifies for the scale argument.
It may be worth considering how all the issues you so correctly and wisely identify have been addressed in the place that seems to continue to exemplify the worst of the crisis. Perhaps they're all addressed improperly or inefficiently. Perhaps trying to address the issues is simply too new to have had any impact at all. Perhaps the solutions are so successful that they've drawn people from elsewhere in need of help, making the crisis falsely appear to be ongoing. Perhaps the critical services you point to are insufficient somehow.
What are your thoughts on explaining this apparent conundrum? I'd very much love to hear! I want to understand.
A large part of it is likely the vast isolation they see from the actual issues. More skin in the game would greatly change things if they actually had to face these problems themselves instead of just answering public feedback with empty platitudes.