In California, the picture of homelessness is complex.
Consider these cases, which we have encountered as physicians who treat patients experiencing homelessness:
A woman in her late 60s became homeless five years ago because her social security benefits were not enough to pay for the room she was renting in a duplex.
A 38-year-old mother and recent survivor of domestic violence, who fled her hometown for safety reasons, remains homeless with her children. She drives for a popular restaurant food delivery service.
And an engineer in his 50s, who holds several electrical engineering patents, suffers from manic-depressive bipolar disorder, and cannot recall the last time he had stable housing.
In the public mindset, the image of homelessness is often a stereotyped picture of a person with poor hygiene, lack of desire to work, tendency toward violence, a substance addiction or severe mental illness. While this may sometimes be the case, in our multi-decade tenure as primary-care providers for those without housing, we see the picture of homelessness is far more multifaceted.
The three people described above are just a small sample of patients (whose ages and circumstances have been changed for privacy) that one of us saw at the Hope Clinic, a newly opened clinic dedicated to providing comprehensive wrap-around services to people and families exiting chronic homelessness. The clinic is part of Santa Clara County Health and Hospital System’s Valley Homeless Healthcare Program.
California holds nearly a quarter of the nation’s homeless population. There are 130,000 Californians without housing, or 33 people for every 10,000 residents. Across the country, the number of people experiencing homelessness continues to rise, as housing supply—especially affordable housing—continues to diminish.
As our cities have grown, California has made little effort to provide for those who are at, near, or below the poverty level. Many of these residents are also service workers, the backbone of the state’s economy.
Although the lack of affordable housing is central to this increase in homelessness, we must recognize that the solution to ending homelessness is not in the provision of housing alone. People who experience chronic homelessness often suffer from a myriad of disabling conditions—physical, mental or substance related—that make it difficult for them to obtain and maintain housing.
Case in point: the elderly patient above, who lost her housing five years ago. She did not have a family or social network that would have enabled her to quickly get back on her feet.
The second patient, a survivor of domestic violence with limited education and a former stay-at-home mom, had significant difficulty navigating the welfare system while caring for her young children in a chaotic shelter environment. She needed an advocate to help her access the complex social benefits system.
The story of the tech worker in the Silicon Valley with a chronic, undiagnosed and debilitating mental illness is surprisingly more common than one would think. One can only imagine the potential healing outcomes had he had regular and accessible mental health care.
In short, the majority of those suffering from chronic homelessness need not only permanent housing, but housing with support, also known as “permanent supportive housing.”
Thankfully, in 2016, Santa Clara County voters approved the $950 million Measure A affordable housing bond for the development of more supportive housing. The bond has already funded more than 20 new housing developments in six South Bay cities that will become available in the next few years—with an overall goal of adding 4,800 new affordable apartments.
In addition, the county has also funded the wrap-around support services that we are privileged to be a part of—an integrated, multi-disciplinary primary care and mental health services team providing both on and off-site medical care. Hope Clinic also has pharmacists, an occupational therapist and a dietician. We partner closely with intensive case management, legal services and social service advocates.
We are happy to report that we are seeing a number of our chronically homeless patients begin to get housed through these initiatives. However, we firmly believe that this should only be the beginning. Nineteen affordable housing developments are not even close to adequate for our population of 2 million in Santa Clara County. In order for us to create a sustainable society in the center of global innovation, we can and need to do better.
We need to continue to vote and advocate for policies and funding that support affordable housing in the region, as well as back the nonprofits and government agencies that are doing the heavy lifting to support the workers who make up the backbone of our everyday lives.
In our community, we partner closely with Destination: Home, a public-private partnership that is advancing collective impact strategies to end homelessness. Residents can also get involved by volunteering with direct service organizations or joining Destination: Home’s Housing Ready Communities initiative to help advocate for new supportive and affordable housing developments.
But also, we can do much more as Californians if we recognize that homelessness is not an “us and them” issue. The patients without homes that we meet every day are people whose families often have lived in the Silicon Valley for generations, back when it was mostly orchards. They are people who went to the neighborhood high schools, and who work in local restaurants or the tech industry.
It is important that every community be open to starting these conversations and not expect a particular region or district to take on the brunt of these efforts.
Santa Clara County, and other counties around California, have taken a huge step in the right direction. The permanent supportive housing model recognizes the journey to ending homelessness truly takes a village. We are all a part of that village.
Cheryl Ho and Huy Ngo are primary care physicians at the Hope Clinic, which is part of the Valley Homeless Healthcare Program at Santa Clara Valley Medical Center in San Jose.