Can We Fix San Francisco?

In December, San Francisco Mayor London Breed declared a state of emergency in the city’s Tenderloin district, which will lead to increased police presence in the epicenter of the city’s homelessness crisis. It was a major turnaround for Breed, who after the police killing of George Floyd in 2020 called for “ending the use of police in responding to non-criminal activity.” The move was criticized by groups like the Coalition on Homelessness, which called it an “expansion of strategies that have been tried and failed” that would contribute to the “instability and poor public health outcomes” of people living on the streets.

Michael Shellenberger, author of San Fransicko: Why Progressives Ruin Cities, called Breed’s new “tough love” approach a “big step in the right direction.” The homelessness crisis, he argues, is actually an addiction and mental health crisis; to stop it, he believes, we need to end policies that permit open-air drug scenes on public property, prevent police from enforcing the law, and undermine the creation of a functional mental health care system. Shellenberger is certainly not a libertarian, though says he appreciates the “cultural libertarianism” of his home state.

In January, Reason‘s Zach Weissmueller interviewed Shellenberger, a Bay Area activist best known for his advocacy of nuclear power, about his foray into social policy, his critiques of both progressive and libertarian politics, and whether America’s cities can clean up their streets without grossly violating civil liberties.

Reason: Your new book is San Fransicko: Why Progressives Ruin Cities. First off, could we talk about the title for a second? It’s a little aggressive, no? Aren’t you worried about scaring off potentially persuadable people?

Shellenberger: I don’t want to scare off anybody, but I believe in truth in advertising. San Francisco and other liberal cities are sick. They have people with untreated mental illness and untreated addiction camping in parks, on sidewalks, using drugs publicly, defecating publicly. It’s a huge public health problem. I don’t just mean homelessness—I also mean the broader urban decay, including rising crime.

I also argue that there’s a sick way of thinking about these problems, which is to pathologize our system as fundamentally evil and wrong, and that that leads to terrible outcomes. The book is about San Francisco, but it’s also really about what the subtitle says, which is why progressives ruin cities. Why is it that cities that ostensibly care the most about poor people, minorities, and people suffering mental illness and addiction treat them so terribly? What’s going on? That’s the reason for the book.

I have identified as a progressive. I now identify as a liberal and a moderate, and I see myself making the case for institutions—police and criminal justice and functioning electricity grids and homeless shelters.

The perspective that you bring to this as a former activist involved in progressive causes is oddly relatable to me, because progressive politics and libertarian politics overlap in many of these areas—drug legalization, criminal justice reform, the rights of those with mental illness. As a former Californian who has seen and documented a lot of the tragedy unfolding on the streets, I’ve had to personally think very deeply about how some of these policies have been implemented and their real-world effects. I still want to see major changes in laws and sentencing across the country that maximize personal liberty, but my general sense is that the way it’s been implemented in practice has emphasized the personal liberty side of the equation while ignoring the personal responsibility part. For a libertarian, those things are bound together. What is your big-picture diagnosis of what’s gone wrong in California cities? 

I’m in California because I love the cultural libertarianism here, the fact that we really reject a lot of the traditional status hierarchy of the East Coast around where you went to school, working in big companies, stuff like that. I love the entrepreneurialism.

I also care a lot about people. I mean, I think the trip that libertarians lay on people is that they care about freedom more. And the trip that progressives lay on people is that they’re more compassionate. The truth is that a lot of us love our freedom and a lot of us care about other people, and we’re looking for some practical ways to solve these problems.

If you take the so-called homeless problem, I believe it’s fundamentally a problem of untreated mental illness and drug addiction, a form of mental illness. It’s often self-inflicted, and it sometimes comes from trauma or from undiagnosed depression, anxiety, or schizophrenia, but sometimes it just comes from partying too much.

We don’t have a functioning psychiatric system. A lot of people that are addicted to hard drugs might have done fine with an antidepressant, some cognitive behavioral therapy, and exercise, which works for almost everybody. We don’t have that, and that’s the traditional progressive criticism.

Then the other issue is why are there so many people on the streets in San Francisco? It’s because we let them. There’s a myth that it’s because of the weather. Certainly in freezing places like Chicago, it’s hard to be on the streets year-round. But there’s other places like Miami, which are warm, which don’t have the same problems that we have. Or they did, and then they fixed them. The solution is basically universal shelter—a safe and clean place to sleep. It should not be so nice that it attracts people to want to stay there.

That’s not the policy we have. We have a “housing first” policy rather than a “shelter first” policy, under this utopian idea that we can just provide everybody who wants their own apartment in San Francisco or Venice Beach with their own apartment. It’s obviously wrong. Just geographically you can’t do it, but financially you can’t do it. And it creates a terrible incentive for people to become homeless.

We need a “treatment first” policy. We need to enforce laws, including misdemeanors, including against public camping, public defecation, and public drug use. Those are cries for help from people. When they break those laws, they should be arrested, brought before a judge, and given the opportunity to have rehab or psychiatric care rather than jail or prison.

We should seek to reduce the size of the prison population. That’s a goal that I had in the 1990s when I worked for [George] Soros’ foundation and Soros-funded nonprofits. I still share that view, but that’s not what many progressive prosecutors are doing. Prosecutors in L.A., San Francisco, Philadelphia, and Chicago are just letting people out of jail, and they’re not prosecuting crimes.

The core American value has been freedom ever since our founding. That’s a beautiful value, and we should continue to have that value, but it does require responsibility, at the individual level but also at the societal level. We need to balance those two values.

In terms of models, I looked at the Netherlands but also Portugal. The Europeans all do the same thing: They don’t allow people to camp publicly, use drugs publicly, defecate publicly. They do require people to stay in shelters.

“Housing first” is the operating assumption of most homelessness policy. There’s a simplicity to it that’s appealing.

If you give people with untreated mental illness and addiction their own apartments and don’t deal with the untreated mental illness or addiction, they end up back on the street, often very quickly. We now know from a big Harvard study that was done over 12 years that there were no better outcomes for people that had housing first than non–housing first, even on their own metric of keeping people in housing.

The National Academies of Science, our premier research body, did a review of the science a couple years ago [and] found that “housing first” did not have any improved outcomes. And there was some evidence that it had worse outcomes because it didn’t deal with the underlying problem of addiction and mental illness. Just to be fair to my opponents on this, their response is, “Well, we never said that you wouldn’t also have services.”

We don’t have functioning psychiatric and addiction care services, but a lot of it is also victim ideology, [which says] that you should give them things, like their own apartment, and offer them help but don’t mandate it, because that would be an extension of the victimization. And that’s where everything goes wrong.

There is some amount of coercion that’s usually required for people to quit their addiction. People do need to be arrested. In Portugal, they do these interventions with a mix of family members, social workers, government officials, and cops. I think that’s where the dogma has interrupted the proper treatment of people with addiction or mental illness: actually requiring some amount of pressure or coercion, if only the enforcement of laws when they break them.

One of the things that social workers do in the Netherlands is offer people their own private room as an incentive, or eventually maybe their own apartment. But even their own room is a really good incentive for people, because people don’t like congregate spaces; everybody’s the same in that way. So that’s a “housing earned” approach. With a carrot-and-stick model, you’re always trying to give people a reward when they respond properly, and then a stick—some consequence—when they violate it. There were big studies done on this in Birmingham, Alabama, actually, including around crack. Crack addicts who were given their own apartment as a reward for passing a drug test did very well.

An important piece of that is to have case managers. You need a bossy, annoying social worker. You’re not supposed to like your social worker. They’re trying to get you independent of them. A social worker needs to have a significant amount of power actually delivering those rewards and incentives.

I want to talk to you about the drug war, which I still see as a giant failure. I think that decriminalization and eventually legalization is the right path forward to alleviate a lot of the suffering we see on the streets and sidewalks—maybe done in a more careful way than it’s been done in some of these cities. You say in the book that you were once a critic of the drug war. Do you now think it’s a good idea? Given what we know about the effects of the black market, people having their lives ruined with jail or prison time, is keeping drugs criminalized a viable path forward?

I still want to see less incarceration. We had a system that was seeking rehabilitation with a model of nonfixed sentences, variable sentences for prison, where there was a lot of leeway on the part of parole boards in terms of reducing time in prison in exchange for good behavior. It was actually the radical left that pushed to get rid of that and have fixed sentences in the ’60s and ’70s. It was the conservatives who then went along with it and said, yeah, we’ll just have longer sentences. So in some ways I think we were going in a better direction in the ’50s.

I think it is also helpful to get some picture of the numbers of people that are actually in jail for drugs. There’s a lot of mythologies promoted by things like The New Jim Crow by Michelle Alexander, and others, which suggest that the majority of people in prison are there for nonviolent drug crimes. It’s not the case. It’s true that half the people in federal prisons are there for drugs, but federal prisons are just about 13 percent of total prisoners. Almost 90 percent of prisoners are in state prisons. And of those, only 14 percent are there on drug charges; over half are there for violence.

Did the drug war succeed or fail? Well, on the one hand, it has spectacularly failed on every level, because we have 100,000 people that died from drugs last year. That’s an increase from 17,000 in the year 2000. I mean, the numbers are mind-blowing. That’s three times more people dying of drugs than car accidents, five times more than from homicides. It’s the No. 1 cause of death right now for people between the ages of 18 and 45. These are terrible numbers.

Our thinking had traditionally been just: decriminalize drugs or prosecute people and lock them up. I think there is a third way, which is much more similar to the Dutch and Portuguese models. [In] the Dutch model, they are putting pressure on addicts to quit. At the same time, if you’re using heroin or cocaine in the privacy of your own home, and you’re not camping on the streets, they’re not going to go after you.

In terms of drug dealing, drug dealing continues in the Netherlands. I don’t think you could get rid of drug dealing or drug use without a severe curtailment of our civil liberties, which nobody, not even the most fascist in our society would support. But you can disallow open drug scenes. [With that focus] you get out of this black-and-white view that you’re going to somehow eradicate drugs from society.

I have arguments with my conservative friends who think that somehow we could do something to stop the flow of fentanyl and meth into the United States. We couldn’t stop the flow of cocaine and heroin, and those are plant-based substances. When you’re talking about synthetics like meth and fentanyl, which are made in labs in Mexico and then shipped across the border, I mean, forget about it. You can’t stop the flow of drugs, and you can’t stop drug dealing or drug use. The right place of intervention, then, is at the neighborhood level and at the level of the addict who is committing crimes.

I think you can make the case for cities prohibiting these open-air drug scenes on public property—on libertarian grounds, even. Where it gets dicey is with the issue of personal consumption or sales within the privacy of your own home or a private venue. And in Portugal, for the record, they will arrest you just for doing drugs, and bring you in front of a drug court, and then force you into rehab. Are you willing to draw a bright line there and focus on the open-air drug scenes and not going after casual drug users? 

I’m very comfortable with that. Being explicit about it and creating some societal consensus is an important step in solving this problem. I am very uncomfortable with the government getting involved in selling these drugs or selling them from pharmacies. I think it’s OK to decriminalize. Decriminalization is different than legalization. I think it should be hard to get those substances, not easy. Right now, $10 a day can get you your supply of fentanyl, about $10 a day for meth as well. I mean, that’s just basically free at that point, when it’s the cost of two Starbucks frappuccinos.

OK, but we’ve had this opioid crisis. And in areas where they crack down on pain pills, people turn to illicit street drugs and the overdoses go up. Isn’t there a case for just allowing the legal sale of all of it? We need to build up a safety net around it. We need to build appropriate treatment centers, put recovery up there as one of the top priorities, and learn to grapple with the reality of these drugs in a more sophisticated manner society-wide. 

I look to the Europeans because they’re ahead of us on this. They had open drug scenes in the late ’80s. They made the same mistake that we are making now. They changed their approach, they involved law enforcement in the early ’90s, and they fixed it. There are supervised drug use sites in the Netherlands. They get between 10 and 20 people per day. That’s a tiny number of people if you think about it.

There are some people that they do give heroin to in the Netherlands—less than 150. Those are people for whom methadone, which is the substitute for heroin, did not work. Suboxone or buprenorphine, which is somewhat superior to methadone, is widely available. I’m on board with the Dutch model. I’m fine if you need to allow some folks to use those harder drugs, but they do not sell heroin or fentanyl in coffee shops in the same way that they do marijuana.

By the way, marijuana smoking is not allowed in public outside of those coffee shops in the Netherlands. And in Portugal as well. They do arrest drug users who use in public. I interviewed the head of the Portuguese drug program, who said very clearly, “We do not normalize drug use.”

I do not think we should make it easy for people to get access to those hard drugs. I have even become somewhat more conservative on alcohol and marijuana. I used to roll my eyes at prohibitions on selling alcohol on Sundays or at the supermarket or past 10 p.m. [Now] I think those can actually lead people to change their behaviors in positive ways. I worry about the heavy promotion of marijuana.

But look, it’s hard. There’s a problem right now in California where we’ve taxed marijuana so much that there’s just a much more thriving black market for marijuana, because they can sell marijuana for so much cheaper. It’s a tough problem.

Your big-picture idea for fixing dysfunction on the streets is this agency that you call Cal Psych, which would override local mental health departments and funnel those with mental illnesses and drug addictions into a centralized system. And you’re a critic of what you call the results of the neoliberal model of contracting to nonprofits. 

But aren’t more localized public-private partnerships more accountable to communities? Why should anyone trust a system run by California’s state government, which oversaw the system of abusive insane asylums of the late 19th and mid-20th centuries? Why would I expect something run out of Sacramento to be cost-effective, humane, or accountable?

In the current system, you have a bunch of charities, churches, private health care providers, and rehab health care providers that are paid by taxpayers at the county level to provide care. Right now, they’re not accountable. They have been struggling for decades. They can’t coordinate even at the local level.

Part of the problem is the population itself. The addict population is highly transient. If it’s a criminal population, they’re often escaping local police jurisdictions that are after them. But if they’re mentally ill, there’s also a high level of transience. So it’s just a huge problem in that sense.

The other big problem is the cost. San Francisco and Los Angeles are attracting huge numbers of addicts from around the region, the state, and the country. There’s people on the streets from Cleveland and West Virginia.

San Francisco’s rich, but it can’t provide psychiatric and addiction care for every addict in America. You have a physical problem: We don’t have enough homeless shelters, psychiatric beds, residential care in San Francisco. And you never will. The city’s just too tiny for it.

In cheaper parts of the state, like the Central Valley, you can have rehab facilities that are on organic farms, with woodworking classes and programming classes to help people get their lives together. And if they’re in Fresno, it’s a lot cheaper than if they’re in San Francisco or Venice Beach or downtown L.A., even. It’s good to get people out of drug scenes. The most famous [example] is American soldiers in Vietnam who became addicted to heroin. They came back to the United States, and most of them were able to quit without any problem, because they weren’t around it all the time.

With Cal Psych, I’m arguing for a super-hierarchical, transparent agency that does contracts with these different providers, so there will still be a lot of private-sector providers. I don’t think you need to nationalize the entire sector. The Dutch, for example, do a big subcontract with the Salvation Army. It’s actually how it works in Massachusetts.

It would be a government agency with a CEO who reports directly to the governor, with regional managers who oversee case workers and contractors.

Look, there’s no perfect model. If this is up and running and has success for a few decades, by 2050 or 2060 or 2070 it may not be working anymore, and you may need to change those institutions. I think this is actually what the Founders meant when they said that you need a revolution every several decades. These institutions do get corrupt.

I know from reading your book that you don’t want to go back to the bad old days of insane asylums and mass incarceration. But the current trajectory in these cities is clearly not right either. What is the middle path? And how do you think that those of us who are legitimately concerned about issues like personal liberty and autonomy and not bringing in heavy-handed law enforcement who bother people for sitting on a park bench with their stuff can be part of a productive coalition to get America’s cities back on track for the 21st century?

We don’t want over-incarceration. That means that we need to rely more heavily on good policing, psychiatry, and probation. I would include, within psychiatry, rehab and addiction care. You also need some kind of case worker. You need empowered case workers—”assertive case management” is what it’s called—to bridge those things.

One of the big arguments for defunding the cops is that they shouldn’t be responding to mental health calls; we should have social workers do that. Actually, less than 10 percent of those mental health calls are safe enough for a social worker alone. A lot of those mental health calls are really scary and involve people engaged in violent activities. Really what you want is more soft cops and more hard social workers, and you want them working together. It sounds very kumbaya, but it’s not easy and it does take the police departments changing.

That’s why I think you need something like Cal Psych, because I think it has to be somewhat hierarchical in the same way that police departments are hierarchical, where there’s some mandate that you have to work with the social worker or you have to work with a cop in this particular way.

In terms of psychiatry, I’m with you. There have been some people that have called for the return to big asylums. The evidence, and basically what everybody says who has to live in one of those, is that residential care is much preferred to big, old asylums. You have to remember, then, that those residential care facilities are going to have to be in people’s communities, and there’s usually very strong NIMBY [“not in my backyard”] resistance. I think some of that is solved by being able to have those residential care facilities spread out more uniformly around the state, not all concentrated in downtown San Francisco. But I think that’s an important reform and probably does need a lot of federal help.

And then probation. We would rather not have the state doing drug tests or electronic monitoring, for example, but those are better approaches than prison. We have to get away from thinking of sentencing as a switch: You’re either incarcerated or you’re not; you either do your time or you’re free. There’s a lot of good middle ground in electronic monitoring, electronic ankle bracelets. The technology is very sophisticated at this point. We should be doing a lot more of that.

One of the things you hear a lot when you interview people is they’ll say, “I really hate my parole officer, they really bug me” or, “I hate my case worker, but I need them in order to stay sober and keep my life together.” I have three friends from high school who became homeless drug addicts. Two are dead; one is alive. He has told mutual friends of ours that he feels he needs to be on probation to be getting the constant care he needs.

It’s not the libertarian ideal, but it’s a lot better than chaos or mass incarceration.

This interview has been condensed and edited for style and clarity. The full video version can be viewed here.

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