To Truly Evaluate How a Government Policy Is Doing, Ask How Many People It’s Killing

California’s Failed Homeless Policies Have Led to a Dramatic Spike in Homeless Deaths.

By: Matt Mahan

Like much of what Sacramento does, pinning down precise metrics on how many homeless people die in California each year is difficult. But the most comprehensive study conducted in recent years shows that in 2021 nearly 5,000 homeless deaths were counted, with the authors themselves acknowledging this is almost certainly a dramatic undercount.

Critics of Sacramento’s homelessness policies rightly question how over $24 billion could be spent in the last five years with no measurable progress. Despite all these tens of billions of taxpayer dollars flowing to homeless programs, the number of homeless continues to rise and California is now home to nearly half of the nation’s unsheltered homeless population.

But perhaps the most important metric of any policy’s success or failure is its impact on mortality. And the status quo on homelessness policy in California is increasingly deadly.

Prior to the 2021 study showing 5,000 deaths in one year alone, the homeless mortality rate in California had been steadily rising, more than tripling between 2011 and 2020. Since the 2021 count, the mortality rate among California’s homeless population has continued to increase. With the increasing prevalence of deadly drugs and more unsheltered people than ever before, our homeless neighbors are dying in shocking numbers from overdose deaths and a broad range of preventable conditions, including freezing to death in winter, heat-related causes in summer, and infections and other preventable diseases year-round.

To put these deadly state policies into perspective, 58,000 Americans died during the entirety of the Vietnam War – a national tragedy that dominated the US political conversation. A review of that available data shows that a similar number of homeless Californians have died over the past ten years. Yet this deadly toll barely prompts a headline, much less the attention it deserves from Sacramento policymakers.

In fact, instead of taking a hard look at our state’s deadly homelessness policies, many politicians and media outlets keep defending these failures.

In San José we have been working to find better solutions – starting with taking a hard look at the state’s preferred homelessness policy, misleadingly called “Housing First.” This approach basically said that the only real solution to homelessness was to build expensive apartments for homeless individuals, units that now cost about $1 million per door to construct in places like San José. We challenged that thinking and we are now producing quick-build and modular units at about ten percent of the cost of a traditional “affordable” unit and in a fraction of the time.

As we started to bring these new units online, we’ve seen, however, that some homeless residents refuse the safe and decent shelter we are offering. So, in San José we have proposed using a brief and targeted interaction with the criminal justice system to compel unwell individuals into the treatment they need to change their behaviors, save their lives, and reduce impacts on the broader community. Under our proposal, a person who repeatedly refuses offers of shelter and other services, such as counseling, could be cited for trespassing and transported to a local recovery center with on-site care. Should this approach fail, our City Attorney would attempt to enroll the individual in our countywide behavioral health courts, such as Drug Court, where they can be ordered to seek treatment.

We are not trying to send people to jail. We are working to “sentence” people who repeatedly refuse shelter to treatment.

It is worth noting that the shelter we are offering is not a cot in a warehouse, but mostly individual units with private bathrooms. These units are nicer than the dorm rooms many of us have lived in and moved our children into when they went to college.

So why are some people refusing to move off the streets and into these safe, decent and clean shelter units? Our observation is that the population refusing shelter is overwhelmingly individuals who are suffering from drug or alcohol addictions, mental health conditions, and frequently both. A California Policy Lab study found that 78 percent of unsheltered homeless individuals in the US reported having a mental health condition and 75 percent had a substance abuse condition. Other studies have corroborated these findings, particularly when controlled for the unsheltered homeless population.

I have heard again and again from people in the recovery community the same story – how a brief interaction with the criminal justice system gave them the time and tools to get “clean” and likely saved their lives. We know that treatment works. The National Institute of Drug Abuse has published studies showing dramatic results for court-ordered recovery programs.

But our common-sense proposal to require people to come indoors, or get the help they need, has drawn furious opposition from some advocates and some self-styled “progressive” politicians.

But there is nothing at all compassionate about letting thousands die on our streets each year when targeted interventions could save so many lives. And it is the very opposite of “progress” to defend the deadly status quo when it comes to our state’s failed homelessness policies.

If you agree that treatment saves lives, please show your support for our Responsibility to Shelter proposal here.

Some Statistical Notes:

The 5,000 estimate of homeless deaths is statistically rigorous, but a spot check of those numbers finds similar and, in some cases, higher results when looking over a ten-year period. For example, in Los Angeles County alone in the past ten years there were approximately 15,037 homeless deaths (with a conservative estimate for 2024, which has not yet been reported). Los Angeles is roughly 25 percent of the state, which extrapolates to over 60,000 statewide deaths over the past ten years. In Sacramento County, which like Los Angeles County is doing a better job of tracking homeless deaths than most counties, there were approximately 1,662 deaths over ten years using a conservative estimate for 2024. Sacramento is roughly 4 percent of the overall state population. That would extrapolate to 41,550 total deaths. In Orange County there were approximately 3,180 deaths in the past decade, which scales to 40,151. The average then is nearly 47,000 for the ten-year period, again with almost all experts agreeing these numbers are undercounted. A comprehensive national study, based on extrapolated data from just 68 counties surveyed (2 percent of counties) estimated the range of homeless deaths in America from a low of 17,000 to a high of 46,500. If you take the midpoint of this wide range, which is 31,750, and multiply by 28% (the percentage of all homeless Americans who live in California) that would translate to 8,890 homeless deaths in California in one year alone. Yet another national study, while it did not estimate the overall number of deaths, did find conclusively that homeless Americans are 3.5 times more likely to die than housed Americans.