Cathy Reisenwitz is a San Francisco-based writer, the Head of Content at a tech startup, and a prominent voice in the city’s YIMBY movement.
Cathy’s work on issues like drug decriminalization and land use has appeared in The Week, Talking Points Memo, Forbes, The Daily Beast, VICE, and Reason magazine, among many other publications. She's also VP of Comms for the San Francisco Sex-Positive Democratic Club and is an outspoken advocate for sex workers.
Jordan McGillis: Cathy, first, thanks for lending your time to this conversation.
I want to begin with the national perception of SF and try to differentiate myth from reality. Having grown up in Indiana, I can attest that just saying the words “San Francisco” to many Middle Americans prompts a mix of derision and moral panic. Within the community in which I grew up that reaction was mostly tied to sexual ethics. Nowadays, you get a similar reaction, but it’s tied to filthy streets, open-air drug use, and, broadly speaking, homelessness.
What are your observations on this issue living in SF and does it qualify as what you’d consider a genuine crisis?
Thanks for having me!
I think many in so-called Middle America have a worldview that's heavily informed by a kind of Evangelical/Puritanical view of virtue and vice. Many consciously and unconsciously believe sexual "promiscuity," filthy streets, open-air drug abuse, and homelessness are inextricably linked. The fact that many less-dense communities in the US are able to mostly cordon off drug abusers, sex workers, and the homeless to certain parts of town doesn't help the perception problem. San Francisco does something similar, pushing people on the fringes toward SoMa and the Tenderloin, where I live. But in SF the problems of untreated drug abuse, mental illness, and homelessness are so acute, and voters' appetite for violent suppression is so small (relative to other places), that they can't be easily contained to those neighborhoods.
I believe the filthy streets and open-air drug use are unpleasant, obviously. But the real problems are actually far worse. Untreated drug abuse, rising overdose deaths, rising rates of severe, untreated mental illness, and homelessness are indeed at "crisis" levels according to at least one international organization.
From my very personal experience, even after living in DC for five years, I was shocked when I got to SF in February 2017. I remember walking to a meeting and coming across a man laid out on the sidewalk, apparently unconscious and bleeding from the head. Not knowing what else to do, I called the police. I didn't wait for them to show up, but I quickly learned that if I called the police every time I encountered someone obviously in desperate need of immediate assistance I would never get anywhere in San Francisco. It's incredibly dehumanizing to constantly walk past other humans in acute distress and feel powerless to intervene. It's also disturbing to realize that if I ever found myself in need of assistance I couldn't count on my neighbors to help either. And how could I blame them?
A few things are going on here that I think many people conflate. First, there's a massive homeless population, somewhere between 8-10k people in a city of 800,000. This is due almost entirely to out-of-control rents, which are due entirely to SF's refusal to build enough housing. But within that population there is a smaller subset, about 30% from what I've read, who are suffering from extreme mental illness and/or drug problems. There's a myth that because SF is less punitive than most cities, and because some of our homeless population does receive pretty generous assistance, that people come to SF to be homeless because it's easy here. That's simply untrue. Most estimates put the majority of SF's homeless as either native to SF or people who used to hold jobs and have homes but lost them due to job loss, divorce, death in the family, etc. There's also a 1000-person long waiting list for a shelter bed. In addition, SF has a policy of street sweeping. While cops are legally required to give notice and hold the homeless people's possessions, in reality cops arrive without notice and trash people's belongings, including their birth certificates, medications, and mobility assistance devices. It's also nearly impossible for most homeless people to access treatment for mental illness or drug addiction. Even people with homes can't access humane mental illness treatment. I've had friends who suffered episodes of acute mental illness strapped to beds and left in the hallway of SF General for hours waiting for treatment.
So the idea that SF's problems stem from our policies being "too permissive" or our benefits being too generous is completely out of alignment with reality. "Cracking down" on homelessness or drug dealing by passing tougher laws or enacting tougher enforcement has never worked to make the streets cleaner or safer in the US. We know from Portugal and Uruguay that decrim and treatment are far more humane and effective when it comes to preventing overdoses and crimes associated with drug abuse. Not only that, but "tough on crime" policies also exacerbate over-incarceration, create tension between police and communities, turn impoverished areas into cash cows for police departments and cities (like in Ferguson), exacerbate existing racial and economic inequalities, and have other negative impacts.
So, first things first, we need to build more housing. Most homeless people just need an affordable place to live. As it turns out, being homeless exacerbates mental illness and drug abuse. But that still leaves a portion of the population who need more than a home. We need to expand services to help those people. More shelter beds. More addiction treatment slots. And more help for people struggling with mental illness. For the tiny percentage of the population who need help with mental illness and/or drug abuse and won't take it when offered, I think we need to expand conservatorship. Conservatorship is when a municipality deems someone incapable of managing their own affairs and hands them over to a "conservator" to take over. This could be a family member, social worker, or bureaucrat. The point is that it's not humane to allow people to deteriorate on the streets without help. Conservatorships should be re-evaluated at least yearly and should last only as long as medically necessary. There's always a tension between civil liberties and care. But in my opinion SF has swung too far in the former direction at the expense of the people who are in clear need of help.
JM: No objections on the housing argument. That's of the utmost importance in this and the wider urbanism discussion. I want to double click, though, on your expanded conservatorship suggestion. In the way you describe it, expanding conservatorship does sound as if it can benefit both the conservatee and the community at large, but it definitely clashes with my libertarian intuitions.
Can you explain the nuts-and-bolts of when and how a person would be taken into custody a bit more?
The basic gist of it is that at the same time severe mental illness and drug abuse skyrocketed in SF we placed fewer people into conservatorship, leading to a large number of needless deaths, hospitalizations, and general suffering.
ER visits due to meth use increased 600 percent and hospital admissions 400 percent in SF between 2011 and 2019. And in the 2020 pandemic overdoses of all kinds further skyrocketed. In 2019, ER visits due to meth use comprised 47 percent of the Psychiatric Emergency Services unit’s visits at SF General. Between 2016 and 2017, more than half of unhoused patients at San Francisco General Hospital’s Psychiatric Emergency Services suffered from a substance abuse disorder, according to an op-ed by Supervisor Rafael Mandelman.
And yet between 2012-13 and 2018-19 San Francisco referred 50% fewer people for conservatorship. Right now in SF it’s very hard to get people with severe mental illnesses into a conservatorship where someone can ensure the conservatee has adequate housing, nutrition, and medical care. “It’s completely inhumane,” Mandelman said. “If you have known a friend or a loved one and seen that person in psychosis and seen how far that psychotic individual is from their true self, you cannot believe keeping that person in that state is somehow honoring their autonomy.”
In 2019 the SF Board of Supervisors implemented Senate Bill 1045, which allows cities to consider conservatorship in extremely limited circumstances, but which at least nominally expanded who is eligible for conservatorship. To qualify, the person must have a professional diagnosis of both a serious mental illness and a substance use disorder, have been subject to an involuntary psychiatric hold at least eight times in the prior year, and have received less restrictive care alternatives from the county. After all that, a judge must decide that conservatorship offers the “least restrictive” and “most clinically appropriate” care.
As written, experts predicted the change should only impact between 10 and 50 people. While around 200 SF residents are what EMTs call “frequent fliers,” only about 50 average eight 5150s per year. Under SB 1045 all conservatorships are set to last one year by default. At any point a conservatee can petition the court to end the conservatorship early. Under this legislation, every person who is referred to court is appointed a public defender and has the right to a court or jury trial.
“I do not agree with Senator Wiener about everything,” Mandelman said at a hearing for the proposal, referring to his frequent sparring partner and SB 1045 Sponsor. “But he is fearless and relentless and I am grateful for his fearlessness and relentlessness on this issue.”
The Dept of Public Health works with the Office of Public Conservator, which operates within the Dept of Aging and Adult Services. The largest non-family conservator is the Public Guardian, an agency of the City and County of San Francisco. Certain non-profit agencies can also be appointed to serve as conservators.
As I understand it, the law as currently implemented has impacted fewer than 10 individuals. I pass by more than 10 people screaming at no one -- in clear need of if not conservatorship, at least access to mental illness and/or drug treatment -- every time I walk through the Tenderloin.
As a civil libertarian, I’m obviously not a huge fan of conservatorship. But as a resident of SF, I have come to believe that in many instances the alternative is worse. People in extreme mental distress, still wearing their hospital gowns and bracelets, wander around the Mission with nowhere to go. I explored the tension between autonomy and care in 2015. Far fewer people would need conservatorship if we had affordable housing and a functional safety net, including access to affordable drug treatment and mental healthcare. “The current system is disconnected, it’s disjointed and there isn’t a treatment plan that follows someone through the system,” Supervisor Haney recently said. “The result is that people enter the system in some way ... and then fall through the cracks.”
But in the meantime, I just don’t think letting people loudly and violently self-destruct on the streets should be an acceptable option.
JM: You mentioned above that the city funnels people on the fringes to SoMa and the Tenderloin. Can you explain that dynamic?
Relatedly, for people who live in the more up-scale areas of town like Pac Heights and Cow Hollow, there's a sense of relief that the problem is somewhat confined, even if they're loath to admit it. Any comments on that element?
Randy Shaw runs the TL Housing Clinic and he's way more knowledgeable than me about all things low-income TL. The Tenderloin Housing Clinic manages 22 properties throughout San Francisco in the Tenderloin, SOMA, Mission, and Union Square neighborhoods.
But I remember reading in the Tenderloin Museum about how successful the TL residents have been in fighting gentrification. One aspect of that I think is really interesting is the fight over SROs. According to the Central City S.R.O. Collaborative, 30,000 tenants or approximately 5% of the city, live in SROs. These are concentrated in the TL, SoMa, and the Mission. More than 60 percent of the people in supportive housing live in SROs. 95 percent of SRO residents stay for more than a year.
Here's a short history of SROs in SF.
I don't know how much you want to know, but here are some things I've learned about the TL and low-income residents. San Francisco likes to forcefully co-opt rental property owners into helping solve the affordable housing shortage through things like the hotel conversion ordinance and master-leasing program. Under the master leasing program, hotel owners agree to spend hundreds of thousands of dollars upgrading their properties and continuing to make repairs. In return, the city guarantees them years of full tenancy and reliable rent. The city leases the hotels from private owners and pays nonprofit groups to operate them.
I don't think you can understand SF or the TL without understanding the history of redevelopment. I'm not sure how much you know about redevelopment. But here's a short history.
The 1940s brought an influx of unmarried men into SF to work. Many of them lived in SROs, which stands for "single room occupancy." Also, in 1940, San Francisco had around 4,800 black residents.
Basically, it's a hotel room meant for multi-month stays. Sometimes it will have its own bathroom and mini-kitchen, but usually the bathroom and kitchen are shared with other rooms.
In the 1950s, San Francisco mayor George Christopher hired M. Justin Herman to head the San Francisco Redevelopment Agency. Over his decade-plus tenure Herman grew the org from about 60 employees to 462.
Soon after starting, Herman began an aggressive campaign to tear down buildings and displace residents of the city’s working class, non-white neighborhoods. Herman’s “redevelopment” displaced more than 10,000 people and cleared more than 60 city blocks. “Negroes and other victims of a low income generally regard [Herman] as the arch-villain in the black depopulation of the city,” according to the Sun-Reporter. "We didn't know who the devil was,” Hannibal Williams of the Western Addition Community Association said. “But we knew who Justin Herman was and that was the devil for us.”
Herman took people’s homes without just compensation, using “blight removal” and “slum clearance” as justification under a government takings called “eminent domain.” This is the same mechanism Donald Trump used to take the homes of low-income people of color against their will and pay them less than market value. It remains a cost-effective way for white developers to forcefully separate low-income people of color from their property.
The 1960s saw growing demand for tourism and “conventioneering” in San Francisco, which Chester Hartman calls “a principal driving force behind the transformation of the city.”
By the late 1970s San Francisco’s residential hotels began converting into tourist hotels to meet demand.
In the late 1970s the SF Board of Supervisors of the city and county of San Francisco—led by Dianne Feinstein— and the San Francisco Planning and Urban Research Association began its own redevelopment project, with the aim of pushing long-term residents out of SoMa to make room for business conventions and tourists.
“The city was transforming itself and money was the engine,” Delaney told WIRED. To attract more conventions, the city planned a "world-class" convention center to anchor the SoMa project. “I was rabidly opposed to the full-fledged development that was pushing people out of the city.”
The SF Board of Supervisors of the city and county of San Francisco destroyed miles of affordable housing to make room for hotels, restaurants, and convention centers, displacing tens of thousands of low-income families. Most left the city, but many residents had nowhere to go.
The Tenderloin was mostly spared.
But the affordable housing razed by the City of San Francisco was never replaced. And SF's Black population never recovered. Today 6% of SF is Black.
Instead, San Francisco’s landed gentry revolted against skyscrapers built to accommodate the city’s housing needs. Simultaneously, California closed state institutions for the mentally ill and the Reagan administration gutted funding for Section 8 housing. With demand growing and supply shrinking, homelessness spiked.
“There is a severe shortage of decent, safe, sanitary and affordable rental housing in the City and County of San Francisco,” the SF BOS wrote in the 1980 Residential Hotel Unit Conversion and Demolition Ordinance (Hotel Conversion Ordinance). Their fix to the problem established a moratorium on the conversion of residential units to tourist and transient use.
It is the purpose of this ordinance to benefit the general public by minimizing adverse impacts on the housing supply and on persons and households of all income levels resulting from the loss of residential units through their conversion to tourist and transient use. This is to be accomplished by regulating the conversion of residential units to tourist and transient use, and through appropriate administrative and judicial remedies.
The SF BOS used the planning code to legally limit the height of new buildings, exacerbating housing scarcity by fiat in the middle of what they themselves described as “a housing emergency.”
To preserve SROs, SF called hotel owners and asked them how many of their rooms were rented out to residents and how many to tourists.
The ordinance mandated that San Francisco hotels with long-term residents can only discontinue long-term rentals and convert to "tourist hotels" after:
1. providing relocation assistance to residents
2. replacing the residential hotel units being converted
Hotel owners can replace the residential hotel units being converted in one of four ways:
1. Construct replacement units
2. Rehabilitate other residential hotel units
3. Construct or rehabilitate transitional emergency housing
4. Contribute an "in lieu" fee to the City's preservation fund or a nonprofit housing group in the amount of 80 percent of the construction cost of the number of units converted, plus site acquisition costs
San Francisco hotels with long-term residents were then banned from renting their SRO rooms to tourists.
Since the Ordinance was first enacted in 1979, local residential hotel owners have raised at least two Fifth Amendment challenges in California state courts. In both instances, the California Court of Appeal held that the Ordinance did not effect a taking of property without just compensation in violation of the Fifth Amendment. [See Terminal Plaza Corp. v. City & County of San Francisco, 177 Cal.App.3d 892, 223 Cal. Rptr. 379 (1986); Bullock v. City & County of San Francisco, 221 Cal.App.3d 1072, 271 Cal.Rptr. 44 (1990).]
This is obviously a terrible deal for hotel owners, many of whom can't sell because the ordinance makes their properties unprofitable. Renting to residents is a terrible deal for them.
Residents pay less than tourists
Residents lock in rent-controlled rates
Residents have residency rights and can take months to evict after they stop paying
Residents tend to exhibit problematic behaviors
Residents call building inspectors and their district supervisor to complain about maintenance issues
It's such a bad deal that many hotels are renting to tourists or keeping rooms empty rather than renting to residents. Out of every 7 rooms not rented out through the master-leasing program, one has been vacant, according to the most recent data available from the city Department of Building Inspection. More than 2,000 SRO residential rooms are vacant at any one time according to Joe Eskenazi writing for the SF Public Press.
“Many owners are not interested in block leasing due to liability,” said Sam Dodge, the Department of Homelessness and Supportive Housing’s deputy director. And San Francisco’s SRO owners point out that costs of modernizing and maintaining buildings are soaring while rent-control means income is stagnant.
Another unintended consequence of the conversion ordinance plus rent control is that many SROs are in terrible shape. Costs for many nonprofit operators have been going up more than 5 percent each year, budgets funded through a variety of local, state, local and federal programs have grown by only 2 percent annually.
Mission Local reported three separate incidents in 2017 where SRO rooms caught on fire and displaced more than 50 people.
Between early 2015 and August 2016 the 124-unit Crosby Hotel in the Tenderloin neighborhood was worst for building code violations, abatement orders from city agencies to fix serious problems, and residents’ ratings for maintenance and repairs.
The Chronicle found:
Weeks-long vermin infestations
Regular power outages
Unreliable elevators that stranded elderly or disabled tenants
Today, SF spends $241 million per year on homelessness. This money is spread across 400 contracts with 76 private organizations.
SF spends $27.2 million of that $241 on eviction prevention. This is important, as most of SF’s homeless used to be housed in San Francisco.
It costs San Francisco $17,353 per year to keep the average person in supportive housing.
Most “supportive housing” complexes were created in 2004, when then-Mayor Gavin Newsom launched a 10-year plan to end chronic homelessness.
But as much as the concentration of poverty in SF results from low-income, majority non-white neighborhoods fighting gentrification, it results far more from high-income white and Asian communities fighting affordable housing and shelters.
I'm not sure if that's what you were looking for, but I'm glad to get it off my chest, haha.