A Debilitating Dilemma: Examining the Intersection of Homelessness and Disability in Los Angeles

I. Introduction: The Public Perception of Homeless Individuals

“Guess what, you wake up with MS and the next thing you know you’re living homeless,” Todd solemnly expressed while acknowledging the fact that people live in fear of homeless individuals. For the last six years, Todd has been living homeless on the streets of Los Angeles (Invisible People, 2019). Living homeless has not only been a difficult experience for Todd, but it has been an even greater struggle due to his diagnosis of multiple sclerosis (MS).  MS has played a significant role in shaping the struggles that he faces and highlights the ways in which disabled individuals are particularly affected by homelessness. After his diagnosis and discovering problems with his social security benefits, Todd suddenly found himself unexpectedly homeless. Living homeless in Los Angeles has exposed Todd to the city’s million-dollar spending on conducting around 40 city-wide sweeps a day (Invisible People, 2019).  During these sweeps, Todd’s belongings are confiscated and thrown away. For the rest of the city, the limited realization that such events are taking place is discreetly contributing to the criminalization of these individuals within the city. This criminalization is inevitably seeping into the fabric of our society and is destroying the humanity of our nation’s most vulnerable populations.

Todd’s story is just one in the backdrop of the reality of being disabled and homeless. Homelessness in the United States can be traced all the way back to the colonial era when urban cities such as Philadelphia and Baltimore found themselves dealing with more significant numbers of homeless individuals than any other city in the country (National Academies of Sciences, Engineering, and Medicine, 2018). From generation to generation, homelessness has evolved as a result of many different conflicts, wars, economic instabilities, and other factors. Nonetheless, the relationship between those with disabilities and those who face chronic homelessness has become much more prominent within the last several decades. According to the federal government’s definition, chronic homelessness is defined as “an individual with a disability who has been continuously homeless for one year or more or has experienced at least four episodes of homelessness in the last three years where the combined length of time homeless in those occasions is at least 12 months” (HUD, 2018, p. 2). As of 2017, an estimated 86,962 of 369,081 individuals are people with disabilities who are experiencing chronic homelessness (USICH, 2018). This number only continues to increase, with research demonstrating a 12% jump in chronic homelessness between 2016 and 2017. In addition to this, more than two-thirds of individuals with disabilities who experience chronic homelessness find themselves without access to sheltered locations. This is especially prevalent in crowded cities such as San Francisco and Los Angeles where the lack of resources has contributed to deteriorating conditions. Nevertheless, I will examine the relationship between sheltered and unsheltered individuals and apply these findings to understanding chronic homelessness on a national level.

For many historians and policymakers, the increasing rate of homelessness remains a mystery. Conversations regarding the homeless disabled community often do not take place, particularly within legislative bodies today. Meanwhile, cities like Los Angeles continue to witness the deterioration of living standards along with the erosion of its urban centers. California, itself, accounts for 42% of all individuals that are categorized with chronic homelessness in the country. Moreover, California comprises nearly 53% of the nation’s unsheltered individuals that are categorized with chronic homelessness as of January 2017 (USICH, 2018). While the ever-increasing numbers of the homeless population within Los Angeles have become a greater public concern, policy failures within the state have inhibited the potential execution of any real change. For this reason, I will emphasize the necessity for Los Angeles leadership to adopt new policies in order to strive towards ending chronic homelessness for disabled individuals.

In this paper, I argue that new housing initiatives and policies are essential for resolving the national homelessness crisis. Through this argument, I will examine the intersectionality of disability and homelessness within the United States from both a historical and policy lens. The current structural policies in place for disabled homeless individuals not only have a history of failure, but they are also conducive towards establishing a stigma that criminalizes these people by both the public and law enforcement. I will discuss the stigma that current policies have projected onto homeless individuals and the criminalization that has resulted from the government’s actions on a national scope. Thus, I will use the case study of Los Angeles to examine how the homeless crisis particularly affects disabled individuals and how the city’s government has failed to accurately understand the severity of the crisis. Finally, I will follow this analysis with recommendations to implement new policies that will attempt to eliminate the poor living conditions and unfair treatment that homeless disabled individuals are subjected to on a daily basis. I contend that implementing the Housing First Model provides a strong foundation to ensuring that effective permanent housing is established in order to help put an end to homelessness. In addition to this, I maintain that helping disabled homeless individuals connect to their greater communities while providing job, treatment, and medical support will take great steps towards eradicating chronic homelessness amongst the disabled community. Putting forth clear policy objectives with the correct understanding of how dire the homelessness crisis is will ultimately ensure that individuals such as Todd have the ability to live with dignity and opportunity going into the future.

II. Historical Considerations

         In order to examine the implications of the homeless national crisis, we must understand its historicity and apply its evolution to the modern-day climate. The term “homeless” derives from its first use in the 1870s as a word referring to those traveling throughout the country in search of work (National Academies of Sciences, Engineering, and Medicine, 2018). At the time, homelessness was characterized as “a crisis of men let loose from all the habits of domestic life, wandering without aim or home” (DePastino 2003, 25). This crisis resulted from the impact of the Civil War, where homelessness was first perceived as a national issue in the eyes of the American people. Industrialization, urbanization, and the emergence of the national railroad further prompted the image of “overwhelmingly young, able-bodied, white men” to ride across the country in search of jobs (National Academies of Sciences, Engineering, and Medicine, 2018).  However, in the wake of the booming economy instigated by World War II, the demographics of homelessness was in the midst of significant change. Homeless populations gradually evolved to encompass older, white, and disabled males who were excluded from gainful employment (National Academies of Sciences, Engineering, and Medicine, 2018). While the war’s economic impact on older, white, and disabled males would continue for several decades, other facts such as race and disability altered the demographic of previous homeless populations and led to what historians consider the early 1980s to constitute “the modern era of homeless” (National Academies of Sciences, Engineering, and Medicine, 2018).

         During “the modern era of homelessness”, Americans witnessed a large increase in homeless populations across the country, specifically in urban areas. One of the factors that can be attributed to this cause was the process of deinstitutionalization. Beginning around the 1950s, deinstitutionalization refers to “the policy of moving severely mentally ill people out of large state institutions and then closing part or all of those institutions” (National Academies of Sciences, Engineering, and Medicine, 2018). Through President Jimmy Carter’s Commission on Mental Health, this initiative was spurred in the 1970s by the proposition that mental health should be treated in the least restrictive way possible (HUD, 2007). While the objective behind this policy was to promote the “greatest degree of freedom” for those participating in treatment services, the decision has ultimately been credited as a structural failure for mental health policy (HUD, 2007). Today, deinstitutionalization has been identified as a root cause for the growing numbers of homelessness amongst the mentally ill and disabled population within the United States. According to current statistics, this process resulted in approximately 2.2 million severely mentally ill people left without treatment and thus without homes (HUD, 2007).

         Historians today find that homelessness stems from two causes: structural homelessness and individual homelessness (Journal of Social Distress and the Homeless, 2019). Structural homelessness encompasses economic trends such as unemployment, poverty, the economy, and the housing market. Thus, the causes and effects usually revolve around large scale social and economic policies that disparately impact populations. Individual homelessness, on the other hand, usually points to disabilities such as mental illness, substance abuse, alcoholism, etc. Historians believe that both structural and individual factors exacerbate the plight of homeless individuals (Journal of Social Distress and the Homeless, 2019).

         Policy responses exacerbate homelessness when they solely target individual homelessness and not the structural issues that make homelessness endemic. An example of this is the Homeless Persons Survival Act of 1986. Introduced as an adjustment to the Social Security Act in order to make “emergency assistance mandatory for needy families with children and for homeless persons” this act succeeded in establishing a transitional housing demonstration program (HUD, 2007). This system of services for homeless individuals, also known as a “system of care”, emphasized a “coordinated network of community-based services organized to meet the challenges of children and youth with serious mental health needs and their families” (HUD, 2007). Regardless of the act’s objective, these services failed to halt the growing number of homeless individuals.

III. A National Reality

            Understanding the history behind homelessness and disability in the United States allows us to apply this context to the current crisis that we are facing on a national level. As of January 2019, an estimated 553,000 individuals are currently experiencing homelessness in the United States (Roundtree, 2019, p. 2). Of this number, over 200,000 individuals are considered unsheltered. Unsheltered homelessness is defined as “sleeping on sidewalks, in parks, in cars, or in other outdoor locations”. Sheltered homelessness, on the other hand, is known as “people who are staying in emergency shelters, transitional housing programs, or safe havens” (HUD, 2018). The distinction between sheltered and unsheltered homelessness is significant given that those who are unsheltered are more likely to experience physical health issues by 35%, mental health problems by 33%, and substance abuse by 45% (Roundtree, 2019). Altogether, these issues perpetuate the cycle of chronic homelessness for unsheltered individuals.

Various factors come into play when examining the leading causes of homelessness for both disabled and non-disabled individuals. According to the U.S. Conference of Mayors, an annual survey revealed that the top causes of homelessness for unaccompanied individuals in major cities are the lack of affordable housing, unemployment, poverty, mental illness, and substance abuse. For a disabled individual, these issues create a much larger negative impact that make it incredibly difficult to remove oneself from the perpetuated cycle of poor living conditions. In context, the average person with a disability makes an income of $750 per month due to their Supplemental Security Income from the federal government (NAMI, 2015). This income is comparable to the average monthly rent for a one-bedroom apartment, which is $780 (NAMI, 2015). According to this connection, a disabled individual would be required to spend 104% of their monthly income in order to pay for lodging. This calculation does not take into account the money that is necessary to purchase food, clothing, transportation, or other necessities. Appallingly, there are nearly 5 million Americans who find themselves in this dire situation. Of these 5 million, only around 362,163 individuals are accommodated in shelters while others are stuck in institutions with a whopping $243-$643 cost per day or are left homeless (NAMI, 2015). Nonetheless, these circumstances compounded with failed policy initiatives exacerbate the homelessness crisis for disabled individuals. Not only are these circumstances responsible for the perpetuation of a debilitating stigma, but they are a perception that has undermined these individuals more than their disability and homelessness combined. 

IV. The Perception of Stigmas Toward Homeless Individuals

Research demonstrates that while Americans are generally compassionate about homelessness, strong stigmas exist toward homeless people today. Political scientists must ask: what causes this compassion paradox? One study from the Washington Post supports the social model and demonstrates how public perceptions of homeless people influence homeless policy. Since homeless individuals tend to lack access to healthcare and sanitation, the public often views them with disgust (Clifford and Piston, 2017). The public’s disgust toward homeless people stems from overly sensitive psychological mechanisms to keep social “pathogens” away (Clifford and Piston, 2017). Thus, government policies reflect the contrast between the public’s desire to help vulnerable communities and the public’s disgust toward homeless individuals. For example, Americans tend to support increases in government aid for homeless people but also support the criminalization of homelessness (Clifford and Piston, 2017). The government must consider such inconsistencies when designing policies to combat homelessness.

Disability and mental health are two very stigmatized concepts that already face a particular public perception without being connected to homelessness. As disability scholar Mike Oliver states in his defense of the social model, “it was not impairment that was the main cause of the social exclusion of disabled people but the way society responded to people with impairments” (Oliver, 2004, p. 2). For disabled individuals who are homeless, oftentimes the way both the government and public treat them is more harmful than the actual barriers they face. This stems from the fact that these stigmas have the potential to criminalize particular individuals by targeting them under by flawed policies. An example of this is race in the context of disabled, homeless individuals. Eric Tars, a senior attorney at The National Law Center on Homelessness and Poverty, contends that the “criminalization of homelessness has a disparate impact on communities of color, but especially on the African-American community” (Jensen, 2016). Although African Americans represent 12.5% of the United States population, they account for over 40% of homeless individuals (HUD, 2018). This is a considerable overrepresentation that puts the relationship between race and homelessness into question. While many different factors can correlate to the criminalization against homeless African American individuals, poverty is often attributed to the “widening gap between affordable housing supply and demand” in addition to the “housing discrimination and racial residential segregation” that helps to create such disproportionate numbers (Carter, 2011). 

         While disability and homeless activists fight to abolish these stigmas, the public continues to criminalize these vulnerable individuals. According to HUD, “homeless people have been the target of a remarkable number of contemporary laws and ordinances that criminalize many aspects of their daily existence” (HUD, 2007). For example, city architects and developers are promoting “hostile architecture” when designing public spaces or seating in urban areas (Paulas, 2019). Hostile architecture can take many forms ranging from spiked chunks of sidewalk to bars constructed in the middle of public benches. While the design is minimalist and often an eye-sore for city-goers, its intention remains clear: homeless individuals are not welcome to sleep here (Paulas, 2019).  In addition to this, unsheltered people with disabilities experience ten times as many police contacts than the typical American citizen (Rountree, 2019). For those with the longest cases of homelessness, the lack of access to emergency shelters and health services places these individuals in an even more precarious situation with local law enforcement. In order to combat this stigma, the government has been hesitant about fully recognizing the extent of homeless individuals that have disabilities. This hesitation has led to cities such as Los Angeles aggravating the current crisis through their policy failures and misunderstanding of how dire the homeless situation realistically is for disabled individuals. 

V. A Case Study on Los Angeles

Since 2013, the City of Los Angeles had 22,993 homeless individuals within its city boundaries. Similarly, Los Angeles Country had 39,463 homeless individuals. Subsequently, the homeless population has increased to 36,600 and 58,936 people, respectively (USICH, 2018). Through research reports by the Los Angeles Time and the California Policy Lab, media has revealed that government studies have downplayed the impact that disability has on homeless individuals. The Los Angeles Homeless Services Authority originally calculated that 29% of individuals living on the streets of Los Angeles were reported to have a mental illness. When the Los Angeles Times conducted their study, they found the number to lie around 67%. What is even more astounding is the fact that in 2019, the California Policy Lab operated by the University of California Los Angeles reported that this number lies closer to 78% (Smith 2019 & Rountree 2019). While the large disparity in statistics is problematic, the greater concern lies with the government’s inability to implement successful policies considering that they don’t have a realistic understanding of how many homeless individuals live with disabilities. 

While nearly half of the country’s homeless population struggles with either a mental or physical disability,  “they don’t necessarily qualify for federal disability payments, which in any case are too low – about $800 a month – to cover rent, utilities, and other needs, even with food stamps tacked on” (Holland, 2017). This dilemma is largely due to 1996 welfare reform failures that have limited those with substance abuse disorders from receiving federal disability aid (Holland, 2017). Considering that homeless individuals with substance abuse disorders represent 75% of Los Angeles’s homeless population, these policy barriers place a significant burden on this vulnerable population (Rountree, 2019). In addition to these struggles, the development of Skid Row in downtown Los Angeles has also been a result from structural policy failures that have perpetuated poor standards of living amongst the disabled homeless population. Skid Row, a half-mile land stretch encompassing 10,000 homeless individuals as of 2015, can be traced back to the 19th century (Casey, 2017). Since its founding, Skid Row’s population has increased parallel to the growth of the area’s deteriorating conditions. In 2006, Los Angeles Mayor Antonio Villaraigosa attempted to curb this population growth through the Safer Cities Initiative (Casey, 2017). Intended to cultivate a safer environment on the streets of Skid Row, this initiative resulted in a complete police occupation of the area (Casey, 2017). As a result, more disabled, homeless individuals found themselves in skirmishes with local law enforcement on a daily basis (Casey, 2017). 

In understanding the homelessness crisis within Los Angeles, one must understand the bureaucratic structures at play as well as the specific policy measures that have failed to produce effective solutions. In 2015, Los Angeles city leaders announced their decision to declare a state of emergency regarding the homelessness crisis that was spreading throughout the city (Jamison, Zahniser, Hamilton, 2015). This declaration never took place. In 2017, Los Angeles residents overwhelmingly voted in favor of the quarter-cent sales tax, also known as Measure H. The measure was intended to allocate over $1.2 billion of the city’s tax dollars towards alleviating homelessness by providing more housing for those on the street (Jamison, Zahniser, Hamilton, 2015). Today, we see the city’s homeless numbers continue to rise with a greater shortage of accessible shelters. However, it is important to note that Los Angeles’ unique governmental structure between its city and county adds a level of complexity to decision-making. Unlike cities like San Francisco or New York, Los Angeles does not have a combined single government composed of both city and county legislation (The Times Editorial Board, 2018). Thus, disputes between the mayor and City Council over whether to pass or veto housing propositions either leave the issue in gridlock or completely derail the progress of certain initiatives. This problematic situation is exacerbated by the fact that the Los Angeles Homeless Services Authority (LAHSA) has established a single point of contact through the current executive director, Peter Lynn (The Times Editorial Board, 2018). Although Lynn’s organization is responsible for collecting and distributing money for homeless operations in addition to performing an annual homeless count for the U.S. Department of Housing and Urban Development, LAHSA does not have the authority to direct homeless operations (The Times Editorial Board, 2018). Thus, important decisions regarding necessary policy actions are left to squabbling politicians who are far removed from the reality of how dire the situation is for those who are homeless and disabled. 

VI. Policy Recommendations

        Within the national and local conversation to resolve homelessness, two main model approaches have been implemented in the United States and Canada: The Treatment First Model and the Housing First Model (Nishio, 2017). While both models suggest different solutions for resolving homelessness, the Treatment First Model “addresses mental health issues by using homeless shelters before being able to access independent housing” (Nishio, 2017). This model is what has been traditionally used by many government entities that have attempted to combat homelessness, specifically because of its lower cost. The other approach, which has proven more effective, is the Housing First Model. The Housing First Model focuses on providing “housing assistance that is offered without preconditions (such as sobriety or a minimum income threshold) or service participant requirements… with rapid placement into permanent housing” (Nishio, 2017). Studies such as the McKinney Homeless Research Demonstration Project have demonstrated that providing permanent, independent housing offers a much more effective solution, particularly because it provides disabled, homeless individuals with a sense of security and an ability to direct their funds elsewhere (Hurlburt, 1996). In cities that have abnormally high property values, such as Los Angeles, this solution lifts a burden from the shoulders of such individuals. In addition to establishing a sense of security, research has demonstrated a strong correlation between stable housing and the development of “self-esteem, a non-homeless identity, social relationships, and a new community role” (Nishio, 2017).

         When attempting to discover the crux of the U.S. homelessness crisis, it is important to recognize that “homeless mentally ill individuals are not a homogenous group, and their residential preferences are not all subject to the same interpretation” (Schutt and Goldfinger, 2011). Therefore, all recommendations that I make should be considered on a case-by-case basis when it comes to particular housing, treatment, and job needs. First, I recommend legislative support behind permanent housing that is similar to the Housing First Model. This method has been very effective over the last 10 years and helps to specifically target chronic homelessness which is a huge benefit for those with disabilities (HUD, 2007). While this recommendation requires costly funding by both state and local health authorities, I believe that the current spending managed by the city is unsustainable and must be redirected. Los Angeles currently spends nearly $30 million per year to conduct city-wide sweeps that only harm and displace homeless individuals (Tinoco, 2019). In addition to this, funds are funneled into the Los Angeles Police Department in order to increase the number of police officers present in Skid Row (Casey, 2017). I believe that both of these practices are wasteful uses of Los Angeles tax dollars and produce little to no beneficial results. 

After implementing the Housing First Model, I recommend establishing connections with communities for these individuals growing apart of in order to ensure their successful transition back into society. Many homeless individuals, especially those with disabilities, face significant ostracization. This is demonstrated through the creation of Skid Row in downtown Los Angeles, where geographical boundaries result in the creation of societal barriers between homeless and non-homeless people. As a result, these barriers prohibit the integration and acceptance of homeless, disabled individuals within society. Therefore, ensuring that previously homeless individuals feel connected to their communities is essential to guaranteeing their personal success once they are able to acquire permanent housing (HUD, 2007). Job training is also an important component of this process in order to establish a stable source of income. As mentioned earlier in this paper, those with disabilities find themselves spending more than what they receive. Thus, a steady income can mitigate these costs and reduce the odds of becoming homeless once again.

Policies will continue to criminalize and stigmatize particular individuals if there are no initiatives or laws put in place to stop them. Therefore, I propose implementing a comprehensive decriminalization policy that is structured to similar propositions written by the County of Los Angeles Homeless Initiative. Through this policy, I recommend including a protocol that prohibits County ordinances from being disproportionately enforced against homeless individuals and families (Los Angeles County Homeless Initiative, 2016). Moreover, I recommend supporting statewide efforts to stop criminalizing homeless individuals. These efforts would include tackling the way the media grossly misrepresent homelessness by changing the homeless narrative. In order to change the narrative, Americans need to understand the authenticity behind the homeless experience and the ways our government has failed to support these individuals. Instead of throwing more tax dollars at particular issues in hopes to resolve them, citizens should encourage community support and rally around these vulnerable populations.

VII. Conclusion

 In this paper, I have argued that the national homelessness crisis has been exacerbated by the government’s failure to implement effective policies. Through establishing a historical framework, I have demonstrated how homelessness has evolved over time and how it currently impacts cities like Los Angeles in the present day. I have also revealed how local and national policies perpetuate a stigma towards homeless and disabled individuals that leave them feeling ostracized by society. In order to combat these significant impediments facing homeless communities, we must adopt a permanent housing model with decriminalization policies in order to ensure equality for the disabled, homeless community across the country.

         Reflecting on the current homelessness crisis that is plaguing Los Angeles has compelled individuals like Todd to share a part of his narrative with the hope that the public will see past the media’s false perceptions of homelessness. Furthermore, being homeless has encouraged Todd to embrace both his disability and way of life instead of giving in to society’s stigmatization of the homeless. “[They] say to themselves that they will never be like that,” Todd shares while reflecting on the way the public often perceives homeless people when encountering them on the street (Invisible People, 2019). But in reality, circumstances like homelessness are sometimes unanticipated and unpredictable. To eradicate this mindset, we must eliminate the “us versus them” mentality that is criminalizing homeless individuals and bring an end to this national debilitating dilemma.

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