I read Heather Knight’s long, interesting front-page article on a San Francisco homeless woman’s ongoing struggles with fentanyl.
The woman, Jessica DiDia, lives in a tent South of Market, and from Knight’s description seems to be high all the time. It’s a very depressing story and one gets the conclusion that DiDia won’t be with us much longer. She’s already overdosed more than 100 times, by her own account, and, as she points out, “It only takes me one hit to die.”
Knight is full of suggestions as to what San Francisco should do with people like DiDia. In fact, Knight seems to blame San Francisco for DiDia’s plight. Her main complaint is that, every time DiDia is treated at San Francisco General Hospital and discharged, the same thing happens. She re-uses, overdoses again, and ends up back in the hospital. Knight asks, “Why does the city…provide so little upon discharge?”
It’s not a hard question to answer. The answer is simply that San Francisco cannot afford the kind of continuous, 24-7 treatment Knight wishes for Jessica and thousands like her. S.F. General gave her great care (for free, one presumes), but, writes Knight, “the hospital’s top-flight care wasn’t matched by its plan for Jessica upon discharge.” That’s because the hospital had no plan for Jessica upon discharge. Neither did San Francisco. There is no plan because there cannot be one. To imagine otherwise is magical thinking.
Think about it. You’d have to provide Jessica with a full staff of assistants to help her, an entourage of experts, including intervening every time she wants to shoot up. And, as Knight asks, “What can be done…if Jessica ultimately rejects all offers of help?” Good question. Knight writes that whenever Jessica was offered shelter, “Jessica resisted. She said sleeping in a treatment center or shelter made her even more anxious…”.
I don’t claim to know much about addiction and recovery, but I do know it takes trained professionals, and they don’t work for free. Considering that there are thousands of Jessicas in San Francisco, I don’t see how it’s helpful for well-intentioned people like Knight to suggest that San Francisco needs to be spending more money. (Would you rather money go towards people like Jessica, or towards public transit?) The city is essentially broke and facing historic deficits. We all know the problems caused by the pandemic. I’m not a defeatist. But I honestly don’t think we can deal with this crisis by taking a treatment-on-demand approach. We’d have to turn the entire U.S.A. into a gigantic, full-time rehabilitation center and tax the hell out of every American.
So what is the answer? I don’t think there is one, except to manage things as best we can. For three years, we—the Coalition—have been calling for Oakland to implement its Encampment Management Policy, which the City Council approved unanimously. The EMP called for prohibiting tents in certain areas (parks, near schools, etc.). Unfortunately the City Council decided not to enforce their own policy, which has languished on the books ever since. We’ve also called for constructing a large, refugee-style camp on the Oakland Army Base, a call that Carroll Fife herself ultimately endorsed. Compel all tent dwellers to live there, provide them with as many services as Oakland can afford, and see how things transpire. But no one is working on that either (although kudos to Fife for continuing to push it).
Management is the best we can hope for in the coming years. Round-the-clock treatment for every homeless person is not going to happen. It’s silly for outlets like the Chronicle to keep calling for it, and to insinuate that if we taxpayers don’t come up with the billions required, we’re somehow bad, uncaring people. We’re a good, compassionate society, but we’re also realistic. There’s only so much money to go around. Ultimately, people are going to have to realize that their own dumb behavior often gets them into trouble, and adjust accordingly.
Steve Heimoff