Topics in Health: Lessons From The Field
Not many reporters want to write about homeless people – and not many editors want to read about them. The subject is considered too depressing, too intractable. Not good reading over the breakfast table, as the saying goes. Too 1980s, some say. Readers have gotten tired of it.
But there are few crises that are more important to cover – right now.
How a society treats its poor – and how many poor that society's various systems create – have always been key indicators of the character and viability of that society. And there are no more desperately poor people in America than the homeless. With that in mind, there are few things more important to remember as you cover homelessness than this: The phenomenon is as much a health crisis as it is an economic one, with physical ailments plaguing virtually everyone on the street, and at least a third of hard-core homeless people suffering from mental illness. That is something few people fully understand.
I've written about the homeless off and on since starting my career as a reporter and editor in 1979. Between 2003 and 2006, I believe I was the only reporter in the nation covering the crisis as a full-time beat, thanks to the extraordinary dedication to the issue by my editors at the San Francisco Chronicle. This means I have been able to observe as a reporter the genesis and development of what we now know as our modern version of homelessness. Several truths have become clear to me and constitute a frame of reference for other journalists in this subject area.
Evolution in attitudes
This is not a crisis that can be alleviated with a sandwich, a short stay in a shelter, and a little job counseling, as was at first hoped when the nation began experiencing homelessness on a large scale in the 1980s. Americans had not seen so many people in their streets since the Great Depression of the 1930s, and nobody, it seemed, really knew how severe the problem was – or would get. With no New Deal-style program on the horizon to handle the problem, the solutions and attitudes have had to develop slowly and painfully.
The idea back then was that this was simply a segment of society down on its luck; the catch-phrase promoted by poverty activists at the time was "We are all just one paycheck away from homelessness." The "one paycheck" sentiment was intended to elicit sympathy, and it was effective – for a time.
Then came the 1990s, and people's patience ran out because of what the media termed "compassion fatigue." It turned out that the homeless needed much deeper help than a societal Band-Aid, and the help that was required was complicated and long-term.
For the most functional homeless individuals and families sleeping in shelters or couch-surfing without income, this involved:
• Creating more lower-income job opportunities.
• Finding a way to replace (with either new funding, or new social engineering techniques) the housing subsidies that had been eradicated in the '80s.
• And providing counseling opportunities to help individuals recover from their personal crises.
However, for the least able and most visible homeless people – the hard-core sleeping in the street – the solutions required more intensive attention:
• Funding more comprehensive drug, alcohol and mental counseling.
• Expanding emergency housing.
• And permitting sustained welfare payments for many months, if not years
It took a long time for aid providers to realize this. It was sobering.
The cause: Not just bad luck or a single misstep
It turned out the problems that threw the most severely homeless people – and even many of the more able homeless – into the street usually did not stem from simple bad luck or one misstep. They involved dysfunctions dating to birth: Abusive family environments, untreated mental illness, early substance abuse, criminal patterning, and poverty or other similarly crippling personal factors that made holding onto jobs and maintaining healthy relationships difficult.
These, of course, are not fixable quickly. If anything, the American public seems to have little patience for long-term, slow solutions to deep problems.
Hence "compassion fatigue" – and the imperative for treating homelessness with public health approaches.
Public attitudes are still often hostile to the homeless, but what health providers, social scientists, and in many cases even the police, have discovered – the slow, hard way – is that the most effective way of addressing homelessness is to give the homeless housing with counseling on the premises, something that has come to be called supportive housing. And it has to be given for free, and quickly. Because of the chaotic lifestyle street-sleeping creates, homeless people are terrible at keeping appointments; providers have found that they must give clients the housing and services as quickly as possible once they agree to accept them, or the opportunity can be lost.
This is a tough thing for many in society to accept. Standing on your own and not giving "handouts" to "freeloaders" is a core American value. But most health providers will tell you that unless you give housing and services to the homeless, you will not be able to help them overcome the crippling problems that put them on the street – and that housing and counseling people in a controllable environment is a lot cheaper than letting them sleep outside, where they require more expensive attention from emergency health and law enforcement agencies.
Today, the newest challenge providers and communities face is the fact that even after being housed and counseled, some homeless people continue their panhandling behavior and hang out on the street so much, in a bedraggled and sometimes inebriated state, that they still seem to be homeless. Women will often have the complications of sexual and physical abuse on the street.
The approach so far, in cities such as Denver and San Francisco, is to gradually tighten up the street behavior rules – so-called "quality of life" laws – and to step up the counseling pressure with the aim of helping people improve their lives more quickly so they can turn to better behaviors.
The challenge of this approach is to do it carefully and interactively so the homeless people who have made progress don't become hostile and abandon the advances they have made – and so there isn't a backlash from compassionate residents in places like San Francisco, where a core constituency opposes police crackdowns on the homeless. It's a tricky problem that hasn't been fully played out yet.
No quick fixes likely
No matter what group you are dealing with, the commonality is this: Homeless people did not get that way overnight, and peeling back their problems to get them into a stable life will be like peeling a very sticky, very thick onion. Keeping this in mind helps me cut to the chase quicker in my reporting.
I am now assertive about getting right into the subjects of addiction, abuse, mental illness, and the other core problems that are essential to most homeless stories – but which many reporters approach too gingerly out of fear of being offensive. Remember, you're not being offensive – you're just being honest and complete. Know this, and your conversations will move quicker and more productively with both homeless people and those trying to help them.
Sometimes those so-called onion layers take awhile to dig through, assertive though you may be. But you have to keep digging until you believe you have arrived at the essence of your story. What you find is seldom happy, but it is always revealing and very human.
When I met 40-something Georgia Mitchell in downtown San Francisco in 2003, she seemed like a remarkably capable (even affable) character who was sleeping on the street only because of bad luck and an off-and-on addiction to crack cocaine. She resisted the efforts of my partner on the homeless beat, photographer Brant Ward, and me to interview her in depth about what led her to the streets. To hear her talk, all she needed was a little governmental welfare help to move indoors and straighten out her life.
Our instincts told us there was much more to her tale. Fortunately, we were able to track her for the next three years before we wrote about her.
As her story unfolded before us, we saw that there was indeed a thicket of grim complications that had led this smiling, mild-mannered woman to where she was and that kept her there. She had come from an abusive home in the South, hooked up with an abusive, drug-addicted man as a young woman, left him for the street and had never actually lived in a stable environment her entire life.
She resisted help because she had no real frame of reference to relate to where such help could lead. This much I could have guessed right away, but what truly surprised me was the actual governmental cost of leaving her on the street instead of housing her in a rehabilitation program.
Through documenting her comings and goings with police, hospitals, rehab clinics, soup kitchens and all the other institutions that give triage to the desperately homeless, we were able to show that her life of sleeping in the street cost San Francisco about $100,000 a year – as opposed to the $20,000 to $25,000 it would cost to give her a long-term housing unit with on-site supportive counseling services.
Brant and I waited until she got into one of those housing units before we produced our story, and the ability to compare costs and outcomes made it a pretty informative article. By contrast, if we had had to bang out a quick profile within weeks of meeting her, we would have probably produced a story that presented her mostly as the sad result of how far one can sink because of an abusive, addiction-riddled relationship.
The important thing was that Brant and I did not take Georgia at face value. We assumed there was much more turmoil than was apparent on the surface, and that this turmoil had direct implications to the health and emergency services of San Francisco – not just to its poverty housing and job programs.
Here's the hitch, though: This kind of reporting takes time.
Even if you have to turn the piece in a few days, the crucial thing is to talk deeply enough with your sources to cut through the surface chatter that always precedes real knowledge of a homeless person's situation.
The average homeless panhandler (and not all panhandlers are homeless) will usually first say, "All I need is a little help to get on my feet a few bucks for the bus a few bucks for a meal ," or any of a number of things aimed at a quick interaction, and what follows will usually involve a story about how life dealt them an unexpected blow that threw them into the street. What they usually don't say is that the panhandle money generally goes to drugs or booze, and that the unexpected blow was just the latest of many missteps or misfortunes that rattled them down the ladder of life, one painful rung at a time, over a period of many years. These details are the most telling, but they don't come until you've had a frank, searching discussion.
Such discussions are not easy. They only happen if you let the homeless people you are interviewing know that you are not being judgmental or exploitative – that you are interested in telling true stories that can not only help them understand themselves better, but help anyone who reads your stories understand the tragedy of homelessness better. This is done by treating homeless people as humans, not just story subjects.
Chat them up at first, be interested in how their day is going, be attentive to what they are doing while you're talking with them. Let them know you are not repulsed by being around someone who may be unwashed, addicted, hungry, jittery, or any of the other things homeless folks can be while hanging in the street. Be brave, be human, be respectful, caring and curious – and most of all, be gently honest. And then keep your ears open for the real story.
If you tell that real story, you will be doing a service not only to your readers, but to the person you are writing about. And, ultimately, to yourself as a writer and a caring person. Make an honest connection. Don't act as if this is some anthropological exercise, and you wish you were somewhere else. The homeless are too often ignored or treated with revulsion by passersby, so making an honest human connection is important to them, and your interview will be the richer for that. If you just aren't interested or you find the subject disturbing, you shouldn't be writing stories about it.
Tips for Reporting on the Homeless
• Be safe, but don't be afraid. Be smart about avoiding dark alleys alone at night, but don't be afraid about talking to homeless people. If you are nervous, interview them in areas where others are around, so you will feel safer. But most homeless people are gracious and grateful that someone - especially someone in supposed authority, such as a reporter - is really paying attention.
• Get as much family, law enforcement, counseling, institutional and other background as you can from your homeless subject, and then use it to research him fully. Be honest about what you are doing, but persistent. To truly flesh out a person's life, you need more than just his recollections and a few comments from the cops or street pals.
• Earn enough rapport and trust with your homeless subject so that he lets you accompany him on his visits to doctors, clinics or hospitals. This is the best -- and often the only-- way to get the real skinny on a homeless person's medical condition. Confidentiality barriers disappear if the patient brings you with him.
Kevin Fagan is a general assignment reporter for the San Francisco Chronicle who between 2003 and 2006 covered homelessness as a full-time beat. During that time, he wrote "Shame of the City," a five-part, award-winning series on homelessness in San Francisco.