[jdietrich]

The key point is early intervention, particularly in adolescents and young adults. Severe mental illness doesn't suddenly emerge out of nowhere - there is an identifiable process through which people decline from "struggling" to "completely unable to function". We know that the longer mental health problems go untreated, the harder they are to treat. Likewise, the longer someone stays on the streets, the harder they become to re-integrate into society.

Housing is only half the equation. For housing-first policies to work (and they can work very successfully), they need to be accompanied by comprehensive psychosocial support to address the issues that cause and perpetuate homelessness. That support is obviously expensive, but it works out much cheaper in the long run.

America has an unusually severe homelessness problem. It is often presupposed that this problem is caused by factors which are unique to America and essentially intractable, which leads to proposed solutions like mass institutionalisation. I believe that this is fundamentally false; the key factor is a lack of political will to invest in the social infrastructure which prevents people from becoming homeless and prevents homelessness from becoming entrenched. This is ultimately a false economy, because the unavoidable costs of having a permanent dysfunctional underclass vastly outweigh the costs of proactively supporting people at the earliest opportunity.

"Ending homelessness" in an absolute sense is a fantasy, but the vast majority of homelessness is avoidable.

[seanmcdirmid]

Note that Finland isn’t doing that in this article. They probably do intervene on problems before they become chronic, but most of those housed in assistive housing require some supervision, are not cured of their addictions or mental illness, and are not expected to ever be independent or productive ever again.

However, by providing some housing and supervision to these people, they wind up saving money because on the streets they would be using way more social resources at a far higher cost.

[beebeepka]

Exactly. You don't even need to care about the people you are helping because, in the long run, it is cheaper to help. This isn't about money. It's largely about having someone to look down on.

[seanmcdirmid]

Ya, I think America is mostly losing because they feel like these people need to be cured into productive members of society. They don’t need to be cured, they just need to be taken care of somehow that doesn’t involve the constant calls to the police and fire department. However, given the lethality of fentanyl, many will die quickly without some kind of rehab.

The other issue is that Finland can manage this nationally, while Americans expect the richest cities with the highest property costs to shoulder the burden locally, how many free flats could be provided in SF?

[throw9away6]

American does not have the structure in place to take care of people in this way. The cost of “housing” a single homes person that easily top 50k a year or more due to high administrative costs and medical costs. It cost more in Seattle to run a RV parking lot per spot than to does to rent a nice 2br apt.

[andsoitis]

> America has an unusually severe homelessness problem.

Maybe.

Over 580,000 Americans are experiencing homelessness. That is a rate of ~0.18%, if my calculations are correct (600k / 332m).

Contrast to Sweden (population 10m) which had an estimated 33,000 homeless people in 2020, yielding a rate of 0.33%. [1]

Contrast to Japan, which has an estimated effective homelessness rate of 0%.

So Sweden has a worse homelessness rate than the US but we all suck compared to Japan and Finland!

1. https://www.homelessworldcup.org/sweden#:~:text=Country%20st....

[oxfordmale]

In the US, a lot of homeless people are likely in prison. There is also a second class of people who live on the streets during thr week(San Francisco), but then travel back to their home for the weekend

The Japanese do have homelessness problem, they are just not recorded. Knowing Japan, it is something bureaucratic. Unless you register yourself as living in the street, it is assumed you live on your last known adress. And you likely can't register yourself as living on the street as that is illegal.

https://www.theguardian.com/world/2003/dec/19/japan.justinmc...

[seanmcdirmid]

A lot of people lose their support network in prison (or lose it before going in) and are released to the streets. They just get an open bus ticket courtesy of the state, go where it’s possible to live as homeless, and that’s it. A lot of the bussing we hear about is simply these open bus tickets prisons (especially Texan prisons) give out to people with no one picking them up.

[TheCleric]

As well the negative feedback loop of how hard it is to get good employment after going to prison.

[sneak]

Correspondingly, I understood Japan's covid numbers were so low during the early stages of the pandemic due to the fact that you could only get officially counted covid tests with great difficulty and discouragement.

[jdietrich]

Definitions of homelessness and data collection methodologies vary to such a degree that it is difficult to make direct comparisons between countries. The term "homeless" includes a broad range of conditions, from sleeping on the streets to living in temporary accommodation. Japan's purported homelessness rate is transparently false to anyone who has spent time in the less salubrious parts of Tokyo.

What is clear is that homelessness in the US is very unequally distributed geographically and has become associated with increasingly severe social problems. The level of homelessness might not be exceptionally high, but there's a prima facie case that the severity of homelessness has. Being inadequately or insecurely housed is undoubtedly bad, but it's a heck of a lot better than living indefinitely in a tent underneath a freeway overpass.

[kalleboo]

The last time I looked into these numbers, the definition of "homeless" between the countries was so wildly different that the numbers were impossible to compare

[dudeinjapan]

Japan has homeless people. Not to the same degree as USA but they exist.

[vorpalhex]

> The key point is early intervention, particularly in adolescents and young adults.

That is entirely false. Full blown paranoid delusion or schizophrenia is not "depression but extra bad".

> Severe mental illness doesn't suddenly emerge out of nowhere

It basically does? I mean it's a cross of genetics and in-vitro development factors with some real life trigger at times, but outside of robust genetic engineering it might as well be from "nowhere".

[jdietrich]

Early intervention is vital in psychotic illness. Single episodes of psychosis can in many cases be prevented from developing into schizophrenia; even if schizophrenia does develop, outcomes are far better for people who receive early and effective treatment.

https://www.nimh.nih.gov/research/research-funded-by-nimh/re...

[vorpalhex]

> Single episodes of psychosis can in many cases be prevented from developing into schizophrenia

Your source does not say that.

> Some people who receive early treatment never have another psychotic episode.

That actual number of some (and not "many", "most" or even "meaningful proportion") is not defined in the page or underlying study.

Broader studies seem to suggest some people regardless of treatment only have an isolated episode. It is not clear the RAISE intervention itself changes that proportion.