Los Angeles continues to grapple with a worsening homelessness crisis, with the number of unhoused individuals in the city increasing by 7.6% since Mayor Karen Bass took office in 2022. The latest count exceeded 45,000 people, a figure larger than the population of nearly 60% of California cities.
Despite a substantial budget allocation of approximately $4.4 billion dedicated to addressing homelessness between fiscal years 2022-23 and 2025-26, the problem has not abated. This funding averages around $100,000 per homeless individual based on the count when Bass assumed office.
A significant factor contributing to this persistent challenge, according to some analyses, is a misunderstanding of the mental and physical health needs of the homeless population. Historically, organizations like the Los Angeles Homeless Services Authority (LAHSA) have suggested that a majority of those experiencing homelessness do not suffer from serious mental illness or substance-use disorders. However, data from studies, including those published in the Journal of the American Medical Association, indicate higher rates of substance abuse, with a significant percentage regularly using methamphetamines, opioids, or cocaine. These studies also report mental health disorder rates among the homeless to be substantially higher than in the general population.
Housing First and its Challenges
California's predominant approach, "housing first," prioritizes placing individuals in permanent supportive housing without requiring sobriety or treatment adherence. This policy, adopted in 2016, has faced criticism for its high costs and questionable outcomes. Some housing projects have incurred expenses exceeding $1 million per unit, a price point many households cannot afford.
Furthermore, concerns have been raised about the financial management of agencies involved in homelessness services. LAHSA, for instance, has faced scrutiny over administrative and financial controls, leading the Department of Housing and Urban Development (HUD) to suspend LAHSA from future federal transactions in June 2026 due to suspected false certifications and inadequate financial oversight. While LAHSA disputes these allegations, the matter remains under litigation.
Data from a 2020 analysis of permanent supportive housing outcomes revealed that a quarter of individuals died while enrolled, and many others returned to homelessness or institutional settings. These results raise questions about the efficacy of "housing first" as a standalone solution, particularly for individuals with complex health needs.
Harm Reduction and Unintended Consequences
Los Angeles' homeless policies also incorporate a "harm reduction" approach, which emphasizes accepting drug and alcohol use and prioritizing the safety of all, including users. This includes initiatives like needle exchange programs and the distribution of naloxone. However, some studies suggest that while needle exchanges may reduce HIV infection, they have been associated with increased overdoses. Similarly, widespread naloxone availability has been linked to more overdoses and emergency room visits.
The tangible impact of these policies is visible in areas like Skid Row, a 54-block district in downtown Los Angeles characterized by widespread drug availability, high crime rates, and a murder rate significantly exceeding the city average. Homeless-related incidents also strain city resources, contributing to a substantial portion of fires and police calls.
Proposed Solutions and Future Outlook
Experts suggest that a shift in policy is needed, moving away from an overreliance on "housing first" and "harm reduction." Potential solutions include improving incentives for self-sufficiency, increasing accountability for city staff and service providers, establishing treatment centers for mental health and substance abuse, and creating sober-living environments, similar to policies enacted in San Francisco.
The analysis suggests that without significant policy changes, particularly a decoupling from current approaches, homelessness is likely to remain a persistent issue in Los Angeles. Many of these proposed changes may face resistance from influential groups who benefit from the current system, and there appears to be limited interest in fundamental policy shifts from current leadership.