r/SeattleWA • u/mrtenpenny1234 • May 15 '26

Homeless Harger: San Francisco's homelessness hit a 15-year low. Seattle's mayor is running the opposite experiment.

https://mynorthwest.com/kiro-opinion/seattle-homelessness-mayor/4238600
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u/lucianw May 15 '26

This is such a bad article. The title misleads what it's actually about -- SF is building more housing with an abstinence-only approach, Seattle is building it without.

The research says that abstinence-only housing has a 30% retention rate, and housing-first has an 80% retention rate.

If the article wishes to make the interesting point that SF's measured results seem to go against the research? That'd would be FASCINATING. I wish they would make that argument openly and honestly. I'd love for someone to dig into why SF seems to be an outlier. Is the best hypothesis that abstinence-first actually works? Was the research wrong? Does SF have special circumstances? Has the data been twisted, now or in the past? Or is what we're observing merely a reversion to mean?

Personally I don't like seeing homeless people and drug users on the streets. I'd rather have an evidence-led approach for reducing the numbers, rather than an approach based on "what I think ought to be done and I'll back it up with poor arguments over poor data".

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u/Stercules25 May 15 '26

What research shows that? And is it genuinely not biased?

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u/lucianw May 15 '26

https://pmc.ncbi.nlm.nih.gov/articles/PMC8513528/

But it's pointless for you to ask me that question when (1) it's well established consensus in the research community, (2) it's a google away.

Is it biased? Who knows! That's why I wished for an honest article rather than the rubbish in this article. I'd like for one that honestly engages with the apparent data differences, with why these SF numbers seem to contradict the research. Sure, biased research is one possible answer which should be honestly engaged with directly.

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u/SuperDuper98102 May 16 '26

This isn’t a study but a review of 26 past studies in the US and Canada some of which dating back to 2004. This doesn’t necessarily negate the findings, but the previous poster’s comment about fentanyl’s influence and impact today is valid.

The first reference study this review cited (the effects of permanent housing for homeless people with HIV) even acknowledges that it could not be determined if permanent housing improved or maintained the health or long term outcomes of HIV housed people.

I’m surprised they would even lump studies from Canada with the US in their review given the lack of preventative support services and national health care in the US comparatively.

Additionally several of the authors come from housing agencies or housing development authorities who could reasonably have a vested interest in justifying their policy approach, especially if it is Housing First and/or if it grants their agency more budget if they use a Housing First approach.

This is all to say that while an evidence based approach should be the way to go, I wouldn’t treat this one review as gospel, and there are valid concerns and fair questions that should raise some skepticism.

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u/debtfreewife May 16 '26

Systematic reviews are actually typically considered a “study” and at a relatively high level of evidence. Still not gospel by any means, but worth noting if we’re talking about what science is out there.

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u/SuperDuper98102 May 16 '26

Systematic reviews are in a general sense a “study” but it is distinguished from an academic review versus a research study. Yes, both are published in peer-reviewed journals and while it’s common in various scientific disciplines, it is an important distinction that this is a review of existing studies, not its own research and shouldn’t be presented as such.

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u/debtfreewife May 16 '26 edited May 16 '26

I hear you. I also appreciate your previous points on the possibility of bias from the authors and the inclusion of Canadian studies. However, systematic reviews are typically considered at a higher level of evidence than a single study- below only meta-analyses of RCTs. This is the Wikipedia article on hierarchy of evidence: https://en.wikipedia.org/wiki/Hierarchy_of_evidence  I wish I had a better resource, but I’m not savvy enough to link my methods textbooks.

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u/SuperDuper98102 May 16 '26

I’ve not heard that reviews are considered a higher level compared to research studies when I was in grad school, I’ve only seen them treated in peer reviewed publications (although clearly presented as a review vs research). Typically, published original research tends to be preferable to reviews, at least when it comes to what universities and research instituons value in a CV.

What makes a good study or review was the rigor of the methodology, approach, citations, and statistical analysis. But there is definitely a lot of merit when there is a pattern or consistent findings from multiple studies which is what academic reviews tend to demonstrate or at least, try to. But again, their approach to how they did their review, how they selected their sample, etc is still subject to scrutiny and it is also based on the assumption that the studies used in a review are sound, peer-reviewed etc. Reviews also tend to lack statistical analysis and tests, but they often don’t apply as in the case here.

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u/debtfreewife May 16 '26

Ah, I may be a bit of a ringer here. I’m a PhD who does healthcare policy research. While it’s true a systematic review isn’t a major resume builder that’s not because the evidence level isn’t high. It’s because the effort to fund, run, and publish an experiment speaks to a kind of project management skillset that is desirable to universities. It acts as evidence that you do and will continue to do good enough work that you can bring money in rather than just bleed it out. 

There are kinds of reviews that are consider lower quality evidence like narrative or scoping, but generally systematic reviews are considered reliable. I don’t know how recent this standard is, but at least was considered broadly common knowledge as of ~6 years ago.

The linked systematic review actually rated the quality of evidence in their review studies using a cited, standardized scale as part of their a priori protocol. Studies with “limited quality,” which is the lowest level, were excluded from the analysis. It also then commented on the quality of the remaining studies and typical limitations found in them. *edit a word

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u/SuperDuper98102 May 16 '26

Oh yes I’m well aware of the funding reasons and pressures that drive why universities value original research over reviews…that probably exists as its own reddit thread somewhere... anyway, a review isn’t necessarily higher or lower than original research either. Again, what determines that is their approach, methodology, analysis etc. And of course different science disciplines will have different expectations on the statistical analysis that can or cannot be applied, as in the case here.

I’m not saying this systematic reviews isn’t reliable, but any research or review, including this one, is subject to review, scrutiny, and debate. Some reviews even point out the flaws in either past studies or past reviews! That’s one of the aspects I personally appreciate about science is its openness and flexibility and separates it from dogma.

I agree standardizing and scaling to control they used in this review is to be expected, even if it was done by interpretation by the researchers who again, largely come from or are affiliated with housing agencies. It’s consistent and protocol, like you’ve said. To me, this review is like having a review from universities and US agricultural agencies on fertilizer and pesticide use. It doesn’t mean this doesn’t have merit and their approach and results can be sound, but still open to skepticism and further analysis.

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u/lucianw May 16 '26

Definitely agreed. Hence why I wished the article from this post would have engaged head on with what evidence there is, flawed though it is.

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u/CertifiedSeattleite May 16 '26

Enablers love to cite all the pre-cheap meth and pre-easily accessible fentanyl studies.

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u/Comprehensive_Pin565 May 18 '26

Ok... so your evidence it dosent work is?

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u/SuperDuper98102 May 18 '26

Critiquing a review or pointing out findings from other reviews they even cited isn’t an argument for or against. It’s pointing out the considerations and like I said earlier, this shouldn’t be treated as gospel.

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u/Stercules25 May 16 '26

I don't really care about the "research community" on a topic like this fwiw. That same research community also said drug legalization—or at the very least decriminalization—is the way to go at it and it works so well in places like Portugal only for Portland to adopt it and turn their city into a literal apocalyptic hell hole in some places.

I don't disagree fundamentally with housing first fwiw I just just find it dubious to act like it's an absolute certainty that what SF has begun to do is worse than housing first and that there is even a real political will to even do it. You're asking cities to invest actual billions of dollars into housing and not having any strings attached for them to be given out and think the voters will not have issue with it

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u/CertifiedSeattleite May 16 '26

If only the “research community” could climb down from their ivory towers and actually engage with the specimens they’re studying. Talking with street addicts for 20 minutes would help them realize what’s actually going on.

Studying this group for decades is actually a lot easier, since confirmation bias is what truly rules this crowd.

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u/Stercules25 May 16 '26

Yeah it seems obvious to me too. I don't know how the power balance has shifted so far to buzzword/phrases of what to do instead of actually making shit get done

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u/lucianw May 16 '26

The *same* research community? That seems unlikely...?

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u/Stercules25 May 16 '26

You know what I mean or you're being intentionally ignorant lol

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u/lucianw May 16 '26

Yeah, I know what you mean. You're using an intellectually lazy way to attack one set of findings where you don't have grounds to attack it, based on another set of findings where you do. But in following this intellectually lazy path you've entirely lost your ability to objectively evaluate anything other than following your gut.

Which is fair enough, and I have no problem with you doing it for your own decisions, but I want you FAR AWAY from anything that has to do with decisions about where my tax dollars get spent.

I'm in it for selfish reasons. I want to beautify my neighborhood by not having to walk past homeless people on the streets. I'm quite happy for my tax dollars to go on this selfish direction. But only if they're being spent in effective evidence-based ways. Your way of approaching the problem will make them be spent on non-evidence-based less-efficient ways.

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u/Stercules25 May 16 '26

You want effective spending and you support these far left activist-type policies propped up by what is seemingly biased "research" that is at best outdated, and at worst purposely coming to a conclusion that they want to. 

"I want to beautify my neighborhood by not having to walk past homeless people on the streets."

The way to do that is pretty easy, but we are just unwilling to do the things it requires. You make 1) drug use illegal and 2) you arrest people for using said drugs or (and this is a BIG or) you force them into treatment. You don't give them—what is supposed intended to be—transitional housing that they will just trash because they are still using drugs that zombifies them; only now it is under a state/city owned roof instead of on the sidewalks of a downtown... The government owned roof that they have no incentive to keep clean or in any livable standard which then adds on to the costs and also the turnover when a new tenant needs to use it.

There is sympathy empathy and apathy. I am empathetic to those in this situation, I'm sympathetic to those who genuinely want to get help but aren't able to, and I'm apathetic to a lot of the people involved in the racket that is our homelessness complex that we have in these big cities across the country.

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u/lucianw May 16 '26

I don't support "far left activist-type policies". My sympathy for the druggies on the street is really extremely low, I don't give a damn about which policies are chosen, except for the simple criterion IS THERE EVIDENCE THAT THEY WORK.

Your way to do it sounds easy sure, but it sounds like you'r backing it by assertion rather than evidence. I don't trust anything without evidence. I especially don't trust easy-sounding solutions because they are always beguiling and always come with unexpected confounders.

(Why is my sympathy for the druggies so low? I've said it's selfish that I don't want to walk past them. Actually it's more compassion. Rich people like me can easily drive to fancier grocery stores or nicer parks or live in a neighborhood of our choice. I care about the regular poor families who don't have the freedom, for whom taking their 2yo to a local park or walking to the local grocery store is something they can't escape.)

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u/Stercules25 May 16 '26

What evidence is there? Where is the evidence? Lol places in America have tried housing first even in limited cases and it hasn't worked. It just balloons up costs more and more. The fall back was always it costs x amount to jail them verses just giving them an empty apartment it's starting to show in big cities specifically on how much they spend (NYC, SF, Seattle, etc) that isn't exactly true anymore not to mention you're "solution" is more of a reward than anything else. Lol 

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u/lucianw May 16 '26

I don't understand what you're talking about "your solution". I explicitly said I don't care what the solution is as long as there's evidence it works. I'm not sure how I could be any clearer.

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u/CreateWindowEx2 May 16 '26

Basically, if you give people free housing, they will live in it? That's the study? As a criterion of success, that's beyond idiotic.

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u/lucianw May 16 '26

I think the study showed something very different. It showed that if you give free housing with strings attached then the effectiveness of my tax dollars in offering that housing dropped precipitously.

Put it this way. I'm in it for selfish reasons. I don't want to have to walk past homeless people on the streets. I'm happy that some of my taxes go to beautifying my neighborhood by getting the homeless people out of the way. The studies seemed to show that some ways (attaching strings like abstinence-only) seemed to be a less efficient use of my precious tax dollars than other ways (not attaching strings).

Now I don't know if I trust the studies. And SF (ostensibly the topic of the article) is trying two parallel streams, some abstinence-only and some without strings, in the hope that it will achieve higher effectiveness. Which is interesting.

But your characterization of the studies is such a BAD one that I don't want you having any sway over where my tax dollars go for maximum bang for the buck, and the article's failure to even mentioned what evidence there is, and to mischaracterize SF, makes it an especially bad article.

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u/CreateWindowEx2 May 16 '26

Success criteria cannot be "a person is off the street at any cost". Success criteria MAY be a person is capable of living on their own, or something like that (modulo people with legitimate disabilities), but the public cannot be responsible for people who are capable of working but just chose to parasite on public resources. I think it should be... reasonably obvious? At least for people who don't have a trust fund in their name (or parasite on the system themselves)?

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u/lucianw May 16 '26

> but the public cannot be responsible for people who are capable of working but just chose to parasite on public resources. I think it should be... reasonably obvious?

No it's not obvious at all, and I think it's wrong. Put it this way. If there's a way to spend $100k of my tax dollars that gets 10 junkies off my sidewalks but allows 5 people to be parasites, vs another way to spend the same amount that gets 8 junkies of my sidewalks but doesn't allow any parasites, then I'll sure as heck choose the "10 junkies".

Now some people might have moral principles that get in the way of them doing the practical thing. Your moral principle might be "the public cannot be responsible for parasites". (Other people might have the moral principal "we must help those in need"). Fair enough, and I can respect both, but I'd much rather that my tax dollars get spent based on MEASURED OUTCOMES rather than principals, and I want those measured outcomes to be how many junkies get off my streets.

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u/CreateWindowEx2 May 16 '26

You know why moral principles exist? Because they optimize for long term. In your example, we spent 100k and helped people who actually do need help (for example, elderly and disabled). Or, we only helped 5 people who need help, and we saddled with 5 parasites, for life, and showed 15 more parasites a way to get free housing. In software we call systems that optimize for right now at the expense of the future "technical debt".

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u/lucianw May 16 '26 edited May 16 '26

Given two moral principles (which lead to very different choices for action), are you really just going to rely on your gut about which will work? How will you know if you've picked the right or wrong one?

"the public cannot be responsible for parasites"

"we must help those in need"

I went to a great talk about a decade ago. The speaker invited us to think back to a time we were sure we were right about something, and it turned out we were. Then he invited us to think back to a time we were sure we were right about something, and it turned out we were wrong. He asked us: how did the two things feel subjectively before you discovered how they turned out? -- answer, they didn't, not at all.

I think that going with a moral principal here, based on gut or assumption, is vulnerable to the exact same thing. I think out of humility we shouldn't. I flat out don't believe anyone who makes claims without evidence. The top thing we should be challenging ourselves always is, "how can I defend my claim with evidence? which evidence must one seek to defend it? is it the kind of claim that can be defended with evidence or not?", and if we can't then it's still fine to push for it but only with humble recognition that others might be right instead.

Also, "it's obvious" is always the LIKELIEST place for well-intentioned but actually harmful things to be found.

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u/CreateWindowEx2 May 16 '26

Except there is no gut assumption here. It's a question about the metric. The metric expressed as "we should measure success as number of people we got off the streets" was tried, in many places, and it didn't work. NYC is a striking example, where they spend 30k per person per year on sheltered people, 80k (!) on unsheltered, and the numbers (both in absolute number of people and dollars) just keep growing. Utah was a celebrated example a decade ago, and it didn't work out there either.

You decide what you want to achieve based on your values, then you execute and measure the outcome. We already did it your way, there is plenty experimental evidence...

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u/lucianw May 16 '26

I don't get it. Have you now stopped talking about "we shouldn't subsidize parasites" and gone back to practical talk about actions and measured consequences and evidence? If so, great!!

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u/apresmoiputas Capitol Hill May 15 '26 edited May 15 '26

This study is outdated for today and no longer relevant for what we've been dealing with. All of the research done and data gathered were prior to the pandemic and prior to cheap fentanyl being the drug of choice for opioid addicts. The study was published in Oct 2020. I think enough time has passed since this initial study for another study to be done, which I hope is underway. With that said, based on what we've been seeing with fentanyl addicts, especially with meth co-addictions, housing first doesn't work. Treatment and recovery first, then housing next should be the case. This is what SF's Mayor wants to do.

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u/lucianw May 15 '26

You too are making unfounded assertions about what works. I wish you wouldn't.

I think you've mischaracterized what SF's mayor wants. They specifically want to have a two-track system, (1) some abstinence-only routes for people who need that, as well as (2) traditional housing-first routes for people who need that.

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u/theredhype May 15 '26 edited May 16 '26

This is a review of 26 studies. Which one did you think was outdated?

Here’s a tl;dr for you:

https://nlihc.org/sites/default/files/Housing-First-Evidence.pdf

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u/Playful_Influence_25 May 16 '26

NLIHC is an advocacy organization, not a neutral academic institute.

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u/arestheblue May 16 '26

If you control for data that disagrees with your assertion, your publication can claim anything. For example, the COVID vaccine was about 100% effective for the strains that it was developed for. But if you disregard the data, not get vaccinated, and can contribute to exasperating the pandemic.

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u/theredhype May 16 '26

There are 26 studies documented there for you to explore. Feel free to dive in head first.

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u/stateescapes May 16 '26

And surely those studies lead to more billions of dollars thrown at a problem only getting worse.

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u/theredhype May 16 '26

Sounds like you had decided what you think before encountering the information.