Supreme Court OKs Local Crackdowns on Homelessness, as Advocates Warn of Chaos – KFF Health News

the US Supreme Court Watershed Decisions Legislation announced Friday on the issue of homelessness would make it easier for elected officials and law enforcement officers across the country to fine and arrest people found living on streets and sidewalks, in broken-down vehicles or in city parks — which could have far-reaching health consequences for homeless Americans and their communities.

In a 6-to-3 majority decision City of Grants Pass v. JohnsonThe majority of justices said it was not cruel and unusual punishment to allow the targeting of homeless people, with criminal or civil penalties, by banning them from sleeping or camping in public places, even if there were no alternative shelter or housing options available to them.

“It’s hard to imagine the chaos this would unleash. It would have dire consequences for mental and physical health,” said Ed Johnson, director of litigation at the Oregon Law Center and the lead attorney representing the homeless defendants in the case.

“If people aren’t provided with things like blankets and pillows, or tarps and sleeping bags to survive while they’re outside, and they don’t have somewhere else to go, they could die,” he said.

The case, one of the most consequential in terms of homelessness in decades, comes amid widespread public frustration over the proliferation of homeless camps — particularly in Western cities like Los Angeles, San Francisco, Phoenix and the like. Portland, Oregon – and the unsafe and unhealthy conditions that often prevail around them.

An estimated 653,100 people will be homeless in the United States in 2023. The most recent federal estimatesMost of these people live in shanties, broken-down recreational vehicles, and sprawling tent camps that sprawl across urban and rural communities.

The city of Grants Pass, Oregon, at the center of the legal battle, successfully argued that fining and arresting homeless people who live outdoors or illegally camp on public property is not cruel and unusual punishment.

Grants Pass spokesman Mike Jacino released a statement Friday saying the city is “grateful” for the decision and committed to assisting residents struggling to find stable housing. Thene Evangelis, the city’s lead attorney, told the Supreme Court in April that if it couldn’t enforce its anticamping laws, “the city’s hands would be tied. It would be forced to surrender its public spaces.”

In the majority opinion, Justice Neil Gorsuch argued that the homelessness crisis is complex and has many causes, writing, “Because of encampments on neighborhood sidewalks, adults and children in these communities are sometimes forced to avoid used needles, human waste, and other hazards while going to school, the grocery store, or work.”

However, Gorsuch wrote, the Eighth Amendment does not give Supreme Court justices the primary responsibility for “assessing those reasons and crafting those responses.” A handful of federal judges “cannot equal the collective wisdom possessed by the American people in deciding ‘how best to handle’ a burning social question like homelessness,” he wrote.

Justice Sonia Sotomore dissented, writing that the decision focused on the needs of local governments and “leaves the most vulnerable in our society with an impossible choice: either stay awake or get arrested.”

Elected officials, both Republican and Democrat, continue to argue that life on the streets is making people sick — and that they must be allowed to move people around for health and safety.

“If the government offers help to people and they can’t or don’t want to accept it, there have to be consequences. We have laws that should be used,” said Sacramento Mayor Darrell Steinberg, an adviser to California Governor Gavin Newsom on homelessness, citing, for example, laws that require the state to fund mental health and addiction treatment.

The high court’s decision may give cities more courage to search encampments and force homeless people to live more transiently — constantly moving around to avoid law enforcement. Sometimes they are offered shelter, but often they have no place to go. Steinberg believes many cities will more aggressively search encampments and force homeless people to stay put, but he doesn’t believe they should be fined or arrested.

“I have no problem telling people you can’t camp in public places, but I wouldn’t criminalize it,” he said. “Some cities will fine people and arrest them.”

Advocates for the homeless say continued relocations will put the health of this population at even greater risk and increase public health risks, such as the spread of infectious diseases. They fear that conservative-leaning communities will criminalize street camping, pushing homeless people into liberal municipalities that provide housing assistance and services.

“Some cities have decided they want to fine, arrest and punish people for being homeless, and the majority opinion tells communities they can go ahead and do that,” said Steve Berg, chief policy officer for the National Alliance to End Homelessness. “If communities really want to reduce homelessness, they need to do what works, which is make sure people have access to housing and supportive services.”

Some health care experts say that as they disperse and relocate — and possibly get arrested or fined — they will lose touch with the doctors and nurses who provide primary and specialty care on the streets.

“It will only contribute to more deaths and higher mortality rates,” said Jim O’Connell, president of Boston’s Health Care for the Homeless program and an assistant professor of medicine at Harvard Medical School. “It’s tough, because cities are grappling with the debate of ‘public safety versus public health.’”

As homeless people get sicker, O’Connell said, their treatment will become more expensive.

“Stop thinking about the emergency room, which is actually cheaper than what we see, which is homeless people being admitted to the ICU,” he said. “I have over 20 patients today at Mass General who are costing a lot of money to take care of.”

In Los Angeles, which has the largest homeless population in the U.S., street medicine provider Brett Feldman predicts more patients will need emergency intensive care because of untreated chronic illnesses such as diabetes and heart disease.

He said patients taking de-addiction drugs or undergoing treatment to improve their mental health will also struggle.

“People are already being moved and camps are being cleared, so we already know what happens,” Feldman said. “People lose their medicines; they lose track of us.”

According to the report, mortality rates among homeless people are two to six times higher than those of people living in stable housing. The May report Drug overdose and coronary artery disease were the top two causes of death from 2017, according to the Los Angeles County Department of Public Health.

Feldman said it can be difficult to provide housing for people or get them into treatment programs.

“They trust us to know where they are so we can find them,” Feldman said. “And they trust that we know where they can get their health care. And if we can’t find them, oftentimes they can’t get their housing paperwork done and they can’t get in.”

The Biden administration has pressured states to expand the definition of health care to include housing. At least 19 Money from Medicaid — the state-federal health insurance program for low-income people — is being put toward housing assistance.

California is taking the biggest step, investing $12 billion Ambitious Medicaid initiative Its main purpose is to help homeless patients find housing, pay for it, and avoid eviction. It is also expanding dramatically Road Medical Services,

Margot Kushel, a primary care physician and homelessness researcher at the University of California-San Francisco, said the Supreme Court’s decision could hamper these programs.

“Now you’re going to see a disconnect with case managers and housing navigators and people losing touch in the chaos and disarray,” he said. “But what’s even worse is that we’re going to lose the trust that’s so important to get people to take their medications or stop using drugs and ultimately get people into housing.”

Kushel said the decision would make homelessness even worse. “Fines and jail time alone would make it easier for a landlord to refuse you housing,” he said.

At the same time, Americans are growing frustrated with camps that are spreading into neighborhoods, around public parks, and near schools. This spread is being seen as more trash, dirty needles, rats, and human feces on sidewalks.

Local leaders in deep-blue California welcomed the conservative majority’s decision, which will allow them to fine and arrest homeless people even if they have no place to go. “The Supreme Court today took decisive action that will finally make our communities safer,” said Graham Noss, CEO of the California State Association of Counties.

Newsom, a Democrat who leads a state with about 30% of the nation’s homeless population, said the decision gives state and local officials “decisive authority to enact and enforce policies to remove unsafe encampments from our streets,” ending legal ambiguity that “tied local officials’ hands for years and limited their ability to take commonsense measures to protect the safety and well-being of communities.”

This article was produced by KFF Health NewsWho publishes California HealthlineAn editorially independent service california health care foundation,