California homeless crisis looms as...

the nexus of mental illness and homelessness. Research indicates roughly 1 in 20 Americans have a serious mental illness, but for unsheltered homeless people, it’s 1 in 4, Insel said. He sees CARE Court as a “twosided mandate,” making counties legally liable for providing services for people whose survival is at risk because of untreated mental illness while putting individuals on notice that they are responsible for accepting that help. Still, he worries the state’s homeless population is so overwhelming in scope, their isolation so entrenched, that it will be difficult to make headway.

“You can have all the clinics and all the medicines and all this good stuff to offer, but if people aren’t engaging with it, it’s not going to help,” Insel said. “And if there’s no relationship and no sense of trust, it’s just really difficult to engage.”

For Daniel Goodman, the return to mental health took both carrot and stick. Looking back, he can see his refusal to take his prescribed medication after being diagnosed with schizophrenia — he felt “freer” without it — set him on a dehumanizing spiral. A primal need for food and shelter led him to ask his mom for help. But without her “hammer” — the ultimatum — he would not have agreed to treatment. And without the medication, he said, no doubt he would be back on the streets, at the mercy of his vicious “witch” and scraping to survive.

“I’ve battled this question [of needing medication] for years,” he said, reaching for his mom’s hand in her sunlit living room. “I accept it now.”

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If California is to make a visible dent in its homeless numbers, affordable housing presents the most daunting challenge. The state lacks the extensive shelter networks common in places with colder climates — an estimated 67% of people living homeless in California are without shelter.

And in recent decades, a mire of zoning restrictions and real estate development practices have transformed the housing market, jacking up rents and home prices and shrinking the options for lowwage workers. For every person moved off the streets, many others stand a paycheck or medical emergency away from losing their housing.

The longer people live on the streets, the more their health deteriorates. Addiction and mental health problems deepen. Chronic diseases advance.

“There’s almost nothing as destructive to health as homelessness, and there’s very little that the health care system can do to make up for it,” said Dr.

Margot Kushel, director of UCSF’s Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital. “You just fall apart.”

The arrival of covid-19 — and fears the virus would carve a deadly swath through shelters and encampments — gave Newsom an unexpected opportunity: open housing units in record time by throwing pandemic emergency funds at the problem and circumventing land-use restrictions and environmental reviews that can drag out approvals.

In 2020 he launched “Project Roomkey,” converting dilapidated hotels and motels into temporary housing for homeless people deemed vulnerable to serious covid infections. That morphed into a program to convert underused structures into permanent housing, and today the retooled Project Homekey has laid the groundwork for more than 12,500 housing units.

But much of that is one-time funding for start-up costs. If cities and counties want to participate, they are required to put up money for ongoing operations and services. And many have decided it costs too much to buy in.

“I really wanted to pursue a project, but it just doesn’t work for a lot of rural counties,” said Jaron Brandon, a supervisor in Tuolumne County, a forested province in the Sierra Nevada.

“Rural areas like ours have much lower tax revenues, and we had to figure out five years of funding, so when you start adding up all these costs and requirements, all of a sudden, we can’t afford to think big. It starts cutting into critical issues and basic services like funding roads and wildfire response and public safety.”

Cities taking part in Project Homekey find it’s hard to move fast enough when the newly homeless keep arriving. An estimated 172,000 people were homeless in California in January 2022, a nearly 13% increase since Newsom took office in 2019.

Sacramento Mayor Darrell Steinberg welcomes Newsom’s push to more aggressively reduce homelessness. He also sees the confounding reality on the ground. The city and Sacramento County have poured millions into new shelter beds and permanent housing, only to see the homeless count surge to 9,200 in 2022, thousands higher than two years prior.

“We have housed over 17,000 people — undeniable success” — in the past six years, Steinberg said. “But it’s not success in the eyes of the public, understandably so, because all we see out on our streets is increasing numbers.”

The agreement came as the two nations confront China’s growing assertiveness in the region particularly in the South China Sea where Beijing has built island fortresses and harassed nonChinese vessels.

The two nations’ security commitment emerged after a meeting between President Marcos and Japanese Prime Minister Fumio Kishida on Thursday, February 9. The agreement is also expected to speed up military deployments for humanitarian assistance and disaster relief.

They also signed several other deals, ranging from infrastructure loans to cooperation on agriculture and technology.

“After our meeting, I can confidently say that our strategic partnership is stronger than ever, as we navigate together the rough waters buffeting our region,” Marcos said following talks with Prime Minister Kishida.

Japan is “one of the Philippines’ closest neighbors and closest friends,” Marcos later told reporters.

But for now, the leaders are taking an incremental approach to defense cooperation, probably to avoid provoking Beijing, said Renato de Castro, professor in the International Studies department at De La Salle University.

“Both countries are still very much aware that they have touched a sensitive nerve in China (by) creating the possibility of an Asian encirclement of China,” De Castro said.

In Beijing’s view, “this might be the beginning of an Asian NATO. Because you really have Asian countries strengthening and enhancing their security partnerships.”

Worried about Beijing’s growing assertiveness on Taiwan and bases in the disputed South China Sea, Manila has been repairing ties with Washington that were fractured in recent years.

Given its proximity to Taiwan and surrounding waters, cooperation from the Philippines would be key in the event of a conflict with China.

“We will also look into ways to promote our defense equipment and technology cooperation and to strengthen cooperation amongst the Japan, the United States, and the Philippines,” Kishida said.

He said Marcos’ visit gave Japan a renewed momentum for the two nations to further upgrade bilateral partnerships for them make further contributions to the peace and stability of the region and the world.

“With regards to our security cooperation, I explained to the President such matters as Japan’s national security strategy and the President welcomed Japan’s commitment to the free and open international order based on rules,” he said.

Japan is also the Philippines’ biggest diplomatic source of active development assistance, according to Manila, and its second-largest trading partner.

It is the only country to have a bilateral free trade agreement with the Philippines.

Steinberg asked himself: “How is it that we are successful in getting tens of thousands of people off the streets only to see the numbers grow?”

Jason Elliott, Newsom’s deputy chief of staff, runs point on homelessness for the governor. He said the question of how to close the homeless spigot is motivating them to think bigger and be more aggressive.

Clear out encampments, and at the same time connect people with housing and services. Steer more federal dollars into homeless response. Amend state land-use laws to enable counties to site and build housing faster. Turn the state Medicaid system, Medi-Cal, into a tool to combat homelessness by marrying health care and housing — for instance, funding the first and last month’s rent and asking insurers to work with landlords to find housing for homeless people.

Elliott rattled through a list of reasons he thinks explain how the problem got so entrenched. California is generous with benefits. Its climate is hospitable. The extraordinary cost of living. He also reinforced the administration’s prime strategy: It’s not just about more money, but forcing cities and counties to go harder at the problem with the resources they have.

“The most important thing that we have to do as a state is build more housing and get more people into services, and fundamentally that is a local government responsibility.” Elliott said. “Local government are the providers of behavioral health services, and they are the ones who choose whether or not housing gets permitted.”

As the administration takes its “just get it done” message across the state, those involved are keenly aware there’s a wider audience.

“There’s a broad sense in this country that we’re falling apart at the seams, and homelessness is part of the proof, to voters, that we’re falling apart. People want this problem fixed, and they want resolute leadership,” said Sragow, the Los Angeles strategist.

“The country is watching. Gavin Newsom has a record of getting out front on big national issues. Sometimes it works, and sometimes it doesn’t.” (Angela Hart/Kaiser Health News)

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

His trip comes a week after Manila announced a deal giving U.S. troops access to another four military facilities in the Philippines.

Japan last year announced a major defense overhaul, pledging to double defense spending to the NATO standard of two percent

On Thursday, February 9, the countries also agreed loan agreements and extensions for Philippine infrastructure projects, including $3 billion to finance major commuter rail projects. 