programs anytime. >> i'm robert doerr, president of ai and i'm happy to welcome you to this >> and the president of aei am happy to both to me today to this terrific conversation with three wonderful people. and to start out by mentioning the person who made us to do this and get it done fast and keep us inspired is sally. when i first came eight years ago the very second scholar that sally welcomed me to this wonderful community so kindly but that also showed me through her work on issues concerning mental

illness, addiction, healthcare , and cities how to be a great scholar. i have been inspired by her work ever since. i am so happy she told us we had to bring our special guests to the aei stage about a discussion of his latest book. i like the subtitle a lot why progressives ruined cities. and as someone who comes from new york city and spent some time in the early 2000's trying to make new york city better from what it had become in the seventies and eighties this has a particular now and it's a great book we had a lovely conversation you will hear aok great conversation today with sally representing aei and her work and also director of administrative policy studies program also is

a great scholar of cities and urban politics and ways in which things that have gone wrong but how they can get better and how things can be improved to make ourte communities more conducive. that is what i wanted to say to introduce this great panel discussion i went to welcome michael to the stage. it?hat is it feels like euro apocalypse one —- apocalypse never which is also a challenge of progressive orthodoxy on another issue. it's remarkable you can cover both so well. with that i will turn it over and welcome you to aei. thank you for being here. [applause] >> and to say a paragraph or two about the book and then we

have one hour so we will try to and and then take questions from everyone else. >> inc. you for coming. this was an important organization and a place i have come to respect and rely on. sally was an important source and inspiration for this book. i have come to agree. so certainly on this issue, a big part of the reason for the current opioid epidemic is due to the mistreatment or lack of treatment of mental illness and with that self initiative self-medicating. but i most known for work on the environment it was published last year as apocalypse never. i had a chance to do a follow-up for harpercollins in

this is what i wanted to do. i had late onset of its if any of, she did very well with a mental illness and livedde in a group home in denver. and two friends from high school who have both died from complications related to drug addiction and homelessness. and i live in berkeley california and a very sensitive person. i was certain the more moderate than it was then it was heartbroken i was are broken and sensitive to the humanitarian crisis on our streets which is both a particular challenge on the progressive west coast that you may know we had 96000 people die of drug overdose

and poisoning and it's a horrible drug epidemic the most famous is the opioid crisis. with the over prescription prescription opioids is a heroin epidemic and out into fentanyl which is a synthetic opioid and over half come from fentanyl. there is a terrible methamphetamine epidemic. now there's another book coming out early next month from the author of dreamland and the new book is about the methamphetamine crisis. i am excited to be here. i have beenn b influenced of another scholar at aei named scott and in particular the work he has done around the history of social programs in the united states and "san fran sicko" goes through that because i'm trying to make an argument that we are dealing with the drug addiction that this is not a function of raising poverty or reagan's

cuts to the health and budget which is one of those tales that progressives like to tell. so i will stop therere and i am honored and grateful. >> ifi will ask the first question. so it is an excellent book and talking about the history of the term of homelessness, can you encapsulate thats? for folks? >> the word homeless is an old word going back to the early 20h century. but it became a propaganda word in the 1980s. by that i mean it was deliberately chosen to mislead people about the nature of the people we call homeless on the streets.

and that is not my opinion that something that numerous scholars pointed out in the nineties and one of the best books on homelessness. it was clearly designed to get all to think of this as a problem on housing. so the frame is poverty and lack of housing. because that is how framing and that's how our brains work also designed to hijack your sympathies and distract usnt from what's going on which is missing on drug addictions in the 1980s that there was a crack epidemic and then the other jargon that would be used of this affiliation from the basic picture that you

become addicted to other substances or drugs and you stop working to service your addictionn you stay with family and friends until you steal or borrow from them and they kick you out and then a separate themselves from you as a traditional pattern and then you end up on the street. so the progressive left on those are voluntary but instead provided with housing which has not served them well. >> so to have the book about moral foundation theory so can you apply that, doing a little

psychoanalysis they can you apply that toad the advocates as well as the politicians? >> sure. so with "san fransicko" it turned out not to be the politicians it was the advocates and the intellectual architects of the discourse of this way of thinking. and also the other big prey is the religious impulse behind all of this apocalypse never argued it was a religion with the vision of the supernatural similarly "san fransicko" makes the same argument on the threats to civilization from and then. is not an expression and in the book that were describing the same thing and the person that has done the best work is

jonathan from new york university and is a cofounder of the theory that argues all major religions have six foundational values. and that they emphasize one of those above all the others. and that value is care or elcompassion. and i mostly agree but going furtheren to argue but will be argue is a sickness of that unchecked compassion. not balanced by what you may call old-fashioned values. but not bound by disciplined or hard work or accountability or responsibility. but to argue the victim ideology or woke religion with

all of those for care around victims. and with that value sanctity. andsa that what you might say is the moral tocr contaminate your body with drugs because your body is sacred and you should care for your body and it's wrong to camp on the sidewalk or defecate because you violate the sanctity that is the traditional view for how is the adherence to the new victim apology that we should perfect protect the sanctity of victims and victims bodies they should be free to do whatever they want because the victims themselves are holy and sacred so it would violate the sanctity of victims were arrest them for breaking the

law for reasons of their addictions. and then to have those defending those living in miserable conditions because of bodily autonomy at the way to say that they are sacred and then respect the sanctity of it and then to be violated byby the system and then not be violated by drugs. and that victim apology is so concerned with victims and then not with the 30 times of african-americans who were killed by civilians that's an interesting question and the answer is that if only the system can be victimizing. so with that honduran drug dealer stabs a drug addict with a machete which happens

frequently as retribution for notfo paying, it is not as important not really to be concerned with as arresting somebody because one in the system is evil. >> and. it denigrates people. >> without political structure that enables all of that. and with thatof religious structure that is taken over people's mind m expresses itself differently. but those thatle have written about the leftward trend overall. and then city being doubted by the left sign of that machine

in that particular state and yet some cities that are self-aware as progressive haven't had the same problems as san francisco or portland with that mindset seems to be organized to create an incentive for politicians to act on it where in other cities and their experience as a backlash. and then all eyes had been on it the past couple of years. and those at the same time people are demanding otheres actual resolutions to this problem. >> great question. the short version it is about culture more than particular institutions so let me say it

this way. my sister is very productive. she lives near boston and those that are dual diagnosed with mental illness and drug addiction. she and her on —- objected strongly to the subtitle of the book. she liked the book she read the book and i am persuaded this is an addiction problem not a housing or poverty problem that progresses don't behave like progressives in san francisco. but what has occurred in the is that theths open drug scene has emerged in boston. i'm not familiar with the east coast but massachusetts in is an open drug scene.

and when you read the coverage of the drug scene it describes it as an open drug scene. it says the opioid homeless crisis but it describes what is occurring there as fundamentally to use drugs and other tenants that are there to realize it is the introduction. in san francisco we have used euphemism there is coverage of the addiction problem but it is homeless and cantons which makes it sounds like everyone is camping out and helping each other as opposed to places of terrible abuse and victimization. so what is the difference? i think some of it is cultural. people would say it is the wild west out here. that is just silly like wild last. to say it is the wild west out here.

and that they created in the 19h century so there is definitely a corrupt political apparatus in san francisco. but then some of that goes to subsidize housing for homeless people and those that run the programs get the people that stay in the apartment to vote for the candidates that they want and then they maintain the funding structure. so torl push back the idea that so that ing any situation including the ones that i admire like in amsterdam which is the gold standard you deal with addiction and mental illness they do being

contracts at the salvation army so it is an ideological problem. i went to denver. obviously paid a lot of attention to philadelphia. and often it's very interesting because i look at as a model for what we should be doing because a very progressive mayor and city council allowed a backlash to pass 60 / 40 but it took the governor and the legislature to band public campaign to make a change. so i think part of the reason i wanted to do "san fransicko" it is our problem for conservatives are we would even call those of the moderate democrats to have thehe language or the thinking or the proposals of how to deal with this problem.

so that progresses hear what they are saying and then that this has been so inspiring this is the untreated mental illness problem but then we need to have helped the mentally ill then it changes how liberals think about it. that is one of the things i wanted to offer with "san fransicko" the moderates on the left and the right. >> getting into those interventions. >> and that they may not know that distinction and then that

permanent supportive housing and shelter just that competing ideologies so what we should do is what the dutch do ino amsterdam so that they have sufficient shelter that they build sufficient shelter. and then we found a homeless man or a man to sleep on the park bench and then they said you can't sleep here. we have a shelter for you. so ultimately the gray area and then to go into the shelter.

so with the shelter first policy that is not safe on the street —- is the basic view that's why you see people in amsterdam so then you get the evaluation if you haveif medical care including psychiatric care to people in their own room and studio apartment that's what everybody wants i certainly want one in amsterdam. [laughter] but you have to earn it. and those that are arguing with people then to say you can have your own room but you are not taking your meds and then you're notou showing up for your job that we arrange for you. so the housing is earned that

is the right way to do it. what we do in california is that deprives for the shoulders of the utopian idea everybody deserves their own house and impart onop —- department is called the housing first policy e-mail tom gladwell did a real disservice on this issue in the mid- 2000 and wrote an article for the new yorker advocating housing first. and this was advocated. and then it became bipartisan. and with that simplistic idea that you need housing to stabilize to overcome the addiction of mental illness but the truth is you need shelter but housing should be turned because itg is expensive it is a reward to make progress on your personal plan. >> i certainly see the wisdom of that.

obviously shoulders have to be so much better than they are i have seen 1 billion patients who sleep outside. that you ask in your subtitle why progresses ruined cities. i have a list of six. then you can fill it in number seven. and a block new housing construction and then divert funding from homeless shelters to the permanent living situations. the rights of people to characterize as victims on sidewalks and parks and they

intimidate experts policymakers by attacking them to be motivated by hatred of the poor and people of color and causing violence against them so with that mentality and of that advocate class the book is incredibly illuminating. now they are quite misguided and they work with people of addiction problems. unless you are incredibly motivated and with free access

and then it seems encouraged not just the old meeting people where they are which i am sympathetic to. and then to have them trust you but and then to do that as well. and that penalty for shoplifting and walgreens are being closed down. and that mentally ill and that puts him to the harm and harm induction which is interesting that relates towa what i was just saying of what i call subsistence harm reduction we

will meet you where you are and we will leave you there. >> that's a great word as opposed to aspiration harm reduction in many hopefully do want to move along but then there is more on —- one left and it is i leadership and that the leadership seems paralyzed maybe you can say more of that. >> so the book has a bonus reason or the seventh reason which is because moderates and conservatives let them that is the punchline of the book and where then i describe why conservatives have failed to with those cities that you documented it will be a surprise to any of you that cities have not been a high priority for republican and

conservatives that they need to be that aei ensued century organizations and in addition toti sally i quote chrissy was responsible for critical race theory that also onn the open drug scene. but then to recall governor gavin newsom form a democratic now an independent but i endorse the former republican mayor san diego in campaigned a little bit. and then gave a very intelligent and well-informed presentation of the reporters and then they went to them and said you just going to arrest

all these people and arrest the homeless? is that what you want? a very liberal media in california. and didn't have a answers that question and had a tactical level. and that moderate democrats. and with those propose psychiatric care. and that most of us to were on the left why they cannot have universal healthcare or why we shouldn't have and i don't think that will work anymore at least on this issue. i'm not saying we necessarily universal healthcare. but that is a sentimental

condition to solve the problem. and on a more philosophical level one of the inspirations from the book is the great late psychiatrist victor frankel famous because he wrote a foundational self-helprc book how he survived the holocaust. and then i wanted to know why he's very popular on the left. . . . . i thought that was

quite lovely pairing of these two values, certainly the right has talked about responsibility but i think really elevating those two things because we can as americans on the left and right go about as a country and we are about freedom and it would be equally aboutar responsibility. i'm curious to know how the different issues that large cities are facing are the sort of hierarchy. which ones are driving people out of them more. san francisco is an interesting place because the power of the economy helped it to defy gravity when they were leaving parts of california but the pandemic by severing place of work from residential kind of showed how much people want to

stay. in some ways it's a been a statement on people's confidence in the government and in the political class but is there something that can turn the tide? when people talk about san franciscoo i think it ranks liko 171st out of 174 on the housing affordability the not median income that looks like the average tech workers income and it ranks again 97th out of 100 and that's kind of well-known, yet there seems to be progress changing the way we regulate to make more of it available. but do you think that there is hope on one of these large issues like san francisco even if they don't quite figure out the homeless problems and mental

if she was behind it with these other big things that seem to matter to people would that restore confidence to do you dok in the political class or do you have to make progress all-out bonds? you have to make progress on a lot of things all at once. >> i have questions about whether san francisco can solve the open drug scene on the problem of homelessness. it's just such a liberal thing and progressive city. it's really strong and powerful. i think that it was like 80 or 90% of san francisco voters i have a lot more hope for california. they are more conservative than

northern it was transient. there has been movement to get more housing we utilized splitting the lot between the two houses. they will remainn extremely hig. the dirty little secret is 65% of the california voters are homeowners and anybody that's owned a home in california for longer than a year has made a ridiculous amount of money on their home.

it's not uncommon to find a value increased threefold or fourfold overol a ten or 20 year period. our value has more than doubled in less than ten years, and so it makes you more conservative in terms of voting for a different candidate because you wouldn't want anything to get in the way of that. at the other thing is depressing is that one of the responses i get from people when i respond people say yeah that's why i don'the go downtown. i'm discouraged about that part of it but in terms of the basic agenda that we are proposing, which is sheltered first, treatment first it pulls at 70 to 80% of support and one of the findings was to show the people arrested for public drug use or public defecation, you know, be

given the choice between jail or drug treatment, it had to stronger support from democrats and republicans which surprised me because i thought of the liberal dreaming of it but the hypothesis and i think it is thright from interviewing people that republicans, a lot of those in california are like why would you even offer the drug treatment, so i think that the public is significantly more conservative than one might be led to believe in the news media or social media. >> one comment and then we can open up for folks. it has to be stayed because if you fix one county, people move to the next and so plus there's no accountability for a lot of these nonprofits that provides the services, but it seems to me you have constantly kind of hanging over your head the

horrible images of these institutions. i would like to see an asylum movement actually come up at, be make it benign and when we have the real asylum movement even back in the past 1800s these were all the forms and it was a beautiful environment and there were no medications and now the synergy of those could be amazing. they are lucky i describe the history of how badly we've dealt

with people with mental illness, schizophrenia, severe bipolar. before dorothy dix created the mental hospitals in the 19th century, people were being chained in basements and on a farm and so this is the most difficult to deal with. we told a story in san francisco the debate among my colleagues and i since this book was in a very w collective effort we tola story where renée describes being askeder to take care of a man with schizophrenia that is a friend of the family anna says sometimes you do things you're not supposed to do. he said i grabbed him a couple of times by the lapel you've got to come with me to the hospital or else andik he said i didn't know where the or else was going to be but it would be really intimidating to be grabbed by renée and he told a story he

kind of basically muffled this guy into getting the treatment he needs but now he has his own apartment and a job. i just talked to him earlier this week and he said i'm fine but there's people staring at me through my window. we told that story because that makes renée look kind of like we are suggesting the rules should be broken we have more mentally ill people than any other institution in the united states right now and they are kept in plexiglass jail cells where things happen and it's plexiglass so they can be hosed

down. i think we need to grow up a little bit as society because that happens is the hospitals were short staffed during the great depression and world war ii and at the magazines took photos and others that looked really bad and many of the reformers in the way that americans tend to be sometimes with of the cultures we said we have to just shut these hospitals down and many people ended up homeless in the streets or in jails and prisons. a part of what i wanted san francisco to do " is to say lets grow up a little bit, this is a difficult group of people to dealup with and sometimes some amount of coercion early on is going to result in greater humanity later on.

>> i sometimes think there is an unholy alliance between antigovernment conservatives who don't like bureaucracy and case management and hassle and if there are some libertarians in there. and now the left doesn't l like paternalism, but how do you respond to someone who says you're going to hassle these people or you are being paternalistic, how have you dealt with that challenge? >> of course it depends we mentioned earlier when we were trying to figure out, we realized we needed a new institution in california so one question is what do you call it and we decided to call it california psych rather than treatment although it would be treating people with like the 25-year-old guy with a heroin problem, with no serious mental

illness, sally would probably say the kind of anxiety and depression that i suffer from, like something that should be manageable without using heavy drugs. we feel like when you explain to people that this is about mental illness, we find many more liberals get that when it's easiest to hardest to accept of the agenda, i would probably go in voluntary treatment is the easiest to accept interestingg heroin addicts for using heroin as much lower than that. funding the police turns out to be popular. i didn't mention but we have three chapters in the book about homicide, the m burger of all crimes and i just came out of it as a liberal and to someone

that's been in the criminal justice just pro- police, like the evidence for policing is outstanding in terms of reducing all crimeses and homicide. i am a big believer in the ferguson affect i think that it's real. there's at least 30% of the progressive hard-core that will never be with us and will have any objection. the radical anti-psychiatry movement genuinely believes they are worse than jails or prisons and basically the deniers of mental illness so the short answer is for the truly open-minded folks to start with psychiatry and for the hard-core wewe didn't have an argument.

i'm glad you mentioned this because the situation is a little different than in san francisco and i was interested to read at the wealthiest man there, ken griffin suggested it's amount of time before they move out of chicago because of the crime problem andnd you wonr not as wealthy or strong as san francisco how long does it take for them to become a failed a f citythat's where these things sm to be going. question, one of the freedoms we havell in this country which is important is thery ability to me out which is i think part of what's behind conservative observation of the situation and also to compare one place to another so with respect to the amsterdam model, which a very interesting part of the talk is any place in the u.s. adopting that model, or are they doing it in florida?

i look forward to eventually you've got to get the message will come up. some people are doing it right with better results versus others doing it wrong. >> yes, miami is doing it better, new york is doing it better. there was we decided to use amsterdam in part because we thought itll was an easier pillo swallow the a new york particularly from san franciscans that defined themselves in opposition to new york. we were like in san francisco because it's not like new york and it's not, it is prejudiced ifhe there is not just prejudice in the sense that one of the things i love about san francisco is when you meet had anybody never in the area asked me where i went to school and i go to parties like nice to meet you where did you go to college is that how i'm going to be ranked on the totem pole.

it was viewed as liberal but everybody does a better job than the progressive cities of the west coast. miami has done a good job and we describe it is similar to a shelter first treatment policy before the pandemic, something like 99% of its homeless we shelter about a third in california. one of the most disturbing findings of the research is that it was homeless advocates in california who've deprived the funding to build sufficient shelter for the homeless and it also fought against the requirement to sleep in the shelters but that's just insane

and one of the things i'm most proud of in this book on the radical left i did find that even some of the most radical left advocates for the homeless, not all of them would say we do need to build sufficient shoulders now to get people out of control but when you look at what works, it's always the same sthing. if there isn't any variation. there are differences between the approach to this and amsterdam. lisbon engages the families more in doing interventions with addictsdi but every one of the five major cities in new york and miami to make sure they have sufficient shelter to require they enforce laws including the public drug use campaign and they make a drug treatment and alternative to incarceration rather than completely optional

whicht is what we've done in california. >> if i could say one thing, we just had a survey center that just yesterday released a report where we ask people to question it and others have asked where would you live if you didn't know where youou were and residents of big cities the majority of them want to leave and they b always kind of have. it's like 80% of people say that that would be the top choice of where to live which is down a considerable amount so there is something going on right now, not just san francisco but elsewhere where they feel like there's a crisis. he feels like you had a target on your back and when we ask people what is the number one

issue you are concerned about its overwhelmingly crime as you would expect. it's kind of gotten in the water but that seems to be just those two issues are huge drivers first, thanks so much it's been a great and fascinating talk. back on the subject of commitment and i would like to hear cy's opinion i know in the history mental health treatment there was a bit of an affect with the introduction of antipsychotic meds to use that

as an alternative to institutionalization and i think i have a lot of negative effects on the long-term for these illnesses and also there were legal or regulatory guidelines. so, i'm curious about how can you overcome these sorts of both legal and practical issues that would rather prescribe antipsychotics or who don't want to go through the hassle of committing or if they face administrative obstacles doing that also howac do you achieve e right balance of let's say long-term institutional care and pharmaceutical treatment?

>> the general resistance to commitment every state has different thresholds although they agree there is a commonality and most have a grave disability although not all if you are hallucinating in the park and freezing but i guess i would say that if the rest of the vision was filled in and in other wordsas there was a good basic mental health infrastructure then so many people would be contained within that there was a time that we needed to use coercive measures you would be dealing with the most forwardly severe individuals and it really

wouldn't be that much of a question that we have to intervene and then once someone is stable, you can use other kinds of especially if they've committed a crime or something called assisted outpatient treatment which i know is in your book to say we want to institutionalize people in the least restrictive setting as much as possible. that's been taken way out of proportion meaning we should never contain but that containment is needed for a period of stabilization, then there's that intermediate phase more maybe they can live in the community, but you know, they are still not taking their meds responsibly. are you familiar with that?

i think there's a criminal counterpart to it but basically there's that continuing supervision, so that was my answer. >> i agree. these t treatments needed to bea better standardized and follow better practices because there is so much inconsistency. we are not using conservatorship nearly as much as we ought to be doing and then also the patient treatment that came out in new york where i can't remember the last name but she was pushed in front of a subway car by a mentally ill person that wasn't taking hisav meds. we have the law in a very similar situation in california. we should be using a lot more. it's just been opposed by

policymakers that have engaged in unconscionable fear mongering that it doesn't exist. i think there are some bad ideas that underline a lot of this. it's funny because on the one hand, there's been a whole pop-culture reaction on the conservatorship for britney spears ands i'm like we don't know what was going on in that situation.e the picture people have is that her father was just manipulating her for money but we have no idea whato kind of behavior she was engaged in or what happened to her but i think for homeless folks there is much more willingness to use conservatorship versus outpatient treatment. one of the doctors that is a character ink the book that wors on skid row has been getting good results with these injectable antipsychotics with people on the streets even

before but to reinforce what sally was saying, a lot of people that you could get into the right care and treatment if you have a proper system before you needed to start arresting everybody. to prevent people from using drugs in public so it does get to the hard-core schizophrenics. >> thank you. it's a a great book. maybe some folks took it already. hopefully there's enoughh, and f there isn't, i know that we arranged to send one to you so you will get one.

thanks, everybody.

good evening virtual audience and welcome. thank you for joining us today. on behalf of harvard bookstore i'm pleased to introduce this event for the new book white space, black hood segregation if the age of inequalities during the conversation. thank you y for joining us tonight. the events like tonight continue tort bring authors into their wk to the community and the new digital