programs anytime. >> i'm robert doerr, president of ai and i'm happy to welcome you to this terrific conversation with three wonderful people. i want to start out by mentioning the person who made us do this and get it done and get it done fast and

kept us inspired that's sally frizzell. when i first came to aei when i was eight years ago the second scholar i met after the great john makin was alice and she welcomed me to this wonderful community so warmly and kindly but also showed me through her work on issues concerning mental illness and addiction and healthcare and cities how to be a great scholar and i've been inspired by her work ever since and i'm so happy that she told us that we had to bring our special guest michael shellenberger to the aie stage and have a discussionabout his latest book , "san fransicko" is that how you say it? why progressives ruin cities. that subtitle, i like that alot . again, "san fransicko: why progressives ruin cities". as someone who comes from new york city and spent time in the 90s and early 2000 trying

to make new york city better from what it had become in the 70s and 80s, this book has struck a particular note. it's a great book. we had a lovely conversation upstairs and you're going to hear a great conversation with sally representing aei and also ryan streeter, director ofdomestic policy . he is a great scholar of cities and urban politics and the way in which not so much things have gone wrong but how things can get better and how things can be improved and make our communities more conducive to human flourishing because this is what we're all after . i think what i wanted to say to introduce this great panel discussion. i want to welcome michael to the state. you might have thought what is this because it seems like yesterday you wrote a populist never which is also a challenge towards progressive orthodoxy on another big issue . it's remarkable that you

broke ground so well with that i'm going to turn it over to sally and ryan and michael and welcome you all to aei . >> i wanted to start just by adding a paragraph about the book and asks some probing questions and we have an hour so will try to end about 1:40. we will take questions from everyone else. >> thanks all of you for coming, it's a pleasure to be back aei and this is an important organization in a place i've come to really respect and rely on. sally is an important source of inspiration for this book. i've come to agree with her on i can't think of anything i disagree with her on certainly on this issue that a big part of the reason for the current opioid epidemic is due to the mistreatment or lack of treatment of mental

illness and that a lot of people were self-medicating when they should have been getting better medical care. i've been most known for my work on the environment. on mywork on the environment was published last year apocalypse never . i had a chance to do a follow-up for harpercollins this is the topic i wanted to do mine on and i laid on schizophrenia. she was never homeless. she did well for folks with that mental illness. i lived in a group home in denver. i had two friends from high school that apple died from publications relating to drug addiction and homelessness another friend that's struggling with long-term cocaine and alcohol addiction. i live in berkeley california. i live in san francisco and it's all part of the world i love and i'm a very sensitive person still even though i'm

certainly more moderate than i was when i was part of the radical left, still really heartbroken and sensitive to the humanitarian crisis on our street which is both a particular challenge on the progressive west coast but most of you may know we had 96,000 people die of drug overdoses and drug poisoning last year. we're in the middle of two drug epidemics, the most famous is the opioid crisis which starts with the over prescription and becomes an heroin epidemic and now we're in fentanyl which is incredibly deadly. half of our overdoses came from fentanyl but where in a terrible mess epidemic. there's a terrific book coming out early next month by sam king dreamland which is a book about the opioid crisis and the book is about the mess crisis so i'm excited to be here. i've also been influenced by another scholar at aei todd winship and particularly by the work that he's done around the history of social

programs in the united states and "san fransicko" goes through that because part of what i'm trying to do is make an argument that we're dealing with a drug addiction and punishing mental illness crisis first and foremost this is not a function of rising poverty or reagan's cuts to the house and budget which is one of the chestnuts that progressives like to tell. so i'll stop there and i'm really honored and grateful to be able to participate. >> i'm going to ask the first question. the chairs were supposed to be, they all look at each other. maybe ryan can move his a bit . one of the things in the book and it's an excellent book, you talked about the history of the term homelessness. could you encapsulate that for folks?

>> the word homeless is an old word. it goes back to the early 20th century but it became a propaganda word in the 1980s. and 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's not my opinion. this is something numerous scholars pointed out in the 1990s including christopher jenks of harvard who wrote one of the best books on homelessness and it was clearly designed to get people to think about this as a problem. we say people are homeless and the frame is where dealing with the problem of poverty and a lack of housing because that's just how framing and cognitive, that's how our brains work so the word homeless is designed to trick your brain into thinking of this as a problem of poverty and is designed to hijack your sympathies and distract us what's really going on which is mental illness and drug addiction.

in the 1980s there was acrack acted epidemic . track and alcohol which were the two drugs that paired in the 80s leading to homelessness and the other jargon that would be used as this word this affiliation and this affiliation, the basic picture is you become addicted to alcohol or other substances or drugs. you stop working to service your addiction. all along you stay with family and friends until you steal from from them or borrow from them and they kick you out and separate themselves you. it's a traditional pattern and you and up on the street. i think the progressive left really the radical left to some extent the broader left as done a real disservice to people that are in need of medical care and to a great extent amount of intervention, legal or voluntary but instead we've been providing them with housing which has not served them well if not dealt with

the root cause of the problem . >> can i do a follow-up? you have a lot in the book about moral foundation theory. and that's rooted in johnson's work, most folks know. can you supply both? it's dual psychoanalysis as it were butapply that to the advocates as well as the politicians . >> sure. the day pray in "san fransicko" turned out to be not the politicians. it's really the big pray were the advocates. the intellectual architects of this discourse of this way of thinking and also i think the other big pray is the religious impulse behind all of this. so apocalypse never argued apocalyptic environmentalism is a religion. it has both a numerology and division of thesupernatural , similarly "san fransicko"

makes that same argument and this is the second book in the trilogy i'm giving on the threats to civilization from within. so i try to understand this religion which is now being called a work religion, it's not an expression used in the book but we're describing the same thing and the person next on the best work on this is jonathan hite at new york university and he is the cofounder of something called moral foundation theory which argues that all religions, all major religions six foundational values. and that what progressives have donewith local religion is they emphasize one of those six values above all the others and that value is care or compassion but care is the word that he used . i mostly agree but we went a bit further i think to argue that this woke religion which is also what we argue is a

kind of san fransickness, a compassion not balanced by old testament values, not balanced by responsibility. we go further and argue that this victim ideology, this woke religion does redefine all five of the other values along with care around victims so for example one of the six moral foundations is the value of sanctity. and in a traditional morality, you might say it's immoral to contaminate your body with drugs because your body is sacred and you should care for your body or it's wrong to allow people to camp on the sidewalk or defecate in public because you're violating the sanctity of the city. that would be a traditional view so how does the adherence to the new technology do it? they would say we should protect the sanctity of

victims andthe sanctity of victims bodies . though victims should be free to do whatever they want because victims of assault are holy, their sacred. we would violate the sanctity of victims by arresting them for doing, a racing the law including related to their addictions so when i what i found in the book is i would find radical left both defending people being attics on the street living in these conditions because of bodily autonomy which is a way of saying their bodies are sacred and we should respect the sanctity of it and it would be violated by the system but it would not be violated by drugs. i find the same thing for example one of the questions is victim knowledge he is so concerned with victims, why are progressives solely

concerned with african americans killed by police and not concerned with the 30 times more african americans killed by civilians ? it's an interesting question and the answer is that only the system can be victimizing so if a honduran drug dealer stabs a drug addict with a machete which is something that occurs frequently as retribution for not paying , that's not as important as or not really to be concerned with as arresting somebody because one has bucked the system and even the system is evil. russo said the society iswhat denigrates people . >> if i can follow up on what you learned in writing the book about the political structure that enables all of that. that's really compelling argument about the ideological and clause i religious structure that has taken over a lot of people's minds yet politically it expresses itself differently

in many places. over the last 20 years or so i and others have written about the leftward trend in citygovernment's overall . in partisan terms you use to have an equal split and you see it retro areas the city being dominated by the left side of the political machine . and yet some cities that are very progressive having had same up some of the same parlance as san francisco or portland where the mindset seems to be organized to create a senate for publications to 20 where as in other cities, i'm familiar with boston, is a progressive city yet their experience with street homelessness is creating a backlash that you don't see in san francisco. and they say you're from there, all eyes have been on it over the past few years and this problem as metastasized. to what extent does the

political class there that you see in other places that might consider themselves progressive yet at the same time people aredemanding other resolutions .>> great question. i think this is the short version is it's really about culture more than it is about particular institutions although let me say this way. my whole family is progressive and my sister is veryprogressive . she lives near boston and does permanent housing for people that are dual eligible or dual diagnosed with mental illness drug addiction. she objected strongly tothe subtitle of the book . she liked the book. she read the book and she was like persuaded this is an addiction problem fundamentally, not housing or poverty problem but progressives in boston don't behave like dresses in san francisco. she's mostly right although

what occurred in the last few months is that an open drug scene has emerged in boston and i'm not familiar that much with the east coast but in a place that is massachusetts, is known as mass and cast in boston but it's an open drug scene and what's so interesting is that when you read the boston globe's coverage of the open drug scene, it describes it as an open drug scene. it says opioid list crisis but it describes what's occurring there as fundamentally a place where people buy and sell and use drugs and the tents that are there are people servicing their addiction. in san francisco we've used euphemisms. there is coverage of the addiction problem but it's homeless and cabinets which is makes it sound like everyone's camping out and helping each other. as opposed to places of real terrible abuse and victimization. so what is the difference? some of it is just cultural.

one of the things when i would interview people they would say it's a wild west out here and i was going to roll my eyes and go on, that's just silly. wild west and by the end of the book i said no, it is the wild west out here. there is a cultural wild west because san francisco was the last city to shut down the opium dens that chinese immigrants created in the 19th century. we had more bars per capita than churches. there's definitely a corrupt political apparatus in san francisco. the most dramatic instance of this is that taxpayer money goes to subsidized housing for homeless people, the mentally ill. the people that run those programs get the people that are staying in those apartments to go and vote for the candidates they want and

those candidates turn around and maintain thefunding structure . there's clearly that i push back against the idea of this is reducible in any way to money goes in any situation including in ones that i admire like in amsterdam which is the model i believe is the gold standard of how you deal with addiction and mental illness there still doing big contracts. they do big contracts to salvation army. i think it's an ideological problem. it's been the last couple of weeks i went to denver . i've obviously paid a lot of attention to philadelphia where there's a bad open drug scene. austin is very interesting to cause i would often have a model for what we are doing because as you know, they had a progressive mayor and city council that came in that allowed public campaign. there was a backlash, voters passed the ballot initiative to ban public campaign but it took the governor and legislature passing legislation to ban public campaign to make a change to things.

i think that part of the reason i wanted to do "san fransicko" was i think the problem for conservatives or what you might call the center right or even the san francisco we would call moderate democrats is they have the language for the thinking or the proposals to how to deal with this problem so it progresses here that they think of what conservatives are saying is we want to lock up all the addicts and put them in jail as opposed to say no and this is why i think sally's work has been so inspiring as this is anuntreated mental illness problem . it's an addiction problem. our proposal something called calcite, liberals love new government programs but when you say we need to have calcite to help the mentally ill and attics, it changes i think i'll liberals think about it so for me that was one of the things i wanted to offer both to moderates on the left and right was we do

need isnot just a messaging question . >> i know we're going to get into these issues of addiction and what the best interventions are before we do that just to a lot of people watching today may not know the distinction of the housing, this is such an essential part of the debate where cities have different fromeach other . what theirhousing tuition is . there's a permanent supportive housing and shelter and all that but could you lay out the kind of competing ideologies when it comes to housing because for a lot of people walking down the street their first impression is people should be somewhere else and there's a whole debate raging about where that should be. >> let me start by saying what i think we should do which is what the dutch do in amsterdam is that they have deficient shelter for everybody that needs it. they've built sufficient shelter for everybody it means they have empty bed at any time, we found a homeless

man or a man trying to sleep on the park bench and the person i was shadowing said you can't sleep here. we have a shelter bed for you,let me take you there . ultimately it's a gray area. he did let the guy sleep there last night but then he said you have to go into shelter. everybody has to be in shelter but it's a shelter first policy and you're saying you need to be in shelter because it's not safe on the street. that's the basic view of the.and that's why you don't see homeless people in amsterdam . when you're in shelter you would be get some evaluation. if you need medical care including psychiatric care so it's also treatment first and housingis something that would be earned . what a lot of people want is their own room. and want their own apartments, their own video apartment. who doesn't want a studio apartment in amsterdam ? i certainly do but you have to earn it. i saw renc was a character in the book, a dutch social

worker basically arguing with people who would be like i want my own room and he would say you can have your own room but you're not taking your beds or you can have your own room but you're not showing up for your job that we arranged for you so the housing is earned. shelter first, housing earned. that's the right way to do it . what we see in california is we have to private funding for the shelters because out of a utopian idea that people, everybody deserves their own house or their own apartment and this is official federal policy all they housing first policy. malcolm gladwell dida real disservice on this issue and in the mid-2000 he wrote an article for the new yorker advocating housing first . philip bogdanovich who worked for george w. bush recently was advocating for housing first it became bipartisan. it's just a really simplistic

idea. the idea is you needhousing to stabilize and overcome your addiction . the truth is that you need shelter for that. housing should be earned because it is expensive. it is our reward formaking progress on your personal plans . >> i certainly see the wisdom of that. i know the incentives are all misaligned here but obviously shelters have to be so much better than they are. i see 1 billion patients who would rather sleep outside. stuff is stolen and worse. you ask yours subtitle why progressives ruined cities and i have a list ofsix reasons . so i'm going to read that. and then you can fill in and tell us.

so you've touched on some of them but i think this is also an organizing summary . they block new housing production in cities and suburbs and diver funding from homeless shelters or the permanent living situations. defendant rights of people they characterize as victims to camp on sidewalks andparks and so on . they intimidate experts and policymakers by attacking them as being motivated by hatred of the poor. people of color and the sick and causing violenceagainst them . if you want insight into the mentality of the advocates class when it comes to this i think yourbook is incredibly illuminating on that . and that's stipulate i think a lot of these people do mean well. they really do want to help people. i personally think they are quite misguided having worked with people of addiction problems for a long time.

if unless you're incredibly motivated, so many people are ambivalent about quitting drugs and yet it if it's available and normalize they're probably not going to stop . so the situations where there's free access and in some ways it's almost encouraged. not just the old meeting people where they are. you don't want to come in with jackboots and a coercive mindset. you want to invite people to get care and have them trust you how long does this based on and sometimes i think way too long and i know you do as well. so a few more. reduced penalties for shoplifting and i hear we have five walgreens being closed down. this is about the mentally ill specifically prefer

homelessness and incarceration to involuntary hospitalization for the mentally ill . and an ideology that blinds them to the harm of harm reduction which is interesting and that goes and relates to what i was just saying about this. what i call subsistence harm reduction which is to say we will be you where you are and effectively leave you there. as opposed to aspirational harm reduction which is we want to move you along and some people, hopefully many who do want to move along and then there's one left. i should make this into a quiz but it's leadership. that's number seven about why how they ruined cities. the leadership teams paralyzed so maybe you can send a little bit more ofthat . >> the book is called why progressives ruined cities but the seventh reason is because moderates and

conservatives let them. at the punchline of the book and that's where i then describe why conservatives have failed to contest progressive agendas in so many cities that were documented. the short answer won't be a surprise to any of you which is just that cities have not been a high priority for republicans and conservatives . aei, manhattan institute and center-right have done great work and in addition to sally i also quote chris rufo who is famous for critical race theory but he was a really terrific journalist on open drug scenes in countries and mental illness in cities and also stephen hyde who isa senior scholar at manhattan institute . but we attempted recall of governor gavin newsom on the former democrat, not independent but i introduce the former public and mayor of diego and campaigned with

him a little bit and we did a press conference in front of an open drug scene in los angeles and gave a very intelligent i thought and well-informed presentation to the reporters but after we were done thereporters went to them and saying what are you doing, you want to arrest the homeless ? it's a very liberal media in california i don't think it's unusual if you ask that question and a lot of cities and the esa good person obviously i endorse him but he didn't have a goodanswer to that question . so that's where i ended up going. at a practical level i'm proposing that the moderate democrats or the center right in california and nationally opposed universal psychiatric care. that's not something that has been traditionally a high republican priority. i think most of us that have

been on the left have heard republicans give reason why we can't have universal healthcare or why we shouldn't have it and i don't think that's going to work anymore or working at least on this issue. i'm not saying we need to permit universal healthcare although personally i think we do need that universal sciaticpsychiatric care is a precondition of solving this problem . at a more philosophical level i one of the inspirations from this book is a great late psychiatrist victor frankel. he's famous because he wrote a foundational self-help book called man's search for meaning about how we survived the holocaust and how we survived the concentration camps by having a positive mentality and i wanted to know why, and he's very popular on the left. popular with progressives and i wanted to know why the left has accepted victor franklin for their own personal

behavior but rejected it as blaming the victims in politics and that's the accusation that the left obviously makesagainst conservatives . and that was where i came to this question of victim apology but one thing i've discovered that victor, he loved america and he loved the freedoms that we have here but he said you know, freedom is not enough and you also need responsibility and he even proposed that he said you've got the statue of liberty on the east coast and he proposed that we build a statue of responsibility on the west coast and i thought that was quite lovely pairing of these two values. certainly the right as talk about responsibility but i think really elevating those two things because freedom attend as americans on left and right tend to go what are we about as a country but i'm arguing we need to go deeper and the equally about responsibility . >> i'm curious to know how the different issues that large cities are facing are

sort of the hierarchy. which ones are driving people out more? i think san francisco is an interesting case is the power of the economy helps it to defy gravity even when people are leaning on other parts of california but the pandemic by discovering a patent place of residence showed how much people want to stay and you see how many people are leaving and in some cases a statement on people's confidence in the government there, in the political class and all that. is there something that could turn the tide? we haven't talked about affordability and when we talk about san francisco that's out of people's mind. it ranks 171st on housing affordability. we have a tech worker index that our housing center puts out that looks at not median income but the average tech workers income and how much home they can buy and it ranks again 97 out of 100 and

that's well-known yet there seems to be some progress on this discussion about changing the way weregulate housing and all that to make more of it available or not it breaks the cost down is another thing . but do you think that there is hope for a city on one of these large issues like san francisco that even if they don't quite figure out the homelessness problem and mental mental illness problems but they solve these other big things that seem to matter to people with that restore confidence do you think in the political class there or do you have to make progress on all of that at once ? a lot of the cities it seems like you have to make progress on a lot of things. >> i have real questions about whether san francisco consult the open drug scene and mental illness problem, what we call homelessness. it's just such a liberal city . it's such a progressive city and the machinery that has allowed for progressives to stay in power and for the homeless problem to get worse

, it's really strong. it's powerful. i think it was like 80 or 90 percent of san francisco voters voted against the recall of the governor so it's very liberal. i have more hope for california. southern california has always been more conservative plus the central valley is more conservative than the midwest so i do have more confidence and i also think this is a problem that needs a statewide solution because one of the words that we use to use to describe the people we now call homeless was transient . and it's because it's a highly transitive population moving from cityto city so the difficult population to treat in that way. i tend to think it would be difficult . there has been some movement to get some more housing. we just legalize splitting your lot into two houses although i just do not think

it's going to significantly reduce housing prices. the housing crisis will remain extremely high and i think the dirty little secret is that 65 percent of 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 people whose jobs increased threefold or fourfold over a 10 or 20 year period. our house value has more than doubled in 10 years. 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 . the other thing that is depressing is that one of the responses i get from people when i would describe working on this bookor twitter is people go yeah, that's why i don't go downtown . you're just like yeah, but those are our fellow citizens out there. and cities are important.

so i'm discouraged about that part of it . but i will say in terms of the basic agenda that we are proposing which is shelter first, treatment first, housingearned . it's pulls at 70 to 80 percent support and one of the interesting findings was when we said people should they be arrested for public dedication or be given the choice between jail or drug treatment, it had stronger support from democrats and republicans which surprised me because of the liberal framing but our hypothesis is that republicans, most republicans of california are like why would you even offer the drug treatment? people should be arrested so the public is more conservative. then even folks in san francisco or i think one might be led to believe other than the news media or social media. >> ..

it seems to me you have constantly hanging over your head is the horrible -- images of sight institutions. i mean, i would like to see an neo asylum movement but this time make it benign and when we had the real asylum movement even back in the pastoral care back in the 1800s and these are on working farms and it was a beautiful environment but there were no medications. now the synergy of those could be amazing. people remember snake pits and people think of shelters ask

what i describe patients, they were lucky if they don't get physically attacked, like f the meds are not stolen. kind of rehabilitating the images of these institutions is a burden you have. >> you how i would agree. i would add and i describe the history of how badly we have dealt with people take a with severe bipolar mental illness but before dorothy dix created the mental health bottles -- mental hospitals, people were changed in basements and on farms or just killed so this is a most difficult group of people to deal with. we tell a story in "san fransicko" a debate among my colleagues and i sensed this book was a very collective effort we tell a story where rené my dutch character describes being asked to take care of a man with schizophrenia who is a friend of the family, and he says a couple times, he

says sometimes you do things you're not supposed to do, you know, and he's like and i grabbed in a couple of times by the lapels and like you got a come with me were going to the hospital or else. he was like i don't know what the or else was going to be but he was a former football player saves a big guy. he tells a story and the guy, he basically muscles this got into getting the treatment he needs but now this man who has serious schizophrenia, he has his own apartment, he has a car and he has a job. and remain said i just talked to them earlier this week and a check in with a week and is that how you doing? he said i'm fine with our people staring at me through my window. when they was like go shutter curtains. he shut the curtains and said okay, it's okay. we told that story. there was some debate because we were like that makes rené look kind of like we're suggesting

that rules should be broken or something our people need to be coerced and i was like it's true but contrast that to the fact that we have more mentally ill people in the los angeles county jail than any institution in the united states right now and their captain plexiglas jail cells where bad things happen and it's plexiglas so they can hose them down. we need to grow up a little bit as a society because what happened is these hospitals were short staffed during the great depression and world war ii and in life magazine and others took photos that look really bad and many of the reformers wanted to improve the conditions in the hospitals but instead in a black-and-white way americans tend to be, the puritan culture as we said we have to shut these hospitals down and result as many of those people ended up homeless on the streets or in jails and prisons. part of i wanted "san fransicko" to do was say hey, let's go up a

bit. this is a difficult group of people to deal with an some amount of coercion early on is going to result in greater humanity possibly later on. >> folks? >> a follow up a little bit. you mentioned paternalism. i sometimes think there's unholy alliance between antigovernment conservatives who don't like bureaucracy and case management and hassle, and there's some libertarians in there. and now the left doesn't like paternalism. how do you respond to someone who says you're just bringing back, you're going to house these people or you're being paternalistic. how have you dealt with that child? >> yeah, and the do say that. by the way of course it depends. i mentioned earlier we were like, trying to figure out, we

realize we need a new institution in california. one question is what do you call it? we decide to call it calcite rather than say cal treatment, even though kal psych would be treating people with like 5 euros guy with the heroine problem with no serious mental illness. sally would say probably the kind of anxiety depression i suffer from, like something that should be manageable without using heavy drugs. we decide to call cal psych because when it's plenty people that really this is about mental illness, we find liberals are likely get that. if you were to rank from easiest to accept two hardest to accept of our agenda, i would probably go involuntary treatment of people with schizophrenia high as the easiest to accept, and

arresting heroin addicts for using heroin as much lower than that. funding the police from that to be very popular, too. i didn't mention, we have three chapters in this book about homicide, the emperor of all crimes, and it just came out of it as a liberal and a someone has been working on criminal justice just really pro-police. pro-police. i was like the evidence for policing is outstanding, in terms of reducing all crimes, ,n terms of reducing homicide. i'm a big believer in the purpose and effect. it's absolutely real. i think there's at least 30% of the progressive hard-core that will never be with us and that will have any objection. i mean the really radical anti-psychiatry movement genuinely believed that psychiatric hospitals were worse than jails and prisons. that includes rd laing and all the basically the deny it's a mental illness.

i guess the short answer is for the truly open-minded folks i say let's start with psychiatry and then for the hard-core i think we need to have an argument with them. >> that gentleman over there. >> i'm glad you mentioned homicide because in chicago the situation is little different than in san francisco and i was interested to read the wealthiest man that run said adel announced just a question of time before the moveout of chicago because of the crime problem. and you wonder the city may not be as wealthy or strong a san francisco, how long does it take for them to become just a failed city? that were these things seem to be going. now question. one of the freedoms we still have in this country, which is important, is a belief to move out, which is i think part of what's behind conservative

observation of the situation and also to compare one place to another. with respect to the amsterdam model, which very interesting part of this talk, look, is any place in u.s. adopting that model? are they doing it in florida? i really look forward eventually come you got to get the message, the message will come up, some people doing it right much better results versus others doing it wrong. >> the short answer is yes miami is doing it better. new york is doing it better. we decided to use the amsterdam in part because we thought it was an easier pill to swallow than new york, particularly first san franciscans who define themselves in opposition to new york. a lot of san franciscans including myself we are in semper cisco because it's not like new york. it is prejudice but there's not just prejudice in the sense one

of the things i love about san francisco is when you meet people, i don't think i've ever had anybody in the bay area asking why went to school, were as when i lived in washington, d.c. and the go to parties, nice to meet you. where did you go to college? it's always like is that how i'm going to be ranked on the totem pole? for those of us in california we like that's not the thing, that there's a much greater value on entrepreneurialism, on innovation. we are snobs at her own way and so choose amsterdam in part because it is for enough been viewed as liberal by people in the san francisco bay area. the short answer is everybody does a better job than the progressive cities of the west coast and certainly better than san francisco. miami has done a pretty good job and we describe what it's done there which is much more similar to a shelter first treatment first policy. new york sheltered before the pandemic something like 99% of its homeless.

we shelter about a third in california. one of the most disturbing findings of our research is that it was homeless advocates in california who have deprived the funding to build sufficient shelter for all the homeless. they have also fought against a requirement to sleep in the shelters. that's just insane. one of the things i'm most proud of in this book because i did, i was able to talk to basically everybody wanted to talk to including the radical left and the very progressive left, i did find even some of the most radical left advocates for the homeless, not all of them, but would say we do need to build sufficient shelter step and get people into shelters because it's gonzo out of control. but when you look at what works it's always the same things. there isn't any variation. there are some differences for example, between liz binns approach to this and amsterdam. lisbon uses engages families more in doing interventions with

addicts but in every one of the five major cities but also in europe and miami to make sure that sufficient shelter for people that it can require them to the shelter they enforce laws including against public drug use, public defecation, and they make drug treatment and alternative to incarceration rather than completely optional which is what we've done in california. >> can i just say one thing with a quickly on the crime question is we just, we have a service at the does national surveys and yesterday released a report we as people a question, others like pew and others of asked what would you let it didn't live where you are? what would you prefer to go? residence of big cities the majority of them want to a big cities. they always kind of happy where this idea a lot of people want to live in big cities. most people would like to live in a smaller city or suburb or a small town but the numbers now are the same as it were one month after 9/11 when pew asked, like a person of people in big

cities say that would be the top choice overdeliver which is down considerable amount from a few years ago. every something going on. not just in san francisco but elsewhere that people feel there's a crisis. remember what it was like 9/11 to be in a big city after that you felt like you had a target on your back. when you ask people what's the number one issue here concerned about in your local community it's overwhelmingly crime as you'd expect but the second issue is poverty and homelessness. crime even in suburbs is a concern right now. it's kind of gotten in the water but that seems to be those two issues are huge drivers for why people are not so enamored with larger city life right now. i i said as a longtime big city resident who loves living in big cities here . >> thank you so much. this is been a really great and fascinating talk. i had a question back on the subject of commitment and

institutionalization and would also love to hear sally's opinion as as a clinical psychiatrist on this is that i know in the history of america, mental health treatment that was a bit of an effect with the introduction of the first generation of antipsychotic meds to use that as an alternative to institutionalization. i think that a lot of negative effects on the long-term care for these very severe mental illnesses. also there were sort of legal regulatory changes and commitment guidelines. it's a lot harder for someone to be involuntarily committed today than it was. i'm curious about how do you overcome the source of both legal and practical issues of

physician and psychiatrist who would rather prescribe antipsychotics or who don't want to go through the hassle of committing, or if they face administrative obstacles to doing that, and also how do you achieve the right balance of, like let's say long-term institutional care and pharmaceutical treatment? >> do you want to go first, sally? >> actually, what i thought you would ask us about the general resistance to commitment. every state has different thresholds although they all agree on of course, there's a commonality with imminent harm to self or others and most have grave disability statute although not all which all it means is if you are just hallucinating in the park in freezing, we can, and -- i guess i would say that if the rest of your vision was filled in, in

other words, the was a good basic mental health infrastructure, then so many people would be contained within that, that by the time we need to use coercive measures you would be dealing with the most severe individuals that it really wouldn't be, 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 a crime, there's something called assisted outpatient treatment which i know is in your book, which is to say that okay we want to keep, we want to institutionalize people obviously in the least restrictive setting as much as possible. that's been taken way out of proportion meaning we should never contain folks, but even so even if we agree that containment is needed for a period of stabilization then

there's that intermediate phase were maybe someone's not, they can live in the community but they're still not taking their meds as responsive and regularly as they can, and that outpatient. are you familiar with that? there is a civil -- no, civil or criminal? that simple, right? i think there's a criminal counterpart to it. but in any case, basically that continuing supervision. that was my answer. >> i agree. part of the vision of cal psych is of these treatments need to be better standardized and follow better practices because there is so much inconsistency. we're not using conservatorship, that's what we call guardianship in california, nearly as much as we ought to be doing out just a kind of irrational libertarianism affair of "one flew over the cuckoo's nest" in snake pits. and then also salvation

treatment which came out of laura's law in new york where laura, i can't member her last name, just pushed in front of a subway car by mentally ill person that was not taking his meds. we have kendra is lot which is similar situation in california. we should be using it a lot more. it's been opposed by policymakers that a been engaged and i think unconscionable fear mongering really driven by a belief that mental illness doesn't exist. there's some really bad ideas that underlie a lot of this. i will say it's funny because on the one hand, i seen this hole, there's been this whole pop-culture reaction against conservatorship for britney spears that you might've seen anybody is like free britney and whatever. we don't know what was going on in that situation, like the picture the people have is that her father was just manipulating her for money but we have no idea what kind of behavior she was engaged in a what happened to her. but i think even, for homeless

folks there's much more willingness to use conservatorship versus outpatient treatment. one of the medical doctors that is a character in a book the works on skid row, she's been getting really good results with these injectable antipsychotics which lasts for 30 days and stabilize people on the streets even before get the medicare but just to reinforce what sally was saying, we think there's a lot of people you could get into right care and treatment he got a proper statewide system before you needed to start arresting anybody. but it is important, like break open the drug scene such as a confusion and to the hard-core schizophrenics, the people the wrap a lot of close around themselves can push the big shopping carts and in the greatest distress and often situation. >> well, thank you. the great book and it's a really great conversation. and everybody lineup.

and if you don't, if there are, maybe some folks took already because i thought -- great. hopefully there's enough, and if there isn't i know that we arranged to send one to you so you get one. >> awesome. >> might not be signed. >> thank you. >> you're welcome. thanks,