A Scientific Approach to Helping the Homeless
SIMON: But first, the writer Malcolm Gladwell seems to make a specialty of looking at old persisting issues in a new way. In the current issue of the New Yorker Mr. Gladwell suggests the problem of homelessness may be easier to solve than we often believe, and at a lower price. But there are other costs, and questions. His piece is called Million Dollar Murray. Malcolm Gladwell joins us from our studios in New York. Mr. Gladwell, thanks so much for being with us.
Mr. MALCOLM GLADWELL (Writer): I'm glad to be here, Scott.
SIMON: And we begin with the fact that you define what I'll refer to as chronic profound homelessness as being less widespread than people may believe.
Mr. GLADWELL: Yeah. One of the big observations that people made when they began to look closely at homelessness was that they used to assume that there was this big broad middle of tons and tons of homeless people who had similar kinds of problems. What they discovered, it's not true, that homelessness is divided up, and there are a very small number of people who have very serious problems and who really make up what we define of and think of as chronic homelessness.
But the majority of people who are homeless are very different. They may only be homeless for a short period of time. Their problems are much smaller by comparison, which suggests that any kind of program aimed at the broad middle is kind of missing the issue, and that we can design programs aimed just at this very small hardcore, are not going to have a much bigger effect.
SIMON: Help us revisualize this, as you did in the article, because you suggested instead of viewing it as a bell curve, it ought to be viewed as a hockey stick.
Mr. GLADWELL: The bell curve is kind of permanently imprinted in our brain. And we think of any kind of problem or phenomenon as naturally following the distribution where there's a few people at one end who have no problem, a few people at the other who have, you know, a kind of little bit of a problem, and then there's a big broad middle and the curve goes up. And what happens when you look at a lot of social problems is you discover that's not the way they are at all. So I use the example in the piece I was talking about, when there was that big, post-Rodney King, there was a big reform movement in the LAPD. And the question was, what is the extent of the problem of kind of violent cops in the LAPD?
And people thought it was a kind of institution-wide problem. Until you look very closely at the incidents of complaints against officers. And what you discover is a small number of officers account for an overwhelming percentage of the complaints against the LAPD. The average cop in the LAPD is fine. So if we design a response to that problem where we focus on the average cop, we've missed the point and we're letting a few bad apples get away with what they've been getting away with.
We need to refocus our thinking and think, oh no, it's a hockey stick, it's a curve that really nothing much happens until we get to the very fringes and all of a sudden everything happens.
And that's all true of homelessness. The problem is concentrated in a very small number of people who are profoundly troubled. And if you think that way about homelessness, it changes the way you attack the problem.
SIMON: So how does that change the approach?
Mr. GLADWELL: Well, it says, for example, we've invested a lot of money in shelters over the last 25 years. Giving them a place to stay isn't dealing with the kind of underlying issue, which is there's a very small number of people who are addicted to drugs, are mentally ill, have severe problems with alcohol, and they live on the streets and every winter they fall down drunk four times and get taken to the hospital and have to get a cat scan. They get complex pneumonia, so they run up a $20,000 bill. Maybe once, twice, maybe three times in a winter they get hit by a car and they get blunt trauma to the head. On and on and on. Very small number who are running up medical bills in the course of a year that could be $150,000.
The guy you step over on the street is costing the system more than anyone else in your life except for the person with end-stage metastatic colon cancer. Right? Now, once you understand that, you think, wait, wait a minute, we could get a full time assistant for that homeless guy and put him in a suite at the Hilton and we could save money.
If these guys cost that much money just by living on the streets, it's cheaper to take them off the street, give them an apartment and assign a full time caseworker to make sure they get back on their medication, back on their feet, help them get a job.
SIMON: Do we know from hard case experience that that would work?
Mr. GLADWELL: Well, that's what we're trying right now. And there are a number, there's a wonderful man named Phillip Mongano(ph) who runs the Bush Administration's Interagency Council on Homelessness. He has convinced a number of cities around the country to start experiments. And when I was writing my article I went to Denver, and they've had an experiment like this going on now for about two years and where they have taken the hardest cases in the city, the people who are at the bottom, and they have given them an apartment, they have put them in substance abuse programs, they've assigned them a caseworker, they've stabilized them on medication, and they've watched. And what they've found is that the overwhelming majority of these people, these very, very hardcore cases, will respond.
They're getting jobs. They're paying their own rent. It's possible, if you provide the right kind of context and give people some attention, we can save them.
SIMON: You certainly know, Mr. Gladwell, that the objection to this that some people have is political and even moral. Do you wind up concentrating a fantastic amount of resources on people who are chronic drug abusers or chronically drunk and ignoring the mother of three who is simply down on her luck?
Mr. GLADWELL: This is a great philosophical dilemma in all of this. Your first thought when you hear, I'm going to take the guy who's sleeping on the street and I'm going to give him a free apartment and a caseworker, is why does he deserve it? Right? But I will say one thing. We are not spending enormous amounts of resources on these hardcore people with these kinds of programs. We're spending enormous amounts of resources on these people without the programs.
If you don't do anything, they'll cost you a hundred grand a year. If you do something, give them an apartment and a caseworker, they'll cost you $25,000 year. We're doing this not out of the kindness of our hearts necessarily. This is such a kind of bizarre social thing, but we're doing this because we think we can save the City of New York and the City of Washington D.C. and the City of San Francisco millions of dollars a year, which we can use on other things. That's why we're doing it. That's our first impulse. It's cheaper.
SIMON: Let me get back though to the mother of three who's down on her luck. Should we not feel morally uncomfortable about not coming up with a solution for her?
Mr. GLADWELL: Yes. I think you're absolutely right. The thing that's driving this strategy towards homelessness is the notion that we have a very limited amount of money, a very limited amount of political will. And what are we going to do with that? Well, we're going to concentrate it on the worst part of the problem in the place where we can save the most money in the short term. That does not mean that we should ignore everybody else. But that's a separate argument, really. I mean what we're trying to show here is, can we, in a relatively short period of time, strike at the core of the problem? And if we can show that we can do that, then I would hope, I would hope that we would then take a step back and say, okay, let's start dealing with people who are also troubled but just not in the same immediate dire straits. I hope we don't stop at this.
SIMON: Malcolm Gladwell, staff writer for the New Yorker, thank you.
Mr. GLADWELL: Thank you so much.
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