Homelessness: California’s Quiet Emergency
The unhoused population in California – more than 171,000 – is, by far, the largest of any state. Three out of every 10 persons in the U.S. experiencing homelessness live in California. In Los Angeles County, homelessness increased by over 60% from 2020 to 2022.
California is, for many, a home without a home.
California’s firefighters and paramedics see the impacts of this crisis, and the human toll it takes, every day on the job. Their firsthand, on-the-streets vantage point makes California’s firefighters uniquely qualified to be a part of the solution to this vexing issue.
“This is the defining challenge for California in the 21st Century,” said CPF President Brian Rice. “Firefighters have a stake in meeting this challenge.”
Why homelessness is a 'firefighter issue'
On a practical level, homelessness – especially in urban areas – has increased pressure on already-strained public-safety resources.
EMS Response: Overall, medical responses are substantially higher for the homeless population. In Los Angeles, 9-1-1 calls are 14 times more likely among homeless patients than those with housing; ER transports are 20 times more likely among the homeless. Many times, firefighters transport the same patient over and over again to hospital emergency rooms, taking critical resources out of service. “From personal experience, I’ve responded on the same individual hundreds of times over my career,” said Jerry May with San Jose Fire Fighters Local 230.
Mental Illness and Substance Abuse: According to a UC San Francisco study, more than 80% of unhoused Californians have experienced a serious mental health condition – more than a quarter had been hospitalized for such a condition. Nearly 2/3 have abused illegal drugs and/or alcohol, with nearly six out of 10 having been hospitalized for substance abuse disorder. “We’re responding to folks in crisis: mental health, drug addiction, alcohol or some combination of all of them,” said Floyd Rollins, president of San Francisco Fire Fighters Local 798. “It’s had a profound impact on the resources and the services we have to make available to deal with this crisis.”
Fire Responses: In many communities, fires connected to the unhoused are on the rise. In San Diego County, one out of every six fire calls are tied to homelessness. During one stretch in Los Angeles, more than half of LAFD’s fire calls were homeless-related. Sacramento County has seen a 77% increase in fire calls related to homelessness. “During dry years, we’ve seen fires on the American River Parkway spread for several acres, requiring aerial response and putting lives at risk,” said President Rice, who has served as president of Sacramento Area Firefighters Local 522.
Firefighter Health and Safety: The high concentration of severe mental health issues, drug addiction and simple desperation can add another layer to the day-to-day risks of the job. Reports of attacks on first responders are not uncommon, and the explosion of fentanyl creates a constant need to be ready for a medical crisis. “You arrive on scene with a person in crisis,” said Rollins. “They may be throwing things, they may have a weapon of some kind or creating a situation that can affect firefighter health and safety.”
Beyond the practical impacts on firefighters’ ability to do their jobs, the challenge of homelessness impacts their ability to fulfill their mission to serve. “There is such despair,” said George Duardo, president of San Diego Firefighters Local 145. “Seeing it 20 to 30 times a shift, that’s a level that human beings just aren’t built for.”
“When we are out in the fire stations, our members say to me, ‘Brian, I’m not helping anyone,’” said President Rice. “Everywhere I go, this is the number one issue for our members.”
A Long-term approach
Local fire agencies up and down the state are starting to answer the call by developing their own programs for dealing with those at highest risk. (See “Local Firefighters Making a Difference," p.9) Individual initiatives from local agencies are being matched by a new urgency from Sacramento, and the voice of California’s firefighters is at the center of those conversations.
Expanding community paramedicine is seen as a major contributor to addressing those chronic responses. This year, CPF-sponsored legislation signed by Gov. Gavin Newsom extends and expands the groundbreaking community paramedicine concept. Built on a long and successful series of pilot programs, community paramedicine gives local agencies the authority to create teams that can direct a variety of patients away from emergency rooms and into more appropriate care.
“The community paramedicine program is fairly new in San Francisco, and we are seeing positive effects,” said Local 798 President Rollins.
On a broader scale, Gov. Newsom’s ambitious CARE Court plan establishes a new method of providing for those experiencing homelessness who are at highest risk from severe mental health issues, substance abuse disorder or the inability to make decisions. First responders, among others, would be able to initiate a court-ordered comprehensive care plan lasting up to a year that would pair shelter with a battery of services. Those who aren’t successful could be subject to hospitalization or conservatorship.
“CARE Court is an amazing opportunity for these individuals who maybe don’t have an advocate, or can’t advocate for themselves,” said May. “It’s about giving these individuals the dignity they deserve, and giving them a long term plan so they’re not getting kicked out of the ER and back on the street.”
Few would argue that addressing mental health issues is the silver bullet to fix homelessness. California’s overall housing affordability crisis plays a major role in the high numbers of unhoused individuals in the state. But when it comes to addressing the most serious aspects of the issue on the street, the fire service – whether rank and file or management – has a role to play, and will do its part.
“We are the ones in the trenches, seeing people go through these issues,” said May. “This is an opportunity for firefighters to be involved and help.”
LOCAL FIREFIGHTERS MAKING A DIFFERENCE
Resonding in an emergency is part of a firefighter's DNA. So it is no surprise that fire agencies and frontline firefighters are stepping in to be part of the answer to homelessness in their communities.
Alameda City: Firefighter/paramedics are a central component of the Alameda CARE Teams. The CARE team responds to 9-1-1 calls involving a non-violent mental health crises. As in a community paramedicine program, these teams can direct patients toward a range of care options that don’t involve a trip to the emergency room. “We recognized that this population needs more than just a medical response,” said Paul Arai with Alameda City Firefighters Local 689. “We work together with the county and behavioral health to bring these services to people where they are at.”
Hayward: Hayward firefighters leaned into their role as service providers early on, providing COVID testing in homeless communities during the pandemic. Now, as part of the city’s Mobile Integrated Health Unit, Hayward firefighter/paramedics are paired with mental health professionals responding to critical mental health patients. The program has already directed hundreds of mental patients away from the hospital emergency room and onto a path toward services suited to their needs.
San Diego: San Diego firefighters were involved early in the city’s Resource Access Program, which focused on the highest 9-1-1 users, who are most often dealing with severe mental illness, substance abuse disorder and the like. The program directs these “frequent flyers” away from emergency rooms and toward treatment and longer-term help, thus reducing a major impact on the 9-1-1 emergency response network.
Sacramento: Identifying homelessness as a “man-made disaster,” the Sacramento Fire Department will lead a new inter-agency response effort. Bringing together law enforcement, behavioral health workers, park rangers and non-profit providers, the program seeks to improve immediate response and get those in crisis off the streets and into housing. “It makes total sense as we are well-versed in managing large-scale incidents with coordinating agencies,” said Sacramento Area Firefighters Vice President Ryan Henry, speaking to Sacramento’s ABC10.