by Armando Del Toro Garcia
I appreciate that we have a hot weather protocol for homelessness, even in famously foggy San Francisco, but the alert notice published by the Department of Homelessness and Supportive Housing (HSH) describing this hot weather protocol made me ask myself some questions. While all of the steps they describe taking in the alert are appropriate, I can’t help but feel underwhelmed by the scale of the response given the severity of our homelessness crisis. Is the hot weather being taken as seriously as cold?
It damn well should be. Hot weather can be deadly. Even housed people die in heat waves. Elderly people are at higher risk, as are children, and people with certain chronic illnesses.
I felt that I should try to understand the problem better before I make a judgment on the City’s answer to the problem, so I did a little reading on the effects of heat waves and heat-related illness.
Even without substance use or mental health issues, people living on the street are already subject to additional risk factors. Without adequate access to water, dehydration can occur rapidly. The heat can induce lightheadedness and fatigue. Without the opportunity to cool off, high exposure to heat can result in heat exhaustion or heat stroke, which can be a cause of permanent health effects, including brain or organ damage. A significant proportion of our unhoused neighbors are seniors, and can suffer significant health issues without the opportunity to get hydrated and cooled off.
The situation only gets worse for those San Francisco residents on the streets who cope with mental health or substance abuse issues, which are at higher risk still. A research paper by Lynette Cusack, Charlotte de Crespigny and Peter Athanasos in The Journal of Advanced Nursing expands on this. The researchers point out that people with schizophrenia are more vulnerable to heat-related illness due to physiological factors. Certain medications for psychiatric or heart conditions can interfere with the body’s thermoregulation, and make people more sensitive to heat-related illness. Alcohol and opioid use both accelerate dehydration and hamper the body’s ability to cool itself with sweat. Amphetamines, cocaine and MDMA elevate body temperature. To complicate things further, withdrawal in extreme heat can be as dangerous as substance use. The withdrawal symptoms can cause pain, additional dehydration and other complications that accelerate dehydration and increased risk of heat-related illness.
It seems then that unhoused people are subject to higher risk, and those who are unhoused but struggling with mental illness or substance abuse are at an even higher risk.
That’s heavy. Now, given a better idea of how serious the problem can be, the advisory provided by HSH regarding its hot weather response does seem to be inadequate. There is enough ambiguity in their advisory that it’s hard to tell whether they are engaging in a robust response. They’re increasing outreach by HOT (that’s the Homeless Outreach Team, no pun intended), but it’s hard to tell whether they increase the number of staff on duty during heat advisories. They claim HOT is providing additional shelter placements, but they are not being transparent about whether or how they are making the additional shelter space available. They provide a list of indoor areas to cool off, but it appears to be a list of resources that are already available during normal weather conditions. They link to additional documents published by the City’s Department of Public Health and the U.S. Centers for Disease Control and Prevention, but they don’t link to any public documents detailing their protocols.
We wrote to HSH to ask for more details about their policy and procedure, and were sent an internal document that did describe more of how they manage high heat events. According to the document, HSH activates their Extreme Heat Policy and Procedure when the temperature is “forecast to be at or above 85 degrees Fahrenheit”.
A major part of their response is sharing heat alerts and resource information with a list of program groups who work with the homeless population. Homeless shelters and programs are part of a largely decentralized system, so it is reasonable for the City’s response to focus on communicating information to these groups. Their policy also describes an effort to track responses and client placements, in order to be able to assess their extreme heat response.
These are good efforts, but there is a lot of room for improvement. The policy document still leaves questions unanswered about the HOT response in extreme heat. The alerts and information they send out are handled through an “email list of local programs, providers, advocates, 311 and City officials,” but there isn’t an immediately clear way to register on this list. A local advocate expressed interest in there being open registration for this email list, so that informal groups, volunteer groups and people on the streets can get this information directly when possible. It also isn’t clear how HSH defines success in their response assessments.
I expected to find approval or disapproval of their hot weather protocol after looking into it, but instead I’m just left with questions. My inquiry has become less about whether the hot weather protocol is sufficient to meet needs, and more about the lack of transparency. I’m reminded of Supervisor Matt Haney’s proposal to create a commission that can provide greater transparency and public feedback for the department’s work on homelessness. Because HSH isn’t overseen by a public body like other departments, it lacks the transparency that would make many of these details easily available. As a result, it’s hard to thoroughly evaluate their efforts.
If you have any positive or negative experiences to share about the City’s response to the hot weather in June, contact us at the Coalition on Homelessness to share.
Data on the impact of heat waves on people with substance abuse issues drawn from the following report:
Cusack, L, et al. “Heatwaves and Their Impact on People with Alcohol, Drug and Mental Health Conditions: a Discussion Paper on Clinical Practice Considerations.” Journal of Advanced Nursing, vol. 67, no. 4, 2011, pp. 915–922.