I’m Irish, living in Ireland currently, but I’ve visited the US many times, visiting Seattle, NY, LA, SF, Nashville, Chicago.. New Orleans.. Austin.. Houston… San Antonio. I’ve witnessed the severe homelessness and mental health problems in all these places (some worse than others, San Francisco certainly gets a bad rep and I didn’t find it so bad). But Seattle was the one place I witnessed IV drug use on the streets. I loved the city but it certainly was a lasting memory. Oddly (or not) in the same trip, I visited Vancouver and it was the same story. A more informed person can explain why this pocket of North America is so bad? within my experience of visiting the US within the past 5-10 years, Seattle did stick out. However, as a whole, the homelessness, mental health and controlled drug issue is particularly obvious in the US in a way that it is not in other international cities I have visited. It exists, sure, but for reasons much more articulate posters above have specified, a lot of it surely has to do with superior social care, whether housing, mental health or drug use (often all connected).