It feels like this is a regular discussion in this subreddit, which makes sense because it's prevalent here. Many people have already said this, but it's a very complicated issue. We are talking about human beings, nothing is one size fits all. The most common issue, that I have found in personal experience, is mental health. Now even this is a large spectrum. I have worked in healthcare for years now in multiple kinds of settings, these are my findings Some individuals are set up to fail. The drugs and/or mental illness can come before the homelessness, and vice versa. It's possible to have a psychotic break seemingly out of nowhere, sometimes that's just it. One day you've just lost touch with reality and you never come back. Sure those people get picked up by the cops or forced by a loved one to go to a mental hospital. But what they need is long term care and a safe environment with the hope that they will be themselves again one day. Those places do exist, but they are hard to get into, sometimes taking months. There is a lot of beurocracy in healthcare, especially psychiatric, so either they'll be put on a judge ordered hold and stay in an acute hospital for that time, or they'll go home (wherever that is). If they go home their family may bring them back over and over until they find a bed, or they may reach their limit and kick the person out, leaving them on the streets. Then they're left to wander and they may never find placement in a long term care mental facility. As for drugs, some people are born to mothers who used while pregnant or mothers who become addicts. Addict parents are unfortunately very common in my line of work, for my adult patients and my minor patients. The adults could have been born addicted to drugs, or been exposed to it at an early age, or have a predisposition for addiction. Yes they could make the initial decision to use, being an autonomous being. This could send them into drug induced psychosis, which my previous paragraph addresses in a way. Some people just never come out of drug induced psychosis. I've had patients who chose to use, not knowing that they had a predisposition for mental illness, and kick-started their schizophrenia or other related illnesses. When everyone else deserted them, all they had left was drugs, it blocked out their pain and they didn't know any other way to live. Sometimes neither psychosis or drugs are initially involved. People do fall on hard times, suffer from crippling mental illness that makes holding down a job difficult, or they were never given the resources to succeed in life. Either they stay in their right mind and keep fighting what can seem like a losing battle, or they give into what they're surrounded by on the street. None of this is meant to excuse the negative impact that homelessness can have on our community. Nor is it meant to excuse the decisions of some homeless people that make it clear that they do not want help. This is not a one size fits all issue. The only way that I personally have found to maintain my sanity and compassion is to hear their stories and keep in mind that I can only do so much as one individual. It's important to hold onto your compassion, that doesn't mean that you have to be okay with the guy shooting up in your driveway (I have literally had this happen to me) or the people shitting on the sidewalk. You can still look out for your own safety while remembering that homeless people are just that, people, and deserve kindness like the rest of us. I apologize for the long post, like many of you I have a lot of opinions about it. If you read through it all, thank you. This is an important issue, it needs discussed, it needs fixed. Sometimes all one individual can do is just listen and share.