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Does a Handout to the Homeless Help or Hurt?

Does a Handout to the Homeless Help or Hurt?We walk down a city street or stop at a stoplight and the panhandler is there, cardboard sign in hand, seeking a handout. What should we do? Close our eyes or open our wallet? Most crucially, no matter what course we decide on, are we helping or hurting?

Because I treat those who are mentally ill and addicted, a population widely represented among those on the streets, I am sometimes asked what I think is the appropriate response when approached for money.

If we shake our heads, are we being heartless? Or is it ultimately kinder to say no and put our time and money toward creating more lasting solutions to poverty, addiction, mental illness and homelessness? If we do give to the panhandler, can we pat ourselves on the back for our compassion or have we perhaps helped preclude change or pushed someone with a substance abuse problem deeper into a downward spiral? Or have we simply been scammed?

There is no single answer to these questions. Each person on the street has his or her own story, and those stories can be hard to capture and quantify. To be sure, we hear tales of those who are only too happy to exploit our empathy – the self-proclaimed “lazy” panhandler who claimed he made $60,000 a year, or the panhandling grandmother confronted while sitting in her new Fiat. Studies suggest, however, that these experiences are more anecdotal than average. A 2013 survey of San Francisco panhandlers, for example, found that the vast majority were homeless and made less than $25 a day. When asked to list everything they spent their money on, 94 percent said food.

What isn’t disputed, however, is that many of those on the streets are dealing with mental illness and/or addictions, and these can be both a cause and consequence of homelessness. (Just how many are struggling with these issues depends on who is doing the counting.) In the San Francisco survey mentioned above, for example, food was the top purchase mentioned but 44 percent also put drugs and alcohol on their list. The United States Interagency Council on Homelessness estimates that nearly half of those experiencing homelessness have substance use disorders, often entwined with moderate to severe mental illness.

The State of the Homeless report, a count of those in shelters and on the streets on a single day in January 2014, found that only about 15 percent of the 578,424 total homeless are the “chronically homeless,” defined as those with a mental illness, chronic substance use disorder or chronic physical illness who are homeless repeatedly or for extended periods of time. Those in this group, however, are more likely to be on the streets than in shelters, the report notes. Thus, they are more visible to us and more likely to be the ones behind the cardboard signs.

Putting Housing First

Ultimately, of course, whether or not to give to those who panhandle on the streets is a personal decision. Yes, it’s possible the money will go straight to drugs or drink or that it will buy misery rather than relief. Conversely, it may well be that it provides an economic and emotional boost to the person on the receiving end. Either way, in terms of potential helpfulness, it’s a literal drop in the bucket. We can’t forget, no matter our personal actions, that what’s needed most is creative and large-scale commitments to tackling issues of homelessness, poverty, addiction and mental illness.

Turns out, there is some good news on that front. Several community, state and federal initiatives have gotten underway in the last few years, and many of them are starting to bear fruit. Among the most promising is Housing First, which does just what its name suggests: gets those with high needs into stable, permanent housing first and then works on dealing with the issues that landed them on the streets, such as addiction. In the past, those with ongoing drug or alcohol issues were often precluded from housing and social services until they got “clean” first. It’s not hard to see how this approach could backfire and make recovery much less likely.

Although some feared Housing First would set up a system of lifetime dependence, it is proving to do the opposite. Because wrap-around support and treatment are offered with the housing, those in need are more likely to return to wellness and sufficiency, providing significant savings in health care costs and social services. A 2009 survey of a Housing First intervention in Seattle for those with severe alcohol dependence found that it saved taxpayers $4 million in the first year alone.

As a result of this program and many others designed to shift the emphasis from shelters to permanent housing and that recognize the necessity of providing treatment and support for addiction and mental health issues such as trauma, homelessness has dropped. From 2007 to 2014, in fact, national homelessness decreased more than 11 percent overall, with the most dramatic declines seen in the number of chronically homeless, down 30 percent, and homeless veterans, down 33 percent.

Some cities have seen more success than others and the decreases are starting to slow, but such numbers give officials renewed hope that homelessness may one day be eradicated. Until then, of course, the question remains: to give to those on the street or not. I don’t presume to guide people in this decision, but I do encourage everyone, no matter what you decide, to acknowledge the panhandler – nod, smile, say hello, make eye contact, something. Sure, there may be times when our empathy is wasted on the scam artist, but we may also be reminding someone who has lost much that they haven’t lost everything.

Does a Handout to the Homeless Help or Hurt?

David Sack, M.D.

Dr. David Sack is board certified in psychiatry, addiction psychiatry, and addiction medicine. As CMO of Elements Behavioral Health, he oversees a nationwide network of treatment centers including drug and alcohol rehab programs at The Ranch in Tennessee and The Right Step in Texas.

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APA Reference
Sack, D. (2019). Does a Handout to the Homeless Help or Hurt?. Psych Central. Retrieved on June 6, 2020, from


Last updated: 19 Mar 2019
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