In the past 12 months, 15.5% of them had spent a night in a shelter, 30.5% had previously been homeless, 25.4% were at risk of becoming homeless in the next two months, and 9.1% had been evicted in the past year. Homeless people are prone to a much higher rate of visiting the emergency department due to mental health issues. Reported obstacles in treating mental health like supportive housing has impacted the healthcare cost and usage. San Francisco's homeless youth experience high rates of psychiatric disorders and substance use and have been known to use the following substances: cannabis, cocaine, narcotics (heroin and methadone) and stimulants (methamphetamine and amphetamine). Homelessness has been associated as a predictor of the use of heroin and recent nonfatal overdose among street-recruited injection heroin users in the San Francisco Bay Area, calling for more targeted interventions to decrease this risk association. San Francisco streets are littered with drug syringes, trash, and feces, resulting in a level of contamination "...much greater than communities in Brazil or Kenya or India". The city spends approximately 30 million dollars per year on the removal of feces and contaminated needles. Of the 400,000 needles distributed monthly, San Francisco receives around 246,000 back — meaning that there are roughly 150,000 discarded needles unaccounted for each month - or nearly 2 million per year. After a visit to San Francisco's homeless camps in January 2018, United Nations special rapporteur Leilani Farha stated that the belief that drug abuse was a root cause of homelessness was not generally true, that the reverse in fact is more prevalent, whereby "Most people on the streets are living with some sort of 'structural trauma,' meaning they have lost their job, can't afford housing, been evicted by a landlord. The structural trauma causes deeply personal effects that can lead to living on the street that triggers drug use." Stigma impacts the fates of the homeless by making them to be an "other" which in turn strengthens power dynamics. Structural forces are then obscured by the stigma. Stigma impacts the fates of the homeless by making them to be an "other" which in turn strengthens power dynamics. The creative communication strategies and practices of the Coalition on Homelessness, Poor News Network, and Media Alliance have both empowered voices from impoverished San Francisco Bay Area communities, and also enabled the development of "counter-public spheres" that work in tangent with mainstream media outlets. Former state assemblyman Mike Gatto, in a 2018 opinion piece, proposed that a new form of detention be created as a method to force drug addicted and mentally ill homeless people (who make up two-thirds of California's homeless population) off the streets and into treatment.