As I sat down to write this article, I found myself reflecting on where to begin. Should I write about what I learned at the 2026 American Psychiatric Association (APA) Annual Meeting, or about the profound sadness I carried with me after walking the streets of San Francisco? Under ordinary circumstances, this column would focus on advances in mental health research, psychotherapy, or emerging scientific developments. This time, however, my reflections extended beyond the conference halls. What remained with me most was not a keynote presentation or a new clinical finding, but the human reality unfolding outside their doors.
For the first time, I want to write about the streets of San Francisco—through the lens of both a mental health professional and an observer. Walking through one of the world’s leading centres of technological innovation, I found myself confronted by the visible realities of addiction and homelessness. The contrast was impossible to ignore.
On one side stood artificial intelligence, neuroscience, and billions of dollars invested in innovation. On the other were people—young and old—standing or lying motionless on the sidewalks, their lives bearing the unmistakable weight of chronic hardship. It prompted a question that stayed with me throughout my visit: How can one of the world’s most technologically advanced regions also be home to such profound human suffering?
Throughout APA 2026, I attended presentations by mental health professionals from around the world on psychiatric care, addiction treatment, and trauma research. Yet each time I left the conference centre, my thoughts returned to the streets outside. We have institutions devoted to advancing mental health, internationally recognized research centres, and increasingly sophisticated treatment programs—but what about those living on the streets? Who is listening to their stories? More importantly, who truly sees them?
According to the World Intellectual Property Organization’s (WIPO) Global Innovation Index, the San Jose–San Francisco technology cluster ranks third globally for innovation. San Francisco is not simply another major city; it is one of the world’s foremost centres of technological advancement, driving progress in artificial intelligence, biotechnology, and countless other fields. Yet this same metropolitan region is also grappling with one of the most severe homelessness and substance use crises in the United States. According to the 2024 San Francisco Point-in-Time Count, the city is home to approximately 8,323 individuals experiencing homelessness, nearly 3,000 of whom are chronically homeless.
Although fentanyl dominates public discourse surrounding the crisis, the stories visible on the streets remind us that addiction has never been reducible to a single substance. Rather, substance use disorders emerge through a complex interaction of biological vulnerability, psychological distress, and social determinants of health. San Francisco’s addiction crisis has been closely monitored through overdose mortality in recent years. In 2023, the city recorded 810 overdose deaths, the highest number in its history. This figure declined to 635 in 2024 and 621 in 2025. While public health officials have viewed this downward trend as encouraging, the crisis remains far from resolved. During the first quarter of 2026, 148 individuals still died from drug overdoses. Although this represents approximately a 26 percent decrease compared with the same period the previous year, fentanyl continues to be the primary substance implicated in the majority of overdose fatalities.
Public health experts attribute this decline, in part, to expanded access to treatment, increased street outreach initiatives, and greater investment in addiction services. Nevertheless, data from the U.S. Centers for Disease Control and Prevention (CDC) continue to indicate that San Francisco has one of the highest overdose mortality rates among major American cities. These figures represent far more than statistical trends. Each number reflects a human life, a family, and a personal history—perhaps someone who once worked in the technology sector, pursued higher education, or spent years living with unresolved trauma.
One of the presentations that left a lasting impression on me during APA 2026 featured Professor Owen Bowden-Jones, one of the United Kingdom’s leading addiction psychiatrists. While visiting the Cambridge University Press exhibit, I purchased his book, How to Talk to Your Child About Drugs. As I left the booth, a single question remained with me: When does addiction prevention truly begin? Does it begin when we witness the first overdose, when a young person disengages from school, or much earlier—in the conversations we have with our children and in the way society responds to its most vulnerable members?
What I witnessed on the streets of San Francisco reinforced the urgency of that question. Addiction rarely begins on the street. More often, it begins quietly—in moments of loneliness, in the aftermath of trauma, or through prolonged experiences of exclusion and disconnection. As a mental health writer, this experience underscored the critical importance of prevention. The individual we encounter using substances on the sidewalk is not simply “a person with an addiction.” They were once a child with aspirations, a student pursuing an education, a professional building a career, or a parent caring for a family. Addiction is neither a moral failure nor a deficiency of character; it is a complex, chronic health condition shaped by biological, psychological, and social influences.
At the same time, the crisis unfolding in San Francisco cannot be understood solely through individual narratives. In neighbourhoods such as Tenderloin and around the Civic Center, highly visible open-air drug markets illustrate the extent to which this has become a systemic public health and social policy challenge. The crisis reflects the convergence of multiplefactors, including international synthetic drug trafficking, homelessness, organized crime, socioeconomic inequality, and untreated mental illness. When we observe someone standing motionless on a sidewalk, we are often witnessing the visible consequences of years of psychological suffering, chronic trauma, and neurobiological change.
City leadership has increasingly acknowledged the magnitude of this challenge. Following his election in 2025, Mayor Daniel Lurie identified addiction and homelessness as among San Francisco’s highest policy priorities. His “Breaking the Cycle” strategy aims not only to expand treatment capacity but also to disrupt open-air drug markets, target organized supply networks, and connect individuals directly with evidence-based care. Newly established Reset Centres are intended to serve as entry points to healthcare and social support systems for people living on the streets. In parallel, the city has expanded treatment capacity through the addition of hundreds of new treatment beds and broader access to medication-assisted treatment for opioid use disorder. Academic institutions, including Stanford Medicine, have likewise reinforced an evidence-based understanding of addiction as a chronic health condition with biological, psychological, and social dimensions, rather than a failure of willpower or personal responsibility.
As I left San Francisco, it was not the latest artificial intelligence technologies, billion-dollar companies, or even the conference itself that remained most vividly in my memory. Instead, it was the image of a person standing motionless on a sidewalk. The notes I had taken throughout APA 2026 and the books I carried home seemed to converge into a single question: As we continue to push the boundaries of technological innovation, what responsibility do we bear toward those who are left behind?
Advances in artificial intelligence and neuroscience hold extraordinary promise for improving human health and well-being. Yet the realities of addiction and homelessness confront us with an equally important truth: understanding the human brain is only part of the challenge. We must also strive to understand the human experience. Scientific progress alone cannot resolve suffering that is rooted in trauma, social isolation, poverty, and systemic inequality.
Ultimately, the measure of a society extends beyond the technologies it develops. It is reflected in how it responds to its most vulnerable members. Perhaps the most meaningful innovation of the future will not be faster algorithms or more powerful computing systems, but social and healthcare systems capable of preventing loneliness, addressing trauma, and restoring hope before people reach the margins of society.
The contrast I witnessed in San Francisco serves as a powerful reminder that technological progress and human well-being do not necessarily advance at the same pace. Innovation has the potential to transform lives, but only if it is accompanied by an equally strong commitment to compassion, prevention, and accessible mental healthcare. Otherwise, we risk creating societies that are increasingly sophisticated in their technologies while becoming less responsive to the people who need them most.
As mental health professionals, researchers, policymakers, and citizens, we face a shared responsibility to ensure that scientific advancement is matched by social responsibility. The future should be defined not solely by what we can invent, but also by our willingness to care for one another.
When we lose sight of the delicate balance between the mind, the human spirit, and technology, it is people who ultimately bear the greatest cost.