It isn't just confined to the US either. The Mrs is from Vancouver, and I've had extended stays over there a few times over the last decade. I'm no expert, but the way it appears is that in the late 90s a particularly hawkish local government closed all the asylums and instituted a 'care in the community' type policy, booted the inmates out and tossed them a monthly stipend. That did not go well. So despite a more UK-like universal healthcare system, Canada is more apt to wash its hands of undesirables in a US-like fashion by tweaking the system away from direct accountability.
Which is why, now, we have areas like East Hastings (immortalised by the Godspeed You Black Emperor track of the same name) which are aglomerations of addicts, the mentally ill, veterans and the general dispossessed - with a roaming tent city on its general periphery.
Your experience of SF matches mine of Seattle and Portland as well. I'm not so well-versed on the socio-economics of the Western US, but it seems to be an endemic problem there too. Certainly as a first-time visitor it's shocking. But 95% of the time, you learn, they aren't that interested in you and you can more or less travel unmolested. I just kept half an eye out, and ladies, do not ever walk barefoot.
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Quiver Search for FATALISTS on Spotify, Amazon, Apple, &c, Tue 24 Aug 2021, 10:18,
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