KOMO news in Seattle this year produced the documentary, “Seattle is Dying,” which chronicles the homeless problem in Seattle. Eric Johnson, who wrote it, asks, “What if Seattle is Dying and we don’t even know it?”
He writes, “I believe that Seattle is dying. Rotting from within.”
The problem of homelessness is a vexing a problem.
As he writes: “It’s about citizens who don’t feel safe taking their families into downtown Seattle. It’s about parents who won’t take their children into the public parks they pay for. It’s about filth and degradation all around us. And theft and crime. It’s about people who don’t feel protected anymore, who don’t feel like their voices are being heard.”
He argues that this is not about demonizing those “who are struggling with addiction and homelessness and mental illness.
“On the contrary. Instead, it asks the question, ‘Why aren’t we doing more? Why don’t we have the courage to intervene in lives that are, in the face of a grave sickness, reeling out of control?’”
This was a controversial report. The solution offered by Mr. Johnson is simplistic: It “can be boiled down to two simple words. Enforcement and intervention.”
This reflects a viewpoint that the answer here is involuntary civil commitment. The answer is to lock people up who suffer from mental illness and drug addiction – and perhaps do so forever.
The program that he puts forward as the ideal is in Rhode Island – and is a solution that, at least according to the report, seems to be working.
There are a few problems with the solution.
One problem – it’s not legal. As a Seattle Times editorial pointed out in April this year, “The current debate dividing Seattle — ‘they’re drug addicts who need enforcement’ versus ‘they’re people who deserve compassion’ — seems pointless in light of this court decision. The court said it doesn’t matter who they are, what problems they have or how to fix them. What the city must provide first, as a baseline, is places to sleep.”
Cities cannot “enforce no trespassing laws to clear out all those people living in greenbelts and under bridges” and there’s a simple reason for that – unless you offer people an alternative, they have to live somewhere.
But there is a second problem, as Shawn Vestal points out in his report in the Spokesman-Review – Rhode Island’s program isn’t doing what “Seattle is Dying” portrays.
“Rhode Island does not lock up homeless addicts indefinitely and force them to complete drug treatment,” he writes. Instead, “what Rhode Island does, more than any other state in the country, is offer voluntary drug treatment to everyone who enters the corrections system. The state applies a program that combines the use of the medications such as methadone with therapy and other components. It’s called medication-assisted therapy, and it’s done all over the country.”
Mr. Vestal notes that “In 2016, Rhode Island dramatically expanded its spending on MAT, starting a new $2 million program. The feds chipped in $1.5 million more this year to expand the program’s post-release supervision.”
He notes: “The program has had truly remarkable success in reducing opioid overdoses. While there are surely some benefits for those in that population who are, or have been, homeless, the program has not ever been sold as a solution for homelessness.”
Shawn Vestal also points out that Rhode Island is a small state. There are just over one million people living in Rhode Island. To put that into perspective, Sacramento County alone has over 1.5 million – 50 percent more people than the entire state of Rhode Island..
I think we need to look at what programs work. And as Rohit Naimpally presented in Davis a few weeks ago, permanent supportive housing has a great success rate.
“This was a paradigm shift that happened a couple of decades ago,” he said. “Rather than require people to get clean or get sober before being provided direct housing, getting people into housing is the first step. No conditions applied.”
Some people don’t like this idea. They want people to be banned from bringing drugs into the facility. They want preconditions.
However, the research – at least according to Mr. Naimpally – suggests otherwise.
“So putting the preconditions doesn’t seem to do much in terms of the outcomes you care about,” he said.
On the other hand, permanent supportive housing has been evaluated multiple times in a rigorous way. He argued that the key thing about permanent supportive housing is that there are no preconditions for entry, long-term assistance, and support services for those that need them.
“All of these cases found that it dramatically improves housing stability,” he said for those who received permanent supportive housing. They found that in two years time, they were less than half as likely to be entering shelters or experiencing housing instability.
“It’s a very cost-effective program,” he said because of the cost-avoided “vastly dwarfs any direct cost of intervention.”
The problem is – until you can house people, it is hard to get them stability.
Leaving that issue aside, whether we take an approach like Rhode Island or combine that approach with a permanent housing solution – it is going to cost money.
In watching “Seattle is Dying” – I kept thinking of course this situation is embarrassing. It’s sad. We lack the resources to do what needs to be done here – whether it is treatment services or whether it is permanent supportive housing.
I was recently in San Francisco for a hearing of a man kicked out of residential treatment because he ate an unauthorized cookie. The judge while compounding the problem in some ways said something that resonated with me – for poor and indigent people, we don’t have the services to help treat addiction and mental illness that are available to people with resources.
We are not going to solve this without resources and money. To implement even draconian measures as proposed in “Seattle is Dying” – we need money and resources. If we are going to put the proper amount of resources in, we don’t need draconian measures.
—David M. Greenwald reporting
I’m not seeing where the ruling states that a city must do this, nor am I seeing any conflict between the ruling and Rhode Island’s program.
Within a facility that I assume does not voluntarily allow drugs or alcohol into its facilities in the first place.
The Rhode Island model sounds quite a bit like Trump’s plan.
Rhode Island’s program isn’t illegal.
Because: “Rhode Island does not lock up homeless addicts indefinitely and force them to complete drug treatment,” he writes. Instead, “what Rhode Island does, more than any other state in the country, is offer voluntary drug treatment to everyone who enters the corrections system….”
Got it?
Yes – I understood that when I made my comment.
The state (and not the city) puts them in prison, where they don’t allow drugs and alcohol in the first place. Probably makes “formally quitting” that much more “compelling”.
Are you a fan of Rhode Island’s program?
Just wanted to clarify that, because it was not clear from your initial post.
Moreover, the state is putting them in prison, not because they are homeless people. As he put it, while there are benefits for homeless people, this is not a homeless program per se.
I found your article unclear, as well as your response regarding whether or not you think Rhode Island’s approach is a good idea.
I don’t have a pre-formed opinion either way. (However, I do wonder if it’s more cost-effective for large numbers of people, than other approaches.)
Here is part of what I found “unclear”, in your article:
So now, you’re acknowledging that it actually is “legal”, it seems.
Apologies for the lack of clarity there. No sleep for the second time this week, this time, my youngest woke up and had to go to ER.
The video portrays RI as something it’s not. What they they have put it forth is being some sort of involuntary confinement which is their proposed solution and it’s not what RI is and it’s not legal.
Thanks – but I found this statement confusing, as well.
Rhode Island’s program: Legal, or illegal? Are they “involuntarily confining” the homeless population, there?
And, would having a state program like that “allow” local police to cite (or remove) those living on the street, since they can offer a place to stay (in prison)? And, if they “refuse” to go, they (legally) end up in a facility like that, regardless? Ultimately, “involuntarily”?
Again, it sounds similar to what Trump is proposing.
Neither is using/carrying/selling hard drugs. Or what about the prolific sexual assaults committed by so-called homeless against other so-called homeless — in Davis! — that Chief Pytel spoke of at a city council meeting? You get really worked up when government does things that aren’t legal, but give a free pass to crimes committed by the so-called homeless themselves. Why is that, I wonder . . .
Court ordered or not, this will lead to a spiral of providing free housing that will bankrupt already financially strained cities. For starters, the state needs to go back to pre-Regan mental-health facility standards. The people walking around downtown Sacramento yelling at themselves should not be on the streets. One attacked me in a coffeeshop there a couple of years ago. She came up behind me and put her arm around my neck and was yelling gibberish. I don’t know what she said, I was playing music on earbuds. I wasn’t hurt, but it was a very disturbing incident and employees had to intervene and throw her out — and I still see that woman roaming downtown Sacramento and looking closer and closer to death.
You are really getting off on that Ninth Circuit Court ruling aren’t you? In my view, that ruling is going to be the slow crumble of what is left of civility in our towns. It also only applies to evenings – as perhaps it should. Cities can in fact clear out such areas after 6am – but some more progressive cities choose not to – or are simply overwhelmed by the volume of the problem.
On that I agree. I think ‘Seattle is Dying’ oversold that as a complete solution, not just one small component. The point was that the visible so-called homelessness is largely a drug problem masquerading as a homeless problem. And as pointed out, drug recovery depends on voluntary participation – which is largely an antithesis to the nature of addiction itself.
And then you get into the usual statistics supporting Drugs First housing, and they guy with cookie . . . etc.
Fine!
The title, including, “homeless solutions are not nearly as simple as people… believe…” is true…
But equating homelessness (or as you seem insistent to call call,it, “so-called”…) to drug use is also false. MH issues, not caused by, and without drug use, are part of the picture. A significant # of homeless have a constellation of things going on… poverty, lack of support (monetary and emotionally), MH issues (including real PTSD, anxiety disorder with panic, etc.) , and alcohol/drugs. Sometimes MH issues, with availability of alcohol/drugs leads to “self-medication” (ironically, some of the MH issue folk, with the right prescribed, legal “drugs”, and/or counselling, might never go to the alcohol/drug thing… requires early identification/intervention). Sometimes (fairly frequently) alcohol/drug use leads to MH issues and both tend to contribute to poverty and lack of support. And all those factors can lead to physical health issues, which just feed the fire.
The solutions are not simple, simply because the problem is not simple… often a constellation of issues. That can become intertwined.
There are folk who do the drug/alcohol thing, have MH issues (including PTSD), and are housed… they have resources, financially and emotionally. And just also be what they call “high-functioning”.
But “so called homeless” not equal to alchies/druggies. It is not that simple. The homeless are not ‘monolithic’.
Offered to avoid framing the issues in too narrow a way.
I said visible so-called homeless. I should have been more specific about what I meant by that. I mean the ones we see that are causing the problems downtown, along the railroad tracks, and along the greenbelts and bikeways. That have piles of garbage, stacks of (I assume, unless you can give me another source) stolen bike parts, poop buckets (or just poo on the ground).
There have always been mentally ill and down-on-their-luck people around. They deserve our help. So do the drug addicts ready to clean up (a small % at any given time). That will take more than all the resources we will ever have at all levels of government.
But something changed about the entire nature and volume of the visible problem. Piles of garbage, pooping in public places. And it all happened, everywhere on the west coast, about 10 years ago.
I asked my homeless friend Brad (not his real name Abby) — homeless by choice for over 30 years in Davis (he won’t be using the shelter or the respite center anytime soon) — and I said, within site of a huge pile of garbage — “what’s up with the neo-homeless and their piling up trash?”. He answered simply: “meth”. He continued (paraphrasing here): “I had my own garbage pile when I was on meth. It’s hoarding, because it all seems like it might have some value. Now that I’m just smoking pot, I don’t have a pile”.
And if you’re curious, “Brad” tells me the reason he lives along a drainage ditch outside Davis rather than seek to be housed, he says, “I can use my social security check on whatever I want, such as this guitar, rather than spending most of it on rent”.
But still you get to the problem that you can’t tell people that they can’t live ANYWHERE, especially when you don’t provide any means for them to earn a sufficient living or to address their physical and mental health problems. And putting them in jail or prison is an extremely expensive solution–$81,000/year according to the LAO (https://lao.ca.gov/PolicyAreas/CJ/6_cj_inmatecost) compared to a housing first solution (https://endhomelessness.org/resource/ending-chronic-homelessness-saves-taxpayers-money-2)
I always try to get the “authorized” ones. (By the way, why is it that I wonder if there’s “more to that story” than this simple statement?)
Because there is . . . you can just smell it . . . like a freshly baked cookie.
Calls for involuntary commitment as a solution to homelessness reflect the woeful failure to invest in voluntary, community-based services. The funds that would be needed to build facilities with the capacity to provide involuntary treatment on such a scale would be far better spent on developing and enhancing voluntary treatment programs and affordable housing options.
Involuntary treatment is also less effective than voluntary treatment. Moreover, civil commitment is disproportionately applied to racial minorities, in large part as a result of the general disparate access to healthcare services based on race.
Unless and until voluntary, less restrictive, alternatives are made available, the massive infringement on personal liberty inherent in involuntary civil commitment cannot be ethically or constitutionally justified.
Regarding voluntary/involuntary, I’m wondering what can/should be done with those who simply won’t (for whatever reason) avail themselves of the voluntary shelter offered? (Which apparently could be within a correctional facility – as discussed in the article?)
Also, some of those folks are mentally ill, and may need intervention (beyond shelter and assistance with “quitting” any possible substance abuse problems). Folks in this category used to be locked-up – involuntarily in state hospitals. Which (let’s just say) was “less than ideal”.
It was less than ideal. But Reagan’s solutions of closing most of the asylums and turning them out on the street is also less than ideal. The solution it would seem is to re-institute the asylums, but with better programs (I’m assuming we’ve learned something about mental illness in the last 50 years), and hopefully monitored medication-based releases. Yeah, we are talking billions, but this has to be a state priority and state problem. Having people who have nowhere to go because they lost their job and their lease – in city shelters alongside active meth/opiod addicts and schizophrenics yelling a moon cakes – is not a sane solution.
I agree, and didn’t realize that Reagan was involved in that.
I think they were declining even before that time. I believe there’s still relics of them around the country – including the one below. Looks like it still included a hospital, as of the date of this article.
(I suspect that “One Flew Over the Cuckoo’s Nest” had at least some influence regarding closures, as well. What a great movie that was/is.)
Lobotomies probably gave these things a “bad rap”, as well. (There’s an excellent PBS program regarding that, and the doctor who championed them.)
https://www.nytimes.com/2013/04/01/us/cuckoos-nest-hospital-is-now-a-museum.html
This is usually attributed to Governor Reagan, but it was a bipartisan bill that he signed.
https://en.wikipedia.org/wiki/Lanterman%E2%80%93Petris%E2%80%93Short_Act
Don… Reagan didn’t just sign ‘bi-partisan legislation’… he proposed and advocated it. Pretty much strictly as smaller government/cost savings. Not so much humanitarian or MH reform issues. Ironic as to how medical/MH issues ultimately affected him. He went thru a tragic condition… as do many others.
He had an advantage as to high quality medical, palliative care, and no worries as to housing and sustenance. Unlike many others.
[edited]
Don – It’s a bit more complicated than that. The Lanterman-Petris-Short Act (LPS), to which the link you provide refers, was in response to State and Federal appellate and Supreme Court caselaw holding that involuntary civil commitment entails a “massive curtailment“ of the fundamental right to personal liberty and requires adherence to stringent constitutional due process standards. LPS specified due process safeguards to protect these fundamental rights and to prevent the indefinite institutionalization of individuals with the psychiatric disabilities.
The problems resulting from the decline in institutionalization (which began prior to the LPS Act) was the failure to adequately fund community-based mental health services—a situation that continues to this day.
“… individuals with
thepsychiatric disabilities.”“The solution it would seem is to re-institute the asylums, but with better programs”
We’re talking probably more than billions. I wouldn’t support involuntary. I would like to see what happens to the homeless population with full funding for shelter, housing, and services. That too costs more than billions.
Hospitals/asylums are never going to “permanently house” more than some limited percentage of the homeless population. (Those with severe, permanently-debilitating disabilities which cannot be successfully managed.)
I strongly suspect that the U.S. will “never” house the vast majority of homeless in a manner that’s advocated by some on here. The cost alone would derail political support.
More likely, there’d be facilities such as “tent cities” and/or large-scale government facilities (such as former correctional facilities) that would be used to provide shelter. Even then, I’m not sure that the government will pay for that (limited) amount of “housing”. And, it’s unlikely (on such a scale) that drugs/alcohol would be openly permitted, pets allowed, etc.
And there will remain a significant portion of the homeless population that will refuse to occupy such facilities.
There may be a lucky few in cities such as Davis, which are willing to spend a significant amount of their own resources, to create “nicer” facilities. But even then, other services provided (such as those by “faith organizations”, or the city itself) will encourage more homeless to arrive. (More than can be housed.)
Been there, done that. Involuntary commitment was so abused that it was eliminated in the early 1970s. That led to the emergence of community mental health centers (my mother worked at one for a while), but then Reagan gutted the budget for these centers, and we started down the spiral where we are today. BTW, Reagan didn’t “close the asylums”–the courts and legislatures across the country did that. Re-opening the asylums, which is likely a very expensive proposition likely on the order of a $100,000 per person per year (see my LAO reference above–a recent SF study found a similar result), also is likely not legal. So let’s not even bother discussing that option. (This is like those who keep advocating for nuclear power as our solution to climate change, and I keep on having to point out that nuclear costs more than twice as much as renewables now.)
I think that Richard’s comment was made in response to mine, but I added another response at 9:29 a.m. today, which I’ll repeat below:
Eric. Voluntary. Requires will. And a certain amount of resolve/bravery. Those using alcohol/drugs, or with MH issues may never get there. It’s a reason for a 72-hour hold. Or, do you oppose that, as it is not voluntary?
I do agree that ‘the state’ should not impose specific treatment…. but we do have a mechanism(s) to prevent someone being a risk to themselves and/or others (do you oppose that?)…
But requiring folk to make a choice… society does that all the time… but they may need an imposed “time out” to make a rational choice.
Bill – Your questions are inapt when less restrictive, voluntary treatment alternatives and housing options are not even available.
So… someone in crisis should never be placed on a 72 hour hold. Involuntary.
So, until those alternatives and options are available, do nothing.
And, may I respectfully ask, what are you doing to making such less restrictive, voluntary treatment alternatives actually becoming available?
But I have to thank you… you taught me the difference between “inapt” and “inept”… had not been familiar with the definition for the former… at first thought it was a typo, but then googled it.
I will respectfully agree to disagree. Happy New Year!
And, in the meantime… we can expect a recurrence of a young homeless man, living on the Nishi property, drinking/inebriated, smoking while lying in his sleeping bag, falling asleep… cigarette ignited his sleeping bag… others, both in the homeless community and City emergency services, tried to help. He died in his early 20’s… homeless flambe. His name was Patrick. May we never intervene to prevent something like that. A logical consequence of his bad choices… all voluntary. Let us never intervene if the intervention is not voluntary.
No. I’m not opposed to 72-hour short-term evaluation holds. Those proposing involuntary commitment to address homelessness, however, are suggesting expansion of existing civil commitment criteria.
Thank you for the clarification, Eric… best to you and yours in the coming year.
Bill – Kind of an impertinent question, but I spent over 35 years of my career advocating for the civil and service rights of individuals with psychiatric, developmental, and other disabilities, including access to community-based housing, services, and supports.
Eric. Thank you for your service. More than fair answer.
Hope you can understand that I, without that context, asked the question.
I had the exact same experience as WM with “inapt”:
Me too!
Me too!
Inaptty New Year!
And in addition to Patrick, I know of a half-dozen or so so-called homeless and/or mentally ill people (add a few more for just inebriated, and quite a few more for suicidal) people hit and killed by trains, several within a few hundred feet of my house, some closer than a hundred feet. I have found some of the body parts.
Union Pacific and the Capitol Corridor have promised to clean up the camps along the entire corridor. It’s happened in some places with limited (especially duration) success, but not in Davis, despite my having called several times about specific people/places.
But I’m just being an arsehole, insisting it’s not a good idea for so-called homeless people to live and/or drink-drug adjacent to giant metal moving objects that can squash a human body, brought there by a poorly-functioning human mind.
Involuntary is not a legal option currently and would require the same political lift as providing voluntary treatment options. In addition, as I reference above, involuntary commitment is much more expensive than other approaches.
The only involuntary commitment I would be in favor of is:
• The clearly schizophrenic who yell at imaginary people (and similar behaviors).
• Those that commit crimes.
I’m not in favor of locking people up for drug use/possession, as I don’t believe that in itself should be criminal. But there are a host of crimes that often go hand-in-hand with drug use.
Ultimately, I suspect that individual cities which (for whatever reason) currently have (or may subsequently attract) a disproportionate number of homeless individuals may experience bankruptcy, if they attempt to tackle the issue on their own. While simultaneously not “clearing the streets” of individuals camping there.
Medically-assisted therapy (MAT) requires a significant amount of resources, and is not effective unless that is ongoing for several months.
https://www.drugabuse.gov/news-events/nida-notes/2015/11/long-term-follow-up-medication-assisted-treatment-addiction-to-pain-relievers-yields-cause-optimism
Even with that, there will be a percentage — a high percentage if only given short-duration treatment, and a somewhat lower percentage if ongoing support is provided — who will not be abstinent and who are probably (I’m guessing) likely to remain homeless. MAT reduces deaths, which makes it an important tool. But I suspect that the cost of the resources will be prohibitive for a small county like Yolo or a single city to take on.
OK… am going to be a jerk…
Everyone reading this is going to die. 100%.
Question is time, place, manner. Might have been appropriate to say,
Just a jerk comment… feel free to delete.
Jerk comments are covered by the first amendment.
(But blogs are ‘private’. Moderation happens)
What is the cost? Any solution will require significant resources; the question is what are the RELATIVE costs?
That’s probably the most relevant comment you’ve made, in my opinion.
A “comparison” of the costs, on a larger scale than how the problem manifests itself in any individual city – which may be experiencing a “disproportionate” share of impacts.
Of course, it’s beyond the level (or potential influence) of this blog. It’s really at a state (if not national), level. Unless one believes that all individuals are “home-grown” to a given locale, and will forever remain that way.