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Tuesday, April 13, 2004 - Page updated at 12:00 A.M.
Susan Byrnes / Times editorial columnist
With little to show for decades of effort and incalculable sums of public and private money, homeless advocates around the country are calling for a paradigm shift in housing the chronically homeless. It's about time practice caught up with what we know.
It's evident in every major American city: What we've been doing isn't working for the estimated 20 percent of the homeless population whose bodies and minds have been ravaged by alcohol, drugs, mental illness, abuse and disease. These are people who cannot seem to get off the street despite steady access to shelters, transitional housing and treatment. For them, it's all a revolving door. Permanent housing options have generally been reserved for those who agree to clean up their lives.
The newer "housing first" approach is based on a simple premise: People are more likely to be successful in treatment when they have a stable home. Somewhere to live should be the first thing we provide.
The question is not whether we want to support these people we already do. It's whether we'd rather pay for shelters, police time, emergency rooms and sobering centers or pay for permanent, supportive housing.
The answer seems obvious. It makes little sense to keep investing in a model that buys no long-term improvement in their quality of life or ours.
In a recent study, Dennis Culhane, a professor of social welfare policy at the University of Pennsylvania, found one chronically homeless mentally ill person in New York costs taxpayers about $40,000 a year in shelter and other acute-care services. The cost to house one mentally ill person in permanent, supportive housing? About the same.
There are an estimated 5,500 to 6,000 chronically homeless people in Seattle. These are our society's sickest and most damaged people. They're literally dying on our streets.
As much as we want it to work, the idea of asking a hard-core population of chronic alcoholics, for example, to put down the bottle before they get a set of apartment keys is unrealistic and impractical. Some can do it for a time, but most end up back on the streets.
The cost of maintaining chronic, homeless alcoholics in King County is staggering. King County's Division of Mental Health, Chemical Abuse & Dependency found 14 chronically homeless people were among the top 20 users of county sobering services. In 2003, those 14 people cost the county nearly $285,000 just for sobering and detox. That doesn't include shelter beds, police or jail time, emergency-room visits or the myriad of other services provided by the city and county.
This makes no sense. We're seeing the same people, year after year. They're not getting better.
We all know their faces. I saw a man the other day setting a bundle of clothes on a dumpster behind a grocery store in Queen Anne. Instantly, I recognized his worn, faraway face. He was there, wandering the same streets, when I rented an apartment in the neighborhood a decade ago.
A proposed apartment house in the Denny Triangle is based on this "housing first" model. The building would allow 75 chronic alcoholics to drink in their rooms, but not in common areas. Counselors and support staff would gently push residents toward sobriety. Rather than urinating in alleys and collapsing on sidewalks, they could use their own bathrooms and sleep in their own beds.
In reality, a significant percentage of chronic alcoholics never achieve sobriety. By definition, they've been alcoholics for more than 15 years and have failed at least six attempts to get sober. This housing-first approach recognizes that. In some ways, it's an admission of failure. It assumes not every problem is fixable. Certainly not right away.
Clearly, housing this population is not enough. Other parts of the social-welfare system have an important role to play in preventing homelessness in the first place. Foster care, mental-health services and other programs have to focus on finding housing options for the most vulnerable people instead of turning them out on the streets.
Still, it's easy to see why the approach is energizing homeless advocates. Suddenly, ending chronic homelessness feels like an attainable goal.
Susan Byrnes' column appears regularly on editorial pages of The Times. Her e-mail address is firstname.lastname@example.org
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