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