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April 29, 2008 -- USA Today (US)

OpEd: Give Them Homes

By Laura Vanderkam

Return to Drug War News: Don't Miss Archive

Seattle hatched an innovative, if obvious, plan to tackle its growing homeless population: House homeless alcoholics. The kicker: The city saved money in what could provide a model for solving a national problem.

SEATTLE -- For the past 20 years, the Rev. Craig Rennebohm has spent at least three days a week walking the streets of this drizzly city. His mission? Helping the chronically homeless people everyone else bustles past. He shepherds people with mental illnesses to doctor appointments. He warms folks up with coffee at Starbucks. And, always, this United Church of Christ minister tries to get some of the 2,000-plus people "sleeping rough" on any given night into housing.

It's slow going. Luke, who hangs out under an Interstate 5 overpass, won't go into buildings because he's worried about gas leaks. Willie, who pushes an oversized cart near a Seattle ferry terminal, tells Rennebohm that he likes to be outside where "the wind blows the powers away."

"Every person out here has their own story," says Rennebohm, author of the forthcoming Souls in the Hands of a Tender God: Stories of the Search for Home and Healing on the Streets.

These stories of chronic homelessness -- blending mental illness, substance abuse and poverty -- are not new. But these days, the country is trying to write a new chapter. In 2003, the federal government set a goal of ending chronic homelessness in 10 years. We're halfway through that decade. We're not halfway there.

But some cities, such as Seattle, have made dents in the problem through innovative ideas. Not far from Luke's and Willie's haunts, a new building at 1811 Eastlake now houses 75 formerly homeless alcoholics, mostly at public expense. The residents are free to continue drinking in their apartments. This has been controversial, to say the least. But a newly released study finds that not only has 1811 Eastlake improved residents' lives, it has actually saved Seattle more than $2 million a year. That's a result worth copying -- even if the concept is difficult to swallow.

Like many cities, Seattle has seen a spike in homelessness over the past three decades. The gentrified downtown no longer contains cheap housing. The de-institutionalization of the mentally ill (many of whom self-medicate with alcohol and drugs) also plays a role. While anyone from families to runaways can be homeless, stereotypical "chronic public inebriates" (CPIs) are the most visible.

They're also the most expensive. Several years ago, Seattle officials discovered that some CPIs visited local emergency rooms 100-plus times a year. When they weren't in the ER, they were often in jail, or drying out in the local Dutch Shisler Sobering Support Center. None of these was optional public services. Police had to arrest people causing disturbances, tourists didn't want to trip over inebriates passed out in the street, and ERs couldn't turn away someone who showed up with a concussion after falling over drunk.

So Seattle's main homeless service provider, the Downtown Emergency Services Center, hatched an idea. Homeless CPIs ran up huge tabs because they were getting drunk on the street. What if they could drink indoors in their own apartments, monitored by staff ready to offer counseling and treatment the second they wanted it? As the resulting 1811 Eastlake project was being built, DESC asked the county to rank Seattle's most expensive homeless alcoholics. When someone on the list showed up at Harborview Medical Center, or in jail, social workers swarmed and offered the keys to one of 75 units. People leapt at the chance.

"We only had to offer this to 79 people to get 75 acceptances," says Bill Hobson, DESC's director. The building reached capacity in March 2006.

Predictably, Seattle residents -- pinched to afford steep rents themselves -- howled. But simply getting CPIs off the streets turned out to be a prudent use of taxpayer dollars. A recently released University of Washington study found that in the 12 months before moving into 1811 Eastlake, residents logged 2,312 days in the county jail. In the 12 months after, they logged 1,343 days. Residents logged 6,432 sobering center visits before 1811 opened; after, they logged 837 visits. Harborview Medical Center visits dropped 32%. The savings dwarfed 1811 Eastlake's $1.1 million operating costs.

Of course, projects such as 1811 Eastlake won't solve the chronic homelessness problem. For starters, people like Luke and Willie are too fearful to instantly take housing when it's offered -- though Rennebohm keeps trying, telling Luke, for instance, that it's possible to find shelter without gas heating. He has had some successes. An older man who moved into supportive housing tells me he has been kidnapped multiple times by the Mafia, but as Rennebohm points out, at least he's talking. Years ago, living on the streets, he would barely say hello.

Through months (or years) of building up trust, Rennebohm can often persuade someone to accept help. Some cities have been able to replicate this on a larger scale. Portland, Ore., for instance, engineered a 70% drop in its chronic homeless population by hiring enough outreach staff and creating enough permanent housing units supported by counselors and nurses to offer one to just about anyone willing to give it a try. This "housing first" philosophy -- similar to the philosophy behind 1811 Eastlake -- recognizes that if you give someone a home, he is by definition no longer homeless. You can figure out the details later.

Perhaps in this era of falling real estate prices and gluts of unoccupied homes, there will be the political will for creating the thousands of new units this philosophy would require nationally, but I doubt it. Housing CPIs who would otherwise be in jail or the ER saves taxpayers money; the payoff from housing a mentally ill man who's just hiding from the world under an I-5 overpass is less clear.

That said, even if getting all the Lukes and Willies of the world off the streets in the next five years is unlikely, projects such as 1811 Eastlake show it's possible to contain the worst aspects of homelessness. Few public policies achieve measurable results and save money at the same time. More cities should give the idea a look.

Laura Vanderkam, a writer based in New York City, is a member of USA TODAY's board of contributors.

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