Furious Seasons

April 02, 2009

Study: Housing Homeless Drunks And Letting Them Drink Saves Millions

Three years ago, an experiment known as 1811 Eastlake opened in Seattle. It's a large apartment complex just off downtown and it houses about 100 chronic inebriates, as the term goes, all of them formerly homeless. The experiment part is that for eons America has attempted to grapple with the problem of urban street drunks by either sticking them in jail (very expensive and a practice that largely stopped in the 1970s), forcing them into housing where they couldn't drink (and inevitably relapsed and got the boot) or leaving them on the streets where they cycled from street to jail to ER to sobering center to homeless shelter to the liquor store to the streets. Commonly, such people (and it's usually guys) run up a $50,000 a year or so tab on the public purse and harm reduction advocate got to think that maybe it made more sense to stick such folks in long-term publicly supported housing and let them drink their brains (and livers) out and it'd wind up being cheaper.

This harm reduction bit got a lot of play in an interesting piece in the New Yorker in 2006, concerning a homeless man in Reno, Nev. known as "Million Dollar Murray."

The Seattle facility garnered tons of press--local and national--when it opened in late 2005 because it was the first big facility of its kind in the US, and many commentators were scornful of the place and the idea that the public would, in effect, be paying these guys to get drunk. I wrote my own piece on 1811 in Seattle Weekly and I'd written earlier of a lawsuit brought in attempt to keep the place from opening at all. My own sense of things--based on a decade or so of reporting on social issues--was that no approach whatsoever seemed to work with chronic street drunks, they were running up tons of expenses on the public dime, so why not try something new?

The 1811 facility wasn't a mats on the floor homeless shelter, but an actual apartment building with units along the lines of a college dorm room.

A new study came out in JAMA this week detailing whether the concept of "Housing First," as it's known, had any impact (here's an AP piece on the study). The 98 street drunks whom the study tracked had cost the public $4,066 a month prior to entering 1811 and afterwards they cost $1,492 a month after six months in the facility and $958 a month after 12 months. That's a pretty big savings and, oddly enough, some of the residents began to drink less. Some even got sober. (Some also died.)

My own interviews with residents there in 2006 turned up several who drank upwards of two fifths of hooch a day and had been for 20 years. Yes, it is amazing what the human body can endure.

While this sort of program would have to replicated elsewhere to see if these savings hold, it sure is a vastly more humane way to deal with a chronic urban problem than in the past. It also has all sorts of implications for addressing homelessness among the mentally ill, chronic crackheads and junkies of every stripe. My own guess is that, for example, housing the mentally ill who are homeless instead of herding them into very stressful homeless shelters or leaving them to the streets would improve their mental health issues dramatically, with or without medications. There is something magical about having a roof over one's head, even a modest one.

On a side note, I sure hope Robert Jamison (formerly a columnist at the now defunct Seattle Post-Intelligencer) and Ken Schram (a commentator at KOMO-TV in Seattle) plus a few other reporters in Seattle paid attention to this study. Because they were wrong, very wrong, about this place. (For some reason, I cannot find Jamison's attack on the place on the new seattlepi.com's website. Weird.)

1811 Eastlake is operated by the Downtown Emergency Service Center, a large social service agency in Seattle.

Full disclosure: I worked 15 shifts as a shelter counselor at DESC's main homeless shelter downtown as a relief, on-call, temporary employee from mid-December 2007 to mid-January 2008. I made $10 an hour. I doubt that it influenced anything I wrote in this post, but I thought I'd let you know.

Posted by Philip Dawdy at April 2, 2009 12:03 AM

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Comments

I worked in a harm-reduction framework in a residential situation that housed 80 people in two apartment buildings.

They were all formerly homeless, drug/alcohol users or ex-users who had a pscyhiatric diagnosis.

ER visits and hospital stays went way way down...saved a ton of money...

and it's the best job I ever had as a social worker...

people were free to be who they were with no coercion.

Posted by: Gianna at April 1, 2009 10:55 PM

Democracy Now's Amy Goodman gets to meet Nickelsville's Anitra.
http://www.democracynow.org/2009/3/30/nickelsville_seattle_newest_tent_city
Also see GOOD Magazine's series on Skid Row:
http://www.goodmagazine.com/section/Features/on_skid_row_introduction

Posted by: Lilly NC at April 1, 2009 11:06 PM

Philip, I like what you said about the importance of having a roof over one's head. It's the most basic necessity of existence, how can one even begin to address a mental illness without a proper place to sleep, protection against the elements and a sense of security from danger?! The human soul needs a home. I'm a blatant and totally unapologetic socialist when it comes to this: every human being should be provided housing by the human community in which they live.

Posted by: David at April 2, 2009 08:00 AM

Peace be with you Philip

I agree with the concept of housing first. I haven't been impressed with it the way I see it implemented. A group of poverty pimps in Humboldt County Ca. have gotten a shit load of money to set up a housing first program. To date they have spent the money and set up exactly zero housing first opportunities.

A second look at the inefficiency of Bush's eight years of ending "chronic homelessness" in ten years will show massive fraud. Here at least (Humboldt county) the poverty pimps picked non-chronic houseless to "case manage" because they showed better success rates. The worst of the addicted/mentally damaged stayed, and in many cases died, on the streets, because the funds earmarked to get them off was waisted on poster childern. And waisted is the wrong word if their intent was to just dope people.

This article has started the next generation of million dollar Murray. It says "Eight of the nine patients have drug abuse problems, seven were diagnosed with mental health issues and three were homeless." What is their solution? "Solutions include referring some frequent users to mental health programs."

The poor get drugged without consent, informed or otherwise.

love eternal
tad

Posted by: tad at April 2, 2009 08:11 AM

What a refreshing idea. A Soteria House without the country setting; without the gardens; without any helpers. And it was still better and cheaper and more humane than the ?? alternatives??

Posted by: Anon. at April 2, 2009 10:17 AM

great article Philip

Posted by: Stephany at April 2, 2009 10:57 AM

The "righteous" person is not going to like the science proving compassion and understanding works better than the stick to help people change.
LINK

Heroin-assisted treatment safe and effective: study
"These people are out in the alleys, injecting heroin of unknown quality and quantity," said Dr. Martin Schechter, the study's principal investigator. "They're committing crimes, they're involved in sex work to pay for that, and they're certainly, in that situation, not going to get better."

Posted by: mark p.s.2 at April 2, 2009 11:46 AM

I dunno dude makes pretty good sense to me!

Posted by: Joe Jackson at April 2, 2009 01:41 PM

You're doing really well on reddit. Why aren't you there moderating!? Now if you could only find a way to make money when they hit your sever.

Posted by: Tony at April 2, 2009 04:04 PM

good, spread the info.

Posted by: Bill Cornelius at April 2, 2009 08:50 PM

I completely disagree with this approach. It is a complete oversimplification. It may be cheaper to warehouse these people and let them drink themselves to death, but why is cheaper always better in America? I also have a huge problem with providing free food and shelter to people who have chosen their situation when there are plenty of others who deserve assistance more. Before Anyone kills me for being unsympathetic, note that the article says nothing about the participants' mental state. If you grant they are mentally ill, then I say again that this approach is completely wrong.

Posted by: Ben at April 3, 2009 06:11 AM

They have done, and published, on housing-first philosophy in NYC also. Great topic to blog about.

Posted by: MedsVsTherapy at April 3, 2009 06:12 AM

The simplest and efficacious solutions are the most hard to be done.
This is great news!

Posted by: Ana at April 3, 2009 11:35 AM

1) @medsvstherapy - I worked at a public-system Mental Health hospital in London, dealing for the most part with unemployed people from (mostly) lower income backgrounds. I read case files & double checked the locations of the Panic Buttons. Of *course* it would be preferable NOT to drug people into catatonia. But some people need meds before therapy is remotely possible.
2) re the group home: on reading the article, my initial thought was "not a bad idea". My next thought was "I hope the staff will have had sufficient training on breaking up fights".

Posted by: Suzanne at April 4, 2009 07:31 AM