Housing homeless alcoholics works for Seattle

Audrey Young,M.D.

Spending money on homeless alcoholics, as Anchorage Mayor Dan Sullivan proposes to do, is never a politically popular move. But the reasons it makes sense should be readily apparent. Homeless alcoholics make our streets and parks less safe. We spend tax dollars on higher police and court system costs, alcohol treatment and emergency health care. Problem is, we've poured both public and private dollars into myriad social programs, trying to coax these folks back to mainstream life, and our efforts seem to have minimal long-term impact, particularly for chronically homeless alcoholics. So is the mayor's plan just more of the same old, same old?

It doesn't have to be. Seattle-based advocates for the homeless, frustrated by a long track record of incremental gains, are seeing some success with new approaches to managing chronic street alcoholics.

Bill Hobson, executive director of the Downtown Emergency Services Center, a homeless advocacy organization, told me that he's shifted toward meeting chronic inebriates "where they're at" rather than asking them to prove their "readiness" for becoming housed and employed.

In social services lingo, "readiness" means showing up on time and in presentable condition for appointments and interviews -- requirements that make complete sense to most middle-class Americans, but not to your average street drinker.

Hobson conceived of a "wet house" where these individuals would have their own personal studio apartments so long as they paid 30 percent of their income as monthly rent and didn't beat anybody up. They could continue to drink as much as they liked. There was no requirement to engage with staff social workers, who were ready with job-retraining opportunities, or with nurses who could help manage medications.

The original wet house concept provoked a heated response, even here in left-leaning Seattle. The media labeled the project "Bunks for Drunks." One prominent Seattle developer sued Hobson over a zoning issue, tying him up long enough to derail the original financing. Fellow homeless advocates told him that the homeless simply loved the streets too much and would reject his apartments.

Hobson's wet house was finally built in 2005, with efficiency studios and dorm-style rooms for 75 people. The county's most expensive individuals, those who circulated endlessly through the county hospital's emergency room, alcohol detox facility, court system and jail, were invited to move in.

To fill 75 slots, Hobson asked 79 people.

Turns out that people don't enjoy being homeless after all.

In the beginning, the staff called 911 constantly. The alcoholics suffered from considerably more chronic disease than had originally been anticipated, and Hobson worried they were in over their heads.

Within months, though, the great majority of residents were drinking significantly less than they had in decades. Their medical conditions stabilized. Several became permanently sober; housing alone seemed to be a civilizing force. City attorneys noted that their old homeless clients no longer clogged the court system. Mental illness was better controlled as medication compliance rose from 20 percent to 80 percent.

When researchers at the University of Washington crunched the numbers, they found that the project saved local taxpayers $4 million per year, thanks to fewer ER visits, fewer stays at alcohol detox and fewer engagements with the justice system.

You don't hear a lot of criticism of Hobson these days.

Spending scarce public funding on a population that appears impervious to help may seem irrational at first glance. But we pay millions of dollars for these folks through indirect channels each year, so ignoring the problem is not an option.

Seattle's example suggests that homeless inebriates may not be totally resistant to help, but that new rules of engagement may be in order. As we continue searching for the best, most comprehensive ways to manage this population, we would do well to support novel approaches like Mayor Sullivan's, designating one person to tackle homelessness broadly and making him or her answerable to the public.

It won't be an easy job. His appointee deserves our support.

Audrey Young, M.D., is a general internist from Seattle and author of "House of Hope and Fear," the story of a big-city hospital.