Chronic homelessness: A better way? By Francie Broderick, PfP Executive Director Originally published: 11/29/2007

Tommy Muffler died last month in Granite City, perhaps from injuries he received in a beating a few days earlier. A Post-Dispatch news story noted that he was homeless and described him as a person who "lived on the margins of society for at least a decade." It mentioned his long-standing drinking problem, including the observation of former neighbors that he "probably was drinking by the time he was 10 or 11."

I was thinking about Tommy Muffler and many other people I have known like him as I drove to Columbia recently to hear a presentation on ending chronic homelessness. A common definition of a "chronically homeless" person is an unaccompanied homeless individual with a disabling condition who has either been continuously homeless for a year or more or has had at least four episodes of homelessness in the past three years.

At the agency where I work, we know a number of things about the chronically homeless people we see: The majority of them have a serious untreated psychiatric disorder. A majority also have a drug or alcohol problem. And they are medically compromised with multiple chronic diseases. Mostly, we know that all of our health care and housing programs have failed them by setting the bar for treatment or housing too high.

We put barriers in the way of getting treatment and services. We insist that -- by themselves, sick, suffering from depression or hallucinations, addicted, hopeless and homeless -- they somehow make themselves well enough to follow all the rules we will put in place for them. And if they can't, we send them back to the streets again and tell ourselves that "they have to hit bottom" before they will be motivated to get better.

Bottom for many of these folks means dead. This is strong language, I know, but it was echoed by the keynote speaker at the conference I attended. Bill Hobson is the executive director of the Downtown Emergency Services Center in Seattle. He spoke about an approach called "housing first" and, specifically, his 1811 Eastlake Project.

Seattle recognized that it had a large number of people who were chronically homeless and chronically inebriated. They were dying on the streets at six to seven times the rate of other people who were homeless. They were costing the city millions of dollars in emergency room use, hospitalization, shelters and law enforcement calls, and they weren't getting any better.

Statistically, given their histories, their odds of fully abstaining from drugs or alcohol were less than 5 percent. So, the city's reasoning went, since we already are spending so much time and money on these individuals, perhaps we should do it in a way that is both more humane and more effective.

This was the beginning of the 1811 Eastlake Project. The people chosen to participate were the most vulnerable and disabled, people with the longest histories of addiction and homelessness, people who still were drinking.

At Eastlake, they are given their own small apartment, for which they pay a percentage of their income as rent. The building at 1811 Eastlake Ave. in Seattle has an on-site support staff that monitors visitors and provides emergency assistance. A clinical staff of mental health and substance abuse professionals come to the building every day to work with the residents.

The results have been exciting. People are staying housed and receiving medical and mental health treatment. The residents' emergency room use has dropped by 90 percent, and some are drinking less.

The only downside I see to this approach is that it makes behavioral health and housing providers - like me - challenge their most deeply held beliefs about how to treat people with addiction. But maybe it's time.

It's too late for Tommy Muffler, but there are thousands of others like him in our community, and it's not too late for them. Not yet.

Francie Broderick of University City is a frequent contributor to the Commentary page. She is the director of Places for People, a nonprofit mental health center based in St. Louis.

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