A reverse approach to homelessness

Strategy: Baltimore may emulate a New York program that places housing before treatment for addiction or mental illness.

June 20, 2005|By Lynn Anderson | Lynn Anderson,SUN STAFF

NEW YORK - Social workers Vickie Stoyanova and Jerome Marzan have their hands full. Their job on this steamy day in Harlem is to drive a homeless man with mental problems and a crack habit to a hotel where he will stay until they find him a new apartment. He was kicked out of his last place after he turned it into a drug den.

As they drive, their charge announces that he is on the lookout for women eating ice cream cones. "Take me away and make me forget about what happened back there," he says, his brain buzzing with jumbled thoughts. Stoyanova, who calls her client a "really sweet guy," later confirms that the 49-year-old is schizophrenic. "But you probably got that," she says.

In most cities, including Baltimore, Stoyanova's sweet guy would still be living under a freeway ramp. He is a client at Pathways for Housing, a program that sets up mentally ill homeless people in apartment buildings with other New Yorkers rather than hotel-like residential facilities with teams of social workers. The program, unlike virtually any other in the nation, is changing the way many in this country, including those in the Bush administration, think about homelessness.

For decades, housing has been the end reward for months of sane and sober living. But for some homeless people, especially those with mental illness, staying clean and rational for an extended period is impossible. Stoyanova's client roamed the streets for 20 years before she and Marzan started looking out for him. They gave him an apartment despite his drug habit and wild mannerisms and have stuck by him through arrests and relapses. The Sun is not identifying him because of his illness.

At the hotel, Marzan gives advice. "Look, you've got to be really cool around here," he instructs. "Don't lose your keys." The man hasn't stopped talking. His bugged-out eyes take in his new surroundings. Before he enters the hotel, he strikes a dramatic pose and delivers one last monologue, this time about the Indian restaurant across the street. "Oh, yes, they remember me," he yells.

A new model

Stoyanova and Marzan know that the man won't soon stop smoking cocaine or inviting junkies home, but that's not the point. He's off the streets and learning, albeit slowly, to function in a rational world. "We understand that he is not going to stop getting high," Marzan says. "But we can get him to take a bath and make sure he gets his food stamps."

Sam Tsemberis, a psychologist who started the program about a dozen years ago, says the concept of housing the homeless before they receive treatment for drug addiction or mental illness isn't something he thought up. "It's what people told me they wanted," he said, referring to the men and women he met as an outreach worker in New York in the 1980s.

Pathways' harm-reduction model, which stresses protection over everything else, is winning converts. As word of its success has spread - 85 percent of the program's clients remain housed - duplicates are cropping up. Philadelphia, San Francisco and Denver are among a growing list of cities with "housing first" initiatives.

Baltimore could join the list soon. Laura Gillis, who heads the city's homeless services department, has invited Tsemberis to visit the city this month to explain how his program works. Members of her staff will also travel to New York to shadow Pathways staff for a day. Gillis will unveil a pilot program similar to the Pathways model in early July, she said.

The effort here will be small at first, with 20 apartments and a matching number of drug treatment slots, but it could be expanded, said Gillis, who is president of Baltimore Homeless Services Inc., a nonprofit arm of the city Health Department. In keeping with the Pathways model, Gillis' staff will sweep people off the streets and give them apartments. Participants will not be forced to enroll in drug treatment or psychiatric therapy, although the hope is that they will eventually.

The cost of the pilot program will be covered by several city agencies, including the Housing Authority of Baltimore City and Baltimore Substance Abuse Systems Inc. Gillis doesn't expect the cost to be exorbitant. The Pathways program costs $22,500 per person a year. More conventional programs cost $40,000 to $65,000. A bed in a New York state jail costs about $85,000. State hospitals charge $175,000.

`Survival mode'

Pathways serves 400 to 500 people a year and has an annual budget of $12 million. Funding sources include grants from foundations and the government, as well as benefits already available to clients such as housing vouchers and food stamps.

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