Sam and Olga had concluded that only involuntary treatment could break the cycle for Andrey – something undetermined, combining long-term injectable medication with intensive therapy and counseling.
They are part of a much larger ideological shift underway, as communities grope for ways to manage exploding homeless populations. California, one of the first states to move away from involuntary treatment, has passed new laws that expand it. New York has invested $1 billion in residential housing, psychiatric beds and comprehensive services.
Sam had pinned his hopes on Washington’s new involuntary treatment law and found it galling that this fall, when Andrey was released, the new system was not yet active. His frustration was often directed at civil rights advocates who opposed forced treatment.
“They have a program, but this one is not to help him,” he said. “Their agenda is to let him go crazy. That includes violence, assault, living in degradation, living in your own filth, starving, eating moldy food. It’s his right.
One day, while making his phone rounds, Sam found himself arguing with Kimberly Mosolf, director of the treatment facilities program at the nonprofit Disability Rights Washington.
She laid out her case: forcing someone like Andrey to take medication again would backfire, making him more resistant to treatment, not less.
She pointed to data from the Seattle area that showed nearly a quarter of people forced to take medication had been forced to take medication more than three times before. Seven percent of them were forced 10 or more times.
“We are seeing a churn effect,” she said. “These periods of brief incarceration, of brief civil commitment, are destabilizing. That’s what the data tells us.
She advised a gentler, slower path forward. If Andrey was given permanent housing, with no strings attached, the outreach workers could establish a relationship and gradually approach the topic of medications. This approach, known in the political world as “housing first,” has become the primary strategy for combating homelessness in American cities, allowing authorities to destroy tent encampments without encroaching on civil liberties.
This is the path that opened up for Andrey.
He received the call on a cold, gray day in late November. He was in his room, registering a torrent of new ideas – that his mother had been inseminated with Joseph Stalin’s sperm, that the government had planted a bomb in his brain and made it explode. The front desk called to say her social worker had come to visit her. She had excellent news.
The local housing authority offered him a one-bedroom apartment in Central Park Place, a low-income apartment building on the grounds of the Vancouver Veterans Affairs Hospital. The residents were mostly veterans, but rooms were also reserved for people with mental illnesses. The rent was $590 a month and could be covered by her disability check.
This placement solved several problems at once. He would no longer risk freezing to death, blocking the courts or frightening pedestrians. For social workers, it was a rare triumph. And for Andrey, that meant the pressure was off: he had a safe place to live, without relying on medication.
On the December morning, when she arrived at the hotel to help him move, Olga was surprised to find him awake, his belongings packed into six bags, eager to leave. All morning he seemed like a different person – alert, motivated, funny. He charmed the manager of the building, which was clean and bright, adorned with Christmas decorations.
He signed forms promising not to punch walls, start fires or smoke in the unit. The building manager asked him, apologetically, to indicate what should be done with his belongings “if something were to happen.”
He blinked. “You mean, what if I’m dead?”
She nodded. There was a little awkward silence.
“Fuck dude!” he said, and everyone in the room burst out laughing.
“Bury me with my stuff!” » he shouted gleefully.
They laughed again. Then the building manager, in a ceremonial gesture, handed him a set of keys on a blue key ring.
Next to the other residents, men between 60 and 70 years old, Andrei seemed vigorous and charismatic, overloaded with the natural gifts of youth. Her apartment was small but spotless, with a window overlooking a sun-drenched road. He accompanied his caseworker to the elevator bank and posed for a memorial photo.
Then the door closed and he found himself in the small room with his mother.