TOPICS > Health

Pathways to Housing for the Homeless Mentally Ill

December 30, 2002 at 12:00 AM EDT


WOMAN: So we may not have to do a visit.

WOMAN: Okay.

BETTY ANN BOWSER: There was half a foot of snow on the streets of New York City, traffic was barely moving, still Susanah Eckblad and Yvette Peterson, slogged through the snow to make their daily rounds.

WOMAN: But when we come back when we drop the van off to ed, I guess he’s still going to be able to get out.

BETTY ANN BOWSER: First stop, 125th Street in Harlem to deliver medication to a mentally ill man who, until recently, was homeless. Then on to another person suffering with mental illness who needed medication.

WOMAN: You have tomorrow morning and evening.

BETTY ANN BOWSER: But she was also broke and out of food.

WOMAN: This is a loan again. You’re already in the hole for $25, so now that’s $45, okay?

BETTY ANN BOWSER: Eckblad and Peterson are case managers for a New York organization called Pathways to Housing. It finds affordable apartments for mentally ill homeless people. Leaders in the field are watching what Pathways is doing because the nation’s homeless population is on the rise. New York City has the largest homeless population in the country. On any given night, an estimated 32,000 people go to shelters run by the city and charities. Thousands more choose to sleep on the streets. One-third of the city’s homeless are mentally ill, and many of them are drug addicts, alcoholics, or both. Most traditional programs for the homeless require those people to take their medication and attend drug rehabilitation as a pre-requisite to get housing, but Pathways has turned that concept on its head: No psychiatric, drug, or alcohol treatment is necessary to qualify for an apartment. Sam Tsemberis is founder of Pathways.

SAM TSEMBERIS: It’s an enormous and futile effort if you try and get people into treatment, clean and sober before you house them. For this particular group that we’re focused on, the ones that stay on the street, it’s not working. And if you offer the person what they want, a choice, they will make the best choice and then, also, own it. So not only do people get into these apartments, they love to keep them once they have them. They think “I have a place to live in for the first time. Maybe I’m going to stop drinking so I can hold on to it.”

BETTY ANN BOWSER: Like 90 percent of Pathways clients, Farook Muside has a long history of substance abuse. He is also schizophrenic, and until four years ago was homeless.

FAROOK MUSIDE: I lived for three years in the bus terminal and subway and trains. It’s painful. Painful experience. I don’t wish it to my worst enemy to have no place. Don’t know where second meal’s coming from, during the winter you suffer cold, rain snow no cover. Sometimes you don’t have a blanket to carry on. That’s what homeless is all about.

BETTY ANN BOWSER: Pathways found Muside an apartment, and like many of the clients they gave him a job. He buys groceries for other homebound Pathways members, he also helps teach a cooking class, and most of the time he’s been sober.

FAROOK MUSIDE: My outlook on life completely changed. My existence changed. I love what I got today. I will do anything to keep it. That doesn’t mean that I don’t go through obstacles and I don’t have no problems. No, I do have my problem, because I am considered, also, mentally ill. Today, I accept that fact. I used to turn away from it. It used to scare me. Today, as long as I keep taking my medication and do the right thing, follow advice, I’m going to be all right.

BETTY ANN BOWSER: In ten years, Pathways has grown from a small organization to a non-profit with 70 employees and a budget of $8.1 million. It is funded with grants from the government and private businesses. The program currently houses more than 400 homeless people and is growing. Pathways will pay 70 percent of a client’s monthly rent if they agree to take part in a money management program. The other 30 percent comes from a federal monthly disability check most of the clients get because they are mentally ill. Participants must also allow two home visits a month from one of the case managers. Eckblad is Muside’s case manager.

CASE MANAGER: I called somebody that has the same job as her and she just said the change hasn’t been processed.

BETTY ANN BOWSER: On this day, she helped him with a problem involving his food stamps.

CASE MANAGER: They have to find out if they’d actually received them back.

BETTY ANN BOWSER: But Eckblad does a lot more. She sees Muside almost every day, she keeps track of his medication. On top of that her case load is small, just ten clients. So she is able to spend a lot of time with him.

SUSANNA ECKBLAD: We just do a wide variety of things. I mean, you know, we talk a lot and sometimes that’s about serious things and, you know, mental health or living with addiction. Sometimes he just might want somebody to come along with him, so we go to the thrift store and buy sweaters.

BETTY ANN BOWSER: While Muside is good about taking his medication for schizophrenia, he is not in any organized psychiatric or drug treatment program. Twice he has slipped back into addiction, and been thrown out of his apartment by a landlord. For that, he would have been kicked out of a more traditional program. But in both instances, Pathways found him a new apartment. Manhattan Institute Fellow Heather MacDonald says that’s a good example of why she thinks Pathways is ill-conceived.

HEATHER MAC DONALD: I don’t agree with the notion that somebody who is severely mentally ill has the capacity to make a choice about whether they should or should not be taking medication. I don’t believe that somebody who is destroying their body and their mind through drugs should be given the option at taxpayer expense to be continuing to use drugs. I think an approach that has rules and expectations for clients in the long-term has a much better hope of integrating people back into society.

BETTY ANN BOWSER: Founder Tsemberis says criticism like MacDonald’s misses the point. He says Pathways isn’t trying to turn their clients into model citizens.

SAM TSEMBERIS: They stay housed all the time. You know, forever more; not necessarily in the same apartment. I mean, they change apartments, things in life happen. People go to the hospital, but they come back and they’re still housed. They might go to jail even. They come back we still house them. The commitment for us is as long as the client wants it.

BETTY ANN BOWSER: In the first year of a long-term study, researchers found Pathways’ clients stay housed longer than those in traditional programs that have strict rules and regulations about substance abuse. And it’s cheaper. Pathways costs about $22,000 a year for each client. When people with mental illness remain on the street, they use up more than $40,000 in public shelter, corrections, and health care services. Jane Whiley says it’s more than just having a roof over her head. Pathways has helped her think about a future life independent of the program. Whiley works for Pathways as a fundraiser. She has not used drugs for 20 years, but has cycled in and out of hospitals for treatment of schizophrenia.

JANE WHILEY: The objective of Pathways is really to have the person go through that evolutionary process or that metamorphosis so they can be people living with mental illness, stabilized, out there productively, pursuing other jobs, representing the best of the worst circumstances.

BETTY ANN BOWSER: But Critic Heather MacDonald questions whether most of Pathways’ clients will ever be able to maintain truly independent lives outside of the program.

HEATHER MAC DONALD: I think it’s both wrong, and it doesn’t work. There’s no way if your goal is to reintegrate into society and ideally work, because that’s the basis of life, and you’re cycle cycling rapidly between, in a buy polar disorder between main why and depression or if you’re schizophrenic and you’re hearing voices, you’re not going to be able to work.

BETTY ANN BOWSER: Despite concerns like that, Pathways founder Tsemberis says his next big push will be on finding jobs for homeless people that are not connected to the program, jobs that could make people like Jane Whiley truly independent.