Treat the Cause, Not the Symptoms

The Downtown Emergency Services Center (DESC) started in November 1979 as an emergency overnight shelter in the ballroom of the Morrison Hotel in Seattle’s Pioneer Square. A small staff served nearly 200 chronically homeless Seattle adults that, “due to their severe and persistent mental and addictive illnesses, were not being served by the existing shelters of the time,” according to their website. Over the next decade, DESC partnered with the City of Seattle, the Greater Seattle Council of Churches, and Washington Advocates for the Mentally Ill to assess the shortages in providing resources for the vulnerable homeless people in the community. The organization rallied in 1984 to create the first severe weather overflow shelter in King County.

Photo credit: David Entrikin

Photo credit: David Entrikin

Phil Spelman was a former volunteer and staff member at DESC for more than 5 years while he studied psychology at Seattle University. “What DESC was originally was exactly that – an emergency overnight shelter,” he says. “My understanding and involvement in DESC is to end homelessness.” When the organization began to expand beyond the original overnight shelter, it created supported housing and outreach programs. One example is Connections, a facility where higher-functioning adults can take a shower during the day, use a computer or learn how to write a resume as part of a job training opportunity.

During his time at DESC, Phil says that his perspective and understanding of the adults living with behavioral health disorders and chronic homelessness that he worked with every day “shifted from ‘these are homeless people’ to ‘these are highly vulnerable, afflicted individuals.’” Most of the folks that he encountered there had diagnoses such as paranoid schizophrenia, along with chronic health problems that come from long-time homelessness. “When I took abnormal psychology, I learned a lot about the conditions that I had seen in real life when I was working at the various projects,” he says.

When Phil first started volunteering downtown, he spent part of his time working at Connections, washing clothes, serving food, handing out mail and toiletries, and interacting with people. “The main shelter worked as a mailing address for a lot of people. Not only for job applications, but to receive a social security check or their disabilities income,” he says.

Photo credit: David Entrikin

Photo credit: David Entrikin

The DESC developed the Vulnerability Assessment Tool (VAT) to help redistribute the limited quantity of services that weren’t reaching those who needed it most. Before, there could be a first-come-first-serve situation, where people could just elbow their way through a line and only the strong survive. There was also favoritism for people who didn’t make trouble during their stays at the overnight shelters, usually because their mental health was far more stable than those who were more vulnerable. “What the VAT does is it assesses vulnerability of continues homelessness and its inherent risks of homelessness on 10 domains,” Phil says. “Domains consist of things like chronic psychiatric conditions, medical conditions, life navigation skills, and substance use. And taken together, the score is supposed to represent is that individual’s level of vulnerability.” In March 2010, the University of Washington completed a research evaluation that found that VAT scores were a reliable psychological indicator of mental health. Since then, the VAT has become nationally recognized by other homeless service providers and adopted for determining
placement of chronically homeless people into supportive housing. “The VAT allows agencies to determine who need the services the most, because they’re so limited,” Phil says. “That’s the way DESC housing works – a person will get a VAT assessment, and if they have a high score it means they’re considered more vulnerable, and they are prioritized for placement in housing.”

Photo credit: David Entrikin

Photo credit: David Entrikin

Once he had earned an undergraduate degree in psychology, Phil applied for a job as a residential counselor and began working at the Evans House on 10th Avenue in Seattle. It opened in 2007 as a residential project with 75 apartments, and each apartment is available to one person. Phil says, “All of the people that live at the Evans House are previously chronically homeless with severe psychiatric diagnoses and/or behavioral difficulties. At that point, it was a fairly new housing project, and it was difficult for me. There were 30 to 40 very high-needs people constantly needing your attention.”

“In my position as a residential counselor, my duties were to monitor and log activities and behaviors, anything that was maybe a little out of the ordinary, anything that really should have been noted,” Phil says. Ideally they would be the eyes and ears of each tenant’s case manager on the housing site in between short weekly check-in sessions. “A person sees their case manager regularly, but the case manager is just dropping in on the situation. They get a snapshot of the person – maybe the person is doing horribly, but on that particular day at that particular time, they appear to be adapting quite well.” During his shifts at the Evans House, Phil says that there were only two residential counselors for 75 tenants. “With many of the folks that I worked with, maybe they didn’t care enough, or have enough training, or just weren’t bright enough.”

Photo credit: David Entrikin

Photo credit: David Entrikin

In addition to activity and behavior monitor logging, residential counselors act as the front line between the mentally vulnerable tenants and the outside world. The Evans House is an apartment building, the residents have leases and are protected by tenant-landlord laws. They can come and go as they please. Even if someone’s mental health is extremely fragile at the time and quickly deteriorating, they are not locked in. In these situations, a good residential counselor will intervene and initiate a chain of communication that will end with that person getting help. “Sometimes this means calling the county mental health professionals and telling them this person is a danger to themselves and potentially to others,” Phil says. “When the mental health professions come out to assess the person, they’re going to have them in the 3-day hold to go to mental health court, where they’ll ask for a 14-day hold at one of the psychiatric treatment places.”

There are very few inpatient treatment facilities in Washington State that specialize in Seattle’s most chronically mentally ill residents. These residents are typically in life-threatening crisis, difficult to stabilize, and ineligible for other inpatient facilities. “The Evans House is essentially the highest level of care that a person can get outside of being in an institution like a psych hospital,” Phil says, “Which are insanely limited in Washington State, no pun intended.” To put everything in perspective, approximately half of the residents at the Evans House are affiliated with the Program for Assertive Community Treatment (PACT). “In order to be a PACT client, you need at least 3 involuntary hospitalizations or incarcerations due to psychiatric circumstances within a year,” Phil says. “So these are people who are really not doing well.”

Photo credit: David Entrikin

Photo credit: David Entrikin

DESC has also pioneered a new approach in housing homeless inebriate adults. The 1811 Eastlake project, opened in 2005, houses 75 residents with chronic alcohol addiction. “The DESC obtained a list of the highest utilizers of emergency medical services within the homeless inebriate population,” Phil says. “These people were located and offered a chance to have a roof over their head, and they’re allowed to drink.” 1811 Eastlake is one of the few housing projects that does not enforce a curfew or an alcohol-free living environment. The DESC website says that a study published in the Journal of American Medical Association shows that “providing housing and on-site services without requirements of abstinence or treatment is significantly more cost-effective than allowing them to remain homeless.”

Research published in the American Journal of Public Health demonstrates that housing projects like 1811 Eastlake “provide a strong rebuttal to the ‘enabling’ hypothesis, which held that providing alcohol-dependent people with housing where they were not prohibited from drinking would cause them to drink even more and experience more dire consequences as a result.” Homeless residents in the study had a 40% decrease in the amount of daily alcohol consumed. For every 3 months spent living in a wet house, there were 8% fewer drinks consumed on the resident’s heaviest drinking days. Withdrawal symptoms decreased by more than half. “The people in the community were outraged,” Phil says. “Very cynical people who don’t understand that homelessness is an extreme stressor. The stress of being homeless is not conducive to not drinking. Once you remove the stress of being homeless, we found that people actually make progress, they set goals for themselves.”

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About lgaylord

Louisa believes in expanding horizons and learning - anything that broadens our minds beyond the here and now, allowing us to learn from the past and innovate for the future. She is particularly interested new and inventive methods of sustainability: city planning and green buildings, creating new objects from old trash, and ways that nature can provide examples for new materials and construction. She is also curious about new scientific breakthroughs, technology and discoveries, and how they will shape the future of consumerism and marketing. While science is important to advancing society, Louisa believes that music, education, art and culture are equally necessary, especially on a local community level.
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