Cars drive by a homeless encampment at 3217 Rucker Avenue in July 2020 in Everett. The Snohomish County Council voted last week to purchase hotels in Everett and Edmonds for using as supportive housing. (Andy Bronson / The Herald file photo)

Cars drive by a homeless encampment at 3217 Rucker Avenue in July 2020 in Everett. The Snohomish County Council voted last week to purchase hotels in Everett and Edmonds for using as supportive housing. (Andy Bronson / The Herald file photo)

Editorial: Don’t mandate treatment at county homeless shelters

Requiring addiction treatment risks keeping people on streets, which could cost taxpayers more in the end.

By The Herald Editorial Board

Snohomish County’s recent move to purchase two motels in Everett and Edmonds might have some wondering if the county is playing a game of life-size Monopoly.

This isn’t a game, of course — not when it involves nearly $20 million in federal covid aid funding to buy the motels — but it could prove to be an effective tool in addressing the county’s ongoing challenges with homelessness and the often-related issues of behavioral health and addiction with which many homeless people suffer.

The Snohomish County Council on Wednesday voted 3-2 to buy the two motels — allocating $10.8 million for a Days Inn on Everett Mall Way and $9.1 million for an America’s Best Value Inn on Highway 99 in Edmonds — for use as supportive housing with onsite supervision and access to services such as food assistance, medical aid, behavioral health support, addiction treatment and job training.

But at that price — and with sincere hopes to see improved outcomes for those experiencing homelessness — some are pushing for a guarantee that the promise of shelter will be linked more firmly to addiction treatment.

County Councilmember Nate Nehring — who with fellow Republican councilmember Sam Low were the two no votes on the purchase agreement — has proposed an ordinance that would mandate drug treatment for those diagnosed with substance use disorder for tenants of the county’s bridge and supportive housing programs, including the two motels.

Nehring had hoped to get the proposed ordinance before the council prior to its vote on the hotels’ purchase, but further action has been delayed until the council’s Aug. 23 meeting, at which time a public hearing in early September will be scheduled.

Rationally, it can seem — particularly to those who don’t suffer from an addiction — to be an easy choice: Agree to treatment, begin the path to sobriety and get a roof over your head. But supporters of what’s called low-barrier or Housing First — getting people in stable shelter, then providing access to services — say requiring treatment or sobriety is the wrong approach for those who are suffering from the illness of addiction.

“I understand where Nate Nehring is coming from,” Everett Mayor Cassie Franklin said in an interview last week. “They all need treatment. But they have significant behavioral health challenges, and they don’t know that they’re sick. Or they don’t really want to get the help they need.”

The City of Everett, which has opened one pallet-shelter campus, managed by the Everett Gospel Mission, and is working to open a second on city-owned land at Glenwood Avenue and Sievers Duecy Boulevard, uses the low-barrier approach.

Franklin admits the city isn’t seeing the participation in treatment that many would like to see, and it’s working with the mission to increase its outreach to pallet shelter residents regarding treatment. But the pallet shelters are now housing those who were some of the hardest cases, the most resistant to treatment, and those most often the highest and costliest utilizers of emergency aid and other services.

The approach is about preparing people to agree to treatment and increase the chances for treatment’s success, Julie Willie, the city’s director of community development, said last week.

“If you think of it as sheltering first, rather than housing first, the idea is that we first try and provide people the stability and safety of shelter, and then that gives the ability, the mindset, to be able to think about what’s next.”

Requiring treatment as a condition of shelter risks leaving people on the street and with even less likelihood of becoming and remaining sober.

“It’s not safe or humane or sanitary for anyone to be living outside,” Franklin said. “If we can get those individuals inside, as we’ve seen with the pallet shelters, they start to stabilize enough where you can maybe start to get them to a place where they will accept services.”

Nationwide, studies and research about Housing First’s success in ending homelessness and moving residents into treatment and sobriety are admittedly mixed.

A report by the Manhattan Institute found that while the Housing First approach has a good record of improving housing stability, it’s “record at addressing behavioral health disorders, such as untreated serious mental illness and drug addiction, is far weaker.”

Another study looking at the outcomes of some 30,000 military veterans in a Housing and Urban Development program, by Yale University researcher Jack Tsai, cited by the Substance Abuse and Mental Health Services Administration, found that many residents who used substances continued to use and had poor mental health compared to nonusers, “but the substance abuse conditions did not worsen.”

The study, the SAMHSA report said, raises questions about when and how to incorporate treatment into these programs. What’s needed is active case management for residents, it said.

“Tailoring case management to the needs of the client would be appropriate,” Tsai said. “But no one has come up with a formula for that yet.”

Franklin, while opposed to requiring treatment to get into shelter, said she does support more treatment programs and even mandating participation as a next step in the housing process.

“You don’t want them sitting in the hotel forever,” she said. “In order to get to the next phase, they’re going to need treatment anyway.”

Snohomish County Executive Dave Somers, quoted in a report by The Herald’s Claudia Yaw, emphasized the intent isn’t to “hand out hotel keys” and then warehouse the homeless.

“What we are proposing is bridge housing to get people back on a path to a healthy, productive life and permanent shelter,” Somers said. “And this housing will have 24/7 wraparound services.”

Beyond the $20 million in American Rescue Plan Act funds used to purchase the 74- and 55-unit hotels, the shelters will be an ongoing expense for the county, but an investment that elsewhere has been shown to reduce costs common to untreated homelessness, such as police and aid calls, emergency room use, court use, incarceration and more.

A 2021 study by Arizona State University’s Morrison Institute for Public Policy found that providing stable housing and supportive services for chronically mentally ill individuals can save the public about $21,000 each year for each person served. That’s a net savings over what’s spent on housing and services against what that person might have cost in services resulting from chronic homelessness.

In our life-size game of Monopoly, that’s a savings we shouldn’t miss collecting when passing Go.

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