Sam and Olga had concluded that only involuntary treatment could break the cycle for Andrey — something open-ended, combining long-term injectable medications with intensive therapy and counseling.
They are part of a much larger ideological shift taking place, as communities grope for ways to manage ballooning homeless populations. California, one of the first states to turn away from involuntary treatment, has passed new laws expanding it. New York has made a billion-dollar investment in residential housing, psychiatric beds and wraparound services.
Sam had staked his hopes on Washington’s new involuntary treatment law, and found it maddening that this fall, when Andrey was released, the new system was not yet active. His frustration was often directed toward civil rights advocates who oppose forced treatment.
“They have an agenda, but the agenda is not to help him,” he said. “Their agenda is to let him just be crazy. Whether that includes violence, assaults, living in degradation, living in his own filth, starving, eating moldy food. That is his right.”
One day, as he made his rounds of phone calls, Sam found himself debating Kimberly Mosolf, director of the treatment facilities program at the nonprofit organization Disability Rights Washington.
She laid out her case: Forcing someone like Andrey to take medication again would backfire, leaving him more resistant to treatment, not less.
She pointed to data from the Seattle area, which showed that almost a quarter of people compelled to take medication had been forced to do so more than three times before. Seven percent of them had been forced 10 times or more.
“We are looking at a churning effect,” she said. “These periods of brief incarceration, brief civil commitment, they are destabilizing. That is what the data tells us.”
She advised a gentler, slower way forward. If Andrey got permanent housing, with no strings attached, outreach workers could build a rapport and gradually broach the subject of medication. This approach, known in the policy world as “housing first,” has emerged as the primary strategy for addressing homelessness in American cities, allowing officials to chip away at tent encampments without encroaching on civil liberties.
This was the path that opened to Andrey.
He got the call on a chilly, gray day at the end of November. He was in his room, recording 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 detonated it. The front desk called to say his caseworker had come to visit. She had great news.
The local housing authority was offering him a one-bedroom at Central Park Place, a low-income apartment building on the grounds of Vancouver’s Veterans Affairs hospital. The residents there were mostly veterans, but rooms were also set aside for people with mental illnesses. The rent was $590 a month, and could be covered by his disability check.
This placement solved several problems at once. He would no longer be at risk of freezing to death, or jamming up the courts, or frightening pedestrians. For the caseworkers, it was a rare triumph. And for Andrey, it meant that the pressure was off: He had a safe place to live that was not contingent on taking medication.
On the December morning when she arrived at the hotel to help him move, Olga was surprised to find him awake, his possessions packed away in six bags, itching to go. All that morning, he seemed like a different person — alert, motivated, funny. He charmed the manager at the apartment building, which was clean and bright, festooned with Christmas decorations.
He signed forms promising not to punch the 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 should happen.”
He blinked. “You mean, if I’m dead?”
She nodded. There was a small, awkward silence.
“Damn, dude!” he said, and everyone in the room cracked up.
“Bury me with my stuff!” he cried jubilantly.
They laughed again. Then the building manager, with a ceremonial flourish, presented him with a set of keys on a blue fob.
Beside the other residents, men in their 60s and 70s, Andrey seemed vigorous and charismatic, overloaded with the natural gifts of youth. His apartment was tiny but pristine, with a window looking out on a roadway drenched in sunshine. He walked his caseworker to the elevator bank and posed for a commemorative photo.
Then the door closed, and he was in the small room with his mother.
