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 broader ideological shift occurring as communities grope for ways to manage growing homeless populations. California, one of the first states to abandon involuntary treatment, passed new laws expanding it. New York has made a billion-dollar investment in residential housing, psychiatric beds and comprehensive services.
Sam had pinned his hopes on Washington's new involuntary treatment law and found it infuriating 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 you,” he said. “Their agenda is to let him go crazy. Whether that includes violence, assault, living in degradation, living in your own filth, going hungry, eating moldy food. “That is their right.”
One day, while making his rounds of phone calls, Sam found himself debating with Kimberly Mosolf, director of the treatment facilities program at the nonprofit Disability Rights Washington.
She made her case: Forcing someone like Andrey to take medication again would be counterproductive, making him more resistant to treatment, not less.
He pointed to data from the Seattle area showing that nearly a quarter of people forced 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 facing a shaking effect,” he said. “These periods of brief incarceration, brief civil commitment, are destabilizing. “That’s what the data tells us.”
She advised a gentler, slower path to follow. If Andrey got permanent housing, without conditions, the community workers could establish a relationship and gradually address the issue of medication. This approach, known in the political world as “housing first,” has become the leading strategy for addressing homelessness in American cities, allowing officials to destroy tent encampments without encroaching on civil liberties.
This was the path that opened for Andrey.
He got the call on a cold, gray day in late November. She was in her room, registering a torrent of new ideas: that her mother had been inseminated with Joseph Stalin's sperm, that the government had planted a bomb in her brain and detonated it. The front desk called to say that her caseworker had come to visit. She had great news.
The local housing authority was offering 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 he could cover it with his disability check.
This location solved several problems at once. He would no longer run the risk of freezing to death, or of crowding the fields, or of scaring pedestrians. For social workers, it was a rare triumph. And for Andrey, it meant the pressure was off: he had a safe place to live that didn't depend on taking medication.
On the morning of December, when she arrived at the hotel to help him move, Olga was surprised to find him awake, with his belongings packed into six bags, and eager to leave. All that morning she seemed like a different person: alert, motivated, fun. She charmed the manager of the apartment building, which was clean and bright, adorned with Christmas decorations.
He signed forms promising not to hit the walls, start fires or smoke in the unit. The building manager asked her, in an apologetic tone, to tell him what should be done with his belongings “if something were to happen.”
He blinked. “You mean if I'm dead?”
She nodded. There was a small, awkward silence.
“Damn dude!” she said, and everyone in the room laughed out loud.
“Bury me with my things!” she shouted jubilantly.
They laughed again. Then the building manager, with a ceremonial gesture, handed him a set of keys on a blue keychain.
Next to the other residents, men in their 60s and 70s, Andrey seemed vigorous and charismatic, overloaded with the natural gifts of youth. His apartment was small but spotless, with a window facing a sun-drenched street. He walked his caseworker to the elevator and posed for a commemorative photo.
Then the door closed and he was in the small room with his mother.
