The man in room 117
Sam and Olga had come to the conclusion that only involuntary treatment could break the cycle for Andrey – something open-ended, combining long-term injectable medication with intensive therapy and counseling.
They are part of a much larger ideological shift taking place as communities look for ways to control growing homeless populations. California, one of the first states to move away from involuntary treatment, has passed new laws to expand it. New York has invested billions in residential homes, psychiatric beds and wrap-around services.
Sam had pinned his hopes on Washington's new law on involuntary treatment, and found it maddening that this fall, when Andrey was released, the new system was not yet up and running. His frustration was often directed at civil rights advocates who opposed forced treatment.
“They have an agenda, but the agenda is not to help him,” he said. “Their agenda is to just let him be crazy. Be it violence, abuse, living in degradation, living in one's own filth, going hungry, eating moldy food. That is his right.”
One day, while making rounds on the phone, Sam struck up a conversation with Kimberly Mosolf, director of the treatment facilities program at the nonprofit Disability Rights Washington.
She explained her case: forcing someone like Andrey to take medication again would be counterproductive, making him more resistant to treatment, not less.
She pointed data from the Seattle area, which found that almost a quarter of people who had to take medication had done so more than three times before. Seven percent of them had been forced ten times or more.
“We're looking at a churning effect,” she said. “These periods of short incarceration and brief civil involvement are destabilizing. That's what the data tells us.”
She advised a gentler, slower path forward. If Andrey were given permanent housing, with no strings attached, outreach workers could build a bond and gradually broach the topic of medication. This approach, known in the policy world as 'housing first', has emerged as the primary strategy for tackling homelessness in American cities, allowing officials to rob tent encampments without infringing on civil liberties.
This was the path that opened up for Andrey.
He got the call on a cold, gray day in late November. He was in his room and registered a flood 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 social worker was visiting. She had great news.
The local housing authority offered him a bedroom in Central Park Place, a low-income apartment complex on the grounds of the Vancouver Veterans Affairs hospital. The residents there were mainly veterans, but there were also rooms reserved for people with mental illnesses. The rent was $590 per month and could be covered by his disability check.
This placement solved several problems at once. He would no longer risk freezing to death, blocking the courts or scaring pedestrians. It was a rare triumph for the practitioners. And for Andrey, this meant the pressure was off: he had a safe place to live that wasn't dependent on taking medication.
When she arrived at the hotel that December morning to help him move, Olga was surprised to find him awake, his belongings stowed in six bags, raring to go. All morning he seemed like a different person: alert, motivated, funny. He charmed the manager of the apartment complex, which was clean, bright and decorated with Christmas decorations.
He signed forms promising not to punch the walls, set fires or smoke in the unit. The building manager asked him apologetically to indicate what should happen to his belongings 'if something were to happen'.
He blinked. “You mean, when I'm dead?”
She nodded. There was a small, awkward silence.
“Damn dude!” he said, and everyone in the room burst into tears.
“Bury me with my stuff!” he shouted jubilantly.
They laughed again. Then, in a ceremonial gesture, the building manager handed him a set of keys on a blue key ring.
Next to the other residents, men in their sixties and seventies, Andrey seemed powerful and charismatic, brimming with the natural gifts of youth. His apartment was small but pristine, with a window overlooking a roadway drenched in sun. He walked with his case worker to the elevator bank and posed for a memorial photo.
Then the door closed and he was in the small room with his mother.