Tag: detox

City Council, City Hall, criminal justice, Drugs, homelessness, land use, Mayor Durkan, Morning Crank, Transit, Transportation

Late Morning Crank: New Homelessness Policies and New Streetcar Claims

1. Update: The mayor’s office says they have been briefing council members on the four elements of its homelessness strategy (spending and accountability, crisis response/creating safer spaces, regional coordination, and affordable housing) but is not rolling out any major new policies. Mayoral spokeswoman Stephanie Formas says rumors around ramped-up enforcement could be related to the previously announced additional $500,000 the city plans to spend on its Navigation Teams. As for the idea that the city plans to implement involuntary commitment to detox for addicted people who decline assistance from Navigation Team members, Formas pointed to a letter to the co-chairs of the One Table task force signed by the mayors of Auburn, Renton, Kent, Bellevue, and Kirkland suggesting that the leaders of the regional initiative (which has been dormant for months but is meeting again next week), should consider “involuntary treatment for those presenting an imminent likelihood of serious harm to self or others, or who are gravely disabled as a result of substance use disorder” and who refuse to go to treatment. Should this become an element of the One Table implementation strategy, it would mean forcing people into short-term detox, which has not been shown to be effective for treating severe addiction.

Original item: Mayor Jenny Durkan’s office has reportedly been briefing city council members on a new policy related to homelessness that, rumor has it, involves more strenuous enforcement of the city’s anti-trespassing and no-camping laws. Conversations with folks on the second floor and advocates working on homelessness-related issues indicate that the new policy could involve involuntary commitments for people suffering from addiction under Ricky’s Law, which allows adults to beheld for up to 17 days in “secure withdrawal management and stabilization facilities,” AKA secure detox, if they are available; since the state and King County would ultimately be responsible for actually funding detox beds, this could be a way of putting pressure on the county for ramping up detox funding. Currently, there are only a few dozen detox beds available in all of King County, including a recently opened facility on Beacon Hill that filled an existing gap in care left by the closure of Recovery Centers of King County; that facility has 32 beds for patients needing detox. Formas said they would be “doing some action items on homelessness and affordability next week.”

So far, according to council log-in sheets, the mayor’s office has met with council public safety committee chair Lorena Gonzalez, council president Bruce Harrell (both yesterday), and council members Mike O’Brien  and Sally Bagshaw (this morning). I will update as I learn more.

2. I reported last week on the Freedom Foundation’s lawsuit challenging a tiny house village” encampment in South Lake Union on the grounds that it violates state environmental rules. One thing I didn’t discuss in detail is the fact that the reason the city has been able to authorize so many tiny house villages—seven, at the moment, or four more than are allowed under a city ordinance limiting the total number of authorized encampments to three—is that each of the new authorized camps has been approved on a rolling conditional basis under what’s known as a “type 1 permit.” Such permits, which must be renewed every four weeks, are meant for temporary uses such as temporary fire and police station relocations or farmers’ markets, as well as any other temporary use that’s meant to last four weeks or less. Type 1 permits can be approved administratively, meaning that they don’t have to go through a lengthy public hearing process or the usual environmental review. (The Freedom Foundation’s lawsuit challenges this premise, and also argues that temporary encampments should be Type 2 decisions, which require more process and are more involved.)

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This struck me as a peculiar way of permitting encampments, given that the city has decided as a matter of policy and law that only three encampments should be allowed citywide. I’m no lawyer, but it also seems like an area where the city could be legally vulnerable—if the city wants to allow more than three encampments, then why not do so through the legislative process, by changing the law, instead of using this workaround? The city attorney’s office had no comment on the legal ramifications of using Type 1 four-week permits to allow tiny house villages.  Wendy Shark, a spokeswoman for the city’s Department of Construction and Inspections, says temporary permits are only for “encampments that are also in the process of applying for the 6-month temporary use permit.  In every case, encampments needing temporary use permits are applying for the 6-month permit or will soon apply.  Since the 6-month permit is a ‘Type II’ application involving public notice and opportunity to appeal to the City’s Hearing Examiner, the Type I four-week permit is a means to establish an encampment in the short term while the longer public process occurs.”

However, since city law currently restricts the total number of longer-term encampments to three, Shark adds that “legislation will be needed to change the current number of interim use encampments that are permitted.”

3. Local transportation Twitter was buzzing this week over a couple of articles about Seattle projects aimed at improving mobility for cyclists, pedestrians, and transit riders. I covered the first, a Crosscut editorial claiming that bike lanes are only for rich white people,  on Wednesday. The second, an article by Times reporter David Gutman, repeated claims from Mayor Jenny Durkan’s office that the delayed downtown streetcar may be too bulky, and use the wrong track gauge, to connect to the existing South Lake Union and First Hill lines. I reported on the same claims in a brief item Wednesday morning, noting that if the claims turned out to be true, it would represent a significant embarrassment for the city along the lines of the time when Sound Transit had to go in and remove tracks installed by King County Metro in the downtown transit tunnel because they were the wrong size for light rail.

Yesterday, however, transit advocates began to dispute the mayor’s claims, and Gutman’s story, pointing out that both of the two types of streetcar bodies that would run along the connected line use the same standard gauge (1435-millimeter) track, and that the difference in the car widths is relatively trivial. The new cars, built by CAF USA, would be about ten feet longer than existing streetcars, which were manufactured by Inekon. The print and current online editions of Gutman’s story include context about the likely actual size of the vehicles and the fact that the gauge of the tracks is compatible with both cars, contrary to what Durkan implied in her statement, which suggested that the city does not even know if “the new vehicles [are] compatible with the current track gauge.”

However, the story that the  Times initially ran online did not include any of that information. After it went up, both FOX News and local conservative radio host Dori Monson latched on to what FOX calls the “streetcar fiasco,” which FOX described, in typical FOX fashion, as the latest setback for a left-wing mayor trying to raise her national profile with “fervent attacks against the Trump administration over immigration, climate change and abortion.”  Monson, meanwhile, suggested that former SDOT director Scott Kubly “should be in prison” and that former King County executive Ron Sims is a fake “man of God” who is destined for hell.

When I asked mayoral spokeswoman Stephanie Formas about the mayor’s statement Tuesday night, she said, “we do know that the cars are heavier, wider, and longer than the current cars, but engineers are looking at all the facts in the context of these cars running on the full system.” On Wednesday, Formas followed up with more details, acknowledging that the tracks are technically compatible with the new cars and that the new vehicles are actually slightly narrower than the existing streetcars, but adding that “evaluation of the existing conditions related to track gauge is necessary to provide accurate data to CAF so that they can account for these differences in the design of the track and wheel profile for the CAF vehicle.”

In addition to concerns about whether the new streetcars would fit into the existing maintenance barn, Formas said that the “dynamic envelope” of the streetcar, which includes both width and length, raised concerns about the vehicles “hit[ting] other elements in the ROW, such as trees, signage, curbs, and poles as they travel along the track.” The streetcar will be still about six inches narrower than a typical King County Metro bus, which are eight and a half feet wide (compared to eight feet, .038 inches for the new streetcars and eight feet, .085 inches for the existing ones.)

Addiction, Drugs, King County

After Two-Year Gap, Detox Center Will Open on Beacon Hill
King County Executive Dow Constantine stands next to a detox bed at the soon-to-open Recovery Place.

The new detox and inpatient treatment center that will open later this year on Beacon Hill doesn’t look like much from the outside. A low-slung institutional building surrounded by a black iron fence and fronted by a small parking lot, it looks somewhat out of place in a residential neighborhood where brightly colored townhouses have sprouted like dandelions in recent years.

Even from the inside, you have to squint to imagine the transformation—from what Valley Cities Behavioral Health Care CEO Ken Taylor called a “ghastly” institution, run by Recovery Centers of King County, into a modern, brightly lit facility with fitness rooms, two large kitchens, and rooms for group meetings and private counseling.

The opening of the new facility, called Recovery Place, marks a significant milestone for detox and treatment in King County—the restoration of 32 beds for people needing medical detoxification from alcohol, heroin, and other drugs, and the first residential detox center in King County where people can access treatment for addiction and mental health issues simultaneously. (Most treatment centers do not deal with dual diagnoses).

The city’s Navigation Center, a new low-barrier shelter less than a mile away, will direct clients to Recovery Place, which will also take patients directly from emergency rooms and (eventually) on a walk-in basis. In addition to detox and a traditional two-to-four-week inpatient treatment program, the center will offer medication-assisted treatment with drugs like buprenorphine to heroin and opiate addicts. “We’re embracing a harm-reduction approach as much as an abstinence-based approach,” Milena Stott, Valley Cities’ director of inpatient services, said.

Valley Cities CEO Ken Taylor in the detox wing of Recovery Place

The last tenant to occupy the building, Recovery Centers of King County, went bankrupt and shut down abruptly in 2015, and since then, the 27 detox beds they provided have been distributed all over King County through contracts with institutions like Fairfax Hospital in Kirkland and the Seadrunar long-term treatment center in Georgetown.  Before RCKC closed down, Taylor said, the building “was dark and damp, and all throughout the central corridors there was plumbing and electrical running literally right down the middle of the corridor.” Outreach workers told me last year that RCKC was known for treating clients rudely and asking “inappropriate” personal questions in earshot of other patients; the new facility, in contrast, will have private consultation rooms. After RCKC closed, the building itself was taken over by squatters and stripped bare, with everything from the toilets to the copper wiring stolen and carted away.  Morgan Irwin, a Republican state representative (R-31) and Seattle Police Department officer who was on hand for yesterday’s tour, said that the last time he was inside the building, which is on his beat, “It was literally flashlight and gun out.”

The building cost $4 million to buy, plus $9 million to renovate. A million dollars of the budget to buy and fix up the building came from King County; the rest came from a combination of state and grant money and a $4.5 million loan that Valley Cities took out from Bank of America to cover the remaining costs. The state’s capital budget, which remains in limbo, is supposed to provide about $2 million toward the cost of repaying the loan, but Taylor said Valley Cities “is going to be able to repay the loan” ion its own if state funding doesn’t come through. “We’re very fortunate. Not every agency can do that.” Ongoing operations will cost about $5 million a year; that funding will come from the state and federal governments as well as from patients’ insurance payments. RCKC went bankrupt, King County Human Services Department director Adrienne Quinn told me, in part because of unfavorable state reimbursement rates, which she was quick to add have been addressed.

Contrary to common belief, not every person with addiction needs detox, although medication can ease the suffering and make it less likely that people withdrawing from opiates, for example, abandon treatment. (Severe alcoholism does require detox because going cold turkey can cause seizures, DTs, and fatal heart conditions.) Buprenorphine, and other opiate substitution medications, can help short-circuit the withdrawal process and get opiate addicts on a path to stability. “I hope that everyone for whom buprenorphine is appropriate will elect to do that,” Taylor said, “but sometimes it takes them time to get to that point.”

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Addiction, neighborhoods

Seattle Detox Facility to Reopen, Providing Some Relief Amid Addiction Epidemic

I’ve written before about the critical need for, and lack of, drug and alcohol detoxification services in King County, particularly for people without private insurance coverage. Detox from drugs and alcohol, experts across the spectrum of treatment philosophies acknowledge, is a critical first step toward getting well; without medically assisted, professionally monitored detoxification, people who are addicted to opiates or, especially, alcohol can become sick or even die. They’re also much less likely to enter long-term treatment.

Until last year, low-income addicts and alcoholics who needed detox in Seattle were usually directed to Recovery Centers of King County, a facility on First Hill that included 27 detox beds as well as long-term inpatient treatment. But RCKC closed abruptly last August, under the shadow of a federal investigation and allegations of unpaid wages. Eventually, King County replaced some of those beds by contracting with private agencies like Fairfax, a mental health hospital in Kirkland, and Seadrunar, a long-term treatment center in Georgetown.

Now, nearly a year later, an agency called Valley Cities Behavioral Health Care plans to reopen an old RCKC building on Beacon Hill as a detox and treatment center that will also include “medication management”–long-term opiate replacement with drugs like suboxone–for people addicted to heroin and other opiates.

Milena Stott, chief of inpatient services at Valley Cities, says the detox center, which will initially have 16 detox beds, is part of a larger push by her agency to “get in the business of doing inpatient treatment,” including treatment of patients committed involuntarily under a law passed this session known as Ricky’s Law, which allows involuntary commitment of people with substance abuse disorders.  “Detox is a point of contact for treatment,” Stott says. “Our position is to engage patients into long-term care after detox … focusing on motivational interviewing and really being welcoming to individuals so they are willing to focus on the next step.”

That focus on being “welcoming” highlights one area where the new facility could differ from RCKC, which is somewhat notorious among people in the recovery community as a place where staff could be gruff, rude, and impatient in their interactions with patients under their care. Mary Guiberson, a case manager with REACH, a group that does street outreach, says that when she went to visit the facility last year, after hearing that the agency’s services were not “up to date,” “the staff was yelling ‘What drugs are you on?’ and all these personal questions–the situation was completely inappropriate.”

For people dealing with trauma, particularly women, Guiberson says being barraged with suspicious questions in a public place can “retraumatize people. … Traditional treatment services are not very trauma-informed.” RCKC also had no group activities or counseling sessions for people hoping to get clean, and was reportedly filthy and poorly maintained inside.

Stott says Valley Cities plans to remodel the inside of the building so that people “feel good when they walk inside. … We strongly believe that patients need to feel good about their healing space in order to engage in recovery. We want it to be a nice facility, and currently it is not. It’s not clean. We want to have a workout space, and beef of the community space so people will come out of their rooms and engage in activities,” Stott says.

Valley Cities will not be providing methadone treatment, which requires clients to show up at a clinic every day, but they are seeking a license from the state pharmacy board to prescribe suboxone, an opioid antagonist that interferes with the patient’s ability to get high from opiates and is an opiate itself, making it somewhat controversial in the recovery community. Suboxone is a highly controlled substance, and is itself addictive.

The facility itself could also be controversial in the surrounding neighborhood, which is just starting to get wind of Valley Cities’ plans. Stott says she hasn’t heard anything negative so far, except from a neighbor who was worried that patients at the facility would leave cigarette butts on his lawn. She hopes to have city approval for building permits by the end of the year; approval from the Board of Pharmacy, which meets just once a month and is backed up with licensing requests, could take longer.

Addiction, homelessness, King County

Homelessness and Addiction, Part 1: Why Don’t They Just Get Help?
Image via Salvation Army.

Last month, Seattle Times columnist Danny Westneat wrote a column that struck a chord with many Seattle residents, particularly those already inclined to believe that people choose to be homeless and addicted to drugs or alcohol. It struck a chord with me, too, although not for the same (or probably the intended) reasons. In the column, Westneat marveled that just a few blocks from the Jungle—the dangerous, massive, unpoliced encampment that stretches along the west side of Beacon Hill—there is a “shelter” that has empty beds every night. (The “shelter” is not actually a shelter, but a long-term Christian rehabilitation center run by the Salvation Army).

“Some shelter beds go empty—even right next to Seattle’s Jungle encampment,” Westneat’s headline roared. “How can this be?,” Westneat wondered. “How can a homeless rehab center next to the city’s most notorious encampment have 10 to 30 empty beds?” Why would anyone in their right mind turn down a “free 60-day stay” in a warm place with food and running water for the dangerous, cold, risky life on offer in a no-man’s land like the Jungle?

This story is an attempt to explain part of how that can be, starting with the difficulties homeless people face on the path toward treatment for drug and alcohol addiction, and  ending with the overburdened shelter system itself, including the Salvation Army rehab center. The questions behind the surface Westneat scratches—with more than 400 homeless people living around a freeway overpass nearby, how on earth could these beds be empty?—are deeper and more difficult to answer than such glib incredulity implies. They include: Who “deserves” government-funded services? Why do some people decline services, including treatment? And what obligation do we have to people who can’t or won’t get help but still, because they are people, need a place to lay their heads?

“We’ve got hundreds of beds in the city every night that people don’t want to go to,” Magnolia homeowner George Pierce said at a meeting of the Magnolia Community Council last week. “How do you get these people out from under the Magnolia Bridge who are stealing, leaving human waste, leaving terrible conditions that city officials have done nothing about?”

Those who do outreach to the homeless and work to get them shelter tell a different story. Chloe Gale, co-director of the REACH program at Evergreen Treatment Services, does direct street outreach to encampments. She says that “in general, all of the beds in our shelter system in the city are full all the time.” Although the city opened up 300 new shelter beds as part of the recent emergency declaration on homelessness, Gale says those beds “filled within days, and most shelters end up turning people away” night after night. While some people living in tents or sleeping on bedrolls under freeways are there because they want to be there or can’t go to regular shelters (which generally bar couples, pets, and people who aren’t sober), “I know there are people who really want shelter and are lined up every night and are getting turned away,” Gale says.

Screen Shot 2016-03-20 at 10.46.01 PM
Neighborhood Safety Alliance  founder Cindy Pierce

Pierce’s wife, Cindy Pierce,  is the head of the Neighborhood Safety Alliance, a group made up of homeowners in Magnolia, Queen Anne, and Ballard who oppose the presence of illegal encampments in their neighborhoods. Like many, Pierce  draws a bright line between the “deserving”  or “truly” homeless who are mentally ill or just down on their luck and those who “choose” to be homeless or continue to depend on drugs and alcohol. “There is a huge difference,” she insisted at a roundtable “Civic Cocktail” discussion hosted by CityClub and Crosscut earlier this month.. “There’s the mental[ly ill], which, we as a society must take care of these people and we must house these people, and the illegal campers out there.”

Despite the views expressed Pierce and many other camp opponents in neighborhoods like Magnolia, the road to treatment and recovery isn’t typically a straight line from a place like the Jungle to a new life as a sober, employable, stably housed member of society. Willpower alone won’t get an addict sober (nor will throwing an addict in jail for a few days), and even addicts who want help end up on long waiting lists for initial intake into treatment programs; by the time their number is up, the window in which they are desperate enough or willing enough or just done enough to want help may have closed.

For many addicts, homeless or not, the first step toward treatment and recovery is detoxification—getting the drug or alcohol out of a person’s system. For alcohol abusers, in particular, detox can be critical: Although many drugs have withdrawal periods that are just more physically unpleasant, only alcohol withdrawal has a relatively high chance of causing a potentially fatal seizure or heart attack, which is why medically supervised detox, with the help of drugs that ease the withdrawal process, is often necessary for chronic drinkers.

But detox beds are in short supply, with wait lists that can stretch weeks or months. If you’re ready change your life starting today, good luck getting into detox even if you do have money; without it, your options are  limited to a few behavioral health centers that contract with the county to provide about three dozen beds for low-income patients at facilities in South Park, Kirkland, and Burien. Those 36 beds are the only non-hospital detox beds for Medicaid patients in King County.

King County Health’s behavioral health and recovery division director Brad Finegood says the county knows the beds they have aren’t enough to serve the county at a time when heroin addiction is on the rise and the population is growing. “We are definitely working as hard as we can to build long-term detox capacity,” Finegood says. “We know we need to be able to provide treatment on demand and, when people need treatment, to provide open access.” But they aren’t there yet.

There was another facility in Seattle, run by Recovery Centers of King County—a nonprofit services provider that suddenly closed its doors last year under the shadow of a federal probe and allegations of unpaid wages. The closure of RCKC, which provided 27 beds for low-income addicts, went unmentioned in the local media except by Seattle Weekly, which broke the news of the closure.

But homeless advocates noticed. Gale, of Evergreen Treatment Centers, says RCKC, which offered bare-bones detox and residential treatment out of a modest building on First Hill, was “a critical treatment facility for people that were homeless. It was the main medical detox program for people getting Medicaid funding, and a significant percentage of the population [there] was homeless or formerly homeless. It’s not perfect, but it did its job, and it’s been there for decades.” And now it’s gone. 

Finegood says Medicaid rules dictate that detox facilities can’t have more than 16 beds—an unintended consequence of rules designed to prevent the warehousing of mental-health patients—although he says that rule is set to expire in April. Another 20 or 30 beds are coming online at two other facilities later this year, Finegood says—alleviating the problem but hardly serving the needs of an entire, growing county.

And detox, Finegood says, is often the first stop before actual, long-term treatment, either residential or outpatient. “We definitely know and understand that detox is a really key component of getting people into treatment in a number of different ways,” Finegood says. “We engage people into a number of different treatment services.” Treatment, as opposed to detox, is where the long work of recovery often begins, and the process of reacclimating a person who may have been living on the streets, hustling for drugs and barely scraping by, for yours, into straight society. 

Timothy Rockey, head of the Salvation Army Adult Rehabilitation Center with which Westneat was so enamored, says that for many, the first barrier to entering the ARC program is that new residents must arrive with a few days’ sobriety under the belts—the ARC doesn’t provide detox. And there are other barriers to entry for programs like the Salvation Army’s, which I’ll describe in more detail in Part 2, which will focus on the advantages and disadvantages of high-barrier and low-barrier approaches to shelter and addiction treatment, later this week.