No Place Like a Home

Hope Magazine

The road to housing for the homeless is often paved with good intentions and poor results.  But Sam Tsemberis is blazing a new trail with a more effective model.

By Frank Rubino

The white speckles dotting Rodney Williams’s face and sweat-dampened tee-shirt attest to his earlier endeavors on this sweltering August morning; painting a dropped ceiling, and blinking a lot.  “I didn’t have the right kind of roller,” he tells his friend, Sam Tsemberis, in the clamorous offices of Pathways to Housing, ten floors above crowded 125^th Street in Harlem.  “It kept drippin’ down on me.”  The two chuckle as Williams relives his ordeal.  “You needed a bigger roller,” Tsemberis agrees. 

Williams has survived worse than paint spatters during his forty-two years.  He has been diagnosed with schizophrenia and spent most of his childhood in psychiatric hospitals in Massachusetts.  He is also alcoholic and well-acquainted with the layout of a jail cell.  He once panhandled daily on the streets of New York, sleeping most nights on subway trains and park benches.  Then, in 1992, he ran into Tsemberis, a social scientist who, “out of complete frustration” with traditional approaches, was launching a novel attack on homelessness with a heartfelt conviction and a $500,000 grant from the state office of mental health.  Williams has been off the street ever since.  He presently maintains a spacious one-bedroom in the Bronx, and, according to Tsemberis, is a pretty good housekeeper.  “This man took care of a lot of us who were down and out,” Williams says, gesturing toward Tsemberis, a native of southern Greece who grew up in Montreal and arrived in New York as a twenty-two-year-old graduate student in 1971.  “He should be getting fitted for his wings.”

Tsemberis is the passionate executive director of Pathways to Housing, which puts people like Williams – homeless, mentally ill, and substance abusing – under their own subsidized roof with nearly no strings attached.  They are not required to accept psychiatric treatment or even remain sober.  That represents a revolutionary departure from the station-to-station, good behavior approach—shelter cot, group home, single room occupancy unit, and finally, individual apartment—that most cities, including New York, employ in trying to house street people with psychiatric problems or addictions.

Equipped with a Ph.D. in psychology from New York University (NYU), Tsemberis was a trained disciple of its “continuum-of-services” model when the city tapped him in 1988 to run Project Help, an outreach program aimed at bringing psychotic street people indoors.  In that job, he approached disheveled people muttering on the sidewalk and offered to take them for treatment.  “But nobody wanted to take me up on that offer,” he says with a wry smile in his office overlooking Manhattan’s altered skyline.  “Nobody wanted to go Bellevue.  Now when I see a visibly disturbed person on the street, I say, ‘How can I help you?’ And when they say, ‘I want a place to live,’ I have the great feeling of being able to say, ‘You know, I can do that for you.’”

Pathways is the only program of its type and scale in the country, according to Mary Brosnahan Sullivan, executive director of the Coalition for the Homeless, a New York state organization.  It operates on the tenet that homelessness, mental illness, and substance abuse are discrete issues to be treated separately.  “After being told hundreds of times, ‘No, I don’t want treatment, I just want a place to live I began to think, `Hey, maybe I ought to try believing these people,"' Tsemberis says. "You give somebody a place to live, it cures their homelessness right away, no ambiguity about it. If you keep that steady, people can work in their variable ways to recover from these other things. In the continuum-of-care pro-grams, if you relapse, you're out. If you go to the hospital, you're out. Any kind of wiggle in your personal life and you're out. Its hard to get it together that way."

Williams, one of Tsemberis's original fifty tenants, is one of nearly four hundred people (three-quarters men, with an average age of about forty) living in Pathways-secured apartments across New York City.  Approximately 85 percent receive monthly disability checks (SSI) from the government, with nearly all of the others collecting welfare. Those on SSI contribute 30 percent of that income toward their rents; welfare recipients chip in their $215 monthly housing stipends. Pathways, which receives federal and state funding, pays the balances for both groups. (Another sixty-five tenants' rents are covered by federal housing Section 8 benefits.) All tenants must agree to two unbendable ground rules: face-to-face meetings, preferably in the apartments, with Pathways counselors twice a month and participation in a money manage­ment plan.

Support is available—Pathways' staff of seventy includes psychiatrists, nurses, social workers and addiction and voca­tional counselors. Each tenant is assigned to a ten-person squad called an assertive community treatment (ACT) team, whose members are on call twenty-four hours a day, seven days a week. Some ten-ants take advantage of this, engaging in talk therapy, taking medication, and working to arrest their addictions. Others do not. Rodney falls somewhere in the middle—he does not contest the notion that he is mentally ill, but he accepts psy­chiatric treatment only now and then. Neither has he jumped with both feet into rehabilitation for his alcoholism, though he says he is drinking less beer than he used to. "He tells me he'll drink a can now instead of a quart," Tsemberis says. "Which, to me, is a cause for cele­bration. You celebrate people's recoveries every step of the way."

Like many of Tsemberis's tenants, Williams has stayed off the street for a long time. Tsemberis says that 85 per-cent of his tenants remain housed after five years, compared to roughly half of those who enter the city's continuum-of­services system. The first three years of data from an ongoing, federally funded study involving 225 randomly assigned, mentally ill, homeless people similarly illustrate Pathways' efficacy. In that study, people enrolled in Pathways have remained housed an average of ninety-nine more days per year than those assigned to the city's system, according to Beth Shinn, a psychology professor at NYU. "It works," Shinn says. "I came into this as an independent evaluator, but I'm convinced that this approach is effective in getting a very difficult popu­lation off streets. It demonstrates that it's not so difficult for people to live in their own apartments so long as intensive supports are available."

Also convinced is Philip Mangano, appointed in March by President Bush as executive director of the U.S. Inter-agency Council on Homelessness. "Sam's idea brings us back to basics," says Mangano. "What homeless people need are places to live in, not shelters to exist in. It's about data, and the data show that these people are retaining their housing and become stable and secure in it. If the data indicated otherwise, I'd be the first to denounce this. But this is working."

Of course, not everyone is thrilled about the prospect of living next door to a psychotic, addicted person who may or may not be taking medication or staying sober. Two years ago, when Pathways began leasing apartments in suburban Westchester County, alarmist headlines and frightened letters to editors popped up in local newspapers. "We worked through it," Tsemberis says, noting that sixty Pathways tenants live peaceably in Westchester today. "Neighbors saw that we stayed on top of things, and it quieted down. If we didn't attend to complaints immediately, whether it's a noise issue, an apartment maintenance issue, or whatever, we wouldn't be able to rent apartments."

There are bumps in the road and not all tenants cruise smoothly to well-being. April Myers, whose bipo­lar disorder can cause her moods to sway so wildly that people have insisted that she must have a twin sister, keeps her one-bedroom flat on 141st Street in West Harlem in pristine condition. It is femi­nine and cheery, with pastel curtains that rustle lightly in a faint summer breeze, and photos of family members adorning a wall unit in the living room. Wearing a print blouse and denim shorts, Myers is a soft-spoken, attentive hostess, offering visitors toothpick-skewered slices of can­taloupe and watermelon from a large, oval tray.

Her life has not always appeared so orderly. She is a thirty-eight-year-old alcoholic who sampled crack cocaine for the first time fifteen years ago, triggering a dependency that precipitated eight years of homelessness. Her voice becomes nearly inaudible when she recalls the misery she endured: "I was beaten up. I was raped. I remember wak­ing up in an abandoned building one morning, and not wanting to go outside because I was embarrassed about being so dirty and smelly. It was a terribly degrading way to be living."

Piercing memories notwithstanding, resisting the temptations of the street has proven an uphill battle for Myers since she signed on with Pathways in 1996. This is the fourth place she has occupied in that time, after losing the first three. When staff would stop by those apart­ments to visit, they would sometimes find addicts hanging out and using drugs, Myers having more or less relin­quished control. Instead of expelling her from the program, however, Pathways found another place for her each time, allowing her to start fresh again.

The faint sounds of kids playing out-side skitter through the apartment as Myers reflects on her bewilderment at getting second, third, and fourth chances. "It amazed me each time," she says, her voice cracking. "It made me feel like, `Who the hell are these people to care about me?'" Two of Myers's ACT team members, Darlene Lee and Christy Respress, eye the hardwood floor as she speaks. "I can't imagine doing it any other way," Respress, the team leader, says later.

Perhaps the fourth go-around will be April's charm. She says she has been sober eight months now, and the three medications she takes daily have leveled out her disposition. She is saving for a TV to go with the new stereo she just got a great deal on, and she hopes to apply soon for her driver's license. She is even making plans to take classes next year at Hostos Community College in the Bronx. "Ain't nothing stopping me but me," she says hopefully.

Tsemberis advises anyone preparing to take on an intransigent social problem to be ready for folks like April Myers. "For some people, becom­ing reintegrated into society is a long haul," he says. "You have to be willing to develop long-term relationships, and you have to know going in that some people will fail initially. And then you have to stick with them, which is the hard part. It can be hard to sustain faith in a person like that. You have to keep reminding yourself that there's a wonderful human being in there somewhere, and wait patiently for that person to emerge."

Surrounding oneself with like-minded staff members is critical, he adds: "It's like a support group. There were many situations that came up—someone would sell all the furniture in their apart­ment, for example—that made me wonder, Jeez, am 1 doing the right thing? Is this really a good idea? Then the people around me would remind me of this per-son who was doing well, and of that person who was doing well. It kept me going more than once."

Today, Tsemberis counts on his staff to do much of the field work (though he still works directly with some tenants), while he concentrates more on quality control—racking his brain and surveying tenants for ideas on how Pathways can do more. In 2003, he plans to open a flower shop at his branch office on 123rd Street in East Harlem, where he will put a dozen more people to work (he presently employs fifty-three tenants, including Rodney Williams, who works on a main­tenance crew), and a drugstore in Brooklyn, where tenants will stock shelves, staff cash registers, and deliver prescriptions. "Work is a big, big part of this," Tsemberis says. "When they're homeless, people don't want to see a psy­chiatrist, they want to see a landlord. And once they're housed, they don't want to see a psychiatrist, either, but they do want to have something to do. Work and mental health are closely related."

About five hundred people are on a waiting list to get into Pathways, but only forty or fifty slots open each year (though last year, an additional twenty-five people facing prison terms for drug offenses were brought in to participate in an alter­native-to-incarceration program). "We don't lose many people," Tsemberis says, shrugging. He hopes to see his elemental idea replicated in other cities, and on that score has in important ally in Mangano, the Bush administration's point person on homelessness, who says that between 2.5 and 2.8 million Americans find them-selves in that distressing situation each year. "The fact that we have more home-less people now than we did twenty-five or even ten years ago demonstrates that there is obviously room for new approaches," Mangano says. "Pathways' performance has secured our attention at the federal level."

At the human level, Tsemberis beams like a proud dad as he describes the reen­ergized souls he encounters daily. "When they first move in, people can't get over the fact that they can close the door and be by themselves, decide when to get up, when to take a shower, when to have a meal," he says. "Then, three months later, they're like, `Listen, I need some-thing to do. And you know what? This apartment you put me in hasn't been painted in years. Can't we do better than this?' I love that. It's like music. It means they're doing well. It is wildly gratifying to see what happens to people when they finally get something so fundamental as a home."