From streets to home: Pathways to recovery

Nutter plan finds housing first, then help.

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Robert Ford, a disabled truck driver living on the streets of Philadelphia, tours his new apartment obtained through the Pathways to Housing program. (Ed Hille / Staff Photographer)

Homeless for five years, Robert Ford has slept all over Center City.

On benches along the Parkway.

On a grassy hill by a Vine Street Expressway ramp.

Outside the Gallery mall.

Near Independence Hall.

At an overnight homeless "cafe" that offers only a spot on a floor with 50 others.

But last week, Ford, 55, a disabled truck driver, was set to sleep someplace new - his own apartment.

He was one of the first Philadelphians to get housing through a program being brought here from New York City as part of Mayor Nutter's plan to reduce homelessness.

Started by psychologist Sam Tsemberis in 1992, Pathways to Housing focuses on people on the streets with mental-health issues, moving them into housing first and later treating their mental illness, and addictions if they have them.

The approach works for the hardest-to-reach people who have lived outside or in shelters for years. Cities such as Washington and Boston are adopting the model - even though the idea of giving subsidized housing to a person who could still be using drugs or alcohol may rankle some.

"What's our choice?" Tsemberis said during a recent visit here. "To leave them on the street and insist that they are clean and sober before getting housing?"

In May, the city announced a $7 million plan to house 700 homeless individuals and families - 125 of them through Pathways. The Pathways portion, a $2.7 million program funded almost entirely through federal grants, began gearing up in Philadelphia in September and made its first placements last week.

"There's no magic bullet," said Marcella Maguire, director of homeless services for the city Department of Behavioral Health. "But I am convinced that for many people, this is the only way they'll get off the streets."

"My own key"

In Pathways ' third-floor offices at 40th and Market Streets, a psychotic man who was placed in his own apartment a few days earlier complains loudly and angrily to the staff about nothing in particular.

In another room, Ford waits quietly for a social worker to drive him to Southwest Philadelphia to look at an apartment.

He ended up on the streets after severely injuring his back and losing his truck-driving job five years ago. Thin and quiet, he walks with a limp but doesn't have money for a $35 cane.

Ford said he'd rather sleep outside than in shelters, where "you might as well be in jail."

Dressed in donated brown trousers and two jackets, he spends his days walking around town with all his belongings in a knapsack. He uses a computer or reads at the Free Library, or watches a movie "over and over and over" at the Visitor Center of Independence National Historical Park.

Ford heard about Pathways from the staff at a homeless cafe at Seventh and Arch Streets. "If these people can help me out, once I move in, I'm not moving out," he said.

Pathways leases properties all over the city, using the federal funding to subsidize rents. Tenants are expected to contribute a third of their fixed incomes from Social Security or disability payments.

Social worker Adam Fussaro showed Ford a studio apartment in a renovated rowhouse on Woodland Avenue.

With his bad leg, Ford had trouble climbing the steep stairs. But opening the door, he liked what he saw. The main room was flooded with light and the smell of new carpet. The fixtures in the kitchen and bathroom were shiny.

"We want you to get off the streets," Fussaro said, "but we want it to be a good fit for you. Think about it for a day."

"There's nothing to think about," Ford quickly replied. "I'm good to go."

"I won't have 50 people in a shelter I have to step over," he said. "I'll have my own key to my own door."

As he stepped outside, he was happy to see a public library a block away.

A better way

The idea for Pathways grew out of work Tsemberis was doing in the late 1980s for Bellevue Hospital in Manhattan.

He was part of an outreach team trying to persuade mentally ill people on the streets to get help. Too often he'd see them back on the sidewalks, no better than before.

"Desperation finally got us to say there has to be a better way," he said."We ended up in the housing business because most people said that's what they wanted the most."

Pathways is different from many other programs for the homeless because it does not require them to be clean and sober before getting housing. It moves people into homes first, then connects them to services for treating mental illness or addictions.

Each tenant is assigned a support team that includes social workers, a nurse practitioner and psychologist, and counselors. No one is forced into treatment, but everyone is steered in that direction. Once people don't have to worry about where they'll sleep, Tsemberis said, they are better able to focus on recovery.

In New York, Pathways houses about 650 clients. Since 1992, Tsemberis said, about 80 percent of tenants have retained their housing.

Among those who haven't, there are many reasons for failure. Mental-health crises lead some back to the streets. Others are overtaken by drug use, or are thrown out because of problems with landlords or neighbors.

Locally, Horizon House, a nonprofit agency that provides services to mentally ill people, has a program modeled after Pathways that houses 153.

Pathways , which is renting its office space from the Elwyn Institute for the disabled, eventually will have a staff of about two dozen here. It will allow the city to greatly expand its ability to house people who were on the streets, said Maguire, of the Department of Behavioral Health."They're the gold standard."

Pathways ' tenants come from a list of 300 mentally ill people identified by the department as in a cycle of living on and off the streets. In Center City, 85 percent of the street population suffers from mental illness, addiction, or both.

Pathways ' approach isn't cheap. But the cost of doing nothing, Tsemberis warned, is higher.

In New York, he said, Pathways spends about $23,000 a year per person for housing and services. If someone with severe mental illness is left on the streets, the cost to society is almost twice that.

"Your tax money is already spent on police, homeless outreach services, and emergency medical care to a much greater degree than when you put a person in housing," Tsemberis said.

With a home,"you have a shot of helping this person get his life together," he said."Why is it better to leave [him] on the street, suffering and paying endlessly for him?"