Monday, April 17, 2006

Spending now, to help the wounded, is just good sense

VICTORIA - I got a call a couple of years ago from a man who wanted to talk about his son. The boy had fetal alcohol syndrome. He couldn't see the consequences of actions, and made terrible decisions.
That had changed for a while in foster care, when he was living on a small farm. Life was structured, and he took to the responsibility involved in caring for the animals. Things were good.
But he turned 19, and was pushed into the world. Trusting and inept, he hung with the wrong people, and became criminal and victim. His dad expected it to end with a terrible phone call.
Meanwhile it was costing us a lot of money to patch him up, lock him up and push him back on the street.
Just like my acquaintance Dave. He's often charming, and an addict. I suspect some fetal alcohol disorder, since he makes such bad decisions.
Dave is a very expensive member of society. In the last year I count two jail stays, at a cost to you of about $12,500.
He landed in hospital at least three times once with one of those nasty - and expensive - drug-resistant infections. Dave skipped out of hospital twice, once with an IV attached to his arm. The ER is still looking for the borrowed crutches, I'm sure. Figure $13,000 for hospital bills.
Then there's the regular calls for an ambulance and ER visits. Say another $1,000.
There's more. Dave sleeps mostly in shelters, or on the street when they kick him out for bad behaviour. Living half the year in shelters, at $70 a night, would cost $13,000.
Social agencies provide support, police keep him moving - say $5,000 minimum for their efforts. And then add welfare, at $7,300 a year.
The grand - yet understated total - is $52,000 a year. All that's buying is a slow-motion decline.
That's not even a complete tally. Here in Victoria people have started to get worried about homeless men and women sprawled on the sidewalks around our busiest shelter. They are bad for business, and tourists don't want to see rough-looking people in sleeping bags sprawled on the sidewalk. There's a cost to that. (People are understandably concerned. It's not good for anyone to have often difficult people camping on city sidewalks.)
Still, figure $52,000 for Dave, without actually providing much of a chance for change. (Dave is a real person, heavily disguised.)
Dave really needs a place to live, with a house parent to help him with choices and talk him out of bad ideas. It could probably be done for about $30,000 per resident.
He'd be better off. Maybe he'd even start to get a handle on things
And we'd be spending $30,000 instead of $52,000.
So why doesn't the government do it?
I got to thinking about how much Dave costs because of a Malcolm Gladwell article in The New Yorker that looked at some of these issues. He was writing about power law theory, which suggests that to fix a problem you don't need to come up with a solution that works for everyone involved. Target the hardcore, and things improve dramatically. (For them, and the collective.)
But Gladwell notes that can be a tough sell. How can we provide free housing to a self-destructive alcoholic, and not to a more deserving single mom? We'll save a fortune by keeping the alcoholic out of jail, the ER and the street, but it still troubles people.
And partly we just don't think people like Dave deserve that kind of help.
But he does. He's clever, and charming and pays attention to what much of the time. He just needs help at life.
And even if you're not so sure he deserves it, the numbers are clear.
Spend $52,000 to support a crazy, dangerous life, or $30,000 to provide a home.
Catching him, and keep him safe, is just the right thing to do.
Footnote: Addiction treatment offers enormous payback. Victoria Police Chief Paul Battershill says that 90 per cent of property crime in the city is done by addicts looking for drug money. That's 8,500 crimes last year. Deal with the addiction - or even just the daily struggle to get drugs - and you create safer cities, and free police for other issues.


Anonymous said...

Your column is right on money (pardon the pun). The economic arguments apply equally as well to our policy of criminlizing drug use at the cost to society of billions and billions, with zero results.

Are we collectively insane? Or are we just so mean-spirited that we'll continue to cut off our noses rather than face the obvious, and start helping ourselves by helping those in need of real help.

Lisa said...

Consider how many teenagers "age out" of foster care each year. Once they do so, the state is no longer obligated to care for them. Children who have never made emotional connections often enter the adult world... and end up homeless, incarcerated or pregnant at a young age and starting the cycle all over again. Shouldn't we invest money in their care?

Anonymous said...

We used to deal with this problem by institutionalizing people. Then a confluence of interests lead to the elimination of those institutions: governments interested in cutting costs, and half-baked humanists who decried the supposed inhumanity of those institutions, probabaly influenced heavily by pop culture like "One Flew Over the Cuckoo's Nest."

I think this is a case where we have to reconstitute residential care for those who can't look after themselves - this would include a large portion of the drug users who inhabit the downtown eastside. Here's the trick, though: it won't work as a voluntary program. We would have to substantially curtail their personal liberties in order to take care of them effectively and gain any of the benefits to be had from residential care. They're just too flakey to be trusted.

KevinG said...

It's an interesting idea and one that I'm naturally sympathetic to. Still I have a couple of questions:

1. is the cost estimate of $30k real or a finger in the air kind of number?
2. If people like Dave will bolt from a hospital where, presumably, the benefits of staying are obvious and immediate, why would he stay in with or take advice from a house mom?
3. What limits would you place on tools to compel him to stay or compel him to make better decisions?
4. Are there examples of this working successfully somewhere?

paul said...

Hey Kevin G.
The $30,000 cost of a group home is my estimate, but pretty accurate. (I used to be a corporate guy and have a good handle on costs.)
Dave and his peers will still bolt and get into trouble. The point is that even with those failures, it's cheaper and more effctive to keep providing support as indicated.
I don't think you can use compulsion, but you can make it harder for people to fall away. SImply removing them from temptation as soon as they're willing makes a difference.
For info on successes, check out Gladwell's original article at