The Right Side of Right

San Francisco is proving that addicts' lives can be saved. Seattle spends billions and lets them die in the street.

A few weeks ago I wrote about my sister. About her native brilliance, and about how wrenching it was to watch late-stage addiction strip away her ability to act for herself.

I was humbled by what followed. Thousands of people across the country read it, connecting with her story and with what it revealed about how badly this country fails people in the grip of late-stage addiction.

A close friend of mine wrote to me. She had been driving through 12th and Jackson, and she teared up at all the sadness of it. A beautiful city that no longer made any sense to her. Reading Liffy's story, she said, gave her hope that someone else saw what she saw, and felt what she felt.

A man wrote that he lives with a disease which, unmanaged, could put him on those same streets, and that if it ever did, he prayed someone would love him enough to commit him against his will until he was well again.

Person after person told me the same story. A brain so altered by the disease that the person could no longer be reached, and a family with no legal power to help them.

People forget a simple truth. Given the right protections, a brain can heal. A life can be saved.

The sharpest response came from Sherman Alexie, the National Book Award–winning novelist, no stranger to addiction himself. He drives past 12th and Jackson, he told me, and curses a city whose empathetic politics serve only as a placebo for the politicians themselves.

A placebo. He found the exact word. Billions of dollars a year in this region, and the medicine treats no one but the people prescribing it.

My father used to say: when you are on the right side of right, you can't be wrong.

He meant it as a cure for hesitation, for good people who know the right thing and stall anyway. And there is a mayor in San Francisco who is, plainly, on the right side of right.

In January, San Francisco counted the fewest people on its streets in fifteen years. Unsheltered homelessness down twenty-two percent in two years, tents down nearly eighty-five percent. And not because rents fell, because they didn't.

Daniel Lurie told his city the truth it had refused for a decade: the people dying on the sidewalk are not a housing statistic. They are sick, and a decent city gets them well.

Then he built what getting well takes. A stabilization center on Geary Street, open around the clock, where police can bring a person in crisis at any hour and a clinician is waiting. Shelter built around recovery. An end to handing out drug supplies to people with no path to treatment.

His approval sits near seventy-four percent, because people were never tired of compassion. They were tired of a failed ideology that left only suffering on the sidewalks.

California went further, and closer to home for me. This year the state began allowing conservatorships that hold a person in treatment for a year, renewed as long as the illness lasts: the power to keep someone safe and cared for until they are well, instead of releasing them the moment they can stand.

It is the mechanism that did not exist for my sister. It is imperfect and underfunded and real, and it is the only compassionate solution a civilized society has.

Now look at what Seattle does instead. It spends more per person than almost any city in America, and saves almost no one. Washington has not written the conservatorship law. It is building no year-long treatment beds. It has no stabilization center where an officer can bring a freezing, hallucinating human being at two in the morning.

What Seattle built instead is a lifeline for the disease, and the disease exists only to kill. Our public health system hands out clean syringes, a metal cooker to melt the dose, a glass pipe, and a square of foil printed with instructions on how to fold it. Everything a person needs to keep using, and nothing he needs to stop.

When Sara Nelson, a former council member who is open about her own recovery, asked the simplest question, how many people who receive these supplies ever enter treatment, there was no answer. No one had counted. Getting them well was never the point.

She fought two years for the city's first real treatment dollars, and won just three hundred thousand of them, out of a budget in the hundreds of millions. And the moment that money was spent, it worked: people went into treatment right away. The beds had been there all along, in private clinics, waiting. The only thing that had ever been missing was a city willing to pay for a destitute person on the streets.

Consider where the money goes. No one can say precisely what this region spends on homelessness. The last full accounting, nearly a decade ago, put it above a billion dollars a year. Everyone who works in it believes the real number today is closer to two.

We do know what happened inside the agency built to coordinate it all. This spring, a forensic audit could not account for some thirteen million public dollars, and found a hole in the books of nearly forty-five million. Gift cards vanished with no record of who got them. Of the largest transactions the auditors examined, not one came back clean. Their own careful phrase for it: “vulnerable to fraud.”

Thirteen million dollars, gone, in a city where people die for lack of a treatment bed. No one was charged. No one was named. The mayor and county executive simply moved the contracts to a new set of desks and called it reform. And that money, spent the way Nelson proved it could be spent, would have carried something like a thousand people off the street and into treatment. Instead it vanished, and they are still dying on the street.

This is the part no one in charge will say out loud: those deaths were choices. Not the addict's choice. His was taken from him by the disease. The city's. Seattle has never once enacted the thing that actually saves a life: the conservatorship law, the treatment beds, the intervention Daniel Lurie built in San Francisco. It will not face the fact the whole crisis turns on, that these are people who have lost the capacity to act for themselves. You do not save them by moving contracts to a new desk. You save them by having the courage to intervene.

People see the wreckage every day and cannot understand how it happens. We give the pipe and withhold the cure. We fund the management of the dying and almost nothing to end it. Then we act bewildered when the tents multiply and the overdoses climb and the families stop bringing their children to the park.

I will say it as plainly as I said it about my sister, because it is the same sentence. We are not saving these people. We are equipping them to die abandoned on the ground, outdoors, in one of the richest cities on earth.

We hand them the instrument of their death and call it harm reduction. We leave them to rot in public, with no bed, no treatment, and no law that can reach them once the disease has taken their mind. And we call that compassion.

On the entire West Coast, no city has carried this philosophy to a crueler end than we have. We spend the most, and we save the fewest.

The case against what I am proposing deserves to be met at its strongest. Involuntary treatment is a grave power, and this country has abused it before, locking away the poor, the disabled, the merely inconvenient, and calling it care. The right to refuse treatment matters. And holding a person for a year against his will is a hard thing to ask of a free society, even to save his life.

All of that is true. And all of it collapses on Third Avenue. We already intervene for people who cannot keep themselves alive. We do not leave the Alzheimer's patient to wander into traffic. We do not let a child fend for herself in an alley. We would never call that freedom. The addict dying in the doorway has lost the same capacity to choose. We have simply decided, in his case alone, to look away and call it respect.

We know what is right. That is the unbearable part. San Francisco knows it. California knows it. Every grieving family knows it. The sick have to be rescued, especially the ones too sick to ask, and it takes a law that can hold them, a place that can heal them, and the plain nerve to build both and to stand up to the people who will call it cruelty.

It is not cruelty. Cruelty is what we are doing now.

The grandmother waiting for her bus on Jackson Street deserves to wait without foil burning at her feet. The children of this city deserve the parks their great-grandparents set aside for them.

And everyone else has a stake in this too. The family coming in from the suburbs deserves to walk downtown without fear. The small business deserves to survive. The office towers deserve to be leased again. The visitor deserves a reason to return. None of this is separate from the crisis on the pavement. It is the same crisis.

Because a city that solves this becomes a city that thrives, and a city that thrives can afford to solve it. Safe streets fill the shops. Full buildings and busy blocks generate the revenue that pays for the treatment and the beds and the care. In Seattle right now, compassion and prosperity are failing at the same time, for the same reason. Fix the one and you begin to fund the other.

A police officer wrote to me after that first essay, a man who deals with this every day. It is heartbreaking, he said, to watch the system refuse to step in for people no one in their right mind would say can care for themselves. Taking responsibility for someone is hard. It means doing painful things. But refusing, because stepping in makes us uncomfortable, and watching people kill themselves instead, that, he wrote, is in the end a form of cowardice.

What we call compassion, a man who works these streets calls cowardice. And he is closer to the truth than any of us.

So let us stop calling it anything else. We are past the time for pilots and half-measures. San Francisco has shown it can be done; California has written the law to do it. The proof is in. What is missing is not knowledge, and not money. It is the will.

The addict dying on the sidewalk, somebody's brother, somebody's son, deserves what my sister deserved and never got: to be taken in, even against his ruined will, and held in real treatment for as long as it takes, a year and another year if the disease demands it, until his mind returns and his life is his own again. That is what the new law in California makes possible. It is the difference between a clean pipe and a saved life.

We already know which of the two is right. And my father already told us what to do once you know.

When you are on the right side of right, you can't be wrong.

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Michael R. Hatch is an investment manager based in Seattle. A Seattle native, he attended Lakeside School and has served on the boards of the U.S. Olympic and Paralympic Committee Foundation, the Seattle Symphony, the Henry Art Gallery, Intiman Theatre, Seattle Children's Theatre, PONCHO, and other civic and cultural institutions. Elizabeth Hatch was his sister.