The disconnect between needs and services ― and the tragic consequences of it ― are indicative of a badly fractured system, the institutional failing of a city rich in resources yet starving for true leadership. What does it say about us if we can’t even use what help we already offer to diminish the suffering that has driven so many to live in squalor and despair?
There has been plenty of talk about what’s lacking ― including too few treatment beds, and not enough transitional housing. Maybe what’s lacking most is the political courage on the part of our leaders to tell people they cannot openly shoot up drugs and occupy streets. Harsh as it may sound to some, living in a tent should no longer be considered an option.
Here’s another hard truth: We let people live in tents because it’s easier than coming up with solutions. But the lack of any meaningful action is just making the situation worse. Mass. and Cass has become a destination for the deeply troubled, and as anyone who deals with treating substance abuse will tell you, the worst place for someone trying to get clean is around other people using drugs.
Dr. Charles Anderson, chief executive of the Dimock Center, reached out to me because he believes his organization can play a bigger role in helping to solve the humanitarian calamity unfolding at Mass. and Cass. He has visited the area several times, as have his staff members. He has talked with Acting Mayor Kim Janey and others working on the situation.
Dimock, which was founded in 1862 as the New England Hospital for Women and Children, has space on its campus to add beds and expand programs to help people break the cycle of addiction. In addition to drug treatment, Dimock provides primary care and mental health services for about 19,000 people annually.
Anderson has spent a lifetime studying addiction. Three decades ago, he chose to train at the Boston City Hospital (now Boston Medical Center) during the crack epidemic because he wanted to learn more about treating substance abuse. His father, also a doctor, ran a recovery program for decades in upstate New York.
“We want to remind people we are here,” said Anderson. “We’re just trying to understand where we can show up as a real value.”
A few years ago, Dimock spent $16 million expanding its dormitory-style treatment center and added nine beds after Boston closed its Long Island recovery campus because of an unsafe bridge. Long Island had 800 beds for homeless people and recovering drug users, giving them a steady place to stay.
Dimock is one of at least a dozen facilities in Greater Boston with treatment beds that allow people to stay for a couple of weeks to get drugs out of their system. Others have available beds too; in recent days, for example, there have been about a dozen empty beds within 30 miles of Boston, according to a database maintained by the Massachusetts Behavioral Health Access.
Three weeks ago, at the state’s request, Dimock began setting aside five beds nightly for people looking to leave Mass. and Cass. So far, only a handful of people have come in. Cost isn’t a barrier because you don’t have pay to receive services.
After detox, people can transition into longer-term programs at Dimock. The center also has three available beds in its clinical stabilization program, which provides intensive counseling, case management, and after-care planning for up to a month. Beyond that, there are 13 beds in Dimock’s residential recovery unit where people can stay for six to nine months.
Dimock relies on a network of providers and nonprofits with outreach teams to bring in patients. These teams walk the streets daily, tending basic needs, such as food, clothing, and medicine, all while attempting to coax those who might be ready for recovery to get off the streets.
But it can be a tough sell. How do you convince someone who has lost everything to drugs that it’s possible to turn around their life, and that now is the time to do it? When one bleak day bleeds into the next, it’s hard to see a way out.
“For some, the idea of coming to detox can be a daunting experience,” said Maia Betts, Dimock’s chief behavioral health officer, as she gave a tour of the treatment center.
“People have lost so much,” she added, “and having to face all that, it’s a difficult place to be.”
Knowing how hard it is to convince people they need help, Anderson, the Dimock CEO, does not rule out the need for involuntary treatment. That includes considering Suffolk County Sheriff Steve Tompkins’s controversial plan to convert an empty detention center into a treatment center for those with outstanding warrants.
“There is no answer off the shelf for this,” said Anderson. “Pushback can be good. Pushback should be met with, ‘Let’s think it through together.’ “
During my visit to Dimock, I spoke to people in various stages of recovery. They have been on that roller coaster of addiction and homelessness, and are well aware of the deteriorating conditions at Mass. and Cass. All of them were unequivocal in their belief that government intervention is needed because people living on the street are often too strung out and traumatized to make clearheaded decisions for themselves.
Jamie Adario, 39, who has been in a residential recovery program at Dimock for four months, said people on Mass. and Cass should be given choices, but one of them cannot be to remain on the streets.
“Don’t allow the option of staying in a tent . . . . It shouldn’t be an option for our community,” she said. “It’s not just about what’s better for the addict.”
It’s also been painful for Christopher Kelley, 56, two years into his recovery at Dimock, to learn about the conditions at Mass. and Cass. As an alcoholic, he has pitched a tent and lived on the streets of Boston on and off for two decades. The Army veteran found sobriety this go-around because, Kelley said, he didn’t want to just exist ― he wanted to live.
As inhumane as conditions are on Mass. and Cass, he understands why some choose to live that way. His late sister, who also battled addiction, used to tell him: “Recovery is not for those who need it. It’s for those who want it.”
Which brings us back to unlocking the paradox of Boston’s opioid crisis.
Michael Curry, chief executive of the Massachusetts League of Community Health Centers, said the health care community has been focused on fighting COVID-19 and getting vaccines into arms, and perhaps only now are leaders able to turn their attention back to substance abuse.
“There are always breakdowns in the bureaucracy,” he said. “How do we make sure people get to the right place at the right time?”
Shirley Leung is a Business columnist. She can be reached at shirley.leung@globe.com.