One night when Todd Chimura was 15, his 13-year-old girlfriend was strangled in a Seattle park. "After that," Chimura, now 22, recalls sadly, "I stayed , drunk for about five years." He took his meals at a city trash container and rotated in and out of county medical clinics. But sooner or later he would stop taking his medicine, get drunk and wake up strapped down in a hospital bed. After his sixth trip to a state mental institution, caseworkers sent him to the El Rey Treatment Facility.
The El Rey is a former Skid Row hotel, rehabbed and reopened two years ago as a rescue mission for homeless mentally ill people. The very design of the building reflects its treatment approach. Staff offices are scattered throughout the facility to avoid any sense of official hierarchy. Glass panels enable staff to see most areas without having to enter them. Traditionally, mental-health programs separate the most severely disturbed from others; as a patient's condition improves, he must move to a new building, new doctors, a new community. But shuttling between clinics can take its toll. "Change is really disruptive in these people's lives," says division manager Mike Nielsen. "They can't handle going to a whole new agency and dealing with new people."
The El Rey takes a "tiered approach," combining three levels of treatment on three different floors. The second floor offers "intensive" care; the third floor gives "congregate" care for people capable of some independence; the fourth floor has apartments with kitchenettes for those who are close to returning to society. The staff is realistic in its expectations: there are virtually no rules about coming and going, and though drugs and alcohol are strongly discouraged, their use is not grounds for eviction. Persuasion rather than coercion is the rule. Unless a client is unmanageable, he will never be thrown back onto the street. Says Nielsen: "El Rey is a place where some people can live indefinitely if they choose to."