For decades, America’s largest city has faced seemingly indefatigable dual crises: mental health on one hand, and homelessness on the other. New York City is unique in having a “right to shelter” baked into local jurisprudence, and yet the sprawling network of homes and hospitals built to accommodate the masses hasn’t ever been enough to truly take care of every single person in need. In 2017, the city sits amid an especially cruel maelstrom: homelessness is at or near Great Depression-era levels; drug overdoses are the leading cause of death for people under 50 nationwide; and many of those affected pass through a savagely punitive criminal justice system every single day.
Whether because of budgetary constraints or a lack of political imagination, it has long been accepted that government—even New York's ostensibly progressive one—can only do so much about these problems. That’s where a plethora of nonprofit organizations have emerged over the years to care for thousands of the city’s most vulnerable. The Bridge is one of them.
“This is what I would say about our clients: People don’t see them," Susan Wiviott, the organization’s CEO, told me in a recent interview.
Photographer Aviva Klein recently spent time at a number of The Bridge’s housing units spread across New York City. The beauty here lies in the mundane, as Klein documented the daily lives of those American policymakers and cultural leaders often neglect to see. We also sat down with Wiviott to understand who it is, exactly, that The Bridge helps, and why their work is necessary. Here’s what she had to say.
VICE: Who is the target demographic for your work? Is there a type?
Susan Wiviott: You walk by them, you walk around them, or you walk away from them sometimes. You don't really sit down and listen to them, their stories, where they come from, and what their lives have been like. What always strikes me when I do that is that most of them have lived lives that many of us who are much more privileged can't even really imagine. It's not like they just became mentally ill. A lot of them have had very traumatic experiences in their lives. Starting back when they were children, a lot of them have been in foster care, institutions, hospitals, homeless shelters, prisons, jails. They've been physically abused. They sort of end up at a point in their lives where they want to take back some control of their life. We help them think about what they want to do, and help them do that, whatever that might be.
It varies widely, for different clients. For some, the fact that they now have their their own place to live that's their's is huge, because you can get to being 30 or 40, and never really had a place to live. For others, they want to go back to school, or work. I listen to people talk about how people don't want to work, and probably the first thing that so many people say is, "I want to get a job." They want to be part of the world. They want to work, be independent, make money, and want sort of everything that the rest of us want. We don't want to be dependent on people.
With that said, serious mental illness is a lifelong chronic illness. That really can be very debilitating, and make it difficult to do all of those things that people want to do. One of the fears a lot of our clients live with, particularly those who are doing really well, is that they're going to wake up one morning, and it's all going to crumble. So I think that's a stressor that, again, most of us don't live with.
The other thing that I think surprises people who aren't familiar with this is how long it can take somebody who, say, has had sort of a psychotic break, or has been hospitalized, to put the pieces back together again. You see this with young people, who are just developing a serious mental illness, which often happens in young adulthood, when people have their first psychotic break. We see a number of people like this, but who have their entire lives ahead of them. And you certainly don't want them to be in and out of hospitals their whole life.
What kind of services does The Bridge provide to these people?
We work with about 2,700 people a year, and 1,200 of those are living in our housing. So we don't work with huge numbers of people, but we work very intensively with the people that are part of our programs, or our housing, which is in Brooklyn, the Bronx, and in Manhattan. We own 23 buildings, so they're in different buildings in different locations. Then we lease about 500 apartments in the community, that we support with services, but the clients live independently in those apartments. The housing ranges from fairly intensive on-site rehab services, to much more independent, something we call ‘graduate apartments,’ which have a rental subsidy, but the level of support is fairly minimal. These are people who are very stable, and can really live on their own. It's just a way of staying connected to us, and we see them once a month. So there's a continuum of services for people.
We don't provide treatment in the housing; treatment is usually taking place in an outside program. But we have a sort of higher clinical presence, with a higher staff-to-client ratio. We’ll have social workers, part-time nurses, case managers, maybe a substance abuse counselor or vocational counselor, all on site. It sort of depends on who the population is, and the kind of program it is. Most of our clients are in treatment somewhere else, so they may come to our clinic, or day program, or a substance abuse treatment program. So they're engaged in a lot of treatment, and other kinds of support, to make sure that we're able to help them in the way that they want, and need.
Just by nature, it seems, The Bridge interacts with other organizations, and clients come into contact with a number of governmental institutions, be it public hospitals, shelters, or jails. How does The Bridge fit into this constellation of help?
Supportive housing in New York is very much a patchwork. The housing gets built with funding from different sources, which often depends on who's using that building. We have some buildings where most of the people are coming right out of hospitals, others where most people are coming right out of shelters, and buildings that just have younger people in them, because there was targeted money for young adults. The sort of good news part of supportive housing is that it really works: it keeps people healthy, and they live longer. We also have a growing aging population, and so we've developed specialized, targeted programming for our older adults.
I have a son who did some work in city government, and is now in graduate school in Chicago. He has a part-time job working for an organization that's trying to develop supportive housing there, and what he said to me is, 'You have no clue how bad things are here." There's nothing, even in other big cities. When they talk about supportive housing, they're talking about ten units at a time. It's just going nowhere, and there's no money, or funding, for it. Even though there are huge problems in New York, there's a lot of money in this realm. We're building a lot of new housing. It's a priority. If the governor and mayor can agree on anything, it is supportive housing. They've both really devoted significant resources to it, and we're really lucky in that way.
Like you mentioned with supportive housing, these services normally exist in a patchwork. There's a number of nonprofits and organizations that work together, to sort of fill in the gaps of government. Where did your group come from?
The Bridge is 64 years old. It came about when they were just starting to deinstitutionalize people, and the very first drugs were coming out. It was actually started by a group of mostly Jewish people, who were being released from hospitals when they realized that there was no help for them once they got out. It really started as a self-help organization. They were sort of running the organization; it was people who needed support in the community, and had no place. There weren't many organizations like this.
What happened over the years is that, as tens of thousands of people were relieved from psychiatric hospitals, the government realized that if you just set people out onto the street, this is going to be a failure. A lot of them were poor, didn't have a lot of education, had a serious mental illness, and were going to end up on the street. So [government] started thinking about what to do, and then it dovetailed with another trend, which was that government realized that it wasn't always very good at providing direct services. And it was very expensive; government employees are expensive, with unions and huge pensions. So they started contracting out these services.
IThat's how the organization grew up. In New York City, you had the additional factor, and this is very key in the field of mental illness: the right to shelter. We now have this absolutely huge, unmanageable problem that we sort of created, in a way, but if you had all of these seriously mentally-ill people in shelter: A) that's really a bad environment for them, and B) they ended up going in and out of hospitals, and jails. They tended to enter a shelter, and never leave. You had to have a solution for that. Since a lot of people would need support for a long period of time, the city, as part of its efforts to provide housing, really created an enormous and really incredibly well-functioning network for people who need help. When I said patchwork, I didn't mean it in a negative way—you just have a lot of different components.
But at this specific moment in New York City, with the growing crisis of homelessness, the kind of revolving door between criminal justice and substance abuse, with mentally ill patients going in and out of jail here, how much good can you really do?
Many of us know people who have a serious mental illness. I can't tell you how many times I go somewhere, and someone says, "What do you do?," and I tell them, and they go, "Oh my gosh, my brother has schizophrenia." But when you have resources, or families that have resources, the way that you engage with the system is very different. I know families where the parents and the siblings take care of that person. When they end up in the hospital, they make sure they're in the right hospital. They make sure they don't lose their housing, end up homeless, and that they always have their medication. But you can only do that if you have resources.
A lot of people who we work with, because of their behavior, have completely alienated their family. Mental illness runs in some families, and sometimes they can’t help, or are also struggling with homelessness, or incarceration. I like to think that what we do is provide that help, when they don't have other resources for getting it. I don't mean this in a condescending way, but they don't have other people to help them. Sometimes when you have a serious mental illness, you cannot do it by yourself. You can't fix it alone. You need help. So that's what we do.