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By Ray Stern
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Vacovsky has a degree in government, but no written qualification in social work--unless you count the Certificate of Appreciation he recently received from colleagues and bosses at Central Arizona Shelter Services, where he has worked as a case manager for 10 years. His job is to get homeless people off the street.
Prior to taking the job, Vacovsky had no experience in case management. He worked for himself selling fuel. When that didn't work out, "I had to come up with something to do. So I ended up coming to CASS. They give you an intense training program here--they say, here's your case load. That's it!"
The place is at 12th Avenue and Madison Street. The state capitol is less than a mile to the west. Only a few blocks to the northeast are the high-rises of downtown, but the contrast is shattering.
There are people sitting or standing in the sun all over the street, which seems broader than it really is because no cars are parked on it or on the surrounding streets. Visitors to CASS who park in the street are told by the receptionist to move their cars to the parking lot that faces the building. An electronic gate opens to let you in. People on the street stare at you as you walk to the CASS building.
It's a shabby brick building, and the seats in the reception area are stained. But the case managers don't have it any better. Their offices are in a trailer around back.
That's where Vacovsky leads me. There are a couple of people waiting to be seen, a man and a woman. They're both manic, and as we walk past them Vacovsky tells them to calm down. "You're in an office," he says. As soon as he turns his back, the woman hangs out her tongue and makes spastic movements with her arms and head.
We go into Vacovsky's small office and he puts on some classical music. "This is what I use to calm the clients," he says, laughing. He sits behind his desk, a huge man with a perpetual look of kindly exasperation on his sweating face.
Even though we're not actually in the shelter itself, the smell of the shelter permeates the office. Not that the shelter is particularly squalid as shelters go--it has a stark tidiness, its rows and rows of bunks bringing to mind a barracks near the front line or a Victorian workhouse. But there's always the smell of bodies that have spent too long in the heat without deodorant, wearing clothes that have been slept in too often. Outside, close to the building and the trailer, there's a fenced-in area where clients just hang out, oblivious to the heat of the day. It has the look of a prison exercise yard.
"It's a safe place for them," observes Vacovsky. "Or as safe as anywhere can be. Things can still be passed through the fence."
I first met Vacovsky nearly a year ago, when I wrote about the failures of ComCare, the organization charged with caring for the indigent mentally ill ("Scream Dement," June 12, 1997). Since I wrote that piece, ComCare has been taken over by the state.
Back then, Vacovsky talked of clients who had died after ComCare had denied them treatment. In fact, one of the people I interviewed for that piece was being denied treatment, and he killed himself a few weeks after the interview. Today Vacovsky tells me of another one he's lost, Lawrence Kopsco, who killed himself in January.
"He was bipolar," Vacovsky says. "But ComCare wouldn't treat him because they said he was a drunk."
Even though people in the mental-health field are almost unanimously critical of ComCare, few are ever willing to go on the record. Vacovsky is not so shy. He has never hesitated to condemn ComCare's petty bureaucracy when it prevents people in need of help from receiving it. One of his colleagues, a social worker, once told me, "Lloyd would make it easier on himself if he wasn't so outspoken."
But it's hard to imagine Vacovsky being any other way. He has an opinion on everything, and won't express it in 30 seconds if 10 minutes will do. In other people, this could be an annoying trait. But Vacovsky so obviously cares about his clients that his monologues, fueled by anger and not ego, tend to inspire rather than annoy. It's hard to imagine anyone without such passion being able to spend 10 years in a milieu so grim.
When he first arrived at CASS, he worked mainly with homeless alcoholics.
"It immediately became obvious that the two areas that impacted our clients the most were substance abuse and mental illness. Ten years ago, these issues were very closeted. Alcoholism was something that happened to Uncle Fred, but nobody wanted to talk about, or schizophrenia hit your Aunt Jane, but you didn't talk about it. So here it was obvious that we had to work on it. So I started working primarily with the alcoholics. It was very frustrating, because nothing worked. We'd send people to programs, everything from very expensive residential programs to just AA, and they constantly came back to us, over and over again."
Frustrated by this, Vacovsky largely gave up working with substance abusers.
"I thought alcoholism was a disease of the spirit, and people chose to be alcoholics, destroy their families."
He began working instead with the seriously mentally ill, "Because you could understand that. It made sense. You say, he hears voices because he has schizophrenia. It's a chemical imbalance. You can treat it."
But, in Vacovsky's estimation, more than half of the 400 people who use the shelter are both mentally ill and alcoholic. And so Vacovsky is once again treating both problems.
"Substance abuse is self-medication," he says. "They take it to deal with hearing voices, just feeling terrible . . ."
As administrator of a pilot program called Smart Recovery, Vacovsky aims at treating alcohol addiction as a medical issue rather than a spiritual one. He's critical of 12-Step programs that ask the alcoholic to give himself up to a higher power.
"You get up in the morning and say the serenity prayer, but alcohol's still the first thing on your mind when you wake up. And your day is spent focused on not consuming any alcohol."
Vacovsky believes that being "in recovery"--as in 12-Step programs--is very different from recovering. He encourages his clients to try Naltrexone, a drug which he claims removes the craving for alcohol and restores the functions of the brain that release endorphins, the brain's natural pain and stress relievers. In the substance abuser, this function has shut down because of the effects of alcohol or opiates.
The program has been successful in the extreme, with many clients being able to leave the shelter after finding work and a place to live. Clients who are seriously mentally ill at least become stabilized, Vacovsky says. The imperative is to move forward rather than dwell on the past.
But CASS faces an uphill climb. In the winter, the shelter may turn away 30 people a night. The rest of the time, accommodation can usually be found for anyone who needs it. The only criteria are that the client is needy, and is doing something about getting out of the shelter.
"But we don't check for proof that they don't have any money," says Vacovsky. "We take it on trust. Many clients don't have ID anyway. And, if it's taking a person a long time, like he might be applying for social security, we'll let him stay months, as long as we know he's doing something about it."
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