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Editorial: Mentally ill, chronically homeless

June 10, 2012  |  
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A man sits on a couch in the field across from the Neighborhood Service Organization's Tumaini Center in Detroit. While the center has no beds, more than 100 homeless people spend the night there resting or sleeping on metal folding chairs.
A man sits on a couch in the field across from the Neighborhood Service Organization's Tumaini Center in Detroit. While the center has no beds, more than 100 homeless people spend the night there resting or sleeping on metal folding chairs. / PATRICIA BECK/DETROIT FREE PRESS
Keith Jenkins, left, 59, of Detroit, and Kelvin Costner, 51, of Detroit, talk outside the Tumaini Center. Both have been diagnosed with mental illness and have improved thanks to the services offered by the center.

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Even the most sequestered suburbanite visiting downtown Detroit can see that cuts in mental health services have pushed mentally ill people onto the street. During the day, more and more of them share the sidewalks with nicely dressed people who walk by them, often without a glance, on their way to the offices, lofts, condos, restaurants and clubs that signal Detroit's downtown revival.

At night, the homeless sleep in shelters, parks and vacant buildings -- or even on flattened cardboard boxes spread across the cement. The traps and trials of street life make it nearly impossible for the mentally ill to manage medications, keep medical appointments and control their illnesses.

Nearly 20,000 of Michigan's 100,000 homeless people live in Detroit. An increasing number of them -- at least a third -- are mentally ill and untreated. With the uncertainties and disruptions of street life, they face enormous difficulties in managing the medications and medical appointments needed to control their illnesses and maintain their health.

Related: Read other installments in Jeff Gerritt’s series about the mentally ill and the prison system

The number of homeless mentally people on Michigan's streets and in its shelters increased significantly after former Gov. John Engler closed 10 of the 16 state psychiatric hospitals during the 1990s -- without putting sufficient resources into community mental health programs. Other cities and states already were well on the way to deinstitutionalizing the mentally ill. But few that did were less prepared than Michigan to deal with the consequences.

"Mainstreaming people was a great idea, but the money didn't follow them into the community," said Reggie Huff, director of homeless services for the Neighborhood Service Organization in Detroit.

Without assistance that combines affordable housing with mental health services, more and more mentally ill people will become homeless. It's a problem Detroit cannot ignore as it moves to redevelop its downtown and Midtown areas.

People difficult to reach

During a hot afternoon last month, people in business suits -- carrying leather attachés or handbags -- covered the sidewalks of downtown Detroit. They walked by the destitute, some with paper cups or outstretched hands, often without a glance. This is the flip side of Detroit's downtown revival: homeless people and panhandlers -- on sidewalks, in parks and by freeway ramps -- sharing the city's heart with new lofts, condos, restaurants, clubs and shops.

One man in a torn shirt stood in front of a bank, asking for money. Two blocks west on Lafayette, a shirtless man in sagging jeans crossed the street in a rage, shouting at no one in particular. Nearby, a middle-aged man, dressed despite the heat in a stained black sweatshirt, sat on a sidewalk near Cobo, gray strands of hair and sweat dripping from a wool hat. He rocked gently and murmured to himself.

Detroit has only 5,032 shelter beds, including emergency shelter, transitional housing and permanent supportive housing. Those beds cover only one in four of Detroit's homeless population.

Among the general population, an estimated 6% are severely mentally ill, according to the National Institute of Mental Health. But it's hardly surprising that a disproportionate number of them -- especially people with bipolar disorder and schizophrenia -- end up homeless, unable to care for themselves, manage money, or accept help from caregivers and family members.

"This is a difficult population to reach and bring into services," said Mark Reinstein, president of the Mental Health Association in Michigan. "They're not very trusting of people they don't know."

Moreover, at least half of the mentally ill homeless suffer from substance abuse, self-medicating on street drugs and further undermining their health and ability to get jobs and stable housing. Even those receiving Social Security disability payments typically receive only $674 a month, too little to secure decent housing and cover other living expenses.

A place of last resort

Mental illness is especially prevalent among the single homeless population served by Neighborhood Service Organization's Tumaini Center at 3430 Third Street in Detroit. On a recent afternoon, dozens of homeless people lingered on the sidewalk, in the street and in littered vacant lots outside the center, as seagulls swirled in the air. A few hundred yards to the west, rows of new condominiums -- promising shoots of a Midtown revival -- symbolize a new Detroit but also threaten to push the homeless out.

Tumaini is a center of last resort, where people may go even if they're high or disruptive. The 24/7 center has no beds, but at night more than 100 people with no place else to go sit on metal folding chairs, many of them nodding in and out of sleep.

Lewis Hickson, Tumaini's operations manager, estimates that 80% of the nearly 1,000 people a year served by the center are mentally ill.

For Kelvin Costner, 51, and Keith Jenkins, 59, the Tumaini Center is home.

A Tumaini client for more than 20 years, Costner, who is schizophrenic, has lived on the street most of his adult life, except for five years in Michigan state prisons for attempted burglary and several stays in state psychiatric hospitals.

Without medication, he falls into severe depression, sometimes using alcohol and crack cocaine. "I feel like the world is coming down on me," he said. "I just want to crawl up in a hole."

Thanks to the mental health staff of the Tumaini Center, Costner is doing better. He takes his medications regularly, helps out the center by hauling donated food and doing odd jobs, and watches out for some of the other mentally ill clients. Like Jenkins, he is waiting for a spot in NSO's new supportive housing program in the former Michigan Bell Building.

Until then, Jenkins stays almost every night at the Tumaini Center, though he rarely sleeps, other than to nod off for a few minutes while sitting on a chair. A former landscaper and roofer, Jenkins was diagnosed with a mental illness in 1989, when he started to receive Social Security disability benefits. NSO staff members, however, have been unable to trace his records and will need another diagnosis to determine his disorder. With severe health problems, including asthma, gout, high blood pressure and diabetes, Jenkins uses a cane but still manages to walk miles to nearby parks and medical appointments, or around downtown.

"I'd like to work,'' he said. "The hardest part is doing nothing."

Frustrated and discouraged

Costner and Jenkins are part of a growing population of mentally ill people who are chronically homeless -- that is, they have been homeless four or more times in the past three years or for one year continuously. More than 5,100 of Detroit's homeless, or about 27%, are chronic, said Tasha Gray, executive director of the Homeless Action Network of Detroit.

The problem will only get worse unless mental health services and disability benefits become easier to access. More federally funded clinics that target the uninsured should integrate primary health with mental health care. Federal and state grants ought to include financial incentives for providing both services at the same site. The federal government should also make single people with mental illness or a substance abuse disorder eligible for Medicaid, which would greatly reduce emergency room costs by enabling people to maintain their health.

Social Security disability benefits give mentally ill homeless people the income and health insurance needed to live successfully in the community. Securing those benefits, however, can take months, even years. Many homeless people never apply for disability benefits and, even when they do, less than 15% are approved on the initial application, according to federal statistics.

"They get frustrated and discouraged because they have to wait so long, and they're not always treated kindly," said David Allen, NSO program director for supportive housing.

The federal government should streamline the process by expanding the list of medical providers authorized to diagnose disabilities to include nurse practitioners, physician assistants and licensed clinical social workers, as recommended by the National Law Center on Homelessness and Poverty.

Long-term, supportive, affordable housing offers the best solution. Mentally ill people need to get into stable housing quickly, even before dealing with mental health, substance abuse, job training, transportation and other issues. But simply providing affordable housing to mentally ill people without support services usually won't work. With proper assistance, however, nearly 90% of the homeless remain housed, national studies show.

Moreover, permanent, supportive housing is, on average, 40% cheaper than the alternatives -- ongoing incarceration, shelter, criminal justice, emergency room stays and other crisis costs associated with chronic homelessness -- studies in Los Angeles County and New York City have found.

"If you're on the street or in a shelter and need medical attention, you're going to the emergency room," said Meghan Takashima, NSO's research coordinator. "You're going to intersect with the police and jails and use public safety resources. All of that ultimately costs more than supportive housing that enables people to remain stable and healthy. Every study shows it works."

A new model for treatment

A new model for permanent supportive housing, developed through a public-private partnership, is emerging in Detroit.

The former Michigan Bell Building on Oakman Boulevard is undergoing a $50-million renovation, including 155 one-bedroom apartments for single homeless men and women. There, they will get on-site counselors and therapists to help them become self-sufficient. Case managers will connect them to other community mental health services.

The Bell Building project will start receiving tenants in July. The building will also eventually include administrative offices for NSO and 200 staff members.

NSO bought the 91-year-old Bell Building from Focus: HOPE, revitalizing the struggling near west-side neighborhood. NSO clients will get education and job training nearby at Focus: HOPE.

Through Section 8 subsidies, tenants will pay rents on a sliding scale, typically one-third of their income. They will have access to a library, chapel, gym, fitness center, computer room, art and music rooms and a walk-out roof garden. Plans also call for a neighborhood health clinic.

Private investors helped pay for the project by purchasing state and federal tax credits. Government and private grants included $1.25 million from the Kresge Foundation and $1 million from the McGregor Foundation.

Another excellent example of supportive housing for the homeless is Detroit's Piquette Square for Veterans, a 150-unit project developed by Southwest Solutions.

Unfortunately, the city's two supportive housing projects will serve only a fraction of Detroit's homeless population, posing a challenge for redevelopment efforts in downtown and Midtown. Even so, they offer a model for providing mental health services at affordable housing sites that will enable mentally ill people to get off the streets and live with the dignity they deserve.

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