THE VOICES ARE BACK WHEN HOMELESSNESS AND MENTAL DISORDERS COLLIDE
Photos by Juan Carlo | Story by Claudia Boyd-Barrett
PART I
Some chronically homeless people haunted by mental health issues
The voices were back.
Jamie Hardy’s blue eyes darted nervously around the room as he sat inside a drop-in center for the homeless in Ventura.
For five days, he said, he’d gone without his medications for schizophrenia. They were stolen, he said, by a street couple he thought were his friends.
Now, the illness he says he’s battled since his teens — the one that propelled him into a decadeslong cycle of homelessness, alcohol addiction and drug abuse — was regaining strength.
Voices clamored for attention in his head. They insulted him, told him he was garbage. They stoked the flames of paranoia, warning him he was about to get jumped by police.
“It’s so real,” he said, his face contorting as he jumped from one conversation topic to another. “It’s been like this all night and all day. Hearing differing things ... It’s embarrassing. I think people are looking at me and thinking, ‘This guy’s crazy.’ ”
Hardy, 50, is one of dozens of people in Ventura County trapped in what can become a revolving door of homelessness and mental illness. They are often chronically homeless, meaning they have a disabling condition — which can include mental illness — and have been homeless for over a year, or multiple times in the past three years.
Mental health problems, such as schizophrenia, bipolar disorder, anxiety and depression, are why some people are homeless and one of the biggest challenges to getting them off the streets, according to social service professionals.
“Homelessness is a pretty logical byproduct of mental illness,” said Jason Meek, executive director of the Turning Point Foundation, a Ventura agency serving the homeless and mentally ill. “You’re paranoid, you don’t trust your boss, you stop going to work. Or you’re depressed and you just can’t get out of bed, you get fired because you didn’t show up.
“You can’t pay your rent because you lost your job. It’s a real quick, snowball effect ... It’s truly not their fault.”
The 2015 Ventura County Homeless Count — a one-day survey in January — showed the number of men, women and children homeless in the county decreased for the third straight year, to 1,417.
Of that total, about 451 adults on a given night were chronically homeless, or 32 percent, according to the homeless count. Nationally, 14.5 percent of all homeless people were chronically homeless, based on the U.S. Department of Housing and Urban Development’s 2014 homeless count report.
Among the county’s chronically homeless, 37 percent reported a mental illness in the 2015 count. Some officials believe the real percentage is likely higher because the annual survey relies on homeless people self-reporting mental illness, and some may not realize it or don’t want to admit it.
SELF-MEDICATION
Hardy said he knew something was wrong by the time he was 17. He heard voices at night. His brother would ask who he was talking to, not realizing Hardy was talking to himself. Hardy said he approached his mother about the problem, but she brushed it off.
So Hardy turned to alcohol, the only thing that made him feel normal again.
“I started drinking beer and I noticed right away the voices started to kind of go away,” he said in an interview when his mind was calmed by medication. “It felt really, really kind of neat. I felt relaxed.”
That began a downward spiral into alcohol addiction, drugs and depression. For a while, he held it together, he said, working as a stock trader in the Bay Area, later at an animal shelter in Las Vegas, and as a host at a Hard Rock Café in Los Angeles. But the alcoholism, drugs and undiagnosed schizophrenia always caught up with him. He’d lose his job and end up on the streets.
Substance abuse is widespread among the chronically homeless, particularly those with mental health issues. Social service agencies refer to these people as being “dual-diagnosis,” because they suffer from more than one debilitating condition. Many homeless people with a mental illness use drugs or alcohol to self-medicate.
A complicating factor is that there is no cure for serious mental illnesses like bipolar disorder and schizophrenia, which require long-term management with medications. But it takes time to figure out what works best for each person.
PART II
Agencies struggle to help homeless who resist services
The frail woman with matted hair sat on the steps of Cemetery Memorial Park in Ventura, the summer sun beating down on her.
She wore a bulky plaid jacket, three sweaters, a T-shirt and dirty pajama bottoms. Black socks and sandals smothered her feet. Skin peeled from her reddened face.
“It’s so hot out here,” mumbled the small woman, known only as Leslie to those familiar with her. A passer-by and others in the park didn’t seem to notice.
Officials say some homeless people have severe mental disorders yet remain on the streets for months or even years. Some exist in a quiet state of physical and mental deterioration. Others become noticeably psychotic or, at worst, behave in ways that can threaten others or themselves.
The challenge for social service providers and authorities is that these vulnerable and sometimes volatile people often refuse help, officials said. They might be paranoid and mistrustful of strangers, especially officials. They frequently don’t realize there is anything wrong.
NO OUTLET
For Kevin Clerici, head of Ventura’s downtown business improvement district, dealing with the chronically homeless is his organization’s biggest challenge.
They wander through the streets and parks. They babble nonsense, have arguments with inanimate objects, perform strange rituals, drink or take drugs in public, and walk around half-dressed.
They might get arrested for a couple of days or taken to hospital, but soon they are back in the public realm, officials said.
“Our system fails,” said Clerici. “It doesn’t provide an outlet.”
People have the right to refuse care. If they are deemed a threat to themselves or others or are gravely disabled, they can be held at a psychiatric hospital for up to 72 hours. In severe cases, and following a hearing, the hold can be extended.
But in most cases, the symptoms that prompt a 72-hour hold clear up quickly and the person is released, said Robert Mendoza, a manager with the county’s Behavioral Health Department.
“Being mentally ill is not a crime,” Mendoza said. “We honor people’s self-determination to live their lives as they choose. If they want to be homeless, then that’s their choice. If they don’t want to be homeless or they’re not in the capacity to really make that decision, then we want to try to help them in that homelessness.”
Mendoza heads a new Behavioral Health program called Rapid Integrated Support and Engagement, or RISE. The program sends out teams of mental health workers to offer help to homeless people. If the person accepts assistance, the team can organize an assessment in the field or get them to a clinic for assessment and treatment. They connect them with a caseworker and follow up with the person for up to a month to make sure they’re keeping their appointments, Mendoza said.
The program, launched this year, is funded in large part by a $7.6 million state grant
Mendoza said teams have contacted 1,220 people so far, but he doesn’t yet have statistics on how many accepted help. He said teams often have to meet with the clients multiple times to gain their trust. The teams will keep trying to engage resistant people for up to a year, he said, but if they persistently refuse help, officials eventually will move on.
“We believe we’re making good progress. But remember, these are the most difficult folks,” he said. Each success story represents “a lot of effort, sometimes it’s weeks of engagement, follow-up calls, missed appointments and then bringing them back. It’s very labor intensive.”
MULTIAGENCY EFFORT
The people sitting at a table at the Ventura Police Department last month provided a snapshot of how many agencies are dealing with the chronically homeless.
There were police officers, state park rangers, a public defender, a hospital caseworker, Ventura’s city attorney and community services manager, a therapist with RISE, and caseworkers with the Salvation Army and two other nonprofit groups.
They’d gathered, as they do every Tuesday, to discuss one of the most vexing problems for public officials, law enforcement and social service providers: how to help homeless people who won’t help themselves.
The weekly meeting is part of the city of Ventura’s Community Intervention Court program. The program, run in partnership with Ventura County Superior Court, attempts to divert chronically homeless lawbreakers from the criminal justice system to social services by allowing them to accept substance abuse or mental health treatment, as well as housing assistance, in lieu of jail time.
Participants typically face charges for vagrancy-related violations such as illegal camping, drinking in public or disturbing the peace. Most are ordered into substance abuse or mental health programs, said Ventura police Sgt. Jerry Foreman.
“We knew we weren’t going to be able to just arrest our way out of the problem,” said Foreman. “We want to change their behavior. They don’t belong in jail.”
It’s difficult work. Many of the homeless who agree to enroll in the program don’t follow through on the judge’s order for treatment and end up back in jail or on the streets. Of 27 participants who signed up for the program in the past six months, just seven have stayed with it, Foreman said. One of those has graduated, meaning he is stable and no longer needs assistance, Foreman said.
PART III
Affordable housing is key to helping homeless
When Daryl McGee first took up residence on the Ventura Pier, Bill Clinton was president, New York’s twin towers were still standing and the Internet was barely a “thing.”
For about two decades, the learning-disabled man survived on the iconic wooden outcrop, said caseworker Fariborz “Hank” Koozehkanani, of the Ventura nonprofit group Project Understanding. He fished for food, cooked on a camping stove and drank his days away.
Today, McGee, 48, is adjusting to a new kind of life in an apartment in Montalvo. He sleeps in a bed, has a refrigerator to store food and has a restroom when he needs one.
“It’s pretty much fun staying here, it’s nice,” McGee said.
He and another disabled man he shares the apartment with were helped through an approach known as Housing First. The concept is to move chronically homeless people into permanent housing as the first step to stability.
Older approaches required homeless people to achieve sobriety or enter a treatment program before being moved into permanent housing. Under Housing First, people receive support to stay in their homes and later are connected with services such as health care, substance abuse treatment, education and job counseling.
McGee’s rent and utilities are paid for out of $860 a month he receives in federal disability benefits. Project Understanding covers the cost of his caseworker through a mix of government funding and private donations. Koozehkanani said he also brings McGee donated food.
PROVEN PRACTICE
Housing First has proved successful in other parts of the country, rapidly moving people off the streets, particularly the longtime homeless and the mentally ill. Studies show it also saves taxpayers millions of dollars on emergency hospitalizations, jail stays, sobering facilities and temporary shelters.
Los Angeles County, which has a large homeless population, has also embraced Housing First. Under a program called Housing for Health, the county’s health department has housed almost 1,000 chronically homeless people in affordable housing developments or in private units that accept federal housing vouchers.
Each person housed saves the county $32,000 per year by dramatically reducing emergency room visits and hospital stays, said program manager Connor Johnson. The county plans to house a total of 10,000 people in the next few years.
When “they’re in housing and their health needs are being addressed ... that’s a savings for the county in addition to being the right thing to do,” Johnson said.
Ventura County’s Continuum of Care board, which oversees distribution of just under $2 million a year in federal funds for homelessness, is pushing agencies to implement Housing First.
The idea is once people’s basic needs for shelter, food and safety are met, they can better focus on improving their lives.
“The wrong conversation that you hear a lot is, ‘We’ll help the people who want to be helped’ ... It’s not fair to say that about some of these folks who are chronically homeless, because they’re just trying to survive,” said Continuum of Care coordinator Tara Carruth.
McGee, for example, now drinks about a 10th of what he used to when he lived on the pier, said Koozehkanani. He said he is working to persuade McGee to see a doctor, because he believes the formerly homeless man uses alcohol to self-medicate for schizophrenia.
Meanwhile, his roommate, Monty Monkress, 50, now receives regular medical care instead of constantly ending up in the emergency room when he was homeless. He said he used to drink until he passed out, because being homeless made him feel isolated and depressed.
“I’m feeling pretty good,” he said. “I don’t have to worry where I’m going to sleep or if somebody’s going to kill me.”
NEED FOR HOUSING
Many officials agree the Housing First model is effective, but they note that first you need housing.
With Ventura County’s sky-high rents, an apartment vacancy rate as low as 3 percent and long waiting lists for subsidized housing, finding an affordable place is difficult for many people. For the homeless and those trying to help them, it can be almost impossible.
“It’s the biggest struggle we face,” said Joe Dawson, who works for Ventura’s Homeless to Home program, a housing initiative run by three nonprofit groups.
Housing providers — typically nonprofit groups — offer permanent units with support services for the homeless. At last count there were 366 units, and usually those are full, said Carruth. That means agencies have to look to private apartments, which are too expensive, she said.
In Ventura, a social service task force study found no development of extremely low-income housing from 2006 to 2013, even though the state determined the city needed 430 such units. Over that same period, 84 percent of all new housing units were built for high-income households.
“We are creating homelessness,” said Judy Alexandre, chairwoman of the task force.
Despite the housing shortage, Carruth and Christy Madden, Ventura County’s senior deputy executive officer, said they are optimistic Housing First will work with creative housing solutions.
Local communities are looking at ideas such as repurposing nonresidential buildings and old motels, building tiny houses or converting shipping containers into homes, Carruth said.
“We have to look at everything, nothing is off the table,” Madden said. “It’s daunting, but I’m actually encouraged because I think this is a time of opportunity. It’s ripe for making systemic changes that are evidence-based and really generate some positive outcomes.”