Pubdate: Sun, 04 Nov 2001 Source: News & Observer (NC) Copyright: 2001 The News and Observer Publishing Company Contact: http://www.news-observer.com/ Details: http://www.mapinc.org/media/304 Author: Sarah Avery, Staff Writer OHIO SHELTERS EVEN TOUGH CASES Columbus Finds That There's No One-Size-Fits-All Solution To Housing Homeless Mentally Ill COLUMBUS, OHIO - The cinder-block building that has been George Smith's home for nearly three years is actually a converted Chinese restaurant on a busy strip leading out of downtown Columbus. As apartment living goes, it's humble; but for Smith, it is salvation from a decade of homelessness that resulted from untreated mental illness and alcoholism. "This is one of the best programs in the state, as far as I'm concerned," he said. "It really provides for people in a bad situation." And although Smith is under no obligation to seek treatment or even stay sober, he and 12 others have been allowed to live in the converted restaurant since it opened in 1999. No similar program exists in Wake County, where the county's largest housing agency for the mentally ill requires drug and alcohol screening. "This gives people a safe place to be, so that maybe they'll begin to work on their mental health and addictions," said Anthony Penn, associate director of the Community Housing Network, which manages Smith's apartment and about 750 others in Columbus. "Here, they are connected with social workers, and people try to make sure they get to doctor's appointments, counseling. Without a safe place to stay, they'll never address their problems." Community Housing Network, which develops and leases homes to people with varying degrees of schizophrenia, bipolar disorders, depression and addictions, has a simple mission: provide people such as Smith with homes in the community to keep them out of hospitals and off the streets. And that's all it does. Nothing more. The agency's work is considered exemplary in Ohio, which mental health professionals have praised as a progressive model since the state enacted mental health reforms in 1988. Many aspects of Ohio's reform plan are now being considered in North Carolina, which still relies on mental hospitals, not community services, to care for people with mental conditions. Wake County has been an especially heavy user of the state hospitals, particularly Dorothea Dix, near downtown Raleigh. On a typical day, Wake County patients occupy 125 of Dix's 490 beds. By contrast, Franklin County, Ohio, where Columbus is located, is allowed by contract to hospitalize 62 of the 6,000 mentally ill people it serves -- the sickest of the sick -- in a state mental hospital on any given day. The Ohio patients must get treatment in the community. "It doesn't mean the nature of the population has changed, but the onus of care is placed on the community," said David A. Royer, chief executive officer of Franklin County's Alcohol, Drug Abuse and Mental Health Board, known as ADAMH, which oversees the county's mental health services. The board is one of 55 throughout the state. Since the 1988 mental health reforms, it has assumed the responsibility, along with the resources, to care for people with mental illness in the community. Franklin's ADAMH board does not offer services itself -- there are only about 60 people on its payroll -- but it contracts with 54 nonprofit organizations to offer the programs needed to keep people out of hospitals: a.. Mental health treatment centers, in which psychiatrists, counselors, social workers and case managers collaborate to treat people's illnesses. a.. Vocational training organizations that help people get back to work. a.. Housing offered through developers such as the Community Housing Network. "Housing is where everything comes together," Penn said. "We have moved people out of hospitals, so have had to wrap services around them." Alice Lin, a mental health consultant and former project manager to North Carolina's joint legislative oversight committee on mental health, said the state can learn from Ohio's example. "The key is that you have to have expertise," she said. "Sometimes you don't need mental health professionals. You need housing expertise." how it's done in columbus At an old two-story frame house on the east side of Columbus, two women sit on the front porch, smoking cigarettes and watching the afternoon traffic. They live here with two others, all of whom have been longtime clients of the state's mental system. The so-called Next Generation house, with its solid oak staircase and heavy construction, is furnished in unpainted hard-edged pine sofas, chairs and tables. One woman sits in a chair and bellows criticisms about the uncleanliness of the house's basement, while a residential aide silently boils greens for dinner. The tenants have many needs, so they have around-the-clock supervision by aides -- the kind of crisis control and oversight that nurses and hospital technicians would handle if the women were in a mental ward. But the aides also prepare meals, do grocery shopping, clean up and manage each resident's calendar of appointments. The aides are not CHN employees, however, because the housing agency isn't in that line of business: "We do bricks and mortar project management," Penn said. The aides work for one of the mental health centers, which closely collaborate with CHN to ensure that all tenants get the level of supervision and intervention they need. As a result, some CHN homes are set up to offer 24-hour oversight; others afford complete independence. "In the beginning, we initially thought that everyone can live in independent housing," Penn said. "But we learned that we needed different types of housing. One size does not fit all." The most challenging clients are people who, like the women in the house, need constant care. At least once a week, their case managers from the mental health center visit them. The managers come to them, not vice versa, to monitor their compliance with medicines and make sure they are progressing in their treatment plans and social development. Additionally, the women have periodic appointments at the mental health centers to see their psychiatrists and receive medical treatment and other services. Franklin County has 30 community treatment teams that consist of five to 12 case managers who fan out to the places where mental health clients live. At least one team dispatches psychiatric drugs to patients throughout the city three times a day. Total cost of services: $100 million. To pay for such care, ADAMH brings in $40 million a year from a special mental health tax that voters approved in 1996 specifically for mental health services. The remaining $60 million is a combination of state and federal money. By contrast, Wake County's mental health budget is $46.7 million. "Community care in some ways is more expensive than institutional care," said Royer, the ADAMH chief executive. "But you have to make a decision about the quality of life. It's not an even trade." Neighborhood Resistance Even with Franklin County's level of commitment, there are gaps in services and public resistance to more programs. The CHN runs 750 units and has helped secure 145 federal housing vouchers, but there are at least 300 waiting for openings. (The majority of people with severe mental illness live at home or with relatives.) And adding new properties to meet the demand is often difficult. Homes can't be clustered in one section of town, and all need to be near public transportation and shopping. Political problems arise, too. CHN properties invariably draw the pitched opposition of neighbors. "NIMBYism is alive and well in Columbus, Ohio," said CHN director Susan Weaver, a reference to the Not In My Back Yard battle cry that homeowners sound when they fear a newcomer will reduce property values or otherwise diminish the neighborhood. Two years ago, the CHN announced plans to build a 16-unit townhome project in the north central area of town for clients who needed limited supervision. Residents of the neighborhood immediately assumed the worst. "We had to get people past their concerns that these are not individuals who are going to rape our children or steal us blind," said Greta Winbush, a resident who was asked by the neighborhood committee to work with the CHN. Winbush, who has a Ph.D. in family studies and degrees in psychology, said she came to the process with an open mind. She said her approach to the CHN project was to make the best of it. And since the complex opened, she said, there have been no problems. Her bottom line: "Everybody has to have a place to live, so how can we be a participant and make that happen safely for everybody? Let me be a part of what is going on." - --- MAP posted-by: Richard Lake