Alone Out There – Mental illness on Eugene’s streets

By Rick Levin, from the Eugene Weekly, January 23, 2014

Few things are as starkly inconvenient to our collective perception of well-being than the ongoing existence of homelessness and mental illness. They baffle our understanding.

And so, when these two uncomfortable facts collide in a very public way — say, in the form of a ragged man screaming at ghosts in Kesey Square — we reach a level of collective dismay that approaches hysteria. Hysteria, which is just fear, drives us to extremes: anger, pity, denial, paralysis.

Eugene, as a city and, more importantly, as a community, is being torn apart, divided politically and socially, not by homelessness and mental illness but by the way we talk about and deal with these issues. Like the rest of the country, we are drawing ever-sharper battle lines separating the haves and the have-nots, the dos and the do-nothings, the bleeding hearts and the rugged individualists. We remain gridlocked, spinning our wheels. The problem persists.

But life is funny: If you don’t deal with reality, reality will deal with you. Let’s look at the reality, then: Of 1,751 folks counted during Lane County’s 2013 One Night Homeless Count, 415 were chronically homeless with a disabling condition, and 202 of them were deemed “severely mentally ill.” Many, like Eugene resident Celine Ecker, are caught in a cycle of mental illness, substance abuse and homelessness as they struggle to survive on our city’s streets.

A ShelterCare report notes that “as many as 500 individuals with mental illness are homeless in Lane County,” and among the 6,000 adults with severe psychiatric disabilities in the region, “about 2,000 are not currently receiving supported housing services.”

White Bird volunteer coordinator Ben Brubaker suggests that these numbers are too low. Most national studies put the rate of mental illness among the homeless at between 25 percent and one-third, yet Brubaker guesses up to 60 percent of Lane County’s homeless population has “significant mental health issues,” and that our homeless population as a whole might be pushing 11,000 individuals.

Lauren Regan, executive director of Eugene’s Civil Liberties Defense Center, says that “even using the government’s numbers, we still have a huge problem” when it comes to our growing population of homeless individuals suffering from untreated mental illness. “These are humans who have just completely fallen through the cracks,” Regan says. “We have an open-air institution. Nobody chooses to live on the streets who are in their right minds.”

St. Vincent de Paul Society of Lane County Executive Director Terry McDonald says the intersection of homelessness and mental illness can be traced in large part to the emptying out of mental hospitals without implementing any ground-level support. “Historically, the connection between de-institutionalization and mental illness on the street is quite clear,” he says. “We downsized mental facilities in the ’80s and ’90s, and with that the number of persons on the street with mental illness rose.”

McDonald says that “as a society, we simply don’t put enough resources into treatment and support services for any of our mentally ill. A society that does not deal with its most vulnerable citizens in a compassionate manner is doomed.”

A vicious cycle

For the past two decades or so, and with heartbreaking regularity, Celine Ecker has been crashing back and forth through a portal separating two very different realities. Most of us, with minor variations, would recognize what lies this side of the portal: home, school, work, relationships, meaning, etc. Most of us, with little argument, call this the real world.

It’s the other side of the portal Ecker occasionally falls through that concerns us here. On this other side is a kaleidoscope world that has been intimately written about and elaborately described but rarely understood. What defines this alternate reality is its complete lack of solid foundation: It’s a place where each resident, like Ecker, speaks a private language with little human communion, and it resembles the so-called real world only in its physical appearances and its savage demands of survival.

This, then, is one more faltering description of the reality experienced by the unsheltered mentally ill. Residents of this world, Ecker included, are treated by many of us as either victims or pariahs, often at the same time, and the paralyzed sympathy they receive is rivaled only by the indifference or outright abuse they suffer. Too often, they baffle our powers of comprehension or empathy.

Ecker says she’s been on a cycle of homelessness, substance abuse and severe mental illness since she was 22, when she experienced her first episode of schizo-affective disorder after a “bad acid trip.” Now 40, Ecker was just released from the Johnson Unit at Eugene’s PeaceHealth Hospital, where she checked herself in to undergo a regimen of stabilizing medication and 24/7 psychiatric observation.

Before that, from Oct. 17 until Dec. 13 of this past year, Ecker survived alone on the streets of Eugene — technically speaking, of course, because while she struggled to stay alive during the cold snap that gripped the region, she was visible but somehow unreachable, among us but not of us.

“I thought I saw a spaceship,” Ecker tells me over a cup of coffee downtown. “I thought that the buildings were Babylon and I was going to stop the spaceships from leaving Earth. I was in control of that. I was an astronaut. I was so delusional that I thought I heard trees speaking. I thought I was supposed to be the next Madonna. That’s funny,” she adds with a laugh.

I’ve known Celine Ecker the better part of a year, and I’ve watched her slowly fall apart, as she’s gone from being a sensitive, highly intelligent and fragile woman to being a person at war with herself, off her meds and increasingly erratic, struggling to maintain a tenuous hold on reality and human relationships; it’s a terribly helpless thing to see, and in my helplessness I’m one more person who failed her.

When Ecker went off her meds in October and disappeared, having lost her housing, I prayed that she wouldn’t die. I ran into her once in December, at the same place we had coffee to talk about this article. It was absolutely freezing outside then, and she was brutally underdressed. I bought her a bagel and cup of coffee, and we talked. It was like communicating with someone you know through a scrim of fuzz in a nightmare where meaning becomes a louder and then quieter echo: At one point, Ecker told me she’d removed her ovaries the previous night, after she’d given birth to three stillborn babies stored now in her backpack. She scrawled me manic notes on free postcards she’d picked up, filling up the space with subliminal advertisements for her future self: “Coming to a theater near you for Christmas, 2017” and “Lunarstream Movie Productions presents the fastest animae star on planet Earth” and “Keep your dreams in your mind.”

And then I said goodbye, please take care, stay warm. I did not, despite Ecker’s distressing condition and isolation and confusion and the arctic cold outside, offer her the shelter of my house. No — my failure is, in some essential way, our failure. I’ll own that.

Though she is now staying in a shelter and under a six-month commitment with the state of Oregon to continue taking her medication and maintain counseling, Ecker says she is worried that the cycle of mental dissolution and homelessness in her life will continue. “I just get scared that I’m going to repeat the pattern,” she says. “It’s happened so many times. There’s only so many chances you get in life. I’ve tried to commit suicide at least three or four times, to the extremity of swimming out into the ocean.”

Being aware of the pattern, Ecker explains, doesn’t help. Despite the fact that she can’t remember large chunks of the past 20 years, she knows what happens when she crashes. “I don’t take my medicine,” she says. “I just think I don’t need it. Sometimes I forget to take it, and more and more I don’t take it and end up on the streets again. It’s out of control. I lose weight. I get sexually abused by men on the streets. I get sleep deprived. I starve for a whole month. I don’t eat. I don’t sleep. I walk around. I feel alienated. It’s like a Jekyll-and-Hyde personality, one extreme to another,” Ecker says.

“I don’t know what I have to do to drill into my head to stop the pattern,” she adds. “I have to take it as a life-and-death disease, literally.”

At one point, I ask Ecker if she senses something is wrong when she’s delusional. She asks me if I know when something’s wrong in my head. It’s a chilling question. Then I ask her if there’s anything I could have done differently. “It’s really hard to talk to someone who is in that state of mind, because you don’t know that you need help,” Ecker explains. “I’m too out there, I don’t relate to anybody. Once someone gets that far out, it’s hard to reel them back in unless they give up.”

Stress kills

Hard, but not necessarily impossible. Many people suggest — including several homeless individuals I’ve spoken with — that Eugene does a better job than most cities in addressing the issues of homelessness and mental illness. Funding and staffing and bureaucratic bloat aside, we do possess a slew of advocates and organizations focused on helping those in need, whether homeless or experiencing mental issues or both: White Bird, St. Vincent de Paul, SLEEPS, Laurel Hill Center, ShelterCare, Buckley House, Looking Glass, Eugene Mission, Egan Warming Center, to name a few.

The Johnson Unit is ground zero for many individuals, like Ecker, who find themselves undergoing severe psychiatric crises. “It’s the isolation of either the mental illness or the homelessness that drives people to the crisis,” says Dale Smith, director of behavioral health services at PeaceHealth, home to the Johnson Unit. “It’s a horribly isolating experience. That is what leads to that desperation and isolation. If you have any degree of paranoia or psychosis, (being homeless) just fuels it like a hot fire.”

“Your lifestyle will create mental illness,” I was told by Mike, a 51-year-old man staying at the Whoville encampment at the corner of Broadway and Hilyard. “The stress. Stress kills. If you’re mentally ill already, the hoops get harder to jump through. Once you’ve gotten down, it’s hard to come back up. A lot of people don’t make it.”

Paul Cooper, another Whoville camper, says that agencies that help the homeless and mentally ill are too often ostracized. “The mentally ill, they can’t help it,” he says. “I feel they’re just kicked to the curb.”

Whoville’s Mama Carrie says about “half of us out here” suffer from mental illness. “Truthfully, people need meds no matter what,” she says. “Whether it’s mental illness or a physical ailment.”

Smith says the focus of the PeaceHealth transition team is to create what’s called a continuum of services, including intensive case management and a “hand-off of care” that engages a patient’s life needs, such as stable housing. “That becomes the focus of that team, establishing some kind of housing,” Smith points out. “The bottom line is really about that support system, that network, so people don’t slip back into that situation. The problem is everybody sees them as failing. They don’t fail. We fail.”

Regan, whose CDLC is currently seeking a court mandate challenging the “criminalization of homelessness in our communities that fail to offer an alternative to the unhoused condition,” says she suspects that up to 90 percent of our homeless population have mental health issues, and that many of these individuals “become addicted to street drugs in an attempt to mask or manage symptoms.” And, Regan adds, the stress and anxiety of such an unstable condition is only exacerbated when a person comes in contact with law enforcement officers untrained in negotiating mental-health crises.

“If you truly want to decriminalize mental illness and homelessness, it has to start with the cops,” Regan says.

As a freshman rep in the Oregon State Legislature, current House Majority Leader Val Hoyle fought for the creation of two new state mental facilities, including the one slated to open in Junction City in 2015. Hoyle, whose own brother has experienced mental-health issues, acknowledges the controversy surrounding the building of the hospital, which some see as one more “Cuckoo’s Nest” means of institutionalizing and deadening patients with heavy pharmaceuticals.

Hoyle insists, however, that hospitalization, while not an end in itself, is a step above incarcerating the mentally ill in jails. “We need to treat mental illness the same way we treat physical illness,” she says, adding that stays should be shorter and followed by strong community support, including reliable housing and services.

“I really want people to get care at the community level,” Hoyle says. “We don’t have enough places for people to go … It’s very clear that stress is a trigger for people who are mentally ill. If you have someone who’s mentally ill and they don’t have a stable place, then it’s harder for them to manage their mental illness.”

Where they’re at

Right now, in this city, in this nation, we all seem to agree that something is broken. What we disagree upon is how to fix it, which means, basically, that we can’t agree on why it’s broken. When it comes to mental illness and homelessness, the issue is clear, whether we are talking about the woman with voices in her head pushing a shopping cart around Four Corners or the sick man-child who shot up Sandy Hook.

Really, it doesn’t matter if we believe the homeless and mentally ill deserve their shameful fate because they’re lazy and weak-willed or, instead, we see them as victims of vast socio-economic factors that alienate and rob them of their dignity. The reality is everything, and in the end, the dynamic causing mental illness and homelessness will not bend to our opinions, which simply reveal the magnitude of our empathy, sympathy, understanding, apathy or action.

Among those who are actually doing something to address the issue, there appears to be a staggering level of agreement about what works and what we need more of to get homeless and mentally ill folks out of crisis: stable housing, continuous care as opposed to one-stop fix-its, as well as peer and community support that includes an ability to broaden our understanding of reality beyond mental issues themselves as an illness.

Many people view White Bird, and especially the mobile crisis service CAHOOTS, as a highly valuable blueprint for the kind of street-level, community-based assistance that helps those on the streets suffering chronic mental issues. “What they do is off-the-charts amazing,” Smith says of White Bird, and Regan says that, given more support for agencies like this, “we would have a better track record of getting those folks stable.”

Brubaker at White Bird challenges the label of “mental illness” — it’s “one of those rough tools we use,” he says — and notes that a big step in helping such individuals is engaging them with openness and empathy instead of pity and sympathy.

“I think helping people to feel like human beings and part of a community is central to helping them be members of society again,” Brubaker explains. “We meet people where they’re at and we treat them like a human being. We believe every individual already has solutions inside themselves. They simply need the support and encouragement to find the solutions.”

Brubaker says that getting indigent people undergoing psychological difficulties into some form of stable environment is of paramount importance — not, he adds, into temporary housing but into a situation that provides a sense of permanence and belonging. It’s a matter of empowerment, Brubaker explains. “Housing first, in general, seems to be the general direction we need to go in,” he says.