Left out in the cold

From The Oregonian, February 23, 2003 – no longer online

Someone broke into his car again.

He might lose his job any day.

And his first client of the day — a severely mentally ill woman two hours away from being evicted — is wailing through Michael Sloan’s speaker phone.

“What am I supposed to do?” she pleads.

Sloan, a 32-year-old “housing specialist” for Cascadia Behavioral Healthcare, the largest publicly funded provider of mental health services to low-income Multnomah County residents, has spent the past year being a bridge between policy-makers and the mentally ill.

But now, as dozens of his clients face the consequences of crippling budget cuts and he the prospect of unemployment, Sloan has found that being a bridge can break your back.

“We’ve got lives in our hands,” he says on a recent Monday marked by a procession of frantic clients and phone calls to his Southeast Portland office. “And I’m scared.”

Falling tax revenue has squeezed $140 million out of the Department of Human Services budget since the last legislative session.

Mental health agencies across the state have laid off hundreds of workers and helped prepare thousands of clients for the fact they are no longer eligible for the services they need to survive outside of psychiatric hospitals.

Most of the state’s 71,000 community mental health clients have been touched by the cuts. The impacts range from losing their antipsychotic medications to being evicted from group homes. Almost 15,000 have been cut from treatment altogether, and come March 1, 100,000 other low-income Oregonians will become ineligible for mental health services should they need them.

Sloan took this job to be a protector of the mentally ill. Now he faces daily what Salem budget crunchers have mostly been spared: the human face of line item reductions.

In less than two hours, the woman on the speaker phone will be on the street because the state program that would have helped pay her rent ended last month.

“What am I supposed to do?” she asks again.

Sloan has lost count of how many times he’s heard those words in recent weeks. Sometimes he’s tempted to sugar coat. To reassure his clients that somehow, some way, things will work out.

This morning, he can’t bring himself to lie.

“I honestly don’t know what’s going to happen to you,” he says. “I’m really sorry.”

From bad to worse

“How’s your resume?” a therapist jokes dryly when Sloan walks into the building a few days later.

Subtract the gallows humor of his colleagues, and Sloan’s office is a cocktail of anxiety and despair.

His agency laid off 118 workers in October in anticipation of the state revenue shortfall. Those who survived the cuts made congratulations cards for each other.

Spangled with glitter and colored feathers, Sloan’s card is tacked to the wall above his desk, but he isn’t reveling in his good luck.

“It looks like we might lose 50 percent of the remaining staff,” his supervisor, Cathy Kuehnl, announces before Sloan can pour hot water for his English breakfast tea. “I’m supposed to be on the speaker phone today to advocate for our program to people who don’t understand it.”

Last year, the cost of a night in a local psychiatric bed increased from $430 to $700. County administrators cut clinics, nurses, housing and outreach workers to make up the difference.

Things only got worse when, without those supports, many people with mental illness deteriorated to the point where they had to be hospitalized, rapidly digging the system deeper into debt.

Instead of continuing to pour resources into psychiatric beds, reformers wanted to get ahead of the money rather than always chasing it. Research shows that with good support systems, fewer people would have to be hospitalized in the first place.

So the county reduced funding for psychiatric wards and stuck the money back into preventive care. Some of those dollars created Sloan’s position on the housing outreach team in January 2002.

Studies show that stable housing makes the mentally ill as much as 50 percent less reliant on the public mental health system. So Sloan and his 13 housing co-workers do everything from splashing Pine-Sol around squalid apartments and schmoozing impatient landlords to signing emergency housing vouchers for the mentally ill to stay in cheap hotels — all on the statistical promise it will save public resources down the line.

It worked. Agency statistics show that psychiatric hospitalizations in Multnomah County have declined steadily during the past six months, from 1,054 in June to 562 in December.

For Sloan and his front-line colleagues, the threat of losing the jobs they have done so effectively feels like a betrayal. As Kuehnl promises to do all she can to persuade top agency administrators to leave the housing team intact, a co-worker pounds his fist on his desk.

“Make sure you adamantly talk about the fact that we are very instrumental in getting these people out of these hospitals,” Jim McNamara tells Kuehnl. “If we’re gone, the hospitalization rate is going up.”

Many mental health workers have inhaled the invective of psychotic or delusional clients who believe that the workers themselves, as part of a vast conspiracy, ordered the cuts that are messing up their lives. Other clients are too ill to realize what’s happened.

For Sloan, a worse predicament is not having the resources to help the clients who want it.

“If I get laid off, I still have to work through the 28th because I have some clients I’m close to getting in housing,” Sloan tells Kuehnl, his voice rising. “Tell them I need to stay until the 28th.”

A difficult road

Two giant, smelly bags of cat food rest on the floor next to Sloan’s desk, waiting for a client who recently lost her public benefits and can no longer afford to feed the three cats that are her only family.

Sloan likes to say he’s compassionate because he knows what it means to need help.

In the fall of 2001, a 16-year-old boy fresh out of driving school ran a stop sign and slammed his car into Sloan’s 6-foot-5 body, shattering his left knee.

After surgery, Sloan couldn’t move, let alone work. He lost his job at an adult foster-care home for men with traumatic brain injuries. He had to sell his bicycle to buy groceries. He would have lost his apartment without his parents’ help.

Sloan, a chatty bachelor whose apartment is convenient to cheap Thai food and $3 movies, spotted his current job in the classifieds just as his credit card was screaming toward its $400 limit.

An insurance settlement from the accident helped Sloan, who still limps, scrape together enough to buy a 1991 Honda Civic wagon for $1,500 so he’d have a way to meet clients too paranoid to venture outside their apartments. But his paycheck never rewarded his altruism. Housing workers such as Sloan make $22,000 to $28,000 a year. Most months, he barely makes his own $525 rent.

Sloan had hoped to use the rest of the settlement for a down payment on a house, anticipating that if he stays in social work, a profession he loves, it might be his best chance at home ownership.

“This is a great time to buy a house!” Sloan says as he drives to his office one morning, mimicking the real estate agent who had waltzed him through a two-bedroom fixer-upper that weekend, a day before agency administrators sent out a memo warning of the impending layoffs.

The thought of having to use his settlement to merely “survive” pulls his nerves as taut as e-strings.

Sloan, who struggles to pay the interest on student loans for a psychology degree he didn’t quite finish, tries to put it in perspective. He need look no further than his dashboard, where wires jut from a hole that used to hold his stereo.

His car has been broken into three times in the past few months, twice on the street outside his office.

“It’s a very dark time,” he says. “You’re seeing the fallout from people getting cut from services. People are desperate. That wasn’t a very nice car stereo I had.”

Hoping for a chance to help

Donna Madden, a 46-year-old Portland woman who suffers from schizophrenia, hobbles into Sloan’s office with her walker. A heavy gold motel key dangles from a string around her neck.

Sloan has used a dwindling supply of emergency hotel vouchers to put Madden up at the Holiday Motel on Martin Luther King Jr. Boulevard until he can help her get an apartment.

Madden has struggled with mental illness since adolescence. But recent knee surgery has made it impossible for her to function without help.

Madden and her son, a high school senior, camped in her daughter’s public housing living room. She says they became homeless when the apartment manager told them they could no longer stay there because their names weren’t on the lease.

Today, Sloan will help Madden fill out a 23-page application for rental assistance that could allow her to move from the motel, where her days are numbered, to her own apartment.

Much rides on the application, because when things go wrong, Madden’s internal voices urge her to kill herself.

Some of Sloan’s most fortunate clients receive just over $500 a month in Supplemental Security Income, or SSI. That leaves even the most modest dwellings beyond reach.

Because the application process for SSI can take as long as three years, many of Sloan’s clients relied on Oregon’s General Assistance Program for disabled and low-income people who are unable to work.

The benefit was only $314 a month, yet it allowed Sloan to use housing programs that require tenants to pay only a percentage of their income.

But a percentage of nothing is nothing. So when voters rejected a temporary state income tax increase last month and lawmakers cut the program, dozens of Sloan’s clients became almost impossible to house.

Those who had housing but lost their income are now starting to be evicted. Several call Sloan crying each day.

Sloan, however, has hope for Madden. She receives $537 a month in SSI — a federal program that’s not vulnerable to Oregon’s budget woes.

“I think I’m going to be able to help her,” he says. “And I’ll feel really great about that. She could be my last success story.”

Layoffs and closures

On Wednesday morning, Sloan doesn’t bother to shower or shave before he goes to pick up his envelope, the one that will tell him whether he still has a job.

He’s been awake most of the night battling insomnia and cleaning his apartment, something he usually does only as a diversion from other unpleasant tasks.

A few days earlier, Sloan and his fellow housing workers were unnerved when told their office building would close, and they should move their client files and office supplies to a downtown site. They were also urged to keep their personal belongings separate.

By the end of this day, Feb. 19, Cascadia will have laid off 180 of its 1,041 employees and announced the closure of 10 sites — mostly clinics — by mid-March. These cutbacks alone will leave about 2,500 people each month without outpatient mental health care in the Portland area.

Sloan feels nauseated when he sees the sullen expressions on his co-workers’ faces as they clutch their letters. But to Sloan’s surprise, he’s been spared. His letter says he will now work at one of Cascadia’s housing complexes that also managed to survive the cut.

His relief is short-lived.

Sloan also learns that he can’t help Madden because the rental assistance program has run out of money.

Even with the $300 a month her teenage son earns working weekends at Popeye’s Famous Fried Chicken, she won’t be able to afford an apartment.

Sloan will worry the rest of the day — not only about whether mother and son will bed down on a curb tonight, but whether the voices in her head will overwhelm.