No housing, no recovery

By Robert Landauer – editorial columnist for The Oregonian, part of the series – “Rescuing the mentally ill,” March 20, 2000. Not available elsewhere online.

The dedication of Nadine Place and Rita Mae Manor brought Independence Day from July to January for a small group of Multnomah County residents.

The new residential care facilities in Southeast Portland enabled 15 severely mentally ill persons to step down from more intensive levels of care, called lockdowns. But barriers down the line produce a relentless traffic jam.

For at least two years lack of bed space has plagued operations at the Oregon State Hospital in Portland.

About 30 patients have been identified as eligible for treatment at the highly secure extended-care center. There is no room, so these seriously ill patients are on a waiting list.

At the same time, roughly 40 patients have benefited as much as is likely from hospitalization. They are ready to move on, perhaps to secure, but less restrictive, facilities like Faulkner Place at 13317 SE Powell Blvd. There, aided by medications, life-skills training and intensive individual and group therapy, many residents eventually graduate to community-based, small-group, structured living arrangements.

But the secure step-down programs are full, too. So the State Hospital was able to release only about a dozen patients a month until . . .

The beds at Nadine Place and Rita Mae are speeding the traffic flow, at least for now, allowing the State Hospital to increase its releases to 20 patients a month in January and February.

But the new treatment homes don’t meet every patient’s needs.

Amy (name changed) came to Faulkner Place from the Oregon State Hospital in August 1995. She has a thought disorder, schizophrenia. She feared that others were plotting to injure her. She sidestepped meaningful human contact. She cheated over whether she had taken medications. Delusions of grandeur led her to believe that she held medical degrees and was a staff member of the State Hospital where she had been treated.

She was not aware of her severe illness. If she did not take her medications, it was clear she could put herself in harm’s way in the community.

By the fall of 1997, Amy’s progress indicated that she was ready to step down to an unlocked setting. No suitable options could be found.

Now, 2 1/2 years later, Amy continues to improve greatly, but still lives in a lockdown. She is one of a number of patients from various extended care facilities competing for very few bed spaces.

Amy and those waiting to take her place pay a personal price for this traffic jam. The meter runs for taxpayers, too.

Oregon State Hospital care for adults averages $314.70 a day, or $114,865 per year. The federal government pays no portion of the State Hospital tab.

As patients step down to secure facilities like Faulkner Place, costs step down with them — averaging $228.69 a day, or $83,471 a year. Federal programs now chip in $93 a day, lowering Oregon taxpayers’ direct bill to $135 a day, or $49,275 a year.

One more step down, to very intensive residential care facilities like Nadine Place, daily costs plunge again, to $125.98 ($45,982 a year). Here federal programs pick up 60 percent of the cost, so Oregon taxpayers kick in $18,393.

At this point patients’ march toward independence slows or stops as they compete for housing with the working poor, the developmentally disabled and low-income seniors. The federal government picks up no part of step-down treatment at this level, so Oregon taxpayers contribute from $83.25 a day down to $18.54 a day at the lowest level of support.

As many as 14,600 Multnomah County residents suffer from a serious mental illness; 10,469 of them received some state-funded services in fiscal 1998-99; and 7,852 need subsidized rent.

Almost 3,000 need a specialized housing program. But only 772 beds in Multnomah County meet the criteria, says a Housing Working Group of the county’s Adult Behavioral Health Division. Specialized housing programs are all at or above 95 percent occupancy. Wait lists run as long as two to three years.

It is a tough task to provide affordable, permanent, service-enhanced housing to persons with mental illnesses, many of them also with physical illnesses and alcohol/drug addictions.

These county residents are poor as well as sick. Most live on just over $500 a month from Social Security. “Living on a fifth of the median income, they can’t afford market rents when even median-income people can’t afford them,” says Marge Ille, of the Housing Authority of Portland

For the mentally ill on Social Security, $150 to $160 is the ceiling of affordability, based on federal guidelines. There is no clean, safe, decent, market-rate housing at that price here.

Even the $250 a month residents pay at Nadine Place barely covers operating costs for the nonprofit Network Behavioral Health Care Inc. — a bargain for the residents. They have 24-hour supervised housing, treatment, skills training and medications management. They have about half of their Social Security allowance left to apply to food, transportation, clothing, recreation, and non-covered treatment-related costs (special diets, massage, acupuncture). Many will probably step down toward less-costly community support. Some will get paying jobs.

Supported housing is a good deal for the community, too.

What happens when the housing needs of the mentally ill in Multnomah County are not met? “2,170 individuals are left to wander our streets, fill our hospital and jail beds, and to somehow fade from a field of vision so as not to trouble the souls of our general citizenry,” says the Housing Work Group.

Progress requires immense public/nonprofit collaboration. The state, Multnomah County and Portland all have housing specialists who help the mentally ill. Churches and charities pitch in, too. But no one is turning data into intelligence that tells us how best to spend the next housing dollar here:

On adult foster-care housing? On more studio or single-room-occupancy beds? On housing where mental illness and addictions are treated at the same time? Or would it be wisest to reduce social worker caseloads so that landlords don’t withdraw their apartments from the already shallow pool available to the mentally ill?

Briefly, no one is in charge.

We have fragments.

We need coordination, a team.

Lack of housing wastes precious resources.

Providing more housing will save money and restore lives.