Try­ing to make con­nec­tion

Men­tal ill­ness’ link to home­less­ness isn’t quite as it seems, ex­perts say

Los Angeles Times - - CALIFORNIA - By Gale Hol­land

Even as Los An­ge­les starts a $1.2-bil­lion home­less hous­ing con­struc­tion pro­gram, res­i­dents from Tem­ple City to Venice are fight­ing to keep home­less projects out of their neigh­bor­hoods.

But since 1995, chron­i­cally home­less men­tally ill peo­ple — a widely shunned sub­group — have been liv­ing in Santa Mon­ica’s Step Up on Sec­ond apart­ments, a block from the tourist­friendly Third Street Prom­e­nade and close enough to the beach to feel the salt air.

“Look around. It’s here,” Rep. Tim Mur­phy (R-Pa.) said dur­ing a re­cent visit, de­scrib­ing why he sees Step Up’s res­i­den­tial pro­grams as a na­tional model.

Mur­phy, au­thor of a ma­jor 2016 men­tal health over­haul bill, was in Santa Mon­ica to tour three of Step Up’s per­ma­nent sup­port­ive hous­ing build­ings, which of- fer apart­ments and coun­sel­ing, case man­age­ment and sub­stance abuse treat­ment to 267 for­merly home­less peo­ple with men­tal health is­sues.

Dur­ing the visit, The Times in­ter­viewed Step Up Ex­ec­u­tive Direc­tor Tod Lipka, staff mem­bers and

res­i­dents. Den­nis Cul­hane, a Univer­sity of Penn­syl­va­nia pro­fes­sor and home­less­ness re­searcher, and An­drew Sper­ling, leg­isla­tive ad­vo­cacy direc­tor for the Na­tional Al­liance on Men­tal Ill­ness, were in­ter­viewed later.

Be­low are their edited re­sponses to com­mon ques­tions about men­tal ill­ness and home­less­ness:

Are most home­less peo­ple men­tally ill?

A rel­a­tively small per­cent­age of all home­less peo­ple na­tion­wide — 13% to 15% — are men­tally ill, but their symp­toms — para­noia and delu­sions — draw at­ten­tion and mis­lead others into think­ing their num­bers are greater, Cul­hane said.

How­ever, Los An­ge­les’ home­less pop­u­la­tion skews heav­ily to sin­gle adults who have lived in the streets a year or longer — a sub­group with a high in­ci­dence of men­tal health is­sues. Lo­cal au­thor­i­ties es­ti­mate that 30% of the county’s home­less peo­ple have se­ri­ous men­tal ill­ness.

Does chronic home­less­ness cause men­tal ill­ness, or is it the other way around?

Lipka said em­ploy­ees at his agency don’t see peo­ple de­vel­op­ing se­ri­ous men­tal ill­ness by virtue of their home­less­ness. But “I do be­lieve long-term iso­la­tion can lead to men­tal ill­ness,” said Steve Elam, Step Up lead life skills co­or­di­na­tor.

Cul­hane said se­verely men­tally ill peo­ple some­times get treat­ment and aid that pre­vents them from be­com­ing home­less.

How many home­less peo­ple are phys­i­cally or men­tally dis­abled?

Cul­hane said half the coun­try’s home­less peo­ple have a phys­i­cal or men­tal dis­abil­ity, or both.

But they don’t nec­es­sar­ily qual­ify for fed­eral dis­abil­ity pay­ments, which in any case are too low — about $800 a month — to cover rent, util­i­ties and other needs, even with food stamps tacked on, he added.

Wel­fare re­form in 1996 made it dif­fi­cult for peo­ple whose im­pair­ment stems largely from sub­stance abuse dis­or­ders to re­ceive fed­eral dis­abil­ity aid, Cul­hane said.

“In­stead of look­ing at in­di­vid­u­als and their bi­ogra­phies and con­di­tions, the ques­tion is why is the dis­abil­ity sys­tem fail­ing?” Cul­hane said.

Is men­tal ill­ness the re­sult of ge­net­ics and brain chem­istry alone, or does trauma play a role?

“We’re still fig­ur­ing that one out,” Sper­ling said. A strong case has been made for a ge­netic role in schizophre­nia, but phys­i­o­log­i­cal and bi­o­log­i­cal brain devel­op­ment, en­vi­ron­men­tal stres­sors and child­hood trauma are also thought to in­flu­ence men­tal health.

“I grew up in Jor­dan Downs and Watts, I’ve seen a lot and I’ve been through two ri­ots,” said Step Up res­i­dent Mar­vin Duck­worth, 57. “My sense of hope and faith is not that strong.”

How many men­tally ill home­less peo­ple have is­sues with al­co­hol and drug abuse, and does drug ad­dic­tion cause men­tal ill­ness?

About half of the home­less peo­ple with se­vere men­tal ill­ness also have prob­lems with al­co­hol or drugs, Cul­hane said. Lipka put the per­cent­age of his agency’s clients even higher — 60% to 70% — but he and the other ex­perts said drug use does not cause se­vere men­tal ill­ness. Rather, home­less peo­ple with un­treated men­tal ill­ness self-med­i­cate to re­lieve symp­toms, Lipka said.

What is the role of pre­scribed med­i­ca­tion in treat­ing men­tally ill home­less peo­ple? Doesn’t it turn them all into zom­bies?

Med­i­ca­tion re­lieves symp­toms, but it “doesn’t cre­ate pur­pose or pos­i­tive mean­ing in your life, even if you have sta­bi­lized with hous­ing,” Lipka said.

Paula Boutte, Step Up’s Santa Mon­ica pro­gram man­ager, said that side ef­fects af­fect peo­ple dif­fer­ently and that med­i­ca­tions and dosages of­ten have to be ad­justed over time. “If you ex­pe­ri­ence drowsi­ness and can’t get up, it’s not qual­ity of life,” Boutte said.

What about forced med­i­ca­tion or other treat­ment for the most se­verely men­tally ill home­less peo­ple?

For the vast ma­jor­ity of home­less peo­ple, forc­ing them to do any­thing is a mis­take, Lipka said.

Sper­ling said Laura’s Law — which au­tho­rizes court-or­dered men­tal health treat­ment for those with se­ri­ous ill­ness and a re­cent his­tory of re­peated vi­o­lence, crim­i­nal ac­tiv­ity or hos­pi­tal­iza­tions — ad­dresses some cases.

But for the 2% to 3% of home­less peo­ple so symp­to­matic that “noth­ing else works, we may need more op­tions,” Lipka said.

Why do peo­ple who grow up in fos­ter care or state cus­tody end up home­less?

Chil­dren sep­a­rated from their par­ents at an early age of­ten suf­fer anx­i­ety and de­pres­sion, Sper­ling said. Lipka said grow­ing up with­out sta­ble re­la­tion­ships makes it dif­fi­cult to learn life skills.

Af­ter years of liv­ing in group homes, “the only thing I knew how to do was to shave and take a shower,” said Step Up res­i­dent Theo Robin, 45.

Most young adults need help from fam­ily to go out on their own, and home­less youths are no ex­cep­tion. Cal­i­for­nia’s re­cent law ex­tend­ing the cut­off for aid to fos­ter chil­dren from age 18 to 21 has re­duced the group’s home­less rates, Cul­hane said.

Do some home­less peo­ple pre­fer to live that way?

Lipka said the vast ma­jor­ity of the clients his agency works with — 97% — want hous­ing “if the sys­tem we had to get into hous­ing wasn’t so com­pli­cated.” Many have been dis­ap­pointed by past prom­ises that fell through.

“Hous­ing be­comes some­thing not in home­less peo­ple’s realm of pos­si­bil­ity,” Lipka said. “The sys­tem has failed them and then we blame it on them.”

Can men­tally ill home­less peo­ple move on to jobs and live in­de­pen­dently or will they need to be sub­si­dized for­ever?

For the chron­i­cally home­less in their 50s and 60s, sta­bi­liza­tion in sub­si­dized hous­ing is the most re­al­is­tic out­come, Lipka said. “We could see less in­ten­sive, less costly per­ma­nent sup­port­ive hous­ing, but that’s dif­fi­cult,” he said. “It’s ei­ther you’re in it or you’re not.”

Home­less young adults with men­tal health is­sues do move on to school, jobs and, in some cases, in­de­pen­dent liv­ing.

“We have a build­ing for tran­si­tional-age youth leav­ing fos­ter care or state cus­tody. They have shorter ten­ancy, re­unite with fam­ily, take com­puter classes and move out and live on their own,” Lipka said.

Should the pub­lic pay for men­tally ill home­less peo­ple to live near the beach when most peo­ple can’t af­ford to?

Lipka said Santa Mon­ica, which sub­si­dizes Step Up, rec­og­nized that its home­less peo­ple are res­i­dents and that a vi­brant city needs di­ver­sity.

Hous­ing and sup­port ser­vices cost less than we are spend­ing now on po­lice, courts, jails and hos­pi­tals to man­age home­less­ness, Lipka said. “Not to men­tion the nui­sance cost of home­less­ness to a com­mu­nity,” he said.

Chris­tian K. Lee Los An­ge­les Times

REP. TIM MUR­PHY (R-Pa.), left, a men­tal health ad­vo­cate, vis­its Richard LaRush at Step Up on Sec­ond, a Santa Mon­ica pro­gram that of­fers hous­ing and ser­vices to 267 for­merly home­less peo­ple with men­tal ill­ness.

Chris­tian K. Lee Los An­ge­les Times

STEP UP res­i­dent Theo Robin says he once bat­tled drug ad­dic­tion. Al­co­hol and drug use doesn’t cause se­vere men­tal ill­ness, ex­perts say, but home­less peo­ple with un­treated men­tal ill­ness self-med­i­cate to ease symp­toms.

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