Men­tally ill face strug­gle to find sta­ble hous­ing

THOUSANDS IN VA. CAUGHT IN ‘VI­CIOUS CY­CLE’

Richmond Times-Dispatch Weekend - - FRONT PAGE - BY KATIE O’CON­NOR

The clear­ing be­side the Wal­mart off For­est Hill Av­enue where Mike Voyter­shark lived for four weeks was nearly sur­rounded by a dense wilder­ness and filled with the sweet, del­i­cate per­fume of wis­te­ria flow­ers.

The pur­ple flow­ers, bloom­ing thickly on tow­er­ing trees, made the place feel beau­ti­ful and re­moved from the busy park­ing lot to its east. Maybe that was why Voyter­shark, a 33-year-old man liv­ing with schizoaf­fec­tive disor­der, chose to call the place home.

But re­ally, Voyter­shark had lit­tle choice in the mat­ter.

Be­fore he lived in a blue tent planted pur­pose­fully in the mid­dle of that clear­ing in April, Voyter­shark had been evicted from Jones & Jones As­sisted Liv­ing on For­est Hill Av­enue, where he’d lived since early 2017.

Not long af­ter he wound up in the clear­ing, Voyter­shark spent the month of May in jail. While in Goochland County for a hear­ing in late April, a judge noted his poor con­di­tion and de­cided it was bet­ter to send him to jail to be eval­u­ated for men­tal health pro­grams than to re­turn to that tent where he was with­er­ing away.

Now, he’s one of thousands of Vir­ginia res­i­dents with a se­ri­ous men­tal ill­ness cy­cling aim­lessly be­tween home­less­ness, un­sta­ble hous­ing and jail.

“It’s this vi­cious cy­cle be­cause we don’t have the suf­fi­cient re­sources,” said Rhonda Thissen, ex­ec­u­tive di­rec­tor of Na­tional Al­liance on Men­tal Ill­ness Vir­ginia. “They’re show­ing up all over the place in sys­tems not re­ally de­signed for them.”

For decades, stake­hold­ers — from men­tal health ad­vo­cates to politi­cians — have agreed that liv­ing in a com­mu­nity set­ting is ideal for peo­ple with se­ri­ous men­tal ill­ness.

Yet Vir­ginia has not pro­vided enough fund­ing to those com­mu­nity ser­vices to pre­vent peo­ple like Voyter­shark from fall­ing through the cracks.

“In Vir­ginia, we are still cre­at­ing our ca­pac­ity to pro­vide the best ev­i­dence­based so­lu­tion for hous­ing for in­di­vid­u­als like Mr. Voyter­shark,” said Dr. Hughes Melton, newly ap­pointed com­mis­sioner of the Depart­ment of Be­hav­ioral Health and De­vel­op­men­tal Ser­vices.

Ac­cord­ing to DBHDS, more than 5,000 peo­ple in the state are un­sta­bly housed.

For some of those peo­ple, lack­ing a safe place to call home means in­ter­mit­tent care at best. But most likely, it means months or years with­out ad­e­quate men­tal health treat­ment, and the ram­i­fi­ca­tions can be far-reach­ing. The con­sen­sus among ad­vo­cates and clin­i­cians and politi­cians is the same: With­out a safe, sta­ble place to live, the like­li­hood that some­one with a men­tal ill­ness will be able to main­tain their health and well-be­ing is nearly nonex­is­tent.

“The real prob­lem is that we do not, as a so­ci­ety, as a state, pro­vide ad­e­quate com­mu­nity-based men­tal health ser­vices to the peo­ple who need them most,” said Anna Men­dez, ex­ec­u­tive di­rec­tor of Char­lottesville-based Part­ner for Men­tal Health. “And when we don’t do that, peo­ple with se­ri­ous men­tal ill­ness end up be­ing evicted from as­sisted liv­ing fa­cil­i­ties.”

Voyter­shark’s prob­lems aren’t unique. Ear­lier this year, an­other as­sisted liv­ing fa­cil­ity res­i­dent, Ger­ald Dix­son, was sent to a ho­tel af­ter his for­mer res­i­dence, St. Fran­cis Home, spent months un­suc­cess­fully look­ing for a new home for him.

Ac­cord­ing to Depart­ment of So­cial Ser­vices emails ac­quired through a Free­dom of In­for­ma­tion Act re­quest, Dix­son re­fused to bathe or take his med­i­ca­tion, both of which are re­quire­ments for res­i­dents at St. Fran­cis, a non­profit Catholic or­ga­ni­za­tion.

The fa­cil­ity sought as­sis­tance from DSS, Adult Pro­tec­tive Ser­vices and the lo­cal long-term care om­buds­man pro­gram, mak­ing it clear that the only op­tion seemed to be send­ing Dix­son to a ho­tel. But none of those agen­cies had an­other so­lu­tion.

So even­tu­ally Dix­son was dis­charged to a ho­tel. His room was pre­paid for a week, and his fu­ture was un­cer­tain.

“What kind of an op­tion is that?” Thissen said af­ter hear­ing Dix­son’s story. “That is not a long-term hous­ing so­lu­tion.”

The state is aware of these chronic hous­ing prob­lems. They’ve per­sisted for more than 50 years, largely since de­in­sti­tu­tion­al­iza­tion, when psy­chi­atric fa­cil­i­ties that iso­lated pa­tients were shut down. The pa­tients were sup­posed to be placed with com­mu­nity-based ser­vices in­stead.

But that never hap­pened. And even though the state has made some ef­forts to ad­dress the is­sues, peo­ple with men­tal and be­hav­ioral is­sues still wind up in ho­tels, tents and jail cells.

Af­ter Jones & Jones kicked him out, Voyter­shark stuffed his things into a back­pack and moved less than a mile away.

His health quickly de­te­ri­o­rated. He de­vel­oped a cough and lost weight, and his de­meanor grew in­creas­ingly sullen.

While tak­ing his med­i­ca­tion, he was talk­a­tive, friendly and an­i­mated, ea­ger to share his opin­ions. But af­ter a few weeks in the clear­ing, a dull­ness de­vel­oped around the edges of his per­son­al­ity.

When he was evicted, Voyter­shark re­ceived a let­ter from Jones & Jones that out­lined about 15 al­le­ga­tions against him. Voyter­shark ar­gues most aren’t true — like the claim that he punched a hole through a wall. He ad­mit­ted to the charge of smok­ing in his room.

When asked about Voyter­shark’s sit­u­a­tion, DSS said Jones & Jones com­plied with the state reg­u­la­tions in his dis­charge. The state’s rules say fa­cil­i­ties must help res­i­dents find a new place to live.

For about a year be­fore mov­ing to

Jones & Jones, he lived at the now-closed Park­wood, an as­sisted liv­ing fa­cil­ity in Cary­town that drew the ire of its neigh­bors for some of the same rea­sons Jones & Jones has — its res­i­dents wan­dered around the area, some­times pan­han­dling, and it also dealt with a bed bug prob­lem, Voyter­shark said.

“That place was hor­ri­ble,” he said. Then, he was so an­gry about the con­di­tions at Jones & Jones — whose for­mer ad­min­is­tra­tor is cur­rently be­ing in­ves­ti­gated by the U.S. So­cial Se­cu­rity Ad­min­is­tra­tion, the Com­mon­wealth’s At­tor­ney and the Rich­mond Po­lice Depart­ment un­der ac­cu­sa­tions that she stole from res­i­dents’ So­cial Se­cu­rity ac­counts and failed to pro­vide ad­e­quate care — that he said he didn’t want to move to an­other as­sisted liv­ing fa­cil­ity even if a spot could be found for him.

“I don’t even know if I’d rather go to a place or ... sleep in the woods at this point,” he said dur­ing an in­ter­view in April the day af­ter he was evicted, and be­fore his health de­clined, he went to jail and his fu­ture be­came even more un­cer­tain.

“As long as I have food and a place to sleep, I’ll be fine.”

The best op­tion

Men­tal health ex­perts say one of the most ef­fec­tive ways to ad­dress chronic hous­ing in­sta­bil­ity for those with dis­abling men­tal ill­nesses is a model known as per­ma­nent sup­port­ive hous­ing.

It in­volves as­sist­ing some­one in iden­ti­fy­ing a safe, sta­ble place to live, help­ing pay the rent and sur­round­ing the per­son with the sup­port — such as so­cial in­clu­sion and men­tal health treat­ment — they need to thrive.

“We can put the best treat­ment in­ter­ven­tions on the ground, and they’re go­ing to be ren­dered in­ef­fec­tive if we don’t also ad­dress [their hous­ing sta­bil­ity],” said Kristin Ya­vorsky, home­less projects co­or­di­na­tor with DBHDS.

Thissen said some­one like Voyter­shark, who was able to live on his own in a tent for a month, would be ideal for a per­ma­nent sup­port­ive hous­ing sit­u­a­tion. He could live in a place he chooses, giv­ing him some au­ton­omy over his sit­u­a­tion, while be­ing sur­rounded by the sup­ports he needs to take his med­i­ca­tion reg­u­larly and maybe even even­tu­ally find a job.

“Peo­ple can’t think about higher level needs un­til their safety and se­cu­rity needs are met,” she said.

The per­ma­nent sup­port­ive hous­ing model rep­re­sents the com­mu­nity-based care that the state has been try­ing to achieve since de­in­sti­tu­tion­al­iza­tion.

“You want to give them some choices and you want to pro­vide for them in the least re­stric­tive set­tings,” said state Sen. Creigh Deeds, D-Bath, who has cham­pi­oned men­tal health is­sues since the death of his son, Gus, who at­tacked the se­na­tor then killed him­self in 2013 af­ter be­ing turned away from a psy­chi­atric hos­pi­tal be­cause no beds could be found.

But a glar­ing prob­lem re­mains: money.

Melton said law­mak­ers don’t re­al­ize the cost-sav­ing as­pects of spend­ing on the model up­front — such as sav­ings in the crim­i­nal jus­tice sys­tem and through hos­pi­tal ad­mis­sions — so the fund­ing isn’t there.

Since 2015, Vir­ginia has put $9.27 mil­lion to­ward per­ma­nent sup­port­ive hous­ing, equat­ing to 700 house­holds. The bud­get that re­cently passed the Gen­eral Assem­bly and was signed by Gov. Ralph Northam in­cludes about $7 mil­lion more in fund­ing.

Ac­cord­ing to DBHDS, 93 per­cent of the in­di­vid­u­als the state has placed into per­ma­nent sup­port­ive hous­ing are still sta­bly housed.

Yet there are still more than 5,000 peo­ple like Voyter­shark who are shuf­fling be­tween as­sisted liv­ing fa­cil­i­ties ille­quipped to pro­vide them the sup­port they need, jail, or a blue tent be­side the Wal­mart off For­est Hill Av­enue.

“We’re just so back­wards and as long as ... we don’t have real sup­port­ive hous­ing with wrap­around ser­vices, then peo­ple are go­ing to end up liv­ing in as­sisted liv­ing fa­cil­i­ties, peo­ple are go­ing to keep be­ing evicted from as­sisted liv­ing fa­cil­i­ties, and peo­ple are go­ing to end up be­ing home­less,” said Men­dez, with Part­ner for Men­tal Health.

“And peo­ple do get ar­rested when they’re home­less, be­cause when you’re home­less you have to do things you wouldn’t do oth­er­wise. And then we won­der why there are all these peo­ple ex­pe­ri­enc­ing men­tal ill­ness in jail.”

En­tan­gled with the law

In­side the Goochland County Cir­cuit Court­house on a re­cent Thurs­day, ev­ery­thing — the benches, floors and doors in the his­toric build­ing — creaked.

The sounds were punc­tu­ated by the soft jin­gle of chains around Voyter­shark’s hands and feet, as he raised his head pe­ri­od­i­cally be­fore slump­ing down again on the bench.

Voyter­shark ended up in jail last month in part be­cause he had sev­eral mis­de­meanor charges pend­ing against him. But it was also be­cause the judge who saw him at the end of April could tell Voyter­shark was un­well, and knew he would just re­turn to the tent af­ter court was over.

The hear­ing on May 31 rep­re­sented the cul­mi­na­tion of about 2½ years of go­ing back and forth with Goochland Cir­cuit Court, a pe­riod marked with Voyter­shark not show­ing up for his hear­ings and fu­eled by his con­stant de­sire for al­co­hol.

He faced charges for fail­ing to ap­pear be­fore the court and for fail­ing to com­plete a Vir­ginia Al­co­hol Safety Ac­tion Pro­gram. It stemmed from a driv­ing while im­paired charge he re­ceived in Novem­ber 2015 while liv­ing with his dad in Goochland. Peter Voyter­shark said his son was driv­ing a small dirt bike on the road at the time.

Af­ter that charge, the court sen­tenced him to 90 days in jail but sus­pended the sen­tence on the terms that he would com­plete the al­co­hol safety pro­gram. But that never hap­pened — the first time he showed up, his eval­u­a­tor deter­mined that, “due to his men­tal health is­sues, he was un­able to an­swer many of the ques­tions,” ac­cord­ing to court records, and his case was re­turned to court as in­ap­pro­pri­ate for ser­vices.

Then in March 2017 — af­ter he didn’t ap­pear for an­other hear­ing — Voyter­shark was or­dered to re-en­roll in the pro­gram. But when he at­tended his first group meet­ing, he tested pos­i­tive for al­co­hol. He ad­mit­ted to hav­ing a beer the night be­fore. His court records noted that Voyter­shark said, “it might be hard for him to stop drink­ing be­cause he loves to drink.” Af­ter that, he was dis­charged from ser­vices again.

It is not un­usual, notes the Sub­stance Abuse and Men­tal Health Ser­vices Ad­min­is­tra­tion’s web­site, for some­one with a men­tal ill­ness to also grap­ple with ad­dic­tion. Ac­cord­ing to the ad­min­is­tra­tion’s 2014 sur­vey, 7.9 mil­lion adults had both men­tal health and sub­stance use dis­or­ders.

So next time he was in court on April

27, Voyter­shark was kept in cus­tody with­out bail so he could be eval­u­ated for men­tal health and sub­stance abuse coun­sel­ing, his record states.

In court on that Thurs­day at the end of May, Voyter­shark had gone more than two months with­out his med­i­ca­tion. He barely moved, sim­ply star­ing at the ground be­tween his shack­led feet.

When he was called to stand be­fore the judge, his at­tor­ney, Keith Wal­drop, told Judge John R. Cullen that Voyter­shark had schizoaf­fec­tive disor­der and had been locked up for the past 34 days.

Cullen sus­pended 60 days of Voyter­shark’s orig­i­nal 90-day sen­tence, and marked the last 30 days as al­ready served. He also re­moved the re­quire­ment that Voyter­shark com­plete the al­co­hol safety pro­gram, since it ev­i­dently wouldn’t im­prove his sit­u­a­tion.

He re­leased Voyter­shark into the cus­tody of his father, Peter Voyter­shark, who would later that day pick Voyter­shark up from jail in Hen­rico County.

The day was marked with re­lief for Voyter­shark and his fam­ily, but it left a daunt­ing ques­tion: What would hap­pen to some­one in the same sit­u­a­tion who didn’t have a father or mother or a friend to rely on?

Many ad­vo­cates agree that, though it is not con­sid­ered a com­mu­nity-based set­ting, some as­sisted liv­ing fa­cil­i­ties can be good op­tions for peo­ple with men­tal ill­ness.

At St. Fran­cis Home in Rich­mond’s South Side, res­i­dents play karaoke, com­plete puzzles and walk around its neatly trimmed court­yard.

But at other fa­cil­i­ties, like Jones & Jones, res­i­dents linger for hours dur­ing the day with­out any ac­tiv­i­ties and wan­der around the busy in­ter­sec­tion nearby pan­han­dling for money or food. A cou­ple have been hit by cars and killed.

“Some as­sisted liv­ing fa­cil­i­ties, maybe many, are not places where I would ever feel com­fort­able hav­ing one of my loved ones live,” said Men­dez, with Part­ner for Men­tal Health.

DBHDS iden­ti­fied 824 peo­ple in the state who are liv­ing in as­sisted liv­ing fa­cil­i­ties but ac­tu­ally need to be in per­ma­nent sup­port­ive hous­ing.

Ya­vorsky said those peo­ple of­ten don’t need the care that a typ­i­cal as­sisted liv­ing res­i­dent re­quires — like help with eat­ing or bathing — but rather need help with house­keep­ing or med­i­ca­tion man­age­ment.

“We know that what peo­ple with se­ri­ous men­tal ill­ness need to live suc­cess­ful, self-di­rected lives in the com­mu­nity, are things like mean­ing­ful so­cial sup­port, mean­ing­ful op­por­tu­ni­ties for com­mu­nity in­clu­sion ... im­me­di­ate ac­cess to cri­sis in­ter­ven­tion,” Men­dez said. “None of those things are ser­vices that as­sisted liv­ing fa­cil­i­ties are ca­pa­ble of pro­vid­ing.”

Vir­ginia’s aux­il­iary grant pro­gram is meant to make as­sisted liv­ing af­ford­able for those with low in­comes who rely on Sup­ple­men­tal Se­cu­rity In­come, like Voyter­shark.

In fis­cal 2017, about 65 per­cent of those in the state’s aux­il­iary grant pro­gram were in as­sisted liv­ing due to a dis­abil­ity, in­clud­ing dis­abling men­tal ill­ness, ac­cord­ing to the Depart­ment for Ag­ing and Re­ha­bil­i­ta­tive Ser­vices, which runs the pro­gram.

But even though they’re of­ten car­ing for the most vul­ner­a­ble pa­tients with men­tal ill­ness, no­body — in­clud­ing as­sisted liv­ing fa­cil­i­ties — can force a res­i­dent to com­ply with the rules or par­tic­i­pate in treat­ment.

“Their hands are com­pletely tied,” Men­dez said. “The ad­min­is­tra­tor is re­spon­si­ble for the health, wel­fare and safety of all their res­i­dents. If, at the end of the day, they can’t con­vince the res­i­dent who is hav­ing a cri­sis to seek help and re­ally en­gage in treat­ment, their only re­course is evic­tion, no mat­ter how much they’re try­ing to do a com­mu­nity ser­vice and no mat­ter how big their hearts are.”

St. Fran­cis pri­mar­ily serves older men and women of lim­ited fi­nan­cial means, ac­cord­ing to its web­site. Com­pared to most as­sisted liv­ing fa­cil­i­ties that ac­cept aux­il­iary grants, St. Fran­cis has sev­eral more rules for ad­mis­sion. Res­i­dents must be 55 years and older, they can­not ex­hibit ag­gres­sive be­hav­ior, and they must take their psy­chotropic med­i­ca­tions.

Dix­son, the man who was dis­charged to a ho­tel from St. Fran­cis, re­fused to bathe or take his med­i­ca­tion.

Jeff McIn­nis, St. Fran­cis’ ad­min­is­tra­tor, said the fa­cil­ity worked for six months to rem­edy Dix­son’s sit­u­a­tion. They in­formed him that he would have to leave if he re­fused to bathe or take his med­i­ca­tion. And even­tu­ally they gave him his 30 days no­tice and started the process of find­ing him a new home.

But find­ing a new home was an­other bar­rier to be over­come. Emails be­tween McIn­nis and Depart­ment of So­cial Ser­vices of­fi­cials show he tried call­ing other fa­cil­i­ties nearby that had beds, but none wanted to take Dix­son.

So even­tu­ally the only op­tion was to dis­charge Dix­son to a ho­tel, which hap­pened on March 20. Dix­son was adamant he didn’t want to leave St. Fran­cis, though, and re­fused to leave the car at the ho­tel. Even­tu­ally, the po­lice had to be called.

McIn­nis stressed that Dix­son was al­ways found to be com­pe­tent and aware of the reper­cus­sions of his ac­tions. St. Fran­cis couldn’t force him into com­pli­ance with the rules.

It’s not clear where Dix­son is now, and he could not be reached for this story. McIn­nis said he was told an­other fa­cil­ity was found for him, but he couldn’t say whether Dix­son ac­tu­ally went.

Tara Ragland, di­rec­tor of adult li­cens­ing with DSS, was un­avail­able for an in­ter­view in the weeks be­fore this story was pub­lished. A spokes­woman for the depart­ment, though, stated that DSS is un­able to com­ment on the specifics of in­di­vid­ual res­i­dents’ cases — in­clud­ing Dix­son’s and Voyter­shark’s.

State code re­quires that an as­sisted liv­ing fa­cil­ity give res­i­dents 30 days no­tice of dis­charge, and the fa­cil­ity should as­sist the res­i­dent in find­ing a new home. In the state’s view, a week in a ho­tel met that re­quire­ment.

“Based on the As­sisted Li­cens­ing Pro­gram Di­vi­sion’s review of this in­ci­dent, the as­sisted liv­ing fa­cil­ity demon­strated com­pli­ance with all ap­pro­pri­ate pro­ce­dures,” the DSS spokes­woman said in an email.

“The real prob­lem is that we do not, as a so­ci­ety, as a state, pro­vide ad­e­quate com­mu­ni­ty­based men­tal health ser­vices to the peo­ple who need them most,” Anna Men­dez, ex­ec­u­tive di­rec­tor of Part­ner for Men­tal Health

A new home

Voyter­shark left jail on May 31 — and he also left Rich­mond be­hind.

Shortly be­fore the hear­ing, his dad found out Voyter­shark would prob­a­bly be re­leased, so he, along with Voyter­shark’s mother and sis­ter, be­gan the dif­fi­cult job of find­ing an apart­ment for him.

Like many who live with a dis­abil­ity, Voyter­shark’s in­come is lim­ited to just over $700 a month from the U.S. So­cial Se­cu­rity Ad­min­is­tra­tion.

The cheap­est rent his father, Peter Voyter­shark, could find is in Hayes, in east­ern Vir­ginia, which at least means Voyter­shark will be close to him. But it still costs more than $500 a month, more than 70 per­cent of Voyter­shark’s in­come.

A per­ma­nent sup­port­ive hous­ing model would guar­an­tee the res­i­dent pays only 30 per­cent of his or her in­come on rent.

But still, Peter Voyter­shark is hop­ing that since Mike Voyter­shark will be close by, he can help his son stay on track. The as­sisted liv­ing fa­cil­ity didn’t work, the tent cer­tainly didn’t work — maybe this will.

Af­ter Thurs­day’s hear­ing, Peter Voyter­shark waited out­side the court­house. The lawyer was ar­riv­ing to bring him Mike Voyter­shark’s back­pack, which he had with him when he was de­tained af­ter his April hear­ing.

“That’s his life in there,” Peter Voyter­shark said.

He re­flected on his son’s sit­u­a­tion, men­tion­ing that pri­vate men­tal health treat­ment is of­ten too ex­pen­sive. Most can­not af­ford it.

In an in­ter­view last week, Deeds said that, although the re­cently passed bud­get in­cludes sub­stan­tial new fund­ing for men­tal health ser­vices, it will not be enough.

More than 44 mil­lion Amer­i­cans live with men­tal ill­ness. Ev­ery day, par­ents like Peter Voyter­shark won­der if their chil­dren will find a sta­ble place to call home by re­ly­ing on $700 in So­cial Se­cu­rity funds — es­sen­tially con­demn­ing them to a life of poverty in ex­change for the treat­ment they need to live their lives.

“You have to al­ways look at what you’ve done and try to see if there’s a bet­ter way to do it,” Deeds said. “It will never be enough.”

JOE MAHONEY/TIMES-DIS­PATCH

Mike Voyter­shark was evicted

from an as­sisted liv­ing

fa­cil­ity and moved into a blue tent in a clear­ing near the Wal­mart off For­est Hill

Av­enue.

JOE MAHONEY/TIMES-DIS­PATCH

Mike Voyter­shark lived for about a month in a tent, where his health de­te­ri­o­rated.

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