Letter to ADAMHS Board for Mental Health Shelter

The Homeless Congress picked as the single most important issue facing our community is that mentally ill people do not have a place to get the care they deserve.  They are placed in one of the two big shelters and cause disturbances and are taken advantage of on an almost daily basis.  NEOCH is not a mental health agency and we do not have trained mental health counselors or psychologists on site.  We are observers and we interact nearly everyday with severely mentally ill people.  None of us can figure out how it benefits the mental health of a person with something wrong with the brain to be placed in a facility with 200 to 400 others.  Does this help the person stabilize?  It just seems like a punishment that will only make their condition worse.

Here is the letter we sent on behalf of the Homeless Congress:

Dear Mr. Denihan

We have a great deal of respect for all you have done in your career even when we were sitting on the opposite side of the table during the White Administration.  We know that the community will miss your ability to manage huge bureaucracies and turn around government agencies struggling.  We are hoping that you will take the lead in finding a better place for severely mentally ill people from having to sleep in the two big shelters in Cleveland.  This is a critical issue especially because we believe that it is extremely damaging to the mental health stability of those struggling to be placed inside a facility with 200-400 people.  The current system is not healthy for those without mental health issues and especially those who are taken advantage of because of their mental illness.  We know that mentally ill people at the two entry shelters are exploited; they have their valuables including medicine stolen on a regular basis, and are abused and even raped in and around the shelters.  We know friends who have repeatedly attempted suicide inside the shelters, and we ask for your help in finding a smaller more caring place.

These vulnerable individuals are afraid of the large crowds.  They are frequently disruptive smearing feces in the bathrooms and cause disturbances in the shelters.  There are regular conflicts that demonstrate the personal care these taxpayers need but cannot find.  They deserve a trained professional staff to help them with their mental health issues.  We would never as a community expect an addicted individual to detox in a shelter with 200 to 400 people.  Why do we expect a mentally ill person to try to stabilize in the chaos of the shelters?  The shelters are unmanageable with all these untreated individuals with a mental illnesses and without personalized care.  The experiment has failed, and we are not building enough Permanent Supportive Housing to keep up with the demand.

A few areas that we will address in a white paper we are preparing on severely mentally ill people in shelter will look at:

  • Current homeless shelter situation has shown that those with severe mental illness are not able to fully integrate into presently available shelters.
  • Those with severe mental illness are unable to receive the health care they need in the current system.
  • Hospitals (ER and in-patient) even St. Vincent’s Psych ER end up admitting these individuals and discharging them shortly after; this results in heightened health care costs, arguably greater instability for the homeless individual (being medicated, then returning to homelessness where consistently continuing medications is unlikely).  Just stabilizing these individuals with medicine and then sending them out to the streets is not helping these individuals or the community.
  • Creating a separate shelter specifically for the severely mentally ill will decrease these problems and increase stability in the lives of severely mentally ill individuals.
  • Separation of shelter programs in other cities have shown its effectiveness; hospitalization rates decrease as a result of specialized shelters.
  • Within these shelters, narrative therapy has shown to be effective; this gives individuals control over their own lives, rather than feeling forced to do anything.
  • “Housing First” plans tend to work well, where attempts for transitional housing are made as soon as soon as an individual is admitted and adequate health care is consistently provided, but we need many more slots for the severely mentally ill.
  • 20-25% of homeless are mentally ill according to many national studies.
  • Rates of criminal behavior, contacts with the criminal justice system, and victimization among homeless adults with severe mental illness are higher than among housed adults with severe mental illness.
  • There are better strategies in other cities that could effectively serve the population.  Cleveland is far behind in providing a quality specialized care for those with a severe mental illness in a smaller setting.  Most of the cities in the United States do a horrible job serving mentally ill people who lose their housing, but there are some bright spots that we could learn from. 

We know that Frontline Services opposes a separate shelter for mentally ill people, and we know that whatever Frontline wants they get.  We understand that they are the largest organization in our Continuum of Care and are granted anything that they want.  We are hoping that with your retirement, you can look at this situation with clear eyes and not through the lens of one misguided organization more interested in a dream world in which a mentally ill person is immediately housed rather than real world we currently reside.  In the Trump/Kasich era, we are going to have mentally ill people who lose their housing and need emergency housing.  These friends are often misunderstood or face discrimination because of their disability which often leaves them without housing.  We need a better system that will provide a soft landing for individuals and then a quick return to housing.  We need a professionally trained staff who have experience in working with behavioral health issues to make this work.  Imagine the fear of being forced into a facility with 400 men or 200 women and having no where else to go.  It is horrible what we are doing to this fragile population in Cleveland.


 Brian Davis

Executive Director

 The ADAMHS Board were willing to listen, but we have not seen action toward creating a caring facility for those with a severe mental illness trapped in our two entry shelters. 

Brian Davis

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Some are Not So Thankful This Holiday

The US Interagency Council on Homeless published a nice profile of a a new book about homelessness on their website.  This is the story of one author's son called "Losing Tim" and goes through the illness that took control of Paul Gionfriddo's son.  It is a nice profile of a mentally ill guy who needed housing from the perspective of his father.    

The Diane Rehm Show on Monday had an interesting show on homelessness.  It was a story of Dr. Robert Okin who studied the horrible mental health system in the United which allows millions over the last 30 years to live on the streets largely ignored and isolated.  Worth listening to on their podcast.

On any given night, more than half a million people in the U.S. are homeless, and up to 50 percent may be suffering from mental illness. One psychiatrist says these people have become invisible to the rest of us, and set out to learn about their lives. He spent two years talking to and photographing men and women living on the streets of San Francisco. What he found were histories of abuse, neglect, and resilience.

I guess capitalism does not reign supreme in the hotel industry.  The Radisson served as the overflow site in New York City which is serving a record number of family homeless paid to house families in the hotel.  Radisson staff were not happy to hear that the hotel was serving homeless families and has rejected any further bookings from the Department of Homeless Services even if they pay more.  The article says that there were no issues, but the hotel is concerned with the stigma associated with offering a place at the inn for homeless families.  Maybe they could open up their parking garage as was done in Bethlehem around 2000 years ago.

Brian Davis

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Behind the Yellow Door Profile

A couple of weeks ago there was an impressive series on the impact of severe mental illness on a family.  Lora wrote up a nice summary of the article and we link to it here.  It dedicates a lot of Washington Post ink to a detailed look at a well adjusted husband's decent into madness. 

A man lives alone behind a yellow door in suburban Maryland. He shuns his wife, refers to his sons as ‘’suns’, ignores phone calls from his father, shuts all the blinds, and never accepts visitors inside. Certainly, one would expect an intervention from the family, friends, neighbors, etc. who have been reaching out to him, but nothing happens. The man has stayed behind the yellow door for two years now and shows no signs of coming out.

Despite his alarming behavior, the man behind the yellow door is relatively healthy and clean. He still tends to the lawn and keeps house. Despite the fact that he shows symptoms of schizoaffective disorder, he cannot be declared dangerous. As a result, he cannot be involuntarily confined to a hospital. He is not desperate or dangerous enough to meet the high standards for involuntary commitment to a mental hospital, and as a result, his family and friends are forced to simply stand by as his erratic behavior worsens. And worsen is exactly what they hope will happen. A psychiatrist recommends that his parents cut him off financially so that he will be forced into desperation, his sister hopes he becomes homeless, and his wife even admits that she hopes he will attempt suicide and fail. In a twisted way, they are only hoping for the best … because unless this man worsens, he may never get better.

Half a century ago, there existed a state of constant fear of psychological diagnoses and mental treatment. Rebellious children, loud-mannered women, immigrants, homeless people, and the like faced incarceration in a psychiatric ward where they were subject to ‘treatments’ of various inhumane natures. Then, a 1975 Supreme Court case changed the system. The ruling established a higher threshold for involuntary commitment to mental institutions and effectively safeguarded the sane from involuntary imprisonment. Now, forty years later, the tables have turned, and instead of worrying about wrongful confinement, people are finding it harder and harder to get into these hospitals in order to seek medical treatment.

That is to say, untreated mentally ill persons are left unaided, homeless, or, in the worst case scenario, left to deteriorate until they reach a breaking point. Today, we hear about large-scale acts of violence in which the perpetrator was reported to have shown signs of mental illness and in which family and friends failed to effectively seek treatment for the shooter. The signs of mental illness were all there, but due to subtle wording of federal legislation, treatment was kept out of reach and violence followed. We no longer fear the witch hunt atmosphere fueled by 20th century psychiatric standards, but instead, we fear for the people who desperately need treatment will be ignored when they could have been helped. We fear the violent psychological breakdowns and imminent suffering that could have been prevented.

Advocates are pressing for a bill to change Maryland involuntary commitment law. They wish to alter the wording of the law so that, to be eligible for involuntary commitment, a person does not have to ‘present’ a danger to himself or others but is only ‘reasonably expected, if not hospitalized, to present’ a danger. [Ohio has stepped forward to pass changes in the involuntary commitment--we will post the changes in a future post.]  Some oppose these changes, arguing that the new language would enable a roundup of the homeless, economically unstable, and the like. We would return to the ‘darker days’ of hospitalization. Would it be worth the risk? Is hospitalization the solution?

As the debate for these legal changes continues, the man behind the yellow door completely cuts off contact with his family. After two years of being a recluse, he leaves the house and is now somewhere on his own. His family loves him and would do anything to help, and for better or for worse, they let him go.

by Lora Zuo

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National Updates on Homelessness

Barb Poppe Stepping down at InterAgency Council

Our friend, Barb Poppe, from Columbus Ohio former shelter director and current US InterAgency Council on Homelessness has announced that she will step down next month.  She is the wife of COHHIO Director, Bill Faith and was the coordinator of funding in Columbus Ohio for years.  The InterAgency Council publishes reports on homelessness and was the first agency to push a housing first strategy.  They also have a really nice newsletter.  Barb put her stamp on the agency by focusing on the rise in family homelessness and beginning to talk about the problem of youth homelessness.  The InterAgency Council is supposed to work with all the federal departments (Social Security, HHS, HUD, Labor and others) that may have cross agency concerns with homeless people.  For example, Social Security not giving out printouts is going to make it difficult for homeless people to get ID which makes it difficult to access entitlements and health care.  The USIAC is looking into the problem that privately funded shelters are having with coordinated intake in Cleveland. 

Surplus Military Property Available in Sandusky

Federal law requires that military surplus property be offered to homeless programs before being sold.  This is rather a dubious law since military bases are rarely in the heart of an urban city where there are large numbers of homeless people.  But it is the law, and NEOCH receives notices of federal surplus property.  This year it is the Rye Beach Pumping Station on Columbus Ave. in Sandusky Ohio 44870.   It is GSA Control Number 1-Z-OH-598-2-AB or HUD number 52401410002 if you want to claim it for a homeless program in Sandusky Ohio.  How you would turn a 6,424 square foot pumping building and 60K of water piping into anything useful for people without housing is difficult to imagine?  The property was listed in the federal register and is available through the General Services Administration in Chicago until March 10.  Good luck and please invite us to the grand opening of the pumping station/homeless shelter.  We would love some pictures of that. 

Justice Department Urges States to Forgive Felons And Allow them to Vote

Attorney General Eric Holder is reaching out to ask the States to restore voting rights to those felons who have paid their debt to society.  Kentucky and Virginia never allow a felon to vote.  Those released from incarceration and probation are stripped of their rights for the rest of their life.  Alabama, Arizona, Delaware, Florida, Mississippi, Nevada, Tennessee, and Wyoming force the individual to beg and plead with the state to restore their voting rights.   There is an estimated 5 million Americans who need to move to a state that forgive and allow people to move on.  I have never understood why we have a national election for President, and we allow each state to do their own thing when it comes to electing the Commander and Chief.  Why can some states disenfranchise felons?  Why can some states require burdensome proof that poor people cannot produce?  Why do some states (Florida, I am speaking of you) make students and old people wait for three hours to vote?  Why do some states allow same day registration and others allow voting by mail?  How is this a fair system?  Holder said about the felons:

"By perpetuating the stigma and isolation imposed on formerly incarcerated individuals, these laws increase the likelihood they will commit future crimes," Holder said during a speech at a criminal justice reform event hosted by The Leadership Conference on Civil and Human Rights at Georgetown University Law Center on Tuesday.

Psychiatric Drugs and Medicaid

The National Alliance on Mental Illness (NAMI) is asking the Department of Health and Human Services and the Center for Medicare and Medicaid Services to not implement the changes to Medicare Part D.  NAMI alleges that this will make it difficult to get anti-depressant and anti-psychotic medications.  The changes will take these drugs off the preferred list of drugs, and may limit their usage in 2015.  NAMI has put a petition together to oppose these changes.   Here is the link.

National Coalition for the Homeless on Bitter Cold

National Coalition for the Homeless Executive Director, Jerry Jones, was on the NPR Program Tell Me More about the extreme weather and its impact on homelessness.  Unfortunately, news reports have identified 10 homeless people died because of the extreme cold weather.   Jones did a good job explaining the hardships faced by the population; the folly of making it illegal to curl up in a doorway; and the strange concept of figuring out how cold it should be before opening an "overflow" or cold weather shelter.  Some cities say 40 degrees or 32 degrees or 20 degrees before they open an winter shelter, which makes it difficult for those without housing to adjust to the winter.  I have advocated that every city in the United States should provide shelter to everyone who shows up for help like we do in Cleveland.  If you are a tax payer in the richest country in the history of the world and you lose your housing, your government should offer you a warm place inside.  Think of the madness in many cities which close the shelters when they get to a certain number and the temperature outside is 34 degrees. Then the law enforcement arm of the city go out and arrest the person who could not find a bed and instead is sleeping on the doors of a religious organization.  This is America in 2014.

Brian Davis

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60 Minutes Piece on Services to the Mentally Ill

There was an eye-opening piece on 60 Minutes on Sunday regarding the treatment of the mentally ill in America.   This is what Congress should be debating today instead of a four year old health care passed law. They focused on the Cook County jail labeling it the largest insane asylum in America.  I think that the Los Angeles jail could make a legitimate claim on that title, but I am not sure it is a fight that either city would want to engage in.  The reality is that mentally ill people run into problems with the law often because they have a hard time finding help.  The Justice Center downtown has a significant number of mentally ill people.   This was a good hard look at the failing mental health system, and the relationship with the mass shootings in Aurora, Navy Yard, Tucson, Newtown, and Virginia Tech.   We have seen this play out locally in East Cleveland and on Imperial Ave. A small-small-small number of mentally ill people have problems that lead to violence.  The problem is that we cast so many away to deal with their problems on their own that it is hard to pick out the few that are going to become violent. 

Everyday, we come across people who are not a threat to themselves or others but need a great deal of help.  We have women who sleep outside and have regular fights with neighbors and rants everyday about people who are out to get her.  She has been in and out of the hospital for years.   She is evaluated and it is determined that she is angry but not a threat to anyone and then released.  She has slept rough for so many years that her body is falling apart.   We have no effective way to deal with her in our society.  Community groups do not have the money or patience to build a relationship with her, and she does not trust any of the agencies that pink slip her into a hospital for evaluation (against her will).  She cannot live independently.  We have tried.  She either begins hoarding items or collecting inappropriate pets and quickly faces eviction from a landlord.  Where can this woman live in our community? [Yes, permanent supportive housing is great, but you have to be homeless for a long period of time, and there are not enough to meet the demand.]

This women who lives outside needs healthcare and health professional attached to housing.   She needs a safe place that will understand how to deal with her hallucinations.   We need to fulfill the promises of elected officials when we shut down the asylums in the 1970s.  We need a massive infusion of funds into the mental health system.  We need help to provide medicine and oversight to people struggling with a mental illness.   We need a place in our society for people who hear voices and those paranoid that is not an expensive jail.  We need a place for people who are frequent flyers at the emergency room and do not realize that they cannot bring a gun to the airport or cause a standoff with the police.   We need a place for people who repeatedly make attempts on their life and are stabilized then released to live on the streets.   I would have been willing to give back my tax cut I received from the state of Ohio for the past five years, if they would provide help for the mentally ill that did not involve homeless shelters, jails or hospital emergency rooms.  

Brian Davis

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Mental Health Shredded Safety Net

Tom and Dorothy Lane are convinced their mentally ill son committed “suicide by cop” two years ago because he was worried about his health-care insurance expiring the next day when he turned 26.

What a powerful opening paragraph from the Columbus Dispatch this past Monday.  What an amazing endorsement for expanding Medicaid in Ohio.  We would be able to serve more people in Ohio who may fear that their insurance and medicine will run out with expanded Medicaid.  The Dispatch did a lengthy look at the Mental Health system in Ohio and the reality that half of those who need treatment can not find help for their mental health issues.   They looked at the large number of people who are not on Medicaid but have private insurance have a hard time finding care for their mental illness. 

The Dispatch estimated that taxpayers pick up $1.3 million from the Franklin County jail because of untreated mental health care. This does not include the billions of unreimbursed care at the emergency rooms throughout Ohio that taxpayers pick up.   The Dispatch mentioned the significant cuts to the Mental Health system since 2007.  One of the surprising advocates has been Governor John Kasich. The Dispatch mentioned that Kasich's brother is mentally ill.   He approved a budget that cut mental health agencies in 2011, and most agencies were happy that they did not receive a bigger cut.   The Governor's rhetoric has been very good, but the actions have not followed suit.  The Governor was quoted in the article as saying, "We haven't done that. The resources haven't been there.  We need to live up to the promises the state of Ohio made," referencing the promises made in the 1980s when many of the psychiatric hospitals closed. It is sad that we can only get good public policy when a relative of a powerful elected official has a disability, is gay or has experienced trauma in their own life.  What happened to empathy for those less fortunate or those who face huge challenges in our society?  Do we have to know a relative to have any ability to imagine how laws or budget cuts will impact their life? 

The article is well worth the read, and has a great deal of information supplied by advocates at the National Alliance for the Mentally Ill.  One of the sad things not mentioned in this article is that we know what works and we know how to serve the population.  We are not going to prevent all tragedies, but with resources we can take care of many of the issues associated with mental illness.  We could do a much better job spotting people who need help and then pushing for evaluation and regular contact with behavioral health professionals.  We could provide housing and some degree of stability to the population. We can provide counseling and medicine to those who feel that is the right path.  We can provide long term nursing care to those who cannot function with the chaos of our world.  But we do not have money to take care of our disabled citizens properly.  One step toward fulfilling the promises made in Ohio toward providing community services to our mentally ill that the Governor referenced is to fight for expanded Medicaid in this state.  

Brian Davis

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The Massive Increase in Disabled People

This weekend the entire hour of This American Life radio program was dedicated to the issues associated with Social Security Disability.  The program dedicated the whole hour to Chana Joffe Walt exploring the SSDI program after noticing a sharp increase in the numbers.   She looked at the lawyers who help get people the proper appeal, the children who are ruled disabled, and the states that are using the program as an alternative to welfare.  There are now 14 million currently living on disability which averages around $13,000 per year. Ms. Joffe Walt makes the point that people would rather live on a stable income with health care rather than the worst possible minimum wage jobs standing all day without health care.  The most amazing part of the story was the woman in Alabama who had no concept of any job that did not involve walking around.  The only person that she had every come in contact with a sit down job was the lady who processed her Social Security claim.  Every other job in her Alabama County involved standing including the fish processing plant, convenience store, nurses, and child care employees. 

Ohio must not have been one of the states that had figured out that transferring the bills to federal government can save millions, because it takes so long to get through the appeal process in Ohio.  There are so many people in limbo waiting for their disability claim.   You can't really work while the claim is being processed or it destroys your case that you are in fact disabled.  It can take years to get access to the proper medical reports, lawyer and to be heard by the appeals judge.  It was fascinating to hear from the doctor in Alabama who was approving these disability claims.  His point was that people who do not even have a high school diploma and there are no real non-hard labor jobs in the community.  The individual has no shot of finding stable employment that they could reasonably expect to perform and therefore met the guidelines for being able-bodied. 

In Hale County, Alabama, 1 in 4 working-age adults is on disability. On the day government checks come in every month, banks stay open late, Main Street fills up with cars, and anybody looking to unload an old TV or armchair has a yard sale.

 It was especially revealing that there were companies working on behalf of county and state governements to comb through the welfare roles and find people who could be switched to the federally supported SSDI program.  These companies get paid for every person that they get on the federal program, and those individual most likely will never work again and will be on federal disability until they reach 65 or 67.  The number of welfare recipients has decreased at the same time the number of people on SSDI increased.  The number of welfare recipients is down from a high of 5 million to around 2.5 million while disability among low income people rose from 5 million in 1995 to 7 million last year.  Some stats from SSDI:

  • 33.8% on the program suffer from Back Pain or other Musculoskeletal disorders.
  • 19.2% on the program suffer from Mental Illness and Developmental disabilities.
  • 10.6% on the program suffer from Heart Disease or stroke
  • 9.2% on the program suffer from Cancer
  • 8.2% on the program suffer from Neurological Disorders
  • 7.7% on the program suffer from other disorders.
  • 4.1% suffer from Respitory Disease
  • 3.7% suffer from Injuries
  • 3.4% suffer from Diabetes.

It was a very good show, and raises a bunch of big issues.  We hope that we can have an adult conversation in the United States about this trend and this will not turn into another discussion about "welfare queens."


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In Case You Missed it in the News

Yesterday the Washington Post had a poignant story about Peter Bis who had passed away while living on the streets of DC.  He had a great story of traveling the country, living next to the United Nations, and then settling in DC.  It is unfortunate that our health care system does not do a better job of taking care of those struggling with a mental illness.  Peter Bis sounded like a great person that deserved a place inside with a door to lock for his peace of mind.  Imagine the stories Bis could have written or the creative mind that could have been unleashed on the world had he not had to worry every single day where he was going to live that night.  Shouldn't someone or some agency have the responsiblity of finding and help maintaining a place to live for people who do not have the capability to take care of their personal affairs because of their disability? 

My own, Peter Bis, is pictured here.  Sam was homeless for a long period of time in Cleveland.  He was the nicest guy you could ever meet.  Life on the streets took a toll on him with a number of violent attacks by young people stealing his stuff.  Life outside is hard on a person's body and shortens your life.  Sam was quiet and spent his time rolling cigarettes for sale.  He never bothered anyone and in another life he was the kind uncle who was wise beyond his years and would be doling out life lessons from his front porch.  He would have been the guy you stop and see in his retirement to keep up on all the gossip in a community. Sam would have done a lot better living in a northern city in the late 1950s when hard work was valued with wages that allowed a person to maintain a house, and we respected our elders.  He never seemed unhappy with his lot in life, but it was tough on his body.  I always sought him out at the shelters or drop in centers to find out what was going on in the community.  If you gave him some time he could tell you how things were going in the shelters or with regard to homeless people.  I knew that if Sam was angry about something it was a big deal, and I had to make it one of my priorities.  I miss Sam who passed away in 2006.

Also, in case you missed it Larry Davis of the Cleveland of HUD Tenants had his letter to the editor published yesterday regarding Phillip Morris.  We had a commentary about Morris in our blog.  One good quote from Larry in the paper:

Phillip Morris displays a complete lack of respect and a gross misunderstanding of the issues facing the poor throughout Greater Cleveland. In implying that a tenant has little right to complain because she is living in government housing, he misrepresents the both the facts and expectations for all involved.

Finally, our friend from ESOP Mark Siefert, the foreclosure specialist in Cleveland has a nice commentary in the Plain Dealer today about the awful state of housing in the United States.

However, none of the thousands of campaign ads this election season focuses on how to fix our housing crisis or bring principal correction to Ohio's underwater families. The housing "crisis" is in fact a catastrophe -- one our politicians need to start talking about immediately.

ESOP is hosting a town hall forum today in Akron focusing on the problems associated with underwater homes.  Check out their website for more information.


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