County's mentally ill fade into the system
By Carol Smith
November 17, 2008
Board members with Community House, the nonprofit that ran the homes, said all former residents have been relocated, but privacy laws prevented them from disclosing where.
There's no public paper trail to trace. The residents, some of whom had lived in the homes for up to 20 years, have simply vanished into the labyrinth of the mental health system -- a tangle that odds are will eventually dump some of them back onto the street, or into jail.
King County continues to have a severe shortage of housing for people with mental illness, but some of the shortfall has resulted from a controversy over the best form that housing should take.
Even as county mental health officials herald an ambitious new plan to spend sales tax money to expand housing for people with mental illness, they've quietly let the boarding homes close because they no longer fit the preferred model, which emphasizes independent living.
In a memo to the buildings' owner last month, mental health director Amnon Shoenfeld said the county didn't want to invest in repairing the debilitated boarding homes because they weren't consistent with its "recovery principles." Recovery refers to a philosophy that people with mental illness can and do improve with appropriate treatment, housing and support.
Meanwhile, waiting lists for mental health housing in King County -- and around the state -- continue to grow.
Plymouth Housing Group, one of the largest providers of such housing, has 800 people on its list and a two-year wait, said Tara Connor, Plymouth's policy director.
The lack of housing has created backups at Western State Hospital, where more than 100 patients are cleared for discharge but have nowhere to go.
The problem is even more acute for those not leaving a psychiatric facility. Western State patients have priority for community housing. Others may have to wait months to years for supported housing, said Robert Fors, a probation officer with Seattle's mental health court.
One of his clients wound up at the Morrison Hotel, a low-income apartment hotel run by Downtown Emergency Service Center, which also provides counseling and case management support to residents.
"We only got him in two weeks before he had to leave Summit Inn," Fors said.
The mental health agency's plan was to put him on a waiting list for Section 8 housing, but in Fors' opinion he would not have been ready for an unsupervised living arrangement, without medication monitoring. "So we squeaked by on that one," he said.
Others in the community are still looking.
"We haven't been successful in finding housing yet," said Alan Hernandez, who is on the Community House board and is the parent of a 28-year-old son who has schizoaffective disorder. "There's a waiting list every place we go."
His son is living temporarily at home. Not among the most recent Inn or Summit populations, he lost his housing at a different facility several months ago for breaking rules.
"What he needs, and he agrees with this -- he needs more supervision," Hernandez said. But such a place isn't available. "I am very angry with the system."
Housing funding lags
The 200 housing units being developed with the $13 million in King County sales tax money won't be available until 2010 or later, Shoenfeld said. Those projects haven't broken ground yet.
The situation irks Peter Sikov, who owns The Inn and Summit Inn.
Sikov bought the buildings 10 years ago, and both had already been in use as housing for people with mental illness for several decades. The Inn, with its leaded glass and entry-hall fireplace, still retains echoes of its roots as a gracious Capitol Hill mansion. Summit Inn -- located about a mile away -- was built as a hotel and still has the high windows and wide hallways of another era.
Sikov, with his long wavy hair pulled back in a ponytail, and a salt-and-pepper beard, doesn't look the part of real estate developer -- but he's been one for 20 years. He's occasionally attracted notoriety -- he bought and moved Jimi Hendrix's old house to save it from demolition.
But as a former director of a mental health agency, the issue of housing for people with mental illness had long been a personal passion.
On a recent walk-through of the properties, which he is preparing to re-lease, he pointed to a pocket Bible left on a cast-off nightstand. "There's something in here about taking care of the least fortunate among us," he said.
Sikov is not the hero of this story, nor the villain.
No one disputes that the boarding homes had deteriorated from neglect and hard wear, or that the residents deserved a clean, safe living environment that wasn't being provided at the end.
The state had cited the agency that ran the two homes with a variety of violations, most of which related to housekeeping and cleanliness standards, and for failing to put adequate resources into staff and resident care, according to records obtained by the Seattle P-I.
The agency was responsible for making the repairs, said Bett Schlemmer, King County administrator for the state agency that oversees residential care services.
Board members said they couldn't afford them. The agency received approximately $32 a day per resident from the county for housing -- about half the total funding for the home, which came from a mix of state, county and federal sources. The county receives an allocation of state funds, which it spends on a variety of services for people with mental illness.
"We pleaded with the county four years ago to increase that," board member Larry Crim said. "You couldn't house a German shepherd for what they were paying,"
When the leases were up this spring, the agency voluntarily closed the facilities.
Sikov fired off an exasperated e-mail to city, county and state officials pointing out that while the homeless population, much of which has mental illness, is growing, it made no sense to remove beds.
Of the more than 2,600 homeless on the street, more than half have persistent mental illness, according to mental health advocates who deal with the homeless population.
The Downtown Emergency Service Center, one of the largest shelter and housing providers, gives emergency shelter to about 5,000 homeless individuals a year, of which 80 percent have severe and persistent mental disorders, said Bill Hobson, executive director of the organization. Of those, more than half also have substance abuse issues.
"I am wondering if there is any leadership ... that can connect the dots?" Sikov wrote. "Anyone ready to step up to the plate?"
Funding new housing is great, but existing housing is being wasted, he said in an interview. "I wish they had put the horse before the cart."
Homeless ranks swell
The dispute has echoes of the push to transfer patients from mental institutions to community care, a movement that started in the 1960s. That philosophy freed mental patients from sometimes appalling institutional conditions, but historians now note it wasn't accompanied by sufficient resources to care for them once they were out in the community.
The result, decades later, has been a growing population of psych patients circulating through jails, emergency rooms and the streets, in part for lack of stable housing.
Housing is a critical component in how well someone with mental illness functions in the community, said Adrienne Quinn, director of housing for the city of Seattle.
Homeless mental patients undergoing outpatient treatment were four times as likely to wind up in jail as those who had housing while undergoing treatment, according to findings presented to the King County Council during deliberations about how to spend the 0.01 percent sales tax money that funds the county's new Mental Illness and Drug Dependency Action Plan.
"We hear this over and over from tenants," said Connor of Plymouth Housing. "They say they cannot begin to deal with their mental health symptoms on the street, but the symptoms get worse and worse.
"How can we expect people to recover or regain their lives if they're living hour to hour in survival mode?"
'No one size fits all'
Still, the question of how best to provide such housing continues to challenge -- and vex -- those in the field.
Larger group housing -- "therapeutic housing" with up to 50 beds -- hasn't been successful, said Richard Kellogg, director of the state's mental health division. "People with mental illnesses want the same kind of housing we want. They want to live where we do, and they tend to do better in smaller settings."
In the Seattle area, the National Alliance for the Mentally Ill has bought two houses in 2006 in Seattle neighborhoods for a pilot residential program -- one for men and one for women. Each home has five or six residents.
The residents must be actively "working on their recoveries," said Nancy Cole, who oversees the houses for the alliance. Each resident must be attending appointments and taking medications as prescribed by his or her mental health providers. Each also is required to be working or volunteering in the community, and for the most part, the residents run their own homes.
The power of the housing program comes from that sense of ownership, and the sweat equity the residents have in their houses. The residents helped fix the houses up, and as the alliance is able to retire the loans, the rent each resident pays will be enough to pay for upkeep.
"This feels like such a safe place to be," said Sandra Maier, a resident in one of the houses, who has coped with symptoms of mental illness for more than 30 years. "Because we share similar experiences, if not identical symptoms, we can understand each other and help each other. There's a very intense level of trust."
The trend toward "recovery"-oriented housing provides both an environment and an incentive for people to stay on track. But such housing doesn't work for everyone.
"We keep looking for one-size-fits-all solution, but there is no one size that fits all," said Connor, who has worked in the mental health field for more than 30 years. Plymouth's model incorporates on-site case managers who are available 24 hours a day in buildings that house up to 70 residents.
Such arrangements help residents combat isolation, she said.
In the same way a positive attitude can't save everyone from cancer, not all people with mental illness recover to the same degree or need the same amount of supervision.
That's an argument for providing a spectrum of options, Sikov said. "Otherwise you end up putting people where they don't belong."
The irony is that the Summit Inn will likely stay open and be leased at "market rates," Sikov said.
The rooms will likely fill up with a similar clientele, but without a mental health agency providing on-site supervision.
Sikov finished his recent walk-through of the Summit. In the hallway sat two red shoes, abandoned by a former resident as though kicked-off midflight.
Each one pointing in a different direction.
P-I reporter Carol Smith can be reached at 206-448-8070 or carolsmith@seattlepi.com.