[Hpn] Homeless Care's Deadly Gaps

chance martin streetsheet@sf-homeless-coalition.org
Sun, 28 Jan 2001 11:45:05 -0700


The question these reporters never get around to asking (or their editors
hack out of the article) is precisely how much $$$ is being squandered on
these "deficient" and "uncoordinated" programs.

Remember, in the District of Columbia it literally takes an act of Congress
to allocate funding for a new stoplight. This creates a culture of service
provision that is incredibly top heavy with management and "policy wonk"
types, while there aren't enough folks doing documented outreach. Outreach
is absolutely essential to the process of determining where gaps in services
are, while a bloated management structure accomplishes nothing so much as
making the services more costly to deliver.

Please note also that no homeless people, and especially any homeless people
who have a psychiatric label, were interviewed for this article. But DC's
Director of Public Health was provided a bully pulpit to deliver some forced
treatment venom: 

> "The challenge for us is that all our programs are voluntary."

Relax homeless friends. Soon everything you ever wanted will be mandatory.

peace,

chance
========================================================

http://washingtonpost.com:80/wp-dyn/articles/A56489-2001Jan27.html

Homeless Care's Deadly Gaps

By Serge F. Kovaleski and Sewell Chan
Washington Post Staff Writers
Sunday, January 28, 2001; Page C01


The recent deaths of five homeless adults in Northwest Washington -- all
afflicted with myriad mental and physical problems -- have revealed alarming
deficiencies in the District's decentralized network of care for the
homeless, according to advocates and service providers.

Although they varied in age, physical appearance and background, the victims
shared the characteristics of the street homeless that the city's support
system -- focused since 1994 on providing transitional housing -- is least
prepared to address, said numerous outreach workers whose organizations
receive federal and city funds.

Each of the five had a severe drinking problem and health complications that
worsened in the months before their lives ended in the cold. Three had
documented symptoms of mental illness. All had greeted offers of shelter or
other assistance with reluctance or even adamant refusal. And while a city
statute permits forcible commitment of mentally ill adults, use of the
provision has steadily declined in part because outreach workers do not view
it as a lasting solution.

Outreach workers in Mount Pleasant and Columbia Heights who regularly
interacted with three of the dead -- Luis A. Benites, Jesus Blanco and
Deborah A. McCollum -- said there is no coordinated and sustained support
system to draw in homeless adults and then address their array of problems.
The fourth victim, Russell T. Gould, was found dead Jan. 4 in an unheated
garage in the affluent Foxhall Village neighborhood. The fifth, Robert E.
Richards, perished next to a steam grate steps from the Washington Monument
early Thursday.

The fatalities have prompted outreach workers to candidly and critically
assess the network of services, from street outreach to long-term treatment
for the mentally ill and substance abusers -- services seen as woefully
inadequate.

Lynn Shea, executive director of the Community Council for the Homeless at
Friendship Place, an outreach organization, said there has been a breakdown
in long-term support for the mentally ill homeless.

"This system has been very non-responsive," Shea said. "The mental health
system looks at the homeless as a class apart. The system is devoid of
consistency and commitment to follow-up. In cases where the homeless are not
being properly medicated or medicated at all, they are self-medicating with
alcohol and drugs."

Improvements Promised
City officials hosted an unprecedented interagency meeting last week and
promised some changes in response to the deaths, the first four of which
went undetected by city agencies involved in homeless services. Until last
month, no homeless person had died from hypothermia in the District since
November 1996, and only a handful of such deaths have occurred since 1992,
officials said. What caused the recent five deaths still is under
investigation, though there were no signs of suicide or homicide.

For the first time, a Spanish-speaking driver will be added to the city's
24-hour hypothermia hot line, which dispatches vans dispensing blankets,
clothing and hot chocolate. Monthly meetings of outreach workers who serve
the mentally ill, which started in October, will be used to scrutinize
clients who are known fixtures of the street.

"We have now isolated a problem, a street problem, that is going to take a
deeper level of mainstream resource commitment and collaboration," said
Stephen Cleghorn, deputy director of the Community Partnership for the
Prevention of Homelessness, the $21 million-a-year public-private entity
that has managed D.C. homeless services since 1994. "And yes, it might be
time to go even more sophisticated on some of the street outreach."

At two city agencies, officials also conceded that services often fail to
reach the homeless adults who are hardest to assist.

Homeless outreach has only begun to recover at the Commission on Mental
Health Services, which is expected to emerge this year from a court-ordered
receivership imposed in 1997. The agency is trying to transform a system
that was "rigid, highly bureaucratic and centered primarily on mental health
centers," said its chief operating officer, Elizabeth Jones.

The commission's Comprehensive Psychiatric Emergency Program, which in
previous years spearheaded homeless outreach, faltered after its director
resigned two years ago. Outreach workers, who said they call the program
only sporadically, complained that its 24-hour hot line is little
publicized.

The commission's agents and District physicians can use a process to
involuntarily commit individuals who pose an immediate danger to themselves
or others. Such commitments last only 72 hours, but often the person
voluntarily remains in treatment, Jones said.

Yet the total number of emergency mental health admissions has declined,
from 823 in fiscal 1998 to 592 in fiscal 2000.

Jones said she was uncertain why this winter's victims had not been treated
by the commission. "Maybe the kind of help they would have accepted was not
available. Maybe they did not feel comfortable with what was available and
the restrictions around it," she said.

The commission hired a coordinator for homeless services in September and is
paying for two programs that provide 250 homeless adults with frequent,
face-to-face counseling and guidance. The Addiction Prevention and Recovery
Administration has worked through its years-old waiting list for
detoxification and funds two programs for Latino outreach and three programs
for mentally ill addicts.

"The challenge for us is that all our programs are voluntary," said Ivan
C.A. Walks, the D.C. health director.

Confronting Mental Illness
But continuing fragmentation in services has stymied an integrated response.
Outreach workers said their efforts to engage three of the victims -- all
found dead in a three-block area in Mount Pleasant and Columbia Heights in
late December -- were frustrated by the lack of long-term treatment.

"What is frightening is that you are seeing more and more folks like them,
who meet everything in terms of mental illness: They are dual diagnosed [for
addiction and mental illness] and consistently falling through the cracks,"
said Brian Anders, the Neighbors' Consejo outreach worker who found Benites'
body Dec. 28. "These are three of the most extreme cases of substance abuse
and mental illness we have dealt with, but they are also very indicative of
what is out there."

Although other homeless adults have died outdoors in the region, including
one Dec. 6 in Fauquier County and one Dec. 20 in St. Mary's County, the
problem is most severe in the District. The partnership estimated that
12,700 people were homeless in the city at some point in 1999, a per-capita
rate about twice that of other cities nationwide.

Like the three who died in the District in December, Gould, 65, was an
alcoholic. His heavy drinking, which began when he was in his late teens,
was treated intermittently at hospitals, acquaintances said. Like the other
three, he refused to spend his life in shelters and institutions.

Benites, Blanco and McCollum would regularly eat at Sacred Heart Church on
Park Road NW, and McCollum would receive dinner every Sunday night from a
food van run by Faith United Methodist Church, of Accokeek. At the church
meals, officials from other organizations discussed health services,
substance abuse counseling and HIV testing.

The Barrier of Trauma
Breaking through to Blanco and Benites, both Central American immigrants who
spoke little English, proved difficult. Simon Talento, a counselor at La
Casa Multicultural Center, an emergency overnight shelter on the same block
where Blanco died, said many homeless Central Americans who were traumatized
by war are uncomfortable in confined spaces such as shelters and distrust
authority.

"We refer to this as the DTs of persecution," he said, referring to the
delirium tremens suffered by alcoholics in withdrawal. "Many of them are
used to running from guerrillas, the army or the national police . . . and
will not come into the programs because they have a sense of
claustrophobia," said Talento, who knew both victims.

Benites, believed to be 35 when he died, often wore a full-length gray coat
and had long salt-and-pepper hair he occasionally had deloused. He would
come by Consejo about every three months for clothes.

"He was always very mannerly, very quiet, very unkempt and very much apart
from the other Spanish speakers, which I suspect was because he had a mental
illness," said Mary N. Sebold, director of the Charlie's Place food kitchen.
She added that Benites consistently refused offers of additional assistance.

Late last spring or early summer, Anders said, "something radically
changed." Anders saw Benites passed out in a park, which was
uncharacteristic for Benites.

Similarly, two summers ago, Blanco was "clean, lucid and sober, and worked
at a church, and then went on a downward spiral, like a 747 in a nose dive,"
Anders recalled. On the streets, he often could be heard cursing. As a
result, he was often brutally beaten.

Blanco, 43, had gone clean several times in the last few years and went into
detoxification at least once. He sometimes attended Alcoholics Anonymous
meetings, and he participated in a special outreach program, funded by the
Community Partnership. Like half the addicts who took part in that outreach
program, Blanco dropped out, Cleghorn said.

Outreach workers had not seen McCollum, 48, for four or five months before
September. They said she was apparently incontinent, which embarrassed her
and made her more reluctant to seek refuge. McCollum had relatives in the
District, but they declined to comment.

Building and Breaking Ties Simply developing a relationship with alienated
homeless adults, much less connecting them to services, requires
persistence, said Michael Rowe, a sociologist at Yale University's School of
Medicine. "It means starting small, sometimes with a cup of coffee or simply
saying hello, and getting to know the person over time," he said. On one
occasion, it took Benites four days before he would accept a ski cap from an
outreach worker.

Gould found a friend and virtual guardian in a wealthy woman in Foxhall
Village. According to people who came to know them both, the woman looked
out for Gould for a number of years. He in turn helped maintain her house,
handled her business affairs and arranged for nurses when she fell ill
before dying about four years ago. The woman left Gould between $5,000 and
$10,000.

After her death, Gould deteriorated dramatically, apparently because he was
drinking a lot more. He had relatives in Northern Virginia, but they, too,
declined to comment. Gould, who attended Cornell University for three
semesters in 1954 and 1955 but never graduated, earned money doing carpentry
and plumbing and walking dogs for residents of Foxhall Village.

Overall, said Francis M. Napoli, who knew him for more than 20 years, "he
did not want to be responsible to anyone else but himself. It was a
lifestyle, his lifestyle. I do not know if his life was tragic to him. It
was free."

As for Richards, the fifth victim, National Park Service employees and U.S.
Park Police began to spot him regularly at least five years ago among a
dozen or so men who slept in and around the Mall, including a grate that
bellows plumes of steam. Richards, 54, stuck out because he would help the
park staff clean up the area, which last week was strewed with blankets and
personal belongings of the men who spend the night on or near the grate.

Richards had a physical disorder that caused him to shake and twitch
noticeably, earning him the nickname "Shaky." Outreach workers said his
physical affliction embarrassed him to the point where he would not
consistently stay in shelters.

 2001 The Washington Post
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