In John 10:10 Jesus promises His followers abundant life. This blog is about my life as His follower.

Thursday, October 8, 2009

Ever think about where mentally ill people live?

I'm not referring to your annoying relatives here.

I'm talking about individuals who have various incapacitating mental illnesses such as various forms of schizophrenia. In California at least, housing is a real problem.

If you've read this blog for long you know that I periodically write about issues involving mentally ill people. I guess that's because I figure few people really have much contact with them, think about them, or consciously care. I care because I have history with mentally ill people; I have a sister who is a paranoid schizophrenic and I ran secured psychiatric facilities for nine years. Somehow I hope that raising awareness will sensitize people to the plight of people who suffer from mental illness. I hope that increased sensitivity will translate into praying for them, looking for ways to give financially, maybe volunteering, and how you vote on various issues.

My experience is all in California so I can only speak to the issue of housing options for the mentally ill here. Basically a mentally ill person is looking at the state hospital, acute care, nursing homes, Board and Cares, personal homes, living with family members or friends, or life on the street.

The state hospital is the place where mentally ill individuals who can not live safely out in the comminity reside. Periodically the state tries to give these folks a chance to make it in less restrictive settings such as nursing homes, from where, if they are successful, the could move on to a Board and Care. This is the highest level of care possible; and the most expensive.

Acute care is reserved for those individuals who are an imminent danger to themselves or others. A person can be locked away in the psychiatric ward of a hospital on what is referred to as a "5150" if that person is, at the moment the law enforcement people encounter him, verified to be a danger to himself and/or others. This criteria is very strict and law enforcement are slow to utilize it because they want to respect people's freedom. If an individual is 5150'd to the acute hospital she can stay for 72 hours against her will for observation. If she is deemed safe, she may be released at that time. She also could be placed on temporary conservatorship; in which case, if the hospital staff and conservator think it is medically justifiable, she may stay in the acute hospital for longer. Theoretically an individual could keep themselves in the acute for longer but basically that does not happen. Acute hospitals typically do not keep patients for more than 10 days tops simply because no payor source wants to put out the money.

Nursing homes are California's solution to the chronically mentally who do not absolutely have to remain in the expensive acute care hospital but still need ongoing care. These are people who, at the end of their acute hospital stay, are still not deemed to really be safe on an ongoing basis to themselves or others. Typically the goal is to put them into the psychiatric nursing home to allow them the time to become more stabilized on their medication and perhaps even benefit from the program the nursing home offers. Most of these facilities are secured and the program they offer relies heavily on the concept of a healthy, environment (referred to as therapeutic mileau), having fun activities and some groups in which the patients can participate. The interesting thing is that many of these patients have been in and out of these facilities for so many years that they know as much, if not more, about the group topics than the staff who facilitate these groups.

Board and Cares are homes or apartment type dwellings where the individuals can live and receive encouragement daily to take their medication as well as have meals provided. Some board and cares are funded to have what is referred to as an agumented program where they may have activities and groups that the individuals who live there can participate in. There are a limited number of these places that are pleasant; many are in the worst parts of town and not the kind of place we would want to live. Mentally ill people who are living in this kind of setting have a bonafide mental illness and are receiving Social Security disability money monthy. All but just a very small amount of this money goes to the Board and Care for the cost of their living there. Board and Cares have much more freedom than state hospitals, acute hospitals or nursing homes, but not nearly as much as a person would have living on their own.

Very few people who are mentally ill and do not take their medication or have symptoms that are treatment resistant are able to stay in their own place. They mess up their money, or they irritate and cause problems with the people living around them, or they participate in a myriad of activities that land them up back in the acute hospital.

Living with families or friends rarely works out. If an individual is not taking their medication, or their symptoms are not able to be managed by any medication the physician's have yet identified, they are incredibly difficult to live with. Sometimes they do things which put other members of the household in danger.

Many of California's mentally ill individuals live on the street. If you go to Santa Monica, San Franciso, or to the down town section of any large urban area, you'll see them on the street. Sometimes they pan handle. I try to never turn down anyone's request for help; rather than money I'll give them food directly. Sometimes I keep stuff in my car trunk, or fast food coupons in my purse, or will just get them food from someplace close by like a fast food place or mini market. I always want to do more, but what can you do?


JD Curtis said...

I've known for awhile that a significant percentage of the homeless population have mental health issues. But what can be done? It just sucks anyway you look at it. We as a society cannot supervise every single mental health patient and make sure that they take their meds. Medication can have a limited effectiveness or bad side effects. I'm at a loss except we can try to support programs that do the most basic (food and shelter) to help these people. Any suggestions? Anyone?

jenny said...

about a schizophrenic person, does that person still capable to think normally?
i have a friend and he says he is schizophrenic...but i'm not so sure....

Just Be Real said...

Tracy very good post. Many years ago I befriended a homeless person who was mentally ill with regards to feeding her almost daily by bringing her food on my way to work. After while her paranoia got so bad she would run away when she saw me. Later on I found out she was a well off woman and even had a bank account.

Thank you for posting this. Blessings.

JD Curtis said...

Jenny, I think there are varying degrees of schizophrenia. Are things getting any better over there?

JBR, that was nice of you. Insofar as at least a partial answer to the truly mentally ill-homeless, I noticed that a lady who frequents a certain dry cleaner next to the coffee shop I go to near my work has befriended a homeless guy (with obvious mental issues) who has been in that little area for YEARS. She drops off a little something for him to eat and engages him in conversation to ascertain his needs. If she has something that will help him, she'll get it to him next time. I guess that oftentimes we can't do anything really huge to make a dramatic difference in their lives. But helping in some of the more basic needs may be the best we can hope for. Still, it's better than nothing.

Tracy said...

I love reading the comments of people who care about other people - thank you guys.

JD, in your second post you make mention of the fact that "oftentimes we can't do anything really huge to make a dramatic difference in their lives" and I think you're right. But that lady you observed sure made a difference in his day to day life, and from my experience, that's where it's at with folks with mentally illness.

They suffer, no cure has been found, they can be challenging to deal with, but we can do it with the most amount of kindness and concern possible.

Jenny - yes sometimes they can think just like you and I. Mental Illness is not reflective of intelligence at all. A person can be really bright, capable in some ways, but because of pervasive, non-reality-based beliefs or voices in their head or seeing things that we don't, act in ways that are counter productive to what's actually happening.

Anonymous said...

Very good post! It makes us stop and think. It seems the number one reason people have a hard time helping these people is that they think they are all imposters. This is how I explained it to my friends the other day. We were driving the streets in town and I saw a homeless person. I gave him $5. Afterwards they said, "He'll just go spend it on cigarettes." This is what I told them, "You know what? I don't care. I've done my part. What he does with that $5 is between him and God."

RCUBEs said...

It is sad that these people are not getting the proper care that they need. They are also a part of the correctional system's population. As they are taken cared of during incarceration, but when released, you just wonder if people who picked them up are capable of giving them the mental health care that needs to follow. I'm glad you posted about this...It's like cancer to society, not because of having people like them, but because our government has not done enough to help them. Blessings to you. Thank you for your prayers.

Robert Madewell said...

Living with even a "mild" mental illness like major depressive disorder is tough enough. I know first hand.

I can't imagine what it's like to be out on the streets with a mental illness. It makes me sad that it happens and it's alarming because it could be me out there.

I think it's a wonderful thing to help people who are in need. Keep up the good work. I'll keep that in mind for myself. Even doing a little is at least doing something. Right?

Tracy said...

I think you're right Robert on two accounts. 1)Even doing a little helps. We can't control the world but we can do right by the people we encounter daily. 2) It could be any one of us out there.

Due to my work I've encountered lots of people with varying types/degrees of mental illness (although also due to my work, I tend to have encountered the most ill people.) I can't telly you how many times I've heard all about the wonderful life someone had prior to the onset of their illness. It always hits me that, but by the grace of God that could be me or one of my children.

Anonymous said...

I would say 80% of the homeless are mentally ill. I am fortunate I got sick young and help quick I responded well to meds aswell. Most of the street people are so clouded by there illness that they don't even know most of the time they need help. I don't know about Cali but in Canada being on medicine is a choice. So with this in mind it is like if we can't give them medicine they won't realise they need it and if they stay unmedicated they don't think they need it. Like a twisted catch 22. I am so glad to see others concered about this epidemic.

Tracy said...

Kyle, it's the same situation in California; so we've got the same catch 22 - ill people do not realize that they need medication so they do not choose to take it. If many (100% of the pop does not have symptoms that respond well to meds)people would take the meds, they would function better and be able to take care of themselves. I do not know any answer, but just would like to perhaps raise the awareness a bit. Data says that in California, about 1/3 of the homeless are mentally ill.

BTW - Your art is wonderful Kyle!

AlyJ said...

Hey. I am doing a research paper on Mental Illness. I wanted to know if you have any websites, or history that You could post. My topic is talking about the treatment, and government funding.

Tracy said...


One good organization, part of whom's mission is to educate the public regarding mental illness, is NAMI (National Alliance on Mental Illness). Their website can be found at:

CNN did a nice piece a while back:

This site is also informative on an introductory level:

Don't know if any of this goes deep enough for what you're looking for. Perhaps somehow through the state dept of mental health you can find out the stats; how many at what level of care, treatment outcomes, etc.


Crystal Cashman said...

I am "mentally ill" my label is "Bipolar with psychosis, DID (multiple personality disorder) Go to yahoo type in: studies done on diabetes ----look at all the scientific studies (research done to figure out cause of illness, and prove how that was concluded) that pop up. NOW: type in studies done on chemical imbalance - IF YOU CAN find EVEN ONE STUDY showing how they figured out mental illness is a chemical imbalance and that meds would normalize us(NOT articles claiming its the based on a study) PLEASE SEND IT TO ME!!!!!! WHen i was diagnosised i was told you have bipolar, it is chronic and uncurable but you can get better by taking these meds because you have a "chemical imbalance" Chemical imbalance is only a theory. Theory means NOT PROVEN IN ANY WAY. It's kind of hard to get better when your whole disorder is based on believing its a "chemical imbalnce" only helped by meds --- when they don't know what causes mental illness at all. If you'd like to know more about the life of a mentally ill person relying on a broken system that makes their living by us taking meds to fix something that's a theory - feel free to contact me. It's been proven the pancreas needs insulin so a diabetic person believes they need to take insulin. I thought I hsd to take meds to correct chemicals in my brain but if you look at a MRI of a normal brain and an MRI of my brain. Mine has lesions, holes, fissures all over that were not on the normal brain. How does having a structurally damaged organ (ironically the organ the entire body relys on to survive)prove meds will fix a chemical imbalance they THINK MAY be the problem BUT HAVE DONE NO STUDIES TO PROVE IT!lol feel free to email Crystal C CA Is a medication allowed to be used by us if its NOT PROVEN by a study? NOPE!!!! The main problem is Satan is evil and rules earth. The people running our country forgot we give them money to serve and help US THE PEOPLE ALL AMERICANS - NOT themselves and the rich. Thank God for you God! I love you Lord.

Anonymous said...

Hi, I am a mentally ill individual and this blog just happened to pop up in a search. I love God and the life he has provided. I realize this is an older post that I am commenting on but felt compelled to comment after reading some of the other comments. First, please believe that whatever I might say comes from love and the need for others to understand.

My diagnosis is PTSD and bipolar. I have gone through a virtual hell here on earth. I just turned 50 this year and have yet to bring this illness under control. I am again homeless, being sheltered temporarily by an old friend who does not want me here. Now, I am a kind, giving, caring, highly intelligent individual. I have a past that you would not believe if you know my situation now. I am unable to work, am on SSDI, but because of a large car payment I couldn't avoid, am unable to find a place for my dog and I to live. Talk about a catch-22. I make too much for the social programs, and not enough to live on. Plus my credit rating is so bad it would make someone bankrupt cry. So that is my situation. I keep trying, I keep falling, I keep getting back up. But I'm not sure how much longer I can do this.

That being said, what I really wanted to comment on are some of the comments that I read. Let me ask you a question. If you saw someone getting hurt in some way, would you ask the person next to you if that person got hurt? No, you would ask the person who was hurt, at least I hope you would. And by the way yes, it is that simple. What I've found being a mental health consumer for as long as I have, is that it's virtually impossible to speak with the medical community about how you feel or what happens to you on the inside. It took me quite some time to come to this conclusion, then I started coming up with metaphors to try and help. In some cases it's made all the difference. I have SEVERE anxiety. So my doctor prescribed me 1/2 mg of clonozapam twice a day, the customary treatment. It took me well over 10 years to get a doctor to finally realize the extent of the anxiety and she was able to help. That was 10 years of my life!

You know, people look at the homeless and only guess how many are mentally ill, how many are addicts, etc. Some of us are completely lucid mentally ill people that could never get a break. We've gone from Wall Street, so to speak, to some of the most horrible of situations. We've been abused, used, stolen from, disowned by those that you would think would love us unconditionally. We have starved, begged, we have lost everything we've had, been told 'no' more times than we can handle. What are we to do then? Can you blame us for being afraid? I'm speaking from a fraction of an inch from being on the streets myself...

So when I hear others putting statistics on who they think who are, I get a little upset. There is a story behind every single homeless person, person locked up in an institution, person in the system.

What is it that we really need, beyond the need to get cleaned up and fed and all that? Love. The kind of love we can always count on. Pity kills. We need to know how to really get well, not the meds they keep giving us that cause horrible things to happen to our minds and bodies. We need good, healthy food bursting with nourishment... doesn't everyone? Has anyone ever thought about how our diets have changed and all these horrible illnesses have popped up out of no where? OMG people, think!

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