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?