As Mental Health Support Wanes, Many Doomed to Homelessness

May 3, 2009
Reprinted with permission from the Dallas Morning News.

By Kim Horner

Richard Antwine's last home was the county jail.

The 47-year-old ended up there, again, after another round of homeless shelters, boarding homes and psychiatric hospitals. This time, it was because he failed to report to his parole officer. He said he missed the appointment because he was hospitalized. He has severe depression and was hearing voices telling him to hurt himself. His court-appointed lawyer said he doesn't belong in jail. "Somebody dropped the ball somewhere," she said.

Antwine's situation is all too common among the chronically homeless, those with disabilities such as mental illnesses who have been on the streets long-term. But it's not new.

Chronic homelessness resulted from a shift away from the institutions that once housed more than half a million mentally ill people. Get people out of the state hospitals, experts thought in the 1960s, and they can live on their own, thanks to medications that were new at the time.

But the mental health services that were supposed to help those people adjust came up short. And many of the people, including growing numbers of Vietnam veterans, were left homeless. In the 1980s, cities looking to revitalize their downtowns tore down the cheap rooming houses where the very poor lived. Finally, in the 1990s, the political climate made it difficult to get more government money for housing and mental health treatment.

The result is today's disjointed system of psychiatric hospitals, substance-abuse treatment centers and homeless shelters. It's a system that comes at a huge expense to taxpayers and doesn't come close to solving the problem.

"We've just come to accept the fact we have homeless people roaming the streets like we have rats roaming the alleyways," said Michael Stoops, executive director of the National Coalition for the Homeless. "We have grown accustomed to having human beings living on the streets. It's kind of a sad commentary."

Shortage of services

On any given night, there are at least 1,000 chronically homeless people in Dallas and more than 124,000 nationwide. At the heart of the problem is a lack of mental health services, a deficiency that's especially acute in Texas.

The state ranks 48th nationwide in spending on mental health care for its poorest residents. And this lack of commitment goes back more than a century, if you believe Dr. J.A. Corley, the superintendent of Texas' first state hospital, the State Lunatic Asylum. He complained that the 9-year-old facility was overcrowded and underfunded after it had filled to capacity with 352 patients.

"Our sister state of California, though younger than Texas, has provided accommodations for over one thousand of her insane," Corley wrote to try to shame the Legislature. That was in 1870.

Such institutions were being de-emphasized by the 1960s, the first of a series of factors that have conspired against the chronically homeless. Among them:

•A shortage of affordable housing. Revitalization efforts in the 1980s led to the tearing down of cheap housing even as federal housing assistance programs were being cut. About 18,000 people are on a waiting list for housing assistance from the Dallas Housing Authority, and the wait is three to five years long.

"The bottom line is we have a housing affordability crisis, and it most negatively affects people on very low incomes," said Dennis Culhane, a University of Pennsylvania professor who has done extensive research on homelessness.

•Low disability benefits. Many of the chronically homeless receive disability checks of about $675 a month, hardly enough to rent an apartment and pay other living expenses.

•Disenfranchisement. People on the streets with mental illness have had little voice among lawmakers. This year, the mayors of Texas' largest cities asked for $50 million over two years to help the homeless. The measure is pending.

•Fiscal conservatism. Advocates for more housing and mental health treatment face a tough political climate.

"Over the last six years, there's no doubt that there has been a tone of fiscal conservatism that has perpetuated the reputation of Texas being stingy with mental health dollars," said state Rep. David Farabee, D-Wichita Falls, a longtime mental health advocate. Farabee said he's hopeful that federal stimulus money also will allow the Legislature to provide more mental health dollars.

•A fragmented system. Many homeless people fall through cracks because of a lack of coordination among social service agencies. A person leaving one psychiatric hospital, for example, may be told to follow up at an outpatient clinic. But if the person doesn't show up, the clinic is not likely to track him or her down because it has no funding to do so.

•Stigma. There's a lack of understanding that the chronically homeless are extremely vulnerable and need significant help putting their lives back together. Instead, they are blamed for their situation.

"Generally, mental illness is something you can't cure by yourself," said John Castañeda, executive director of Turtle Creek Manor, a Dallas center that serves people with mental illnesses who also face addictions. "To say 'pull yourself up by your own bootstraps' won't work. It's impossible."

Many challenges

Richard Antwine wants to get off the streets. He wants his own apartment. And he wants to work.

Some days, he walks several miles asking business owners if he can sweep their parking lots. He talks about making a little money clipping other homeless guys' hair, saying he once attended a barber college.

But he's up against a lot. His severe depression has left him suicidal at times. He hears those voices. He has abused cocaine and alcohol, a common escape from mental illnesses.

He has a criminal record that includes drug possession, theft and unauthorized use of a motor vehicle. The divorced father of three grown daughters does not have the kind of family support that keeps some others from spiraling into homelessness.

Antwine's sister, JoAnn Williams of Garland, has watched him through psychiatric institutions, shelters and jail for years. She cooks for him and gives him cash here and there, but she has a family to take care of and said her brother needs more help than she can provide.

"I don't know where he is from one day to the next," she said. "If I don't hear from him, I don't have no way of calling him. He don't have a phone, and I don't know if he's dead. I watch the news all the time. Sometimes I am scared to watch the news."

'Good intentions'

Across the nation, thousands of people like Antwine have ricocheted through institutions for years despite the many programs designed to help them.

"We've had a quarter-century of good intentions, well-meaning programs and human gestures, but to be honest, they have not worked," said Philip Mangano, executive director of the United States Interagency Council on Homelessness. "The antidote to homelessness is, shockingly, a place to live."

Many programs to help the homeless traditionally have not placed enough emphasis on housing, Culhane, the professor, said.

"We have a lot of homeless people who get social services, shelters, mental health services, all of which does nothing to solve their housing problem," he said. "It's not a good use of resources to spend all this money and they're still in a cardboard box on Main Street."

Mangano, who will leave his post this month, led efforts to encourage cities including Dallas to adopt 10-year plans to end chronic homelessness. This has led to increased funding for special housing and support for the chronically homeless, and that's gotten a number off the streets.

But there's still not nearly enough housing, leaving many chronically homeless people like Antwine to fend for themselves.

Passed around

Antwine's dizzying ordeal through psychiatric hospitals, emergency rooms, boarding homes and shelters in just the last four months shows how the lack of care can doom someone to the streets.

In January, he spent about two weeks at Terrell State Hospital, a psychiatric hospital with about 300 beds and several aging empty buildings that once housed nearly three times that number of patients. From there, he was taken to a clinic, but he left before seeing the doctor.

Instead of going to a boarding house as planned, he ended up at The Bridge, Dallas' homeless-assistance center. Soon after, he said, he was robbed and stabbed as he searched for an East Dallas rooming house. He recovered at a Pleasant Grove boarding house but soon left over a rent dispute. From there, he went to the Salvation Army's shelter and finally to another boarding home.

In March, Antwine was placed under the care of a special team of caseworkers who stay in close contact with patients to make sure they take medications, show up for appointments and remain stable. It's an intensive service that few receive because of strained budgets. Antwine started feeling better and made plans to move into an apartment on April 1. But even the caseworkers had no control over what happened next.

Police arrested Antwine as he walked downtown on a warrant for not reporting to his parole officer. Instead of moving into a new home, Antwine was in jail, wearing a striped uniform, eating skimpy bologna sandwiches and staring at the wall because he could not afford anything to read.

"I don't know what's going on," Antwine said last month. "I'm just sitting here doing nothing when I shouldn't be here."

'It's a travesty'

At an April 17 parole hearing, Antwine's lawyer, Raquel D. Brown, argued that her client tried to do everything right.

"That's why I think it's a travesty," she said.

On Thursday night, after a month in jail, Antwine was released.

His whereabouts were unknown.

Copyright 2009. Used with permission from Dallas Morning News.