NYAPRS Note: As in RI, the experiences of care managers in NY’s Health Homes may help with valuable advocacy for more housing first approaches across the state, and increased funds to move people out of a revolving door of limited assistance and toward stability and recovery.
In the Shadows: Rhode Island’s Mentally Ill Homeless are Hardest to Reach, Help
Providence Journal; Paul Davis, 11/1/2014
In the dark corners, weedy lots and cemetery plots in South Providence, another world exists.
It is a hidden place, where homeless men and women battle schizophrenia, depression, posttraumatic stress disorder and childhood trauma. They live just beyond the glare of the city’s fast-food restaurants. Some huddle under greasy blankets. Others sleep with their feet or heads next to tombstones.
Few have regular doctors. When things get bad, some drink or take drugs.
“I have brain damage, but I don’t know how it happened,” says Joseph Borrasi, who sits at a Broad Street bus stop on a Monday night. He has an apartment now, he says, but he’s lived in homeless shelters and on the street for years.
Once, he says, he fell asleep in Kennedy Plaza. When he woke, he was covered with snow. “I ended up in the hospital. My feet were frozen.”
Another man, Billy, slumps next to him. He sleeps at Harrington Hall, a homeless shelter in Cranston, but he can’t find his way home. He has lost his state-issued ID card, too. His face is hidden by a black hoodie.
Outreach worker Megan Smith and psychiatrist Craig Kaufmann spot Billy and help him cross the street to the right bus stop. Both work for ACCESS-RI, a statewide program of the Mental Health Association of Rhode Island.
Craig Kaufmann, a psychiatrist and outreach worker, left, and outreach worker Megan Smith, of ACCESS-RI, a program of the Mental Health Association of Rhode Island, offer assistance to a man at a Broad Street bus stop.
On Monday nights, they talk to the homeless and try to help. According to Smith, more than half of the people she works with suffer from mental illness or substance abuse. A fifth grapple with severe mental illness.
Before she leaves Billy at the bus stop, Smith promises to help him get a new ID card.
Cards and bus passes are essential for health care and other services. “If you can’t get around, and you can’t prove who you are — that closes a lot of doors,” Smith says.
The two caseworkers squeeze through a narrow alley. They spot a mound of blankets near a dumpster in the back of a darkened lot. A few yards away, behind a fence, drivers order meals at a KFC restaurant.
“Hello,” says Smith, shining a light on the ground. “Are you OK under there? We’re outreach workers. We’re just making sure you’re OK.”
Smith carefully pulls back an old U-Haul blanket. A man and a woman huddle underneath.
“Do you need anything?” Kaufmann asks.
Food, the man answers. “Please.”
Kaufmann buys two chicken meals and leaves the food on the ground.
Back on the street, Smith shakes her head. The need is great out here, she says.
“These are the people that society says are not worth our time.”
Hardest to reach
About a quarter of the nearly 3,780 homeless men and women in Rhode Island suffer from some form of mental illness, says Eric Hirsch, a Providence College sociology professor and chair of the Rhode Island Homeless Management Information System steering committee.
Nationwide, the numbers are about the same. Anywhere from 20 percent to 30 percent of the homeless population suffers from severe mental illness. By comparison, only 6 percent of Americans are severely mentally ill, says the Washington D.C.-based National Coalition for the Homeless.
They are among the hardest to reach, experts say.
Craig Kaufmann, a psychiatrist and outreach worker, navigates back alleys in Providence looking for those who need help.
Many struggle with childhood trauma and suffer again when they are forced into treatment or an institution, says Kaufmann. That makes them wary of any kind of outreach or help.
Smith adds that “often the only time they come into contact with the system is when they end up in a hospital ER room, or in the courts for crimes like panhandling.” They see the state system “as scary and coercive and not client-centered.”
Even if they want help, few can find the time. “They have to worry where they are going to eat or sleep each night. They have to worry about street violence, or someone stealing their medicine,” Smith says. Getting to a clinic can be a major hurdle. As a result, many live in the shadows of cities like Providence, Cranston and Pawtucket.
“They are sleeping at Waterplace Park,” says Don Laliberte, director of social services at Crossroads Rhode Island. “They sleep under overpasses, at India Point Park, at the Salvation Army or at Classical High School.”
Going wide
Case workers and providers are tackling the problem in a number of ways.
Years ago, social service agencies — often working with the state — focused on helping those homeless men and women who were the easiest to reach and treat. Agencies were rewarded with money, but they weren’t reaching the neediest population, says Don Boucher, assistant executive director at Riverwood Mental Health Services in Providence.
“If you came in for a pill every day, you could stay in the program for 20 years,” Boucher says. But the approach missed those who avoided the social service network.
Now, agencies are rewarded for more aggressive, far-reaching efforts. “It’s a much more recovery-based system. Five years ago, you could go deep but not very wide. Now you can go wide and less deep. But it means treating more people.”
That approach includes more housing vouchers and apartments for those facing long-term mental-health problems, physical disabilities, addiction, criminal records and other barriers to housing.
In 2006, Riverwood began finding apartments for the homeless through a program called Housing First, launched by the state and United Way of Rhode Island.
Since then, Riverwood and other agencies have helped the homeless — many of them men and women with mental health and addiction problems — move into more than 1,000 housing units.
According to advocates, the mentally ill become more stable once they are housed and receive ongoing support from case workers, psychiatrists and others. They spend less time in hospital emergency rooms, detox centers, shelters, prisons and jails. The reduction in emergency services and Medicaid costs could save taxpayers millions of dollars in the long run, say supporters of the housing program.
Opening Doors R.I.
In 2012, state officials adopted Opening Doors Rhode Island, a program to prevent and end homelessness in the next few years.
“If we can get permanent housing for those who have been living in our shelter system for years, we will be very happy,” Providence College’s Hirsch says. “My big concern is that we need to get back to building and rehabbing low-income housing. We are going to need units, just as we need rental subsidies for the tenants.”
The efforts echo those at the federal level.
On Thursday, the U.S. Department of Housing and Urban Development said the number of homeless Rhode Islanders has fallen by 7.2 percent since 2010.
HUD Secretary Julián Castro attributed the decline in part to efforts to find permanent supportive housing for the chronically homeless, including those suffering from mental illness.
In the last decade, advocates have fought for more money for rental vouchers, new affordable housing and service costs. Support from the General Assembly has been uneven.
This summer, lawmakers agreed to increase the real estate conveyance tax by 15 percent to raise money for the state’s lead hazard abatement program, housing rental subsidy, homeless prevention assistance, and housing retention assistance.
But some advocates worry the move won’t generate enough money to build new affordable housing, pay for rental vouchers and help agencies provide needed services to the homeless and mentally ill.
Still others worry that a looming $10-million loss in health-care services will affect Rhode Islanders with behavioral-health difficulties.
“The success that we’ve had around the rental voucher program and dedicated funding stream” from the General Assembly has helped, says Jim Ryczek, executive director of the Rhode Island Coalition for the Homeless. “But you have to see it in the context of the overall poverty” in the state, a high unemployment rate “and cuts in other programs.”
Housing is key
Crossroads Rhode Island, which runs the state’s biggest homeless shelter, focused on housing two years ago.
In July, the agency found a Providence apartment for 42-year-old Elizabeth Avanzino, who struggles with depression, posttraumatic stress syndrome and bipolar disorder.
Before she moved into the Henrietta Street apartment, Avanzino slept with friends, in shelters and on the street for nearly a dozen years. Avanzino, who lived for a time in Newport and Narragansett, worked as a waitress in Providence but also used drugs and was arrested for possession.
“I lived in tents and in cemeteries and in crack houses and in abandoned houses. It was scary. I was abused and overdosed. When you’re out there you’re not living, you’re surviving.”
Now Avanzino is seeing a doctor and attending classes designed to help her get a job.
“I feel like I’m living again,” she says.
A Styrofoam cross
Smith and Kaufmann end their Monday night outreach work in the Grace Church Cemetery.
In the last two months, two mentally ill homeless women — Wendy M. Tallo and Irene M. Weh — died in the cemetery, a neglected patchwork of weeds, trash and grass.
The graveyard is a gathering place for the homeless, even though it’s a favorite spot for drug users and prostitutes, too. People have been beaten and killed on the street, so the cemetery seems safer, advocates say.
In the dark, Smith and Kaufmann walk between the tombstones. Some graves lean forward. Others have fallen. Smith finds a Styrofoam cross decorated with red plastic roses, a marker for the 46-year-old Weh, who died in the northernmost point of the cemetery. Friends placed the marker there.
Farther away, the two caseworkers pass the spot where Tallo, a homeless 43-year-old mother, died. Police say she hanged herself.
At a memorial Monday, Tallo’s friends remembered her as a caring woman with a warm smile. A good friend, Ashley Flynn, said she tried to get Tallo to come home with her just before she died. But she refused.
Smith shines her light into the dark. No one should die in a cemetery, she says.