California Off Track with Homelessness & the Seriously Mentally Ill

James Mark Rippee, my brother, sleeping behind a wall on a bustling street in Vacaville, in Solano County, California as people go about their daily routines...

California has the most homeless people of any state. The state's homeless population grew 17% last year, according to recently released federal data, and the correlation between mental illness and homeless are especially high in California. Depending on the source, 40% to 51% of all homeless have some type of mental illness. My brother who suffers being blind, a Traumatic Brain Injury (TBI) and Schizophrenia with Anosognosia has lived on the streets in California for 13 years – after being evicted from his apartment and removed from the Section 8 housing program when in a delusional state – he set a small fire on his front porch. His serious mental illness ignored – by all the programs and services he was on… and he was left to wander the streets of our hometown sleeping behind dumpsters and buildings, including, ironically, the County Services building.

We do have an affordable housing crisis in this state... even those of us native Californians who do not suffer from mental illness cannot afford or even find decent housing without assistance, roommates, living with family, etc... and those who are physically disabled and on a fixed income especially - are always one month away from possible homelessness. Just imagine the obstacles that a person with serious mental illness would have in finding and/or keeping housing without assistance or services.

Treating those with serious mental illness must be the primary concern, but no person with serious mental illness can truly thrive while living on the streets even with treatment. It would bring the strongest of us spiraling into depression and anxiety and hopelessness. The shortage of affordable and proper housing options is even more pronounced for the seriously mentally ill. Not enough psychiatric beds, transitional facilities, or supervised group homes specifically for the mentally ill. And we must do better than just sticking them in “senior” or “memory” board & care homes. If the mentally ill do get treatment and services - they still need to be able to afford housing and have the right to not be discriminated against in housing assistance programs.

Short-term, temporary shelters do not solve the homeless crisis either and it will never be solved in our state or anywhere else in the nation until the root causes like serious mental illness are addressed along with needed affordable housing and especially supervised housing for those who have serious mental illness until they are stabilized and can transition to community housing. Just giving the seriously mentally ill tenancy referrals to community housing is not enough and throwing more money for pilot programs for serious mental illness of those who need help is like throwing uncooked spaghetti at a wall and expecting it to stick. Why do we need more pilot programs? It’s been established that almost half of the homeless are suffering from some form of mental illness. We already know that treatment, services, and placement in proper housing is the answer.

The new funds recently approved by our Governor in the state of California are being made only available to those seriously mentally ill who are declared incompetent to stand trial and have already committed crimes that would normally lead them into incarceration or state hospitalization. What about all the homeless seriously mentally ill who have yet to commit any serious crimes but are living out on the streets?

Why are our laws to protect the most vulnerable segment of the homeless population dependent upon them committing crimes before they can receive treatment, placement in the few psychiatric beds available, supervised group housing, or God forbid, permanent affordable housing?

We need to push for better legislation to get laws changed and updated for LPS & Probate Conservatorship, and change HIPAA regulations to allow significant others and family members of the seriously mentally ill to make decisions for their loved ones who are incapable of accepting help due to their mental illness, especially if they also suffer from anosognosia or lack of insight to their own mental illness.

Fixing the homeless problem encompasses much more than just providing beds in temporary shelters - especially when those beds exclude the seriously mentally ill living out on the streets! What is truly needed is more beds in psychiatric hospitals and supervised group homes or supervised housing with onsite mental health and social services.

The law regarding the IMD Exclusion needs revision or to be thrown out altogether. Medicaid or Medi-Cal as it is known in California will not reimburse any hospital if the facility has more than 16 beds. So, while more psychiatric beds are desperately needed there is disincentive as those facilities that could have more beds know that they won’t be paid if they go over the limit of 16 beds.

We must change the very definition of "Gravely Disabled," to include involuntary treatment to include "Medical Necessity" and add new supervised mental health residential facilities that are so lacking in our state and across the nation.

My own brother is exactly the kind of vulnerable, seriously mentally ill homeless person who would never benefit from our current lame and inadequate attempt at fixing the homeless problem. Being blind, disfigured, physically disabled, brain-damaged from a TBI, diagnosed Paranoid Schizophrenic with Anosognosia – no tenancy referral or help getting into community housing is going to help him. In fact, those are similar services who abandoned him and dumped him out onto the streets to begin with because they couldn’t meet his needs.

The seriously mentally ill are the segment of the homeless population that most people base their disdain and bias against, and certainly the most ardent cause of NIMBYism. People who at first, are disgusted by them or fear them eventually become desensitized to them - averting their eyes and wishing them away, and ultimately these lost souls become invisible.

Even our own state and federal government cannot see them. Oh, they know they are there but merely finding them an embarrassing blight on a sunny California landscape.

And some may say – indeed… accuse the family members of the seriously mentally ill of abandoning them to the streets even when current HIPAA laws do not allow immediate family members to be told anything about their affected loved one's medical conditions with serious mental illness, nor to have access to their medical records to pursue legal action, including the LPS Conservatorship court process in their attempt to protect the affected family member. Over the last 30 years my brother has been arrested 100 times. We checked with the county jail in Solano County to verify the number of times and the cost. But the county still refuses to assist our family with initiating a public conservatorship.

And the response is always the same – he has his civil rights… the laws, designed to protect his civil rights, have prevented those who love him the most from getting him into care and off the streets. Families must be listened to… Families, regardless of whether they have legal guardianship or not, conservatorship or not - should have the right to intervene and get their loved ones to treatment and the right of the seriously mentally ill should not mean that they have the right to die on the streets.

As Darold A. Treffert, MD, and Former Officer. American Association of Psychiatric Administrators, American Psychiatric Association and American College of Psychiatrists said,

"In the zeal to impeccably protect the patient's civil liberties and rights, an increasing number of troubled and psychotic patients are what I choose to term dying with their rights on."

If family members are helpless in trying to access care, in what way can they help their homeless loved ones with SMI? Yes, I said help - not fight homelessness. A war against homelessness is the phrase most often heard from communities and even lawmakers who just do not “get” it.

The fear that prevails along with stigma easily turns into an acceptable discrimination where people just want them off their streets and out of their communities – regardless that help for them is almost always elusive and unattainable. To ignore the seriously mental ill population of the homeless is punitive and undeniably preposterous when attempting to solve the homeless crisis in our state.

Our family has tried for decades to find help for our brother, and what we want for our brother is to get him assistance to get off the streets and to be safe and well-cared for... in whatever way that we can. We started out believing that we could get guardianship over a decade ago. We found out that couldn't happen and then also found out that there was no longer any such thing as a "Ward of the State"... so we learned about the Conservatorship process both LPS and Probate, and tried for years to make that happen, but was stalled at every corner we turned as our own County of Solano presented every obstacle they could put in front of us to block us from that goal.

All the while, people blaming our family and making unsubstantiated claims that we had abandoned him to the streets. We, more than anyone know what our brothers’ needs are and we understand he won't agree... because he does not even recognize that he has a mental illness -- let alone - brain damage from his original accident. Without that insight - he is not capable of making sound decisions and the law will not allow us as his family to make choices for him.

What are we to do? Just sit back and watch him die on the streets from the elements? Wait for a possible tragedy to occur with police? Or another car hitting him when being blind, he walks out into traffic, as just happened a few months ago? At what point is it apparent that all we are asking for is common frickin' sense? That we, as the people who love him most know what is best for him?

He is indeed a perfect example of the need to reform Conservatorship laws, and an example of why we need new and better psychiatric facilities with at the minimum of 3 times the number of available beds in every county in the state, or compassionate supervised housing that meets needs with on-site services for the seriously mentally ill.

Yes, there are many reasons for homelessness and many homeless are not always seen on the streets… There are the families that fell on hard times, the domestically abused spouses, or the single parents with children, who tend to stay as far out of the public's eye as possible for fear of losing their children.

Those who remain on the streets so visible - are far more unsettling types of homeless people… The vets, despondent and possibly suffering from a disability including PTSD, depression/anxiety or addiction… The drug addicts who so obviously need medical intervention and mental health treatment… and the seriously mentally ill, who do not even have the necessary ability to ask for help or to make the right choice when help has offered them. Those who cannot truly -of sound mind, make decisions about their own care.

Mental health advocates across our state and nation are frustratingly, screaming at the top of their lungs to get our government officials to address the root cause of homelessness and the issues of the seriously mentally ill as a priority - and soon. Only then perhaps there will be a serious reduction in the number of homeless on the streets with SMI. We need legislation to deal with this societal flaw that binds our hands as family members who want to find help for our loved ones. No one wants them off the streets more than their family members.

Too frequently they end up in jail rather than receiving help for brain illnesses that are not their fault. We need to get the seriously mentally ill into proper safe facilities instead of using our jails as "mental illness shaming & punishing facilities," or our streets as their de-facto “housing.”

Temporary or transitional shelters won't take the seriously mentally ill. When are State Mental Hospitals going to have beds available for other than the Criminally Insane who've already committed crimes going to be funded and built, and why do we not take care of the seriously mentally ill before they commit crimes or become homeless?

There is far-reaching agreement that the state’s extraordinary cost of living and escalating homelessness problem is rooted in a shortage of housing in general and a lack of lower-cost housing. However, there are two things for sure and that is we need more affordable housing and we need changes in the laws that allow the cracks in which the seriously mentally ill fall into and on to our streets.