A Healing Sense of Community : Private Efforts May Offer Best Hope for Homeless

It is a spare, tiny room, with a crucifix in one corner and a pile of dirty clothes in the other. At times, Susan Shiffrin can hear annoying, boisterous laughter down the hall. But for now it is home, something the 43-year-old woman has rarely known.

“They can say I’m crazy, but you really don’t remember anything after electro-shock treatment,” she said with agitation, rocking back and forth on the edge of her bed. “Sometimes I can’t focus. Is that a crime? I didn’t ask to live on the streets.”

It is difficult to piece together the strands of Shiffrin’s troubled life, but this much is certain: she is bright, has been a patient in several mental hospitals and until recently was homeless, living in cheap downtown hotels or on benches in Central Park.

All that changed last month, when Shiffrin was given a room at the St. Francis Residence, a former single-room-occupancy hotel converted by Franciscan priests into a 90-unit rooming house for people like her. Psychiatric care is available, but so are hot meals, clean sheets and a firm promise that Shiffrin can stay as long as she likes.

“These people needed help, and it was clear that putting them in large shelters or impersonal hospitals was no solution,” said Father John Felice, who helped open three St. Francis residences in lower Manhattan. “For us, it was an act of simple human decency.”

Across the nation, there are only a handful of community homes like the St. Francis Residence. Most are funded privately, with no long-term aid from federal, state or local governments. Sponsors believe these projects represent the best hope for America’s nearly 250,000 mentally ill homeless people.

In Los Angeles, which has an estimated 30,000 homeless persons, there is no program like the St. Francis Residence. Community activists and local officials hope to open at least one such hotel within a year, but meanwhile there is no source of permanent, community-based housing for the city’s nearly 10,000 homeless mentally ill.

As a result, growing numbers of street people continue to crowd the city’s downtown area and outlying neighborhoods, many of them showing obvious signs of mental distress. Los Angeles’ response has mainly been “stop-gap” programs offering food, medical assistance, temporary shelter and counseling, according to Mollie Lowery, who directs a Skid Row agency dealing with the homeless mentally ill.

Variety of Programs

Elsewhere, cities like Philadelphia, Chicago and Seattle have come up with a variety of programs--some attempting to duplicate the St. Francis approach and others simply trying to meet the emergency food and shelter needs of a troubled and sometimes volatile population.

It is often an uphill struggle. Efforts to open permanent housing for mentally ill street people have run into local opposition from New York to San Francisco, and as a result sponsors have fought battles to convince residents that their newest neighbors are not a threat.

Above all, these advocates believe it is wrong for society to “wash its hands” of the homeless mentally ill by warehousing them in large shelters, where there are no specialized services for them, or by sending them to costly mental hospitals.

The reasons, mental health professionals say, lie in the special characteristics of the nation’s homeless people.

Research has shown that 20% to 30% of the homeless are mentally disabled, suffering from differing degrees of depression, agitation, schizophrenia and withdrawal, according to Dr. Richard Lamb, a USC psychiatry professor and expert on the subject.

Some are former patients of mental hospitals who have been discharged into the community. Others developed these problems more recently and have not found help, given the shortage of psychiatric hospital beds in most American cities, he said.

A few may require long-term care in state mental hospitals, but the vast majority do not, according to a growing number of mental health professionals.

Psychiatrists contend they can “stabilize” most through psychotherapy and medication with drugs like Thorazine and Haldol, Lamb said. More important, many of the experts believe that such treatment is best carried out in a community-based facility.

A key reason is that patients receive more personalized care in a smaller setting, and benefit from a homelike environment where they can observe normal life around them.

Structured Home

“Anyone who has worked with this population realizes that, for most, the ideal solution is referral to a structured home in a (residential) neighborhood,” said Amelia Klein, a social worker who directs a placement program for mentally ill street people in Philadelphia.

“These people are vulnerable and need care . . . but they can learn to live useful lives in the community,” she added. “They may not turn around and work 40 hours a week anytime soon, but neither should they be sent to a hospital where society may forget about them.”

The experience of the St. Francis residence is a case in point.

Earlier this month, several residents at one of the Manhattan hotels spoke proudly of the weekly workshops they attend, all designed to give them job skills. Joseph Brown, a schizophrenic who once lived in Central Park, said he stuffs envelopes and hopes to get part-time work next month.

His girlfriend Rochelle Zeigler said she puts perfume bottles in boxes and also hopes to find a part-time job. The shy woman added that she must take medication to “drown out the terrible voices” she used to hear, but still shows up for her workshop four days a week. Such individualized help can rarely be provided in large institutions.

Most important, clients who spend time at the residence tend to pull their lives together--and stay off the streets--far more than people who were treated in other city facilities, such as hospitals and shelters, according to several studies.

A recent report by New York’s Bellevue hospital, for example, showed that a group of homeless schizophrenics who were referred to the residence and then tracked for a year spent an average of 20 nights on the street. That compared with an average of 121 nights on the street spent by those referred to other institutions and programs.

The difference, says Felice, is that his case workers can pay more attention to individual patients and respond to danger signals, such as friction with other residents or feelings of isolation, long before they cause someone to disappear back onto the streets.

‘Just Takes Willpower’

Felice says the St. Francis model could be duplicated in other cities, adding: “The point is, you have to want to do it. There’s no magic formula here. It just takes willpower.”

It also takes money.

The Franciscans’ New York hotels, for example, cost several million dollars to acquire and rehabilitate. Most of the funding came from private donors, supplemented by state and city grants. At one point, a developer who had illegally demolished several low-cost hotels was ordered by the city to pay the Franciscans $1.9 million to help buy a new residence, as part of his punishment.

But other groups have been intimidated by the substantial start-up costs, and by the scarcity of public money earmarked for such facilities. With mental health care traditionally centered on large institutions, federal and state governments continue to channel the bulk of their resources to hospital care, even though a growing number of the mentally ill live outside those facilities.

“If you don’t have a large amount of money up front, you would have a tough time opening one of these homes,” Felice said. “But the crazy thing is, even with that expense, it’s still a lot cheaper to run one of these than to care for people in hospitals.”

Since the first St. Francis Residence opened in 1979, the living subsidy for each patient has averaged only $15 a day, after a portion of each resident’s federal disability check was collected for rent, Felice said. By comparison, it costs New York an average of $136 a day to care for a patient in a mental hospital.

Besides money problems, homeless advocates have also faced protests and legal challenges from residents who do not want such community-based facilities in their neighborhoods. In a number of local battles, neighbors have contended their property would decline in value and that their safety will be threatened.

Research on real estate values in communities before and after these facilities open their doors has found no marked effect, according to Jennifer Wolch, an urban planning professor at USC.

But that has not defused the problem, she said, adding: “In deciding whether to open such homes, local officials often forget that the issue is as much a political, planning decision as it is a financial consideration . . . . It’s a very important part of the whole process.”

Despite these concerns, a number of cities and private groups are exploring innovative approaches to help the homeless mentally ill.

In Philadelphia, city officials became alarmed by the rapidly growing number of mentally ill street people and combined all of the public programs aimed at them and then focused on the most severely disabled.

By pooling state and municipal funds, the city acquired a series of homes in residential neighborhoods and began offering special treatment. Marvin Levine, a city official who helps direct the program, conceded that the 400 residents of these homes are only a tiny fraction of those who need help among Philadelphia’s approximately 13,000 homeless street people. Still, the program is growing and provides “quality care, humane, individualized care, and to us that is very important,” Levine said.

Women of Hope

One component of Philadelphia’s effort is Women of Hope, a 24-bed dormitory in back of a church operated by the Sisters of Mercy Hospice. The project offers permanent shelter to mentally ill women who have been tossed out of other city programs because of anti-social behavior.

Social workers build trust with these women by offering a “low-demand” environment in which they are not expected to socialize, take showers or clean their rooms until they are ready to do so. Progress is slow, but some clients have shown improvement, said Supervisor Vernnie Vereen.

In one case, a woman often prowled the church parking lot at night, screaming about “gargoyles” and “veils,” and enraging neighbors. The woman gradually reduced her nocturnal shouting after staff members began to gain her trust.

In San Francisco, homeless advocates have launched a “Self Help Clinic” in the seedy Tenderloin district that provides counseling by former street people themselves. This approach was tried because some street people suffer from a paranoia that can be difficult for a traditional case worker to penetrate.

Clients who wander into the storefront center are not expected to keep regular appointments, take medication or perform any other tasks. The goal is to build trust between street people and social workers, a process that usually take many months, said Sara Colm, an activist who helped organize the program.

Even when some clients make progress, homeless advocates are often overwhelmed by the sheer numbers of people who are not getting any help. In Seattle, the directors of several shelters for mentally disturbed street people are pessimistic about the future.

“The system here is completely overwhelmed . . . sometimes I think that we’re nothing more than a well-intentioned Band-Aid on a festering social problem,” said Ken Cole, who helps operate the Downtown Emergency Service Center, which served more than 5,000 people last year.

In Los Angeles, homeless advocates say they are trying to meet the emergency needs of street people, but concede that the absence of permanent, low-cost housing for the mentally ill complicates their efforts.

Ralph Mitchell, director of the county-run Skid Row Mental Health Services, said his office provides a variety of services to homeless men and women, including psychiatric counseling, medication, referrals to shelter beds and help in applying for government benefits, such as Supplemental Security Income payments.

Although there are several Skid Row hotels where homeless people can stay, Mitchell said they are not geared to the mentally ill’s needs. A project to designate one such hotel for these people is “just getting under way” and is not expected to be completed for another year, he said.

Mollie Lowery, who runs the Los Angeles Men’s Place (LAMP) on Skid Row, provides a more informal atmosphere than the county project. The homeless can come and go as they please, without appointments or requirements.

“We see our job here as being the first entryway into the system . . . the first place where they can get out of isolation and begin reconnecting with people,” she said.

80 Clients a Day

The project, which receives private and county funding, sees about 80 clients a day. In the past few months, LAMP has rented several apartment buildings around the city to house mentally ill homeless people.

“Truly, we have a long way to go here,” she said. “And in terms of providing real housing for these people, we are light years behind the East Coast.”

Back in her room at the St. Francis Residence, Susan Shiffrin lights a cigarette and begins talking rapidly about socialism, family members who no longer visit her and her favorite lines from “The Rime of the Ancient Mariner.”

At times, it sounds like babble. But she suddenly pauses, recites parts of the poem with conviction and speaks sadly about “the dark voices out there” that come looking for her.

Staff workers say it may be a long time before Shiffrin is capable of taking care of herself, but no one is rushing her. More important, she has her own space.

“For now, I guess I’m staying here,” Shiffrin said softly. “Where else would I go?”