Mentally Ill and Truly Homeless : Center to Serve Only Stable Clients With Kin

Anave Andrea Thomlison, 53, has seven children she hasn’t seen in years.

“They didn’t know how to deal with my mental illness,” said Thomlison, who is homeless and manic-depressive. “I am an embarrassment to my family. I feel like a leper around them.”

Thomlison, who has been living on the streets around the Santa Ana Civic Center for the past two years, said she has been raped and robbed and has tried to commit suicide several times.

Her only refuge has been a Garden Grove activity center, a United Way agency run by the Mental Health Assn. of Orange County, where she receives meals, counseling and lessons in coping.

She is among the county’s estimated 5,000 homeless and mentally ill people, about 3,000 of whom are served annually by the Mental Health Assn.

But as of Saturday, when the new fiscal year begins, county officials have mandated that the association eliminate services to the homeless and devote efforts to more stable mentally ill patients, those typically with homes and families.

Of the association’s $1.1-million budget, $800,000 comes from the county, said Sandy Cusmano, the group’s director of development. Because of the county’s bankruptcy, “the homeless are no longer a county priority,” Cusmano said. “According to our county contract, our focus is going to have to change from serving the homeless mentally ill to those under more stable conditions.”

Doug Barton, county deputy director of mental health, said programs for the homeless and mentally ill are most costly and least effective, because most of the patients don’t take their medicine regularly to stabilize their disabilities. Without a home and family, the homeless patients are hard to supervise and require more work, Barton said.

“The dilemma is that effective outreach is very expensive,” Barton said. “With a population that doesn’t comply with their medication, and with county budget cuts, we cannot afford to provide that level of service.”

Rather, county officials said, the money needs to target patients in crisis who benefit from short-term help.

Since 1990, the Mental Health Assn. has operated two centers in Garden Grove and Costa Mesa, where, on a daily basis, up to 90 homeless, mentally ill clients have received counseling and referrals, Cusmano said. The clients also participate in group counseling, trips to museums, the beach and the zoo. They come to shower, do their laundry, share meals, and look for jobs.

More chronic mentally ill patients are paired up with case managers who monitor their medication and help them find housing.

Outreach workers last year began combing Orange County streets in a 37-foot mobile home, picking up mentally ill patients being discharged from psychiatric hospitals or others at homeless shelters, and taking them to the centers.

Now, under the county’s directive, “the emphasis at the centers will be to serve the more stable, chronic and persistently mentally ill,” said Tim Mullins, director of the County Mental Health Department.

The new clientele will be adult outpatients who have stable living conditions, but need medication, vocational and rehabilitation services. A full-time psychiatrist and two nurses will be hired to offer them acute and short-term intervention, Mullins said.

Mullins said that programs for the homeless and mentally ill are targeted in countywide cuts because they are not cost-effective. And after last December’s bankruptcy cut the Mental Health Department’s $14-million budget in half, Mullins said, the homeless program had to be dissolved.

“We regretfully have to take two steps back,” he said.

The county will continue to pay for beds at various homeless shelters, he said, but the current 42 beds countywide for the homeless and mentally ill will be reduced to 18.

Tim Shaw, executive director of the Orange County Homeless Issues Task Force, predicted that more mentally ill patients living on the streets will reach a crisis point before they receive help.

“You’ve got people out there who are dually diagnosed with mental illness and substance abuse,” Shaw said. “Once they are off their medication and have no place to go, they just decompose.”

Mullins agreed that more of these patients now will end up in psychiatric hospitals or the victims of crime.

“They are the most vulnerable of all mentally ill patients,” Mullins said. “They tend to be victims, not perpetrators, of crime on the streets.”

Mullins said that many of these people have been on the streets since the 1970s, when a massive number of psychiatric patients were released from hospitals. The goal was to send these patients to community clinics or back into society. But many simply landed on the streets.

John Seltzer, a counselor at the Garden Grove activity center, knows the perils of the streets firsthand. He first entered the center several years ago as a client diagnosed with severe depression.

“I pretty much clung to this place when I was homeless,” said Seltzer, 26. “MHA allowed me to have my life again. I probably would have committed suicide if there was no place for me to go.”

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Homeless Health The number of clients served by the Mental Health Assn. of Orange County has grown steadily during the past five years. Total cases*: 5,620 Homeless cases: 2,965 * Estimated Source: Mental Health Assn. of Orange County