The homeless mentally ill get a refuge and a fresh start

July 05, 1994|By Jonathan Bor | Jonathan Bor,Sun Staff Writer

Think of the homeless mentally ill, and someone like Norma Jean Wilson may come to mind. There she is, wearing everything she owns: three pairs of pants, two sweaters, three coats, sneakers without soles and two wool caps wrapped in scarves.

Matted hair hangs to her earlobes. Hands jitter as if electrified. Eyes dart from side to side, fixed on demons nobody else can see. Her speech is fragmented, all phrases with no thread.

She panhandles outside restaurants, collecting coins for doughnuts and thrift-shop clothes. She sleeps by day and walks all night, moving constantly in a city full of risk.

This was her life last October, when professionals at a storefront mental health clinic in West Baltimore first laid eyes on her. Since then, team members at ACT -- Assertive Community Treatment -- have guided her to a breakthrough.

Ms. Wilson, 49, now sleeps in the same bed every night, sees a therapist and takes medication that brings focus to her thoughts. And she speaks with a new vocabulary.

"Last night we watched television and went to a jazz concert outside," she says. "Someday, I want to learn to swim."

Sitting in a boarding-house bedroom, she wears crisp denim shorts and a clean knit shirt. She flashes a warm smile that puts others at ease.

As cities across the country struggle with homelessness, perhaps no population has proved more difficult than that suffering from severe mental illnesses such as schizophrenia, manic-depressive disorder and major depression. Poverty is just the beginning. Even if offered housing, many are too confused to pay rent, shop for food or prepare a meal.

Many find the street a welcome subculture that accepts them with few questions asked. On a given night in Baltimore, about 2,400 people are homeless, according to studies. About a quarter suffer from severe mental illnesses but receive only erratic medical treatment.

For 3 1/2 years, the ACT team has intervened in the lives of 120 of the city's homeless mentally ill -- packaging housing, substance abuse counseling, shopping trips and even showers with psychiatric care. The effort seems to be paying off. In a study, the University of Maryland compared the progress of 77 ACT clients with that of 75 "controls" -- homeless people who tapped the city's loose network of community mental health centers, hospital psychiatric wards and drop-in centers.

After one year:

* Eighty-one percent of the ACT patients were no longer homeless, compared with 60 percent of those receiving conventional services.

* Nine percent of the ACT patients were living on the streets, 10 percent in hospitals and jails. In contrast, 20 percent of their counterparts were homeless and 19 percent were in hospitals and jails.

* ACT patients made fewer visits to emergency rooms, spent less time in psychiatric hospitals, displayed fewer psychiatric symptoms and voiced greater satisfaction with their lives. More than 90 percent say they were involved in continuing mental health programs, compared with 60 percent of those who navigated the system on their own.

"It's a one-stop shop," says Dr. Anthony Lehman, director of mental health research at the University of Maryland Medical Center, which runs the program. "There are services in the community, but they are very fragmented. You can go to a community mental health clinic and get medication and treatment, but you probably can't get housing and case management there."

The team includes psychiatrists, social workers, nurses and former mental patients serving as "consumer advocates." In 1991, it was established with a $3 million, three-year federal grant. Now it runs off a state grant and Medicaid reimbursements. Funding is obtained by Baltimore Mental Health Systems Inc., an umbrella organization that oversees programs serving the mentally ill.

The team treats 75 people, most referred by hospitals, soup kitchens, drop-in centers and other programs. They have spent an average of five years on the streets.

Nobody has been able to determine how long Ms. Wilson was homeless.

"As best we can determine," says her psychiatrist, Dr. Ann Hackman, "this lady has years that are lost."

10th-grade dropout

This is Ms. Wilson's account:

In 10th grade, she dropped out of Southern High School to care for her two children, a boy and a girl. She moved into a Cherry Hill housing project, connecting briefly with other young women rearing families. But parenthood was overwhelming.

Occasionally, she would pay a baby sitter $100 and leave the house for a few days of drinking. Sometimes, she would pop amphetamines while drinking whiskey and beer.

"I couldn't make it by myself, so I gave the children to foster care," she says, adding that she saw them only a few times after that. She worked brief stints in a brush factory and a restaurant kitchen. For two years, she stripped on The Block.

For a while, she lived in cheap hotels, then she became homeless after repeated failures to hold a job.

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