Get Off The Street

Homeless & Mentally Ill

originally published November 8, 2006

What puts many homeless people on the street is not an unwillingness or physical inability to work, but rather an internal struggle with mental illness or substance addiction. “Mental illness or addiction definitely impacts a person’s ability to maintain an income or secure housing,” says Laurie Wilburn, Adult Mental Health Services Coordinator for the Athens office of Advantage Behavioral Health. “Add to that being homeless, and it’s really hard to escape the situation.”

The 2006 homeless count commissioned by the Athens-Clarke County Department of Human and Economic Development shows that 26 percent of the county’s 475 homeless people suffer from severe mental illnesses. Chronic substance abuse affects roughly half of the county’s homeless population.

Courtney Davis, Executive Director of the Athens Area Homeless Shelter, sees first-hand the connection between mental illness and homelessness. The shelter runs a job training, referral and education program for its clients, and of the 299 participants it served in 2005, Davis said 40 percent suffered drug abuse problems, 29 percent faced alcohol addiction and 16 percent were mentally ill. “These people have a difficult time keeping a job,” she says. “Without treatment, they simply aren’t going to be able to work.”

As the homeless struggle with substance abuse and mental illness, Athens’ two hospitals are often left to foot the bill. Specific figures are not broken out for homeless populations, but in 2005, the two hospitals spent a combined $47.5 million in charitable care (a figure given this year by hospital officials and included in the “summary of learnings” released by Partners for a Prosperous Athens in August). Although hospitals are legally required to provide emergency care to anyone who walks through their doors, the emergency department is the most expensive and least cost-effective way to provide care. Emergency rooms are not able to provide the long-term treatment needed to manage mental illness or substance abuse problems. Homeless patients with these complicated problems are often admitted to the hospital for a few days and discharged onto the street before out-of-control symptoms bounce them back to the emergency room. “Trying to manage your symptoms if you’re homeless - it’s just not going to happen,” Wilburn says.

A study published in the July issue of the journal Psychiatric Services describes a more effective approach to managing substance abuse and serious psychiatric illness in chronically homeless adults. Two Berkeley researchers examined homeless patients at two supportive housing shelters that provided long-term treatment of mental illness and substance abuse. The key element in the study was the on-site support provided to residents, who did not have to be concerned about finding housing. The researchers found that providing housing along with on-site treatment significantly reduced the number of emergency room visits among those patients. Analyzing 173 participants over a two-year period found that placement in a supportive housing facility - where on-site treatment was provided - reduced costs by about $1,300 per person in emergency care.

Although Athens does not have a residential treatment facility like those available in San Francisco, the Assertive Community Treatment (ACT) program managed by Advantage Behavioral Health is similar. This small, taxpayer-supported program combines housing with 24/ 7 access to mental health care. “What can cost the hospitals up to $500 a day runs about $30 a day with an ACT client,” Wilburn says.

Started in 1998, the ACT staff includes a psychiatrist, registered nurse, licensed therapist, substance abuse professional, vocational rehabilitation specialist, peer specialist and a paraprofessional. Using housing vouchers to place participants in apartment complexes throughout the community, ACT staff members maintain a close relationship with patients. Though its scope is limited - with a budget only able to serve roughly 40 people at one time - the program has proven successful at taking homeless people with a mental illness or substance abuse problem and transitioning them back into society without adding strain to the local hospitals.

Advantage recently applied for more money to expand the ACT program, but did not receive that highly competitive grant, Wilburn reports. “There’s so much emphasis on emergency care and treating the results of the problem, whether it be through the hospital, jail or courtroom,” she says.

But a program such as ACT usually alleviates the future need to use such expensive resources. “We are usually able to transition people out of the program within six months,” Wilburn says. “This really takes a long-term financial burden off the hospitals, police departments and courts.” And for the patient, it takes them off the street and puts them back into society.

Joe Dennis

joe.dennis@yahoo.com