HOSTest with the Mostest

Mental health workers going out into the community are more effective than those sitting in offices.
Duh.

I might not still be alive if it weren’t for DESC’s mental health outreach program. My life certainly wouldn’t be what it is now.

I have bipolar disorder. There is a lot that can be done for that condition, but if it isn’t diagnosed, or treated, it gets progressively worse. So it was progressively disrupting my life, until in October 1995 I found myself 45 years old, just coming out of a depression that lasted eight months, sick, out of work, broke and homeless, isolated from my family and almost everyone else in my life.

I went into the Wintonia Apartments to ask advice, because it was the only low-income housing place I knew. They directed me down to Angelines.

Angelines has a lot of reference information. When I walked in and explained my situation, God bless ’em, they gave me a whole packet. There must have been two dozen sheets of contacts for shelter, housing, food, clothing, medical care, you name it. And they said I could use the phone, free, to call any of them. This is generous help.

I … went … to … the … phone … and … called … the … YWCA … shelter … got … the … voicemail … left … a … message … sat down … on a couch … and stayed there the rest of the day. I had used my daily energy already.

That night they referred me to Noel House for shelter. One of the other women walked with me to Noel House, three blocks away, to make sure I found it.

That night was one of the nights that a DESC mental health outreach worker, Debbie Shaw, was at the shelter.

My entire family had bad experiences with doctors and psychiatrists: being misdiagnosed, getting the wrong treatment, having conflicts, etc. I did not find it easy to talk to everyone about my mental health and needing help. I did not find it easy to trust “social worker types.” But Debbie was so real, respectful, responded to me as an equal, she felt completely safe to talk to.

I had been up to Country Doctor Community Clinic, lucked into a doctor there I was comfortable with, gotten a diagnosis, and actually had a prescription for Lithium in my pocket. I didn’t have the money to pay for it. Debbie helped me get that prescription filled and get disability benefits, worked with me over the next few months as I got stabilized. She eventually helped me get housing, and finally helped me move in with furnishings from Sharehouse.

At that time, the mental health outreach program — a program in which case workers went out to the places where homeless people who needed mental health service were likely to be found — was called ACCESS. It was a pilot project of the Federal government, and Seattle was one of the few cities in the country where it was piloted. It was tremendously successful: according to studies of a similar program in California, mental health outreach services to homeless people result in a 78% reduction in hospital stays, 85% reduction is jail time, and shorter shelter stay.

The pilot program ended, however, and the Federal government didn’t finance a permanent program. The King County Mental Health and Chemical Dependency Department, however, stepped forward to fund a program for Seattle, and DESC (the Downtown Emergency Shelter Center) stepped forward to manage it. DESC has been in continuous operation for 21 years. Their mission is to serve the most vulnerable homeless people: those who are mentally ill, medically compromised, chemically dependent, men over 55, and all women. DESC calls their program HOST (Homeless Outreach, Stabilization & Transition). An extension of the program, continued support for people now in housing (the program I’m in now) is called SAGE (Support, Advocacy, Growth & Employment).

90% of the funding for these programs comes from King County, but 10% comes from the Federal government, from a program called PATH (Projects for Assistance in Transition from Homelessness). PATH funding requires periodic community meetings where the program is explained and community members have the opportunity to present evaluation and needs. The May 15th meeting was a PATH-required community meeting.

HOST case workers are looking for people who aren’t looking for help, or who would not be able to locate help on their own: people who are confused and/or with limited mobility, like I was; people who have survival needs, but don’t believe they do (after you have lived in extreme deprivation long enough, you adjust); people who deny that they are ill, who distrust “the system” because of bad experiences or other trauma or their illness. HOST workers meet us where we’re at, not just physically. If I had been willing only to accept food and shelter and someone to talk to, Debbie would have provided that and waited until I trusted her enough to go a bit farther. Sometimes it takes a long time. Sometimes a case worker will see someone on the street several times a week, a few minutes each time, giving them dry socks and sandwiches, before that person is ready to take the next step.

This is healing by relationship. It is slow, and it can be frustrating. In these days of pressure to prove “outcomes” by statistics in order to get funding, “We need the Big X’s – people we can fix up and throw into our Win box,” as Greg Rennebohm of the Mental Health Chaplaincy puts it. But the “official office” approach has its own inefficiencies, as Greg demonstrates with an anecdote. A man came into one of the community mental health clinics. He was given a standard series of questions, and was wildly off on what day it was, what time it was, where he was: he thought that Eisenhower was the President. He was “indigent” — broke, homeless. The “intake worker” noted that he definitely qualified for services — and gave him an appointment for 10AM the next morning.

Who thinks he made it to the appointment?

Everyone at the meeting testified to the value and the wonderful work of HOST. Others, however, testified to continued need. With eleven case managers in the downtown area, two in the University District, one to visit Capitol Hill a few hours a week, and similar coverage across town, HOST is spread thin on the ground. Elaine Simons, of PSKS (Peace on the Streets by Kids from the Street) testified to urgent needs on Capitol Hill. PSKS now has an office, and has youth coming in asking for services that they cannot provide, and they don’t know where to refer them because everything is overloaded. Alfred, one of the youth with PSKS, described a friend who “travels from one end of Capitol Hill to the other and only knows one face, mine.”

Alfred says we need to help younger people now because they are going to be the 55 and older mentally ill homeless people later. Alfred says we need to help everyone. We know how to do it.

Will we?

May 31, 2001 Column for The Great Speckled Bird emagazine