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Mentally ill fall deeper into crisis on the streets of California's Shasta County

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Mentally ill fall deeper into crisis on the streets of California's Shasta County

Picture of Alayna Shulman

This series of articles examines the fragmented and overwhelmed mental health system in Shasta County and how its failings impact patients and public safety, and contribute to the problem of homelessness. The project was produced through the California Health Journalism Fellowship, a program of the USC Annenberg School for Communication and Journalism.

Other stories in this series include: 

Kim Stanley, left, talks to Dr. Douglas McMullin and Erin Sweet, a licensed vocational nurse, both with the Shasta Community Health Center, last month at her camp.
Record Searchlight
Thursday, December 17, 2015

In the tangled Manzanita woods of north Redding, Dr. Douglas McMullin approaches a small, rain-splattered tent.

“Anybody home?”

McMullin maintains the gesture of knocking, even though the sound is barely audible on polyester.

Kim Stanley, 49, emerges from a nearby tent — that one is just a “guest tent,” she explains.

A case manager for Shasta Community Health Center’s Health Outreach for People Everywhere (HOPE) Van, Heather Russell, recognizes Stanley. She asks how she’s been.

“Betters; betters. I have up days, bad days.”

Stanley’s bad days are probably worse than the average person’s, though — she is both homeless and mentally ill.

“Every day is stressful out here. You’re tired; you’re exhausted ... and when people treat you badly for no reason, you’re crushed; you’re overwhelmed and crushed.”

While local officials say it’s hard to gauge the number of homeless people in the area at all — let alone how many of them have a mental illness — the estimates are high. And experts say it’s not just the numbers that matter.

In some cases, untreated mental illness adds to a climate of fear toward homeless people, if the person’s disorder or the substances used to self-medicate lead to antisocial outbursts or just bizarre behavior. In others, mental illness and homelessness combined simply creates an unthinkable social and medical condition for those going through both.

It’s at this intersection that McMullin works. He, Russell and a few medical residents at Shasta Community do “street outreach” like the kind that led them to Stanley almost every week, and McMullin estimates at least 70 percent of the people he encounters don’t just have a mental health issue but one that “contributed hugely” to their becoming homeless.

“It’s just hard to get things organized in their head,” McMullin said. “It makes it extremely difficult for them to kind of do what the rest of us have learned.”

Other estimates of the scope of the problem vary. The city of Redding and Shasta County Homeless Continuum of Care Council’s most recent yearlong survey on homelessness from 2012 found that 26 percent had a mental illness, though that’s based on self-reporting. State and national studies generally estimate about a quarter to a third of the homeless population have a severe mental illness, such as schizophrenia or bipolar disorder — not just a more manageable mood disorder.

Those lower-level mentally ill people are the ones for whom becoming homeless could trigger a full-blown episode.

“Mental health is a huge issue with (homeless) people, whether the mental health issues helped lead to their homelessness or the mental health issues came about because of experiencing the devastation of homelessness,” said Rev. Andy Bales, chief executive officer of Union Rescue Mission in Los Angeles, noting that some 90 percent of the women who stay at his mission suffer from at least depression because they’re often victimized on the streets.

And experts say the toll of homelessness is not just borne by those living it — the cost to treat homeless people in emergency rooms or arrest them is essentially billed to taxpayers and the insured.

“It’s a gross misuse of ER. If you get in a car accident and you’re bleeding to death, you want that ER to function really well and not be just bogged down with a lot of other issues,” McMullin said. “It’s something we really should look at if we want to help fix this. ... We’re all paying for this, and we’ll find out what that’s costing us.”

Talks are underway to stop the cycle of mental illness either leading to or being worsened by homelessness, and one next step is determining that cost. Redding City Councilwoman Kristen Schreder has piloted a homeless study to reveal the true scope of the problem and then develop a plan for it.

“We don’t have good data,” she said. “We get that number, and we can say, ‘Oh, if we continue on the path were doing now, here’s what it’s going to cost.’ And the alternative can be spending money, but in a different, more directed way.”

In the meantime, government agencies and nonprofits are doing what they can, but acknowledge the inherent difficulty in treating someone with a severe mental illness and without a home address.

“You try. But we go once a week,” McMullin said. “What happens to them the rest of the week?”

WHY I’M OUT HERE

The street outreach team members hunker down to fit under a makeshift tent covering Ray Delgado: a pile of clothes serving as his bed; an actual blanket covering him, but protected from rain by a garbage bag.

“Come into the house, y’all,” Delgado, 48, says with a smile.

The team is familiar with Delgado, so McMullin starts to examine an old injury on his leg.

“How you doin’, Doc?” Delgado asks in his gravelly voice. He’s wearing a black baseball cap imprinted with “THE GOLDEN STATE”.

“Thanks for letting us come in your house,” McMullin says as he continues cleaning Delgado’s wound.

It’s nothing, apparently.

“Aw, man — this is what our house is all about.”

The questions turn back to Delgado, and he assures the team he’s staying dry on this rainy fall day. He’s immobile, so it’s important the team makes sure he’s warm where he is.

“Hey, this is what the outdoors is like, you know? Twelve jackets and a couple shirts,” Delgado says.

While Delgado seems cheerful on this sunny fall morning, it’s a temporary facade.

“I think I’m in a permanent depression,” he says, his face growing serious. “That’s why I’m out here.”

Russell reminds Delgado that she has an apartment reserved for him through a local nonprofit, but he just needs to pay an outstanding $200 electric bill from his old home.

He has to pay off a few other debts, he says, and then he will.

Until then, Delgado says there’s a silver lining to being homeless and depressed.

“I fit in out here. I think we’re all depressed in one way or another.”

As the team hikes out from Delgado’s camp, a friend of his calls out to them.

“More people like you out here, this town would be a whole lot better.”

FINDING THE WILL TO EXIST

Under a bridge in the heart of town, the team calls out to see whether anyone is behind the pinned-up blanket acting as a wall.

A young man stands up, groggy but polite as he apologizes for the mess.

“It looks like my bedroom — you’re good,” McMullin quips.

Russell asks how the man is doing. He’s just trying to find the motivation to get up, he tells her.

The bridge has apparently been a hot spot for some time, splashed in all kinds of nihilistic graffiti deriding men, love and God.

The man tells the team his own actions landed him on the street. His girlfriend is the one who really needs the help, he says.

Some homeless mentally ill people either don’t realize they need help or are afraid or ashamed to seek it, said Ken White with the Good News Rescue Mission.

A few weeks ago, he spotted a man outside a gas station talking to himself. White talked and prayed with the man and bought him a meal, hoping he’d show up for the mission’s annual Thanksgiving banquet.

When the man walked through the door that day, White was overjoyed — but it was short-lived. White also saw on the man’s record that he had only come to the mission a few times to take a shower, not to access any of its rehabilitation services.

“There was obviously mental illness there. And those are the folks that my heart just breaks for, because they’re so hard to help, because so many of them won’t refer themselves here for care,” he said. “We’re hoping to help those types of folks, but sometimes those are the hardest to help.”

And the Rescue Mission can only do so much. While it has a counseling program, it doesn’t have doctors on staff or a clinic to treat severe mental illness.

“It’s not nearly where we need it to be,” White said. “I strongly believe there’s a significant population out there that we’re not touching.”

McMullin guesses the man under the bridge has bipolar disorder, which — left untreated — can include a short fuse that leads to interpersonal issues.

What tipped him off?

As the team got ready to leave, one of them asked the man: What got you here and what keeps you here?

“People.”

BY HERSELF

Russell and McMullin approach a small tent facing the Sacramento River and ask whether the woman inside needs anything.

An exasperated voice replies.

“I need to sleep. If you have anything, you can put it down. If not, I just need to rest.”

Since it can be hard to locate homeless patients — and many of them watch out for one another — McMullin asks whether she’s seen one of the other campers, Rose.

“I don’t know anyone,” the woman says, the irritation in her voice growing.

Apparently sensing it’s time to leave her be, Russell tells the woman she’ll just leave a business card in case she needs anything.

“I don’t want your g--damn card!” the woman screams, her voice rising to a hoarse shriek.

“OK,” Russell says. “Have a good day.”

The team quickly files out as the woman continues to shout after them.

“You son of a bitch! Get the f--- off.”

They never get a clear picture of who the woman is or her condition, but McMullin knows an episode when he sees one.

“That is mental health in action. ... Most of us would take hours to get to that (level),” he says. “I always have, like, a first gut reaction ... and then I go, OK, if I hadn’t slept for two weeks ...”

Indeed, they try not to take such aggression to heart.

“I don’t ever take it personally,” Russell said, though she noted that incident was the worst aggression she’s encountered in six years on the job.

Those kind of anger symptoms associated with untreated mental issues can be the exact reason someone ends up homeless — and why he or she stays that way, McMullin said.

“We all have our little fuses, but what if it was really short and you couldn’t even deal with people? How could you find a job, a place to stay tonight, anything like that?” McMullin said. “Brain or mental-health issues are physical, and for people to try to do better, you need to have them in a stable setting and the right medications administered regularly. That’s only going to happen if they’re in stable housing. You can’t give a homeless person stable medications. ... If she were on medication, she would be able to deal with that.”

Later, the same woman can be heard screaming from a hundred yards or so away.

“Shut up! Shut up!”

Russell says she doesn’t like the sounds of it — the team should go make sure no one is bothering her, she says.

A man rushes over to the HOPE team as they carefully descend a leaf-covered embankment toward her tent. That’s his girlfriend, the man explains, and she’s bipolar.

Russell tells him that they just want to make sure she’s not being bothered.

“No, no,” he says. “She’s by herself.”

After the team makes sure she’s alone, the man slowly enters the tent, and the woman begins to sob.

GETTING THROUGH TODAY

Rose Cash sits in her wheelchair under a tarp draped across some tree limbs as the HOPE team chats with her.

But her attention keeps shifting to a loud group of men nearby.

“Are those nice guys or not?” McMullin asks protectively.

“Yeah,” she says, not sounding fully convinced. “They’re nice.”

Two female members of the team remove Cash’s soaked plaid jacket so they can take her blood pressure. Once it’s off, Cash realizes the drenched garment was actually making her colder.

Cash has a litany of problems: She’s coming off heroin, has spina bifida, and keeps getting robbed because people know when she gets her disability payment, she says.

But there’s something darker that keeps her down.

“You know the reason why I get sad and depressed and stressed out? It’s because I have a 2-year-old. And, like, instead of me, like, being the mom that I should be, like, I’m out here being selfish, like, getting high off of meth or whatever. And I keep myself high so that I don’t think about that and think about how f---ed up it is that I’m not there for her,” Cash says, breaking into tears. “That’s what I’m going through.”

Situations like Cash’s are not uncommon, said Denise Morey, who has worked in case management and transitional housing for mentally ill people.

“People with mental health issues, they turn to drugs to escape memories,” she said.

And the combination of being stressed from homelessness and personal woes can make it hard to put in the legwork to get into a home.

“If you don’t have a place to live that’s safe and secure, then you’re always worried about, ‘Where am I going to get food? How am I going to not get beat up by the guys who want my money or my stuff?’” McMullin said. “The imminent issues of surviving today are overwhelming, and that person can never move on to think more long-term, like, ‘How can I get a job? How can I get out of this? How can I save some money?’”

HOUSING FIRST

McMullin believes the way around that quandary is the Housing First model, in which chronically homeless people are provided with housing and case management before they’re off drugs or rehabilitated in other ways. The idea is, a stable environment can facilitate recovery.

“In this field, we say housing is medicine, because that’s when you start to solve problems,” he said. “It’s really clear their problem is homelessness. You solve that problem, you solve this problem.”

The Housing First model that Lloyd Pendleton, former director of the Utah Homeless Task Force, pioneered in his state has made national headlines since it was implemented in 2005. The area’s chronic homeless population is down 91 percent, Pendleton said.

“This small population is very expensive; here’s a more humane and economic way to address their issues,” he said.

Tenants pay a portion of their own rent and have requirements, but otherwise aren’t forced to become model citizens before getting into a unit, said Pendleton, a retired Ford Motors executive.

Not only does the program save money — or, at worst, break even — it treats people with humanity and makes space for those going through a temporary bout of homelessness without any drugs or alcohol involved. That includes families.

“We were able to absorb this increase in family homelessness because we took so many chronically homeless people out of the shelters,” Pendleton said. “If you take a chronically homeless person, put them into housing, you can put 10 people into that same bed over the next 12 months.”

Shasta County has two programs based on the Housing First model for families, but only a small one for childless adults that’s housed about 20 people since its inception in June.

That program — simply called the “unsheltered adult” program — isn’t funded in any way, so it doesn’t include rental assistance.

The program consists of one employee who helps chronically homeless adults without kids get into a home and then helps them stay there.

Melissa Janulewicz, regional services branch director with the Shasta County Health and Human Services Agency, said the program may seem controversial, but it’s proving time and again that it helps stamp out the root causes of homelessness.

“The philosophy behind Housing First is that housing is a basic human need, and if you take care of that basic human need, then other social issues can be addressed once that basic human need is met,” she said. “It is a different approach to homelessness, and probably not universally supported, but the research is showing it does make a tremendous difference. Once the roof is over a family’s head, they are so much more likely to address the other social issues in their life, if they’re not worried about where they’re going to sleep tonight.”

At the Good News Rescue Mission, Director Jonathan Anderson also has ideas for ending the cycle of mental illness and homelessness, an issue they talk about at the mission “all the time.”

The mission has a fairly new therapy program, but Anderson said he wants to see whether medical providers would be interested in having office space on-site so that homeless people could more easily get medical care, or at least come on-site once a month or so to give educational talks on mental health.

Bales, the L.A. mission CEO, said a similar collaboration has worked wonders at his shelter.

“It’s not taking away from the resources that we have to feed and shelter people,” he said. “So really, any community can pull partnerships together and make that happen.”

Having the services on site is important because housed people sometimes don’t realize how hard it is for homeless people to get around town, Anderson said.

“I’ll make space,” he said, “so people aren’t getting lost in the process of referrals and trying to figure out transportation.”

That complexity is a large part of what Cash says keeps her on the street.

“You gotta seek,” she said. “You think about, ‘OK, well, how am I going to get money? How am I going to eat?’ ... which sounds stupid, but ... I’ve got to stop and think about, ‘What am I going to do to get through today?’”

McMullin interjects to offer Cash some encouragement.

“I don’t see you staying out here forever. I just — I just don’t see that.”

“I don’t want to,” she says weakly.

“We’ve got to get you connected.”

Cash says she hears about people who are homeless for decades. She couldn’t even handle it after two months.

“I hate it out here.”

Cash is 26 years old.

BROKEN EVERYWHERE

Stanley, the camper in the woods, pulls down one side of her black sweater to show McMullin a shoulder injury from falling off her bike. But most of the visit is spent talking about her mental health. “There’s no safety, there’s no respect. That’s the whole thing — you don’t get treated like a person anymore. ... It creates your mental issues, because you’re attacked.”

McMullin asks Stanley whether she’d like help getting into some kind of housing.

“No strings?” she asks dubiously, her arms crossed. “I wouldn’t believe ya; I wouldn’t believe ya for the world.”

While Stanley otherwise appears to trust the HOPE team, she admits the treatment she’s received since becoming homeless — both from other homeless people and those who look down on her — has turned her cynical.

“I don’t believe in safety anymore. I don’t know. I was trusting when I got here. And somebody I trusted, a lady, tore my heart out, because it turns out she really is a dope fiend, and was telling me to celebrate recovery and took me into a great church. I don’t believe in safety and trust.”

What if it were true, that she could get into a home? Would she do it, they ask again.

“Yes,” she says — with one major stipulation. “If there was no people around me.”

But Stanley says she hasn’t lost faith entirely.

“I don’t believe in safety and trust; I believe in Heather,” she says, tears filling her eyes as she nods toward Russell. “She’s one of the goodness still out in the world.”

Stanley needs a hug, says Erin Sweet, a nurse with Shasta Community.

“Watch the shoulders,” Stanley says as they embrace. “I’m broken everywhere.”

[This story was originally published by Record Searchlight.]

Photograph by Andreas Fuhrmann/Record Searchlight.