Mental health options available to homeless

No one seems to know much about the homeless people who walk the streets of Oakland and… No one seems to know much about the homeless people who walk the streets of Oakland and occasionally wander into buildings at Pitt

They are just a few of the more than 2,000 homeless people living in Allegheny County, according to the Allegheny County Department of Human Services.

Approximately 22 percent of them suffer from a mental disorder, and approximately 24 percent of them have been diagnosed with mental and substance abuse disorders.

About 14 percent of the homeless have criminal histories, and sometimes these worlds – those of alleged lawbreakers and the mentally ill – mesh.

Some insist that the law ensures that people get the mental health care they need. Others say that sometimes people fall through the cracks of a mental health care system that’s a vast improvement from what it was 20 years ago but still has a long way to go.

Bennett says he only sporadically encounters people who are both homeless and suffering from a mental disorder and that, for the most part, they aren’t dangerous. Only in rare instances will they become a threat to themselves or others.

If, for instance, a mentally ill person stops in the middle of a busy street and fails to react when police try to intervene, the responding officers are forced to make a judgment call.

They give the person two options: First, officers can suggest a “201,” which means the person can be voluntarily committed to an institution like the Western Psychiatric Institute. Those who choose a 201 are free to leave the institution at any time.

Bennett said this sometimes poses a problem, as people who are familiar with the system will choose a 201 and then leave their treatment prematurely. They wander back onto the streets and become “nuisance people.”

More often, officers are forced to choose the second option: a “302,” or an involuntary commitment to a mental health care facility. Representatives from Western Psychiatric did not return phone calls inquiring about the 302 procedure. But Allegheny County processes approximately 5,000 302s each year, according to Denise Lamar, a court liaison for the Allegheny County Department of Human Services.

When the police take someone to the hospital, doctors have 72 hours to decide if the person presents a clear and present danger to themselves or others, said Frank Cecchetti, an attorney at the non-profit organization Mental Health America. He or she can then be hospitalized for a maximum of five days. If the doctors feel a person needs further treatment, they can ask the person to voluntarily commit, or they can petition the court for a 303, further treatment not to exceed 20 days.

Doctors can repeat this process if necessary, except the third time they can keep the person up to 90 days and the fourth time up to 180 days.

The county delegate must authorize all involuntary commitments.

Lamar said people considered for 302s must present a “clear and present danger to themselves or others,” and they can’t be under the influence of alcohol or drugs. A “clear and present danger,” she said, requires that a person not merely make a threat, but that they have a specific plan to carry it out. For example, they may say they plan to use a gun to commit suicide.

Adult patients keep their right to medical self-determination unless the courts take it away, either through the involuntary commitment procedure previously mentioned, or by appointing them a guardian.

“Some people simply don’t understand they’re suffering from a mental illness and do not see the effect it’s having upon themselves or others,” Cecchetti said. “As a preventative to harming themselves or others, involuntary commitment is quite appropriate.”

Some doctors say it may be appropriate for the police to 302 people, because they don’t have contact with them on a daily basis. But voluntary commitment is the goal.

“Sometimes the over-paternalistic or the pushy way to [get someone help] is to 302,” said Dr. Jason Rock, who works once a week at the Wood Street Commons homeless shelter, 301 Third Ave.

Rock once committed, against her will, a woman who disclosed suicidal thoughts to him. She was furious, he said, but he saw her later and she was recovering.

“I believe what you told me,” Rock said to her. “To not [302] puts someone at risk.”

Others agree that people do need help, but say that sending them to an institute like Western Psychiatric isn’t the solution. Dan Hawkins, a mental health advocate for Mental Health America, was dual-diagnosed with a mental disorder and a substance abuse disorder more than 20 years ago.

He was in mental health care facilities twice.

“A state hospital is the closest thing to incarceration,” Hawkins said.

Hawkins insisted that the homeless and mentally ill can look for alternatives.

The Allegheny County Department of Human Services publishes a list of mental health care facilities on its website.

Among the facilities listed are Mercy Behavioral Health, 412 E. Commons, and Operation Safety Net, 1518 Forbes Ave.

Shelter workers often help the homeless and mentally ill access county programs.

Rebecca LaBovick, a registered nurse who works at the Jubilee Association, Inc., 2005 Wyandotte St., and Wood Street Commons, among other places, said a doctor will fill out medical assistance applications for many homeless people. Other times they can “tap into” the county prescriptions program for samples of medications.

LaBovick estimated that more than 75 percent of the people who walk through the doors of the Jubilee Association are uninsured and marginally homeless or living in substandard housing. She said people can find themselves in these conditions for several reasons.

Some merely lose jobs. Others are restricted by their mental illnesses or drug dependencies.

Many people, she said, attempt to self-medicate themselves. Instead of taking the medicines prescribed to them, they purchase street drugs.

Hawkins, who was diagnosed with a drug dependency 20 years ago, said people “can get the same effects from street drugs that they can get from psychiatric drugs, but without the side effects.”

Cocaine, he said, can silence the voices in a person’s head, without causing dry mouth, weight gain or impotence.

Allegheny County Chief Executive Dan Onorato introduced a 10-year plan to end homelessness and its causes two years ago.

“Currently, strides have been made to co-locate mental health clinics and primary health care for the homeless clinics through a SAMHSA [Substance Abuse and Mental Health Services Administration] grant from the U.S. Department of Health and Human Services,” according to the plan.

“This process has allowed consumers who are experiencing homelessness, especially chronic homelessness, the ability to receive services in a more comprehensive and streamlined manner.”

An update to the plan, released Oct. 3, 2007, states that 808 people were housed in permanent housing for persons with disabilities programs last year.

Of them, 73 percent had serious mental health issues and 71 percent had chronic alcohol and drug issues.

Data collected by the Allegheny County Department of Human Services indicates that as many as 390 mentally ill people may still be roaming the streets. And their data isn’t complete.

A disclaimer on the bottom of the chart indicates that the data does not account for all the homeless people, only for those receiving services.

“We feel we’ve met some success over the past two years,” said Marge Lubawy, a spokesperson for the Department of Human Services.

But others have their doubts.

“Maybe they prefer to be on a specific street corner. Is it fair for us to tell them [to leave]?” Rock asked. “But to not make folks aware that there could be help, I wouldn’t want that to be an issue.”