Mind unsound, body unsheltered

Before being admitted into Chico’s psychiatric health facility, colloquially called the “Puff Unit,” more than a decade ago, Jimmy Shirah planned on killing himself by jumping in front of a train.

“My grandfather died by getting run over by a train, so I thought that was the way I’d go,” he said. “Then, I got to thinking about what my counselor said: ‘What about the people driving the train? That will affect their life. And everybody who loves you—that will affect their lives.’ I got to thinking, ‘Oh, man, you’re right.’

“But I was close a few times,” he added. “I was at a point to where everything did not matter.”

Before coming to Chico in 2002, Shirah was a gambler—“but not a winner,” he emphasized—in Reno, where for a stretch he depended on blackjack winnings to live week-to-week out of a motel. He lost everything. After hitchhiking to Oroville and staying overnight at the Oroville Rescue Mission, his search for medical services led him to Chico.

“I needed to see a counselor, I needed to get my meds in order,” he said. “I had my medication, but I had three different medications in one bottle. I didn’t really understand which one was which. I was just taking them.”

During childhood, Shirah was diagnosed with severe bipolar disorder, and ADHD (attention deficit hyperactivity disorder), symptoms of which only heightened during his first few months on the streets of Chico. The combination of medication and heavy drinking—mostly whiskey—made Shirah “feel like I was always falling asleep,” he said.

He drank the whiskey both to feel warm and to cope. But it was expensive, so he panhandled. He recalls sleeping on the back porch of a vacant home, in truck beds and in the hallways of professional buildings left unlocked, but never in campsites with other homeless people.

“I was really alone,” he said.

At a certain point Shirah became aware that his body was shutting down; his need for medical care was urgent. He had to get off the street. He did, in fact, make several appointments with case managers through Butte County Behavioral Health, but following through was another matter.

“I’d make an appointment, but rather than go to the appointment, which was my whole intent, something would trigger me and I’d go isolate,” Shirah explained. “A lot of it was self-sabotage. Something was going on in my brain that told me, ‘You’re not mentally ill.’”

Shirah’s general story is not unusual. That is to say, mental illness can be a major factor contributing to why people, in Chico and elsewhere across the U.S., end up on the streets and stay there.

And as the local homeless population has expanded over the past few years—about 1,550 countywide, at last count, compared with 1,380 in 2009—these public health issues have become increasingly high-profile. That’s especially true in Chico’s downtown, where it’s commonplace to see people grapple with the acute symptoms of mental illness.

But, strangely, Chico has a reputation as a community where services for those in need are readily available, as a city of bleeding hearts, which suggests a disconnect. Something must be keeping mentally ill people out of treatment and on the streets. As the CN&R discovered, a wide range of factors are at play, many of them related to mental function most people take for granted.

It’s worth noting that mental illness is not limited to the homeless community—it’s pervasive among the general population, too. According to a recent study from Mental Health America, 42.5 million adults in the U.S., or about 18 percent of the population, live with a mental health problem.

Meanwhile, the U.S. Department of Housing and Urban Development says about 20 percent of the 600,000 or so homeless people across the U.S. live with serious mental illness—defined as “resulting in serious functional impairment, which substantially interferes with or limits one or more major life activities.”

Based on his observations as executive director of the Torres Community Shelter for the past six years, Brad Montgomery agrees that mental disorders tend to be more severe among the homeless. “There’s no denying that there are a considerable number of people on the streets for whom mental health is a contributing factor,” he said.

In the 2013 Point in Time Homeless Census and Survey, conducted every other January by the Butte Countywide Homeless Continuum of Care, 23 percent of respondents said they live with a mental disorder. But coordinator Meagan Meloy said that figure comes with a major caveat—all of the respondents were “sheltered,” as in, spending nights in shelters, transitional housing, motels, or with family or friends. Those living on the streets full time might report higher rates, Meloy said.

As director and co-founder of the Shalom Free Clinic, along with the thrift store on First Street, Nancy Morgans-Ferguson is familiar with the “unsheltered” homeless people who frequent downtown. At the thrift store, Morgans-Ferguson and volunteers provide individuals who live on the street with basics like blankets and clothing, toiletries and whatever food is on hand.

“The people we see at the store can’t go to the Torres Shelter because they’re using, or went there and didn’t follow the rules, or because they have pets,” she said. “We regularly see about 100 homeless people, some every single day, and I’d say the majority of people we see are mentally ill.”

The perceived negative effects the presence of homeless people, along with the distinctly younger transient population, have on downtown businesses has been a hot topic both in the public and private sector for quite some time. Over the past two years, a group of business owners hired armed guards to rouse the homeless from sidewalks during the holidays, two charity organizations were told by park rangers they couldn’t set up food-distribution sites for the destitute at City Plaza, and the City Council passed the civil-sidewalks ordinance, which makes it illegal to sit or lie in pedestrian paths of travel adjacent to commercial properties from 7 a.m. to 11 p.m.

The community’s concerns have not been unwarranted. While it’s unfair to make generalizations about the members of a demographic or subpopulation, the behavior of some homeless people, particularly those suffering from mental illness, can be erratic and even frightening.

“The reality is, it does affect our quality of life to have hundreds, if not thousands, of homeless people living in our streets,” Montgomery said. “It affects us financially—people don’t want to go downtown and shop, businesses struggle.”

That affects the city’s coffers by way of reduced sales tax revenues. Meanwhile, the population strains the resources of the community’s public health and nonprofit organizations.

Take Enloe Medical Center, which annually writes off millions of dollars in charity care provided to homeless people who end up in the emergency department for both critical and noncritical conditions—and sometimes just to get out of the elements.

“We have a finite number of beds in the emergency room, and we’re trying to turn people over within two to three hours,” said Judy Cline, nurse manager of Enloe’s emergency department. “So, when you’re unable to disposition a patient because they’re homeless and on a 5150 [involuntary psychiatric hold], they’re tying up a bed for 10, 24 or 36 hours that eight or more people couldn’t use for a variety of other emergencies. It does have a tremendous impact when you only have so many beds.”

Lt. Dave Britt of the Chico Police Department said that, in a given year, officers might respond to mental-health-related calls more than 200 times—for a single homeless person. That’s certainly not the norm, but Britt said a small handful of severely mentally ill people on the streets demand much of officers’ attention.

Prior to 2012, officers with the TARGET team—whose mission was to target root causes of major community problems—would make a list of the individuals with the most calls and, with the help of clinicians from Behavioral Health, establish relationships with them to “really figure out what makes them tick and get them into treatment voluntarily,” Britt said.

But the TARGET team has been defunct since police staffing levels were cut in 2012. “Now, we’re putting a finger in the dike, stabilizing that situation and moving on to the next call,” Britt said.

Police do attempt to connect troubled people with Behavioral Health, but “they’re kind of tapped out,” Britt said. “They have limited resources like anybody else does. When we’re taking somebody over there, they’re triaging, trying to figure out who needs treatment the most.”

Jeremy Wilson, community services program manager at Behavioral Health, acknowledged that the agency’s resources are stretched thin. “Public systems are two to three years behind the recession,” he said. “Since we’re publicly funded, there hasn’t been the same level of funding as in the past. We’ve had to really narrow it down, make sure we’re doing intensive services first. But now that we’re starting to breathe after the recession, we’re seeing public funds slowly inch back up.”

Every year, Behavioral Health receives funding through then-Assemblyman Darrel Steinberg’s 2004 Mental Health Services Act (or Proposition 63), under which California’s wealthiest residents pay an additional 1 percent tax for every dollar earned over $1 million. The money has been used to form more than a dozen programs and physical sites, including wellness centers in Chico, Paradise and Oroville.

On top of that, last April, Butte County was awarded a competitive grant through Sen. Steinberg’s Mental Health Wellness Act of 2013, including $867,425 for residential beds and $1.075 million for crisis triage. With that funding the county has placed triage teams—made up of a licensed clinical and a peer advocate who has lived through similar crises—in local emergency rooms. Another team splits time between the Torres Shelter and the Jesus Center. “It lets us meet people where they are,” Wilson said.

There are other moving parts to consider. For example, the Affordable Care Act’s expansion of Medi-Cal, which most homeless people qualify for, has provided more people access to benefits than ever before. At least, in theory. Mental Health America recently reported that U.S. residents are still having trouble accessing mental health care, despite the expansion, noting that there is one provider for every 790 people.

So there’s a substantial financial component at play.

But Bill Such, executive director of the Jesus Center, has a more altruistic take on why this all matters. He says that, while the most ragged and abrasive homeless people can be hard to understand and empathize with, they are human beings whose lives are inherently valuable.

“We’re a Christian organization; we believe everybody is made in God’s image,” he said. “Therefore, the most callous, bruised, physically decrepit person with whatever mental condition they have is essentially precious to us because of who they are. …

“We’ve got mentally ill people on the street who are not pieces of shit, is my point.”

Society tends to “sweep these people under the rug,” Such said, by ignoring them and not giving them eye contact. It can be a dehumanizing experience, he said.

“They’re looking for the same basics things we are—like human warmth,” he said.

That’s a sentiment shared by Morgans-Ferguson, who maintains the homeless and mentally ill are part of our community whether we like it or not.

“I hate this idea that homelessness happens to someone else,” she said. “It doesn’t—it could be my son, any of our children or parents.”

For a few months starting more than a year ago, Tom Hansen walked around downtown Chico at night “like a zombie,” he said. He’d gravitate to the City Plaza, mostly just to be around other people, and then listlessly wander the streets until sunrise.

Hansen, 56, now lives in transitional housing after spending most of last year on the street and at the Torres Shelter. He’s had episodes of anxiety and depression throughout his adult life, and suffers certain social phobias, which were a factor when he lost his job at a distribution center in Los Angeles in October 2013.

“I’m not one of these people who’s very personable,” explained Hansen, who appears to be frowning, though it’s unintentional. “People like me when they get to know me a lot, but not as far as first impressions go. One problem I have is with authority figures at work, trying to get along with them. You have problems with the supervisor? You’re out the door.”

Hansen came to Chico to stay with family, but felt intrusive after a few months and decided to leave. Faced with few options, he still hesitated to check into the Torres Shelter. “What I envisioned was something like jail,” he said. “But it’s not like that.”

Of the service providers the CN&R spoke with, most have observed people who fear facilities. That mindset may be indicative of the greater stigma surrounding mental illness in general, said Behavioral Health’s Wilson. “People know they need help but they’re afraid to walk into a building that says ‘counseling center,’” he said. “That stigma [prevents] them from getting healthy and moving forward.”

That’s just one personal factor that may keep a mentally ill and homeless person from improving his or her situation. Many others relate to everyday functionality—the ability to complete tasks many of us might take for granted. For instance, the bureaucratic systems and paperwork associated with getting treatment, which can be frustrating even for the most lucid individuals, can be most discouraging, Shirah said.

“The first time I went into [Behavioral Health] and saw the paperwork, I walked right back out,” he said. “I’m not that good with paperwork.”

Despite his 22 years of nonprofit work, Montgomery, of the Torres Shelter, said that there are times when even he doesn’t understand what to do next to help guests at the shelter. He understands, then, why it is so difficult for those with mental illness to be their own advocates.

“It takes determination and rational thought, and if you’re struggling with serious mental health issues, [or] you’re hearing voices, it’s unreasonable to expect you to navigate these systems,” he said.

“You just have to jump through so many hoops,” agreed Amanda Wilkinson, supervisor of case management at Enloe’s emergency department. “When you apply for Medi-Cal, you wait, then they send you a packet, then you send it back, then you wait. There are multiple steps to accessing resources. There is no slam dunk.”

Other barriers to treatment can be even more basic. At the Shalom Thrift Store, Morgans-Ferguson sees people who miss appointments with case managers because they don’t know the time or date, don’t understand how to use the bus system, don’t have access to a phone, or can’t leave their belongings unattended.

“Where are you going to leave your stuff? It’s going to get ripped off, so you have to drag it all with you,” she said. “But a doctor’s office isn’t going to let you drag in your shopping cart and 14 bags of clothing.”

The greatest barrier of all may be that some people simply don’t want help. Some say they want to maintain a sense of independence, Such said, while others believe that nothing is wrong with them.

“Someone with schizophrenia, they have their own reality,” he said. “They don’t think they’re not normal.”

And by law, unless a crime is committed or a case meets the criteria for 5150—the individual is demonstrating a clear danger to him or herself or others—no one can be forced into treatment.

Such provided an example of a mentally ill and severely alcoholic woman he’s interacted with at the Jesus Center over the last six months.

“She’s going to die. I’ve seen it many times before,” he said. “She asked me for a pair of shoes; I gave her a pair of shoes, put The New Testament in the bag and said to her, ‘Look, I’m here to help you, if you want—more than a meal. Come talk to me if you want to change.’

“She doesn’t want the help. She just said, ‘Thanks, Bill’ and walked away.”

All the services providers the CN&R spoke with agree on one point: When it comes to issues as sweeping as mental health and homelessness, there is no panacea. However, most agreed that concentrated outreach efforts would go a long way. Ideally, that would involve professional clinicians, therapists and peer assistants, in addition to a law enforcement presence, to develop ongoing relationships with the mentally ill population on the streets.

For the police department’s part, Lt. Britt is optimistic about possibly reinstating the TARGET team in the future as the four-year year plan to buoy police staffing levels proposed by community safety advocates Clean and Safe Chico and approved by the City Council last summer goes into effect. Until he has more officers to adequately cover patrols, though, “it’s extremely difficult to do the proactive stuff,” Britt said.

The Downtown Ambassadors have been filling the void to some degree. Volunteers in yellow T-shirts regularly fan out downtown to provide homeless people with advice and information on social services. Ambassadors even will step in if a mentally ill person is suffering a manic episode, “going off in the plaza or a store downtown,” said volunteer coordinator William John Reick. “Hopefully, we de-escalate the individual, see what their needs are, and to whatever extent we can, get them into services.”

That part isn’t so easy, he’s found.

“I’ve been at my wit’s end,” he said. “We have resources to help a lot of homeless people, but specifically for the mentally ill portion, those full-dependency individuals, we don’t have the adequate resources.”

Indeed, continual case management is an area of possible improvement, Montgomery said. He believes that local crisis-intervention services work well, but follow-up is lacking.

“We’re concerned with what happens after that acute period,” he said. “How long does it take for that person to get medications, see a psychiatrist, stabilize their condition?”

For Shirah, it was an extended process. However, following his 72-hour stint in the Puff Unit so long ago, Behavioral Health connected him with a case worker and psychiatrist who helped him get his medication regimen under control and better manage his symptoms. And after some time at Stairways Recovery House, he kicked his alcohol addiction, too.

For those who reach out for help, and are willing to jump through the hoops—like Shirah—it’s possible to live a full, healthy life.

Shirah’s darkest time—when he was planning to jump in front of a train—is a distant memory these days. He currently maintains a job through Northern Valley Catholic Social Services, going out into the community and giving presentations about the Northern Valley Talk Line. (He worked as a phone operator for the talk line for about three years, providing peer-to-peer support for the mentally ill, or people who just want to talk about life.) He regularly works at the NVCSS booth at the Saturday Chico Certified Farmers’ Market.

And about a year ago, Shirah got married.

“She’s the love of my life,” he said. “She’s so supportive in everything I do. We’re really happy together.”