OHIO SHELTERS EVEN TOUGH CASES

Columbus Finds That There's No One-Size-Fits-All Solution To Housing
Homeless Mentally Ill

COLUMBUS, OHIO - The cinder-block building that has been George
Smith's home for nearly three years is actually a converted Chinese
restaurant on a busy strip leading out of downtown Columbus.

As apartment living goes, it's humble; but for Smith, it is salvation
from a decade of homelessness that resulted from untreated mental
illness and alcoholism.

"This is one of the best programs in the state, as far as I'm
concerned," he said. "It really provides for people in a bad
situation." And although Smith is under no obligation to seek
treatment or even stay sober, he and 12 others have been allowed to
live in the converted restaurant since it opened in 1999. No similar
program exists in Wake County, where the county's largest housing
agency for the mentally ill requires drug and alcohol screening.

"This gives people a safe place to be, so that maybe they'll begin to
work on their mental health and addictions," said Anthony Penn,
associate director of the Community Housing Network, which manages
Smith's apartment and about 750 others in Columbus. "Here, they are
connected with social workers, and people try to make sure they get to
doctor's appointments, counseling. Without a safe place to stay,
they'll never address their problems."

Community Housing Network, which develops and leases homes to people
with varying degrees of schizophrenia, bipolar disorders, depression
and addictions, has a simple mission: provide people such as Smith
with homes in the community to keep them out of hospitals and off the
streets. And that's all it does. Nothing more.

The agency's work is considered exemplary in Ohio, which mental health
professionals have praised as a progressive model since the state
enacted mental health reforms in 1988.

Many aspects of Ohio's reform plan are now being considered in North
Carolina, which still relies on mental hospitals, not community
services, to care for people with mental conditions. Wake County has
been an especially heavy user of the state hospitals, particularly
Dorothea Dix, near downtown Raleigh. On a typical day, Wake County
patients occupy 125 of Dix's 490 beds.

By contrast, Franklin County, Ohio, where Columbus is located, is
allowed by contract to hospitalize 62 of the 6,000 mentally ill people
it serves -- the sickest of the sick -- in a state mental hospital on
any given day.

The Ohio patients must get treatment in the community.

"It doesn't mean the nature of the population has changed, but the
onus of care is placed on the community," said David A. Royer, chief
executive officer of Franklin County's Alcohol, Drug Abuse and Mental
Health Board, known as ADAMH, which oversees the county's mental
health services.

The board is one of 55 throughout the state. Since the 1988 mental
health reforms, it has assumed the responsibility, along with the
resources, to care for people with mental illness in the community.

Franklin's ADAMH board does not offer services itself -- there are
only about 60 people on its payroll -- but it contracts with 54
nonprofit organizations to offer the programs needed to keep people
out of hospitals:

a.. Mental health treatment centers, in which psychiatrists,
counselors, social workers and case managers collaborate to treat
people's illnesses.

a.. Vocational training organizations that help people get back to
work. a.. Housing offered through developers such as the Community
Housing Network.

"Housing is where everything comes together," Penn said. "We have
moved people out of hospitals, so have had to wrap services around
them."

Alice Lin, a mental health consultant and former project manager to
North Carolina's joint legislative oversight committee on mental
health, said the state can learn from Ohio's example.

"The key is that you have to have expertise," she said. "Sometimes you
don't need mental health professionals. You need housing expertise."

how it's done in columbus

At an old two-story frame house on the east side of Columbus, two
women sit on the front porch, smoking cigarettes and watching the
afternoon traffic. They live here with two others, all of whom have
been longtime clients of the state's mental system.

The so-called Next Generation house, with its solid oak staircase and
heavy construction, is furnished in unpainted hard-edged pine sofas,
chairs and tables. One woman sits in a chair and bellows criticisms
about the uncleanliness of the house's basement, while a residential
aide silently boils greens for dinner.

The tenants have many needs, so they have around-the-clock supervision
by aides -- the kind of crisis control and oversight that nurses and
hospital technicians would handle if the women were in a mental ward.
But the aides also prepare meals, do grocery shopping, clean up and
manage each resident's calendar of appointments.

The aides are not CHN employees, however, because the housing agency
isn't in that line of business: "We do bricks and mortar project
management," Penn said.

The aides work for one of the mental health centers, which closely
collaborate with CHN to ensure that all tenants get the level of
supervision and intervention they need. As a result, some CHN homes
are set up to offer 24-hour oversight; others afford complete
independence.

"In the beginning, we initially thought that everyone can live in
independent housing," Penn said. "But we learned that we needed
different types of housing. One size does not fit all."

The most challenging clients are people who, like the women in the
house, need constant care.

At least once a week, their case managers from the mental health
center visit them. The managers come to them, not vice versa, to
monitor their compliance with medicines and make sure they are
progressing in their treatment plans and social development.

Additionally, the women have periodic appointments at the mental
health centers to see their psychiatrists and receive medical
treatment and other services.

Franklin County has 30 community treatment teams that consist of five
to 12 case managers who fan out to the places where mental health
clients live. At least one team dispatches psychiatric drugs to
patients throughout the city three times a day.

Total cost of services: $100 million.

To pay for such care, ADAMH brings in $40 million a year from a
special mental health tax that voters approved in 1996 specifically
for mental health services. The remaining $60 million is a combination
of state and federal money. By contrast, Wake County's mental health
budget is $46.7 million.

"Community care in some ways is more expensive than institutional
care," said Royer, the ADAMH chief executive. "But you have to make a
decision about the quality of life. It's not an even trade."

Neighborhood Resistance

Even with Franklin County's level of commitment, there are gaps in
services and public resistance to more programs.

The CHN runs 750 units and has helped secure 145 federal housing
vouchers, but there are at least 300 waiting for openings. (The
majority of people with severe mental illness live at home or with
relatives.)

And adding new properties to meet the demand is often difficult. Homes
can't be clustered in one section of town, and all need to be near
public transportation and shopping. Political problems arise, too. CHN
properties invariably draw the pitched opposition of neighbors.

"NIMBYism is alive and well in Columbus, Ohio," said CHN director
Susan Weaver, a reference to the Not In My Back Yard battle cry that
homeowners sound when they fear a newcomer will reduce property values
or otherwise diminish the neighborhood.

Two years ago, the CHN announced plans to build a 16-unit townhome
project in the north central area of town for clients who needed
limited supervision. Residents of the neighborhood immediately assumed
the worst.

"We had to get people past their concerns that these are not
individuals who are going to rape our children or steal us blind,"
said Greta Winbush, a resident who was asked by the neighborhood
committee to work with the CHN.

Winbush, who has a Ph.D. in family studies and degrees in psychology,
said she came to the process with an open mind. She said her approach
to the CHN project was to make the best of it. And since the complex
opened, she said, there have been no problems.

Her bottom line: "Everybody has to have a place to live, so how can we
be a participant and make that happen safely for everybody? Let me be
a part of what is going on."