ILL-TREATED, ILL-HOUSED

The wiry 45-year-old woman dug deep into her worn maroon purse and
snatched out a pink sheet of paper. It was her latest humiliation -- a
citation for sleeping on a park bench in downtown Raleigh.

For Sharon Page, a schizophrenic with a taste for cocaine, the ticket
testified to a harsh reality: Try as she might, she could find no
place to live in Raleigh.

In late spring, a shabby, shotgun-style house on Cooke Street where
Page used to rent a room was condemned. She stayed on, lighting
candles at night and hauling her toilet waste in a bucket to the back
yard, until she was forced to leave. The next rooming house she found
shut down within weeks, leaving her penniless. Homeless shelters were
full. So the park became her nightly destination.

Page's predicament is common in Wake County and elsewhere in North
Carolina, because too little exists outside of mental hospitals to
deal with the varied and complicated problems of people who have
mental illnesses.

The issue plays out in dramatic form each day in Wake County, which,
as one of North Carolina's wealthiest counties, offers a wide
selection of community programs to help people such as Page. But it's
as if the county put together a bounteous menu, then stocked only
enough food to provide a single helping of each dish.

The county's fallback has been Dorothea Dix Hospital in Raleigh. Dix
serves 16 counties, but one-third of its admissions come from Wake. A
consultant's report released in August 2000 said that Wake's
dependence on Dix to house its mentally ill people is convenient and
cheap because the hospital is in downtown Raleigh and the state picks
up the tab.

But earlier this year, Dix administrators faced problems with
crowding, staffing levels and patients' care. As a result, they
insisted that the hospital adhere to its mission of offering critical
care for people during mental health crises. People would be
stabilized and released to their communities. And no longer, hospital
officials said, would Dix admit patients whose psychosis stemmed from
alcohol or drugs.

The decision hit Wake hard. Patients were traded back and forth
between the county's emergency services office, where people enter the
system, and Dix. Collegial relationships between county and hospital
staffs grew strained.

Dr. Brian Sheitman, director of medical services at Dix, said the
hospital is still receiving too many patients, with too few staff, and
too little support.

"With the Department of Justice coming in, we are going to get
absolutely slammed," Sheitman said. "I would like to alert the public
that we have a major problem in mental health. When you get to a
certain point, the system crashes, and we are dangerously close to
that."

Sheitman and other mental health professionals repeatedly cite three
major needs to improve care: adequate housing, sufficient vocational
training and community treatments. The success of job training and
treatments, however, depends on housing because w psychotic enough to
need a bed in a hospital or rest home, where many mentally ill adults
are confined. But she's not a good candidate for private housing, either.

CASA, a nonprofit agency that provides a limited number of rentals to
mentally ill tenants in Wake County, disqualifies people who still use
illegal drugs. And Page won't abide by the mandatory drug tests and
other rules required by a downtown apartment house for the mentally
ill -- the only one that is supervised around the clock.

"I'm real discouraged," said Page, taking a cigarette break on the
back porch of Hargett Street Drop-In Center, a county day program that
is her only steady refuge. "It's not cold yet. But it will be."

Complicating Factors

Hundreds of other people are ineligible for CASA's services because
they, like Page, struggle with substance-abuse problems.

Last March, police found two pieces of crack cocaine in the Cooke
Street house where Page lived. By September, Page risked going to jail
because she hadn't completed a drug treatment program a judge ordered
her to attend.

With mental illness, problems don't divide easily. Substance abuse and
severe psychiatric disorders, increasingly, go hand-in-hand.

The U.S. Surgeon General estimates that as many as half of the people
with mental illness are also addicted to drugs and alcohol. And
substance abuse often leads to criminal charges, so the problems
compound each other.

People with both diagnoses are often the most difficult to place in
housing, because active addictions disqualify them, even in some
homeless shelters. They may have spotty work histories, bad or
nonexistent credit, criminal records. As a result, they run a constant
triangle between the streets, jail and Dorothea Dix Hospital.

But Dix's stricter policy about whom it will admit has created new
pressures. Friction has arisen between Dix and county mental health
workers, who never know when their referrals will be rejected. One day
in July, a tall, bespectacled 31-year-old schizophrenic and crack user
named Stephen reappeared at Wake County's Emergency Services
Department in a building behind WakeMed -- ground zero for mental
health in Wake County.

A busy, 24 hour-a-day hub, it moves 7,000 desperate people a year
through seven small care rooms with seven blue vinyl recliners. Here,
county doctors and social workers see people at their sickest and
decide where to send them: Dix, the emergency room, a scarce bed in
the county detox program, home.

Stephen (a county psychiatrist advised him not to release his full
name) was diagnosed as psychotic. As a result, the doctor recommended
admitting him to Dix. But Dix sent him back, contending that his
problem was drug-induced and therefore not the mental hospital's business.

Twice more over the next few days, Stephen pingponged back and forth,
until finally Dix admitted him.

"We're sending fewer people to Dix and more out of county" to
psychiatric hospitals in Butner and Goldsboro, said Crystal Farrow,
director of emergency services. But that's much farther for sheriff's
deputies to transport sick people so it's more expensive. Overall,
Farrow said, the county is also sending fewer patients to the state
hospitals. But for years it has used more than its share of state
hospital beds, particularly for people such as Stephen, whose mental
illness is complicated by substance abuse.

A financial analysis prepared by the Alcohol/Drug Council of North
the freedom of deciding what you want to have for your next meal is
important, and you don't have that in group homes."

Getting independent housing, however, is daunting. And it's not just a
matter of finding affordable homes. People with mental illnesses often
don't drive and must rely on public transportation. They don't always
keep their places up. Their judgment can be questionable. CASA has had
tenants tear apart walls to track down the source of voices that
harass them. Others have accidentally set fires. Such tendencies
discourage reputable landlords from taking a chance.

Many people double up with family or friends in overcrowded lodging,
arrangements that are rarely permanent. Or they spend huge portions of
small incomes on bad housing in rough parts of town, where drugs and
other destabilizing forces tempt them. For Sharon Page, the
schizophrenic woman who struggled all summer to find housing in
Raleigh, the negative forces of the street have made her path difficult.

In July, after one house was condemned, she moved just south of
downtown to a $400-a-month rooming house with no air conditioning,
foul-tasting water and leaky plumbing. But in early September, she
said, her landlord shut it down. And Page, who lives on a monthly
disability check of about $550, was out of cash.

Homeless shelters that admit women in Raleigh were full. After a
police officer ticketed Page for sleeping on the bench in Moore
Square, she doubled up in a single room with a man she met at a
community clubhouse for the mentally ill. She hoped to stay only until
she could afford a place of her own.

Although Page sticks with her mental health treatment, many basic
aspects of life still confuse her. The medicine from the county clinic
quiets accusing voices that once plagued her. But she can't keep the
amount of her monthly disability check straight.

And she's had trouble with a dangerous drug: crack cocaine. At the
Drop-In Center, the county-run day program Page frequents, the pieces
of paper that Page pulled from her worn pocketbook offered glimpses of
her fragile existence.

One scrap of paper included the typed telephone number of the latest
probation officer assigned to track her after the crack cocaine arrest
in March.

On the back of an envelope in her bag was the phone number of her
daughter, a young woman with a very troubled mother. "She checks in
when she can," Page said.

Page maintains that she used crack rarely. But she said she
understands why anyone suffering with mental illness might resort to
drug and drink for an occasional escape.

"You want to feel good," Page said.

In November, after months of waiting, Page landed a spot in a shelter
for homeless women. She was trying to stay drug-free. If she failed,
there was nothing good on the horizon: just the next run-down rooming
house, the streets or jail.