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No Room At the Inn

Ramon Johnson
20 Years After: Ramon Johnson periodically stays at the Julian Street Inn, the only emergency shelter for the homeless mentally ill in Santa Clara County.

Photo by Christopher Gardner

Santa Clara County's mental health program is better than most. Nevertheless, many of the county's homeless mentally ill are undiagnosed, untreated and ignored.

By Traci Hukill

RAMON JOHNSON HAS a decision to make. Camden High School, where he was student body president and voted "Class Mouth" his senior year, is holding his graduating class's 20-year reunion this summer. By then he hopes to be mentally stable, living in a house under the county's Shelter Plus program and pursuing a degree in broadcast journalism at De Anza College. The question is this: When people get down to the time-honored reunion tradition of "catching up," will Ramon tell his former classmates that over the last 20 years he's experienced too many psychotic breakdowns to count, attempted suicide at least four times, developed dependencies on alcohol, coke and crack and at various times been homeless?

Believe it or not, he just might. He wants to "come out of the closet," in his words, and be accepted for who he is. Ramon, like hundreds if not thousands of other homeless mentally ill people living in Santa Clara County, suffers from schizophrenia and bipolar disorder in addition to a nasty chronic drug problem. While he waits for his Social Security check to clear so he can move into transitional housing, he's staying at the Julian Street Inn, the only emergency shelter for the homeless mentally ill in the county.

While we sit talking at a picnic table in a park not far from the inn on a bright March morning, I'm struck by how articulate Ramon is, how easily he carries his 6-foot-tall frame, how well he tells entertaining stories. He's just a big, mellow guy with an Afro who likes to listen to his Walkman and write songs. It's hard to reconcile the person before me with the character he describes in recounting his life.

When he was 9, a teenage neighbor sexually abused him, his parents got divorced and he started hearing voices. At 14 he discovered his mother's suicide. His own first suicide attempt came just after high school, and on his release from the hospital he experienced homelessness and intense drug use for the first time.

A stint in the Navy followed thereafter, punctuated by heavy drug use and a marriage turned sour. When he finally left the Navy with a bad-conduct discharge, he attempted suicide again, and the cycle started once more. In the last year and a half, he's been hospitalized five times for psychotic breakdowns and suicide attempts, all accompanied by drug use. He's been in and out of the Julian Street Inn twice since August and says he's been clean and sober since January.

At various times doctors have prescribed medicine for his illness, but Ramon, like a lot of bipolar sufferers, is a little in love with the manic part of his disease because he feels so creative when he's manic. The medicine, he complains, squelches his creativity, and so he usually just stops taking it, returns to his old haunts and "self-medicates," in the argot of mental health workers, which means he gets high on whatever he can find. As he puts it, "I get the 'fuck its,' and I just want to go."

Ramon is lucky to be living in one of the most progressive counties in the state. He has a service team of mental health professionals to work with, a number of transitional housing programs available to help him get back on his feet and a chance to go to school through a program sponsored by the Department of Rehabilitation. Nevertheless, Ramon's pattern of recidivism--a depressingly familiar problem to mental health care workers--suggests that the follow-up care he receives just isn't enough to keep him on track in the long run.

MORNINGS AT THE Julian Street Inn are a bustling, noisy affair, with phones ringing, aides scurrying and clients milling about. Jan Bernstein, resource coordinator for Inn Vision (the Julian Street Inn's parent program), is showing me around the place. Small and stocky with black hair and warm brown eyes, she exudes serenity, stability and mellow optimism. She embodies the notion of going "placidly amid the noise and haste."

Located an ironic stone's throw from the $136 million Arena, the 10-year-old Julian Street Inn houses 70 homeless mentally ill people a night. It's a welcoming place from the outside with its terra-cotta paint job and red tile roof, but inside I'm not so comfortable. As we pass through the sunny courtyard I try to have some class and not stare at a beefy woman in a shower cap gazing dully ahead, her face impassive as mud. When we cross a corridor, I see a man squatting against the wall, cursing loudly in a gravelly voice at no one in particular. In the library, a small man in a leather jacket sits in a corner, rocking himself to and fro. His eyes don't register our presence.

Upstairs from the courtyard, Bernstein opens a door using a weighty ring of keys. A large, tidy room with a dozen or so beds nestled cubby-style into the walls greets us. People can stay at the Julian Street Inn rent-free for 30 days, then up to 60 days longer at a modest $140 a month--far cheaper than motels or board-and-cares, the two primary options for this population. Bernstein explains that the rooms are kept locked during the days so clients, especially those with depression, don't sleep the days away.

The Julian Street Inn offers daily seminars on subjects like self-esteem, money management, HIV awareness and relapse prevention, and although attendance is sometimes quite high, it fluctuates according to the time of the month and whether people have recently received their SSI checks. When the checks come, people bolt, and many of them spend the money on drugs, especially crack and crank but also heroin and alcohol. Then they're broke and return to the Julian Street Inn for another few weeks until the next check comes.

Ramon provides some insight into why this cycle continues. "Usually about a month [at the Julian Street Inn] is all you can take," he admits. "There are different psychiatric levels, and it's hard to sleep. If you have problems with interpersonal relationships, it's hell. ... Actually, a lot of the tension that builds up there leads people to abuse drugs. When the checks come, you'll see an exodus out of there."

Sophia Johnson, the Julian Street Inn's director, is pragmatic about what the program can accomplish, even with its seminars and four full-time caseworkers.

"Realistically, for the 30-day clients..." She finishes the sentence with a helpless gesture. "Drug abuse really brings them down. They get their money, then by the fifth or tenth of the month they're out of money. For the 90-day clients, I hope for them to be substance-free [by the time they leave here]."

The Julian Street Inn obviously serves a crucial purpose by offering immediate shelter to the homeless mentally ill. Other agencies like the Emergency Housing Consortium offer excellent transitional housing programs, but no other emergency shelter exists in the county--and just a handful exist in the state--exclusively for this population, which some estimates pin at 4,000 for Santa Clara County alone. The problem, it seems, lies both in the paucity of facilities like the Julian Street Inn and in the tremendous workload borne by the county-administered service teams whose job it is to guide people like Ramon from the Julian Street Inn into mainstream society.

SANTA CLARA COUNTY makes an exemplary effort to care for its mentally ill citizens. In spite of budget cuts over the last eight years approaching $30 million, the county has managed to boost its Access program--the gateway agency to the county's mental health services--by 22 percent this year. It has funded a team of mental health workers to accompany police officers on patrol in an effort to keep the mentally ill out of county jails. It is one of the few counties in California that budgets for expensive, state-of-the-art medications like Clorzil and Olanzapine. And last year Santa Clara County's $600,000 contribution to the Julian Street Inn exceeded federal contributions by $300,000 and almost matched the state's $700,000 contribution.

But lest the good become the enemy of the best, consider that according to County Homeless Coordinator Kathy Espinoza-Howard, about 16,000 people experienced homelessness in the county during 1995­96. Roughly one quarter of those, she estimates, probably suffered from mental illness: thus the figure of 4,000, which some mental health administrators view with a little skepticism.

Says Kitty Palmer, health services supervisor and overseer of a specially funded homeless service team, "the national stats show 20 to 25 percent of the homeless population has some form of 'severe and persistent' mental illness. I think we're a little less than that."

Even if the figure of 4,000 is double the real total of homeless mentally ill folk wandering Santa Clara County's streets, only a fraction of that population is being served by the system. The service team Kitty Palmer supervises is the only one of the county's 30 mental illness service teams dedicated exclusively to serving the homeless. Since July of last year, they have served more than 170 individuals--a wonderful accomplishment, but a drop in the bucket nevertheless.

Palmer is quick to point out that the other service teams, which usually consist of physicians, counselors and social workers, also serve the homeless mentally ill by default simply because any number of things can result in a seriously mentally ill person's becoming homeless: economic hardship, failure to take medication, another psychotic breakdown or substance abuse, which practically goes hand in hand with some types of mental illness. But even with other service teams' assistance, Dr. Solang Tom, interim director of the mental health administrative office, guesses that only about 500 of the 5,600 adults in the service team system are homeless. Mental Health's Adult Services office estimates an even lower number: 360.

Access Program Supervisor Craig Wolfe says each service team has 200 to 250 clients, which averages out to a staggering 40 or 50 cases per staff member.

"It's a firehouse mentality," he observes, "because you have to spend most of your time on the unstable [people in] your caseload. ... My belief is these people are making Herculean efforts to provide services to this population, but there's not enough resource to meet the need."

While talking to Craig I can't help but remember something Jan Bernstein said to me as we stood at a busy intersection waiting to cross the street one day last month. We were discussing why the homeless mentally ill don't get the funding that either "regular" homeless populations or "regular" mentally ill populations receive. She looked me straight in the eye and said, "This isn't a sexy population. The fastest-growing segment of the homeless population is women with small children. People don't mind giving to them. But these people," she said, gesturing toward the Julian Street Inn, "no one wants to think about them."

RAMON SEES HIS SERVICE team therapist once a week and his psychiatrist twice a month. Even so, he's worried about relapsing, worried that one day he'll skip his meds, get high and topple off his precarious perch atop reality. What he needs is constant companionship, but that's not possible, so instead he's patching together a community of people who can help keep him on course.

"My plan is to try to saturate myself with the assets available to me," he says. "I'm trying to make myself accountable to people, keep people plugged into me so I don't drop between the cracks." To this end he plans on keeping close contact with his service team, the Department of Rehabilitation, which is funding his return to school next month, and an AA group with which he feels comfortable. It won't be easy, but then nothing's come easy to him.

In a perfect world the county would receive enough funding from state and federal sources that it could foster healthy outreach services and ensure an effective continuum of care for those already in the system. Instead of measuring its success relative to the failure of other counties, it would gauge itself absolutely against the population it strives to serve. But for now, "better than most" will have to do.

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From the March 20-26, 1997 issue of Metro

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