Losing Tim

Losing Tim: How Our Health and Education Systems Failed My Son with Schizophrenia is now in the Columbia University Press catalog.

Cover Photo Credit: Hartford Courant, Shana Sureck

You can find it using this link: http://cup.columbia.edu/book/978-0-231-16828-1/losing-tim

It will be available in the Fall of 2014.  It is a story of how the mental health policies of the last generation of policymakers (of which I was a member) failed my son, and how the policies of this generation of policymakers continue to fail him, and so many like him.

I can't say that I hope you will enjoy it, but I do hope you will find it moving.
 
And that it will help move us all - including the next generation of policymakers - to action.  It is long past the time we could pretend that neglect is a synonym for common sense and compassion.

The People on the Plaza

On a recent bright and sunny Monday afternoon, I took the sixteen-minute BART ride from Oakland – where I was doing some work – into downtown San Francisco.  I went to several places where people who are homeless tend to congregate. 

What I saw made me wonder.  Do we realize that if we do nothing, up to half of the people who are chronically homeless are likely to die in the next ten years?

I exited the BART train at the Civic Center/UN Plaza station.  When I arrived above ground, I saw more than a hundred homeless people in the vicinity of the station.  They were sitting or resting on the plaza, pretty much keeping to themselves.

Scores of tourists, business people, and shoppers hurried about their business.  There was no interaction between the two groups.  It reminded me of the way old-time cartoons had the action layered on top of a static backdrop – a crowd bustling with activity set against the backdrop of stationary homeless people.

I witnessed something similar in at least three other settings that afternoon.

I walked into Buena Vista Park, a beautiful, wooded park on a hill along Haight Street with awesome, expansive views of San Francisco.  As I climbed its paths, I passed by several people out walking their dogs.  They barely noticed the homeless people sleeping or sitting on the grassy lawn nearby. 

In the nearby panhandle of Golden Gate Park, a few joggers and sunbathers also ignored the small groups of homeless people sitting together under the trees.

And at the Powell Street station later on that afternoon, hundreds of shoppers passed by scores of homeless people without paying them the least bit of attention.

At first, I didn’t see what was wrong with this picture.  I was impressed with the live-and-let-live spirit of the community, where no one hassled anyone else. 

But then I looked more closely.  The people passing through the plaza were so accustomed to the homeless people on the plaza that they were not moved – either to anger or to sympathy – by seeing them.

San Francisco has an estimated 24,000 people who are homeless.  Its governmental agencies and nonprofit community do far more for them than most. 

According to a recent article in the San Francisco Chronicle, the city has moved 8,000 people off the streets since 2004, and has 1,155 emergency shelter beds.  A new homeless health care clinic will open this summer with the capacity to accommodate 50,000 visits per year.  And because the homeless population is aging, 77 new apartments are opening for homeless seniors.

But that doesn’t mean that chronic homelessness isn’t a problem anymore.

The National Alliance to End Homelessness released a new report last month that documented some improvements in the prevalence rates of both overall homelessness and chronic homelessness in the United States over the past ten years. 

But the same report shows that the numbers of homeless people have remained steady during the last four years, in spite of an improving economy.  (Perhaps cutbacks in mental health funding are a reason.) One person in every five hundred is homeless. And out of every ten thousand veterans, 29 are homeless.

Here's something to think about.

The Chronicle article also noted that the mean age of the homeless population increased from 34 to 53 between 1990 and 2010, and that the life expectancy of a person on the streets is 64.  It is possible that chronic homelessness is decreasing because of better services.  But it is also possible that it is decreasing because chronically homeless people are dying off.  In the next ten years, half could be dead.

The NAEH report makes it clear that the problem of homelessness is not limited to warm weather and service-rich communities like San Francisco. 

In fact, Colorado, Oregon, Washington, Wyoming, and Alaska are among the eleven states with the highest rates of homelessness in the country. 

There is a clear connection between behavioral illnesses and chronic homelessness.  I plan to talk about this in a presentation I will be making at a breakfast open to the public sponsored by the Middlesex County Coalition on Housing and Homelessness in Haddam, Connecticut on Friday, May 17.

My goal in that talk will be simple – to remind people that no matter where you fall on the philosophical spectrum, doing nothing about homelessness is not an option. 

You may be able to walk right by the people on the plaza without them saying a word, but this doesn’t mean that they shouldn’t command your attention.

To reach Paul Gionfriddo via email: gionfriddopaul@gmail.com.  Twitter: @pgionfriddo.  Facebook: www.facebook.com/paul.gionfriddo.  LinkedIn:  www.linkedin.com/in/paulgionfriddo/ 

Anna Brown's Death

Anna Brown was 29 years old when she died suddenly last September.

She left two small children. 

Sometimes, the tragic and untimely death of a young mother commands our attention.  Anna’s death in Missouri drew a little national interest just last week. 

She died alone on a concrete jail cell floor.  It happened just a few minutes after she was arrested for trespassing.  She refused to leave a hospital emergency room while she was in agonizing pain.   

Anna Brown was homeless, had mental illness, and was on Medicaid.  Hospital officials thought she was a drug-seeker.  They were wrong. 

According to news reports, a morning fog blanketed St. Louis on September 20, 2011 – the day Anna died.  She spent much of her final day going from emergency room to emergency room begging for care.  She started at St. Louis University Hospital complaining of pain in her leg.  She was evaluated and released with a prescription for painkilling medication. 

Unsatisfied with her care, she went next door to Cardinal Glennon Children’s Medical Center.  There clinicians found tenderness in her leg, but explained that they could not treat her because she was not a child. 

Her pain was so bad that she could not walk.  So she was transported by ambulance to a third hospital, St. Mary’s, where she was diagnosed with a sprained ankle. 

But Anna Brown was afraid something more serious was wrong with her.  So when St. Mary’s said she could go, Anna Brown refused.

That’s when St. Mary’s had her arrested for trespassing.  

A police officer later reported that “they thought that she was a drug seeker.”  The police wheeled her out of the hospital in handcuffs.

When she arrived at the jail, she was having trouble breathing.  Officers placed her on the floor of her cell and left her alone.  She died within fifteen minutes of undiagnosed blood clots in her leg that traveled to her lungs.

What a tragedy.

It was compounded by others in Anna Brown’s life.   

She had lost her house a couple of years earlier to a tornado.  She lost her job shortly thereafter.  When she could no longer afford to pay her heating bills, her service was discontinued and she took to building fires in her apartment to keep her children warm.

Child protective services found out, and the state removed her children from her care.

Her mother took in the children, and reported that the family court gave her a choice – she could care for Anna’s children or Anna, but not both.  She was forced to choose her grandchildren over her daughter.

So Anna became homeless.  At the time of her death, she was using city shelters and frequenting a drop-in center for people with mental illness.  Contrary to the assumptions of the clinicians who examined her on her last day of life, she was not using drugs.

Too much of Anna’s story isn’t uncommon. 

We have all read reports about patients with mental illness “flooding” hospital emergency rooms because of state cutbacks to mental health services.

These usually suggest that patients choose emergency rooms for non-emergency health reasons because they have no place else to go. 

In defending its actions just last week – a full six months after Anna Brown’s death – St. Mary’s Hospital sounded this theme.  It issued a statementthat read in part “the sad reality is that emergency departments across the country are often a place of last resort for many people in our society who suffer from complex social problems that become medical issues when they are not addressed.”

That statement may be true.  But Anna Brown wasn’t suffering from “complex social problems” when she showed up at St. Mary’s. 

She was suffering from neglect of her medical condition.  That neglect didn’t begin at St. Mary’s; it just ended there.

And we are mistaken if we think this doesn’t happen every day in every state in the nation.

Medicaid emergency room co-pays, cuts to mental health and substance abuse treatment, inadequate funding to combat homelessness, and anti-loitering laws are all just symptoms of this neglect.

Anna Brown died from blood clots, but she also died because too many people looked past her suffering and saw a caricature of a homeless, mentally ill patient, and jumped to a conclusion about what they think such a patient represents.

Anna Brown may have visited far too many emergency rooms on the day she died, but the fault wasn’t hers.  And she and her loved ones paid the price.   

If you have questions about this column or would like to receive an email notifying you when new Our Health Policy Matters columns are published, please email gionfriddopaul@gmail.com.

California Screaming

I first heard about James McGillivray, Lloyd “Jim” Middaugh, and Paulus “Dutch” Smit about a month ago, though not by name.

A tiny news crawler reported that three men were victims of a serial killer in southern California.

James McGillivray’s body was found near a Placentia, CA, shopping mall on December 21^st.  53 year-old McGillivray hung out almost every day at the mall.  Regulars there called him humble, unobtrusive, and a “nice guy.”  A 17 year-old commented “I don’t know why someone would kill him.”  McGillivray was sleeping when he was attacked and stabbed to death.

Jim Middaugh’s body was found along a riverbed trail in Anaheim on December 28^th.  He was also stabbed to death as he slept.  After his death, his mother – to whom Middaugh was exceptionally close – described her six foot, four inch son as a “gentle giant.”

Dutch Smit was 57 years old when his body was found outside a Yorba Linda public library on December 30^th.  He left three children and 10 grandchildren.  He was described by his daughter as “an honest and sincere soul.”  He enjoyed the library, often sitting and reading quietly for hours on end. 

McGillivray, Middaugh, and Smit had one thing in common.  

They were targeted for death because they were homeless.

The police considered McGillivray a “loiterer,” but his homelessness may have been tied to his drinking.  According to the National Coalition for the Homeless (NCH), a 2008 survey identified substance use as the leading cause of homelessness among single adults.

Smit, who called himself a wanderer, not a transient, was a hoarder who left his home when it became too unsafe to live in.  Hoarding is a symptom of mental illness.  Mental illness is the third leading cause of homelessness among single adults.

Middaugh lost his transitional living apartment for sex offenders after he had lunch with a friend at a Chinese restaurant that was too close to a public park where children might be playing.  He had been convicted for “lewd and lascivious acts on a minor under the age of 14.”  But the crime for which the 42 year old was still being punished had occurred more than twenty years in the past.

80% of crimes of violence against homeless people are committed by people under the age of 30. 

The suspect in the executions of McGillivray, Middaugh, and Smit is 23 years old.  Itzcoatl Ocampo, of Yorba Linda, CA, is a former Marine who served in Iraq.  As a Marine, Ocampo was reported to have earned at least four medals and commendations.

Ocampo was caught with blood on his hands on January 13^th, while executing a fourth homeless man, John Berry, a 64 year-old Vietnam Veteran.  Ocampo targeted the others simply because they were homeless, but apparently attacked Berry as retaliation after Berry spoke out in the media about the murders.  During the assault, a Good Samaritan intervened and chased Ocampo down. 

Police and prosecutors seem certain that Ocampo does not suffer from PTSD or other mental illness, but his attorney is not so sure.

There is no doubt that the Good Samaritan, 32 year old Donald Hopkins, now does.  He is receiving counseling after witnessing the violence because the scene keeps playing over and over again in his head.

This story – and the relative lack of national news attention it has received – bothers me a lot. 

Perhaps it is because of the way we treat homeless adults.  Of 235 cities surveyed by NCH, 33% prohibit “camping,” 30% prohibit “sitting or lying,” and 47% prohibit “loitering,” all of which are often selectively enforced against homeless people.  Of the ten "meanest cities" toward people who are homeless, three are in California, but my home state of Florida is home to four – St. Petersburg, Orlando, Bradenton, and Gainesville. 

Or maybe it is because we ostracize even children with behavioral health conditions, setting many of them on their path toward isolation and homelessness as adults.  The school district in my old Connecticut home town of Middletown made news last week for forcing such children into cell-like “scream rooms.” The federal government is now investigating.

Or maybe it is because my son also happens to live in California, and is homeless, has mental illness, and self-medicates.  He has been beaten up, cited for “sitting or lying” on a sidewalk, and been in jail, but he also loves reading in libraries, has an honest and sincere soul, and has been described as a gentle giant.

But I think what screams out most to me is that these executions call attention to our deeply flawed views about homelessness, behavioral health diseases, and the victims of violence in America.  

If you have questions about this column, or wish to receive an email notifying you when new Our Health Policy Matters columns are published, please email gionfriddopaul@gmail.com.