Out of institutions and needing shelter

PEOPLE like Clarence Brister Jr. can be found in almost any city in America. He is tall, good looking, pleasant, and polite when approached. But Clarence, a Vietnam veteran, is obviously homeless.

And he would probably also be diagnosed as mentally ill. Standing along a road in Memphis, Clarence leans against his grocery cart, filled to overflowing with newspapers, plastic bags full of blankets, and assorted personal items. He says he sleeps under a nearby expressway -- adding that some of the missions offering shelter are stealing the money contributed to them.

Clarence points to ``arrows'' in the sky and wonders that no one else in Memphis sees them. ``I can tell you that they are not US,'' he adds.

Clarence says he is trying to get to Washington to see his family. But, like thousands of homeless, mentally disturbed individuals, Clarence does not appear to be going anywhere.

``The streets have become the mental asylums of the '80s,'' says Rodger K. Farr of the Los Angeles County Department of Mental Health.

Often, the most visible of the homeless in the United States are people with mental problems. Estimates vary, but most experts say 30 to 50 percent of the homeless fall into this category.

Some of these people are former patients at mental institutions who were discharged during the movement to deinstitutionalize the mentally ill in favor of treatment in community settings. In 1955, approximately 560,000 people lived in public mental hospitals. By 1980, there were only 120,000. And experts point out that as the population has increased, so has the number of those needing care. Some, particularly the young who have mental-health problems, have never spent long terms in hospitals, but may have been admitted for short visits on an emergency basis.

Experts note that two groups are heavily represented in that portion of the homeless population which is judged to have mental difficulties: Vietnam veterans and single women without children. (One estimate for the Los Angeles skid-row area is that 90 percent of the homeless women have mental problems.)

Critics say these people are victims of a system that has set them adrift. One reason deinstitutionalization has backfired, according to some experts, is that the money previously spent on large institutions never followed the mentally ill out into the community as intended. Budget cutting has also had an impact. An advocate for improved mental-health services in California estimates that mental-health programs there have lost 40 percent of their funding since 1967.

Community health centers that were set up during deinstitutionalization often dealt only with mental-health issues and were not prepared to handle questions of housing, jobs, or training people to adapt to independent living. In addition, these centers were frequently located far from areas where the poor congregated -- areas with cheap room and board.

Though many people with mental difficulties are able to function on their own in society, those who can't are clustered in shelters, train depots, libraries, and under bridges.

In Seattle, Ken Cole, director of the Downtown Emergency Service Center, estimates that 40 percent of the people in his shelter have at least one significant symptom of mental illness. The shelter, which currently serves 200 people a night, is able to employ three mental health workers, and someone is on duty 24-hours a day.

But many smaller shelters, especially those run by nonprofit groups or churches, cannot maintain full-time workers in their facilities.

Lee sits in a spare-looking room at the Memphis Union Mission. He and two dozen others, mostly men, sit through a mandatory 30-minute prayer meeting led by a preacher. After reading from the Bible, the preacher asks if anyone is ready to ``call on the Lord.'' A few raise their hands.

Lee asks a few questions, saying he liked what the preacher said, but isn't God a personal thing, and doesn't man come to God in his own time? As the others shift in their seats, obviously ready for the free lunch at the end of the sermon, the preacher says the questions can be discussed later.

The lunch does not get rave reviews from the guests -- Lee laughs that the bread turns up at the edges like an old plank -- but they eat the sandwiches nonetheless. Lee says he stopped in the mission when he saw the sign for a free lunch. An out-of-work Vietnam veteran, Lee says he left his job with the Postal Service because they believe he has psychiatric problems.

The mission will give Lee a meal and spiritual comfort. But he is not likely to find mental-health services here.

And so a debate rages over whether deinstitutionalization is the wisest choice for the nation's mentally ill. Are communities the best place for these individuals to live, or should they be returned to asylums? Can the intensive programs needed to help these people be made available, and, in an age of massive spending cuts, how will such programs be funded? Can the current mental-health system, which many consider overly bureaucratic, be reformed?

Some mental-health experts argue that deinstitutionalization went too far, because it did not take into account that some of the people couldn't function on their own. Others defend deinstitutionalization as an excellent concept that just needs fine tuning.

The Robert Wood Johnson Foundation, which specializes in health issues, has recently announced a grant program designed to provide housing for the mentally ill. It is being cosponsored by the US Department of Housing and Urban Development, the National Governors' Association, the US Conference of Mayors, and the National Association of Counties.

Members of the foundation are convinced that treatment in community settings is the best way to help the mentally ill. But what is needed, says Linda H. Aiken, vice-president of the foundation, is a program that offers a comprehensive range of settings and services, a clear assignment of responsibilities for each mentally ill person in a community, and an authority with budgetary control over the wide range of services.

Many who deal with the homeless mentally ill point out that it is not easy to win the trust of these individuals. ``It sometimes takes three, four, five months before the trust level is built up so that they will sit and talk to us,'' says Mr. Cole in Seattle.

Los Angeles's Mr. Farr sees the situation as a national emergency, says the mental-health system needs to deal with the issue on three levels: an emergency stage providing health care on the streets and in clinics; a stabilization level where workers provide the mentally-ill homeless with increased services and housing; and long-range planning to prevent future problems.

Kevin Flynn, a psychiatrist who does volunteer work with the homeless in Los Angeles, would like to see more mental-health workers encouraged to work with the homeless, but not necessarily as a part of a bureaucracy. He proposes a tax write-off to encourage charitable work. He notes that a mental-health professional doing charitable work today is allowed to deduct travel expenses but not an hourly fee for services provided.

Still, many who see the mentally-ill homeless, dressed in garbage bags or living under a bridge, question how well this population can be served. Some even argue that these people are being denied their rights by the very movement that claims it wants to help them. One reason for deinstitutionalization was the horrendous conditions in some mental institutions.

But in gaining civil rights, many of the homeless have ended up on the streets. In New York City, where cold winter weather is hazardous to people living on the streets, civil liberties groups protested when Mayor Edward I. Koch ordered that the homeless be rounded up on nights when the temperature drops below freezing. Civil libertarians contend the homeless feel safer on the streets than in the shelters, and that the answer is to reform the shelter system. Others counter that civil liberties are for people with a rational mind.

Dr. Flynn points out that, in California, the gravely disabled can be hospitalized against their will if they are endangering themselves or others.

On the roadside in Memphis, Clarence Brister goes through a stack of documents that he says proves a judge is taking funds from his bank account. He says he can't reach his family by phone, but he has been trying.

``It's not that they don't care,'' he says. ``But I do get lonesome.''

A nearby counseling center has a card with Clarence's name on it. He had stopped in toward the end of November, and a note said he would come back a week later. He had not returned.

Clarence says he doesn't trust the system; he says the Veterans Administration has not been a help, and that too many people give him the runaround.

``People are down on me for being homeless, and I ain't got a penny.'' Second of four articles. Next: Homeless people looking for opportunities.