The challenge of maintaining a mental health safety net is relatively new in Ohio. In decades past, state mental hospitals bore full responsibility for care and treatment. If patients and their families thought the quality of care was lacking, at least it was always clear who was in charge.
Since then, the system has changed a lot. During the late 1980s Ohio's state mental hospitals have been closed or drastically scaled back; they now handle only the most unstable cases. This has left thousands of people with serious mental conditions on their own in the community. They have more autonomy than ever before. But since funding for community services is still well below demand, there's a much greater risk that people with mental illness will not get what they need to stay stable.
Gilbert Boyd is a 54-year old Clevelander who's spent twenty years navigating the mental health system. His diagnosis is paranoid schizophrenic, and because of that he's eligible for some of the best the system has to offer: psychiatric services through Medicaid, housing that's subsidized by the county, and a monthly check from social security. That does not mean getting by is easy. Gilbert's check from the government is about $550 per month. Once the rent is paid, and medical necessities are met, there's not much left for other essentials-like food. Luckily, Gilbert's found a way around the problem.
Gilbert Boyd: I've been to the food pantry. They will give me two or three big big bags of food that will last a week, and that will last until my check comes out... They let you go twice a month.
Gilbert's caseworker is Sean O'Hagan with the Center for Families and Children. Sean's job is to make sure that people like Gilbert don't miss opportunities. That could mean shepherding a client through the six month process it takes to sign up for Social Security, or finding space in addiction recovery programs. Sometimes it means coming up with fresh ideas for finding transportation or grocery money. Sean says it's not that safety nets don't exist. But he's very frustrated with the limitations of what's available.
Sean O'Hagan: It seems really with most aspects of the work we're in that there is that wait associated. When you're trying for social security determination, you go down to the office and fill out an application, you have to wait generally around six months to hear back. The hunger centers and food pantry are great—we can get them in on an emergency basis. We can get food for folks and that's just a phenomenal benefit. But with lots of other things there is a wait.
He gets particularly frustrated with the absence of available housing. Wait lists can be as long as five years. And Sean says, that is not a reasonable goal for any client to work toward.
Watching Gilbert and Sean hanging out in Sean's Midtown Cleveland office, the two may seem like an odd pair. But the bond they've formed over the past six months may be the most important part of Gilbert's safety net. Both men agree that everyone with mental illness should have the chance to make a personal connection with someone who can be an advocate. Gilbert says that among the people he knows living on the streets, many are missing emotional support.
Gilbert Boyd: I think if you can get them into a shelter, they can get started and someone can get them connected with a social worker. That way they can have something going for themselves.
Sean O'Hagan: When you're working to engage folks, even if they aren't going to work with you right away, they are going to have needs, and doing things like connecting them to the hunger centers or the shelters, just doing things to help them meet some of those basic needs is an important first step.
The one-on-one interaction that's been so helpful to Gilbert has not been easy to replicate. Caseloads among Cuyahoga County's mental health agencies are higher than administrators would like. It's not unusual to find one worker handling fifty or more people.
One local researcher agrees that creating an effective safety net is as much about timing and accessibility as it is about services. Mieko Kotake Smith is a professor of Social Work at Cleveland State University, and a member of the local mental health board. In 2000, she published a report on recovery that detailed what was most helpful in keeping people with severe psychiatric disabilities in control. She says most can find a kind of recovery, but it may take them years to accept the illness and find a treatment that works. The safety net must be prepared to support them during that period, which is often a matter of years.
Mieko Kotake Smith: I don't think we have any formula to deal with that period, because each individual goes though a very special kind of trauma. I think our mental health system has to be very cognizant about that very volatile period until the medication is settled and the consumer finds right medication.
Professor Smith's report details information you might expect, detailing symptoms, a lack of financial resources, and access to services. But it also stresses the importance of emotional support. Instead of concentrating on creating a massive safety net, she says the mental health system might try to become more flexible and tolerant of change its clients are going through. In Cleveland, I'm April Baer, 90.3.