Give Them Shelter

Arthur Pokorski wears T-shirts with pockets, and if you ask him about his left arm, he will tell you about the 20 scars, white and puffy, running like hash marks on the inside of it. Pokorski, who is 5 feet 4 inches and looks professorial in oval glasses, heard voices one day in San Francisco almost 20 years ago. He'd never had a mental problem before in his life—this was a classic psychotic episode. The voices told him to take a razor blade and kill himself. He tried to comply, and he awoke several hours later in a pool of his own blood.

"It was a very bad day," he says. He was 20 at the time and has been trying to adjust to that suddenly new reality ever since.

In 1996, he sold all his possessions, moved to Seattle, and put to sea as a cook on bottom-fishing boats, in search of a better day. Off-season, he stayed in a small apartment in Belltown and drank a 12-pack of Bud Light each day. A schizophrenic will tell you: The voices are so strong you'll do anything for a release. The voices continued. He became unemployed in 2002. He drank himself right into the psychiatric unit at Harborview Medical Center. Following his release last summer, he crashed at a hostel downtown and started drinking again.

One day last October, by then broke, Pokorski checked out of the hostel and walked with a duffel bag bearing all he owned to a parking lot along Second Avenue. He sat and drank beer. It was a warm day, and he wore shorts and a T-shirt and a thin vest. He was drunk and hearing voices again. Two men stole his belongings and drove off. That was enough, he decided—of the voices, suicide attempts, death by cheap lager— enough of the marginal living. "I feel like I'm in prison for things I didn't do," says Pokorski, 38, a Polish immigrant, who became an American citizen in 1995. He walked downtown and checked himself into the main shelter at the Downtown Emergency Service Center (DESC), a homeless shelter–cum–psychiatric ward. He was one of the lucky ones. DESC turns away 100 people a night.

Two decades after America deinstitutionalized hundreds of thousands of mentally ill people, the community safety net that was supposed to serve them is ripped. Over the past four years in King County, up to $70 million has been slashed from services for low-income, chronically mentally ill people. It's about to get worse. Come next January, about 2,000 King County schizophrenics, bipolars, and depressives will find that they no longer have services, due to cuts in federal and state funding. People like Pokorski who want to get better won't get the chance. They will be loosed upon the streets and left to deal with their demons, untreated.

Are we really that stupid?

Enlightenment, But No Money

Thirty million Americans have a major mental illness, according to the National Institute of Mental Health. As many as 3 million are considered chronically mentally ill. Schizophrenic, sufferers of bipolar disorder, or severely depressed, they are ill to the point of disability and, in many cases, have been for years. That 3 million is a group much larger than the American prison population.

The Downtown Emergency Service Center serves homeless people of all kinds. But social workers think about two out of three clients either take psychiatric medication—or ought to.

For generations, veritable prison was what we offered the mentally ill in America. We shuffled them off to large state hospitals, some so immense that they housed 10,000 patients. That system was in many ways a shame and a disgrace. Patients forgotten by their families, helpless and unprotected, were raped, assaulted, and murdered by hospital workers and other patients. The mentally ill were sometimes forced to undergo lobotomies and scientific experiments. Common treatments included leather restraints and crude medications that obliterated mind, body, and soul.

We weren't interested in their rehabilitation or recovery. The paradigm was a warehouse.

When Ronald Reagan became president in 1981, he resolved to fix this—partly to offer some of the less severely ill in state hospitals a measure of freedom, but mostly because getting them out of the hospitals would cut government spending.

Supported by many advocates for the mentally ill, the goal was to shift these patients to a system of community care. There would be medication and therapy and life-skills classes and vocational training. There would be transitional housing, residential housing, and subsidized long-term housing. Continuity of care was what this new paradigm was supposed to be for people who mostly knew a continuity of hell. The mentally ill—known by professionals as clients or consumers—would go into the system and, someday, come out the other end, productive members of society.

But the mental-health system has evolved into a fragmented mess. More than 100 federal agencies fund it. The largest of those is Medicaid, sister program to Medicare. Medicaid pumps about $35 billion into treatment and services by making payments to states and requiring each to match the federal money. At approximately $70 billion, the public mental-health system in America is twice the size of Microsoft's annual sales.