Orange County

People with mental illness at increased risk for homelessness, incarceration

Ellen Miller says her mental health got worse when she was homeless, especially her post-traumatic stress disorder.
Ellen Miller says her mental health got worse when she was homeless, especially her post-traumatic stress disorder.

Ellen Miller was recovering in the hospital when she realized her ID was gone.

She’d had a seizure sitting near a transit building in Charlotte in 2015, and someone had stolen her belongings.

Miller was homeless at the time.

“I’m like, they freaking robbed me,” she said. “I can’t believe I’m having a seizure – a grand mal seizure – and you took my (expletive). Really?”

Miller’s seizures are triggered by stress. Before she became homeless, she would have one or two seizures every few months. While homeless, she had two or three a day.

Miller has bipolar disorder, obssessive-compulve disorder and severe post-traumatic stress disorder. She said her mental health got worse when she was homeless, especially her PTSD.

Dr. Nathan Copeland, a psychiatry resident at UNC Hospitals who wrote “Emergency Department Boarding: The Canary of Mental Health Care,” said people with mental illnesses are especially vulnerable to becoming homeless. Mental health spending has decreased more than 30 percent in North Carolina since 1955, when the deinstitutionalization movement started gaining popularity nationwide.

“There’s nothing therapeutic about (homelessness),” Copeland said. “And so you’ll see people with mental illness who get worse when they are homeless, because it’s so distressing for them.”

Of the estimated 11,448 homeless people in North Carolina in 2014, 18.9 percent – nearly one in five – had a serious mental illness, according to the N.C. Coalition to End Homelessness.

In Orange County, an estimated 108 people are homeless, the 2015 Orange County Community Health Assessment reported. The numbers don’t include people who are living with relatives or who were recently released from hospitals, jails or other institutions.

‘Anything sharp’

When Miller was homeless, even going to sleep was a challenge. She and a friend would take turns – six hours sleeping, and six hours watching.

“We’d find little cubbyholes to hide out in,” Miller said. “And we made sure that nobody, you know, followed us when we went there. And then of course you’d sleep with a sharpened stick, or anything sharp that you can find, because you don’t feel safe.”

Miller said she was never well rested.

“You’d get like maybe one or two hours of sleep,” she said. “You’re awake, because you’re afraid to sleep.”

Kristin Lavergne, co-director of the Inter-Faith Council for Social Service, said the stress puts homeless individuals at risk for developing a mental illness.

And finding treatment is difficult, especially without health insurance. It took Miller 17 months to find a psychiatrist.

Miller said she has prescriptions for 12 medications: three for chronic pain, three for mental health and six related to her breathing. But even when she had medication, she sometimes forgot to take it.

North Carolina used to have more case managers to remind people about medication and get them to appointments, but with the budget cuts, case management has diminished, said Patricia Hussey, executive director for Freedom House Recovery Center.

“If they don’t show up to the psychiatrist when their meds need refilling, especially those people who are really dependent on certain medications … to remain stable, that can end up with a very negative response,” she said.

‘Big mistakes’

When Rep. Verla Insko started advocating for mental health reform in the N.C. General Assembly, she thought the system would not take long to fix.

“It’s been 17 years,” Insko said. “I thought we could get it done in five to 10 years, we would have a really good mental health system. But we made some big mistakes and got off track.”

North Carolina’s mental health system used to primarily treat people in institutions. But many people who were institutionalized could have received treatment in a community setting, Copeland said.

“It takes people away from their families,” he said. “You know, it takes people away from friends, their loved ones.”

In 2001, Gov. Mike Easley signed a bill into law closing state-run psychiatric hospitals. A $35 million trust fund established by legislators and money that once funded those hospitals was supposed to go toward community-based services to treat people that were previously committed.

Instead, Insko said, the funds were used to balance the budget. Other savings from closing beds were used to fund the new Central Regional Hospital, Insko wrote in a News & Observer article in June, 2016.

“There weren’t any community-based services that were being established,” Insko said. “But the state started closing mental health beds, because that’s what the plan called for.”

Safety net

Without a stable mental health system, prisons and hospitals have become the safety net for people with mental illnesses, Copeland said.

In North Carolina, an estimated 8,617 prisoners are mentally ill, compared with 2,443 people in hospitals receiving treatment, according to a 2010 study by the Treatment Advocacy Center and the National Sheriffs’ Association.

“Prisons are, of course, terrible places to treat mental illness, because they’re just not designed for it,” Copeland said. “And they’re just horrible places to be. You know, they’re not good places to rehabilitate.”

Even when care is available, many people face long wait times, Lavergne said.

“When that person finally does say, ‘Yes, I want help,’ or ‘Yes, I want to see somebody about this’ and you go on the phone and it takes a month to get an appointment, that’s not good,” she said.

Sometimes, patients seeking mental health services have to return to emergency departments for weeks to get a spot in a psychiatric hospital.

At the emergency department at WakeBrook Hospital in Raleigh, someone seeking mental health care is twice as likely to be homeless than someone in the general population, according to a study by Dr. Brian Sheitman, the medical director of UNC-Wakebrook.

WakeMed Hospital had to divert all medical health cases to other hospitals in May 2016, because the 60-bed hospital had nearly 100 mental health patients waiting for treatment.

“These are things that we’ve never seen before,” Copeland said. “And it just keeps getting worse. ... You keep thinking it’s going to be the breaking point, and it’s not.”