{"id":368669,"date":"2021-10-31T12:00:51","date_gmt":"2021-10-31T12:00:51","guid":{"rendered":"https:\/\/theintercept.com\/?p=374763"},"modified":"2021-10-31T12:00:51","modified_gmt":"2021-10-31T12:00:51","slug":"atlantas-mental-health-problem-and-ours","status":"publish","type":"post","link":"https:\/\/radiofree.asia\/2021\/10\/31\/atlantas-mental-health-problem-and-ours\/","title":{"rendered":"Atlanta’s Mental Health Problem \u2014\u00a0and Ours"},"content":{"rendered":"

H<\/span>armony lay in<\/u> a 6-foot-wide stream of her own waste, swaddled in a blanket infused with feces. She propped up her matted head on her right arm, looking up at two downtown ambassadors from the community improvement district who had come out to ask her to move for the fourth time in a week. They needed to pressure wash the sidewalk.<\/p>\n

Harmony is not her real name. Atlanta\u2019s powers that be know who she is.<\/p>\n

Phillip Spillane, a good friend of mine among the ambassadors, had called 911 to get paramedics to take her to Grady Hospital that Friday. He has made this call about once every two weeks, when the state of Harmony\u2019s squalor becomes too much to bear for an observer with a soul.<\/p>\n

I came upon them as paramedics were piling back into a Grady ambulance. I watched them drive away, an impassive expression on the face of the paramedic in the passenger seat as she watched Harmony, who remained on the sidewalk.<\/p>\n

It was the same expression on the faces of most of the people walking by. I\u2019ve seen it every time I\u2019ve come downtown to Atlanta to talk with her. It\u2019s not that passersby don\u2019t notice her, but people make an immediate mental calculation about their ability to help someone in this kind of distress. The social reaction \u2014 the human reaction \u2014 left over is a carefully deliberate nonchalance meant to provide some dignity to\u00a0a person in a state of public humiliation and to retain some dignity of their own on the scene of a moral catastrophe.<\/p>\n

Of course, some people realize that they\u2019re about to step in her shit and can\u2019t keep from scowling.<\/p>\n

This story starts with Harmony. It does not end with her.<\/p>\n

\n\"2-ambulance-back\"\n<\/div>\n

Harmony wants to be seen. Her survival depends on being seen. Dangerous things happen to people out of sight, in her mind. She won\u2019t go into Woodruff Park next to the Walgreens for fear of being attacked. But on the sidewalk, people will see her, and some will bring her food as an offering to their own conscience. The lights on Peachtree Street will keep her safe in the darkness, if one can call any of this safe.<\/p>\n

Harmony called out to me by name. It shocked me.<\/p>\n

In what universe would someone fighting to keep the black flies from airlifting her off the sidewalk, with all the cops and social workers and the musical dance number of homeless people around her, have the presence of mind to remember my name<\/em>?<\/p>\n

In that flash of casual lucidity, I saw all of her problems illuminated.<\/p>\n\n

If Harmony had the wit to remember me, then, perversely, it meant that she might not be\u00a0unwell\u00a0enough<\/em> to be committed involuntarily to a hospital for treatment. Hearing my own name pissed me off.<\/p>\n

Harmony isn\u2019t exactly unique; thousands of people in Georgia\u00a0have mental illnesses and developmental disabilities and addictions, flitting into and out of the state\u2019s care in between long bouts of homelessness. But Harmony is at the center of the Familiar Faces project, an official list of people with severe and persistent illnesses whom Fulton\u00a0County, where Atlanta is located, and the state desperately want to get off the street and out of the county jail.<\/p>\n

I would argue that no one currently experiencing homelessness in Fulton County, if not the state, requires more help than Harmony.<\/p>\n

I would argue that no one currently experiencing homelessness in Fulton County, if not the state, requires more help than Harmony.<\/blockquote>\n

And yet despite millions in resources, much of which the state cannot figure out how to spend, Harmony remained unhoused at the foot of the iconic Coca-Cola sign above the Walgreens at Five Points \u2014 in the heart of Atlanta\u00a0\u2014 as she has on and off for years, in a state of abject human degradation, with all of this misery taking place less than 100 yards from the very steps of Georgia\u2019s Department of Behavioral Health and Developmental Disabilities headquarters.<\/p>\n

The people who can help her can see her from their offices. They might walk by her on the way to lunch.<\/p>\n

We spend less to treat mental illness than we should. As a result, Georgia is dead last<\/em> in the 2021 national rankings<\/a> for access to mental health care, as measured by the nonprofit advocacy group Mental Health America. Our miserable placement comes because poor and working-class people cannot afford routine mental health care \u2014 Georgia did not expand Medicaid, after all \u2014 and because we have about half the mental health providers as the national average.<\/p>\n

Harmony has been the subject of intense discussions with the overseers of a federal consent order with Georgia\u00a0that requires the state to prevent people\u00a0with severe and persistent mental illnesses from falling into homelessness after being discharged from state facilities.<\/p>\n

But a tug of war between the state, city, county, and others has made it difficult to figure out who should foot the bill for her care. Simple housing seems inadequate \u2014 she probably needs residential nursing assistance, since she can\u2019t clean herself, and no one appears to be willing to provide housing without that care. The hospitals don\u2019t want her because she doesn\u2019t want to be there. Jail simply exacerbates her mental illness, with no easy alternative for police or social workers to use. And so she is left like an incontinent animal in the backyard, treated primarily as a sanitation problem.<\/p>\n

I didn\u2019t want to focus this story on Harmony. I don\u2019t want to exploit the image of her crisis as some act of poverty porn without being able to help her. I have been wrestling with the question of consent, because it is hard to imagine someone living like this who is\u00a0well enough to participate in the telling of their own story. I say this, though she has said she wants me to write. Frankly, I didn\u2019t believe her until the day she called me over by name. It meant that her memory was relatively intact.<\/p>\n

And that\u2019s the problem. Because if she\u2019s lucid enough to consent to my reporting, then she\u2019s lucid enough to refuse treatment, which she does regularly. Harmony\u2019s plight highlights the failures of Georgia\u2019s health care systems \u2014 and that makes the story worth telling. The questions I hope to raise\u00a0are whether we should accept that Harmony\u2019s stated demand to be left alone should be enough, why it takes so long to act, and what our moral and legal choices look like.<\/p>\n

\n\"3-court\"\n<\/div>\n

H<\/span>armony is 38<\/u> and has been in and out of state hospitals for much of her life, she told me. She doesn\u2019t\u00a0like to stay there. She will, in fact, fight her way out.<\/p>\n

Held at a Piedmont\u00a0Healthcare facility in January, Harmony got mad when a guard asked her to stay in her room, according to court records. She pushed him, then started smashing computer equipment. Police charged her with a felony \u2014 the first after a long line of misdemeanors \u2014 for breaking a laptop. She spent 123 days in jail in Newton County before being convicted and sentenced to time served in May, with five years of probation and a required mental health evaluation.<\/p>\n

She told the Newton County court that she was paranoid and schizophrenic, had a ninth-grade education, and was\u00a0at the time prescribed a suite of psychiatric medications: Seroquel, Depakote, Geodon, Haldol, and Risperdal. She also said she was using drugs.<\/p>\n

Judge Layla Zon accepted her guilty plea after a few questions to see if Harmony understood what she was agreeing to.<\/p>\n

\u201cI am also going to find on the record that the defendant appears to be competent based upon the time that I spent asking her questions,\u201d Zon said. \u201cShe also appears to be coherent, very responsive appropriately to my questions. She is being medicated for the medical diagnosis that she has of paranoid schizophrenia. And that medication actually helps her understand the proceedings rather than impair her ability to understand the proceedings.\u201d<\/p>\n

After the plea, Harmony spoke up, according to the court transcript.<\/p>\n

THE DEFENDANT: Can I ask you something?<\/p>\n

THE COURT: Yes.<\/p>\n

THE DEFENDANT: Can I ask you something? I know that you the judge and lawyer\u00a0\u2014 judge, lawyer, help, case dismissed.<\/p>\n

THE COURT: What was your question?<\/p>\n

THE DEFENDANT: Judge, lawyer, help, case dismissed.<\/p>\n

THE COURT: Judge, lawyer does what now?<\/p>\n

THE DEFENDANT: I said judge, lawyer, help, case dismissed.<\/p>\n

THE COURT: What about the case being dismissed? I don’t understand your question.<\/p>\n

THE DEFENDANT: I said help, case dismissed.<\/p>\n

THE COURT: You want the case to be dismissed?<\/p>\n

THE DEFENDANT: I said, I’m telling you all four names, four names y’all said. I’m telling you four names: Judge, lawyer, help, case dismissed.<\/p>\n

THE COURT: Okay.<\/p>\n

THE DEFENDANT: I said that’s what I wanted to tell you.<\/p>\n

THE COURT: You wanted to tell me to dismiss the case?<\/p>\n

THE DEFENDANT: Huh-uh. I had wanted to tell you that.<\/p>\n

DEPUTY: I’m sorry. Is she in court right now?<\/p>\n

THE COURT: Yes.<\/p>\n

THE DEFENDANT: Yeah, I’m in court.<\/p>\n

THE COURT: But I can’t understand what she’s saying. Judge, lawyer, help\u00a0\u2014<\/p>\n

THE DEFENDANT: I said I had wanted to tell you something. That’s all I wanted to tell you.<\/p>\n

DEPUTY: She just wanted to tell you those words.<\/p>\n

THE DEFENDANT: I had wanted to tell you something.<\/p>\n

THE COURT: Okay. You wanted to tell me judge, lawyer, case dismissed?<\/p>\n

THE DEFENDANT: Yes.<\/p>\n

THE COURT: Okay. But you told me earlier that you wanted to plead guilty to the charges.<\/p>\n

THE DEFENDANT: Yeah. I said\u00a0\u2014 I just said that\u00a0\u2014 really I took my time served. But I just said case dismissed. Other than saying time served, I said case dismissed.<\/p>\n

THE COURT: Okay. Well, I can’t dismiss the charges because the State is going forward. The prosecution is moving forward with this case. And that’s why you have an option of pleading guilty or going to a jury trial. And you told me that you wished to plead guilty.<\/p>\n

DEPUTY BELL: I think she was trying to tell you she knows those words.<\/p>\n

THE DEFENDANT: I said, can I\u00a0\u2014 can I ask you this? Can y’all give me time served?<\/p>\n

DEPUTY BELL: She’s trying to tell you she knows those words.<\/p>\n

THE COURT: I did give you time served. I sentenced you to five years on\u00a0\u2014<\/p>\n

THE DEFENDANT: I thought Eddy Cossio\u00a0\u2014<\/p>\n

THE COURT: I sentenced you to five years on probation and the jail time that I ordered that you have to serve I’m giving you credit for time served. Now, where do you\u00a0\u2014<\/p>\n

THE DEFENDANT: Okay. Okay.<\/p><\/blockquote>\n

Harmony told the court she was homeless. The court instructed probation to send her to the Rainbow Community Shelter in Covington because her uncle would no longer take her in. (I have been unable to locate her uncle.) Three days later, the shelter kicked her out for misbehavior, and she found her way back to a downtown Atlanta street corner.<\/p>\n

People with serious mental health problems in Georgia\u2019s hinterlands almost always find their way to the streets of Atlanta. The most common service delivery strategy in \u201cconservative\u201d counties for\u00a0homeless people\u00a0or people who need drug treatment or women running from an abusive spouse is a bus ticket to Peachtree Street. It keeps taxes low and lets them brag about much \u201ccleaner\u201d their communities are.<\/p>\n

I spoke with Harmony\u2019s probation officer in Newton County. Harmony never received the post-conviction psychiatric evaluation required by the court. She has never made a probation meeting. At first the officer was only marginally aware that Harmony was even on her caseload. Harmony did have an active warrant for her arrest for violating her probation, not that anyone \u2014 anyone<\/em> \u2014 really wants her in jail. Because what\u2019s the point? Unless it\u2019s to force her or someone else to clean her, in ways that are likely to be traumatizing\u00a0to\u00a0all involved.<\/p>\n

\n\"4-List-E-with-pen\"\n<\/div>\n

I<\/span> dream of shit.<\/u><\/p>\n

I stepped in Harmony\u2019s waste as I walked over to her. I didn\u2019t realize it at first, of course. I felt the squish on my shoe as I approached. Her shit was everywhere. I scraped my sole on the sidewalk without thinking, then realized what had happened. I tried to ignore it.<\/p>\n

Harmony was nude from the waist down, covered with a blanket, as usual. Her thin top exposed a chest full of open sores. Some had healed and scarred over a bit since the last time we spoke. Her 300-pound frame was dusted in a light coating of her own feces. A cloud of black flies buzzed around her.<\/p>\n

Harmony asked me for food, but I didn\u2019t have time to run to Rosa\u2019s Pizza for her preferred meal of a pepperoni slice. She then asked for pen and paper. I walked into Walgreens to buy some. The smell stayed with me. I couldn\u2019t tell if I was imagining it or not. I wondered if I was radiating the smell of her waste as I picked up a notepad and some Sharpies.<\/p>\n

I handed them to her, along with a bag of gummy bears, and she began to fill four pages with one-word lines:<\/p>\n

Uplift<\/p>\n

Withhold<\/p>\n

Law<\/p>\n

Government<\/p>\n

Authority<\/p>\n

Federal<\/p>\n

Sever<\/p>\n

Peace<\/p>\n

Unite<\/p>\n

Equal<\/p>\n

I asked Harmony what they meant. She sort of shrugged and quietly said that this was her. She was describing herself. Perhaps. She was very quiet.<\/p>\n

Harmony wanted fresh blankets. I said I wasn\u2019t in a position to get some for her right then. She offered me some of her gummy bears. I politely refused. Harmony saw a white cardboard paper lollipop stick on the sidewalk. Wrapped in the soiled blankets, she wasn\u2019t able to reach it. She asked me to give it to her, so I picked it up off the shit-smeared sidewalk and handed it over. She started cleaning out her right ear with it. And I left.<\/p>\n

I went to lunch. I sat away from others, wondering if my shoe still smelled of her. I couldn\u2019t go home. The entire interaction, punctuated by my own impotence at being able to resolve anything for her, left me vibrating with a kind of moral fury I didn\u2019t want to dump in my own house. I went to a movie instead\u00a0\u2014\u00a0the theaters remain mostly empty on Friday afternoons. I took a paper towel to my shoe in a sink, found a private spot in a dark corner, and wept where no one could see me.<\/p>\n

\n\"5-caseworker-emt\"\n<\/div>Later, Spillane told me that Fire Truck 25 had rolled in from southwest Atlanta to Five Points to take the call about Harmony. Firefighters parked the truck on Edgewood Avenue and spoke to her. After a few minutes, it became clear that they couldn\u2019t \u2014 or wouldn\u2019t \u2014 talk her into coming with them. They met with the team from a Grady ambulance. After a short, familiar conversation, everyone left Harmony to roll around in her own shit. Again.<\/p>\n

I had spoken with that crew four days earlier as they were bundling a man I knew well into the back of an ambulance for the third time in a month. I stopped to chat. He\u2019s one of a cast of characters better known downtown by nicknames like Ooo-wee or the Angry Man\u00a0or\u00a0Smiley. I know their real names. My friend has a history of passing out drunk on the sidewalk, as he has done for the better part of a decade. He perked up a bit when he saw me. We\u2019ve been speaking for years about his need to stop drinking and get off the street. He was sober for a while a couple of years ago. I wish it had lasted longer.<\/p>\n

I asked the EMTs what they would want the public to know.<\/p>\n

A paramedic took out his phone and pulled up a calculator. \u201cEvery time an ambulance comes to take him to Grady, it costs $1,700,\u201d he said. \u201cThat\u2019s before he walks through the door.\u201d They pick him up once a week. The state of homelessness and inebriation my friend lives in costs the public about $88,400 a year\u00a0at minimum, he said. For that much money, four or five people could be provided permanently supportive housing.<\/p>\n

They knew Harmony well. When I brought her up, they just shook their heads. They come to take her just as often \u2014 only she won\u2019t go.<\/p>\n

I asked Harmony that day if she was still OK with me writing a story about her, and she said yes. If someone offered her an apartment, I asked, would she take it? She said yes to that too. I asked her if she would go to a nursing home. She said no.<\/p>\n

I dreamed that night about what a jail would do with Harmony. How would they clean her? Would they just hose her down like in a prison movie, or would they give her the dignity of cleaning herself? Could she take a shower? How would they clean the shower? I awoke with a start after dreaming about being trapped in a stopped-up public toilet stall with no toilet paper and people peering through the gaps in the door.<\/p>\n

\n\"6-ER\"\n<\/div>\n

T<\/span>he next morning,<\/u> paramedics arrived to take Harmony to Grady and then to a state hospital, come hell or high water. Harmony had finally drawn enough attention. She refused to go willingly, as usual. This time, they shot her full of the aggression-reducing antipsychotic Haldol and carted her away anyway.<\/p>\n

But this story isn\u2019t about Harmony.<\/p>\n

It\u2019s about all the things that have to be broken to leave someone in Harmony\u2019s state, living in her own shit on an iconic Atlanta street corner for five months.<\/p>\n

It\u2019s about how we react to seeing someone like Harmony \u2014 the same someone, over and over \u2014 or to squalid tent encampments under a highway, or to someone clearly out of their wits begging people\u00a0in cars at a stoplight. We ask ourselves what in the cherry-flavored fuck<\/em> are we doing with our tax money, if this is what we get. How can we call this a “developed” country when this kind of dismal wretched misery greets us in public places? Who do we hold responsible for this failure?<\/p>\n

And I\u2019m not talking about reactionary libertarian sociopathy. I\u2019m not entertaining amoral bastards who shout \u201cGet a job!\u201d from their SUV window and then call the cops to get rid of \u201cundesirables\u201d in their neighborhood, patting themselves on the back for how their hard work made them successful.<\/p>\n

Hundreds of thousands of Americans have schizophrenia. Schizophrenia cackles at Darwinist meritocracy.<\/p>\n

I want people to understand why it takes so damned long<\/em> for what we laughingly call \u201cthe system\u201d to help someone like Harmony.<\/p>\n

People experiencing chronic homelessness driven by mental illness have often been burned by the system. For someone wrestling with delusions, it can take dozens of contacts simply to convince them that a caseworker isn\u2019t a figment of their imagination.<\/p>\n

Even when a caseworker gets a client to say yes, they are met with a system that is underfunded, poorly coordinated, riven by competing interests, the last political priority of policymakers, and dependent on private housing providers\u00a0that manifestly do not give a shit about keeping people off the street.<\/p>\n

\u201cMental health is messy,\u201d said Fulton County Commissioner Bob Ellis, in a hearing about establishing a diversion center \u2014 something homelessness strategists have been calling for for years.<\/em> \u201cIt involves so many different layers, people want to get into whose role is it. That\u2019s part of the reason stuff never gets done. It\u2019s the state\u2019s role, the county\u2019s role, the city\u2019s role, law enforcement\u2019s role. It\u2019s the family\u2019s role because they need to take care of it. We can get caught in that trap as well.\u201d<\/p>\n

\n\"7-jail\"\n<\/div>\n

H<\/span>armony is<\/u> unique. And yet there are at least\u00a0100 Harmonys on the streets of Atlanta.<\/p>\n

The county knows each of them by name. There\u2019s a list.<\/p>\n

A few years ago, folks working on strategy around mental illness and jail wanted to better understand who the \u201chighest utilizers\u201d were. Who are the people who bounce in and out of jail most frequently? Who is taking a $1,700 ride to Grady once a week? From these questions arose a data project to identify and target them for intensive outreach and prioritized service.<\/p>\n

Fulton County now calls this the Familiar Faces program. We used to call them frequent flyers. (I have to wonder if Delta Air Lines objected.) The top hundred make the list.<\/p>\n

Kristin Schillig, who works for the Fulton County courts, is the keeper of that list. Schillig and I have been friends for years. We worked together on a judicial task force trying to get people with mental illnesses out of the county\u2019s jail. I peppered her with familiar questions.<\/p>\n

Familiar Faces cross-references Fulton County Jail data with Grady Hospital\u2019s own high-utilizer tracking system, mental health data, and the Atlanta\u00a0Jail. The federal government is funding the project now \u2014 $250,000 a year, for three years \u2014 to see if it can drive down costs and reduce the burden on the jail, she said. But she\u2019s learning about where everything goes wrong.<\/p>\n

\u201cI think the story for me is that there are so many gaps in the system,\u201d she said, exasperated. \u201cGeorgia is 51st in investment in mental health care. We\u2019re working for nothing. This is, by far, the hardest thing I\u2019ve ever done. The traditional systems, they fall through every crack.\u201d<\/p>\n

<\/div>\n

The systems in place to catch high utilizers aren\u2019t working yet. Of the 100 people identified by Familiar Faces, only two had previous contact with Atlanta’s Policing Alternatives and Diversion Initiative, a pre-arrest diversion program, she said.<\/p>\n

\u201cWe hear people don’t meet criteria a lot for various community, behavioral health, and housing programs,\u201d she said. \u201cSystems in place are so rigid. There needs to be more flexibility, some flexible funding streams are needed to fill the gaps. Also, establishing the Center for Diversion and Services is the key missing infrastructure gap to keep Familiar Faces out of jail. It’s an easy win.\u201d<\/p>\n

\u201cWe have a plan,\u201d she said. \u201cWe’ve had other plans. We need action.\u201d<\/p>\n

Harmony\u2019s arrests are absurd. Behold a selection of recent narratives from arrest reports:<\/p>\n

\n\"8-4-police\"\n<\/div>Criminal trespassing: \u201cThere was a female at the location that refused to leave the premises. When I made contact with the female \u2026 she stated she was not going to leave. She stated she had already been served with a trespass warning and advised me to take her to jail. I attempted to offer her a referral to the pre arrest diversion, but she stated she wanted to go to jail.\u201d<\/p>\n

Simple assault: \u201cOn the listed date and time Ofc. Moore and I were enroute to a call when a black female ran up to the patrol car and stating that she needed help and that she wanted to go to jail. [She] then put her hand in the window and tried to strike Ofc. Moore in the chest with a closed fist, but did not hit him. When Ofc. Moore was taking [her] into custody I went over to assist him and [she] kicked me in the leg stating that she wants to go to jail because she has not slept in a long time. Grady EMS unit 260 responded to the location because [she] was very irate and was talking out of her head.\u201d<\/p>\n

Larceny (other): \u201cVictim … stated his two bags were taken with a few items but he confronted [her] because she was wearing some of his clothing items. [He] did not see who took his bags. He stated he left his two bags outside while he entered the Xpress Store and when he came out those bags were gone. Arrestee … admitted to going inside of the bag and putting clothing items on because her clothes displayed human feces on them.\u201d<\/p>\n

Public urination\/defecation: \u201cOfficer Randall … was flagged down by citizens in the area of 236 Forsyth St.\u00a0the Garnett Office Building. While there, Mr.\u00a0B. Jones advised that the accused … continues to defecate and urinate on city sidewalks. Officer Randall and Brown have warned and arrested the accused in the past for the same violations. Today Officer Randall contacted the pre arrest diversion along with Grady which the accused … refused saying take me to jail. Officer Randall was left with no other resources because the accused behavior would not change.\u201d<\/p>\n

\n\"\"\n<\/div>It\u2019s very rare for someone\u00a0with mental illness to beg police to be taken to jail. The idea that desperate people regularly commit petty crimes in order to be fed a warm meal under the roof of the jailhouse is mostly a myth. It propagates precisely because it\u2019s so rare: It stands out in the mind of any cop\u00a0who encounters it.<\/p>\n

For every one of these encounters, there are probably a handful of police interactions\u00a0in which cops didn\u2019t bother to arrest Harmony. But they didn\u2019t help her either, because there\u2019s no place to take her except jail. For pre-arrest diversion to work, there has to be a place to divert someone.<\/p>\n

Fulton County Superior Court Judge Robert McBurney presented<\/a> the Familiar Faces project to Fulton County commissioners earlier this month, hoping to convert part of the city jail to a diversion center, a place where people in crisis can be taken in lieu of arrest.<\/p>\n

\u201cWhen 911 is called and an officer responds to a gas station and there\u2019s a gentleman there acting erratically … the only option we have right now is to take that person to jail,\u201d McBurney said. \u201cNow that\u2019s not fair. There\u2019s [the Policing Alternatives and Diversion Initiative], but it doesn\u2019t work 24\/7 unfortunately. … PAD is not a cure-all.\u201d<\/p>\n

Three out of\u00a0four times when a cop rolls up on a high utilizer with rap sheets that are an inch thick \u2014 someone about to be charged with criminal trespass, public drunkenness \u2014 that person gets arrested because there\u2019s no other option, he said.<\/p>\n

“They stay longer, they cost more to take care of, and they come back sooner. They\u2019re built-in recidivists.”<\/blockquote>\n

\u201cThey are superutilizers of our jail,\u201d McBurney said. “They stay longer, they cost more to take care of, and they come back sooner. They\u2019re built-in recidivists.”<\/p>\n

It costs about $30,000 a year to keep someone in a jail cell. The example McBurney used from Harris County, Texas\u2019s diversion center showed that the government saved $5.50 for every dollar it spent on its diversion center, simply by keeping people out of jail and the hospital.<\/p>\n

People working on this problem in\u00a0Fulton County have been talking about establishing a diversion center since 2018. I know this because I tried to get one set up at a county-owned property in Summerhill and was summarily castrated<\/a> by neighborhood political blowback. Even now, with a proposal to build an alternative to jail in a jail,<\/em> county commissioners are wrestling with how to do so without impeding other priorities\u00a0\u2014 like jailing people.<\/p>\n

\u201cIt really impacts what [the sheriff] is trying to do with bed space,\u201d Commissioner Natalie Hall said to McBurney, challenging the idea at the text-messaged behest of Sheriff Patrick Labat.<\/p>\n

Every single elected official speaking about the subject of the diversion center \u2014 a central component to the city and county\u2019s pre-arrest diversion strategy \u2014 extolled the virtues of diversion. But I have to ask where the hell the City Council and Board of Commissioners\u00a0have been for the last three years. None of this is new. It\u2019s just everyone\u2019s last political priority.<\/p>\n

After years of inaction, I\u2019m\u00a0calling bullshit.<\/p>\n

Elected leaders want to look like they care about homelessness and poverty while ignoring calls for actual action. In this case, the need to relieve overcrowding at the county jail is a more pressing political problem than a woman sleeping in her own waste on an Atlanta street corner.<\/p>\n

\u201cThis conversation started way before I got here,\u201d said Commissioner Khadijah Abdur-Rahman. \u201cAt some point, we have to move past the conversation. \u2026 Business owners every day have to watch a person with a behavioral issue remove their clothes or for whatever reason have an accident in front of them or in their shop.\u201d<\/p>\n

\n\"10-hospital-bed\"\n<\/div>\n

H<\/span>ere\u2019s what<\/u> it\u2019s supposed<\/em> to look like:\u00a0A person with psychiatric trouble (or a bystander) reaches out to a government authority \u2014 the cops, the paramedics, the state \u2014 to get help. Psych paramedics come. If a person in trouble won\u2019t go with them, a social worker comes in to enroll that person remotely in social services and find them some housing. It might be temporary, like a hotel room, but the contact leads quickly to permanent housing with a connection to social services.<\/p>\n

We talk about housing first because that\u2019s the policy the system has been designed around. People are not expected to get clean or become compliant with their medications or get a job before being given housing. The housing comes first to help with all the other problems.<\/p>\n

When people are easy, this works. But people aren\u2019t always easy. People in crisis, frankly, rarely are.<\/p>\n

\u201cAt the highest level, maybe we need to make it less hard for people to access our systems,\u201d said my friend Cathryn Marchman, executive director\u00a0of Partners for Home, Atlanta\u2019s homelessness nonprofit coordinator. \u201cWe have to make sure that the opening into these services can\u2019t be this restrictive. More accessible, lower barrier for anyone who walks through the door \u2014 hospital, housing system, whatever kind of resource. My general beef is that nonprofits and service provision across the system has to stop cherry-picking who we serve.\u201d<\/p>\n

\u201cWe have to make sure that the opening into these services can\u2019t be this restrictive.”<\/blockquote>\n

Social workers see the same people over and over again. It scrapes away empathy.<\/p>\n

\u201cIt\u2019s so hard with Grady because they are so overwhelmed,\u201d Marchman said. \u201cIn a case like Harmony that is so extreme, I think systems often lose sight of …\u201d She trailed off. \u201cI think they just get jaded. We see behavior as manipulation, as less worthy for access. And certainly, far more difficult and challenging.\u201d<\/p>\n

Atlanta is not California. I spent a couple of weeks in Los Angeles a few months ago and San Francisco last year, and I can safely say that there is no equivalent to Skid Row or the Tenderloin in this state. Anyone making that comparison should be ignored.<\/p>\n

That said, at the start of the coronavirus pandemic, Atlanta embarked on a massive, federally funded program to scoop up as many people experiencing homelessness as it could and house them. While quite successful, observers say the void has been filled with people on the street who are much harder to serve.<\/p>\n

The Department of Behavioral Health and Developmental Disabilities issued 765 housing vouchers for people with severe and persistent mental illnesses in fiscal year 2021, said Maxwell Ruppersburg, the department\u2019s director of supportive housing. Only a\u00a0few more than 200 people actually got housing, even with money in hand from the voucher, he said.<\/p>\n

The state had a budget of about $27.3 million for supportive housing in 2020. It spent $11.9 million. This fiscal year, the state cut the supportive housing budget to $20.6 million. The state has spent $12.9 million. It would have spent the other $8 million if it could have found people to take the money.<\/p>\n

Supportive housing costs $15,000 per year, give or take. That\u2019s about 533 people left unserved.<\/p>\n

\u201cYou hear about waiting lists with other programs,\u201d Ruppersburg said. \u201cWe don\u2019t typically have a waitlist. But we have more of a problem with folks receiving vouchers, and then they can’t secure housing. And so the vouchers expire. Ultimately, they get extensions, but at some point they do expire.\u201d<\/p>\n

The reason, simply enough, is that few landlords want to rent to someone they fear will trash their building. Housing has been tightening in\u00a0the Atlanta metro area for the last decade. There\u2019s no shortage of renters without severe psychiatric problems willing to pay full price for an apartment. And there\u2019s no mechanism in the law to force a landlord to rent to someone.<\/p>\n

The easy cases are covered, more or less, at least until the eviction moratorium lifts. But the moratorium made landlords far more cautious about whom they will rent to, constraining supply all around.<\/p>\n

Georgia\u2019s housing policy rests almost entirely on private accommodation, subject to neighbors waging war on Section 8 at zoning board meetings.<\/p>\n

\u201cThere is an element of housing discrimination that’s occurring. First, we never know about it individually,\u201d Ruppersburg said. \u201cBut it’s fair to believe that that’s happening at a systemic level.\u201d<\/p>\n

\n\"11-checkup\"\n<\/div>\n

S<\/span>ome people need<\/u> more than housing to get healthy.<\/p>\n

The state has a legal standard for involuntary commitment, requiring someone to present \u201ca substantial risk of imminent harm to self or others as manifested by recent overt acts or recent expressed threats of violence which present a probability of physical injury to self or to other persons\u201d or appear \u201cto be so unable to care for his\/her own physical health and safety as to create an imminently life-endangering crisis.\u201d Colloquially, people working with mental illness on the street refer to this as a 1013, for the form used to commit someone.<\/p>\n

When a cop rolls up to a person showing signs of psychiatric distress, they can make an arrest. They can\u2019t 1013 them. Only a doctor, licensed social worker, family or marriage counselor, advanced practice nurse, or physician\u2019s assistant can sign the form. That means a cop has to wait for Grady or the state to send an ambulance. Every time a clinician signs the 1013, they put their professional career on the line to say someone is\u00a0unwell enough to require crisis stabilization whether that person wants it or not.<\/p>\n

The bar, plainly, is very high.<\/p>\n

The state legal standard requires hospitalization to be the \u201cleast restrictive level of care available for the individual\u201d in order to gain admittance to a state hospital for crisis stabilization.<\/p>\n

A hospital can hold someone against their will for crisis stabilization only for five days at a time. After that, either the hospital must obtain a legal order for involuntary treatment or the patient must consent willingly to a longer-term stay;\u00a0otherwise, the patient walks.<\/p>\n

Harmony walks fairly often.<\/p>\n

No one with clinical responsibility for Harmony\u2019s care would speak to me on the record about her case, citing privacy laws. The question of admittance has been a bit moot for the last few months, in Harmony\u2019s case, because Georgia Regional Hospital has substantially slowed down its intake of new patients.<\/p>\n

\u201c[The Department of Behavioral Health and Developmental Disabilities], along with our health care peers, has been navigating workforce challenges for several months now,\u201d Ruppersburg said. \u201cOur workforce shortages are exacerbated by the additional demands of quarantine units, when needed as a result of the Delta variant, and the increase in demand for behavioral health crisis services nationwide.\u201d<\/p>\n

In August 2019, Georgia\u2019s state psychiatric hospital averaged about 15 psychiatric care beds out of service. This August, it lost an average of 99 beds.<\/p>\n

\n\"12-waiting-room\"\n<\/div>The loss of capacity at state hospitals comes at the same time that demand has increased. In June, crisis referrals from the Georgia Crisis and Access Line rose 31 percent over the same month in 2020. This increase in referrals came at a time when nursing shortages resulted in a 10 percent reduction of available beds in behavioral health crisis centers and crisis stabilization units across the state.<\/p>\n

A legislative committee has been reviewing Georgia\u2019s civil commitment rules. This spring, the Georgia Behavioral Health Reform and Innovation Commission suggested changes to the state\u2019s legal standards.<\/p>\n

\u201cThis unreasonably high bar forces families and caregivers to postpone intervention until it appears that tragedy is on the verge of striking, even when it is obvious to all that the individual is in crisis and heading swiftly and inevitably to that point,\u201d the panel wrote<\/a>. \u201cForcing people to get worse before they can get help defies copious research demonstrating that the longer severe mental illness remains untreated, the lower the person\u2019s prospects for recovery are. Of course, it is rarely possible to intervene at the very moment that disaster is imminent. More typically, the waiting allows disaster to occur, causing needless human suffering and victimization, and often damning the individual to face serious criminal charges.\u201d<\/p>\n

The panel said no legal or constitutional imperative requires \u201cimminence\u201d as a standard. At least 20 states recognize psychiatric deterioration as a good enough reason to hospitalize someone without their consent.<\/p>\n

\u201cUnder the current law, the potential harms recognized as important enough to warrant intervention are, by definition, those that involve serious physical injury or death,\u201d the panel wrote. \u201cUnfortunately, this disqualifies many individuals in mental health crisis who may not be facing obvious external dangers, but who are powerless due to loss of insight (ability to recognize their own illness and need for treatment) to volunteer for care and protect their minds from harm that could be irreparable in the absence of timely medical aid.\u201d<\/p>\n

\n\"13-milledgeville\"\n<\/div>\n

G<\/span>eorgia\u2019s history with<\/u> mental health care is a literal horror story.<\/p>\n

The state famously warehoused patients for most of the last century in ways that led parents to threaten their children with a trip to Milledgeville<\/a> if they misbehaved. Today Georgia is under a federal consent order\u00a0that requires\u00a0the state to provide housing to people with serious and persistent mental illnesses who meet criteria laid out in the court settlement.<\/p>\n

That settlement order defines much of the state treatment that doesn\u2019t start behind prison bars. (For every person with a serious mental illness in a Georgia state mental hospital, five are in prison.) Only recently has the\u00a0Department of Behavioral Health and Developmental Disabilities begun to reach beyond the agreement to arrange for some new kinds of social services support.<\/p>\n

“Some of the systems have been established. For example, they’ve increased the number of [Assertive Community Treatment] teams and intensive case management teams, and they’ve created a housing program for people with severe persistent mental illness,” said Susan Walker Goico, head of\u00a0Atlanta Legal Aid’s\u00a0Disability Integration Project.<\/p>\n

Most treatment for mental illness doesn\u2019t require hospitalization. There\u2019s a strong legal and medical bias for treating mental health in the least restrictive way possible. At best, that would be in one\u2019s own home on an outpatient basis. Less restrictive than that might be supportive housing or a group home with a therapist, nestled in a neighborhood.<\/p>\n

We don\u2019t have enough of any of this.<\/p>\n

Whenever someone proposes a supportive care facility or a group home, NIMBYs lose their minds and assemble in force to block it.<\/p>\n

\u201cTo me, the problem is that the individuals who could benefit from all of these great services have not been reached,\u201d Goico said. “There has not been a real concerted effort to identify people who need supportive housing and connect them to housing and community services that they need. I’m talking about, you know, people who are coming out of prisons and jails, people who are cycling in and out of the emergency department, people who are coming out of Georgia Regional Hospital, public psych hospital, off campus. So, I mean, there are a lot of problems actually making the connection for these people to the services that were created.”<\/p>\n

Here’s the thing: In Harmony\u2019s case, as with most of the extreme cases around Atlanta, there\u2019s no shortage of contact. The problem is that it\u2019s often the wrong<\/em> contact.<\/p>\n

\n\"14-cops-or-caseworkers\"\n<\/div>\n

A<\/span> constellation of<\/u> observers and interested parties has\u00a0orbited Harmony for the last five months. Tammy Hughes, the social impact director for Central Atlanta Progress, has been demanding action from the city and county. The\u00a0Atlanta Police Department\u00a0employs a team of police officers specializing in homeless intervention who have been responding to calls about Harmony. Fulton County\u2019s behavioral health department has been trying to coordinate services with Grady Health\u00a0System and state hospitals about Harmony\u2019s case for months.<\/p>\n

Harmony has<\/em> a caseworker. Caroline Henderson, a care navigator at\u00a0the Policing Alternatives and Diversion Initiative, has been regularly visiting Harmony on the street corner for months.<\/p>\n

Moki Macias, the initiative\u2019s executive director, like other service providers, politely declined to comment for this story, citing patient privacy.<\/p>\n

\n\"\"\n<\/div>PAD provides an alternative to arrest for police when encountering someone in a state of obvious distress \u2014 mental illness, extreme poverty, addiction. Instead of making yet another arrest for public intoxication or whizzing on the sidewalk or something similar, an officer can call in a caseworker from PAD to get that person shelter and social services.<\/p>\n

At least that\u2019s how it\u2019s supposed to work. Roughly 18 percent of all arrests made in the city of Atlanta are divertible, according to figures from PAD. Almost all still end in an arrest, though, because the cops cannot be bothered to engage the program, or there is an objection from the arrestee or a victim, or PAD is tied up with another case.<\/p>\n

I helped design PAD while I was working for Central Atlanta Progress, and I\u2019ve counted on\u00a0its staff more than once to help someone with a tough problem over the years. I have, in fact, stood in Macias\u2019s offices next to the Greyhound station downtown screaming at hospital administrators over the phone because they wouldn\u2019t admit someone who presented herself to me for help. And I have also watched that same person refuse to go with a Grady EMT team after an initial intervention.<\/p>\n

Roughly 18 percent of all arrests made in the city of Atlanta are divertible. Almost all still end in an arrest.<\/blockquote>\n

The work requires the patience of an anvil. I can\u2019t do it. My fear is that PAD can\u2019t do it either.<\/p>\n

By that, I mean that while Atlanta has consistently increased funding for the initiative over the years, it has also consistently expanded PAD\u2019s scope. With each expansion, the public officials responsible for mental health and public safety have laid more of the burden of ameliorating deep social and structural problems on Macias and her staff of 32 administrators, care navigators, and harm reduction specialists.<\/p>\n

PAD workers are among the few who go under the bridges and into the woods and behind the gas stations to make actual human connections with people in profound distress. Most of the time, they are responding to a call from Atlanta 311 or police for assistance with a problem that needs a social worker more than a cop.<\/p>\n

\n\"\"\n<\/div>Some context, for scale: PAD, as I have mentioned, has 32 employees. The Atlanta Police Department has 1,300.<\/p>\n

Between 3,000 and 4,000 people are experiencing homelessness in the city of Atlanta right now. About one-third of them have a serious and persistent mental illness. One-third of them have a serious drug problem. Often those two groups overlap. PAD will go out to about 40 new people on the street in a good month, enrolling a dozen or so into\u00a0its care.<\/p>\n

The city of Atlanta relies on outreach from a handful of caseworkers at Intown Collaborative Ministries to reach chronically homeless people as well. (I have served on that organization’s board since 2016.) The state supplements this outreach with\u00a010 three-person teams through Projects for Assistance in Transition from Homelessness.<\/p>\n

\u201cPATH has often been seen as the primary homeless outreach resource in Atlanta when other programs and funding exist for outreach to individuals experiencing homelessness, including individuals with severe mental illness,\u201d Ruppersburg said. \u201cPATH represents an integral part of a larger puzzle.\u201d<\/p>\n

PATH teams are also supposed to be in the field, building relationships and connecting people\u00a0with mental illnesses to housing. In practice, that has diminished substantially since the beginning of the pandemic.<\/p>\n

PATH contacted about 20 percent fewer people in fiscal year 2021 than the previous year and enrolled about 10 percent fewer people into case management services, according to figures provided by the Department of Behavioral Health and Developmental Disabilities. Given the 31 percent increase in crisis contacts,\u00a0those numbers\u00a0suggest that we\u2019re not imagining things when we look onto the street\u00a0and\u00a0find more despair than we used to.<\/p>\n

\u201cEach agency has different staffing patterns which may reduce the ability to provide active field work to encampments,\u201d Ruppersburg said. \u201cWe have PATH agencies\/teams where three-quarters of the staff has been out of office due to Covid during some period during the pandemic. PATH teams have always had collaborative relationships with stakeholders and community partners providing homeless outreach.\u201d<\/p>\n

Statewide, about 1,547 people receive psychiatric case management through PATH. Half of the state\u2019s PATH teams serve metro Atlanta. That means PATH serves about six times as many people as the pre-arrest diversion program.<\/p>\n

Consider that PAD is on track to increase its caseload by about 100 clients this year. That\u2019s roughly the same number of clients that PATH teams lost in metro Atlanta over the same time.<\/p>\n

Far too many people in positions of authority are pointing to PAD as a sign of their police reform credentials and the salvation of serious community problems, while PAD\u00a0is scrambling to serve the unrelenting avalanche of need around us amid structures that do not work.<\/em><\/p>\n

\n\"17-street\"\n<\/div>\n

I<\/span> got a call<\/u> from a Chicago number Thursday night from a woman squatting at a boarded-up house owned by Morehouse College. She had told me a few days earlier that in the course of survival sex work she had been raped repeatedly at the property.\u00a0I wrote about it.<\/a>\u00a0Morehouse\u00a0responded by sending workers to throw the squatters’ food and clothing in the back of a truck and bulldozing the\u00a0tent encampment across the street.<\/p>\n

All pretensions aside about social justice at the school\u00a0that Martin Luther King Jr. attended, Morehouse has been acquiring nearby properties for 20 years in a neighborhood that has tumbled into despair and neglect, the better I think for the college to buy up land cheaply. They are not playing nice here.<\/p>\n

Morehouse hit the squatters after dark, impeding news cameras and complicating any kind of social services relief. PAD stops taking calls at 7 p.m. Atlanta’s largest shelter, the Gateway Center, stops intake midday, as does Atlanta Mission. Only the Salvation Army shelter might take someone without special dispensations from social services managers, and they restrict people to 10 days of care a year without enrollment in a program.<\/p>\n

I made some phone calls and wrangled an after-hours\u00a0bed at a women’s shelter. But in the time it took to drive across town, she had disappeared.<\/p>\n

Such is the system that left Harmony on a street corner. Harmony\u2019s needs are diverse and unusual. The woman I hoped to help Thursday had common problems. Anyone trying to escape\u00a0a beating from a drunken spouse might run into the same situation I did Thursday night on a rough block in south\u00a0Atlanta, with everything that works closed for business. A functional system would not depend on personal connections to find help. It would have flexibility. It would be able to adapt.<\/p>\n

Now consider how this system will react when 25,000 more people show up looking for help.<\/p>\n

I fear what happens as the eviction moratoriums end and the piles of furniture left on sidewalks grow. Atlanta\u2019s poor have long faced housing insecurity. Roughly one out of six households in the city had an eviction filing on their record before the pandemic. In the month after the Supreme Court struck down the federal eviction moratorium in September, landlords in Atlanta\u2019s five-county region filed more than 11,000 evictions, according to the Atlanta Regional Commission. That\u2019s actually fewer than the same month in 2019, but the pace is accelerating.<\/p>\n

According to the Atlanta Journal-Constitution, landlords filed about 100,000 evictions during the pandemic, moratorium be damned. Some went through because tenants didn\u2019t really know their rights or because they had violated lease agreements. But courts simply placed many evictions on hold.<\/p>\n

Until now.<\/p>\n

About 62 percent of Georgians believe they may be foreclosed on or evicted in the next two months for being behind on payments, according to a\u00a0U.S. Census Bureau<\/a>\u00a0survey conducted last month. It is by far the highest percentage in the United States.<\/p>\n

There aren\u2019t actually enough marshals to process all of the evictions that are coming. People will be forced from their homes in fits and spurts. Many residents will look for relief from Georgia\u2019s Department of Community Affairs, which has a $1 billion allocation for emergency rental assistance from the federal government.<\/p>\n

Good luck.<\/p>\n

After eight months with cash in hand,\u00a0the department had spent about\u00a09 percent of its money<\/a>. The federal government is probably going to claw some of the remaining cash back.<\/p>\n

Almost none of the people knocking on the Department of Community Affairs\u2019 door have Harmony\u2019s problems. They\u2019ll have different problems. And when those problems don\u2019t neatly fit into existing lanes for help, people will fall through the cracks. The sheer scale of need will turn those cracks into chasms. I can\u2019t tell how many new faces will be competing with Atlanta\u2019s familiar faces for help.<\/p>\n

We need to get better at providing assistance to people in need, fast.<\/p>\n

Illustrations: Matt Huynh for The Intercept<\/em><\/p>\n

The post Atlanta’s Mental Health Problem \u2014\u00a0and Ours<\/a> appeared first on The Intercept<\/a>.<\/p>\n\n

This post was originally published on The Intercept<\/a>. <\/p>","protected":false},"excerpt":{"rendered":"

What kind of a society lets a woman live in her own feces on an iconic Atlanta street corner for five months?<\/p>\n

The post Atlanta\u2019s Mental Health Problem \u2014\u00a0and Ours<\/a> appeared first on The Intercept<\/a>.<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[118,2851],"tags":[],"_links":{"self":[{"href":"https:\/\/radiofree.asia\/wp-json\/wp\/v2\/posts\/368669"}],"collection":[{"href":"https:\/\/radiofree.asia\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/radiofree.asia\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/radiofree.asia\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/radiofree.asia\/wp-json\/wp\/v2\/comments?post=368669"}],"version-history":[{"count":5,"href":"https:\/\/radiofree.asia\/wp-json\/wp\/v2\/posts\/368669\/revisions"}],"predecessor-version":[{"id":373470,"href":"https:\/\/radiofree.asia\/wp-json\/wp\/v2\/posts\/368669\/revisions\/373470"}],"wp:attachment":[{"href":"https:\/\/radiofree.asia\/wp-json\/wp\/v2\/media?parent=368669"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/radiofree.asia\/wp-json\/wp\/v2\/categories?post=368669"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/radiofree.asia\/wp-json\/wp\/v2\/tags?post=368669"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}