By Alan Prendergast
By Michael Roberts
By Michael Roberts
By Amber Taufen
By Patricia Calhoun
By William Breathes
By Michael Roberts
By Melanie Asmar
The remarkable change in the well-being of the Valdez residents shows what a caring staff supervising the mentally ill on a day-to-day basis can do. Unfortunately, the home has a perpetual waiting list, and Silver receives calls every day from social workers trying to place people there. She says the solution to the problem of the homeless mentally ill is right at her feet. "I don't think it's very complicated at all," she says. "We just need more places like this."
That, says Mullen, is exactly what the lawsuit is about. "The coalition for the homeless took a boarding home with no services and started helping them," she says. "Sheryl Silver is just the opposite of what I find when I'm working with the state."
But Livingston claims that as a result of the lawsuit, the state has spent millions to improve services for the mentally ill in Denver. He also says that almost all of the housing units provided by Denver are now full. The state is also paying for additional services like vocational training and a mobile crisis team. "Everybody agrees that things are better now than they were four years ago," he says. "Everybody agrees people fortunate enough to be in the Goebel class have much better services than people in other parts of the state."
An analysis prepared for the legislature's joint budget committee estimated that the state would spend an average of $8,480 per person per year on mental-health services for people in the Goebel class (under the settlement agreement, that covers 1,600 severely mentally ill people living in central Denver). And as Livingston pointed out, people in other parts of the state aren't so lucky. Those who are eligible for Medicaid receive an average of $3,255 per year in mental-health services, while people who don't quality for Medicaid receive a paltry $500 per year.
Colorado ranks 29th in the country for mental-health spending. Hancock says other states have found ways to get the mentally ill off the streets without reopening the state hospitals. Wisconsin pioneered a program known as Assertive Community Treatment, whereby a team of ten social workers takes responsibility for one hundred mentally ill people. Everyone on the team knows all the clients, and they work together to arrange housing, vocational training, medication, etc. The teams visit homeless shelters and look for people hanging out on the street, trying to win their confidence and bring them into the system -- a difficult task with paranoid schizophrenics. A network of "clubhouses" and drop-in centers provides a place for mentally ill people to go during the day.
"This is a way to help them connect," says Hancock. "This has been successful in keeping people out of the hospital and out of prison. There's a circle of support that needs to be there in the community for these people to survive."
Mary Boland, a vice president of Catholic Charities in Denver, has been involved in the Goebel case for several years. She served as a plaintiff's representative on an oversight committee created as part of the settlement, then resigned in frustration after a year, concluding that the state wasn't serious about its commitment.
"There wasn't a political will to enforce the terms of the contract," she says. "The state has chosen to keep contesting this. They've been doing this for fifteen years rather than rolling up their sleeves and putting this behind them. My sense is that Marva Hammons hopes this goes away."
Mullen has been involved in the Goebel case since its inception, when she was working in the Denver legal aid office. She helped draft the initial lawsuit with several other attorneys who were interested in the plight of the homeless mentally ill and took over as lead attorney in 1985. Now in private practice, she has continued to pursue the case, working on behalf of a group of people that she believes society has all but abandoned.
"These people can't speak for themselves," says Mullen. "This kind of treatment of this fragile population is intolerable."
Even though the court has ruled that Colorado failed to meets its obligations under the settlement agreement, the state has increased its services for mentally ill people in central Denver to some extent. More of them have a place to live and are receiving at least some type of treatment, thanks to the extra spending that grew out of the lawsuit. But those who have worked with the mentally ill for years say Colorado is still a long way from providing decent care for the population once housed in state facilities.
"It's a non-system right now," says Dr. Ed Casper, director of Behavioral Health at Denver Health Medical Center. "We get them in our emergency room, we get them in jail. There's no follow-up care and no system to support outpatients. There's no system of care for people who were in the state hospital."
Casper remembers when large numbers of the mentally ill were discharged from state hospitals in the 1970s, with promises that local mental-health centers would have the funding to care for them. "What was supposed to happen was, the money was supposed to follow the patient, but that money never made it to the community," he says. "They said all these services would be available in the community, but it didn't happen. We've taken apart the state hospital system and have not replaced it with anything."