Mental Health Team Tends to ‘Cannots’ Among Homeless

Karen Mason maneuvered a huge white van down the side streets of Oceanside, heading south of Hill Street toward the seedy part of town. Her mission: to deliver a pair of red shoes.

The shoes, the 42-year-old clinical social worker explained, were for a woman she was trying to befriend. “She told me she needed some size 8 shoes, so I’m trying to build a relationship with her,” Mason said.

Such small gestures are a common way of opening a dialogue between Mason and her potential clients, the mentally ill homeless people of Oceanside. Mason, an employee of the county mental health clinic on Mission Avenue, is one of three people on a “homeless outreach” team that delves into street society to encourage people who will not or cannot help themselves to obtain counseling, medical aid or other assistance.

Mason works with social worker Bev Davis, who operates out of the Escondido county mental health clinic, and Joanne Albus, a nurse who works on the team part time. Together, they must serve the needs of the mentally ill homeless for the entire North County.

Most Needy Often Shyest

The effort is necessary because those who need help the most are often the least likely to show up at the clinic door. “They may be frightened and paranoid in general, or may be frightened of mental health people because they may have been hospitalized against their will in the past,” Mason said. “They usually have a lot of trust problems. They don’t know what you can do for them.”

Once a week, Mason heads to the place where she is to make the shoe delivery, Brother Benno’s soup kitchen in Oceanside, which offers free meals, live music, unconditional acceptance and a bit of prayer seven nights a week.

The rest of Mason’s work hours are taken up seeing patients and responding to emergency calls from the police and from citizens concerned about a friend or a stranger who appears to be in dire emotional straits. Such calls keep the homeless outreach team busy enough that they rarely have time to go wandering through the community searching for crises. The demand for assistance is so high that trouble, literally, comes looking for them.

When the beeper attached to her blue jeans goes off, Mason swings into action, taking the white van to the person’s location and making an on-the-spot clinical assessment of their needs.

Sometimes the person in question just needs talking to and some friendly advice on where to obtain a hot meal, a clean bed and financial assistance. Often the patients are brought into the clinic for further evaluation and sometimes must be hospitalized against their will if they appear dangerous.

But even then, hospitalization occurs only if there is a spare bed available in the county’s tremendously overburdened mental hospital and if the patient has Medi-Cal or some other way to pay for treatment.

Recently the outreach team encountered a schizophrenic homeless woman who was nine months pregnant. “She was not taking care of the baby--she barely realized she had one,” Mason said. The woman also was suffering from a severe vaginal infection, which could have had serious effects on the baby during birth. She refused treatment for her mental illness, prenatal care or medical care for the infection, and she refused to go with the social workers to the clinic.

“We had to get the police to fifty-one fifty her,” Mason said with a sigh, using the jargon for Section 5150 of the state Welfare and Institutions Code, which provides that a person can be arrested and institutionalized for being a danger to himself or others. Luckily, the pregnant woman had Medi-Cal. “Otherwise, she’d be out on the streets or in a field giving birth somewhere,” Mason said.

In another instance, a woman who held a social worker at the Oceanside clinic at gunpoint was taken to the County Mental Health hospital downtown but released because she was not aggressive by the time she got to the hospital and denied having homicidal thoughts. After her release, the woman went right back to the clinic where she had threatened a worker’s life, Mason said.

“We only have a few hospital beds, and they are almost always full,” Mason explained. “Only the most dangerous go into them.”

In San Diego, the new, $9.5-million County Mental Health hospital on Rosecrans Street opened two months ago with 62 “acute care” beds, which provide short-term care for the most seriously ill, and 36 “intermediate beds” for stays lasting up to a few months. An additional 13-bed ward has yet to open because of lack of money to staff it.

County mental health workers were glad to see the facilities upgraded from the old, crowded hospital in Hillcrest, which is now being converted for use by the UCSD Medical Center. But, said Dr. Thomas Henley, director of the Oceanside clinic, “I’m sure we still need 10 times that number of beds.”

Numbers Are Unknown

The consensus among physicians is that, nationwide, 1% to 3% of the population is mentally ill. But the percentage of mentally ill people among the homeless is at least 25% to 33%, Henley says.

The numbers of homeless and mentally ill in the North County coastal area are unknown, Henley said, because so many of them never seek public assistance.

“Oceanside is somewhat of a blighted area and has a significantly high poverty population, so it might have a somewhat higher concentration than other suburban areas in San Diego County,” Henley said. Both the homeless and the mentally ill populations have grown along with the general population boom in the area, he added.

Mason said there are three categories of homeless people: the have-nots, the will-nots and the cannots.

The have-nots, who constitute about 30% of the group, are those who are “almost accidentally homeless,” Mason said. “They are able to function fairly well but have had bad luck, like being laid off or evicted.” The have-nots are motivated to help themselves, and they are not mentally ill or substance abusers, she said. A number of community assistance programs are geared toward these people, who are considered good risks for a shelter in a residential area or a housing loan.

“The will nots,” Mason said, “are the indigents people see and think they represent the whole of the homeless population. They are often panhandlers, drug addicts and alcoholics, people who do not want to work, and do not want to change. “They are the most visible and the most irritating,” Mason said.

The remaining third of the homeless, classified as cannots, are the outreach team’s primary concern. “They cannot find shelter and jobs and food and so on because of their mental illness,” Mason said. “They may be hallucinating or responding to voices in their head. Thought disorders like this interfere with their ability to hold a job, let alone to navigate some of these social service systems.”

Recipe for Failure

“Imagine yourself being a homeless person and needing to find a job and a place to sleep. You may have no place to take a shower, nothing to put on. And then you go looking for a job, but you don’t have a residence, and you don’t have any ID. You won’t get through the front door.”

“Add to that the fact that you are mentally ill, you cannot communicate your thoughts clearly and you cannot answer questions,” Mason said. “It’s hard enough to find a job even when you’re not operating at a deficit.”

On rare occasions an employer will offer jobs to homeless mentally ill, and once in a very great while an employer will even seek them out, as in the case of Arvel( Sass. “I do buy a lot of material from the homeless, and I put ‘em to work too,” said Sass, owner of a recycling center down an alley from Brother Benno’s Kitchen.

“I’m here to provide a service to the community, whether it’s the homeless or keeping stuff out of the landfill,” Sass said. “I hired a man in Encinitas and he turned out to be the best, the hardest worker anyone could ever be.”

Nodding toward a young woman wearing a sweat shirt with the logo “Teddy Lover,” Sass noted, “She’s over 50% of the work force here. She’s very motivated, and you can’t take that away from people.”

Dawn, 23, giggled nervously then averted her eyes, a look of apprehension on her face. One of Mason’s clients, she needed assistance filling out some forms to obtain financial aid, but didn’t ask for help until Mason gently questioned her.

Dawn, homeless since March, said she came to Oceanside from Sacramento to join her sister, then got married and stayed after her sister moved away. “I was married for about a year, then my husband left, to Las Vegas,” she said.

Disoriented and affected by a learning disability, Dawn started to work at a Burger King but was fired. “Dawn can never keep a job because she has information-processing problems and doesn’t have a good frustration tolerance,” Mason explained.

Thanks for the Help

While Dawn sprinted off toward an encampment near the railroad tracks to retrieve some forms for Mason to sign, her friend, Richard, thanked Mason for her help in getting them both ID cards--the crucial item for receiving any type of government assistance.

Richard, 43, also homeless and an employee of the recycling center, befriended Dawn on the street and is assisting her through the maze of paper work required for general relief benefits. “We help each other out,” he said. “As far as backup goes, there’s a lot of people out here that are good people.”

Richard said he had been homeless for 11 months, since his most recent release from a detoxification program. “I used to do asphalt paving,” he said. “Now I try to find work picking up cans.”

Richard, articulate and polite, said his situation stemmed from a stressful home environment in Vista, where he couldn’t seem to stay away from alcohol and drugs. “I went to the detox center, and my sponsor suggested I not go back to Vista. I did once and got drunk, and I’ve never gone back again,” he said. Since then, he said, “I’ve been roughing it out here, kind of working it out on the street.”

Richard praised Brother Benno’s Foundation, which provides a variety of services for the poor besides operating the soup kitchen. “People need that, they need to know there’s a place where they can have an address and have a place where they can clean up, and that’s important. Who’s going to hire someone who’s smelly?”

“When you do shower you feel better,” he said. “These guys who don’t shower feel bad, and that’s why they stay down.”

Richard said most of the homeless people he knows use the showers at the beach restrooms, which have the double drawback of having cold water and being outdoors. The public restrooms at the bus depot are also popular places to wash up, he said.

Brother Benno’s foundation is working on turning the boarded-up Americanization Center at Division Street in Oceanside into a day center for the homeless, a place where they could shower, eat, use the telephones and arrange job interviews. The plan, however, has met with furious opposition from neighbors.

A short distance from the recycling center, Harold Kutler, founder of Brother Benno’s Kitchen, kicked off the dinner hour with the pledge of allegiance and a prayer.

Making the Rounds

During dinner, Mason made the rounds of the picnic tables in the fenced-in patio. Mason politely inquired of a woman in a purple shirt whether she had followed the mental health clinic’s referral to get medical attention for an infection. “I got it. I got help from a good doctor,” the woman said with a smile. “His spirit was clean.”

Next, Mason tried to soothe a sunburned man with a frightened look on his face. “Ed is a little paranoid,” she explained. “He needs shelter, medical treatment for a dislocated shoulder and treatment for mental illness.”

“But Ed is real scared. If I can get him to go in to the clinic, and it’s OK, then maybe I can get help to him.”

After dinner, Kutler stood outside the soup kitchen and chatted with the patrons. “I don’t think anybody realizes how many mentally ill people there are out there on the streets,” he said. “It’s frightening. And there’s not much anyone can do about it.”

Kutler said he is often hard-pressed to identify the mentally ill ones, because they frequently seem lucid. “Then one night, you spot them talking to themselves, and you know.” Even those who started out sane tend to “get funny after a while” on the streets, with the constant stress of survival, he said.

“There’s not too much support and sympathy for the mentally ill around here,” Kutler said. “It’s immoral. These people are victims, they’re not freeloaders. They just are not capable of doing what society expects of them.”