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Letting recovery take root

March 1, 2006
by CARL CLARK, MD
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Homeless consumers are empowered to make decisions that fundamentally change their lives

Meet Marika. She was consistently homeless for 12 years, and on and off the streets before that. Suffering from bipolar disorder, she had been addicted to alcohol and drugs since her teens, self-medicating her long-undiagnosed mental illness. She bounced in and out of mental health counseling, mostly at financially strapped agencies with few resources beyond medication— at one point, she took 20 prescription pills a day.


In 2003, she wound up on the streets of Denver. Through a partnership between the Colorado Coalition for the Homeless (CCH) and the Mental Health Center of Denver (MHCD), she found housing and mental healthcare. MHCD began by asking her to make choices about her life and her care. This was a radical concept for Marika—no one had ever asked her what goals she wanted to accomplish.

Recovery was not a straight path for Marika. At one point, she stopped taking all her medications, had a psychotic episode, and landed in the hospital for 21 days. Upon her discharge, CCH took her back into its transitional housing and MHCD continued working with her.

In the ensuing months, Marika turned her life around. Through MHCD's “2Succeed in Education and Employment” program, she obtained a competitive job at Denny's, working 40 hours per week. She also worked on her GED and took a computer course through 2Succeed. After completing these educational programs, she found an administrative job at a Fortune 100 company in early 2005, where she works today.

Marika has her own apartment—not government-subsidized housing—and is engaged. She has rebuilt relationships with her family, and rejoiced in getting paid time off from work when her granddaughter was born. She still sees a counselor and takes medications (down to a much more manageable three pills a day). She understands her disease, knows better how to manage it and the warning signs to look for, and is self-sufficient.

All of us in the mental health field have stories like Marika's that we recall with a great sense of accomplishment, stories we turn to for hope and inspiration and evidence that we can make a difference. Marika's story illustrates how MHCD helps homeless consumers—one of the most difficult populations for any provider—to recover. MHCD's system of care emphasizes and facilitates consumer strengths and recovery by providing wide-ranging, yet thoroughly integrated, services in an atmosphere of consumer choice. Perhaps MHCD's most important innovation is a “360-degree” approach to measuring recovery, using environmental, clinical, and client-specified subjective indicators. Our signature approach was awarded the 2005 Community Provider of Excellence Award by the National Council for Community Behavioral Healthcare.

MHCD brings one homeless person off the street every day—into housing and into treatment. While a tiny drop in the bucket of Denver's homeless population, these individuals account for approximately 70% of our consumers. It seems fitting, then, to explain MHCD's approach through the lens of serving the homeless mentally ill.

A Foundation of Funding

MHCD is fortunate to have access to unique funding created by the so-called “Goebel settlement,” a landmark resolution to a long-running class-action lawsuit. The Goebel lawsuit is named after Ruth Goebel, a homeless woman with mental illness who died on the streets of Denver because of a lack of housing and access to mental healthcare. The class-action suit was brought forth on behalf of homeless people with mental illness and provides services/funding for 1,600 people at any given time to receive the evidence-based treatment services that make a difference in people's lives. The settlement created a pool of funds for treating Denver's homeless mentally ill and fostered an impressive (and unfortunately all too rare) basis for collaboration between MHCD and local shelters.

TABLE 1. Consumers’ housing status at admission and discharge

Selected housing status

Admission (n = 92) %

Discharge (n = 92) %

*Independent housing includes consumer-owned or -rented units and living with family or friends.

Shelter

50.0

26.1

Street

34.8

13.0

Supported housing

3.3

16.3

Other independent housing*

7.6

38.0

Even with the Goebel settlement, MHCD struggles with fragmented funding sources just as every provider does. As our colleagues who employ a recovery-based approach know, many funding and reimbursement rules are not recovery-oriented. It is a constant challenge to determine how to make available funding fit our model and receive sufficient support to continue our work.

A Network of Partnerships

MHCD works closely with CCH, shelters, and other providers to identify needs and develop services, and we support each other in seeking funding. Such close coordination enhances each organization's ability to meet homeless consumers’ needs. Two cornerstones of this collaboration are:

  • Shelter outreach. MHCD case managers are housed full time at three local homeless shelters. Being on-site enables them to identify individuals in need of services and bring them into MHCD's program. In 2003-2004, one shelter case manager identified 63 people who became MHCD consumers.

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