A place to sleep: Many of Virginia’s mentally ill caught in cycle of housing instability

June 10, 2018 | By Katie O’Conner

The clearing beside the Walmart off Forest Hill Avenue where Mike Voytershark lived for four weeks was nearly surrounded by a dense wilderness and filled with the sweet, delicate perfume of wisteria flowers.

The purple flowers, blooming thickly on towering trees, made the place feel beautiful and removed from the busy parking lot to its east. Maybe that was why Voytershark, a 33-year-old man living with schizoaffective disorder, chose to call the place home.

But really, Voytershark had little choice in the matter.

Before he lived in a blue tent planted purposefully in the middle of that clearing in April, Voytershark had been evicted from Jones & Jones Assisted Living on Forest Hill Avenue, where he’d lived since early 2017.

Not long after he wound up in the clearing, Voytershark spent the month of May in jail. While in Goochland County for a hearing in late April, a judge noted his poor condition and decided it was better to send him to jail to be evaluated for mental health programs than to return to that tent where he was withering away.

Now, he’s one of thousands of Virginia residents with a serious mental illness cycling aimlessly between homelessness, unstable housing and jail.

“It’s this vicious cycle because we don’t have the sufficient resources,” said Rhonda Thissen, executive director of National Alliance on Mental Illness Virginia. “They’re showing up all over the place in systems not really designed for them.”

For decades, stakeholders — from mental health advocates to politicians — have agreed that living in a community setting is ideal for people with serious mental illness.

Yet Virginia has not provided enough funding to those community services to prevent people like Voytershark from falling through the cracks.

“In Virginia, we are still creating our capacity to provide the best evidence-based solution for housing for individuals like Mr. Voytershark,” said Dr. Hughes Melton, newly appointed commissioner of the Department of Behavioral Health and Developmental Services.

According to DBHDS, more than 5,000 people in the state are unstably housed.

For some of those people, lacking a safe place to call home means intermittent care at best. But most likely, it means months or years without adequate mental health treatment, and the ramifications can be far-reaching. The consensus among advocates and clinicians and politicians is the same: Without a safe, stable place to live, the likelihood that someone with a mental illness will be able to maintain their health and well-being is nearly nonexistent.

“The real problem is that we do not, as a society, as a state, provide adequate community-based mental health services to the people who need them most,” said Anna Mendez, executive director of Charlottesville-based Partner for Mental Health. “And when we don’t do that, people with serious mental illness end up being evicted from assisted living facilities.”

Voytershark’s problems aren’t unique. Earlier this year, another assisted living facility resident, Gerald Dixson, was sent to a hotel after his former residence, St. Francis Home, spent months unsuccessfully looking for a new home for him.

According to Department of Social Services emails acquired through a Freedom of Information Act request, Dixson refused to bathe or take his medication, both of which are requirements for residents at St. Francis, a nonprofit Catholic organization.

The facility sought assistance from DSS, Adult Protective Services and the local long-term care ombudsman program, making it clear that the only option seemed to be sending Dixson to a hotel. But none of those agencies had another solution.

So eventually Dixson was discharged to a hotel. His room was prepaid for a week, and his future was uncertain.

“What kind of an option is that?” Thissen said after hearing Dixson’s story. “That is not a long-term housing solution.”

The state is aware of these chronic housing problems. They’ve persisted for more than 50 years, largely since deinstitutionalization, when psychiatric facilities that isolated patients were shut down. The patients were supposed to be placed with community-based services instead.

But that never happened. And even though the state has made some efforts to address the issues, people with mental and behavioral issues still wind up in hotels, tents and jail cells.

After Jones & Jones kicked him out, Voytershark stuffed his things into a backpack and moved less than a mile away.

His health quickly deteriorated. He developed a cough and lost weight, and his demeanor grew increasingly sullen.

While taking his medication, he was talkative, friendly and animated, eager to share his opinions. But after a few weeks in the clearing, a dullness developed around the edges of his personality.

When he was evicted, Voytershark received a letter from Jones & Jones that outlined about 15 allegations against him. Voytershark argues most aren’t true — like the claim that he punched a hole through a wall. He admitted to the charge of smoking in his room.

When asked about Voytershark’s situation, DSS said Jones & Jones complied with the state regulations in his discharge. The state’s rules say facilities must help residents find a new place to live.

For about a year before moving to Jones & Jones, he lived at the now-closed Parkwood, an assisted living facility in Carytown that drew the ire of its neighbors for some of the same reasons Jones & Jones has — its residents wandered around the area, sometimes panhandling, and it also dealt with a bed bug problem, Voytershark said.

“That place was horrible,” he said.

Then, he was so angry about the conditions at Jones & Jones — whose former administrator is currently being investigated by the U.S. Social Security Administration, the Commonwealth’s Attorney and the Richmond Police Department under accusations that she stole from residents’ Social Security accounts and failed to provide adequate care — that he said he didn’t want to move to another assisted living facility even if a spot could be found for him.

“I don’t even know if I’d rather go to a place or … sleep in the woods at this point,” he said during an interview in April the day after he was evicted, and before his health declined, he went to jail and his future became even more uncertain.

“As long as I have food and a place to sleep, I’ll be fine.”

The best option

Mental health experts say one of the most effective ways to address chronic housing instability for those with disabling mental illnesses is a model known as permanent supportive housing.

It involves assisting someone in identifying a safe, stable place to live, helping pay the rent and surrounding the person with the support — such as social inclusion and mental health treatment — they need to thrive.

“We can put the best treatment interventions on the ground, and they’re going to be rendered ineffective if we don’t also address [their housing stability],” said Kristin Yavorsky, homeless projects coordinator with DBHDS.

Thissen said someone like Voytershark, who was able to live on his own in a tent for a month, would be ideal for a permanent supportive housing situation. He could live in a place he chooses, giving him some autonomy over his situation, while being surrounded by the supports he needs to take his medication regularly and maybe even eventually find a job.

“People can’t think about higher level needs until their safety and security needs are met,” she said.

The permanent supportive housing model represents the community-based care that the state has been trying to achieve since deinstitutionalization.

“You want to give them some choices and you want to provide for them in the least restrictive settings,” said state Sen. Creigh Deeds, D-Bath, who has championed mental health issues since the death of his son, Gus, who attacked the senator then killed himself in 2013 after being turned away from a psychiatric hospital because no beds could be found.

But a glaring problem remains: money.

Melton said lawmakers don’t realize the cost-saving aspects of spending on the model upfront — such as savings in the criminal justice system and through hospital admissions — so the funding isn’t there.

Since 2015, Virginia has put $9.27 million toward permanent supportive housing, equating to 700 households. The budget that recently passed the General Assembly and was signed by Gov. Ralph Northam includes about $7 million more in funding.

According to DBHDS, 93 percent of the individuals the state has placed into permanent supportive housing are still stably housed.

Yet there are still more than 5,000 people like Voytershark who are shuffling between assisted living facilities ill-equipped to provide them the support they need, jail, or a blue tent beside the Walmart off Forest Hill Avenue.

“We’re just so backwards and as long as … we don’t have real supportive housing with wraparound services, then people are going to end up living in assisted living facilities, people are going to keep being evicted from assisted living facilities, and people are going to end up being homeless,” said Mendez, with Partner for Mental Health.

“And people do get arrested when they’re homeless, because when you’re homeless you have to do things you wouldn’t do otherwise. And then we wonder why there are all these people experiencing mental illness in jail.”

Entangled with the law

Inside the Goochland County Circuit Courthouse on a recent Thursday, everything — the benches, floors and doors in the historic building — creaked.

The sounds were punctuated by the soft jingle of chains around Voytershark’s hands and feet, as he raised his head periodically before slumping down again on the bench.

Voytershark ended up in jail last month in part because he had several misdemeanor charges pending against him. But it was also because the judge who saw him at the end of April could tell Voytershark was unwell, and knew he would just return to the tent after court was over.

The hearing on May 31 represented the culmination of about 2½ years of going back and forth with Goochland Circuit Court, a period marked with Voytershark not showing up for his hearings and fueled by his constant desire for alcohol.

He faced charges for failing to appear before the court and for failing to complete a Virginia Alcohol Safety Action Program. It stemmed from a driving while impaired charge he received in November 2015 while living with his dad in Goochland. Peter Voytershark said his son was driving a small dirt bike on the road at the time.

After that charge, the court sentenced him to 90 days in jail but suspended the sentence on the terms that he would complete the alcohol safety program. But that never happened — the first time he showed up, his evaluator determined that, “due to his mental health issues, he was unable to answer many of the questions,” according to court records, and his case was returned to court as inappropriate for services.

Then in March 2017 — after he didn’t appear for another hearing — Voytershark was ordered to re-enroll in the program. But when he attended his first group meeting, he tested positive for alcohol. He admitted to having a beer the night before. His court records noted that Voytershark said, “it might be hard for him to stop drinking because he loves to drink.” After that, he was discharged from services again.

It is not unusual, notes the Substance Abuse and Mental Health Services Administration’s website, for someone with a mental illness to also grapple with addiction. According to the administration’s 2014 survey, 7.9 million adults had both mental health and substance use disorders.

So next time he was in court on April 27, Voytershark was kept in custody without bail so he could be evaluated for mental health and substance abuse counseling, his record states.

In court on that Thursday at the end of May, Voytershark had gone more than two months without his medication. He barely moved, simply staring at the ground between his shackled feet.

When he was called to stand before the judge, his attorney, Keith Waldrop, told Judge John R. Cullen that Voytershark had schizoaffective disorder and had been locked up for the past 34 days.

Cullen suspended 60 days of Voytershark’s original 90-day sentence, and marked the last 30 days as already served. He also removed the requirement that Voytershark complete the alcohol safety program, since it evidently wouldn’t improve his situation.

He released Voytershark into the custody of his father, Peter Voytershark, who would later that day pick Voytershark up from jail in Henrico County.

The day was marked with relief for Voytershark and his family, but it left a daunting question: What would happen to someone in the same situation who didn’t have a father or mother or a friend to rely on?

Many advocates agree that, though it is not considered a community-based setting, some assisted living facilities can be good options for people with mental illness.

At St. Francis Home in Richmond’s South Side, residents play karaoke, complete puzzles and walk around its neatly trimmed courtyard.

But at other facilities, like Jones & Jones, residents linger for hours during the day without any activities and wander around the busy intersection nearby panhandling for money or food. A couple have been hit by cars and killed.

“Some assisted living facilities, maybe many, are not places where I would ever feel comfortable having one of my loved ones live,” said Mendez, with Partner for Mental Health.

DBHDS identified 824 people in the state who are living in assisted living facilities but actually need to be in permanent supportive housing.

Yavorsky said those people often don’t need the care that a typical assisted living resident requires — like help with eating or bathing — but rather need help with housekeeping or medication management.

“We know that what people with serious mental illness need to live successful, self-directed lives in the community, are things like meaningful social support, meaningful opportunities for community inclusion … immediate access to crisis intervention,” Mendez said. “None of those things are services that assisted living facilities are capable of providing.”

Virginia’s auxiliary grant program is meant to make assisted living affordable for those with low incomes who rely on Supplemental Security Income, like Voytershark.

In fiscal 2017, about 65 percent of those in the state’s auxiliary grant program were in assisted living due to a disability, including disabling mental illness, according to the Department for Aging and Rehabilitative Services, which runs the program.

But even though they’re often caring for the most vulnerable patients with mental illness, nobody — including assisted living facilities — can force a resident to comply with the rules or participate in treatment.

“Their hands are completely tied,” Mendez said. “The administrator is responsible for the health, welfare and safety of all their residents. If, at the end of the day, they can’t convince the resident who is having a crisis to seek help and really engage in treatment, their only recourse is eviction, no matter how much they’re trying to do a community service and no matter how big their hearts are.”

St. Francis primarily serves older men and women of limited financial means, according to its website. Compared to most assisted living facilities that accept auxiliary grants, St. Francis has several more rules for admission. Residents must be 55 years and older, they cannot exhibit aggressive behavior, and they must take their psychotropic medications.

Dixson, the man who was discharged to a hotel from St. Francis, refused to bathe or take his medication.

Jeff McInnis, St. Francis’ administrator, said the facility worked for six months to remedy Dixson’s situation. They informed him that he would have to leave if he refused to bathe or take his medication. And eventually they gave him his 30 days notice and started the process of finding him a new home.

But finding a new home was another barrier to be overcome. Emails between McInnis and Department of Social Services officials show he tried calling other facilities nearby that had beds, but none wanted to take Dixson.

So eventually the only option was to discharge Dixson to a hotel, which happened on March 20. Dixson was adamant he didn’t want to leave St. Francis, though, and refused to leave the car at the hotel. Eventually, the police had to be called.

McInnis stressed that Dixson was always found to be competent and aware of the repercussions of his actions. St. Francis couldn’t force him into compliance with the rules.

It’s not clear where Dixson is now, and he could not be reached for this story. McInnis said he was told another facility was found for him, but he couldn’t say whether Dixson actually went.

Tara Ragland, director of adult licensing with DSS, was unavailable for an interview in the weeks before this story was published. A spokeswoman for the department, though, stated that DSS is unable to comment on the specifics of individual residents’ cases — including Dixson’s and Voytershark’s.

State code requires that an assisted living facility give residents 30 days notice of discharge, and the facility should assist the resident in finding a new home. In the state’s view, a week in a hotel met that requirement.

“Based on the Assisted Licensing Program Division’s review of this incident, the assisted living facility demonstrated compliance with all appropriate procedures,” the DSS spokeswoman said in an email.

A new home

Voytershark left jail on May 31 — and he also left Richmond behind.

Shortly before the hearing, his dad found out Voytershark would probably be released, so he, along with Voytershark’s mother and sister, began the difficult job of finding an apartment for him.

Like many who live with a disability, Voytershark’s income is limited to just over $700 a month from the U.S. Social Security Administration.

The cheapest rent his father, Peter Voytershark, could find is in Hayes, in eastern Virginia, which at least means Voytershark will be close to him. But it still costs more than $500 a month, more than 70 percent of Voytershark’s income.

A permanent supportive housing model would guarantee the resident pays only 30 percent of his or her income on rent.

But still, Peter Voytershark is hoping that since Mike Voytershark will be close by, he can help his son stay on track. The assisted living facility didn’t work, the tent certainly didn’t work — maybe this will.

After Thursday’s hearing, Peter Voytershark waited outside the courthouse. The lawyer was arriving to bring him Mike Voytershark’s backpack, which he had with him when he was detained after his April hearing.

“That’s his life in there,” Peter Voytershark said.

He reflected on his son’s situation, mentioning that private mental health treatment is often too expensive. Most cannot afford it.

In an interview last week, Deeds said that, although the recently passed budget includes substantial new funding for mental health services, it will not be enough.

More than 44 million Americans live with mental illness. Every day, parents like Peter Voytershark wonder if their children will find a stable place to call home by relying on $700 in Social Security funds — essentially condemning them to a life of poverty in exchange for the treatment they need to live their lives.

“You have to always look at what you’ve done and try to see if there’s a better way to do it,” Deeds said. “It will never be enough.”

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