American Psychosis (22 page)

The state of Illinois not only encouraged the placement of severely mentally ill individuals in nursing homes but also abetted the process by intentionally misdiagnosing patients so that they would be eligible for federal Medicaid. Nursing homes in which more than half the patients had diagnoses of mental illnesses are officially categorized as “institutions for mental diseases” (IMDs) and ineligible for Medicaid. State-employed nurses in Illinois therefore went to nursing homes and reclassified many patients. For example, a 65-year-old woman who had had schizophrenia for decades was no longer diagnosed with schizophrenia; instead, her diagnoses were arthritis, ovarian dysfunction, and dandruff. According to the 1998
Chicago Tribune
report, “the state has modified at least 1,000 psychiatric patient files at 20 other nursing homes, collecting an extra $30 million from Medicaid since 1995.”

States reaped rich Medicaid rewards by using such arrangements, and nursing home owners did as well. In Illinois, this included multimillionaire Morris Esformes, an ordained rabbi, who owned 18 nursing homes, and his business partner, Leon
Shlofrock, a former union leader who owned 7 other homes. Shlofrock described his business success in an interview with the Chicago newspaper:

It’s like falling off a log. If you knew at all what you were doing, you had to be successful. It’s almost impossible not to make money—unless you’re a total and complete idiot.

To facilitate his business interests, Shlofrock founded a lobbying group, the Illinois Council for Longterm Care, which in 1998 was headed by a former state legislator. State records showed that the Council “contributed hundreds of thousands of dollars to legislators of both parties, while successfully lobbying for higher state and federal subsidies. . . . The nursing home industry, based on total contributions, ranks among the top five most powerful political action groups in Illinois.” Shlofrock acknowledged that he had “successfully crafted state regulations that favor him, such as limiting the training requirements of nurses aides.” He also acknowledged being on a first-name basis with those wielding political power. “It’s nice when you walk into a room and the governor says, ‘How are you, Leon?’ . . . You have to have access. It’s as simple as that.”

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Illinois was not the only—merely the most publicized—state in which nursing home abuse of mentally ill individuals became news during the 1990s. At a nursing home in Florida, it was alleged that “aggressive mentally ill residents . . . have killed, injured, fought and committed sexual battery upon other residents.” There were also occasional exposés of board-and-care homes during the 1990s, including one home in New York described as “filthy, an overpowering stench . . . rampant roach problem. . . . Two [residents] wore pajamas all day.” In one board-and-care home in California, a mentally ill woman was found in a “room with no windows, an open bucket for a toilet, and a padlock securing the door.” In response to such publicity, authorities pointed to the total lack of coordination between agencies at the federal, state, and county levels: “There are too many agencies here. There is a mishmash between these agencies, and the board-and-care operators are dodging everyone.”
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It was also during the 1990s that the ghettoization of board-and-care homes, previously an urban phenomenon, also reached smaller towns. For example, Devine, Texas, a town of 4,100 residents south of San Antonio, had more than 500 patients discharged from San Antonio state hospitals living in mostly rundown board-and-care homes. Ocean Grove, New Jersey, a historic town of 5,600 residents founded by the Methodist Church, had at least 600 patients, most of who had been discharged from nearby Marlboro State Hospital. One street became known as “Thorazine Alley” because of its accumulated trash. Ocean Pathway, a street once labeled by the
National Geographic
as
the “shortest, prettiest street in America” had to have all its hedges removed because they were regularly being used as a bathroom. Ocean Grove mothers could no longer let their children play outside alone. As one said: “All the pleasures of visiting friends, playing together in the parks, and bike riding are not permitted unless I escort them.” Despite the concentration of discharged patients, New Jersey set up no outpatient clinic, day program, or vocational or rehabilitation program in Ocean Grove.
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Mentally ill homeless persons continued to be the most visible manifestation of the nation’s failed mental health policies during the 1990s. When Yetta Adams, diagnosed with schizophrenia and alcoholism, froze to death in 1993 on a Washington bench across the street from the headquarters of the Department of Housing and Urban Development (HUD), the Secretary of HUD joined the crowd to find out what had happened. He later wrote: “Yetta Adams’ death jarred me and all my colleagues at HUD.” A study of 99 mentally ill homeless women—like Yetta Adams—done at that time in Washington reported that two-thirds of them had been raped and that “violent victimization was so high as to amount to normative experience for this population.”
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In San Francisco, by 1998 the city’s homeless population had increased to 16,000, of which an estimated 6,000 were thought to be mentally ill. Mayor Willie Brown called it “the most complex problem” he faced, and the local paper described it as “a cancer on This City’s soul.” Included among the homeless were a Cornell University graduate who was trained as a physician and a Stanford University graduate who was trained as a lawyer, both diagnosed with schizophrenia. The father of the latter said: “He needs hospitalization and custodial care, but we can’t seem to get any help for him without violating his civil rights. It is very painful for all of us.”
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In 1992, Larry Hogue achieved celebrity status as a homeless person in New York City when he was publicly labeled “The Wild Man of West 96th Street.” Diagnosed with bipolar disorder and cocaine addiction, Hogue set fires beneath cars, broke stained-glass church windows, masturbated in front of children, threatened to eat the dog of one resident, and on one occasion tried to push a schoolgirl into the path of an oncoming truck. Such behavior continued for almost a decade; the media became fascinated with Hogue because, despite multiple brief psychiatric admissions, officials claimed that state commitment laws prohibited his long-term involuntary hospitalization. During these same years, Hogue continued to received $3,000 each month in disability benefits from the Veteran’s Administration, most of which was used to buy cocaine.
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Hogue’s terrorization of an upscale, West Side New York neighborhood helped focus attention on the effects homeless mentally ill individuals were having on public spaces. Writing in the
Wall Street Journal
at this time, a woman said that “a simple visit to the local elementary school, post office or grocery store . . . can be a Dantean journey
through the dark underside of our society.” Another woman described “a deranged man” who tried to bite her husband’s leg: “We have, sadly, grown accustomed to the images of madness on our streets and the menacing life that lives on them and now owns them.” Approximately 20 homeless men were described living in the men’s room at Pennsylvania Station:

One man was trying to bathe in the cold trickle at the sink. Another was building a fire in a corner to heat the remnants of some abandoned food. A third was curled at the base of a toilet, asleep. They hunkered or leaned or sat or sprawled in total silence.

At New York’s Kennedy International Airport, approximately 12 homeless people were living permanently, including a 33-year-old woman who had been “sent to the airport by Jesus Christ after a short-lived dalliance with a man named Joseph from Queens.” George Will reflected on this problem in an editorial:

We are focusing exclusively on the individual, and in terms of his or her rights. But the community, too, has rights, needs and responsibilities that, if attended to, will leave the homeless better off. . . . Society needs order and hence has a right to a minimally civilized ambience in public spaces.”
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Finally, the 1990s witnessed a continuing increase in mentally ill persons in jails and prisons as well as an apparent increase in mentally ill–related homicides. Problems in jails and prisons were reported from virtually every state:

1992, California: The use of the Santa Clara County jail’s psychiatric unit had “more than doubled” since 1986, and “there are 16 times as many outpatient psychiatric visits in the jail as there were five years ago.”

1993, Texas: Travis County jail officials reported “a dramatic increase in prisoners with mental and emotional disorders.” The jail psychiatrist said: “We’ve become the state hospital.”

1994, Ohio: The
Cleveland Plain Dealer
described “an explosion in the number of mentally ill inmates” in Ohio prisons.

1997, Michigan: The
Detroit News
headlined: “Mentally ill flood prisons: critics say state is dumping patients out of psychiatric hospitals.”

1999, Utah: The police chief of Salt Lake City said that “never in his 40 years in law enforcement has he seen so many psychologically disturbed people on the streets and in jails.”

2001, Georgia: Between 1992 and 2001, the number of seriously mentally ill individuals in Georgia’s prisons quadrupled, from 1,251 to almost 6,000. The annual spending for mental health services increased from $2.6 million to $24.1 million.
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Estimates of the percentage of jail and prison inmates who were seriously mentally ill varied geographically but ranged from 8% to 12% (Florida) and 12% (Texas) to 16% (California) and 33% (Tennessee). A federal Department of Justice survey in 1998 reported that “16% of State prison inmates” and “16% of those in local jails reported either a mental condition or an overnight stay in a mental hospital.” These estimates contrasted with estimates from the 1970s averaging around 5% and estimates from the 1980s of around 10%.
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Given the numbers of seriously mentally ill persons ending up in jails and prisons, the process of getting them there increasingly involved the police. In Los Angeles between 1987 and 1993, annual calls to the Police Mental Evaluation Unit more than quadrupled, from 12,613 to 54,737. In New York the number of mentally ill persons taken to hospital emergency rooms for evaluation increased from 18,500 in 1986 to 24,787 in 1998, and the police department was said to be “the world’s largest psychiatric outreach team.” Many of the arrests involved repeat offenders, including Gloria Rodgers, a mentally ill woman in Tennessee who in 1999, after 259 arrests, was finally “committed indefinitely . . . to a state mental hospital.”
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Despite an increasing number of training programs to teach law enforcement officials how to respond to mentally ill individuals, tragedies continued. In California’s Ventura County, police killed 32 individuals between 1992 and 2001; 18 of these were mentally ill. In New York and Seattle, studies reported that one-third of the people killed by police were mentally ill. Conversely, untreated seriously mentally ill individuals were also increasingly reported as having killed law enforcement officers. Between 1998 and 2002, in the Washington, D.C. metropolitan area alone, six law enforcement officers were killed by individuals diagnosed with schizophrenia.
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Violent behavior by individuals with serious mental illnesses, most of whom were not being treated, became increasingly visible in the 1990s. Interviews with 1,401 members of the National Alliance for the Mentally Ill in 1990 revealed that in 11% of families the severely mentally ill family member had physically harmed another person during the previous year. A study of mentally ill patients living in New York reported that they had committed three times more violent acts (e.g., used a weapon, hurt someone badly) compared to nonmentally ill persons in the same community. By this time, the association of untreated mental illness and violence had become so clear that even those who had previously been skeptical were persuaded. John
Monahan, a professor of law at the University of Virginia, concluded his 1992 literature review as follows:

The data that have recently become available, fairly read, suggest the one conclusion I did not want to reach: Whether the measure is the prevalence of violence among the disordered or the prevalence of disorder among the violent, whether the sample is people who are selected for treatment as inmates or patients in institutions or people randomly chosen from the open community, and no matter how many social or demographic factors are statistically taken into account, there appears to be a relationship between mental disorder and violent behavior.
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Throughout the 1990s, the public was constantly reminded of this association by high-profile homicides committed by mentally ill individuals. The names of the perpetrators flashed across the evening news with predictable regularity, each story different and yet each remarkably the same. If the individuals had been receiving treatment for their mental illness, such tragedies would probably not have occurred. As the decade progressed, the pace seemed to quicken: James Brady in Atlanta; Gary Rimert in South Carolina; John Kappler in Boston; Betty Madeira in Los Angeles; Kevin McKiever in New York; Gary Rosenberg in Rochester; Jeanette Harper in Virginia; Debra Jackson in Minnesota; Gian Ferri in San Francisco; James Swann in Washington, DC; Colin Ferguson in New York; Linda Scates in California; William Tager in New York; Michael Laudor in New York; John Salvi in Massachusetts; Wendell Williamson in North Carolina; Michael Vernon in New York; Reuben Harris in New York; Mark Bechard in Maine; John DuPont in Pennsylvania; Alfred Head in Virginia; Daniel Ellis in Iowa; Jorge Delgado in New York; Steven Abrams in California; Julie Rodriguez in Sacramento; Larry Ashbrook in Fort Worth; Russell Weston in Washington; Lisa Duy in Salt Lake City; Michael Ouellette in Connecticut; Paul Harrington in Michigan; Salvatore Garrasi in New York; Andrew Goldstein in New York—the list seemed to stretch endlessly. After each headline, people inevitably asked why it had happened; no answers were forthcoming, and then the story was gone. The only tragedy that generated sustained attention was the Weston case because he killed two guards as he stormed the U. S. Capitol, trying to reach a machine he believed could reverse time. Because several members of Congress were nearby when this happened, it did get the attention of Congress, at least briefly.