At any given time, there may be a few hundred homeless people in Seattle’s Pioneer Square neighborhood, huddling under the overpasses from the persistent Washington rain. It’s a familiar place for Geraldine, who has spent the past 20 years caring for her 38-year-old son, who is mentally ill.
When her son is not in prison or in hospital, Geraldine, 64, makes daily visits to a three-block area to bring him food, drink and warm clothing. She knows the color of his sleeping bag, and seeks it out among the dozens of others in between the shopping carts and trash bags. Sometimes he rejects her help. Other times, he gives her gifts to other people on the street.
Often, her son has lost more weight, and his hair is more unkempt. His eyes look distant and strained.
These days, however, instead of going to Pioneer Square, Geraldine makes aweekly trip to a psychiatric hospital, where her son is being treated for schizophrenia.
It’s the longest Geraldine’s son has been stably housed since his initial diagnosis nearly 20 years ago, but she’s afraid he will end up back on the streets, in prison, or dead – because of the lack of safe, long-term housing available to people with severe mental illness.
“It’s all-consuming. I think about it all the time, even when I’m doing things I enjoy,” Geraldine told the Guardian. “Then I think about him and how he is living.”
Ever since her son disappeared from home as a teenager, he has ping-ponged through jails, homeless shelters, halfway houses and the streets, and Geraldine has spent that time working to find him a safe place.
She emails, calls and meets advocates, politicians and administrators on her son’s behalf. She is not comfortable providing her surname – her complaints within the system have caused her to be a recognized name, and she is afraid those complaints will affect her son’s chances to receive adequate care. She also asked that her son not be named.
Geraldine, who has two other children, believes stable housing is the only way her son can manage his schizophrenia and lead a safe, healthy life. Despite being her son’s primary caregiver, Geraldine doesn’t have the resources to provide him with the so-called “supportive housing” she believes he needs, and which, research shows, could keep him from returning to jail or the emergency room.
Gretchen Locke, at social policy thinktank Abt Associates, has researched homelessness for more than 20 years, and is a firm believer in the power of supportive housing.
“It really does facilitate stable housing, and also reduces the use of expensive crisis care, which is often where homeless people end up. If [people with mental health problems] are not stably housed, they’re more inclined to end up in the emergency room or jail or detox and those kind of expensive safety net services,” Locke said.
“Stable housing can provide a platform for addressing mental illness that may not have been addressed in the past.”
Once in supportive housing, mentally ill people rely less on other expensive services, according to a University of North Carolina Charlotte study from February this year.
Researchers found that the total hospital bill for 61 chronically homeless adults – 38 of whom had a mental illness – decreased by $1.8m over one year that they spent in supportive housing. Once in housing, residents had a 78% reduction in emergency room visits and a 79% reduction in days spent at the hospital.
Supportive housing programs don’t always pay for themselves, but because mentally ill people tend to use more expensive services, the costs of putting them in supportive housing are often offset by decreases elsewhere, said Dennis Culhane, a professor of social policy at the University of Pennsylvania and the director of research for the National Center on Homelessness among Veterans at the US Department of Veterans Affairs.
“Being homeless involves a range of dehumanizing experiences, and also greatly puts people at risk of victimization and exposure to injury – as well as being marginalized,” said Culhane. “Housing, by its nature, affords people protection: socially, physically and emotionally. So it’s really about transforming people’s quality of life.”
Geraldine is an expert on these type of supportive housing programs, and is a familiar face to workers at one of the programs in Bellevue, which she hopes her son can get into when he’s discharged.
In January 2013, more than 387,800 people were homeless, according to government estimates. A 2006 study shows that 20 to 25% of the single adult homeless population has some form of severe mental illness. That suggests somewhere between 70,000 to 96,000 homeless people have severe mental illness.
The amount of supportive housing is increasing, but turnover is relatively low in those units, and the demand is high.
Left without reliable housing, Geraldine’s son has been hospitalized involuntarily at least four times. Hospitals are often overwhelmed by the number of people seeking psychiatric care, in part because the amount of psychiatric beds available decreased by 14% from 2005 to 2010, according to the Treatment Advocacy Center.
The alternative to hospital care – prison – terrifies Geraldine. “People tell me to stay away and see what happens,” she said. “I know what happens. He ends up in jail.” Her son has been incarcerated at least 20 times.
Incarceration is a fairly common fate for people with severe mental illness. Jails house 10 times as many mentally ill people as state hospitals,according to an April 2014 Treatment Advocacy Center report. The three largest state-operated mental health facilities in the US are Cook County jail in Illinois, LA County jail, and New York’s Rikers Island jail, where a homeless veteran on anti-psychotic medication was “baked to death” in March.
“While some mentally ill individuals are charged with violent offenses, the majority are charged with crimes seemingly committed to survive, including retail theft, trespassing, prostitution and drug possession,” Dart said.
Dart said that in 2013, more than 1,200 men were in the mental health dorm of his jail for an average stay of 87 days before they even went to trial. At that rate, it cost more than $12,000 to house each person, for a total of more than $14m.
“Far too many times, they are released to the community, where the vicious and predictable cycle starts over,” Dart said.
The first time Geraldine’s son went missing, she called jails and hospitals across the western US, eventually finding him at a jail in Arizona, where he was being held on an assault charge. He had been missing for nearly a year by then. Geraldine still doesn’t know how he made it from Washington to Arizona in that time – he left home without money.
She bailed him out of the jail and put him in a hotel room, where he made calls in the middle of the night and flooded the bathroom because, convinced the shower curtain was covered in germs, he refused to use it. Geraldine could tell her son was afraid of her, but she didn’t know anything about mental illness, and assumed his behavior was drug related.
She left; he ended up in jail again. She came back; he was put in a hospital. She moved to Arizona; he was discharged to a halfway house. Then he violated probation by having marijuana in his system and was put in jail again.
“That’s the beginning, and it hasn’t changed,” Geraldine said. “Wherever he is, I fly there, and try to get him help.”
Geraldine is now an unofficial expert on how to get prison guards, hospital staff and municipal workers to give her information they swear they aren’t supposed to tell her. She routinely skirts government bureaucracy to get her son basic necessities, like an identification card he needed in order to apply for benefits.
“I’ve been fortunate – would he push that hard? Or know to? Would he have anyone in his life to do that? Would my sons do that? Even if they want to, I don’t think they would. It’s taken 20 years to learn what to push and what not to push.”
Geraldine conservatively estimates that she’s spent $100,000 on her son in the past 10 years. That money does not include his hospital stays, which are absorbed by the hospital, or jail time, which is paid for by taxpayers.
Geraldine has lost a self-created business and had cancer four times. She started to see a therapist for the first time in March and recently took up exercising again. She works seven days a week, in part because this has been her most difficult financial year ever, and in part to try to take her mind off her son.
In December, Geraldine went to Seattle’s mental health court in an attempt to keep her son institutionalized. While there, she had to take the stand and testify about her son’s mental health. She had to recount the times he attacked her, his stints in jail, the early hours he’d spent pacing outside her suburban apartment and his delusions, including the times that he has believed he is Jimmy Carter, or Jesus. And she had to talk about the premonition he had that, in 2015, he killed his mother.
“You have to say all the worst things you could possibly say or they’re not going to hold him,” Geraldine said. “It’s heartbreaking. It’s betraying. It’s the worst [thing] in the world and you lose all trust.”
While she was in the courthouse, she held the elevator door for a person pushing a wheelchair. When she turned to look at the man in the wheelchair as it came up next to her, she realized it was her son. Seeing him vulnerable and disheveled, she began to cry. That’s when, she said, he told her: “You asked for this, mom. This is what you wanted.”
Of course, that was not what she wanted. Her dream is to be able to afford a home with a guest house, so her son can be in a safe, stable situation and still have some sort of independence. Since that’s a financial impossibility, she hopes she can at least get him a safe place to stay when he is discharged from the psychiatric hospital, a prospect that terrifies Geraldine and could happen any time.
For now, the judge hearing Geraldine’s son’s case ruled that he must stay in hospital. Still, he’s at the best place he’s been since his initial diagnosis. He works at the hospital cafe and is reading books on how to become a peer counselor. While he is safely off the streets, her biggest preoccupation is where he will end up next and how long he will be able to work towards the life they both want for him, one in which he can manage his symptoms before his progress is halted or reversed.
“As a parent you think, I mean, I know I made a lot of mistakes, I worked all my life … Everybody wishes they had done certain things differently,” said Geraldine. “I just feel like, with all of this I still can’t, I still can’t change anything. I don’t believe in living in fear, I believe in being optimistic and hoping that there is an answer and believing in something.”