Finding your footing after release from a psychiatric unit, rehab facility or even prison because of mental illness and related fallout isn’t easy. Rejoining family, locating treatment, connecting to the community and reentering the workforce can be high hurdles. Too often, people with fragile mental health fall by the wayside without secure, stable housing and a strong, caring support system. For those people, one option is residence in a supervised group home — a licensed facility with 24/7 staffing and therapeutic services.
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Running a group home is a vocation for the good-hearted, but not the faint of heart. For Mark Mayle, who runs four group homes in Ohio, it all began about 25 years ago as a personal mission.
“We got our first referral — a lady with traumatic brain injury — and she’s still with us today,” Mayle says. “Within six months we had five beds full. I got the bright idea of building nine more rooms onto a house, and it just grew from there.” Today, residents have a variety of mental health diagnoses, including bipolar disorder, depression and schizophrenia.
Trained staff members help residents meet their needs, from daily living skills to medication and treatment management. Residents mingle in the living area and watch TV or relax in their own rooms, which are usually individual but sometimes shared. Most of the time they eat together in the common dining room. “It’s really a family environment,” Mayle says.
While Mayle has attended numerous trainings, educated himself with extensive reading and communicated with multiple physicians, psychiatrists and other therapists, he says no discussion or paperwork can convey the day-to-day reality of dealing with residents.
“My staff spent most of last night with a client in psychosis,” Mayle says. “And, of course, sometimes that behavior can become combative.” More often, it’s about helping people get through difficult times, like a person struggling with depression. “Especially during the holidays, it gets kind of tough,” he says, recalling one Christmas he spent directing traffic around a suicidal client experiencing a crisis in the middle of the road.
[See: Coping With Depression at Work.]
Terry Russell, executive director of the National Alliance on Mental Illness of Ohio, is appalled by the lack of appropriate living arrangements for people with serious mental illness. One tragedy, he says, is the incarceration of mentally ill people for misdemeanors and low-level felonies, despite relatively recent innovations like mental health courts.
Ideally, people with mental illness who want to live independently and find work can do so, Russell says. However, “Wanting to live on your own and your ability with your illness are two different things,” he adds. “These illnesses can be so mean that the person is disabled. This is a public health issue. These are biologically based brain disorders.” Thirty percent of people released from state psychiatric hospitals go to homeless shelters, Russell says, and “that’s just unacceptable.”
In many cases, families want to help but are overwhelmed. “Fifty-seven percent of all caregivers of the mentally ill are family members who are ill-equipped to deal with their loved one,” Russell says.
To find a good treatment program, Russell advises, families can contact their local NAMI chapter or mental health agency. “Call your local mental health center,” he says. “And don’t take no for an answer.” In the overburdened mental health field, he says, squeaky wheels get the grease.
Community mental health centers and day programs help people socialize in the face of what can be a lonely illness, Russell says. Unlike a medical episode like gallbladder surgery, where visitors check in on patients and keep them company, mental illness is not a “bring-a-casserole” condition. People can easily become isolated.
Most people with mental illness make their way back into the community with independent living or supportive housing. For those who struggle, a group home can provide the support and structure they need, Russell says. In Ohio, about 520 group homes exist for people with severe mental illness, with five residents on average. Reimbursement up to $1,110 comes from residents’ Social Security income, with the state making up the balance. In his work with the Ohio Adult Care Facilities Association, Russell has advocated for better group home reimbursement, which leads to improved quality for residents.
Criminal Justice Crisis
Mental illness is far overrepresented in U.S. jails, says Dr. Fred Osher, director of health systems and services policy for The Council of State Governments. While serious mental illness exists in 5 percent of the general population, that figure rises to 17 percent in the jail population, Osher told journalists attending a National Press Foundation conference in September. And among those with mental illness in jail, 72 percent have a co-occurring substance use disorder.
Disproportionately high arrest rates, longer prison and jail stays, limited access to health care and higher recidivism rates are among the factors driving this imbalance, Osher explained. And once people are released into the community, continuity of mental health care is dangerously lacking. Reducing the number of people with mental illness admitted to U.S. jails is the goal of Stepping Up, a national initiative of the CSG Justice Center, with which Osher is involved.
With scarce resources available, it’s important to identify which individuals have the greatest need for mental health treatment and the highest likelihood of committing crimes, Osher says in an interview. Supportive housing, halfway houses and group housing facilities get high-risk people into safe, comfortable places that assist with needs such as medication compliance to keep them in recovery and healthy.
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Community Members
Eventually, some group home residents are ready to move on. “If a client gets to a place where we feel they can do better — and they feel they can do better — in the community with the supports that we provide on a daily basis, then we can transition them into supportive housing,” Mayle says. Sometimes that means living with a roommate and peer who also has a mental health diagnosis.
For others, the group home is their permanent home. Mayle says one of his favorite clients has been with them for about 15 years following a lengthy prison term. His schizophrenia symptoms are such that he cannot work. “But he gets out,” Mayle says. “We take him shopping; we have an activity center, and he does well.”
Many residents participate fully in the outside world. They may get their driver’s license and work full-time, Mayle says. Some earn GEDs or take online college courses in the small computer center. Those with dual diagnoses — a mental illness plus a substance use disorder — may attend outside groups like Alcoholics Anonymous in addition to group and individual therapy within their home.
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Community Living Options for People With Serious Mental Illness originally appeared on usnews.com
