Apartment helps man gain upper hand over mental illness

Sunlight streamed through the windows and the scent of sandalwood incense filled the air the day Aron Washington moved into his apartment

Tall and lithe, Washington tried a few yoga poses in the still-empty living room and spoke about his dream of starting a nonprofit corporation that would "bring right brain people and left brain people together over music and dance."

Six months ago, Washington, an artist with schizophrenia and bipolar disorder, shared a small room with two other men in a noisy, crowded nursing home for the poor, where his days revolved around the institution's schedule of meals and medicines. He got $30 a month in spending money from his disability check.

But since June 20, the 31-year-old Chicago man has proved he can live in his own apartment, with help from a small Illinois pilot program called Direct Connect. The program found him an apartment, helped him shop for furniture and got him out of the nursing home where he landed after a stint of homelessness.

"I want to start saving, start getting together a little nest egg," he said. "I want to live a purpose-driven life."

Others are less fortunate.

In Illinois, more than 9,000 people with serious mental illnesses were living in nursing homes as of June 30, 2006 -- an increase of more than 1,000 from the previous year, according to information provided to The Associated Press by state officials as a result of a state Freedom of Information Act request.

In addition, another 4,654 people with serious mental illnesses were living in a type of nursing home classified as an Institution for Mental Disease.

Many states closed large mental institutions in the 1960s through the 1980s, leaving thousands of mentally ill people homeless. A patchwork system of underfunded community-based services emerged in some states. But others, including Illinois, relied on nursing homes, largely funded by Medicaid, to care for the mentally ill.

Some lawmakers believe programs like Direct Connect could save Illinois $9,000 per person each year and help thousands of mentally ill adults, many younger than 40, who live in nursing homes. But for now, the 2-year-old program is in limbo, awaiting an end to legislative gridlock.

"As soon as final budget issues get resolved, the program should be able to obtain its funding," said Rep. Sara Feigenholtz, a Chicago Democrat who chairs the House panel on human services spending.

Feigenholtz, an early supporter of Direct Connect, said Illinois should strengthen programs that encourage independence and recovery. Institutions foster dependence in people who otherwise are capable of improving their lives, working and paying bills, she said.

"I'm looking forward to the data on cost-effectiveness" of the Direct Connect program, Feigenholtz said. "It will give us a roadmap of where Illinois should be investing more resources."

Not everyone agrees.

Robert Hedges, board president of the Illinois Health Care Association, a group representing nursing homes, said housing mentally ill people in apartments can be disastrous without adequate oversight to ensure they take their medications and do well. Some will end up back in institutions or on the street.

"If you ask residents with mental illnesses, 'Would you like to live out in a little apartment?' Every one of them is going to say, 'Yes.' That doesn't mean they have the ability to live on their own like that," Hedges said.

Three mentally ill people relocated by Direct Connect have moved back into institutions. They needed more medical attention for problems such as diabetes or their symptoms of mental illness grew worse after moving, said Tony Zipple, CEO of Thresholds, the nonprofit agency that runs Direct Connect.

But Illinois faces a class-action lawsuit that claims many more mentally ill people in nursing homes could live in apartments or group homes if they got help managing their lives.

Filed originally on behalf of Ethel Williams and Jan Wrightsell, two women with mental illnesses who wanted to move from an institution, the lawsuit describes the living conditions at the Chicago facility where the women lived with scant freedom, privacy or treatment.

"Residents wander aimlessly in and out of the common room and smoking room with nothing to do the majority of the day," the lawsuit states.

Benjamin Wolf, an attorney with the ACLU of Illinois, who is helping with the lawsuit, said the agency would "like the opportunity for everybody who wants the opportunity to get out of an institution."

"Illinois historically has significantly underfunded its human services and spent more proportionally on institutions rather than in the community," he said.

The lawsuit cites a 1999 landmark ruling by the U.S. Supreme Court that the Americans with Disabilities Act requires community placement of the mentally disabled whenever appropriate. The court said segregating the mentally ill amounted to "unjustified isolation," while recognizing that states need to maintain a range of facilities for people with mental disabilities.

Teresa Kurtenbach, a spokeswoman for the Illinois Department of Healthcare and Family Services, said she couldn't comment on pending litigation.

But she said in an e-mailed statement that the state has "made significant progress in the process of rebalancing the delivery of long term care services for people with mental illness to promote the use of non-institutional community options" under Gov. Rod Blagojevich.

The day Washington moved out of Somerset Place, a Chicago institution serving mostly poor adults with mental illnesses, some staff members and another resident predicted he wouldn't make it on the outside.

"They said, 'You'll be back,' " Washington said.

"I said, 'I'll be back to visit.' "

Direct Connect staff want to make sure he stays on his own.

"We're not going to abandon anybody," said Zipple, adding that, while the program awaits renewed funding, caseworker time is patched together from other programs.

Caseworkers meet with Washington twice a week. Besides keeping tabs on his meds, they help manage his money, discuss vocational plans and check on his physical health. Washington has elected to have Thresholds receive his monthly disability payment, but he decides what bills get paid.

When Washington doesn't take his meds, his mind races and he ends up in jail, detox or in a hospital psychiatric unit, he said.

"It's like coming to from a seizure," he said. "Thoughts. Can't contain them, can't cease them. Just reflect upon them, sometimes I get lost in my head."

Direct Connect has helped 43 people with mental illnesses, including Washington, move into their own apartments and another eight move into groups homes.

The program, which spent $766,000 in its first 21 months, needs an infusion of money from state lawmakers before it can return to finding apartments.

"It's a new day. It's a watershed mark," Washington said of how his apartment changes his expectations for his future. "It's a necessary step I'm taking in what I'm going to do in life."