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By Craig Malisow
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Every day, Maverick Chevalier, who seems to be a courtly, gentle man, 41 years of age, fishes his own feces out of the toilet, puts it in a plastic bag and stores it in a pail with a lid on it. When the bucket fills up, he takes it down to the Dumpster.
Now Chevalier, who is mentally ill, picks out his own "doo-doo," as he calls it, not because he's irrational, but because his apartment complex managers are refusing to fix his toilet. They tell him he just didn't maintain it well enough, didn't keep the stains off it. He's tried to scrub away the rust and slime, used all kinds of bleach, and with a background in janitorial service, he knows something about cleaning. But the toilet clogs up if he tries to flush solid waste. If he reports it to management, they'll send someone to fix it, but it'll usually take a whole day, and that means he can't use his toilet at all.
He says managers won't clean his carpet, either. He's been waiting three months. "They say they busy; they got other things they're trying to accomplish," he says with a certain air of resignation. Mental health workers have advised him to get out. After six years, though, Chevalier is reluctant to move. "I've been here so long and I'm so secure here," he says.
Maverick Chevalier, a paranoid schizophrenic, has carved a tolerable world for himself out of unacceptable conditions. He could do worse. Which doesn't make what he puts up with defensible, but it does reflect the sorry state of life in Houston, Texas, for someone who is mentally ill and trying to negotiate the days and months ahead with nothing more than a $500 monthly SSI check.
Aretha Johnson operates Liberty Island Community Center on Boone Road. Converted from a former hotel and restaurant, it has 209 beds, a gymnasium, swimming pool, beautiful dining halls and sparkling hallways. Rooms are equipped with used furniture from hotel chains such as Marriott.
Liberty Island is the largest assisted-living facility in the Houston area. It offers housing as well as a weekday adult day-care program. It provides medication, structure, cleanliness and meals. It employs 12 maids. Stopped-up toilets are fixed. Carpets and floors are cleaned regularly. Aretha Johnson wants it clean, and besides, the state, which does regular inspections, might otherwise shut them down.
But Liberty Island is not filled up. There is no waiting list. Even when it cuts the monthly price of $1,500 to a rock-bottom $750 -- Johnson says that's the break-even point -- it's still too much for the folks without family, without independent income.
Call it the $250-a-month gap. A gap between third-world living (right here in the U.S. of A.) and a chance at dignity.
Tom Mitchell is the very active director of ACT, the Assertive Community Treatment program in Harris County. Part of the Mental Health and Mental Retardation Authority of Harris County, ACT assigns its ten-member teams of social workers, nurses, counselors and doctors to provide around-the-clock support for its mentally ill clients.
It begins with the medicine, making sure that clients take theirs. Of the 300 or so clients that ACT's three teams work with, 35 of the patients see an ACT person every single day for their medication. For two clients, that's twice a day.
Beyond that, ACT team members help clients find housing, take them to the supermarket, to the dentist, the doctor. Those who have problems are pulled in before their troubles escalate to full-scale crises. This not infrequently brings ACT into contact with the owners or managers of the places where the mentally ill live.
"Personal care homes, some of them won't put up with any behavior at all. They want them to act like these perfect angels, and if they talk back to them or do anything, they kick them out. These people are mentally ill, after all," director Mitchell says. "There's even a few cases where we strongly suspect that they just look for a reason to kick them out and they always do it within the first week the person gets there, and then they keep their whole check. And then it's a battle to get it back."
Housing for the mentally ill has always been a problem, Mitchell says, and in Harris County, it's certainly not getting any better. "We run into a bind sometimes with people. They get kicked out of where they were living and something happens, they get kicked out on the street. And we have to scramble to find a place for them in a shelter somewhere."
A member of the ACT advisory board, Dale Ramey, has been pushing hard for an agreement between ACT and Liberty Island, where her son Tim is a resident and an ACT client. "The dedication of that woman over there is incredible," Ramey says of Johnson. "She sincerely cares about the people living there."
Mitchell favors a proposal for Liberty Island to set aside some beds for the newly homeless mentally ill. These are not the same people heading to the reopened and streamlined (now six beds) NeuroPsychiatric Center or the Ben Taub emergency room. Their crisis isn't a psychiatric one; it's housing.
ACT figures it needs an estimated $36,000 in funding to add a staff person who would work more with short-term Liberty Island residents, Mitchell says. After a few days, the client could move either into a regular bed at Liberty Island or on to another facility. "At least that will give us a little time," Mitchell says. It would benefit Liberty Island, an already overworked ACT team and the mentally ill.
Mitchell also would really like the state legislature to vote to fill that $250 gap. It would be far cheaper, he says, to subsidize these people at $250 a month and keep them stable, rather than to keep paying for crisis hospital visits that are $550 to $600 daily.
Bernadette Moreno has been at Liberty Island for three months, coming off a five-month stay in jail. The 35-year-old had decided to stop taking the medication for her bipolar condition because it made her sleepy and she wanted to do well at her new job.
This got her into trouble. When she stops taking her medicine, she gets to thinking she can do anything, and that's not always good. "I'd been up for seven or eight days straight," she says, rubbing one arm. "This [Pasadena] police officer, he started asking me questions. He grabbed me. I shoved him away from me. Then I ran."
The police chased her. "They beat the tar out of me," she says. She remained so angry that when they put her in the holding cell, she pulled the ceiling down on herself. She was charged with assaulting a police officer, destroying public property, resisting arrest and creating a public disturbance.
"At the time, pulling down the ceiling and fighting the police department seemed like a good idea," she says ruefully. "I got five months for it."
Her mom got her set up at Liberty Island, and she likes it there because "there's stuff to do." She knows she shouldn't be in charge of her own medicine.
A major part of the support that Liberty Island provides is that staff members watch residents and get them to a doctor if they're about to fall off track. Even those who are taking their medication may need it adjusted. "You try to get to them early so they're not in the hospital that long. We ask them if they'll go in voluntarily," executive director Johnson says. "Sometimes we're doing commitments."
As she moves through the hallways, it's clear that the residents like Johnson. She gets a special cheer at lunch because in addition to the regular healthy meal mandated by the state, they've brought in pizza to reward the residents for helping them pass their latest inspection by the Texas Department of Human Services.
A licensed vocational nurse, Johnson got her start in the assisted-living business after she volunteered at a mental health facility and was devastated by the squalid conditions. Her mother, Almether Johnson, and her aunt helped her establish a home for the mentally ill.
They put together $5,000 from Johnson's life insurance, $1,200 from her income tax return and $4,000 from the aunt to get started. Her first patient took Johnson's bed, while Johnson slept on the couch.
In November, she'll have been in business 18 years.
"Everybody has to have a purpose in life, and they have to feel worthwhile," Johnson says. And when people start to feeling better, they want to get a job. "We've got to give them real work opportunities, to have a chance at the real all-American dream."
But there are obstacles. Getting a job is a success, but patients who make more than a certain small amount have their all-important Medicaid benefits pared back and eventually dropped. That's a scary prospect that stops many of the mentally ill from applying for that first job.
There have been massive cutbacks in the job-training programs offered through MHMRA, and some of the private companies prey upon the mentally ill, ACT leader Mitchell says.
"When Medicaid came in, Medicaid was supposed to be this big panacea of extra money, but once the legislature saw it, they decided well, the mandate every year has been 'Make it up with Medicaid.' " Problem is, Mitchell says, Medicaid does not cover vocational training.
His "dream" model is Minnesota Diversified Industries out of St. Paul. It employs more than 500 people, dedicates at least half of its positions to people with disabilities including the mentally ill, and is a multimillion-dollar operation with relationships with other companies such as 3M. Employees assemble CDs, cassette tapes and filters used in medical labs.
Salaries are good, averaging $9 an hour, and workers get medical insurance, vacations and tuition assistance. "They do a lot of things to make it more tolerable for people with mental illness. They don't worry about people talking to themselves as long as people still produce and still work."
Maverick Chevalier was not so fortunate. As "trainees," Chevalier and other men were sent out in teams to clean offices. They worked 25 hours a week (five days a week, from 9 a.m. to 2 p.m.) and were paid a $30 "stipend."
Even though Mitchell is outraged at the practice, Chevalier was satisfied. He hadn't worked in years, he says, and "I needed something I could do, something to occupy my time."
He wanted to stay; worked there for about six months, until the arrival of summer. "I was content there. I was eager to wash those windows. It just got too hot."
A program to teach janitorial work on its face sounds like a good idea. But then you find out that for five years before Chevalier entered training, he'd worked as a janitor at night as part of the now-defunct Fairweather Program through the Tri-County Mental Health Authority in Conroe. There, he had performed the same chores that he supposedly was "learning" how to do for little more than a dollar an hour.
The ACT advisory group has pledged to help Mitchell raise money and to petition the legislature for the $250 monthly subsidy. Liberty Island's Johnson hopes it works. "I'd like to see some people try to live on $500 a month for food and board and everything," she says.
Living that close to the bone means the centers that house these people need extra help, Johnson says. The Houston Golf Association just gave Liberty Island $100,000 toward the $360,000 needed to replace the roof and put in new air conditioning, she says. The association told her it hopes this donation will inspire others to contribute.
Johnson says the owner of another personal-care home called her recently to say she was shutting down. She'd taken in nine mentally ill adults, with only their SSI checks. The woman told Johnson that "$4,500 a month isn't enough." She'd been advised she needed a new air-conditioning system, and there was no way she could pay for it, Johnson says. "She felt bad about those people sitting there without air conditioning, so she got them transferred to another home."
Mitchell says wryly: "You hear those stories. There's others in cases like that who don't shut down."
The number of personal-care homes has declined in Houston, Mitchell and Johnson agree. "They're either shutting down or getting worse or reopening up as an unlicensed facility," Mitchell says.
"I thought if I got more numbers, we'd be able to do it, but we can't," Johnson says. "I don't like to turn people away; in fact, if mental illness is their primary diagnosis, I won't. But $500 a month is not enough.
"We need help to maintain this," Johnson says. "We need the support of the community."
Community support and a minimal subsidy seem like much better choices than seeing more people thrown out on the streets, or living in hellholes where their $500 a month doesn't even provide them with a working toilet.