Mentally Ill Swing
Between Jail, Hospital

By Alan Elsner

(ROCHESTER, NY) Jerome Collier, who suffers from severe schizophrenia, has spent his entire adult life bouncing from jail to hospital and back to the streets, a fate shared by tens of thousands of mentally ill Americans.

Collier, 49, has suffered from severe schizophrenia for at least 30 years.

"I lived on the streets for 20 years. I didn't have nowhere to go. I did weed, cocaine, heroin, speed, acid, mescaline--I mixed it all up with my medication when I took it. I've been suicidal and homicidal. I've been in every emergency room in the county," said Collier.

Project Link, a six-year-old program spearheaded by University of Rochester psychiatrists Steven Lamberti and Robert Weisman, aims to identify severely mentally ill patients like Collier and help them reestablish some semblance of a normal life. The benefits to society could be immense.

"Jails and prisons have become the final destination of the mentally ill in America. It's a huge problem. There are more mentally ill folk in state prisons than in state hospitals. The Los Angeles County Jail has become the nation's largest mental institution," said Lamberti.

"So many people are trapped in what I call a Bermuda Triangle of prison, hospital and the streets," he said.

Project Link takes severely mentally ill patients--there are currently 45 enrolled--and gives each one a case worker, who makes sure they take their medications, keep in touch with medical and social service providers in the community and stay out of trouble. Fifteen participants are living in group housing supplied by the program.

To Lamberti, the housing is crucial. Most private landlords are reluctant to rent rooms to mentally ill tenants. But without stable housing, they are almost impossible to treat.

A study looking at outcomes for 54 past and present participants found that in the year before joining the program they spent an average of 109 days in jail and 105 days in the hospital. In their first year in Project Link, they averaged 40 days in jail and 14 in the hospital.

COSTS DRASTICALLY CUT

The program also drastically cut the costs of caring for participants, from an estimated average of $62,500 per person to $14,500. One participant used $146,000 in emergency room care alone the year before he signed up.

Of the estimated 5.6 million people with severe mental illness currently living in the United States, some 2.2 million are believed not to be receiving any treatment.

In the 1980s and 1990s, the number of available beds in mental hospitals plummeted while the prison population more than doubled to around 2 million, of whom around 15% are believed to be suffering from severe mental illness, according to various studies. That totals out at around 300,000 people.

In Rochester, a city of around 750,000 near the shores of Lake Ontario, a regional psychiatric hospital that once held over 3,000 inmates was cut to just 200 beds in the 1990s.

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Almost all the participants in Project Link were abusing drugs and 95% were unemployed at the time of enrollment. Around a third were enrolled straight out of jail, and almost half referred by hospitals. Some 57% were either on parole or probation.

"Few of our patients are ever going to be able to hold down regular jobs but if they can stay out of jail and live in one place with a roof over their heads, and they are not harming themselves or others, that can be counted as an achievement," said Weisman.

"Our clients are often tough and obnoxious and don't follow directions or trust authority. We try to reach out to them with case workers from their own communities," he said.

Collier lived for years by committing petty and sometimes not so petty crimes. He used to steal cars, break into houses, cheat people out of money--anything for a fix.

"Once I broke into a house and set a fire. A fireman got hurt real bad trying to put it out," he said.

The indirect costs to society of the crimes people like Collier might have committed and the damage they might have caused had they not been enrolled in Project Link are real, but impossible to measure.

Now, Collier lives in a group home and is handed his medication every day by a trained custodian. He spends his days and evenings attending community programs.

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