Norman Grayson said he spent about six months looking for a place to live because mental illness, a criminal record and poverty all but squeezed him out of the housing market.
He recently finally found a place, for $422 a month in the Hill District. The landlord agreed to let him in even though Mr. Grayson's Supplemental Security Income hadn't yet kicked in.
"That was a blessing," said Mr. Grayson, 51, who spent four years in various state prisons for a North Side robbery.
For many people with serious mental illness, the specter of homelessness is just around the corner.
Housing can be as important to recovery as medication, yet the mental-health system struggles to meet the demand for safe, affordable housing. To make matters worse, some clients' behavioral problems make then unwanted tenants.
Without affordable, stable housing, "many people remain in a constant state of crisis. They circle in and out of the jail, hospitals ... and shelters," Sally Ricci, an official with Supportive Services Inc., told the Beaver County commissioners this year in a letter seeking funding for her agency's housing programs.
The December 2008 closure of Mayview State Hospital -- the South Fayette facility serving Allegheny, Beaver, Greene, Lawrence and Washington counties -- helped to highlight the housing challenges confronting local residents with serious psychiatric problems.
• Some of the 305 patients moved out of Mayview from 2005 to 2008 were placed in institutional settings -- such as nursing homes and long-term structured residences -- simply because of a shortage of apartments. This occurred even though officials said community integration was the chief goal of closing the hospital.
A special five-part series
Overview and portrait of former Mayview State Hospital patients.
Monday, Sept. 23:
Community hospitals struggle with mental-health caseloads.
Tuesday. Sept. 24:
Police, courts improvise to manage ill offenders
Wednesday. Sept. 25:
Housing a weak link in mental-health system
Sunday, Sept. 29:
The future of mental-health treatment
• Stigma still limits housing options. Because of community opposition, including concerns that former Mayview patients posed a threat, Pittsburgh Mercy Health System in 2009 scrapped plans to open a long-term structured residence and acute-care program in Baldwin Township.
• After going into a community hospital for emergency treatment of a mental-health problem, some patients remain longer than necessary because of a shortage of beds in extended-care facilities and step-down programs.
• Allegheny County Common Pleas Judge Beth Lazzara, who oversees the county's mental-health court, said she has seen offenders' mental health deteriorate in jail while they wait for openings in outpatient treatment programs.
Officials said housing for people with mental illness was in short supply even before Mayview closed. The residents' high level of unemployment and poverty are problems, they said, and the state's decision last year to end a cash-assistance program for low-income residents made matters worse.
"I'm sure that increased homelessness," said Christine Michaels, executive director of the southwestern Pennsylvania chapter of the National Alliance on Mental Illness, an advocacy group.
John Bell, 45, covets the empty houses in Washington, Pa.
He says he lives "wherever." He works as a day laborer and tries to manage depression and bipolar disorder, sometimes without medical help. He said he wishes he could live in one of the vacant houses he sees in town, but he has no money to put a roof over his head.
Mr. Bell is among a handful of people with mental illness who frequent a drop-in center operated by Washington County Mental Health Association. They may camp out at night and visit a number of social service agencies in town to get meals and other necessities. They use the drop-in center to socialize.
"For me, it's a good place to sit and gather my thoughts," Mr. Bell said.
Many of those in homeless shelters have mental illnesses and substance abuse disorders, according to data provided by the NAMI. In some cases, it's difficult for mental-health workers to persuade clients to seek help. It also can be difficult to meet clients' needs even after they appeal for help.
Bethlehem Haven, an Uptown women's shelter, said it's seeing more women with severe illnesses that are going undiagnosed or untreated. Many of the women have no insurance and don't know how to apply for medical assistance, said De'netta Benjamin, shelter clinical director.
Finding them long-term housing is a challenge. "We basically begin our discharge planning at admission," Ms. Benjamin said. Bethlehem Haven offers overnight shelter for 28 women, with a maximum stay of 60 days, and offers other housing programs.
Ms. Benjamin said Mayview's elimination, economic problems and other factors have been responsible for the increasing demands for the shelter's services.
"I think if Mayview were still open, it would give more options for long-term care," Ms. Benjamin said. "Long-term care beds are limited."
Supportive Services, Pittsburgh Mercy Health System and other organizations that provide long-term housing for people with mental illness say they cobble together funds from a variety of private and government sources. But demand for housing regularly exceeds the supply.
"Right now, we're at 100 percent. I have a waiting list of 13 to 15 people," said Jeff Huber, CEO of Supportive Services, which has 77 units of housing in 28 Beaver County properties. "We have no openings whatsoever, and I don't know anybody else who has any."
Pittsburgh Mercy has about 115 units in various parts of the city. "We always have them full, and yes, there are waiting lists," said Stephanie Chiappini, program manager for Pittsburgh Mercy's homeless assistance programs, collectively known as Operation Safety Net.
Not all of the agency's homeless clients have mental illness. Among those that do have psychiatric conditions, Ms. Chiappini said, are people with schizophrenia who have been reluctant to seek treatment.
The shortage of housing exists in rural areas, too. Steve Plyler, residential director for Lawrence County-based Human Services Center, has eight to 10 people on a waiting list for various housing programs but believes the need is much greater than that.
Because of the large number of offenders with mental illness, Supportive Services and a new social service agency, Adaptive Behavioral Services Inc. in East Liberty, say there's an important need for "re-entry programs," including housing, that would help offenders transition to the community after serving their jail and prison sentences.
Mr. Grayson is among those receiving treatment and other help from Adaptive Behavioral.
He spent four years in state prisons for the North Side robbery -- a crime that he said occurred during a period when he was drinking and off his medications.
After being released from prison, he lived at a Downtown halfway house. He said he spent six months looking for a permanent home, a search conducted with the assistance of Adaptive Behavioral.
Kevin Jordan, the agency's general manager, said public housing authorities, which provide subsidized housing to the poor, routinely deny admission to felons. He said clients with mental illness might get around that barrier by arguing that they're entitled to a special accommodation under the Americans with Disabilities Act.
Ms. Ricci of Supportive Services runs Stone Harbor, a 12-bed home for offenders with mental illness and drug and alcohol problems in Beaver County. She said her clients are "high profile, in the news a lot" because problems with impulse control repeatedly get them into trouble. Without Stone Harbor, she said, some would sit in jail because they have nowhere else to go.
"Their families don't want to take them in. They don't have any friends, no traditional support system," she said.
Stone Harbor, supported by the U.S. Department of Housing and Urban Development, offers up to two years of housing. Ms. Ricci said she helps the offenders sign up for food stamps and medical assistance, schedule mental-health and drug and alcohol services, and look for permanent housing.
Some Stone Harbor clients cycle through two or three times and achieve longer periods of stability in the community after each stay. "It's progress, not perfection," Ms. Ricci said.
Sometimes, people with serious mental illness get kicked out of rental homes because they're unruly or they unintentionally set fires or cause landlords other kinds of grief. Mr. Huber said he's seen people evicted for these reasons.
Gerald Sutyak and Garry McGrath opened Anna's Home, a personal care home in Monongahela, to accommodate some of the patients moved out of Mayview. They said they were surprised by how combative some were.
"Some needed 24/7 eyes on," Mr. McGrath said.
Amid state and county budget cuts, the pair said, they devoted all available staff time to resident care and let other matters slide -- only to have state inspectors cite them for housekeeping and clerical violations. They recently closed the home, forcing Washington County officials to relocate the 11 residents.
Most of the residents at Smith's Personal Care Home in Beaver Falls have mental-health issues. Co-owner Colleen Colella said she routinely turns away prospective residents if she believes they'll be disruptive.
The money, she said, isn't worth the trouble.
Joe Smydo: firstname.lastname@example.org or 412-263-1548. First Published September 25, 2013 4:00 AM