A Visit to Dix Hill

On Saturday May 4th,  I walked in the annual NAMI Walk on the campus of Dorothea Dix Hospital. NAMI is a grassroots advocacy organization founded by family members of persons with schizophrenia in the 1970s. These family members came together to advocate for better care of their relatives, and for mental health professionals to stop blaming families for causing schizophrenia. Today, NAMI is the one of the largest mental health advocacy groups in the US, with national and state offices, and local groups that vary in the intensity of their grassroots work. Their focus is much broader than schizophrenia these days.

I walked with a team from the UNC School of Social Work, and ran into lots of friends, as I've been in the mental health field in NC for the past twenty years, and a long-time advocate. I saw kindred spirits from NAMI Wake, Gerry and Ann Akland, and Louise Jordan, and my friends from NAMI Orange, Lisa Hamill, and Barbara and Gove Elder. Barbara and Gove are also active with Faith Connections, and are working with faith communities to be more inclusive of persons with mental illness. I walked with former clients, and with Club Nova members.

The Dorothea Dix Hospital, originally called Dix Hill, was created through the advocacy work of one woman: Dorothea Dix. Starting in the 1840s, she crusaded across the US for moral treatment of the insane, creating reports on how they were inhumanely housed in prisons and poorhouses, and was successful in getting state legislatures to make land grants to create state hospitals. In the early days, the state hospitals in NC were full communities -- with working farms growing food to feed the patients, and patients working in the facilities on the grounds.

 The history of Dorothea Dix Hospital

At the end of her life, Dorothea Dix was dissatisfied with her progress toward improving the care of the mentally ill. There was a significant historical event that may have gotten in the way: the Civil War. During those years, she shifted her care to nursing the wounded.

The Dix campus is currently in the news -- it's a beautiful piece of land with rolling hills, expanses of green, and lovely trees. The hospital closed last year as part of the state plan to shift care from the state hospitals to local communities. The empty forensic unit building looks grim with its fences topped by barbed wire, but the cottages with stone fronts are lovely. And many state workers in the NC Department of Health and Human Services still work in buildings on the grounds.

What will become of Dix Hill? The city of Raleigh, and a group of prominent citizens called the Dix Visionaries, foresee a city park along the lines of NYC's Central Park. In her last days in office, Gov. Perdue signed a contract with the City of Raleigh to lease the land for a park. But, the Republican legislature is challenging the deal.

Dix Legacy Park

Whatever the outcome for the land, the vision that Dorothea Dix had for humane care of the mentally ill seems to have been thrown to the wayside in NC. The headline in the Raleigh News and Observer this morning is about the increasing number of the mentally ill in jails. They land there for minor offenses, don't get proper treatment, and get worse, not better.

In No Man's Land: The Mentally Ill

Before we left the grounds, David and I knew that a visit to Dix Hill wouldn't be complete without a stop at the Dix Cemetery.

Starting in 1859, patients who died were buried on a lovely hillside.

If they had no family, they got a plaque like this:

There were long rows of these small plaques. Some were visible, some were not. Were they buried beneath the grass, or had they been removed? We saw dates that spanned a hundred years.

If there was someone who loved you, you might have a monument like this -- we saw two honoring mothers.

And if you were part of a social group, they may have remembered you the way the Woodsmen of America did.

Dave and I enjoyed our day -- we had fun with friends, raised money for a good cause, and we visited ghosts who constantly remind me of why I do what I do.

Ms. Dix, we still have a long way to go. Whatever happens with this beautiful land in Raleigh, I hope we won't forget your vision of humane care for persons with mental illness, and that your spirit will stay around to sustain us.

Out in the Cold

I started this blog a year ago, when I first volunteered with the Orange County Partnership to End Homelessness, and the 100K Homes Task Force. Next Wednesday, I'll again participate in the Point in Time count of persons experiencing homelessness, on a team that will try to find unsheltered persons -- that means we'll be looking in the woods, and under overpasses, and in parking lots. 

Today, it's cold and we've had freezing rain and sleet since this morning. I came home early, put an extra pair of socks on, and have been hanging out in my bed with my laptop. I've tried to get my dogs to lie on my feet because they just won't warm up. But Sox and Jasper are by my side, snoozing away. Flash the cat is here, too, either attacking my cold feet or trying to sit on my laptop.

I love my house with its open and airy spaces--except on days like today. Those open and airy spaces are hard to warm up.

But I am very grateful for my house, and my pets and my family. I have these things, and my life is good.

I've thought about the people I've met this year who are homeless. We've been able to house some, and to get them connected to mental health and medical care. But still, there are some stories of human misery, and our ability to get people into warm spaces of their own is limited. We are currently working with a man who's lived in a storage unit for more than a year; one who is living in an apartment that is being renovated with unfinished walls and no heat; and one who was living in a crawlspace until he was forced to leave. There was a woman in an abandoned house, using cement to try to fix a dental problem.

Why are they out there? Extreme poverty--many are disabled,and may not receive disability income. They may have medical conditions, psychiatric conditions, intellectual disabilities, or traumatic brain injuries. Many abuse substances -- some have been drinking for years, and burned every bridge they crossed. Or they've just had bad luck.

One of the saddest things to me is what happens to people who are mentally ill and homeless. Often, they have a hard time in shelter settings, and may be asked to leave, or even be banned from the shelter property. They may behave in ways that are hard for shelter staff to handle, or they may break a rule, and suffer the consequences. On nights like these, when it's bitter cold, where do they go?

Federal housing policy is promoting a Housing First model -- that means providing housing with no strings attached. What they've found is that if people are stably housed, they have a base to start working on the other things in their lives. Unfortunately, affordable housing stock and rental subsidies don't meet the growing need.

On these cold wintry days, think about the people that we don't want to see -- imagine that you are in that situation, and think of the things you can do to make our world a more compassionate place.

Day Two: On the Streets and In the Woods

Yesterday we started out slow--second day up at 3:00 a.m. Spencer forgot the gift cards, so we had to meet another team to pick them up. It was cold and clear with a bright starry sky.

First, we decided to drive around the parking lots of shopping centers to see if we could find people who were sleeping in their cars. One of our volunteers had seen a car that she thought someone might be living in near an office complex. She pointed out the car, and I walked over to see if someone was in it. The back windows were open, and I could smell cigarettes and see clothes and bedding. I called out, but got no answer. Spencer looked in the front seat and saw a man asleep under a sleeping bag. He woke up and we asked if he would talk with us. He said no, and asked us to leave him alone. We walked away, but Spencer thought he might know him, so went back and asked again. This time, we got a very clear refusal to participate. We'll note that we found a man sleeping in a car, but that's all the information we'll be able to report.

Next we went back to one of the campsites we visited on Tuesday. This site is by a stream, in town, in a very private area. We found our way, and came into the camp, calling out. We walked through an arch made of bamboo, used the steps cut into the stream bank, and came to a sitting area. Near the chair, there was a small bucket with a toothbrush and toothpaste. The tent was nestled in a spot surrounded by bamboo. I approached, said hello. The man woke up, remembered us from yesterday, and asked that we give him a minute and he would come out talk with us.

He was a Hispanic man, in his mid-40s, dressed in casual clothes. He said he used to live in an apartment in Carrboro but couldn't pay for it and had to leave. He was the only one in the camp that night, but said that others come and go, and some get "bad drunk." He was willing to do the survey, and gave us his name and social security number, and let us take his photo. He works when he can, doing odd jobs.

He told us he had a heart condition, and showed us a device strapped to his chest. He gets his treatment at UNC in cardiology. He didn't know the name of his condition, but said he loses consciousness about once  every 40 days, and that the device gives him a shock. Was it a defibrillator?

One of the purposes of the Vulnerability Index is to identify those homeless individuals most at risk of death. We had just found one. There were no signs of severe mental illness, perhaps some anxiety and sadness, but what would you expect when you aroused in the middle of the night by a group of strangers?

He told us there were other campsites nearby, and gestured and pointed. We tried to find the another site, but couldn't find a path, and found our way blocked by a fence.

From there, we went back to the sites we had seen on Tuesday, close to I40. We walked into the woods, and found the tent empty, just as it had been the day before. Spencer wanted to walk further into the woods so we started walking and saw a light ahead of us. That led us to a second tent, and a man wearing a headlamp. Spencer knew him.

He was white, in his mid-40s. He said he had been homeless for more than year, and had had to leave the shelter when we started a work program. He goes to the program daily. He had recently been denied disability but was planning on appealing. He was skinny, with a cup of coffee in his hand, and shivered in the cold. He had been in foster care. Had had a head injury. And he had recently been diagnosed as having the early stages of mesothelioma. He was nicely dressed, and said that he slept in the tent, and then caught the bus into down and tried to stay busy in the day. One of the volunteers asked if he panhandled, and he said he would never do that.

He pointed out a tent a short distance away--the occupant had already left for the day.

The site I would have liked to have seen in Chapel Hill was also near a stream near a bridge. There was a man who lived there who was an artist -- he built mosaics around the camp, and brought in calla lilies and other plants to beautify the area. We had heard that the artist was no longer there, having decided to return to his homeland.

The image below is not from one of our camps -- but it gives you an idea of the care some people put into making these spaces a home.

In contrast, other sites looked like this:

http://www.aksenate.org/ellis/121109_homeless_camp.jpg

We had a great team, and talked about meeting to continue our early morning walks in the woods. It was heartwarming to see the volunteer participation in this event--some of us mental health workers and community activists and others concerned and caring citizens. I learned alot, and will have more to say on the experiences.

Watch for an article on the initiative in this Sundays' News and Observer.

Scouting Camp Sites

Spent some time this morning with Solomon and Spencer scouting campsites in Chapel Hill--looking for places that people without homes might sleep for the night. We checked out some abandoned houses not far from downtown, with lots of evidence of human activity. We saw sleeping bags and clothes, long abandoned, along Bolin Creek. And we found two sites with tents. Talked with one man. We'll go back tomorrow morning with our volunteer team, bringing coffee, gift cards, and asking folks we find to complete a survey designed to identify the people most at risk of death. And we'll give people a chance to tell their stories. I hope you will listen.

At one of the sites, there were clothes hanging to dry, and personal touches--decorations hanging from tree branches--and a dog leash clipped to a tree, but no sign of a dog.

Homeless Count

As I go through some transitions in my professional life, I am taking some time to get back to my roots as a social worker. These last few years have been tough in my line of work -- privatization of the historically public mental health system in NC; funding cuts in the system, not to mention in my household; and struggles with the power structure and trying to create change from within the system. What I've seen is an increase in human suffering, and fewer resources available to alleviate it.

So, on Tuesday and Wednesday this week, I'll be getting up at 3:00 a.m. to participate in the Orange County count of unsheltered homeless individuals.

It's part of this national grassroots effort: http://100khomes.org/

I'll be co-leading a team of six volunteers. My group will include a homeless outreach worker from Housing for New Hope, the mayor of Chapel Hill, Mark Kleinschmidt, and town council member Penny Rich.

We'll be visiting homeless camps within the town limits. We'll see the invisible people, and hopefully give them the opportunity to tell their stories.

Stay tuned . . . I'll report on the experience here.

http://100khomes.org/