The Arlington Voice goes to press as the 2003 General Assembly, constrained by limited revenues, worked toward completing its fiscal 2004 budget and adjournment February 22.

For advocates seeking strengthened community-based mental health services, the good news is that no further cuts were made in those mental health services. Differences between the Senate and House budget versions, however, remained to be resolved.

One issue is the difference between the Senate and the House on Governor Mark Warner’s plan to begin "restructuring" the state’s mental health system by taking $22 million of general fund support for state psychiatric hospitals for community-based services. The Senate, based on the action of its Health and Human Resources Subcommittee, objected to the proposal on grounds it relies on unidentified savings at state hospitals. The House statement is not as strong.

NAMI-Virginia has argued that additional "bridge" funding is needed in such a restructuring. "The Governor’s plan is a ‘cost neutral’ one, meaning that it will not cost the state additional funds. It is not possible to close five hospital wards one day and open community programs the next. There must be a period of time when both programs operate simultaneously, so consumers do not get hurt. This will cost additional money," NAMI-Virginia said in a budget alert.

NAMI-Virginia is also opposing an amendment to require the Mental Health Department to treat sexually violent predators – felons who can be civilly committed after serving prison sentences because they are deemed too dangerous to release to the community. NAMI-Virginia argues that there is a mandate to serve this population, but inadequate resources are being allocated for this purpose, which will drain future limited resources from other MH programs. Moreover, it says mental health services and facilities for sexual predators should be part of the budget for the Corrections Department. NAMI-Virginia calls the plan a "dump," with dire consequences for mental health consumers.

NAMI-Virginia also cited another issue in the establishment of a Preferred Drug List (PDL) for Medicaid recipients. Although atypical antipsychotics were exempt, NAMI-Virginia urged that all psychiatric medications be protected. Its argument was that consumers in other states with PDLs have been inappropriately denied access to vital medication. Exempting atypical antipsychotics is important, but consumers have more than psychotic disorders. It makes no sense to partially treat ill individuals and then make them "jump through hoops" for other illnesses, NAMI-Virginia said.

The County is seeking models for supported housing arrangements that reflect "best practices," and that maximize the choice and options for consumers, according to two Arlington County staff members working on the project.

Marikay Crangle, Housing coordinator for the Arlington Mental Health Center, and Jane Burr, director of Arlington’s Homeless Services, addressed our February Advocacy meeting. Their presentation brought NAMI-Arlington members up-to-date on the staff work to develop supportive care models for the $7.5 million voted by the County Board in November for affordable housing for those with disabilities, including those with mental illnesses. Also addressing the meeting was Terry Hemming, director of Residential Services for PRS, Inc.

The County is seeking an "integration of affordable housing support services, especially for those who would otherwise not have stable housing," said Burr, noting that this could be both transitional and permanent housing. Current thinking is for the County to work with Arlington’s nonprofit housing providers – AHC and Arlington Partnership for Affordable Housing (APAH) – using the County dollars as equity for the purchase of units in perpetuity. The support services would be separate.

APAH has already developed a model program – Project Hope – that provides units for four individuals with serious mental illness, while the County provides the support services. AHC, formerly Arlington Housing Corporation, is working with the County in developing nine housing units under a $500,000 federal Shelter-Plus-Care grant.

"We want to develop a program offers choice, that uses as much natural, including peer, supports as possible and that maximizes options," Burr said. Residential stability maximizes long-term outcomes. With more choices, there is greater satisfaction with services. "Long-term stability is economically justified because fewer, more expensive resources are used," Burr said.

One focus is on independent living. Individuals would sign their own leases, which would ensure due process rights for them, but could also result in their eviction. No credit checks would be required, however. The support services would come to the individuals.

The County is also looking at group homes and clustered units that use close-by, live-in managers to develop a range of options.

Crangle, in her presentation, reviewed findings of a housing survey done in 2000 of 373 consumers, family members and staff. A critical finding was that 22 percent of the consumers surveyed reported they were homeless at least once during the previous year. "There is a lot of homelessness among consumers," Crangle said. The survey showed that 61 percent of the consumers wanted to live independently in an apartment; 19 percent of the individuals would live with a roommate. "They wanted affordable housing, close to friends, significant others and families," the same things that surveyed family members wanted, Crangle said.

"We want to develop a system that responds to the needs and wants of consumers," she concluded.

Hemming discussed PRS’ Willow Lane intensive housing program. The six-bed program is targeted towards six men with long hospitalizations and, Hemming said, "has been enormously successful. We have had no rehospitalizations."

The two-year program, funded by a federal HUD grant, also has not had any openings, although one of the men is contemplating moving to his own independent apartment and a second recently died of cancer. Hemming attributed success to the fact that PRS staff, working with discharge planners, met with the consumers for four months prior to their joining the program. Three are now employed, two of whom work up to 35 hours a week. PRS also works with the Fairfax-Falls Church Community Services Board, which provides a social worker and case managers for the men at a mental health center.

Although funded by a HUD grant, the men also pay 30 percent of their income towards their housing.

PRS did experience NIMBYism ("Not In My Back Yard") in locating the program. PRS planned to acquire the seven-bedroom house and move the men into the neighborhood without fanfare. The seller, delighted at selling the home for a good cause, told neighbors who immediately coalesced in opposition. Hemming said the relationship today is good with the neighborhood and PRS is now credited with reviving the neighborhood association. "We felt the neighborhood was the best chance to integrate the men into the community," Hemming said.

On a panel sponsored by NAMI-Northern Virginia, five panelists last January talked about their programs and how these programs served those with mental illness in the area.

The programs, financially supported by NAMI-NV, were Arlington’s Clarendon House clubhouse (through its Friends of Clarendon House nonprofit); PRS, Inc.; Pathways Homes Inc.; Laurie Mitchell Employment Center and The Job Avenue, now an offshoot, but once an integral part, of Clarendon House.

The objective of Clarendon House, said Program Director Becky Wright, is to keep the members of its psychosocial day program out of the hospital and in the Arlington community at the individuals’ highest level of functioning. "The main emphasis is to have people feel better about themselves," said Wright, who described the activities that occupy the 55 to 60 individuals who attend the program daily. The activities include pre-vocational counseling, food preparation, communications and maintaining the clubhouse. In addition, three days a week – Wednesday, Friday and Saturday – social activities are offered.

The clubhouse also offers supportive counseling, crisis intervention and support for family members.

Wright said the Arlington program is unique in several areas: It offers medication and medical services, education about medications and peer support services.

"Individuals need a lot of case management services," Wright said. She indicated that Clarendon House had a waiting list of about 20. "We try to get people in as fast as possible," she said. Members’ ages range from 23 to 67 years.

Wendy Gradison, president, described the multi-faceted programs of PRS, Inc., formerly Psychiatric Rehabilitation Services, Inc. It was founded 40 years ago as The Social Center.

PRS, Inc., located in Falls Church, operates three clubhouse programs in Fairfax County – in Reston, on Route 1 (Ingleside) and in Falls Church, serving several hundred persons. The day programs offer skill training and support with a large employment component. "We work with a client so that he or she may be able to succeed," Gradison said. Thirty percent have jobs, but PRS wants to increase that number to 50 percent.

PRS also runs Compeer, a mentoring program where volunteers are matched with individuals who have serious mental illness and provide friendship and social activities for the ill person. PRS operates an Intensive Care home for five individuals and residential support services for those who live independently in their own homes. Gradison said PRS is looking to begin a day drop-in program, which is needed in the area.

PRS funds its programs through Medicaid reimbursements, grants – including those from the Fairfax-Falls Church Community Services Board – and from private-pay clients.

Pathway Homes, Inc., started in 1980 by NAMI-Northern Virginia families, provides permanent housing and comprehensive supportive housing services in Fairfax, Prince William and Arlington counties and the City of Alexandria for about 270 persons, according to Joel McNair, president. Pathway Homes has about 400 on its waiting, with a great number waiting for 24-hour supervised housing. These include those who are homeless, at the state institutions or living with families.

Pathway services are a "drop in the bucket, but we are a drop that would be missed if we were not here," McNair said.

The lack of housing and supportive housing is the most critical unmet need, McNair said, especially for intensive services for the highest level of disabilities, such as the 36-bed assisted living facility and the DAD group home. Sixty individuals are served in 24-hour supervised accommodations. Less disabled individuals (140) can live more independently in apartments or townhouses, where staff can drop by weekly. Most individuals are in their 40s, with a range of ages from 20 to 70 years.

The nonprofit gets about one-third of its funding from Fairfax County, one-third through federal funds and one-third through state funds. Private donations also provide support.

The Laurie Mitchell Employment Center (LMEC) is a consumer-run, drop-in center that offers computer training and employment services to anyone who comes to the program. Operating both at the Alexandria offices of Service Source on evenings and Saturday, and at the PRS Ingleside clubhouse Mondays and Wednesdays from 2 to 8 p.m., LMEC seeks to empower those it works with through computer training and in helping them find and retain employment. "We are open to anyone who wants to use our Center," said Cynthia Evans, a LMEC staff member.

Also discussing employment services was Jose Campos, program manager for The Job Avenue, Arlington’s supported employment program. Those with mental illness have an unemployment rate three times that of others with disabilities, mostly due to personal fears, he said. "They are scared to lose their Social Security benefits and the governmental insurance that goes with them. They need education, empowerment and opportunities to work, and they need support once they get a job."

The Job Avenue objective, Campos said, is to place individuals with mental illness in jobs that they like. "When someone is given the opportunity to do what he or she wants to do, he or she will succeed." The Job Avenue staff provides support – someone to be there for the individual if needed.

Campos said the Arlington program has two staff members and serves 89 people, 72 of whom are employed.