Role of Maine shelters in flux No longer just for the ‘homeless,’ facilities serve the mentally ill and addicted

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BANGOR – Dennis Marble, executive director of the Bangor Area Homeless Shelter, describes the work he and his counterparts are doing this way:

“You know, it’s kind of like being in a little old boat. It’s full and it’s constantly shuttling between two ports. It only ties up to load and unload. It needs paint and you can hear the little motor. The cracks are starting to form and the water’s up over the waterline.

“That’s how full it is, and no one is standing on the dock with a hundred grand to repair the boat – and you can’t stop what you’re doing because the people need to get in and off. That’s about what it is.”

When Marble took the helm of the Bangor homeless shelter 11 years ago, the average stay for residents was about eight nights. Today, he said, it is more than a month.

“We’ve basically been full for the last two years,” he said. “We’re right around capacity every night. We have added three cots to an evening lounge for the winter just to try to take on three more.”

The shelter, which today has 33 beds plus the three temporary cots, opened 20 years ago on Christmas Eve. It originally had 10 beds and provided services to both families and individuals, who stayed overnight only. It since has evolved into an around-the-clock operation, with a dozen paid staff members, Marble said.

The population it serves also has changed. Though it also houses people with temporary problems connected with being homeless, the Bangor shelter now primarily houses people with a range of mental and physical health problems coupled with extreme poverty, who make up about 75 percent of those staying there at any given time.

Some stay for up to a month, or until they qualify for less temporary assistance. Others have stayed several months, or, as in the case of one 70-year-old woman with leukemia and mental health issues, as long as four years.

For safety and security reasons, the Bangor shelter allows only adults to remain there. Homeless families must go to other organizations, including the state Department of Health and Human Services, municipal general assistance programs and family-friendly shelters, for emergency shelter.

A broken system

In a recent interview in Marble’s small corner office on the ground floor of the shelter, a three-story brick structure at the corner of Main and Cedar streets, he said Maine’s homeless shelters like the one in Bangor increasingly have become default housing facilities for people who, ideally, should be in medical or supportive housing environments – people with mental illness, chronic drug or alcohol addictions, and in some cases both.

“The reason this is happening is because of this public policy and the lack of appropriate affordable housing – and underline ‘appropriate,'” Marble said. “Appropriate may mean, in some instances, a medical clinic, a counselor, life skills. It might just mean a friend, company. Somebody to rock on the front porch with. It’s up to the needs of the individual. We can design different things.”

When the trend to dismantle the old state mental hospitals began in the 1970s, the expectation was that patients would make a transition from institutions to community-based programs. Deinstitutionalization was supposed to result in the more humane and liberal treatment of mental illness in community-based settings. But in many cases, it proved an idealistic notion that fell victim to politics and budgets. The programs for the most part did not follow.

Out on the streets, people with mental illness and addiction problems are guaranteed neither a home, food, health nor safety.

Unintended consequences

As Marble and many others see it, the morphing of the homeless shelter into what Marble calls an “underfunded mental health facility” is one of the unintended consequences of the “downsizing” of the state’s mental health institutions, including Bangor Mental Health Institute, now known as the Dorothea Dix Psychiatric Center.

A major complaint of the critics of deinstitutionalization was that adequate community resources were not put into place to support patients after their release. As a result, many did and still do wind up in homeless shelters or jails, which are increasingly hard-pressed to house them adequately.

“I look at some of the folks who come here and it’s pure and simple – they can’t [fend for themselves],” Marble said. “And for me to say the right thing for them is to live their lives in this shelter and that’s their choice? That ends up ringing hollow really fast.”

Redefining the problem

According to Marble, his own epiphany about “homelessness” came about a year ago.

“I started wondering about the word ‘homeless,’ and the conclusion I came to was that these folks are not coming to us predominantly homeless. They come here very poor and with major disabilities, and as a result we, by public policy, make them homeless.

“We put them in positions in which they can’t maintain their own housing and we call them homeless,” he said. “And we as a society expect that, for the most part, private nonprofits will then take care of them because they’re homeless.

“If we instead looked at these folks and said, ‘This is a health care issue,’ for example, I don’t think we would have places like this shelter all over the state taking care of these folks,” he said.

“If we get accurate with our descriptors, logical answers may follow, but we have to hold our system accountable to do that work,” he said.

“If that expectation didn’t exist, if we didn’t expect that government had a role in taking care of people who are vulnerable, then this wouldn’t be an issue,” Marble said. “But we do live in that system. We expect that kids at risk, that victims of domestic violence, that elderly people with Alzheimer’s, are needing our help and that the state has a delivery system and responsibility in that.

“I think the state has completely dropped the ball,” he said, adding that the federal government has done so as well.

Marble notes that most European countries don’t have homelessness like that found in the United States.

“They, by public policy, impose more taxes on their citizens and provide more services through those taxes, be it job training, universal health coverage, be it subsidies for public transportation,” he said.”They don’t have homeless people. They’re put in housing or they’re put in hospitals. They’re not left to be on the streets or need a private nonprofit or be in a jail or in a hospital [emergency room] by policy, kind of like we do with people with mental retardation in this society,” he said, adding, “You don’t see folks with [mental retardation] running all over the streets. We have said that’s a disability we need to take care of.”

High cost of homelessness

Only 27 percent of the Bangor shelter’s nearly $500,000 annual budget comes from state and federal sources. The shelter has to raise the balance locally, often through charitable donations from residents and businesses.

“This is not about local situational homelessness, so asking the private world, local citizens, the local community to support it is a misuse of funds. It’s an aberrant public policy. Because part of this whole little, stupid, wrong setup that we’ve got is an unfunded local mandate,” he said. “It basically says, in terms of dollars, the state and feds aren’t gonna do it so you, the local community that has a shelter within it, has to.

“I would be OK with that if this facility were about a local situational need,” he said. “If this was about citizens of the Bangor area in temporary housing crisis, that would be an OK model. We [would] locally reach out to each other and take care of this.”

Stating the problem another way, Marble said that a typical three-day crisis involving a homeless person with mental illness might happen like this: It can start with a police call, move on to an emergency room evaluation, and end with a short stay in an acute psychiatric bed before the person is discharged back into the community to begin the cycle anew.

“You’re probably spending around $5,000 for three days. That same $5,000 would buy a lot of housing and stability. It would be a lot more than three days.

“I don’t want to be a part of this kind of system. I don’t think most people want to be a part of this kind of system,” he said. “I think we’d all like to do better.”

A better approach

“If we could develop an alternative to shelters, with appropriate services and support, we might head off a lot of this recidivistic and high-end health care need,” Marble said. “It’s no more expensive to provide stable housing with preventive medical care than to keep people at risk in shelters with emergency care. It doesn’t cost more money to do the right thing. We might even save a couple dollars. The savings aren’t huge, but we’re going to get more mileage out of that than pumping money into this Band-Aid.

“I think all we need to do is look accurately and simply at what is going on,” Marble said. “I don’t think it takes rocket science. If we have a democratic republic with an expectation that part of the reason for the existence of government is to take care of our people most at risk through some kind of a safety net that exists, then I think it’s up to ‘we, the people’ to hold our government accountable to that expectation.”

The solution need not be complicated, Marble said. He would begin by bringing together policymakers, housing providers and the medical community and ask them: “If you could, how would you change the delivery of care to these people that you’re seeing in and out of crisis? What would they need? How do you make that work? And then you just pair that with the housing.”