Cascadia Housing: not always for healing

From the Portland Tribune, May 24, 2012

Eric Hossack is trying to regain the inner strength to live on his own again, and cope with a mental illness that led him to heroin addiction, homelessness and multiple suicide attempts.

But recovery isn’t so easy living at Harriet Court.

Sean M., a resident at Cascadia Housing's Harriet Court apartments for mentally ill tenants, in Southeast Portland, says fellow residents are running wild, with minimal oversight from Cascadia since Nancy Wagoner (right) left her post with the mental health nonprofit last fall.

Sean M., a resident at Cascadia Housing's Harriet Court apartments for mentally ill tenants, in Southeast Portland, says fellow residents are running wild, with minimal oversight from Cascadia since Nancy Wagoner (right) left her post with the mental health nonprofit last fall.

The 16-unit apartment building near Southeast Portland’s Mt. Scott Community Center is reserved for mentally ill tenants who are transitioning to independent living. It’s one of 20 such apartment buildings in the county operated by Cascadia Housing, and one of two where the mental health nonprofit places sex offenders.

Hossack, who has borderline personality disorder but is not a sex offender, says nobody told him before he moved in that four sex offenders were living at Harriet Court. He installed a camera outside his dorm room to guard against a neighbor who he says is a rapist and a crackhead.

“People are going off their meds to the point where they are going crazy,” says Harriet Court resident P. Dawson, who is bipolar with post-traumatic stress disorder and personality disorder. Dawson estimates there are five drug addicts at Harriet Court — at least two of them openly selling illegal drugs — making her often scared to leave her room.

Fistfights and shouting matches are common in the hallways, says Sean M., who calls himself a high-functioning schizoaffective. “A lot of these people just kind of run wild,” he says.

The three residents say Cascadia Housing, an arm of mental health nonprofit Cascadia Behavioral Healthcare, has sharply reduced staff visits to Harriet Court since last fall, largely leaving tenants to manage themselves.

Come nighttime, Harriet Court can seem like “Lord of the Flies” meets “One Flew over the Cuckoo’s Nest.”

Cascadia officials say they lack funding to hire social workers or mental health professionals to make regular visits to Harriet Court and 10 of its other properties for mentally ill people living independently, which collectively house 130 tenants.

The dearth of residential services for these people on the bumpy road to recovery is just one of many holes in Oregon’s tattered mental health system.

To stretch its funds, Cascadia is relying more on its apartment property managers to address issues involving mentally ill tenants, says Jim Hlava, vice president of Cascadia Housing.

Hlava says he’d like to have a full-time mental health professional who could be a floater to visit the underserved sites and serve as “kind of a safety net.”

But Cascadia doesn’t have the money.

Hlava says he recently asked a property manager at another Cascadia apartment building to drop by regularly at Harriet Court, and he’s trying to do the same at other underserved properties.

Off-site services not enough

Eric Hossack, a mentally ill tenant at Harriet Court, says recovery is harder when illegal drug use, prostitution and violent behavior by fellow residents is tolerated at the Cascadia Housing project.

Eric Hossack, a mentally ill tenant at Harriet Court, says recovery is harder when illegal drug use, prostitution and violent behavior by fellow residents is tolerated at the Cascadia Housing project.

Nancy Wagoner, a former Cascadia case manager and alcohol and drug counselor, used to visit Harriet Court a few times a week to check in on tenants, along with other Cascadia properties. Wagoner, who left her post last September, says the nonprofit has since eliminated the service she provided, though she deems it critical.

“It’s setting people up for failure if you don’t provide the support,” Wagoner says.

Cascadia tenants in independent apartment units still can visit doctors or mental health clinics in the community. But a lot of mentally ill people are prone to stop taking their meds or halt visits to therapists, Wagoner says, which can send them into a tailspin. “They can’t get it together to get to a clinic, so it’s much easier to go to where they live,” Wagoner says. “If someone’s coming there regularly, they’re going to notice.”

With little on-site supervision, Wagoner says, less-assertive residents — many of them recovering drug addicts — can fall prey to drug dealers, addicts or other aggressive residents in their midst.

Jason Renaud, long-time mental health advocate with the Mental Health Association of Portland, says well-managed apartments for mentally ill tenants often are more civil than regular apartment buildings. But “buildings go bad” sometimes, says Renaud, who worked for Cascadia a decade ago. “There are times when management needs to be turned over, and there are times when resources need to be applied to get them back to civility.”

Cascadia houses 594 mentally ill people in 43 facilities. Those include: locked treatment centers; less-restrictive state-licensed facilities offering on-site mental health care; supported housing, which offers fewer on-site services; and independent housing, the final transition before people, ideally, move on their own.

By law, Cascadia can’t force the 321 people in its 20 independent living apartments to seek therapy or take prescribed medicines, Hlava says, and it’s not required to provide them any on-site human services.

Housing mentally ill people in independent living apartments is cost-effective and a good model for transitioning them to the outside world, says Bob Joondeph, executive director of Disability Rights Oregon. But the model works best when residents retain individualized treatment plans and feel physically secure where they live, Joondeph says.

Providing housing for such people, absent other services, is far better than allowing them to become homeless, he says.

But some might benefit from residential professional services, he says.

State of neglect

Lori Bouferrache, a mentally ill tenant at Cascadia's Lone Pine Apartments in Gresham's Rockwood neighborhood, says some tenants need more oversight where they live.

Lori Bouferrache, a mentally ill tenant at Cascadia's Lone Pine Apartments in Gresham's Rockwood neighborhood, says some tenants need more oversight where they live.

Wagoner recently paid visits, with a reporter, to tenants in three Cascadia properties, and several greeted her like a long-lost friend, saying they haven’t heard much from Cascadia since she stopped making the rounds eight months ago.

Harriet Court has been neglected since she left, Hossack says, and hasn’t been cleaned regularly.

Hossack, who says he’s been off heroin for nine years, says his neighbor had a hooker at his room on April 14. “You could smell the crank coming out of his room,” he says. Hossack says he’s contacted Cascadia, but “they don’t call you back any more.”

Dawson says she’s only seen the new Cascadia property manager twice in seven months, and didn’t get a satisfactory response when Dawson complained about all the “mayhem” at Harriet Court. “She said, ‘I’m not trained in mental health, so I can’t help you with your problems,’ ” Dawson says.

Harriet Court has become a “party place,” Dawson says. “It was a lot better when we had a manager who came here on a regular basis.”

Sean M. concurs. “I don’t see them unless there’s a serious problem. In typical Cascadia fashion, they sweep things under the rug.”

Relying on property managers

Hlava says his property managers have been regularly visiting Harriet Court and other independent housing, but residents may not be aware of their presence or efforts to weed out problems.

Cascadia recognizes the benefit of sending trained professionals to visit tenants at its independent apartments, and patches together different approaches depending on available funding, Hlava says.

The agency obtained outside grants to pay for the equivalent of 2.5 residential service coordinators, who spend about 10 hours a week each at nine of Cascadia’s independent living apartments, Hlava says.

“Their job is to help people connect to needed resources in the community and to problem-solve them to be good tenants,” Hlava says.

At six other Cascadia independent housing apartments, the agency collects enough rent to have live-in property managers, who function much like regular apartment managers. Cascadia gives them a discount on their rent to oversee the properties, and hopes they’ll identify problems emerging with tenants, Hlava says.

Harriet Court is the largest of Cascadia’s five independent housing apartments that don’t have either on-site property managers or regular visits from people with human services training.

Hlava says all his property managers are compassionate people. However, they may be gone much of the time at work or elsewhere, and paid to be on site for only a limited number of hours each week. It’s unclear if property managers are equipped to deal with the unique needs of the mentally ill, many of whom have histories of substance abuse or criminality.

At Cascadia’s 17-unit Lone Pine Apartments in Gresham’s Rockwood neighborhood, there’s one tenant “who needs help really bad,” says Lori Bouferrache, a resident who is bipolar and has depression, panic attacks, and hears voices. She says the elderly man doesn’t appear to bathe or ever clean his room, which emits a pungent odor into the hallway when his door is opened. Paramedics recently called to his room refused to enter because there was so much trash on the floor, and Bouferrache says she had to help get him dressed and into his wheelchair.

“If we had people checking on these people, there wouldn’t be that,” she says.

Leland Hale, a retired Cascadia maintenance worker who has lived at Lone Pine since 1995, says Cascadia’s attitude toward residents has changed. “They always seemed to care more about the clients,” Hale says. “Today it just seems like it’s about money.”

His wife, the on-site property manager, hasn’t even met Cascadia’s asset manager named to replace Wagoner last fall, Hale says.

Wagoner says she often lobbied Cascadia managers to provide more residential services. She recalls showing them evidence that Cascadia was violating a management agreement with the state agency that funded one of its buildings and obligated Cascadia to provide on-site services. The building is the 31-unit Lafayette Court apartments near Powell Boulevard and Southeast 87th Avenue.

Karen Tolvstad, policy and communications manager for the Oregon Housing and Community Services Department, confirmed that a 1991 management agreement required on-site services. “They have to provide psychiatric rehabilitation services to their residents,” Tolvstad says.

Hlava says he doesn’t recall any such meetings, and that Lafayette Court tenants can obtain services as needed at community-based clinics.

Following the money

Oregon’s mental health funding woes led to Cascadia’s founding a decade ago, as a super-sized agency formed from the merger of several financially strapped programs. By 2008, it was the dominant mental health provider in Multnomah County, with 23,000 clients and a $60 million budget.

It nearly went bankrupt that year and was bailed out by the state and county, with some programs parceled off to healthier nonprofits. Now Cascadia has a $42 million budget and serves 12,000 clients a year, providing mental health clinics, group and individual counseling, outpatient services, and housing.

Before the 2008 financial implosion, Cascadia had a different approach to housing management, Hlava says. It employed people with human services backgrounds, like Wagoner, to regularly check in with residents in a portfolio of properties. During the meltdown it became clear the nonprofit was lax about maintaining its buildings and complying with federal, state and local regulatory agencies, Hlava says.

“Not getting that stuff done put us on ‘watch lists’ by our regulators and our bankers,” says Hlava, who moved over from the human services side four years ago to manage Cascadia Housing.

He began hiring professional real estate asset managers to oversee the properties. Hlava says he hopes to inculcate skills among those asset managers to work well with the mentally ill when they make site visits.

Now the properties are in better shape physically and financially, he says, and Cascadia Housing is in compliance with regulations.

Recent visits to three Cascadia properties showed all were attractively landscaped and well-maintained structurally.

Many Cascadia tenants are doing “fabulously” without any on-site services, Hlava says, which he sees as evidence the independent housing model is working. “People do find ways to take care of themselves,” he says.

But he acknowledges that funding is the reason tenants in some independent living units get residential services from social workers while others get little to none.

In today’s arcane, underfunded world, mental health services are provided where grants or other government funding is available. Lafayette Court once offered regular group therapy sessions on site. But Medicaid stopped reimbursing for that, Hlava says, so the program ended. When that site opened in the 1990s, there was a full-time staffer on site. Residents could buy into a low-cost meal program on site, and were taken on trips to the grocery store. Other facilities had half-time staff.

Those on-site staff are long gone, Hlava says, and that was a different era for mental health funding.