The snow swirled around an old woman wrapped in a thick gray blanket sprawled on the sidewalk near the United Nations. The silver rings on her hand and the studs on her embroidered denim shirt shimmered in the cold night air.
A psychiatrist, a psychologist and a social worker from Project Help, the city's program to hospitalize the mentally ill homeless, approached her. "Are you warm enough?" the psychiatrist, Vladmir Milstein, asked gently. "Are you get-ting enough to eat?"
"Leave me alone!" shrieked the woman, waving her arms and shaking a lit cigarette in her hand. "I'm not deaf, dumb or blind! I don't need your help! I can take care of myself!"
The team moved on. The woman was diagnosed as a paranoid schizophrenic, but she wasn't ill enough to admit to Bellevue Hospital's psychiatric ward. She wasn't hurting anyone. She wasn't close to freezing. In clinical language, she was "adaptive," and "not a threat to herself or others" - not eligible, therefore, for admission to the city's overburdened psychiatric wards.
Three years after former Mayor Edward I. Koch launched Project Help with the hope of getting the mentally ill homeless off the streets, experts say their plight is as bad as ever. The Coalition for the Homeless estimates that 40,000 people, about one-quarter of whom are mentally ill, live on the streets, in subways, parks and abandoned buildings. "It's getting worse," said Mary Brosnahan, director of the coalition.
Many of the people served by Project Help, program officials say, are in a revolving door, treated for an acute ill-ness, then released to inadequate housing, then onto the streets again until they are picked up once more. Sometimes, the Project Help team monitors them for weeks or months on the street, helpless to take them to the hospital until their con-dition becomes dire.
The problem, said Sam Tsemberis, a clinical psychologist and director of Project Help, is not an excess of civil lib-erties but a shortage of housing.
"The problem is not that you can't bring them in," Tsemberis said as his team began its rounds at Grand Central Terminal on Thursday night. "The problem is there are basically no services when you bring them in.
"It's not because of deinstitutionalization," he said. "That's a complete myth. Deinstitutionalization began in 1955. In 1965 you didn't have homeless people; in 1975 you didn't have homeless people. Homelessness was created in 1980 when Ronald Reagan cut public housing programs."
The woman who now sleeps on the heating vent outside the United Nations once worked as a post office clerk and a machine operator, her state hospital records show. She had a history of mental problems, and her children were placed in foster care in the mid-1970s. But she managed to live on her own in a room in Manhattan until 1981 when she was forced out, apparently by a fire. Her records show she was unable to pay the rent at another room that she managed to find.
Since then, she's been hospitalized several times at Bellevue and at Creedmoor Psychiatric Center in Queens. Last year, she was picked up by Project Help, admitted to Bellevue, transferred to Creedmoor, and discharged to Seaview Manor, a group home in Queens that a state watchdog group has attacked for unsanitary conditions. Within a few days, she ran away from Seaview Manor, and has been living on the streets since. She still receives about $ 400 a month in federal disability insurance.
"What does she want?" said Denise Francois, an intensive case manager at Creedmoor who released details of the woman's history on the condition that she not be identified. "Her freedom. Not to be told what to do."
Francois and Tsemberis believe the woman could get by on her own in an apartment, despite her mental problems, if she only had the money. It would take about $ 400 a month alone to pay for a hotel room in the city.
At Grand Central Terminal, a crackling message came over the walkie-talkie that Sgt. Michael Euell, head of the Transit Authority's homeless outreach team, held in his hand: an intoxicated man was being ejected from the subway at Penn Station for urinating on the platform.
It was 10 p.m. Thursday, snowing hard, and below freezing. In years past, the Transit Authority would have al-lowed the drunk to sleep it off on the subway; no one was ejected when the temperature dropped below 32 degrees.
But this year, TA police are rigorously enforcing rules against begging, urinating or lying down on subway plat-forms or in cars. And, for the first time, TA police are ejecting violators, even when the temperature drops below freez-ing.
Euell drove to Penn Station to supervise the transfer of the man to the shelter. Three police officers escorted him to a Transit Authority bus waiting outside, and he was driven to the Bedford-Atlantic Shelter, a city shelter for 1,000 men in Brooklyn.
Despite the threat of eviction, few accept the offer of rides to the shelter. Lt. John Romero, director of the TA po-lice's homeless outreach team, says less than one-third of the homeless contacted each night by social workers from the Human Resources Admininstration and police officers agree to get on the buses.
Romero says the homeless are reluctant to accept the rules of the shelters, the curfews, the early wake-up calls, the restrictions on use of drugs and alcohol. Advocates say many fear violence in the shelters, and, while acknowledging that security has improved in the past six months, claim that serious assaults and petty thefts are still commonplace.
For commuters, the new regulations mean the trains and stations will be cleaner, fewer seats will be taken up by people stretched out sleeping, and fewer panhandlers will wander up and down the cars. But Tsemberis worries what will happen to the homeless who move into spots that are more dangerous than the stations and trains: tunnels, aban-doned buildings and the nooks and crannies of the stations.
"The stakes are higher this year," said Tsemberis as he continued his rounds at Grand Central. "All the transporta-tion terminals have taken really serious steps to enforce passive laws - no loitering, no urinating, no sitting down. A lot of the people we used to see in the terminals are on the streets now, or hidden."
Milstein, the psychiatrist, told Tsemberis they'd found their first patient of the evening. "He looks awful," Milstein said. "He has feces all over him. He's covered with urine. He's barefoot."
The man was willing to go to Bellevue, Milstein said; even if he had not been, he was ill enough to be committed involuntarily. The man, shuffling slowly, dressed in a thin, tattered jacket, was accompanied to a van waiting outside and driven to Bellevue.
"The sad thing is, two months from now, he's going to be back on the streets," Milstein said.
Courtesy of Newsday
December 30, 1990, Sunday
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