Safety Center Issues: Keeping the Mentally Ill Out of Harm's Way

There's a disturbing disconnect between the push for a Safety Center to divert the mentally ill and the publicly intoxicated from jail to temporary treatment, and the need for long-term supportive housing to deter the many who are homeless from becoming repeat offenders.

At a recent meeting of a Safety Center Coordinating Committee, its two prime proponents, Sheriff "J.J." Jones and District Attorney General Randy Nichols, seemed focused on quick fixes. A three-day stay for the mentally ill in a Crisis Stabilization Unit would "take them out of that psychotic event, and then we don't have to deal with them anymore," the sheriff asserted.

But especially for the estimated 40 percent of those arrested purely for bizarre behavior who are homeless, repeat offenses are the rule. Roger Nooe, the University of Tennessee professor emeritus of social work who is widely recognized to be the Knoxville area's leading authority on homelessness, has written, "Perhaps the most critical issue in breaking the cycle of incarceration of the mentally ill is finding permanent housing, consistent with the ‘housing first' orientation… If a chronically mentally ill homeless individual is able to quickly obtain stable, appropriate, permanent housing, then the issues of mental illness, chemical addictions, education, and employment become eminently more manageable. The ‘housing first' approach combines affordable, permanent housing with the support services necessary to remain in permanent housing. A lesson learned is that without the stability of permanent housing, supportive services alone will not yield sufficient results. It is equally important to realize that permanent housing alone will be equally unsuccessful if not coupled with appropriate supportive services."

"Housing First" was, of course, the watchword of the Ten-Year Plan to End Chronic Homelessness, which our city and county governments collaboratively adopted in 2006. But after some initial successes, of which the 56-unit Minvilla Manor on Broadway and the 48-unit Flenniken Landing in South Knoxville were most notable, further implementation of the plan got stonewalled by neighborhood opposition to any more such housing in any other part of town. And, as such, the plan has been interred.

City Mayor Madeline Rogero held out hope for a revival when she announced last spring the formation of a Mayor's Roundtable on Homelessness to prepare "a stakeholder-driven, comprehensive community plan to address homelessness." Any list of stakeholders has to start with the Volunteer Ministry Center, which runs Minvilla and also provides case management services to Flenniken residents. But while she believes a great deal more is urgently need, not even VMC's usually buoyant CEO Ginny Weatherstone is optimistic about the prospects for any more large-scale supportive housing any time soon.

The city's Chief Policy Officer Bill Lyons reports that "We're still working on the homelessness report—it's near done, but not quite done." He goes on to say that "As time goes by and folks can see that Minvilla and Flenniken are not negatives at all to their neighborhoods, that on the contrary there are no problems associated with them and that they help people, then we can get toward a climate of a lot more acceptance and can revisit the concept of more supportive housing at some point in the future."

For the nonce, the prospect of a Safety Center is undeniably the something that's better than nothing. While an RFP selection process is contemplated, it's taken as a given that the facility would be operated by the Helen Ross McNabb Center, the community's foremost provider of mental health services and also substance abuse treatment for the most unfortunate.

As envisioned by McNabb's CEO Andy Black, the Safety Center would consist of a 15-bed "sobering station" for intoxicants, co-located with a 15-bed Crisis Stabilization Unit that would do just what its name implies for the psychotic. Anyone arrested for these offenses—and these offenses only—would have to consent to be placed in the safety center for up to 72 hours rather than go to jail. Upon release, the mentally ill would be furnished with a treatment plan, including medications and referral to a McNabb or other provider of outpatient care.

By relocating its existing CSU with the sobering station in a building McNabb has just acquired adjacent to its Center Pointe Addiction Services facility on Ball Camp Pike, Black foresees being able to double the size of a Medically Monitored Detoxification Unit from six beds to 12, and also expand McNabb's residential alcohol and drug rehabilitation program for which there is presently a long waiting list.

In a lower profile way than VMC, McNabb is also a significant provider of supportive housing for the formerly homeless with 88 units spread among 11 locations. As with VMC's, these are for individuals who can live somewhat independently with oversight by a case manager.

Black and Weatherstone agree that the most pressing challenge is to address the needs of the more acutely ill who aren't capable of maintaining a residence on their own, but are dubiously deemed ineligible for institutional care even though most of them have a history of hospitalization.

A state-funded McNabb program called PACT provides intensive outpatient services to 100 such individuals in what Black calls "a hospital without walls." But it's also a hospital without a roof, and some of its patients drift.

Augmentation and expansion of the PACT program may be the best single hope for breaking the cycle of incarceration that Nooe speaks to so poignantly. But space constraints dictate that these possibilities be addressed in a separate column.