Beyond Lakeshore

Finding a safe, quiet, clean place to live

Feature Story

by Kevin Crowe

No one's sane on Cinco de Mayo. The Old City was flooded with bodies yawping together in the most primitive communion. Night breeds insanity in the bars, feeding off of a singular restlessness. It's the incontrollable id of Knoxville.

The one - armed man came out of nowhere, to the corner of Jackson and Central. He was dancing, poorly, encouraged by the patio clientele of Hanna's. Earlier, after being chased away from the Urban Bar, he yelled, â“Do you smoke rock? I'm gonna go buy a rock and whoop your ass!â” The bouncer didn't give the threat a second thought. He'd heard it before.

And the cheers continued to come from Hanna's, as the man shook his stub to an odd rhythm, out of synch with the '80s tunes blasting out of the nearby dance clubs. Everyone that passed by was accosted. The one-armed man would strike a pose, holding his dirty, Styrofoam cup out in phony acquiescence. â“Can ya help an old man out?â” he'd say. Then the dance would go on.

Over time, his ego thoroughly stroked by beery crowds, he became more boisterous, spitting obscenities at anyone who didn't have any spare change. It was only a matter of time before he offended the wrong person. He went too far around midnight, when a young prep, sporting a Polo shirt and khaki shorts, took a swing at the one-armed man. Their scuffle didn't last long before two doormen came across the street from Manhattan's.

They charged full tilt, knocking the Styrofoam cup into the street. The one-armed man sat on the sidewalk for a minute, catching his breath before he began to pick up his lost money.

He was in the middle of the street, on his knees, slowly searching for any coins he could find. No cars honked. No one yelled. The night went on, as if nothing had happened. Soon he was back on his feet, cup in hand, taking on a much more subdued demeanor when he asked for change. The cheers had stopped. He passed by the large, tinted windows in front of Hanna's. He saw his reflection, shook his stub a few times to make sure everything was still in working order, and continued up Jackson Avenue toward Barley's Taproom.

The next morning, the streets were nearly empty, littered with the remains of the seething madness of the night before. A few cars passed by. Heading down Central was a middle-aged man with a thick beard, just walking and talking to himself. He'd stop, make a few gestures like a preacher might. His speech was muddled, an incomprehensible spewing of fire and brimstone. â“Hey!â” he'd say, followed by what sounded like an archaic language. His English blended seamlessly with complete nonsense. â“You know what?!â” The vicar of a mad sermon, he came to the intersection, still preaching to an invisible audience.

A personality is a full Congress of orators and pressure-groups, of children, demagogues, communists, isolationists, war-mongers, mug-wumps, grafters, log-rollers, lobbyists, Caesars and Christs, Machiavels and Judases, Tories and Promethean-revolutionaries. â" Henry Murray

e's not going to come through our doors,â” says Dr. Bruce Spangler, the chief operating officer at Volunteer Ministry Center (VMC). He's talking about the street preacher, who first showed up on Gay Street last month. â“We're too crowded, we're too loud. It's almost as if his nerve endings are on the outside.

â“We've tried to engage him, but he just won't respond. These are the people who are the hardest to reach.â”

Fifty-five percent of those living on Knoxville's streets have a mental health issue, according to a study conducted by Roger Nooe, professor emeritus in social work at UT and chairman of the 10-year Plan to End Chronic Homelessness. These are the people we see everyday. On park benches, shaking and staring at nothing in particular. On the sidewalks, talking to themselves.

â“It starts with saying that we're not going to keep doing it like we've done it before,â” Mayor Bill Haslam said when the 10-year plan was first announced, and Nooe's study found that 30 percent of discharged psych patients will be homeless within six months.

â“There are many individuals for whom it is constant, they're just so sunk,â” says Jenny Weatherstone, executive director at VMC. â“It's interesting to know that a person who is mentally ill and is recovering, what they needâ"the thing that will most help their recoveryâ"is an atmosphere that is fairly structured, that is calm. That, first of all, meets their basic needs so they can relax. And that does not describe any shelter, including ours, nor does it describe life on the streets, yet that's where so many people end up.â”

Chronic mental illness, which includes paranoids, neurotics and psychotics, continues to be a prima facie reason for homelessness. Sixty-four percent of those who actually receive treatment for their emotional and mental illnesses have been hospitalized at one point in their lives, according to Nooe's study. To put it another way, 35 percent of the entire homeless population in Knoxville has been hospitalized at some point. And, interestingly enough, 12 percent of those who have been hospitalized have been in mental health institutions 11 or more times.

â“Of the homeless in Knoxville,â” Dr. Spangler goes on, â“it's suggested that 20 percent are what we describe as chronic. I think it's the chronic homeless that we see on the streets. Those are the ones we may see as a nuisance, either a sanitary nuisance or a verbal nuisance. Those are the folks who have the most mental health issues, and to get the services for those folks is very, very hard.â”

When the push to deinstitutionalize mental institutions began to spread across the nation in the early '70s, reports indicated that nearly 65 percent of the discharged patients returned to live with their families. By 2006, however, more patients found themselves lost. Last year nearly 35 percent, with nowhere else to go, were discharged directly to the streets. Some found their way to the homeless shelters. Most find that, when their prescriptions either run out or are stolen, their mental health continues to deteriorate.

In Kentucky, chronic homelessness has become such a problem that state legislators are pushing a bill (HB376) to create a homelessness prevention pilot project. The project, if it becomes a reality, works on several levels, which includes these provisions:

⢠To ensure that discharge is voluntary;

⢠To collect information on available employment, medical, mental health and other community services in the county;

⢠To contact the homelessness prevention director about the person being discharged;

⢠To ensure that a discharge plan is not completed without written consent from the person being released;

⢠To provide appropriate housing, including but not limited to a 24-month transitional program, supportive housing, or halfway house. More importantly, the bill says that discharge to an emergency shelter (or the streets) is not appropriate.

The bill, much like the 10-year Plan here in Knoxville, suggests improving the services available to discharged patients. The plan stresses individual case management, more outreach programs and coordinated shelters and services, anything to keep people from falling through the cracks. Many will have no other option than to use the shelters as makeshift long-term housing. The shelters, like the mental institutions, are overwhelmed.

These recommendations are, according to Nooe's study, â“an important step in the right direction,â” to provide a framework that, if successful, will create a better link between the city's homeless population and community resources.

â“It's addressing what happens every day,â” Weatherstone says of the pending legislation in Kentucky, â“that people who have been hospitalized are coming out on the street, and that's not OK.â”

"One of the things VMC works very hard at, to deal with mental health on a day-to-day basis, is harm reduction, to be sure someone has a safe place at night,â” Dr. Spangler explains. â“Sometimes we're putting Band-Aids on until a new system can be readied. It's been said many times, but the issue of mental illness and the homeless is a community issue. It's not a VMC issue. We're attempting to respond to it. Once we begin talking about itâ.â”

â“What we are trying to do is provide housing,â” Weatherstone adds. â“We're in the beginning stages, so it's still on a limited basis. But we have been able to house people who we knew to be profoundly mentally ill. We've found that, once they're able to get into a small, quiet, clean place of their own, we will sometimes see a remarkable difference immediately. I attribute that to a good night's sleep. There's something that begins to happen; when we place people into housing, they have a case manager, a go-to person who stays on top of them. The success that we see comes from removing them from the environment of the street.â”

Of those who have reported prior hospitalization, Dr. Nooe concludes in his study, 39 percent had spent time at Lakeshore Mental Health Institute, East Tennessee's only state-run mental health hospital.

Weatherstone remembers one lady who came into VMC. She sat in the waiting room, pulled her legs up to her chest, and gently rocked herself in the fetal position. She chanted, as if it were a mantra, â“I miss Lakeshore, I miss Lakeshore, I miss Lakeshoreâ.â” Over and over and over.

â“In many instances,â” Weatherstone says, â“we're just putting on Band-Aids, and that's the best we can do. It really does take the community as a whole to recognize that mental illness is bigger than just the homeless populationâ. One in four Americans is mentally ill. We haveâ"here in this shelterâ"sons and daughters of extremely prominent people, the family not able to deal with the illness anymore. Mentally ill people really are the sons and daughters and brothers and sisters of all of us.â”

From the beginning, the institution set itself the task of preventing â‘mendicancy and idleness as the source of all disorders.' In fact, this was the last of the great measures that had been taken since the Renaissance to put an end to unemployment or at least to begging â. In short, all that man has been able to invent in the way of irregularities in his conduct. â" Michel Foucault, Madness and Civilization

In 1886, when the East Tennessee Asylum for the Insane first opened its doors, 100 patients were shipped in from the overcrowded asylum in Nashville. Hundreds of spectators were on hand to see these â“lunatics,â” people who lived in the modern-day equivalent of a leper colony. The asylum, a foreboding brick structure, might have seemed more like a prison than a mental health institution.

The Daily Chronicle , in anticipation of the asylum's opening, wrote: â“The asylum practically becomes a cheap side show, while each patient, with a nature probably more sensitive to his besetting weakness than one supposed to be in his right mind, is thus forced to stand and be humiliated by the heartless or thoughtless critical comments of outsiders, who simply go to the institution from the motives of idle curiosity.â”

The newspaper went on to describe these early patients in detail. â“There are many who are under treatment for some special eccentricity, and who are altogether sane on all other subjects. For instance, here is a man who labors under the delusion that he is the president of the United States. Another feels that he is the Savior, and another yet believes that he is a prophet sent into the world by the Almighty, to bring about a new millennium. All sorts of curious delusions are entertained by these poor unfortunates, whose ideas on all other subjects are just as rational as those who walk our streets day after day.â”

The institution was first called Lakeshore Mental Health Institute in 1976, but there was already a rich literary tradition that had grown up alongside the asylum. Some of Tennessee Williams' family were hospitalized at Lakeshore, and the institution most likely served as the model for his fictional â“Lions Viewâ” asylum in his one-act play Suddenly Last Summer . And a necrophiliac dies inside the asylum in Cormac McCarthy's Child of God .  

Tales of hydrotherapy, electric shock and drugs filled sensationalist newsprint. In 1970, 273 patients died while being treated at Lakeshore. There were also reports that the hospital had become a dumping ground for the elderly.

In 1971, after a midnight visit from state Rep. Richard Krieg, stories began to circulate about sordid living conditions. Papers reported rat and cockroach infestations. Nurses said they had been attacked, even stabbed, by patients.

Cars would deliver booze at night, completely undeterred by the hospital's staff, which was severely understaffed and overworked.

When an undercover reporter with the daily Knoxville Journal had herself committed in 1984, she reported that chronic patients had built up a resistance to Thorozine and Haldol. One woman, who the reporter referred to as â“Sally,â” sat in a chair and chanted:

Is this forever?

Is this forever and ever?

Is this forever and ever and ever?

â“We do not have a country club here,â” Dr. Manuel De La Rocha, director of the medical staff at Lakeshore, told the Journal . â“When people feel better, they want to leave.â”

Lakeshore continued to be the subject of media scrutiny. In the '80s, the move to privatize the hospital's operations failed miserably. The state cut funding, year after year, reducing the number of beds at Lakeshore from 2,400 in 1970 to 500 by 1989. As Jeff Zimmer of the Journal put it, â“For the 1990s, the controversy surrounding the hospital is almost ironic.â”

The current superintendent, Lee Thomas, describes his facilities as â“overutilized.â” On May 13, 1988, Alan Mallicoat was turned away even though he had severe suicidal tendencies. Hours later, the 20-year-old ended his life with a shotgun blast. A $600,000 lawsuit followed.

Budget cuts continued, and Lakeshore lost more beds. Superintendents dropped like flies. Today, the city owns 60 acres of Lakeshore's 300-acre farm, which now operates as a public park. There are currently only 180 beds at the institution. Three buildings aren't being used, and the city tore down three others, including the wings of the original, castle-like building.

Back in 1986, the News-Sentinel , in an upbeat, nearly enthusiastic tone, described the hospital's downsizing: â“In the late 1970s Lakeshore found itself with increasing numbers of patients ready for discharge, but no appropriate place for them to go. The Lakeshore staff went to the community, asking for help in setting up a boarding home program for older patients who no longer had families.â”

Still, in 2007, patients are being discharged directly into the streets. When Weatherstone first came to VMC, there was an elderly woman at the shelterâ"â“very childlike, very mentally illâ”â"who had just cashed a Social Security check. There she was, holding a thick wad of $5 bills. â“She wanted friends so badly,â” Weatherstone says. â“She just wanted to be with someone.â” She took the money around the room, asking, â“Will you be my friend?â” Each friend cost $5.

â“She had them lined up,â” Weatherstone recalls. â“Before we stopped it, she had probably gone through half her check. That was one of the saddest things I've ever seen.â”

â“Original sin is excessive goodness,â” Dr. Spangler muses.

Mental health care is in disarray,â” says Dr. Joel Hornberger, COO at Cherokee Health Systems. His words are familiar to those working in mental health care today.

John F. Kennedy issued the Mental Retardation and Community Mental Health Centers Construction Act of 1963, which began the push for deinstitutionalization and outpatient services. Then, in 1999, the Surgeon-General released a report that said, once again, mental health services are in need of an overhaul. Again, on February 1, 2001, President Bush announced The New Freedom Initiative, which echoed past reports.

All of them, written in lengthy legalese, come to the same conclusion: Mental health care is in disarray, and something needs to be done.

Hornberger says that nearly 82 percent of Americans will suffer from a diagnosable mental illness at some point in their lives. â“If you look around, if there are three other people in the room, then one of you is likely to suffer from mental illness of some kind. But what happens is people don't seek treatment. Some do, of course, but many go untreated.

â“It seems as if there are these two silos, the mental health and the medical silo. They each do their own thing. You've got the mental health arm and the medical arm.â”

Dr. Dennis Freeman, CEO at Cherokee Health, has been working with the mentally ill in Knoxville for nearly half a century. He first began seeing patients during the '60s in counties north of Oak Ridge, working in tandem with primary health care.

â“I used to go to national meetings, and people would ask about my work and would be amazed at the idea of mixing these two kinds of care. But it's now catching on everywhere. An integrated care model has a lot of interest nowâ. It's a big shift for many.â”

Cherokee Health Systems currently has more than 45,000 clients, with nearly 300,000 visits each year. â“Patients who have long-standing psychiatric illnesses,â” Dr. Freeman goes on, â“they die 25 years earlier [than a mentally sound person]. It's a public health crisis. We've known for a long time that they die early, but it's not the psychiatric illness. It's the untreated diabetes, cardiovascular problemsâ. They're very unhealthy. And in the old days, when people were hospitalized for long periods of time, they got medical care at the institute. Now, with the quick turnaround, they come back into the community, and they often don't get medical care. That's just another reason to push for an integrated approach, because often these people are not so tuned in to the need for preventive maintenance. They're sometimes, unfortunately, not welcome in the general medical sector, so that's one of the downsides....

â“We're all in the same pot, aren't we? But for the grace of God, there I go.â”

It may have been a little naÃve, when the push for deinstitutionalization first began. In Washington D.C., there's a bell at the offices of Mental Health America. It was created by melting down iron restraints that were once common in insane asylums. When the bell rings, it's supposed to be symbolic of our emancipation from mental illness, a symbol that has yet to ring true.

While the man of reason and wisdom perceives only fragmentary and all the more unnerving images of [truth] , the Fool bears it intact as an unbroken sphere: that crystal ball which for all others is empty is in his eyes filled with the density of an invisible knowledge. â" Michel Foucault

There're crazy people,â” says Rodney Fuson, who has been on the streets for nearly two years. On most nights, he can be found wandering from pub to pub, trying to sell flowers to barflies. â“You just have to deal with itâ. It's sad.â” In a strange way, he's just summed up the last 50 years of mental health care initiatives. You just have to deal with it . One way or another.

Fuson takes a seat at a bench on Market Square on this humid Saturday night, and starts to recite a poem he's been writing. His voice grows loud, drawing looks from passersby. His coarse, countrified delivery feels as though he's forcing his untrained words to sound like poetry. The result is haunting, if not sadly beautiful:

Love is like a river, flowing from the sky/ Love will hit you 'tween the eye/ Love is good, I know she would/ Love is bad, could be sad/ Love will fall from the moon, hope she comes back soon/ Love is in my life, 'cause the bitch was my ex-wife/ Love is true, now I'm blue/ Love is a story, 'cause it comes from this country, homeless boy.

His poem, like most things, is still a work in progress.


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