"Musings" by Liz Rebensdorf, President NAMI East Bay

The public image of those with mental illness is too often one of erratic, sometimes violent behavior in the persona of a scruffy individual who is noisy and unpredictable. My guess is that this individual is either not taking prescribed medication or is a person dealing with serious substance abuse issues - or both.

Untreated, people living with SMI experience distortions in thinking and perception and they are often unable to engage in logical thinking, self insight and the ability to differentiate reality and fantasy. This is an illness, not a life choice nor a by-product of character flaws or upbringing. We don’t know how to cure it, but we do know how to stabilize the symptoms.

It is important to know that there is a large community of persons with SMI who are able to hold jobs, raise families, have social interactions...essentially live a stable life. They take their medications, perhaps engage in therapy and take care of themselves. Among this group are activist individuals, also with a diagnosis (current jargon identifies them as "consumers", "peers" or "individuals with lived experience") who are actively engaged in self-care, group activities and advocacy for services. Often, their efforts are geared towards supporting others by modeling coping skills. Housing choice is most often to live independently.

There is yet another community of people with SMI, the ones I hear about most often. These are the quiet individuals "in the back bedroom". Carrying a diagnosis of SMI, they are the sufferers having an internal struggle with their own brain function. Sometimes they live with family members and sometimes they reside in a Board and Care facility. Medication compliance may be high but lifestyle engagement is low. At the risk of over-generalizing, I’d describe these sons/daughters as passive, isolated, lonely, and unengaged socially and vocationally. They are often preoccupied with internal machinations. And, their realization that other people their age are moving on is a poignant one, sometime resulting in irritability and upset, more often sadness. These are not the lives they anticipated when they were young and wondering what life would hold for them. Caring families suffer in the loss of the essential child they raised and for whom they had dreams.

As we face the crisis of homelessness, we need to understand that an estimated 40 percent of people living on the street have a SMI. Stable, permanent supportive housing is the crucial thing they need to achieve stability. Traditional housing without long term support will not work for them.

One of the main types of housing that can work for people with SMI are licensed Board and Care homes, where housing, meals and medication support are provided. Yet the number of those homes is drastically declining. Inadequate government reimbursement has simply made many of them financially unsustainable in the Bay Area. Skyrocketing housing prices mean that as operators "age out", they can sell or rent their property for multiple times more money.

We must stem this current rush to closure and ensure reimbursement adequate to feed and support individuals who can live stable lives in permanent supportive housing. Operators need a professional network and support. This is a statewide problem and calls for a state solution and state funding.

Without urgent action, there will be more seriously mentally ill persons "living" on our streets. As an aging mother, I am fearful of what will happen to my son if the housing options that have helped stabilize his life keep closing down. I am not alone. Families across California live with the same anxiety. We know what can be done. The question is whether there is a will to do it.