By Kartar Diamond
My son has been evicted from nine board and care homes, a dual diagnosis center, and a couple of sober living houses. This is not unusual for a man in his twenties with schizophrenia. In some instances, he was evicted for causing property damage. He used to punch holes in the walls, and when asked why, he would blame the wall! He told me that the drywall was flimsy and thin.
So, who do I blame here? Do I blame the wall? The board and care? My son? The way I raised him?
I must blame the system. The system does not provide what our loved ones with schizophrenia need. It promised my son would have a roof over his head and be cared for, and it broke its promises, again and again, in so many ways. Because of their illnesses, our loved ones are not able to hold the system accountable and demand what they need. We family members beg the system for what turns out to be intermittent, barely adequate housing, where any brief crisis in our loved ones’ illness is enough to cause eviction.
I can only speak about our experiences in Los Angeles County, California. But I assume that the licensed (and unlicensed) housing challenges are similar across the nation. I am in the paradoxical position of wanting more board and care homes—licensed supportive housing specifically for people with serious mental illness—to be built in my county. Even though the reality of living in a board and care with a serious mental illness is pretty grim, the alternative for people with a brain illness is usually the street or jail.
Our Odyssey from One Short-Term Roof to Another
We first tried the sober living house option because therapists said my son should live with higher functioning people. Unfortunately, the owners and managers of the sober living houses were not educated or well-equipped to handle mental illness; they were trained to manage addiction matters. So my son did not stay there long.
We also tried a dual diagnosis facility, a name that implies that they cater to both mental illness and drug addiction, a common co-occurrence. In our case, the facility failed my son in both categories. Instead of giving him an eviction notice of thirty days, or even a few days, they ordered him to get out of his home in ten minutes. What they did to him was clearly an overreaction and illegal, and it propelled him into a period of homelessness.
Our only other option was a board and care.
What Is a Board and Care?
A board and care in California is a licensed facility specifically for those with mental illness. Let’s be honest: No person of sound mind would choose to live in a board and care. Some are better than others, but few have a wholesome, cozy, homey vibe. Most are not in particularly safe neighborhoods, and most are within walking distance of liquor stores and drug dealers.
In your average board and care, a person shares a bedroom in a noisy, dilapidated building with old furniture. There may even be bedbugs. My son lived at board and care homes with anywhere from fifteen to one-hundred-thirty people; occupancy numbers did not seem to correlate with the quality of care. Often, at least a few residents are actively unstable, behaving in psychotic and concerning ways that need professional attention. Unfortunately, many board and care homes employ people at minimum wage with no obvious training in mental health care.
Residents may go for weeks or months without showering, changing their clothes, or brushing their teeth. Staff will ignore serious lapses in basic personal hygiene and well-being. The only ill people spared from this neglect are those with actively involved family members.
Some board and care homes do not feel safe. Even if the building has locks for every room and surveillance cameras everywhere, your loved one cannot be sure their personal possessions will not be stolen. You cannot even be 100 percent sure that your loved one will not be assaulted by other residents—or worse, by staff members.
Very few board and care homes offer features or services that are genuinely therapeutic. Some offer recreational activities, but most residents don’t participate and little is done to motivate them. Lack of motivation is a common sign of schizophrenia. Many of those with schizophrenia don’t even enjoy watching television. Board and care homes are better than homelessness, but they are just about “warehousing people,” to quote one of the psychiatrists I was commiserating with one day. They are not about treating or curing people. This can be terribly disappointing for a parent to realize.
What’s on the Menu and Who Can Complain
Well-meaning people suggest that schizophrenia can be cured with a superlative diet and nutriceuticals. While this hope seems unrealistic, nutrition is very important to cognitive function, physical health, and moods. The sad fact is that board and care homes cannot afford to always serve fresh, nutritious food, even if they want to.
Your three meals and two snacks per day are generally not particularly healthy or tasty. Board and care homes buy in bulk and probably shop at Food Banks as well.
One memorable day, my son called me to say that he needed me to place $10 on his debit card so that he could take himself out to lunch. That day he was given a half-frozen, half-burned TV dinner for lunch, which was inedible.
I had to call the board and care to confirm this was really the case. As a parent of a man with schizophrenia, I am never 100 percent sure if my son is willfully lying to me or having a delusion. The board and care quickly confirmed that they had a “problem” in their kitchen that day and served residents frozen and burned TV dinners for lunch.
This kind of event shows how powerless our family members are to demand quality care. A non-mentally ill person would create a scene if they received such disrespect in a restaurant, and management would apologize. But if a mentally ill person expresses anger, staff may well ignore the person’s outrage, even when it’s justified, and chalk it up to their mental illness.
The Ideal Board and Care Would Offer Support and Services
For a person with serious mental illness to stand any chance of recovering or gaining more functionality, they need all kinds of support and services from family members and mental health professionals. But the costs involved are too much for many families to bear. Depending on a number of other influences, living in a board and care can make a person more, instead of less, symptomatic.
Board and care homes cannot evict people who don’t take their medication. If residents refuse medication, the staff can only wait and see if they become psychotic enough to qualify as being dangerous to themselves or others. After this legal/medical distinction is met, they can call the police or case managers and have them placed on involuntary holds at hospitals. This is often the board and care home’s ticket to eviction.
The Paradox: We Desperately Need More Board and Care Homes
Board and care homes in California are closing at alarming rates because they run at a deficit. Exact statewide rates of closure are unavailable, but the beds are rapidly disappearing. Los Angeles County alone lost 949 beds between January 2016 and May 2019, according to August 2019 figures from that County's Department of Mental Health. Since 2012, San Francisco County has lost more than a third of its board and care homes serving people under age sixty. A 2018 study by individuals working with the Los Angeles County Department of Mental Health and the Los Angeles County Board of Supervisors revealed that many board and care homes in the county need a budget twice the one they work with to just break even. Board and care homes accept as full payment $1,000 per month with many residents using their entire Supplemental Security Income (SSI) benefits to pay for their room and board. I think it costs more per day to put your dog in a kennel. Who in their right mind would open a new board and care with that kind of business model? This is a real crisis for people with mental illness who cannot live on their own or at home with relatives, and who need constant supervision.
With the recent closings, an increasing number of unlicensed group homes have cropped up that have all the above flaws and more, and do not answer to any regulators. They can provide or withhold whatever services they want. This is a step in the wrong direction.
While board and care homes are severely lacking in what they offer residents, we actually need more of them, not fewer, to prevent more homelessness among the mentally ill population. An estimated 25 percent of the homeless population has serious mental illness in the United States, and among those who are chronically homeless, the rate may be as high as 33 percent to more than 50 percent in some areas. We know that it costs less to properly provide care for people with serious mental illness than to allow them to succumb to the revolving doors of hospitalization, incarceration, homelessness, and legal services required when they aren’t provided the very basics to live safely and stabilize their mental illness. I often grieve over how much worse the situation will get before it gets better, if it ever does.
State or federal benefits like SSI should be greatly increased or supplemented to subsidize stays in licensed board and care homes, or government and nonprofits need to build licensed housing specifically for the care of people with serious mental illness, or both. Residential drug rehabilitation facilities, unlicensed group homes, sober living facilities, independent apartments, and mixed housing don’t do enough to move people with serious mental illness off the street and out of jail.