When social worker Dana Wilcox visited six of his mental patient clients each week, they often begged to be allowed to get out.
The six were crammed with five other persons into four rooms, sleeping side by side on cots and surrounded by debris. Dirty dishes and cigarette butts were strewn everywheree. "I've never seen a dirtier place," said a security guard familiar with the arrangement.
Until this week, Wilcox's clients lived not in a state institution or a nursing home, but in a three-bedroom garden apartment in Suitland. They were supervised by one of their own, a 41-year-old woman described by Wilcox a paranoid schizophrenic "who can be very carazy at times."
Maryland hospital officials, following a growing trend in health care philosophy, had discharged the six from psychiatric wards so they could live more normal lives in the community.*tBut last week, in a case that some health care professionals said illustrates chronic dificulties with this approach, the Suitland household was disbanded.
Management officials at the apartment complex, inspecting the four room unit, found one resident, an 87 year-old woman, sleeping in her own waste. All but two of the 11 occupants-who included five friends or relatives of patients-were ordered to move out by today.
Two days ago two of the patients, Wilcox said, were headed back to state mental hospitals. The others who left moved in with family members of into other housing.
The six patients were clients of Family Services of Prince George's County, a nonprofit health care corganization paid about $230,000 by the state this year to ensure that 450 mental patients find housing and receive adequate care.
But, according to Wilcox, a Family Services case worker, housing is a serious problem and such crowding as that in the Suitland apartment is virtually unavoidable.
"There is a lot of prejudice to deal with in finding housing of these people," Wilcox said. "We've had 100 landlords turn our clients away in the southern half of the county. We can handle all the services but the housing. We just can't manufacture places for people to live."
In addition, Wilcox said, the Family Services staff, like that of many community health organizations, is spread thin. Only eight staff workers are assigned to the service's 450 patients throughout the county, and Wilcox alone has a caseload of 60.
Family Services workers noted, too, that they are limited in what they can do for clients, since the program's aim is to return former patients to the mainstream of society.
The Suitland apartment, Wilcox said, was rented two years ago by two Family Services clients released from Spring Grove Hospital.
One of them encourage other patients from the hospital to move in with her, Wilcox said, and Family Services referred three other persons from Spring Grove to the apartment. Then, others moved in: a patient's two sons and one of their friends; a retarded brother, ad the 87-year-old woman, who is the mother of another of the mental patients.
One of the apartments' original renters, said Wilcox, managed the house. "She was collecting rent from all of those people, and I could see that she was taking in more than the apartment cost," he said.
Only six persons are allowed by county law to live in a three-bedroom apartment, and managers of the apartment complex discovered the state of the apartment last Monday after receiving calls from neighbors.
"I've never seen a dirtier place," said a security guard who went to the apartment. "The residents there were begging us to get them out. They said [the woman who was the unofficial organizer of the home] wouldn't let them leave and wouldn't give them their money."
Wilcox, meanwhile, had been visiting the apartment once a week to see his six clients. The organizer "has been diagnosed as a paranoid-schizophrenic, and she can be ver crazy at times," he said. "She did organize the apartment, and she seemed to be doing a good job of managing those people. De facto, she ran the place.
"The other people sometimes complained, and I told them that if they didn't wish to live there, they had every right to move, and I would help them. But housing is so difficult to find for these people. They all said they had nowhere else to go."
The record of Family Services has been "very, very good," according to Tony Stout, who supervises the program for the maryland Department of Health and Mental Hygiene, which funds the program. "They have a reputation for being a sort of model of this kind of work.
"But there are limits to what they can do," Stout said. "They have limited resources, and they have to place a lot of people in private housing."
In addition, state regulation of the family service operation, and others like it, is limited. Wilcox said that state officials inspect the records of that aftercare program several times a year, and require Family Services to submit quarterly reports on the number of persons they are serving and housing.
But, Wilcox said, there are no state inspections of the living conditions of Family Service clients who are placed in private housing.
Department of health and Mental Hygiene officials, who asked no to be named, also said that Family Services had been overburdened with work. But they noted that in most areas around the country, programs like aftercare are not even provided.
In most areas of Maryland, Stout said, mental patients released into the community must survive largely on their own, with only the limited programs of local health departments to help them.